Journal of the National Cancer Center最新文献

Precision radiotherapy is a critical and indispensable cancer treatment means in the modern clinical workflow with the goal of achieving “quality-up and cost-down” in patient care. The challenge of this therapy lies in developing computerized clinical-assistant solutions with precision, automation, and reproducibility built-in to deliver it at scale. In this work, we provide a comprehensive yet ongoing, incomplete survey of and discussions on the recent progress of utilizing advanced deep learning, semantic organ parsing, multimodal imaging fusion, neural architecture search and medical image analytical techniques to address four corner-stone problems or sub-problems required by all precision radiotherapy workflows, namely, organs at risk (OARs) segmentation, gross tumor volume (GTV) segmentation, metastasized lymph node (LN) detection, and clinical tumor volume (CTV) segmentation. Without loss of generality, we mainly focus on using esophageal and head-and-neck cancers as examples, but the methods can be extrapolated to other types of cancers. High-precision, automated and highly reproducible OAR/GTV/LN/CTV auto-delineation techniques have demonstrated their effectiveness in reducing the inter-practitioner variabilities and the time cost to permit rapid treatment planning and adaptive replanning for the benefit of patients. Through the presentation of the achievements and limitations of these techniques in this review, we hope to encourage more collective multidisciplinary precision radiotherapy workflows to transpire.

Necroptosis is currently attracting the attention of the scientific community for its broad implications in inflammatory diseases and cancer. However, detecting ongoing necroptosis in vivo under both experimental and clinical disease conditions remains challenging. The technical barrier lies in four aspects, namely tissue sampling, real-time in vivo monitoring, specific markers, and distinction between different types of cell death. In this review, we presented the latest methodological advances for in vivo necroptosis identification. The advances highlighted the multi-parameter flow cytometry, sA5-YFP tool, radiolabeled Annexin V/Duramycin, Gallium-68-labeled IRDye800CW contrast agent, and SMART platform in vivo. We also discussed the up-to-date research models in studying necroptosis, particularly the mice models for manipulating and monitoring necroptosis. Based on these recent advances, this review aims to provide some advice on current necroptosis techniques and approaches.

Background

Because of the rarity of occult breast cancer (OBC) and limited experience in OBC treatment, the optimal treatment strategy is unknown. This study aimed to compare the efficacy of axillary lymph node dissection (ALND) plus radiotherapy with that of mastectomy plus ALND in patients with OBC.

Methods

Relevant clinical data between January 2004 and December 2015 were retrospectively collected from the Surveillance, Epidemiology, and End Results database. The clinical characteristics and prognoses of patients who underwent ALND plus radiotherapy or mastectomy plus ALND were compared before and after propensity score matching.

Results

Overall, 569 eligible patients with OBC were included in this study. Of these, 247 patients underwent ALND plus radiotherapy and 322 underwent mastectomy plus ALND. The 5-year overall survival (OS) rates in the ALND plus radiotherapy group and the mastectomy plus ALND group were 89.2% and 80.6%, respectively; and the corresponding 5-year breast cancer-specific survival (BCSS) rates were 95.2% and 93.0%, respectively. After propensity score matching, the OS in the ALND plus radiotherapy group was significantly better than that in the mastectomy plus ALND group. In addition, further subgroup analyses revealed that ALND plus radiotherapy prolonged OS in the pN3 subgroup. Among patients receiving adjuvant chemotherapy, those who underwent ALND plus radiotherapy had better BCSS and OS than those who underwent mastectomy plus ALND.

Conclusions

ALND plus radiotherapy could improve the OS of patients with OBC, especially those with pN3 disease and those receiving chemotherapy. ALND combined with radiotherapy is the optimal treatment strategy for patients with imaging-negative OBC.

“Screening” is a search for preclinical, asymptomatic disease, including cancer. Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers. Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure, using more tolerable interventions. The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care. An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer, as well as a subsequent decrease in cancer-related mortality. Otherwise, screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person's remaining natural lifespan: a phenomenon known as “overdiagnosis.” We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening, including neuroblastoma, prostate cancer, thyroid cancer, lung cancer, melanoma, and breast cancer. The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening, even with a test of accepted benefit, with a goal of informed decision-making. We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.

Immune checkpoint inhibitor-based immunotherapy has revolutionized the treatment approach of non-small cell lung cancer (NSCLC). Monoclonal antibodies against programmed cell death-1 (PD-1) and PD-ligand 1 (PD-L1) are widely used in clinical practice, but other antibodies that can circumvent innate and acquired resistance are bound to undergo preclinical and clinical studies. However, tumor cells can develop and facilitate the tolerogenic nature of the tumor microenvironment (TME), resulting in tumor progression. Therefore, the immune escape mechanisms exploited by growing lung cancer involve a fine interplay between all actors in the TME. A better understanding of the molecular biology of lung cancer and the cellular/molecular mechanisms involved in the crosstalk between lung cancer cells and immune cells in the TME could identify novel therapeutic weapons in the old war against lung cancer. This article discusses the role of TME in the progression of lung cancer and pinpoints possible advances and challenges of immunotherapy for NSCLC.

Hepatocellular carcinoma (HCC) is a common malignancy with high mortality rates. While surgery can be curative in early-stage disease, 80% of patients cannot undergo surgical resection. Stereotactic body radiotherapy (SBRT), an emerging, non-invasive, precision treatment, has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world. This article aims to review current guideline recommendations on SBRT, clinical evidence, and outcome comparisons with other local treatment modalities. Attempts are also made to compare the differences in clinical trials between Asian and Western countries.

Background

Breast cancer survivors with psychological problems have higher mortality than those without. Therefore, it is important to monitor and manage their psychological status. This study mainly aimed to dynamically estimate the prevalence of anxiety and depression and to clarify the factors associated with anxiety and depression of patients undergoing adjuvant chemotherapy. The secondary objective was to investigate the relationship between depression and anxiety and quality of life (QOL) in Chinese early-stage breast cancer patients.

Methods

In a prospective observational single-center cohort study with early-stage breast cancer patients (n = 290), depression and anxiety severity, QOL, and social support were measured using the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) scale, and the Chinese version of the Social Support Rating Scale (SSRS), respectively. Canonical correlations were applied to identify correlates between anxiety and depression and demographic and clinical variables. One-way repeated measure analysis of covariance (RMANCOVA) was used to analyze dynamic changes in anxiety, depression, and QOL. Relationships between anxiety and depression and QOL were analyzed using two-way RMANCOVA.

Results

The overall anxiety and depression prevalence rates were 35.2% and 44.1%, respectively. Age (P = 0.042), surgical method (P = 0.009), social support (P = 0.001), and breast cancer family history (P = 0.045) were significantly associated with depression. The number of children (P = 0.048) was significantly associated with anxiety. FACT-B scores differed between anxiety and depression and nonanxiety and depression groups, and patients with higher HADS depression and anxiety scores had lower FACT-B scores during chemotherapy (P < 0.001).

Conclusions

We observed dynamic changes in anxiety and depression and QOL and associated factors of anxiety and depression. These findings can provide guidance for psychological monitoring and support for breast cancer patients during the postoperative chemotherapy period.