Korean journal of clinical oncology最新文献

Inflammatory myofibroblastic tumors (IMTs) of the duodenum are exceptionally uncommon, and their epidemiologic and clinical characteristics remain poorly defined because of the limited number of reported cases. We previously reported a case of duodenal IMT in the Korean Journal of Gastroenterology in 2018, with follow-up data available only up to 12 months. IMTs typically behave in a benign manner, but they may occasionally demonstrate local invasiveness and recurrence; therefore, achieving complete surgical excision is crucial, followed by long-term surveillance. In the present manuscript, we provide a subsequent long-term follow-up report of the same patient, offering an extended 88-month postoperative course and additional radiologic and pathologic details not included in the earlier publication. This follow-up report highlights the long-term benign behavior of the tumor despite positive surgical margins and anaplastic lymphoma kinase (ALK)-negative immunohistochemistry, contributing meaningful information to the scarce literature on adult duodenal IMTs.

Primary Ewing sarcoma of the uterine cervix is an exceptionally rare and aggressive malignancy, with only 34 cases reported in the literature. Early recognition and prompt multimodal treatment are essential due to its poor prognosis. We report a case involving a 32-year-old multiparous woman who presented with foul-smelling vaginal discharge and irregular bleeding. Clinical examination revealed a 6×6 cm friable cervical mass extending into the upper vagina. Imaging demonstrated an FDG-avid cervical mass with regional lymphadenopathy. Histopathological analysis, supported by immunohistochemistry and fluorescence in situ hybridization, confirmed Ewing sarcoma with EWSR1 gene rearrangement. The patient received neoadjuvant chemotherapy with VDC (vincristine, doxorubicin, cyclophosphamide) and PIE (cisplatin, ifosfamide, etoposide) regimens, followed by surgical resection, adjuvant chemotherapy, and pelvic radiotherapy. Although initial disease control was achieved, the patient experienced disease recurrence with distant metastases after a 7-month disease-free interval and succumbed to the illness 9 months after diagnosis. This case underscores the importance of including Ewing sarcoma in the differential diagnosis of rapidly growing cervical tumors, particularly in young women. A multidisciplinary approach involving early molecular diagnostics and aggressive combined therapy is critical to improving clinical outcomes in such rare and aggressive cases.

Purpose: This systematic review and meta-analysis aimed to examine the relationship between ovarian and colorectal cancer, with a particular focus on the standardized incidence ratio (SIR).

Methods: A comprehensive search was conducted across multiple databases, including Scopus, Web of Science, PubMed, and Google Scholar. A total of 20 studies were included in the final analysis.

Results: The results indicated that women with ovarian cancer had a significantly higher incidence of colorectal cancer (SIR, 1.69; 95% confidence interval [CI], 1.39-1.98), with an increased risk for both colon (SIR, 1.57; 95% CI, 1.14-1.99) and rectal cancers (SIR, 1.58; 95% CI, 1.38-1.78). Subgroup analysis of borderline ovarian tumor revealed an SIR for colorectal cancer of 1.27 (95% CI, 0.99-1.55), with a significant risk in the serous subtype (SIR, 1.38; 95% CI, 1.09-1.67). Conversely, studies examining ovarian cancer in women diagnosed with colorectal cancer showed an SIR of 1.48 (95% CI, 1.17-1.79). Specifically, women with colon cancer had a higher incidence of ovarian cancer (SIR, 1.64; 95% CI, 1.25-2.03), while women with rectal cancer showed a decreased risk (SIR, 0.88; 95% CI, 0.77-0.99). The results underscore the potential bidirectional relationship between ovarian and colorectal cancers, which may be influenced by genetic predispositions.

Conclusion: Future advanced genetic studies are needed to better understand the underlying molecular mechanisms. Additionally, the results emphasize the importance of careful cancer surveillance and early detection strategies for women with a history of either ovarian cancer or colorectal cancer.

Purpose: This study aimed to compare clinical, nutritional, and endoscopic outcomes among Roux-en-Y (RY), uncut Roux-en-Y (uRY), and Billroth II with Braun anastomosis (BB) reconstruction methods in gastric cancer patients after distal gastrectomy.

Methods: This retrospective study analyzed gastric cancer patients who underwent laparoscopic distal gastrectomy between January 2018 and December 2022, categorized into RY, uRY, and BB. Demographic, pathological, clinical, nutritional, and endoscopic data were collected over 24 months. Endoscopic outcomes were assessed using the RGB scoring system, evaluating residual food, gastritis, and bile reflux. Delayed gastric emptying was defined by clinical and imaging criteria. Multivariable linear regression was performed to identify relevant factors associated with 24 months RGB scores and mixed linear model was applied to assess the time interaction.

Results: A total of 221 patients were included (70 RY, 75 uRY, 76 BB). Baseline characteristics, perioperative and nutritional outcomes were comparable among groups. The uRY group showed less weight loss at 3 months (5.9%, P<0.05) but did not differ in other studied periods. The RY group had the lowest RGB scores at all time points, while BB showed the highest and progressively worsening scores. Regression model showed that BB and uRY was related to increase 24 month RGB score. BB showed increased RGB score while RY was stable in time and uRY showed intermediate change in the mixed linear model (P<0.05).

Conclusion: The nutritional clinical outcomes were comparable between the reconstructions. RY reconstruction demonstrated favorable endoscopic outcomes, while BB was associated with higher RGB scores in time.

Purpose: To evaluate clinicopathological characteristics and long-term outcomes of patients with positive resection margins identified during intraoperative frozen section (IFS) in gastric cancer surgery.

Methods: A retrospective analysis of 5,894 patients who underwent gastrectomy between May 2005 and December 2023. Among 207 patients with positive IFS margins, 121 were included after exclusion criteria. Additional resection was performed in 87 patients, while 34 received no further resection. Patients were divided into survivor group and non-survivor group for comparison. Patients' demographics, perioperative and survival outcomes were analyzed.

Results: R0 resection was achieved in 100 patients (82.6%), while 21 patients (17.4%) had R1 resection. During follow-up, 76 patients survived and 45 died. Five-year overall survival rates were 95.7% for stage I, 56.6% for stage II, and 32.9% for stage III. The non-survivor group showed significantly higher rates of R1 resection (35.6% vs. 6.6%, P<0.001), advanced stage disease (82.2% vs. 40.8%, P<0.001), and pathological high-risk features. In multivariate analysis, TNM stage and R0 resection status were the most significant prognostic factors. Proximal margin length did not correlate with survival outcomes.

Conclusion: TNM stage and achieving R0 resection were the most important prognostic factors in patients with positive IFS margins. R0 resection had greater survival impact in low-risk groups, while R1 resection was associated with poor outcomes regardless of stage, emphasizing the importance of complete tumor removal when technically feasible.

Purpose: In Korea, the Health Insurance Review and Assessment Service (HIRA) mandates patient participation in outpatient multidisciplinary team (MDT) meetings as part of national cancer quality assessment. However, the necessity of involving patients and families in MDT discussions remains debatable. This study explored international expert perspectives on patient participation in gastric cancer MDTs.

Methods: A cross-national expert survey was conducted in September 2021 among 15 gastric cancer specialists from Korea, China, Japan, Singapore, and the United States. The survey assessed the frequency of patient and family member attendance, perceived pros and cons, and preferences regarding mandatory versus selective involvement. Additionally, MDT structures and policies were reviewed by countries.

Results: Most respondents reported that patients and families rarely or never attend MDT meetings: nine stated that patients are never included, three reported "usually not," and three indicated "sometimes." None consistently included patients. The most cited benefits were sharing opinions with patients and families simultaneously, followed by improved explanation of treatment and legal protection. Major concerns included hindered discussion, inefficiency, and logistical challenges. Only four respondents supported routine participation, while 11 favored case-dependent involvement.

Conclusion: International experts do not widely support mandatory patient participation in MDT meetings. A flexible approach that allows MDTs to operate with or without patient involvement may better reflect actual clinical practice.

Autophagy process is important in the removal of damaged organelles following radiation interaction. Autophagy maintains stability or balance between intracellular environments at the cellular level. High linear energy transfer radiation is a complex and under-researched field of cancer and radiation biology. In-depth investigation in this area is necessary because autophagy has both protective and detrimental effects on cells, and the specific response can vary depending on factors like the type of radiation, the cell type, and the stage of cancer. Ionizing radiation exposure caused significant alterations in the autophagy genes (ATG3, ATG5, ATG7, ATG8, ATG12). Autophagy blocker could prevent cells from autophagic cell death in response to high linear energy transfer radiation. We have outlined how autophagy can reverse complications of serious diseases in tumor cells and tumor microenvironment, which will contribute to a new direction for better treatment of diseases.

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity associated with oxaliplatin-based chemotherapy in gastric cancer patients. Recent studies suggest that high-dose intravenous selenium may exert neuroprotective effects in patients receiving platinum-based chemotherapy.

Methods: This pilot study analyzed patients with stage III gastric adenocarcinoma who underwent gastrectomy between January and December 2024. A total of 28 patients receiving adjuvant capecitabine plus oxaliplatin (XELOX) chemotherapy were included and divided into two groups: one receiving chemotherapy alone (non-selenium: n= 17) and the other receiving an intravenous injection of selenium (2,000 µg/day) before chemotherapy (selenium: n= 11). CIPN severity was assessed after the first chemotherapy cycle and at the completion of chemotherapy using standardized grading criteria.

Results: Baseline clinicopathological characteristics, including age, sex, body mass index, preoperative comorbidities, extent of resection, operation time, and hospital stay, were comparable between groups. No adverse events related to high-dose selenium administration were observed. There were no significant differences in chemotherapy-related adverse events, such as hand-foot syndrome, nausea, vomiting, diarrhea, and loss of appetite, between the two groups. While CIPN severity was similar between groups after the first chemotherapy cycle, by the end of chemotherapy, the selenium group exhibited significantly lower paresthesia severity compared to the non-selenium group (P < 0.0001).

Conclusion: High-dose intravenous selenium appears to be a safe and potentially effective intervention for reducing paresthesia associated with oxaliplatin-based chemotherapy. Further large-scale prospective studies are warranted to validate these findings and establish optimal dosing guidelines.

Purpose: Multiple primary tumors arising in the same individual pose challenges for precision oncology, particularly in the context of hereditary cancer syndromes such as Lynch syndrome. While these tumors may originate from a shared germline predisposition, it remains unclear whether they also share somatic alterations that could be therapeutically exploited. This study aimed to characterize the extent of somatic genomic overlap between synchronous or metachronous gastric and colorectal cancers within young Korean patients.

Methods: Nineteen patients diagnosed with both gastric and colorectal cancers before age 55 underwent whole exome sequencing of formalin-fixed paraffin-embedded tumor tissues. Microsatellite instability (MSI) status was determined, and germline mismatch repair (MMR) variants were assessed to identify Lynch syndrome cases. Somatic mutations, mutational signatures, and copy number alterations were analyzed to quantify intertumoral genomic similarity within individual patients.

Results: Among the 37 tumors analyzed, 36.8% of gastric and 44.4% of colorectal cancers were MSI-high. Germline pathogenic MMR variants were identified in seven patients. Despite shared hypermutated phenotypes, the proportion of overlapping somatic mutations between paired tumors was consistently low (< 5%). Mutational signatures varied by MSI status and included SBS1/5 (aging) and SBS15 (MMR deficiency). Notably, one non-Lynch patient exhibited MYC amplification in both tumors, confirmed by fluorescence in situ hybridization.

Conclusion: Even in patients with shared germline predisposition, primary tumors arising in different organs demonstrate substantial genomic divergence. These findings suggest that organ-specific selective pressures drive independent tumor evolution, underscoring the need for individualized molecular profiling and therapeutic targeting in cases of multiple primary cancers.

Purpose: This study aimed to analyze the benefit of neoadjuvant chemoradiation therapy (nCRT) versus adjuvant chemotherapy alone after surgery without nCRT on oncologic and perioperative outcomes of patients with extremely low rectal cancer requiring abdominoperineal resection (APR) when initially diagnosed.

Methods: Between March 2001 and December 2018, 88 patients who underwent APR for low rectal adenocarcinoma (anal verge < 4 cm) with clinical stage II and III (clinical T3/4, N -/+) were retrieved from a retrospective database. Sixty-eight patients received adjuvant chemotherapy alone after APR without nCRT, and 20 patients received nCRT before APR.

Results: Median follow-up was 59.7 months. The 5-year disease-free survival rate was significantly higher in the nCRT group compared to in chemotherapy alone group (85.5% vs. 58.2%, P= 0.022). The 5-year overall survival rate was also significantly higher in nCRT group compared to in chemotherapy alone group (79.6% vs. 60.0%, P= 0.042). The total recurrence rate was 45.6% in chemotherapy alone group and 15.0% in the nCRT group (P= 0.010). There was no significant difference in circumferential resection margin positive rate, postoperative morbidity, and mortality between the two groups.

Conclusion: Based on present data, the oncologic outcomes are better in nCRT compared to adjuvant chemotherapy alone after surgery without nCRT in patient with extremely low rectal cancer requiring APR initially diagnosed, even if curative resection is possible at first.