Asia-Pacific journal of clinical oncology最新文献

Aims: This study aimed to evaluate temporal trends in treatment patterns for localized soft tissue sarcomas (STSs) and identify factors associated with relapse-free survival (RFS) and overall survival (OS).

Methods: A retrospective cohort study was conducted using the Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) and electronic health records from a high-volume sarcoma unit. Patients aged ≥18 years with grade 3, localized STS ≥5 cm diagnosed between 2013 and 2023 were included. The cohort was divided into two periods (2013-2017 and 2018-2023) to assess changes in treatment practices. Kaplan-Meier and Cox proportional hazards models evaluated RFS and OS.

Results: Among 202 patients, radiation use decreased in the late period (79% vs. 64%, p = 0.03), with a trend toward increased systemic therapy (8% vs. 16%, p = 0.13). Median RFS was 19 months (95% confidence interval [CI]: 14.9-26.0), with no significant difference between periods (hazard ratio [HR] 1.30, 95% CI: 0.93-1.82, p = 0.13). Median OS was 48 months (95% CI: 38.1-62.9), also showing no difference (HR 1.20, 95% CI: 0.80-1.78, p = 0.38). Radiotherapy improved RFS (HR 0.69, 95% CI: 0.49-0.98, p = 0.04) but not OS. Systemic therapy showed no RFS or OS benefit. Exploratory analyses identified age, tumor size, FDG-PET SUVmax, site, and Sarculator risk as prognostic factors.

Conclusion: Treatment patterns evolved over time, reflecting emerging evidence, but no significant RFS or OS differences were observed. Further research is needed, including exploring prognostic factors like elevated baseline FDG-PET SUVmax.

Hematologic malignancies are cancers that affect the bone marrow, lymphatic system, and hematopoietic cells, resulting in various cancer subtypes and clinical manifestations. Currently, tissue biopsy in hematological malignancies is typically performed for genomic profiling and has limitations such as invasiveness, lengthy procedures, and high expense. On the other hand, liquid biopsy serves as an emerging tool used for examining the blood or other bodily fluids of patients, for the purpose of identifying genetic mutations, biomarkers, or cancer-related substances. Liquid biopsy biomarkers include circulating tumor DNA (ctDNA), microRNA (miRNA), and exosomes. In the context of hematological malignancies, these biomarkers offer valuable insights into disease etiology, enabling effective disease monitoring and guiding treatment decisions owing to their differential expression patterns. This review critically examines the recent advancements and effectiveness of liquid biopsy biomarkers in the areas of diagnosis, therapy, and monitoring. The challenges and future directions of liquid biopsy for hematological malignancies are also discussed.

Gastric cancer is a common malignant tumor and a leading cause of cancer-related deaths globally. Recent research has shed light on the impact of N6-methyladenosine (m6A) methylation on the proliferation and metastasis of various malignancies, including gastric cancer. The methyltransferase complex catalyzes m6A methylation, with methyltransferase-like 3 (METTL3) serving as the sole catalytic subunit of m6A. Growing evidence indicates that METTL3 plays a pivotal role in the development and progression of gastric cancer; thus, targeting METTL3 could be a new treatment strategy for gastric cancer. In addition, recent studies have identified a role for METTL3 in the development of drug resistance in gastric cancer. However, these recent advancements have not yet been highlighted. In this review, we synthesized recent studies on the complex role of METTL3 in the pathogenesis and drug resistance of gastric cancer to elucidate the underlying mechanisms involving interplay with coding and noncoding RNAs, both dependent and independent of the methyltransferase activity of METTL3. These findings advance our understanding of METTL3 in gastric cancer, and they also have important clinical implications for the development of novel therapeutic approaches, including targeted and personalized treatment strategies, ultimately improving the management and care of patients with gastric cancer.

Aim: To examine quality of life (QoL), including physical, social, functional, and emotional well-being, and depressive symptoms among Thai patients with advanced cancer and their association with demographics, self-blame, perceived stigma, and quality of care.

Methods: We screened 392 medical records for patients seeking care at the National Cancer Institute in Thailand to achieve the APPROACH study target of 200 patients with Stage IV cancer per site. We surveyed participants using the APPROACH questionnaire, which comprised validated instruments (FACT-G, CES-D) and items developed by study investigators. We used multivariable regression models to examine associations.

Results: Participants rated QoL more favorably than other APPROACH participants in Asia, and consistent with levels found in Singapore and the United States. Likewise, perceived cancer-related stigma (3%) was uncommon. However, self-blame (67%) was prevalent, a quarter of participants (27%) reported symptoms suggestive of clinical depression, and many (62%) expressed interest in mental health services, though prior use was minimal (n = 3). When associations with QoL were considered, characterological self-blame was negatively associated with overall QoL (β = -7.09, p = 0.026), physical (-3.69, p < 0.001), and functional (-0.91, p = 0.009) well-being, while high quality of care ratings were associated with better overall QoL (5.56, p < 0.001), enhanced physical (1.95, p < 0.001), functional (1.66, p < 0.001), and emotional (1.59, p < 0.001) well-being, and fewer depressive symptoms (-2.59, p < 0.001).

Conclusion: Despite relatively high QoL ratings, the pervasiveness of self-blame and its association with reduced QoL, the large proportion at risk for clinical depression, and the strong interest in mental health services suggest that many Thai patients with late-stage cancer may not be receiving sufficient mental health support at the end of life. Efforts to integrate mental health care into oncology services and comprehensive palliative care should be considered.

Aim: To evaluate treatment results of a neoadjuvant regimen consisting of Docetaxel + Cisplatin + S-1 (DCS) in patients with locoregionally advanced unresectable gastric adenocarcinoma characterized by tumors with bulky regional lymph nodes (T1-4a, N-bulky, M0) or T4b tumors (any N, M0)).

Methods: This study included 78 patients with locoregionally advanced gastric adenocarcinoma treated at a university hospital in Vietnam, comprising 47 retrospective and 31 prospective cases. Patients received 2 - 4 cycles of DCS chemotherapy, with each cycle comprising intravenous docetaxel (35 mg/m²) and cisplatin (35 mg/m²) on days 1 and 15, and oral S-1 (40 mg/m²/twice daily) from days 1 to 14, repeated every 4 weeks. Clinical treatment response was assessed after every three cycles and re-staging evaluation by using the RECIST criteria and contrast-enhanced CT scans after 2 - 4 cycles, depending on patient response and tolerability. Patients with a good response and down-staging were referred for gastrectomy.

Results: The median age was 58 years, and 64.1% were male. Following neoadjuvant chemotherapy, the proportion of T4b tumors decreased from 78.2% to 52.6%, while T4a tumors increased from 20.5% to 43.6%. The rate of N-bulky decreased from 23.1% to 11.5%. Anemia and neutropenia were the most common hematological toxicities, predominantly grade 1-2. Gastrointestinal toxicity and hair loss were the most frequent clinical adverse events, mostly grade 1-2. Among 65 patients (83.3%) achieving an objective response to neoadjuvant chemotherapy, 42 (53.8%) underwent gastrectomy, with R0 resection achieved in 92.9%.

Conclusion: Neoadjuvant chemotherapy using the DCS regimen every 4 weeks demonstrated high effectiveness and safety in patients with locoregionally advanced unresectable gastric adenocarcinoma characterized by extensive regional metastases, and increased their eligibility for successful gastrectomy (R0 resection).

Trial registration: Not applicable. This study is a retrospective and prospective cohort study, not a clinical trial.

Immune checkpoint blockade (ICB) therapies have revolutionized the treatment of cancer by harnessing the body's immune system to recognize and eradicate tumor cells. Despite clinical successes, the systemic administration of checkpoint inhibitors remains hampered by limited tumor targeting, immune-related adverse events (irAEs), and the absence of real-time monitoring to guide therapeutic responses. The emergence of nano-immunoconjugates-nanoscale platforms functionalized with immune checkpoint inhibitors (ICIs) and imaging agents-represents a next-generation strategy to address these challenges. By enabling site-specific delivery and integrating molecular imaging modalities, such as positron emission tomography (PET), magnetic resonance imaging (MRI), near-infrared fluorescence (NIRF), and photoacoustic imaging, nano-immunoconjugates, offer dual benefits: enhanced immunotherapeutic precision and non-invasive monitoring of drug biodistribution and immune engagement. Various nanocarrier systems, including liposomes, polymeric nanoparticles, dendrimers, gold nanoparticles, and exosomes, have been engineered to deliver programmed death-1 (PD-1)/PD-L1 and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) inhibitors with superior targeting specificity, stimuli-responsive release, and imaging compatibility. Preclinical studies have demonstrated improved T-cell activation, reduced tumor burden, and favorable biodistribution profiles, whereas early clinical investigations highlight their translational potential. However, challenges, such as immunogenicity, regulatory complexity, and scalability persist. This review systematically explores the mechanistic foundations, nanoformulation strategies, integrated imaging approaches, tumor microenvironment (TME) navigation, and clinical outlook of nano-immunoconjugates.

Background: Colorectal cancer is a significant global health burden, with locally advanced colon cancer (LACC) comprising up to 20% of cases and associated with high rates of local recurrence and distant metastases. Although neoadjuvant chemotherapy (NAC) is well established in several gastrointestinal malignancies, its role in LACC and locally recurrent colon cancer remains debated. This study aimed to assess the perceptions and current practices of colorectal surgeons in Australia and New Zealand regarding the use of neoadjuvant therapies in these settings.

Methods: A structured 16-question online survey was distributed via Qualtrics to 275 colorectal surgeons affiliated with the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). The survey included demographic questions and 13 clinical scenarios addressing the management of LACC and locally recurrent colon cancer without distant metastases. Responses were collected over 1 month, with one reminder sent at 2 weeks. Data were analyzed using Microsoft Excel, and responses were presented as percentages with bar graphs illustrating management preferences.

Results: Ninety-seven surgeons (35.3% response rate) completed the survey; 86% were based in Australia and 70% had more than 5 years of consulting experience. Overall, 57% of respondents had previously employed neoadjuvant chemotherapy ± radiotherapy for non-metastatic LACC. In T4N0 disease, 54.3% opted for upfront resection, while 46% favored neoadjuvant strategies (29.4% chemotherapy and 16.3% chemoradiotherapy). For T4N1/2 disease, 63.5% preferred neoadjuvant therapy. Management varied in more complex scenarios: in obstructing cecal cancers with retroperitoneal invasion, 75% favored upfront resection; in non-obstructing transverse colon cancers invading the liver and sigmoid cancers with bladder invasion, decisions were split between upfront surgery and neoadjuvant treatment. For locally recurrent cancers, the majority preferred upfront surgery in non-T4 cases (68.5%), whereas over half (56.5%) opted for neoadjuvant therapy for T4 recurrent disease, particularly when vascular structures were involved.

Conclusion: The survey reveals a paradigm shift among colorectal surgeons in Australia and New Zealand toward incorporating neoadjuvant therapies for managing LACC and locally recurrent colon cancer. While upfront resection remains standard of care, there is increasing adoption of neoadjuvant strategies to downstage tumors and potentially improve oncological outcomes. Further high-quality evidence and randomized controlled trials are warranted to refine patient selection and optimize treatment protocols in these challenging clinical scenarios.

Background: This study investigated the impact of Digital Breast Tomosynthesis (DBT) training workshops on doctors' performance in simultaneous-double-reader scenarios.

Methods: Ten pairs of Vietnamese readers, including radiologists, registrars, and breast physicians, participated in the workshop, which featured lectures and breast image reading sessions provided by Australian experts. The first session included a test set of 30 screening full-field digital mammograms (FFDM) (10 cancers and 20 normal cases) with DBT images provided during the answer review stage. The second session with 35 cases (15 cancer) and session 3 with 30 cases (11 cancer) consisted of screening FFDM mammograms, DBT slices, and synthesized images. Participants used the BREAST-VIETRAD platform to view breast images and detect cancer lesions using the RANZCR-BIRADS scale. The study assessed performance disparities between the first and second DBT sets using the Wilcoxon Signed Rank test and explored the correlation between score changes and reader experience.

Results: There were significant improvements in the readers' sensitivity (0.553 vs. 0.91; p = 0.005) and lesion sensitivity (0.419 vs. 0.709; p = 0.005) from the first to the second DBT set, matching the sensitivity seen in FFDM sets. This improvement was consistent across both low and high breast density cases. Notable enhancements in lesion sensitivity were also observed for detecting masses (0.340 vs. 0.633; p = 0.011), calcifications, and architectural distortions (0.450 vs. 0.933; p = 0.011). The probability of score improvement (ROC AUC and JAFROC FOM) in DBT of pairs of readers with both less than 3 years of experience in reading mammograms is five times greater than those with over 5 years of experience.

Conclusions: Training sessions with simultaneous-double readers significantly improved Vietnamese clinicians' breast cancer detection capabilities, highlighting the importance of tailored educational programs to enhance diagnostic accuracy in regions lacking formal screening initiatives.