BMC Cancer最新文献

Background: Selective RET inhibitors have been approved by the Chinese government for the treatment of RET-rearranged non-small cell lung cancer. This study aimed to illustrate the efficacy and safety of selective RET inhibitors in a real-world clinical context in China.

Methods: Patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring RET rearrangement and receiving RET tyrosine kinase inhibitors (RET-TKI) in the real world were enrolled in this retrospective study. Clinical data, including baseline clinicopathological information, efficacy parameters such as objective response rate (ORR) and progression-free survival (PFS), and adverse events (AEs), were collected from the electronic medical record system. The pattern of treatment failure of first-line RET-TKI was also described.

Results: Fifty-one patients were enrolled in this study. RET-TKI induced an ORR of 73.1% and a median PFS (mPFS) of 22.7 months (95%CI, 11.7-33.7) in the first-line setting. The ORR and mPFS were 58.3% and 17.7 months (95%CI, 9.1-26.2), 55.6% and 14.7 months (95%CI, 12.6-16.8) in the second-line and later-line settings, respectively. No significant difference was observed among different application lines with respect to the ORR (P = 0.534) or PFS (P = 0.795). In the first-line setting, RET-TKI significantly prolonged PFS compared to other regimens including chemotherapy-based regimens, multikinase inhibitors and other systemic regimens without chemotherapy (P < 0.05). Poor ECOG performance status was related to shorter PFS (P = 0.018). The most common AEs of grade 3 or worse were a decreased neutrophil count (11.4%) and anemia (11.4%). No new AEs or grade 5 AEs were observed. Brain metastasis was one of the most common patterns of treatment failure. In patients with baseline brain metastasis, the intracranial ORR was 50%, and the DCR was 100%.

Conclusions: RET-TKI had favorable efficacy and safety in real-world contexts in China and should be considered the preferred choice for first-line treatment in RET-rearranged NSCLC patients.

Background: Non-hypervascular hypointense nodules (NHHNs) can transform into hypervascular hepatocellular carcinoma (HCC) during the long-term follow-up. However, the risk factors for NHHN hypervascular transformation in chronic hepatitis B virus (HBV)-infected populations are unknown. This study assessed the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for HCC development in patients with chronic HBV infection.

Methods: A total of 86 patients with HBV infection who underwent gadoxetic acid-enhanced MRI at the First Affiliated Hospital of Sun Yat-sen University between January 2011 and July 2019 and were followed up for 2 years were retrospectively reviewed. Imaging features, including cirrhosis, steatosis, and NHHNs, were collected. Radiomics features were extracted from the entire liver. The HCC development predictive models were built based on each patient's clinical data, MRI features, and radiomic features. We then collected the qualitative and quantitative features of each NHHN and investigated the risk factors of hypervascular transformation.

Results: Thirteen patients developed HCC within two years. The risk factors for HCC development in patients with chronic HBV infection included older age, cirrhosis, and NHHNs. The MRI, radiomics, and integrated models developed all had an area under the curve (AUC) above 0.8. The potential risk factors for hypervascular transformation of NHHNs were the diameter of the NHHN (OR = 1.69, 95% CI:1.23, 2.32, P = 0.001) and the signal intensity (SI) ratio of the NHHN to the liver in the hepatobiliary phase (HBP SI ratio*10, OR = 0.36, 95% CI:0.11, 0.85, P = 0.044). The AUC of the hypervascular transformation model was 0.846 (95% CI:0.719, 0.972).

Conclusion: In chronic HBV infection population, patients with older age, cirrhosis and NHHNs are more likely to develop HCC within two years. Models based on these factors or radiomic features can effectively predict HCC development. The diameter of the NHHNs and the signal intensity ratio of NHHN to the liver in the hepatobiliary phase are potential risk factors for the hypervascular transformation of NHHNs.

Background: Globally, prostate cancer is a common disease among men. However, limited epidemiological data exists regarding prostate cancer in Tanzania. Consequently, there is insufficient evidence to convince policymakers of the need to combat this health issue. The study aimed to assess the prevalence, trends and clinicopathological characteristics of prostate cancer in northern Tanzania.

Methods: This cross-sectional study with chart review utilised data from the Kilimanjaro cancer registry, identifying all adult men diagnosed with cancer from January 2015- December 2021. The study recorded variables such as subject age, symptoms, Gleason score, prostate specific antigen (PSA) and metastatic statuses at presentation. Risk stratification followed American Society of Medical Oncology criteria, including low, intermediate and high-risk categories. The analysis was conducted using STATA version 17.

Results: Over the study period, 5164 adult men were registered, with prostate cancer accounting for 1619(31.4%) and showing an increase trend in incidence. The mean age at presentation was 73.9(± 10.1) years, and the majority of study subjects were from Kilimanjaro region 1200(74.1%). After applying exclusion criteria, 714 subjects with histologically confirmed diagnoses of prostate cancer remained. Of these, 710(99.4%) were symptomatic at presentation, with lower urinary tract symptoms being the most common symptoms in 548(76.8%). The median PSA at presentation was 109(36.2-263) ng/mL with 349(51.1%) having a PSA of > 100ng/mL. Gleason group grades 4 and 5 accounted for 207(29.5%) and 219(31.2%), respectively. A total of 178(43.6%) subjects had metastatic disease at presentation. The treatment of choice for a large proportion of subject 440(94.6%) was androgen deprivation therapy.

Conclusions: The burden of prostate cancer in northern Tanzania is high and the majority of subjects present with symptoms. A large proportion of subjects have metastatic disease at initial presentation, emphasizing the need for prostate cancer screening.

Objective: The aim of this study was to investigate the efficacy and safety of the combined treatment regimen of D-TACE, HAIC, and Lenvatinib in patients with massive hepatocellular carcinoma, with the goal of providing a safer and more effective therapeutic strategy for individuals suffering from massive hepatocellular carcinoma.

Materials and methods: A retrospective analysis was conducted using clinical data from 118 patients with unresectable massive hepatocellular carcinoma who underwent treatment at the Interventional Department of Wuhan Union Hospital between June 2018 and December 2021. Based on the treatment approach, the patients were divided into two groups: the D-TACE + HAIC + Lenvatinib group (N = 54) and the D-TACE + Lenvatinib group (N = 64). The primary study endpoints included the objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) of the two groups. Additionally, the occurrence of treatment-related adverse events in both groups was considered as a secondary study endpoint.

Results: Following the treatment, the D-TACE + HAIC + Lenvatinib group exhibited significantly higher ORR and DCR compared to the D-TACE + Lenvatinib group (68.5% vs. 43.8%, 90.7% vs. 73.4%, P < 0.05). Moreover, the D-TACE + HAIC + Lenvatinib group demonstrated longer mPFS and mOS in comparison to the D-TACE + Lenvatinib group (8.6 months vs. 6.6 months, P = 0.005; 19.5 months vs. 14.1 months, P < 0.001). There was no statistically significant difference in the occurrence rate of common treatment-related adverse events between the TACE + HAIC + Lenvatinib group and the D-TACE + Lenvatinib group (P > 0.05).

Conclusion: The combined treatment regimen of D-TACE, HAIC, and Lenvatinib demonstrated superior therapeutic efficacy and safety in managing unresectable massive hepatocellular carcinoma. This combination therapy may serve as a viable option for improving the prognosis of patients with unresectable massive hepatocellular carcinoma.

Background: In this study, we aimed to evaluate the real-world efficacy and safety of camrelizumab and identify clinicolaboratory factors that predict treatment outcomes in patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) receiving camrelizumab.

Methods: Herein, 174 patients with unresectable advanced, recurrent, or metastatic ESCC treated with camrelizumab monotherapy (n = 30), camrelizumab + chemotherapy (CT; n = 91), and camrelizumab + radiotherapy (RT; n = 53) between October 1, 2019 and October 1, 2022 were included.

Results: The median follow-up time was 20 months (range, 1-34 months). The median progression-free survival (PFS) and overall survival (OS) of the whole cohort were 8 months [95% confidence interval (CI), 6.5-9.5 months] and 14 months (95% CI, 11.2-16.8 months), respectively. After multivariate analysis, receiving > 4 cycles of camrelizumab was identified as an independent predictor of better PFS [hazard ratio (HR), 0.56; 95% CI, 0.38-0.827; P = 0.004] and OS (HR, 0.532; 95% CI, 0.341-0.83; P = 0.005). An intermediate-to-poor lung immune prognostic index (LIPI) was identified as an independent predictor of worse PFS (HR, 1.505; 95% CI, 1.032-2.196; P = 0.034) and OS (HR, 1.657; 95% CI, 1.094-2.51; P = 0.017). The disease control rate of patients in the camrelizumab monotherapy group, camrelizumab + CT group, and camrelizumab + RT group was 92.3% (95% CI, 74.9-99.1%), 90.6% (95% CI, 82.3-95.9%), and 96.1% (95% CI, 86.8-99.5%), respectively. The treatment-related adverse events (AEs) of grade 3 or higher were reported in 67 patients (38.5%). The most common treatment-related AEs were decreased neutrophil count (23.0%), decreased white blood cell count (19.5%), anemia (7.5%), and pneumonitis (4.6%). One patient (0.6%) died from a treatment-related AE of immune checkpoint inhibitor-induced myocarditis.

Conclusion: Camrelizumab was safe and effective as both monotherapy and part of a combination therapy. Longer PFS and OS were associated with receiving > 4 cycles of camrelizumab and having a good LIPI. LIPI can be used as a prognostic biomarker for ESCC patients receiving camrelizumab + RT.

Trial registration: ClinicalTrial.gov Identifier: CHICTR2000039499. Registered: 19th October 2020.

Introduction: This study aimed to evaluate the consistency of lung cancer case assessments across multidisciplinary team (MDT) sites in Denmark. The goal was to appraise the comparability of outcomes between hospitals in a real-world context.

Methods: We prepared sixty comprehensive, fictitious lung cancer case stories, complete with images, and distributed them to the four primary lung cancer MDT conferences in Denmark. These cases were subsequently evaluated as had they been ordinary patients during regular MDT meetings. We compared the conclusions on assigned TNM stage and proposed treatment intent using Kappa statistics.

Results: The consensus on assigned stage (Stages IA-B, IIA-B, IIIA-B, IV, and undetermined) corresponded to a Fleiss' Kappa-value of 0.62 (95% CI: 0.52-0.71). The overall assessment of curability, categorized as Curable, Incurable, and Undetermined, corresponded to a Kappa-value of 0.72 (CI: 0.61-0.84). However, for cases unanimously judged by all MDT sites to be Stage III, the concordance on treatment intent was poor, with an agreement coefficient of only 0.32 (95% CI: -0.27-0.97).

Conclusion: In detail, the level of agreement on assigned stages was less than desired. In consequence, comparative analyses of treatment results from different hospitals or centres may be prone to bias caused by systematic differences in stage assessment or intent of treatment. The least consensus was observed for cases in Stage III, indicating a need for quality improvement efforts to ensure a higher degree of consistency in MDT decisions.

Background: Multiple first-line treatment options have been developed for advanced non-small cell lung cancer (NSCLC) in each subgroup determined by predictive biomarkers, specifically driver oncogene and programmed cell death ligand-1 (PD-L1) status. However, the methodology for optimal treatment selection in individual patients is not established. This study aimed to develop artificial intelligence (AI)-based personalized survival prediction model according to treatment selection.

Methods: The prediction model was built based on random survival forest (RSF) algorithm using patient characteristics, anticancer treatment histories, and radiomics features of the primary tumor. The predictive accuracy was validated with external test data and compared with that of cox proportional hazard (CPH) model.

Results: A total of 459 patients (training, n = 299; test, n = 160) with advanced NSCLC were enrolled. The algorithm identified following features as significant factors associated with survival: age, sex, performance status, Brinkman index, comorbidity of chronic obstructive pulmonary disease, histology, stage, driver oncogene status, tumor PD-L1 expression, administered anticancer agent, six markers of blood test (sodium, lactate dehydrogenase, etc.), and three radiomics features associated with tumor texture, volume, and shape. The C-index of RSF model for test data was 0.841, which was higher than that of CPH model (0.775, P < 0.001). Furthermore, the RSF model enabled to identify poor survivor treated with pembrolizumab because of tumor PD-L1 high expression and those treated with driver oncogene targeted therapy according to driver oncogene status.

Conclusions: The proposed AI-based algorithm accurately predicted the survival of each patient with advanced NSCLC. The AI-based methodology will contribute to personalized medicine.

Trial registration: The trial design was retrospectively registered study performed in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Nagoya University Graduate School of Medicine (approval: 2020 - 0287).

Background: There is no relevant research on the symptoms and emotions of patients with advanced thyroid cancer in mainland China.

Aim: To investigate the symptoms and negative emotions of patients with advanced thyroid cancer and to analyze the correlation between the two preliminarily.

Methods: Using a convenience sampling method, 180 patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at West China Hospital of Sichuan University from January 2023 to December 2023 were selected as the research subjects. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY) and Hospital Anxiety and Depression Scale (HADS). The correlation between symptom severity and negative emotions was determined by Spearman correlation analysis.

Results: Disturbed sleep was the symptom with the highest incidence (74.4%) and the greatest severity (3.0 points), while mood distress was the symptom with the highest incidence (63.3%) and the greatest severity (2.0 points). 71 patients (39.4%) had anxiety, and 62 patients (34.4%) had depression. All symptoms and symptom interference were positively correlated with anxiety and depression (P < 0.05).

Conclusion: Patients with advanced thyroid cancer have multiple symptoms that seriously affect their daily lives and emotions. Medical staff should conduct targeted observation and preventive treatment to reduce the burden of symptoms and improve the negative emotions of patients.

Objective: Many investigation have sought to identify therapeutic targets and treatment strategies for skin cutaneous melanoma (SKCM). Numb, an endocytic adaptor protein, is known to act as a tumor suppressor in various human cancers. However, the roles of Numb and its homolog NumbL in immune microenvironment, and their effect on melanoma remain largely unexplored.

Methods: We analyzed the expression levels of Numb and NumbL, as well as immune signatures of SKCM patients by UCSCXenaShiny v1 database. We also constructed animal model using Numb and NumbL conditional knockout (cKO) mice. Distribution analysis of immune cells in tumors was performed by flow cytometry and pathology staining.

Results: Numb and NumbL were found to be consistently expressed at low levels in SKCM patients. In addition, alterations in tumor immune microenvironment were identified. The CD8⁺ T, CD19⁺ B, and NK1.1⁺ CD49⁺ cells were decreased in tumors of Numb and NumbL cKO mice, confirming previous bioinformatics analysis of immune signatures. Additionally, we observed CD68⁺ macrophages to be increased as judged by tumor pathology staining.

Conclusion: Numb and NumbL were found to inhibit melanoma cell growth by modulating immune cell activity. These results suggested that Numb and NumbL may be potential therapeutic targets for SKCM patient immunotherapy.

Background: Gastric cancer poses a significant global health challenge. We aim to use period analysis to assess the changes in gastric cancer treatment at our center over the past 15 years. This study reflects the current state of gastric cancer treatment at our center and provides valuable data to support clinical advancements.

Method: We used period analysis to evaluate the survival status of 3915 patients with gastric cancer at Nanfang Hospital, Southern Medical University, over a 15-year period spaning from 2008 to 2022. The 5-year relative survival rates were analyzed.

Result: Our findings indicate that the 5-year relative survival rate at our center from 2018 to 2022 is 71.4%. From 2018 to 2022, the 5-year relative survival rates for patients aged < 40, 40-54, 55-69, and ≥ 70 reached 67.5%, 73.5%, 72.0%, and 67.1%, respectively. For stage IV patients, the 5-year relative survival rate reached 29% in 2018-2022. For stage I-III patients, the 5-year relative survival rate reached 89.7% in 2018-2022. The five-year relative survival rate for patients who underwent laparoscopic surgery at our center rose from 50.3% in 2008-2012 to 71.4% in 2018-2022. Overall, there has been a notable increase in the 5-year relative survival rates, regardless of age, gender, region, or tumor stage.

Conclusion: Period analysis over the past 15 years shows significant improvement in the 5-year survival rate for gastric cancer at our center. This progress is due to standardized surgical techniques, perioperative management, and immunotherapy, providing robust data for evaluating the efficacy of recent treatments.