Journal of cancer research and therapeutics最新文献

Objective: This study aimed to explore the efficacy and prognostic value of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) treatment.

Subjects and methods: Relationships between the baseline levels of AFP and DCP and the clinical characteristics of 314 patients with HCC who underwent TACE were retrospectively analyzed. Kaplan-Meier curves and Cox regression models were used to analyze the survival data.

Results: Before TACE, the patient distribution was as follows: 180 were positive for both AFP and DCP, 37 were negative for both, 24 were positive for AFP only, and 73 were positive for DCP only. Of the 131 patients included in the follow-up study after TACE treatment, 47 (35.88%) belonged to the AFP and DCP double-response group, 38 (29.01%) to the single-response group, and 46 (35.11%) to the no-response group. The overall objective response rate was significantly higher in the double- and single-response groups than in the no-response group (P < 0.001). The overall survival (OS) and progression-free survival (PFS) rates in the double-response group were significantly longer than those in the other two groups (P < 0.001). The response types of AFP and DCP were independent risk factors for PFS (P = 0.003) and OS (P = 0.007).

Conclusion: The combination of AFP and DCP provides a valuable serum biomarker for assessing the efficacy of TACE in patients with HCC. The goal for TACE treatment in dual-positive patients is to achieve a dual response for AFP and DCP.

Background: Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial in locally advanced colorectal cancer (CRC). This study aimed to evaluate its survival benefits and safety.

Methods: A retrospective cohort of 3008 CRC patients undergoing resection (2014-2019) was analyzed. Propensity score matching (PSM) generated 188 HIPEC and 188 control patients. Outcomes included operative metrics, complications (Clavien-Dindo ≥III), and 3-year overall survival (OS)/disease-free survival (DFS). Multivariable Cox regression identified prognostic factors.

Results: Post-PSM, HIPEC required longer operative time (215 vs 185 minutes) and hospital stay (9.2 vs 7.5 days), with comparable major complications (12.8% vs 10.6%, P > 0.05). HIPEC showed superior 3-year OS (87.2% vs 80.5%, HR = 0.54, P = 0.029) and DFS (81.7% vs 75.2%, HR = 0.59, P = 0.037). Multivariable analysis confirmed HIPEC (OS: HR = 0.54, 95% CI: 0.31-0.94; DFS: HR = 0.59, 95% CI: 0.37-0.93) and laparoscopic approach as independent survival predictors.

Conclusion: Prophylactic HIPEC (43°C, 60-90 minutes) may improve survival in locally advanced CRC without increasing major complications, supporting its integration into surgical practice. Further validation through multicenter trials is warranted.

Objective: The research aims to study the application effect of personalized 3D printed side hernia fixation plates in the care of patients with permanent colostomy for colorectal cancer.

Methods: A total of 110 patients with permanent colostomy of colorectal cancer are selected from the Wound Ostomy Nursing Clinic of the First People's Hospital of Huai'an City from December 2018 to January 2023. They are randomly divided into the research group and the control group, with 55 cases in each group. The control group uses a stoma pocket and wears an abdominal band to fix the tissue around the stoma, while the research group uses a 3D printed side hernia fixator to fix the tissue around the stoma with the abdominal band. At 1, 3, and 6 months after surgery, the inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1β (IL-1β), and skin condition around the stoma scores are observed in both groups of patients. The incidence of stoma complications, pocket replacement frequency, abdominal belt wearing frequency, and abdominal belt displacement within 6 months are also analyzed.

Result: The time effect and grouping exchange effect of changes in CRP, IL-6, IL-1β in both groups of patients were statistically significant (P < 0.05). At 1 month after surgery, there was no statistically significant difference in the expression levels of CRP, IL-6, and IL-1β between the two groups of patients (P > 0.05). At 3 and 6 months after surgery, the expression levels of CRP, IL-6, and IL-1β in the research group were significantly lower than those in the control group (P < 0.05).

Conclusion: Patients with permanent colostomy for colorectal cancer can effectively reduce inflammatory reactions by wearing an abdominal strap on the basis of personalized 3D printed side hernia fixators.

Background: No report is available on the treatment of primary colorectal cancer (CRC) by transarterial chemotherapy combined with lipiodol chemoembolization in tumor-feeding arteries.

Aims: To determine the safety and efficacy of transarterial infusion chemotherapy (TAI) and lipiodol chemoembolization for the treatment of primary CRC.

Methods: Thirty-seven patients with advanced CRC received TAI and lipiodol chemoembolization once a month, 1-3 times in all. Clinical efficacy, complications, and effectiveness were evaluated 1 month after each session.

Results: All 37 patients were successfully treated. The most common complications were abdominal discomfort, nausea, tenesmus, and myelosuppression. The overall disease control and objective response rates were 97.3% and 67.6%, respectively. Twenty-four patients survived and 13 died; the median survival duration was 21.1 months. Age was a significant influencing factor of overall survival.

Conclusion: Transarterial chemotherapy combined with lipiodol chemoembolization appears to be safe and effective for treating advanced CRC.

Objective: This study aimed to investigate the clinical outcomes of cryoablation-chemotherapy combination for the treatment of liver metastases (LMs).

Materials and methods: This study included 199 patients who received cryoablation-chemotherapy combination for LM treatment at our hospital from October 2009 to November 2017. The patients' clinical characteristics and their overall survival (OS), complication, local tumor control, and recurrence rates were assessed.

Results: Of the patients, 66 (33.2%) and 133 (66.8%) developed colorectal liver metastases (CLMs) and noncolorectal LMs (NCLMs), respectively. Their follow-up duration ranged from 7 to 74 months (median: 37 months), with 1-, 3-, and 5-year OS rates of 71.2%, 40.9%, and 19%, respectively. The OS rates in the CLM group were 81.7%, 57.2%, and 31.9%, compared with 68.3%, 34.4%, and 12% in the NCLM group, respectively. As regards the initial local treatment efficacy, the CLM group exhibited an objective response rate (ORR) of 74.2% and a disease control rate (DCR) of 95.5%, compared with 60.2% and 85.7%, respectively, in the NCLM group, with significant differences observed between the groups (ORR, P = 0.050; DCR, P = 0.039). Serious postoperative complications rarely occurred in both groups.

Conclusion: Cryoablation-chemotherapy combination treatment is safe, feasible, and effective for LMs. Its efficacy is mainly dependent on the primary tumor site, making it a potential alternative for clinical treatments. CLMs had better prognosis than NCLMs. A maximum tumor diameter ≥3 cm, time to LMs ≤12 months, and absence of neoadjuvant TACE were identified as statistically significant predictors of poor prognosis in patients with LM.

Aim: This systematic review and meta-analysis compared fibroblast activation protein inhibitor (FAPI) and 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) regarding diagnostic efficacy in primary liver cancers, focusing on sensitivity, specificity, and clinical applicability.

Materials and methods: PubMed was searched (up to July 31, 2024) for studies evaluating FAPI and FDG PET/CT for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. A total of 9 studies involving 214 patients and 416 lesions were analyzed. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Diagnostic parameters were synthesized using R Studio's "Mada" package with a random-effects model. Heterogeneity was assessed via I² statistics.

Results: FAPI PET/CT exhibited superior pooled sensitivity (0.918, 95% CI: 0.862-0.953) to FDG PET/CT (0.472, 95% confidence interval [CI]: 0.309-0.642). FAPI demonstrated lower specificity than FDG (0.464, 95% CI: 0.281-0.647, vs. 0.678, 95% CI: 0.505-0.851). Furthermore, it obtained a higher area under the curve (0.846 vs. 0.627), indicating high overall diagnostic accuracy. Moreover, FAPI demonstrated superior performance in detecting small lesions (≤1 cm) and FDG-negative tumors, particularly in cirrhotic livers. Contrarily, FDG showed better specificity for benign lesions. Across studies, heterogeneity was mainly attributed to lesion size, cirrhosis prevalence, and tracer subtypes.

Conclusion: FAPI PET/CT achieved higher sensitivity and diagnostic accuracy than FDG in primary liver cancers, particularly in early-stage and metabolically heterogeneous tumors. FAPI offers transformative potential for clinical use despite its lower specificity in patients with cirrhosis. To optimize integration into diagnostic pathways, standardized protocols and large-scale validation are needed.

Objective: To explore a noninvasive predicting model for identifying patients with stage I lung invasive adenocarcinoma (IAC).

Methods: This study enrolled 289 patients from two medical centers, with 227 and 62 patients in the training and validation sets, respectively. Patients' chest computed tomography (CT) images were used. The K-means cluster algorithm was employed to group patients into new clusters based on radiomics features. In addition, logistic regression was used to develop prediction models. Diagnostic efficiency was assessed using the area under the receiver operating characteristic curve, along with calibration and decision curve analysis.

Results: The K-means cluster algorithm classified patients into cluster 1 (training: 143; validation: 35) and cluster 2 (training: 84; validation: 27). Cluster 2 had a higher proportion of patients with IAC. The optimal model incorporating tumor diameter, tumor type, and cluster labels achieved the best discriminatory performance, with area under the receiver operating characteristic curve values of 0.848 (95% confidence interval: 0.799-0.898) in the training set and 0.744 (95% confidence interval: 0.583-0.905) in the validation set.

Conclusion: This study proposes a radiomics model that accurately identifies patients with IAC. This prediction tool could aid in personalized risk classification and treatment planning.

Background: This study developed a nomogram using computed tomography (CT)-based delta-radiomics features and clinicopathological factors to predict lymph node metastasis (LNM) in patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant chemoradiotherapy (nCRT).

Methods: This study retrospectively enrolled 170 patients with ESCC receiving nCRT. The delta-radiomics signature model was constructed utilizing least absolute shrinkage and selection operator regression, and the radiomics score (radScore) was determined for each patient. A combined nomogram was established using the radScore and independent influencing factors obtained through univariate and multivariate analyses. The consistency and predictive ability of the nomogram were assessed using the calibration curve and the area under the receiver operating factor curve (AUC). The clinical benefits were assessed using decision curve analysis (DCA).

Results: Two predictive models were constructed. The AUC values for the delta-radiomics signature model were 0.881 [95% confidence interval (CI): 0.827-0.935]. According to the univariate and multivariate analyses, the tumor length, tumor differentiation, and radScore were independent factors influencing LNM (P < 0.05). A combined nomogram was constructed from these factors, and the AUC reached 0.938 (95% CI: 0.898-0.979). DCA demonstrated that the clinical benefits of the nomogram for patients across an extensive range were more significant than the radiomics model alone.

Conclusions: This CT-based delta-radiomics nomogram model could benefit LNM in patients with ESCC following nCRT.

Abstract: Pulmonary sclerosing pneumocytoma (PSP) is a rare pulmonary tumor of pneumocytic origin, traditionally considered benign and associated with a favorable prognosis. However, accumulating evidence suggests that PSP may exhibit potentially malignant behavior and marked histopathological heterogeneity, which can complicate accurate diagnosis. These features often create diagnostic challenges during preoperative biopsy, intraoperative frozen section analysis, and postoperative histopathological evaluation. Herein, we report a rare case of recurrent, multifocal PSP exhibiting sarcomatoid features and harboring a p.E17K mutation in the AKT1 gene.

Background: Managing intestinal fistulas is complex and challenging due to the development of postoperative complications. It is essential to evaluate the effects of computed tomography (CT) body composition imaging biomarkers on major postoperative complications in these patients following definitive surgery.

Methods: A total of 88 patients with intestinal fistula, who underwent definitive surgery were retrospectively reviewed. Each body composition index was calculated by dividing the cross-sectional area of the adipose or muscle tissue at the level of the third lumbar vertebra, as identified on a preoperative CT scan, by the square of the height. Postoperative complications were scored according to the Clavien-Dindo classification.

Results: Sixteen out of the 88 patients (18.08%) had major postoperative complications. In the univariate analysis, lower quadratus lumborum index (QLI; P = 0.047) and quadratus lumborum areas ([QLA]/body mass index [BMI]; P = 0.023), higher C-reactive protein (CRP; P = 0.036), longer length of stay (LOS; P = 0.002), and fewer preoperative admission histories (P = 0.049), were identified as risk factors. In the multivariable regression analysis, QLI (P = 0.011; odds ratio [OR] = 0.383) and LOS (P = 0.012; OR = 1.006) were identified as independent risk factors for major postoperative complications. Furthermore, QLI, QLA/BMI, CRP, LOS, sex, and age showed the highest area under the curve of 0.815, with a specificity and sensitivity of 64.8% and 93.8%, respectively (P < 0.001).

Conclusion: Patients with lower QLI and QLA/BMI, longer LOS, and higher CRP were prone to have major postoperative complications.