Journal of cancer research and therapeutics最新文献

Background: Pulmonary sarcomatoid carcinoma (PSC) is a rare lung cancer characterized by early metastasis and invasion. It is predominantly diagnosed at a locally advanced or metastatic stage, hindering the possibility of surgical intervention. However, a standard treatment for advanced PSC remains unestablished. This study evaluated the effects of chemotherapy and immunotherapy-based strategies in patients with advanced PSC.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database and data from three cancer centers were used in this retrospective study. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted to identify the prognostic factors.

Results: In total, 202 patients with stage IV PSC were identified from the SEER database (median OS, 5 months). The median follow-up time of patients from the three centers was 18.8 months. First-line treatment with immunotherapy-based regimens and chemotherapy was administered to 12 and 27 patients, respectively. The median PFS was 2.1 and 7.3 months [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.06-0.40; P < 0.001], while the median OS was 3.6 and 21.4 months (HR, 0.21; 95% CI, 0.09-0.50; P < 0.001) in the chemotherapy and immune-based groups, respectively. The immunotherapy-based regimen was an independent prognostic factor for PFS (HR, 0.21; 95% CI, 0.08-0.55; P = 0.001) and OS (HR, 0.20; 95% CI, 0.08-0.49; P < 0.001).

Conclusions: Conventional chemotherapy offered limited benefits in patients with advanced PSC; however, those who received first-line immunotherapy-based regimens exhibited significantly improved responses.

Abstract: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the most important methods for treating a wide range of hematologic malignancies and bone marrow failure diseases. However, graft-versus-host disease (GVHD), a major complication associated with this method, can seriously affect the survival and quality of life of patients. Acute GVHD (aGVHD) occurs within 100 days after transplantation, and gastrointestinal aGVHD (GI-aGVHD) is one of the leading causes of nonrecurrent death after allo-HSCT. In recent years, fecal microbiota transplantation (FMT) has been attempted as an emerging treatment method for various diseases, including aGVHD after HSCT. Studies have shown encouraging preliminary clinical results after the application of FMT in aGVHD, particularly steroid-resistant aGVHD. Additionally, several studies have demonstrated that the gut microbiota plays an important immunomodulatory role in the pathogenesis of GVHD. Consensus guidelines recommend FMT as a secondary option for the treatment of aGVHD. This article aims to review FMT treatment for GI-aGVHD after allo-HSCT.

Aims: To investigate the incidence and factors influencing surgical site infections (SSIs) in patients undergoing robot-assisted radical resection for colorectal cancer and assess their health and economic impact on the patients and hospital.

Materials and methods: This retrospective case-controlled study comprised patients who underwent robot-assisted radical resection for colorectal cancer at a tertiary hospital in China. Information about baseline characteristics, perioperative details, postoperative SSI incidence, hospitalization costs, and follow-up was collected. Univariate and multivariate analyses were performed to identify the independent risk factors for SSI. Propensity score matching was used to evaluate the health and economic impacts of SSI on the patients and the hospital.

Results: The overall incidence of colorectal SSI in 546 patients undergoing robot-assisted radical resection for colorectal cancer was 11.72% (64/546). Intraoperative blood loss, duration of operation, preoperative absolute lymphocyte count, preoperative and postoperative serum albumin levels, tumor location, gender, history of radiotherapy or chemotherapy, surgical wound classification, and preoperative hypoalbuminemia levels were associated with SSI. Rectal cancer, male gender, and class 3 or 4 surgical wounds were identified as independent risk factors for postoperative SSI. SSI prolonged the hospital stay by 6.60 days, increased the patient's direct costs by 31,669.88 CNY, increased the economic burden by 3,262.38 CNY, and caused an indirect economic loss of 50,546.79 CNY for the hospital.

Conclusions: Patients undergoing robot-assisted radical resection for colorectal cancer are at a high risk for SSI. SSI can prolong postoperative hospital stays and increase the economic burden for patients and hospitals.

Background: The management of residual nodules after video-assisted thoracoscopic surgery (VATS) for multiple pulmonary nodules (MPNs) is challenging. Microwave ablation (MWA), which is highly repeatable and minimally invasive, has garnered widespread attention in the treatment of MPNs.

Methods: Ninety-one patients with MPNs who underwent VATS for resection of high-risk nodules followed by MWA for residual nodules were examined. Clinical efficacy and complications were assessed. The primary end points were MWA success rate and complete ablation rate. Secondary end points were local progression-free survival (LPFS), overall survival (OS), and complications.

Results: MWA was successfully completed in all patients. Mean tumor diameter, ablation time, and ablation output power were 0.81 cm, 3.4 minutes, and 39 W, respectively. LPFS was 100% at 3, 6, 12, and 24 months, respectively. OS was 100% at 12 and 24 months, respectively. No intraoperative or postoperative deaths occurred. Complications with MWA were infrequent. Pneumothorax was most common, occurring in 31 patients (34.07%); among these, seven (7.69%) required closed thoracic drainage. Pleural effusion occurred in six patients (6.59%), hydropneumothorax in five (5.49%), and pneumonia in three (3.30%). The pain level after MWA was moderate-to-severe in 29 patients (31.87%).

Conclusion: MWA is safe and feasible for treating residual nodules in patients with MPNs who have undergone VATS. The incidence of complications was low, and most complications were mild.

Abstract: Mesenchymal stem cells (MSCs) are a class of protocells that can differentiate into various cell types and have robust replication and renewal capabilities. MSCs secrete various nutritional factors to regulate the microenvironment of tumor tissues. The mechanism by which they inhibit or promote tumor growth may be closely related to MSC-derived exosomes (MSC-Exo). However, the role of MSC-Exo vesicles in tumors remains controversial. This review discusses the potential applications of microRNAs in exosomes derived from MSCs in treating tumors.

Background: This study investigated the clinical efficacy and prognostic factors of ablative treatment in hepatocellular carcinoma (HCC) patients with and without diabetes mellitus (DM).

Methods: Retrospective data were collected from HCC patients who underwent ablation between January 2016 and December 2019. The baseline clinicopathological characteristics and long-term outcomes, such as overall survival (OS) and recurrence-free survival (RFS), were compared between those with and without DM. Predictive factors associated with survival and recurrence were identified through univariable and multivariable Cox regression analyses.

Results: Of the 3528 patients enrolled in the study, 588 (16.7%) had concurrent DM. The 1-, 3-, and 5-year RFS rates in patients with DM (73.8%, 33.7%, and 5.8%, respectively) were significantly (P < 0.001) lower than those in the non-DM patients (70.4%, 37.6%, and 18.6%, respectively). Likewise, significant differences (P < 0.001) in the 1-, 3-, and 5-year OS rates were observed between the DM (99.9%, 78.1%, and 29.1%, respectively) and non-DM (99.9%, 85.9%, and 54.3%, respectively) patients. Multivariable Cox regression analysis identified DM as an independent risk factor for OS [hazard ratio (HR), 1.982; P < 0.001] and RFS (HR, 1.175; P = 0.002).

Conclusion: Patients with DM exhibited a poorer oncological prognosis than those without DM following ablation for HCC. DM was identified as an independent factor influencing the prognosis of HCC patients after curative ablation. Thus, active therapies targeting DM might enhance oncological outcomes and facilitate individualized treatment decisions.

Abstract: Adenoid basal carcinoma of the uterine cervix is a rare epithelial neoplasm. Adenoid basal carcinoma constitutes less than 1% of all cervical adenocarcinomas and has a favorable prognosis. Adenoid basal carcinoma is assumed to arise from a multipotential basal or reserve cell layer in the cervical epithelium. We report a case of adenoid basal carcinoma of the uterine cervix with complaints of bleeding per vagina in a 40-year-old female. The carbohydrate antigen 125 level was elevated (100 U/ml), and the MRI abdomen and pelvis revealed increased signal intensity in the anterior lip of the cervix. The local examination revealed thickening of the anterior lip of the cervix and induration in the left fornix. The patient was diagnosed with carcinoma cervix stage IB2 (FIGO Stage). The patient was operated by a radical robotic hysterectomy. Microscopic examination revealed small basaloid tumor cell nests with peripheral cell palisading and microcyst formation. The tumor cells showed p63 immunoreactivity in basaloid tumor cells and were negative for CD117 and S-100P. This tumor should be differentiated from adenoid basal cell hyperplasia, which has a favorable outcome, and adenoid cystic carcinoma, with a dismal course.

Abstract: Cushing's syndromes (CSs) due to the thymic neuroendocrine tumors are rarely seen. Here, a case of ectopic CS originating from an atypical neuroendocrine tumor has been presented. A 49-year-old woman was hospitalized with symptoms of fatigue, chest pressure, dyspnea, muscle weakness, and resistant hypertension. There was marked hyperpigmentation in the whole-body surface suggestive of adrenocorticotropic hormone (ACTH) excess and there were physical features of CS. There was deep hypokalemia. Basal hormone profile, dexamethasone suppression tests, midnight cortisol, and 24-hour urine cortisol levels were suggestive of ectopic CS. The pituitary magnetic resonance imaging revealed a 5 mm cystic lesion and the patient refused inferior petrosal sinus sampling. Thorax computerized tomography showed an anterior mediastinal mass. A fluorodeoxyglucose-positron emission tomography showed the same mediastinal lesion (suvmax: 11.4), and no other tumor focus was detected. There was an aggressive cortisol excess causing acute respiratory distress syndrome, making it difficult to perform the surgery. We immediately started fluconazole and octreotide therapy and were successful in lowering the cortisol level. Then a complete resection of the tumor had been able to be surgically performed and tumor cells showed strong cytoplasmic immunopositivity with ACTH. A definitive diagnosis of "ACTH secreting atypical thymic carcinoid tumor" was rendered based on the histopathological and immunohistochemical features. There was only surrounding vessel invasion, and no lymphoid or other organ metastases were detected. As there were surrounding vessel invasions, a two-cycle regimen cisplatin-etoposide chemotherapy and radiotherapy were employed. After surgical and medical therapy, the cortisol and ACTH levels turned to normal. The patient is in biochemical and clinical remission and has no tumor recurrence yet. Ectopic ACTH-producing thymic carcinoids are rare but life-threatening tumors because of the underlying malignancy and severe hypercortisolemia. It is important to consider this disease and perform appropriate treatment at the right time. Today, surgery is the standard therapeutic modality if it is possible to perform, but there is not a clear and constant recommendation for nonsurgical therapeutic modalities. Further studies are needed for the optimal treatment strategies.

Objectives: Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival.

Materials and methods: We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan-Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes.

Results: Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3-70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions.

Conclusion: Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.

Abstract: In recent years, advances in radiotherapy technology have led to the use of high-precision radiotherapy such as volumetric modulated arc therapy (VMAT). Total body irradiation using VMAT technique (VMAT-TBI) was performed for the first time in our hospital. A 56-year-old male patient diagnosed with B-cell acute lymphoblastic leukemia was performed TBI as pretreatment for haploidentical-related peripheral blood stem-cell transplantation. The prescribed dose was 4 Gy for planning target volume in two fractions. The treatment plan was divided into two plans: upper body and lower body with three and two isocenters, respectively. The overall treatment time with VMAT-TBI was approximately 55 min, and it was not significantly longer than that of moving couch techniques. VMAT-TBI is a less burdensome and more accurate treatment for patients, and it may be a useful treatment for TBI.