Journal of cancer research and therapeutics最新文献

Objectives: The purpose of this study is to retrospectively compare the therapeutic efficacy and safety of single session microwave ablation (MWA) and multiple session MWA for multiple malignant lung tumors.

Methods: Retrospective analysis was conducted on clinical and pathological data of 103 patients with such malignancies treated from January 2020 to December 2022. Patients were categorized based on the number of MWA sessions required. Patients who had received only one MWA treatment were included in the single session MWA group, and patients, who had received two or more MWA treatments were included in the multiple session MWA group. Chest-enhanced CT scans were performed at 1, 3, 6, and 12 months post-MWA to assess ablation outcomes. The primary focus was the median overall survival (mOS), while secondary endpoints encompassed median local progression-free survival (PFS), technical success rates, safety, and complication rate. Analysis was performed by log-rank test and Cox proportional hazard regression model, using the Common Terminology Standard for Adverse Events (version 5.0) to assess safety within 28 days after MWA.

Results: Of 103 patients with multiple malignant lung tumors, each undergoing at least two tumor treatments during 168 MWA sessions. The median OS for the entire cohort stood at 27 months, with a corresponding median local PFS of 26 months. Patients in the single session MWA group had a median OS of 33 months compared with 13.1 months for those in the multiple session group (P = 0.001). Notably, adverse factors affecting survival after adjusting for confounding variables included T stage (P = 0.002), comorbidity (P = 0.018), solid tumor interior environment (P = 0.043), and multiple session MWA sessions (P = 0.035). No produce-related deaths or grade 3 or 4 adverse events occurred, with pneumothorax being the most common complication (13.1%). There is no significant difference in the occurrence of complications between the two groups (P > 0.05). Additionally, single session MWA exhibited superior OS and local PFS compared to multiple session MWA sessions, with statistically significant differences.

Conclusion: For multiple session lung malignant tumors, the single session MWA group is superior to MWA in terms of survival and local tumor control, with no statistically significant difference in the incidence of complications between the two groups. The findings suggest that single session MWA procedures might be advantageous over multiple session MWAs.

Abstract: Percutaneous image-guided thermal ablation (IGTA) is increasingly utilized for the management of primary and metastatic lung tumors. Several academic societies across various countries have issued clinical practice guidelines, opinion statements, and recommendations for IGTA in the treatment of lung tumors. However, unresolved conceptual and practical challenges persist, underscoring the need for a more comprehensive consensus on the safe and effective application of IGTA, particularly in Asian countries. Consequently, the guideline committee of the Asian Conference on Tumor Ablation (ACTA) established a dedicated working group to develop recommendations for the clinical use of IGTA in lung tumors. Through a thorough analysis of current literature and key clinical questions, the ACTA working group identified 10 critical issues, including indications, modality selection, technical considerations, and management of complications. Following extensive discussions and iterative revisions, experts from Asia-Pacific countries have formulated a consensus to guide clinical practice.

Purpose: This retrospective study evaluated the safety and efficacy of co-ablation (Co-A) for subpleural malignant pulmonary nodules (SMPNs).

Materials and methods: A total of 88 consecutive malignant lung tumor patients treated for Co-A were retrospectively reviewed. Subpleural lesions were assessed using computed tomography (CT). In the lung window, a distance of 1 cm between the nodule and the pleura was defined as subpleural. Overall, 68 patients comprising 41 men and 27 women (mean age, 63.54 ± 13.82 years; age range, 15-87 years) were enrolled, dividing into the SMPN group (n = 53) and the nonsubpleural malignant pulmonary nodules group (NSMPN, n = 15). The mean tumor size was 22.78 ± 6.30 mm (range, 10-30 mm). Follow-up was conducted using CT at 1, 3, and 6 months after Co-A, and the complications and safety profiles were recorded.

Results: The technical success rate was 100%. No significant difference in overall complication rate was observed between the SMPN (40.7%, 24/59) and NSMPN (50.6%, 10/19) groups (χ2 = 0.835, P = 0.361). The median follow-up duration in all patients was 5.38 ± 3.14 months (range, 3-14 months). The 3- and 6-month local recurrence-free survival (LRFS) rates in the SMPN and NSMPN groups were 97.7% and 100%, respectively, and 90.9% and 100%, respectively (P > 0.05).

Conclusion: These findings indicate that Co-A may be a safe and effective treatment strategy for SMPNs.

Background: Gut microorganisms are involved in the occurrence and progression of various types of cancer, including colorectal cancer. Previous studies have shown that the disruption of commensal homeostasis can promote tumor metastasis. The present study aimed to investigate the effects of gut commensal dysbiosis on the risk of colorectal cancer liver metastasis (CRLM) and its mechanisms.

Materials and methods: A mouse model of CRLM with the commensal dysbiosis background was established. This model was used to investigate the impact of commensal dysbiosis on CRLM.

Results: Commensal dysbiosis promoted CRLM development via the C-C chemokine ligand 6 ( CCL6 ) and C-C chemokine receptor 1 ( CCR1 ) axis. Moreover, it altered the liver tumor microenvironment (TME) by recruiting tumor-associated macrophages (TAMs), notably M2-like TAMs, and promoted liver metastasis growth. Liver metastasis was promoted via the upregulation of CCL6 expression levels, which resulted in CCR1 +TAM infiltration into the TME. Notably, inhibiting CCR1 expression could reduce CRLM.

Conclusion: Commensal dysbiosis could promote CRLM development via CCL6/CCR1 signaling. Targeting this signaling axis could be an effective method to inhibit CRLM by regulating the TME.

Objective: To evaluate diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) for the prenatal differentiation of fetal adrenal neuroblastoma (NB) from benign masses.

Methods: This retrospective study analyzed prenatal magnetic resonance imaging/DWI data from 54 pregnant women (59 adrenal masses) with a suspected solid adrenal mass on ultrasound. Cases with severe malformations or poor image quality were excluded. The minimum ADC (ADC min ), mean ADC (ADC mean ), and relative ADC (rADC) values within the tumor solid components were measured. Group comparisons and receiver operating characteristic (ROC) curve analysis were performed to assess the diagnostic performance.

Results: Eighteen masses (30.5%) were classified as NB, while the remaining 41 (69.5%) were benign, including sequestration, hematoma, and teratoma. The NB group showed significantly greater gestational age at detection (mean age, 35 weeks), higher right adrenal prevalence (66.7%), and larger maximum diameters (3.6 cm vs. 2.4 cm; P < 0.01) compared to the non-NB group. The ADC min , ADC mean , and rADC were significantly lower in the NB group ( P < 0.001). ROC analysis identified ADC min as the optimal diagnostic parameter (area under the curve = 0.981). An ADC min threshold of 1382 μm²/s yielded 97.56% sensitivity and 100% specificity.

Conclusion: These findings indicate that the quantitative DWI parameter ADC min can reliably differentiate fetal adrenal NB from benign lesions prenatally. Its high sensitivity and specificity may provide an objective basis for clinical decisions and optimized perinatal management.

Background: Vascular endothelial growth factor (VEGF) overexpression is linked to aggressive metastasis and poor prognosis in patients with breast cancer. This study aimed to develop a noninvasive model integrating ultrasound and clinical information for VEGF prediction and to evaluate its clinical utility in risk stratification for lymph metastasis and prognosis.

Methods: Breast cancer ultrasound findings, clinical data, immunohistochemical results, and prognostic information were collected from three centers to develop the intelligent model. ResNet-50 was used to extract ultrasound features, which were then combined with clinical information using logistic regression. Class activation mapping and an alignment nomogram were used to visualize and explain the model's prediction process. Model performance was assessed using the area under the curve (AUC), confusion matrix, calibration curves, and decision curve analysis. Prognostic relevance was evaluated by examining the lymph node metastasis and recurrence-free survival (RFS) rates.

Results: Data from 609 patients were divided into four sets: training, validation, internal test, and external test. The combined model demonstrated satisfactory performance in the internal (AUC, 0.852; 95% confidence interval [CI], 0.756-0.928) and external (AUC, 0.837; 95% CI, 0.778-0.892) test sets. In the external test set, high-risk VEGF patients predicted by the combined model exhibited higher lymph node metastasis rates (67.8% vs. 12.1%; P < 0.001) and poorer RFS (log-rank P = 0.022). The prognostic accuracy for recurrence peaked at six months (AUC, 0.806).

Conclusion: This noninvasive intelligent model could precisely predict VEGF expression, indicate the risk of lymph node metastasis, and provide prognostic insights.

Abstract: In oncology practice, the pursuit of life-prolonging treatments often raises critical ethical and clinical questions about the balance between aggressive interventions and the preservation of quality of life. As cancer therapies continue to advance, there is an increasing risk of over-treatment, where the focus on extending life may inadvertently compromise a patient's comfort, dignity, and overall well-being. This article explores the concept of "Do Not Kill the Patient before He Dies," urging oncologists to adopt a patient-centered approach that prioritizes thoughtful decision-making and individualized care. This article examines the challenges of navigating the fine line between curative and palliative intents, particularly in advanced-stage cancer, where the benefits of treatment may diminish relative to its side effects. The article highlights the consequences of over-treatment, drawing on case studies, patient narratives, and evidence-based research to illustrate how aggressive interventions can lead to physical, emotional, and financial burdens for patients and their families. Key strategies to mitigate these risks are discussed, including the role of shared decision-making, honest communication about prognosis and treatment goals, and the timely integration of palliative care. By fostering a culture of empathy, collaboration, and respect for patient autonomy, oncology practitioners can ensure that therapeutic choices align with the values and priorities of those they serve. This article advocates for a paradigm shift in oncology, emphasizing the importance of not just prolonging life but enhancing its quality.

Abstract: Clear Cell Sarcoma-like tumors of the gastrointestinal tract (CCSGT) are extremely rare entities to be diagnosed and treated. Histopathological diagnosis and treatment of such rare malignancies is a challenge. This case report describes the treatment of a non-metastatic rectal CCSGT. The patient underwent abdominoperineal resection (APR) followed by adjuvant radiation to a dose of 60Gy over 30 fractions over 6 weeks. This report represents the first documented case of a localized clear cell sarcoma-like tumor of the rectum successfully treated with adjuvant radiation therapy, highlighting the potential role of radiotherapy in managing this rare malignancy.

Aim: The aim of this study is to investigate the diagnostic performance of the deep learning method using Magnetic Resonance Images (MRI) and 18F-fluorodeoxyglucose and Positron Emission Tomography (F-18 FDG-PET/CT) in determining axillary lymph node metastasis (ALNM) in breast cancer patients.

Materials and methods: In our study, all patients aged 18 and over who were diagnosed with breast cancer and operated on in the General Surgery Clinic of Adana City Training and Research Hospital between November 2017 and April 2023 were retrospectively examined from the hospital system. Demographic characteristics of the patients included in the study, menopausal status, type of operation performed, metastasis status in the postoperative histopathological evaluation of the axilla, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) status, Ki-67 proliferation index, lymphovascular and perineural invasion status, MRI and F-18 FDG-PET/CT images, and histopathological features, size and grade of the tumor were recorded. MRI and F-18 FDG-PET/CT images of the patients were evaluated by experts in the field, and the diagnostic performance results of the Convolutional neural network (CNN) model trained with the same images were also recorded.

Results: 177 patients were included in our study. When the patients' demographic and clinicopathological parameters and ALNM status were compared, a statistically significant difference was found between ER status, lymphovascular-perineural invasion and ALNM status (P < 0.05). The model trained using both MRI and PET/CT achieved the best performance: sensitivity 89.35%, specificity 63.21%, accuracy 68.04%, and F1 score 79.84%. The CNN model outperformed expert interpretation of either modality alone.

Conclusion: The deep learning model demonstrated promising diagnostic capability for noninvasively detecting ALNM. While not yet a replacement for SLNB, such models may assist clinical decision-making and reduce the need for invasive procedures in the future.