Cancer Management and Research最新文献

Vitamin D (VD) has been the focus of extensive clinical research, yet conclusions regarding its biological roles remain inconsistent. VD exerts its functions through the vitamin D receptor (VDR), a nuclear transcription factor that regulates the expression of VD3-responsive target genes. Notably, divergent findings across studies have been reported regarding VDR expression patterns and functional roles, underscoring the complexity of VDR in cancer biology. Whether this complexity interferes with VD's biological activity-thereby contributing to the variable impacts of VD3 on cancer prevention and treatment-remains unclear. This review systematically addresses: (1) the association between VDR expression (assessed by immunohistochemistry) and cancer prognosis; (2) the roles and mechanisms of VDR in cancer; (3) the multi-level regulatory networks governing VDR expression and activity; and (4) the translational implications of VDR in cancer therapy. Elucidating the precise roles and mechanisms of VDR is critical for optimizing cancer treatment strategies and resolving conflicting clinical evidence.

Cancer treatment has entered the era of immunotherapy after surgery, radiotherapy, chemotherapy, and targeted therapy. The immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs) have become a significant concern in clinical practice, given the broad application of these agents. This article reports a case of immune polymyositis involving the myocardium and rhabdomyolysis in a patient with lung adenocarcinoma combined with brain metastases treated with sintilimab. In addition, there was simultaneous involvement of other systems with immune-associated hepatitis, thyrotoxicosis, and secondary hypoadrenalism. After high-dose corticosteroid shock therapy administration, the patient's symptoms and indicators improved significantly.

Background: Non-small cell lung cancer (NSCLC) is a prevalent malignancy where adjuvant therapy is crucial. Astragalus polysaccharide injection (APS-I) has shown potential as an adjunct due to its immunomodulatory properties, but its impact on survival outcomes requires further validation.

Objective: This study employed propensity score matching (PSM) to evaluate the efficacy of APS-I combined with conventional therapy versus conventional therapy alone in the adjuvant treatment of NSCLC.

Methods: In this retrospective cohort study, NSCLC patients receiving adjuvant therapy between January 2018 and December 2024 were enrolled. After 1:1 PSM, 54 matched pairs were allocated to the APS-I + conventional therapy group or the conventional therapy alone group. Outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), immune function, quality of life (QoL), and adverse events.

Results: The APS-I group demonstrated significantly superior short-term efficacy, with higher ORR (77.8% vs 33.3%, P<0.001) and DCR (96.3% vs 70.4%, P<0.001). Survival outcomes were significantly improved: median PFS was 12.8 months versus 8.2 months (Hazard Ratio [HR]= 0.143, 95% CI: 0.082-0.250, P<0.001), and median OS was 23.3 months versus 17.0 months (HR= 0.249, 95% CI: 0.154-0.401, P<0.001). The APS-I group also showed a significantly higher Karnofsky Performance Status (KPS) improvement rate (60.5% vs 27.9%, P=0.003) and a lower incidence of adverse events (11.1% vs 33.3%, P=0.014).

Conclusion: APS-I combined with conventional therapy shows promise in improving survival and quality of life, but multicenter RCTs are warranted to validate efficacy before clinical adoption.

Objective: To investigate the development trend of prognostic nutritional index and psychosomatic symptom clusters (multidimensional fatigue, generalized anxiety, difficulty in emotional regulation) in patients with lung cancer, and to analyze their correlation and predictive relationship.

Methods: One hundred and eighty-five patients with lung cancer were selected as the research objects using the convenience sampling method. The prognostic nutritional index and psychosomatic symptom cluster were followed up at T1, T2, and T3 after the operation. Repeated measures ANOVA and cross - lag model were used for statistical testing.

Results: A total of 185 questionnaires were distributed, and 7 invalid questionnaires were excluded, with an effective recovery rate of 96.22%. The results of repeated measurement showed the scores of prognostic nutritional index (F = 3.342, P = 0.031), multidimensional fatigue (F = 5.362, P < 0.001), generalized anxiety (F = 6.003, P < 0.001), and emotional regulation difficulties (F = 0.885, P = 0.420) at the three time points. Results of the cross - lag model: The level of prognostic nutritional index negatively predicted multidimensional fatigue symptoms (T1→T2: β = - 0.415, P = 0.003; T2→T3: β = - 0.433, P = 0.005) and generalized anxiety symptoms (T1→T2: β = - 0.364, P = 0.007; T2→T3: β = - 0.350, P = 0.012). The prognostic nutritional index at T2 significantly and negatively predicted emotional adjustment difficulties at T3 (T1→T2: β = 0.158, P = 0.151; T2→T3: β = - 0.233, P = 0.024). While in the psychosomatic symptom cluster, only multidimensional fatigue negatively predicted the prognostic nutritional index at the next node (T1→T2: β = - 0.314, P = 0.003; T2→T3: β = - 0.342, P = 0.001).

Conclusion: The prognostic nutritional index of patients with lung cancer after surgery is closely related to the psychosomatic symptom cluster. The prognostic nutritional index has a negative predictive effect on the psychosomatic symptom cluster, and the multidimensional fatigue symptom also has a negative predictive effect on the prognostic nutritional index.

Objective: To evaluate the effects of comorbidities and lifestyle factors on the prognostic value of preoperative carcinoembryonic antigen (CEA) for tumor-node-metastasis (TNM) staging in Chinese patients with colorectal cancer (CRC).

Methods: A retrospective cohort study of 307 patients with CRC from Beijing Luhe Hospital (2020-2024) was performed. Clinicopathological data, including TNM and Numerical staging (AJCC 8th edition), serum CEA levels, and covariates (comorbidities and lifestyle factors), were analyzed using univariate and multivariate logistic regression. Multivariable logistic regression with multiplicative interaction terms (CEA × modifier) was used to test for effect modification.

Results: Elevated CEA levels were significantly associated with advanced TNM staging (Stage III-IV vs stage I-II, p < 0.001). Multivariate analysis confirmed that CEA was an independent predictor of T stage progression (HR = 1.15, p= 0.017), lymph node metastasis (N stage: HR = 1.17, p = 0.046), and distant metastasis (M stage: HR = 1.06, p = 0.018). Formal interaction analysis revealed that alcohol use significantly amplified the CEA-stage association (HR = 3.11, 95% CI 1.11-8.74, p = 0.031), whereas coronary heart disease attenuated the relationship (HR = 0.40, 95% CI 0.18-0.87, p = 0.022), yielding a paradoxical inverse association in affected patients. In addition, hypertension nullified the predictive utility of CEA, with a significant stage association observed only in the nonhypertensive subgroup.

Conclusion: Preoperative CEA exhibits robust predictive accuracy for TNM staging in Chinese patients with colorectal cancer; however, this performance is critically modulated by alcohol use, coronary heart disease, and hypertension. Systematic incorporation of these three effect modifiers into preoperative risk-stratification algorithms will refine staging accuracy and enable patient-tailored therapeutic strategies.

Purpose: The purpose of this study was to investigate the status and influencing factors of kinesiophobia in patients during the early postoperative period following head and neck cancer (HNC) surgery.

Patients and methods: This prospective cross-sectional study employed convenience sampling to recruit 367 patients undergoing radical head and neck surgery between September 1, 2024, and April 30, 2025. Participants were interviewed by trained researchers using a self-designed general information questionnaire, the Tampa Scale for Kinesiophobia-11 (TSK-11), the Chinese version of the Brief Fatigue Inventory (BFI-C), and the General Self-Efficacy Scale (GSES). Univariate analysis was performed using the chi-square test, Mann-Whitney U-test, or Fisher's exact test. Correlation analysis was conducted using Pearson's correlation coefficient. Multivariate analysis was conducted using multiple linear regression.

Results: The average score of kinesiophobia was 18.42 ± 4.97. The completion rate reached 98.65%. Males accounted for 51.77%, while females comprised 48.23%. Pearson correlation analysis demonstrated a significant positive correlation between TSK-11 and BFI-C scores in patients with HNC (r = 0.801, p < 0.001). TSK-11 scores were significantly negatively correlated with GESE scores (r = -0.816, p < 0.001). The results of the multiple linear regression analysis indicated that the included independent variables explained 82.1% of the variance in the dependent variable. Skin flap transplantation (t=7.996, 95% Cl 2.306-3.811, p<0.001), immobilization (t=6.483, 95% Cl 2.224-4.162, p<0.001), lymph node dissection (t=6.608, 95% Cl 1.540-2.845, p<0.001), tracheotomy (t=7.666, 95% Cl 1.749-2.956, p<0.001), GESE (t=-3.406, 95% Cl -0.229-0.061, p<0.001), and BFI-C (t=3.028, 95% Cl 0.169-0.795, p<0.001) were significant influencing factors for kinesiophobia in patients during the early postoperative period following HNC surgery.

Conclusion: The proportion of head and neck cancer patients experiencing kinesiophobia in the early postoperative period is relatively high. Research has demonstrated that this phenomenon is closely associated with self-efficacy, fatigue levels, and the type of surgical procedure. Therefore, it is recommended that healthcare professionals should consider kinesiophobia as a core indicator in postoperative rehabilitation assessments, with particular attention to patients undergoing complex surgery or exhibiting low self-efficacy and high fatigue levels. Early identification of high-risk individuals and the implementation of multidimensional intervention strategies-including enhancing self-efficacy through cognitive behavioral therapy, implementing stepwise fatigue management programmes, and providing personalized rehabilitation guidance for patients undergoing specific surgeries-will ultimately reduce the incidence of kinesiophobia.

Gastric cancer is a digestive tract malignant tumor with high incidence and high mortality rate in the world, and patients with advanced gastric cancer often face clinical difficulties such as drug resistance and significant toxic and side effects. Traditional Chinese medicine shows unique advantages of multi-target and multi-pathway regulation in the comprehensive treatment of gastric cancer. Buyang Yiwei Decoction is a classic prescription for replenishing qi and nourishing blood, and combining tonification with dispersion. Clinical studies have confirmed that Buyang Yiwei Decoction combined with chemotherapy can significantly improve the performance status of patients with advanced gastric cancer, decrease the levels of tumor markers, and alleviate chemotherapy-induced organ damage/toxicities. In this paper, we systematically combed the key biological processes of the PI3K/AKT signaling pathway in the occurrence and development of gastric cancer. Our study found that the core active ingredients of Buyang Yiwei Decoction have been shown to inhibit the abnormal activation of the PI3K/AKT pathway, down-regulate the key phosphorylated proteins in this pathway, regulate downstream effector molecules, and thereby exert the molecular mechanism of inhibiting gastric cancer cell proliferation, inducing apoptosis, suppressing invasion and metastasis, and reversing chemotherapy resistance. However, current studies on the holistic mechanism of Buyang Yiwei Decoction remain insufficient; the evidence for clinical translation is weak; and the precision of its therapeutic targets needs to be improved. The next step is to further elucidate the multi-component synergistic mechanisms by which Buyang Yiwei Decoction regulates the PI3K/AKT pathway through an integrated approach combining network pharmacology, animal model validation, and multi-center clinical research. It is also essential to clarify its precise therapeutic value in targeting specific pathological processes. This will provide a more targeted, mechanism-elucidated, and higher-level evidence-based scientific foundation for its clinical application as an adjunctive strategy in the precision treatment of gastric cancer.

Background: Risk stratification is one of the most critical parameters guiding treatment decisions in nonmetastatic prostate cancer. Although it is well established that high risk (HR) and very high risk (VHR) groups diverge prognostically, the real-world impact of this distinction in non-surgically managed patient populations has been less extensively evaluated.

Methods: In this retrospective study, 81 patients with nonmetastatic prostate cancer were analyzed (HR: n=24; VHR: n=57). All patients received androgen deprivation therapy (ADT), and 65.4% additionally underwent radiotherapy (RT). Clinical and pathological characteristics, early PSA responses, overall survival (OS), and disease-free survival (DFS) were compared between HR and VHR groups.

Results: At diagnosis, VHR patients presented with higher PSA values, worse Gleason scores, and more advanced stages. Although PSA responses at three and six months were similar between groups, long-term outcomes were significantly inferior in the VHR cohort. Median OS for the entire cohort was 72.1 months in VHR patients versus 97.1 months in HR patients (p=0.039). Among those receiving RT, the difference was preserved (HR: 104.5 months vs VHR: 75.1 months; p=0.032). Median DFS was 23.3 months in the VHR group and 44.5 months in the HR group (p=0.026). During follow-up, recurrence/metastasis occurred in 54.4% of VHR patients compared with 16.7% of HR patients (p=0.002).

Conclusion: Our findings show that the VHR classification maintains strong prognostic value even in non-surgically managed patients, underscoring its role as a biologically distinct and aggressive disease entity. Standard RT+ADT seems insufficient in this subgroup. The study supports exploring intensified treatment strategies, such as prolonged ADT, brachytherapy boost, pelvic nodal RT, and, where appropriate, novel androgen receptor signaling inhibitors or chemotherapy.

Background: The effectiveness of third - line treatment for metastatic colorectal cancer (mCRC) still needs enhancing. In real-world clinical practice, third-line treatment options are complex and varied. However, real-world data on third-line treatment for mCRC remains limited. Further investigation is needed into treatment patterns, the efficacy of different regimens, and their influencing factors.

Methods: This study retrospectively analyzed 229 mCRC patients receiving third-line therapy (2013-2023). Kaplan-Meier method was used to draw the overall survival (OS) and progression-free survival (PFS) curves. With the chemotherapy group serving as the control group, the efficacy differences between third-line regimens were compared using the Log rank test. Univariate analysis was first conducted to evaluate prognostic factors, the indicators with statistical significance were analyzed by multivariate analysis using the Cox proportional hazards model.

Results: Fruquintinib plus immunotherapy achieved a median PFS of 8.8 months (95% CI: 8.6-9.0), which was significantly longer than the 3.6 months (95% CI: 3.1-4.1) in the chemotherapy group (p = 0.034). All 229 patients had proficient mismatch repair(pMMR) tumors or genetic testing suggestive of MSI-L/microsatellite stability(MSS). The third-line median PFS in the setting was 3.8 months, and the median OS was 13.3 months. Univariate analysis identified metastasis local treatment, RAS/BRAF mutation status, metastasis-to-PD2(defined as the second progression following first-line treatment initiation) interval, baseline CEA, and baseline CA199 as significant prognostic factors. Multivariate analysis confirmed metastasis-to-PD2 interval and baseline CA199 as independent prognostic indicators.

Conclusion: In the real-world setting, fruquintinib combined with immunotherapy was associated with benefits in third-line treatment of patients with pMMR mCRC. Shorter metastasis-to-PD2 interval and elevated baseline CA19-9 levels at the start of third-line therapy were independent poor prognostic factors.

Purpose: Women living with chronic conditions and/or living in poverty have a higher risk of developing cervical cancer compared to the general population due to lower rates of cervical cancer screening (CCS). Human papillomavirus (HPV) self-collection tests improve CCS rates in under-screened populations by reducing barriers. However, some women are concerned about the ability to adequately perform self-collected sampling for CCS. This study examined how existing HPV self-collection patient education materials can be enhanced to increase self-efficacy in self-collecting samples.

Methods: We conducted three focus groups with 13 women living in zip codes associated with high poverty rates or chronic conditions in north central Florida. The Information-Motivation Behavioral Skills Model (IMB model) and the Patient Education Material Assessment Tool for Printable Materials (PEMAT-P) guided the focus group discussions. Focus group interviews were recorded and transcribed, and thematic analysis was used to analyze the data.

Results: Opportunities for improvement included: (1) Information: Using simplified language, including HPV and cervical cancer information, clear explanations about mailing procedures, information on access and interpretation of results, and visual elements to increase user confidence in medical soundness and safety, (2) Motivation: offering the materials in various languages and balancing design for inclusion of all women, and (3) Behavioral Skills: enhancing visual aids through clear directions to instructional videos, use of zoomed-in images, and projecting variable female anatomy figure positions to illustrate proper device insertion to encourage actionability.

Discussion: This study helps to bridge the gap in studies aimed at enhancing participation in HPV self-collection by examining opportunities to improve current HPV self-collection printed patient education materials and instructions among women with increased cervical cancer risk. Participants identified opportunities to enhance language, visual aids, and inclusivity - factors that may improve women's confidence in self-collection and ultimately increase rates of CCS in underserved women.