Cancer Management and Research最新文献

Purpose: To investigate the clinical value of vascular cancer thrombus and myometrial invasion combined with tumor markers (epididymal protein 4 (HE4), carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153), carbohydrate antigen 199 (CA199)) in predicting sentinel lymph node (SLN) metastasis of Endometrial Cancer (EC).

Methods: A retrospective study was conducted on 150 patients with EC during January 2022 to December 2024. Patients were divided into a metastatic group of 32 cases and a non-metastatic group of 118 cases. The clinical data and tumor markers [HE4, carcinoembryonic antigen (CEA), CA125, CA153, CA199 and alpha fetoprotein (AFP)] levels were collected. Logistic regression analysis was used to identify the influencing factors of metastasis. The predictive value was evaluated by Receiver operating characteristic curve (ROC). Principal component analysis (PCA) was performed to analyze the distribution characteristics.

Results: The incidence of vascular cancer thrombus (62.50%), the proportion of myometrial invasion ≥1/2 (90.63%) and serum levels of HE4, CA125, CA153 and CA199 in the metastatic group were significantly higher than those in the non-metastatic group (P<0.05). Vascular cancer thrombus, myometrial invasion ≥ 1/2, HE4, CA153, CA125 and CA199 were all influencing factors of SLN metastasis of EC (P<0.05). The AUC of the combined detection of vascular cancer thrombus, myometrial invasion, HE4, CA153, CA125 and CA199 was 0.904, with sensitivity and specificity of 85.59% and 84.38%, respectively. The combined detection has a high predictive value for SLN metastasis of EC. When the first principal component (PC1) was plotted against the second principal component (PC2), patients with SLN metastasis had significant disturbances in vascular cancer thrombus, myometrial invasion, HE4, CA153, CA125 and CA199. There were significant individual differences and dispersed distribution among EC groups, while patients without SLN metastasis could cluster well.

Conclusion: The combined detection of vascular cancer thrombus, myometrial invasion combined with HE4, CA153, CA125 and CA199 can effectively predict SLN metastasis of EC. But these influencing factors had great fluctuation and uncertainty in patients with SLN metastasis of EC, which may be related to the complexity and heterogeneity of the disease.

Cancer cachexia (CC) is a prevalent metabolic disorder in patients with advanced cancer, characterized by persistent skeletal muscle mass loss and irreversible body weight reduction, which significantly diminishes quality of living, therapeutic effectiveness. At present, the specific pathogenesis of CC is only defined as skeletal muscle loss induced by signaling pathways. In the clinical treatment of tumor cachexia, it has been clearly defined that there are multiple methods available for treating this disease, including nutritional therapy and exercise, but all of them have very little therapeutic effect. Surprisingly, traditional Chinese medicine has achieved initial success in treating malignant tumors, and the combined treatment of traditional Chinese and Western medicine has yielded remarkable results. Therefore, it is an urgent need to elucidate the more specific pathogenesis of CC to develop effective treatment approaches, which enhance patients' nutritional health status as well as their overall quality of life and survival ratings. This article aims to review the pathogenesis of CC along with clinical treatment strategies and drug utilization.

Background: Recent innovations in technology have significantly advanced the imaging capabilities of positron emission tomography/computed tomography (PET/CT). Digital PET/CT provides sensitive and high-resolution imaging and can improve the detection of small lesions as compared to conventional (analog) PET/CT. This study aimed to compare the diagnostic performance of digital versus analog PET/CT for detecting lymph node metastases and to assess the maximum standardized uptake (SUVmax) values in patients with resected non-small cell lung cancer (NSCLC).

Methods: We enrolled a total of 103 patients with lung adenocarcinoma or squamous cell carcinoma who had undergone preoperative PET/CT in either analog or digital scanners. The primary endpoint was comparison of the diagnostic performance of the two modalities for lymph node metastasis, and the secondary endpoints were comparison of the SUVmax values and correlation of the SUVmax values with the Glut-1 (glucose transporter type 1) expression.

Results: Of the 103 patients enrolled in the study, 61 had undergone analog PET/CT, and 42 had undergone digital PET/CT. Significantly higher SUVmax values on digital as compare with analog PET/CT were obtained for cT1b tumors (D/A ratio = 3.42, p = 0.002) as well as cT1c tumors (D/A ratio = 2.10, p < 0.001). However, no significant difference in SUVmax values between the two types of PET/CT was obtained for tumors exceeding 3.0 cm in diameter. A stronger correlation was found between tumor Glut-1 expression and the SUVmax values obtained digital PET/CT as compared with the values obtained with analog PET/CT. Digital PET/CT also showed a higher sensitivity (71.4% vs 37.5%) for detecting lymph node metastases, although the specificity was slightly lower (88.6% vs 96.2%), and the overall accuracy was comparable (85.7% vs 88.5%) between the two types of scanners. False-positive lymph nodes on digital PET/CT were obtained in conditions such as pneumoconiosis and anthracosis, while false-negatives results were obtained in conditions such as micrometastases and/or low lymph node Glut-1 expression.

Conclusion: These results suggest that digital PET/CT shows improved diagnostic sensitivity and that the results of digital PET/CT are better correlated with tumor metabolic activity, which results in improved detection of lymph node metastases. These results support the clinical usefulness of digital PET/CT for optimizing perioperative strategies and increasing diagnostic confidence in the management of NSCLC. Future multicenter prospective studies and a standardized redefinition of SUVmax are urgently needed to validate our findings and to establish more reliable clinical application of digital PET/CT in patients with lung cancer.

Purpose: This study longitudinally examined symptom clusters and sentinel symptoms in lung cancer patients across radiotherapy phases, providing a theoretical foundation for targeted symptom management.

Methods: In this prospective longitudinal study, 244 patients were recruited via convenience sampling from a tertiary cancer hospital in Southwest China between January and December 2024. Data were collected using the General Demographic Questionnaire and MD Anderson Symptom Inventory (including the lung cancer module). Assessments occurred at four time points: T1 (one day before radiotherapy), T2 (after 10 sessions), T3 (after 20 sessions), and T4 (at end of radiotherapy). Exploratory factor analysis identified symptom clusters from symptoms with >20% incidence, while Apriori algorithm modeling analyzed intra-cluster associations to determine sentinel symptoms.

Results: Five symptom clusters emerged: psychological (sadness, distress, sleep disturbance), respiratory (chest tightness, shortness of breath), lung cancer-specific (coughing, expectoration), radiotherapy side-effect (dry mouth, pain, decreased appetite), and perceptual (at T1: pain, numbness, at T2: dry mouth, pain, decreased appetite, numbness, constipation, at T3 and T4: forgetfulness, somnolence, fatigue, nausea, constipation). At T1, distress, shortness of breath, and coughing were sentinel symptoms for the psychological, respiratory, and lung cancer-specific clusters, respectively. Pain was the sentinel for the radiotherapy side-effect cluster at T3, and somnolence for the perceptual cluster at T4.

Conclusion: Lung cancer patients exhibit multiple stable symptom clusters during radiotherapy, with sentinel symptoms varying by phase. These insights offer new perspectives on timed assessments and precision nursing interventions, while providing key theoretical and practical guidance for building early warning models and intelligent symptom management pathways.

Background: Stem cell therapy is a potential approach for tumor treatment; however, its efficacy and safety remain incompletely controllable. Therefore, early prediction of tumor progression and therapeutic evaluation post-treatment to guide timely therapeutic adjustments is essential. Radiomics has recently been widely applied to assess tumor behavior and characteristics. This study aims to investigate the predictive value of MRI radiomics for therapeutic outcomes in the early stages of stem cell intervention in colon cancer.

Methods: Subcutaneous tumor models were established by implanting CM38 colon cancer cells into the inguinal region of C57BL/6 mice. Bone marrow mesenchymal stem cells (MSCs) were intravenously injected via the tail vein within 24 hours. T1 weighted MRI scans were performed on day 7 to extract radiomic features, monitor tumor growth, and evaluate neovascularization (CD34) and proliferation (Ki67) via immunohistochemistry. An early-stage MRI radiomics model was constructed to predict colon cancer progression.

Results: Tumors in the stem cell intervention group exhibited faster growth compared to the control group, though no significant volume difference was observed in the early phase. A total of 1162 radiomic features were extracted, with 17 strongly associated features (including texture features, first-order features texture and shape features) selected to build the prediction model. The final model demonstrated an AUC > 0.8 across both training and testing datasets.

Conclusion: Intravenous MSC injection promotes the progression of subcutaneously implanted CM38 colon cancer. An MRI radiomics-based predictive model was successfully established, enabling early prediction of tumor progression post-intervention.

Purpose: This study evaluates the effect of pandemic-related diagnostic and treatment delays on 3-year disease-free survival (DFS) in Taiwanese breast cancer patients.

Material and methods: This single-institution study analyzed breast cancer patients across three distinct periods: non-COVID-19 in 2017, pre-COVID-19 in 2019, and during the COVID-19 pandemic in 2020, to investigate the impact of the COVID-19 pandemic on DFS rates and recurrence rates. DFS was defined as the interval from surgery to the occurrence of breast cancer recurrence or death, whereas overall survival (OS) was defined as the interval from surgery to death from any cause. Follow-up protocol included regular clinical examinations and annual imaging, with a minimum follow-up of 36 months unless an event occurred earlier.

Results: The demographics of breast cancer patients changed from 2017 to 2020, with an average age increasing from 54.6 to 58.6 years. While overall survival (OS) did not vary significantly across the cohorts, DFS differed significantly, with the 2020 cohort experiencing a significant decline in DFS compared to 2017 (p = 0.027). Recurrence rates also increased, from 3.1% in 2017 to 7.6% in 2020.

Conclusion: The COVID-19 pandemic had a negative impact on the DFS of breast cancer patients, with the 2020 cohort experiencing a significantly shorter DFS time compared to the 2017 cohort.

Background: EGFR exon 20 insertion (Exon 20ins) is the most common type among rare EGFR mutations. It involves over 100 identified subtypes. These mutations are generally insensitive to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). The development of small-molecule targeted agents specifically designed for Exon 20ins has brought new hope to this patient population. However, responses to Exon 20ins targeting agents vary across different insertion subtypes, and there is currently a lack of research focused on treatment strategies specifically for near-loop mutations such as P772_H773insGNP.

Methods: To explore individualized treatment strategies, we reviewed the medical records of a patient with Exon 20ins P772_H773insGNP. Relevant medical history, laboratory and imaging findings, and treatment details were collected and analyzed.

Results: This case report describes a patient with advanced non-small cell lung cancer (NSCLC). The patient was diagnosed with adenocarcinoma of the right upper lobe (T3N1M1a, stage IV). Next-generation sequencing (NGS) detected an EGFR exon 20ins, specifically P772_H773insGNP. The patient experienced disease progression despite multiple lines of therapy. Following multidisciplinary discussion, furmonertinib was initiated as sixth-line therapy. The best overall response was assessed as partial response (PR), and as of the last follow-up, the patient had achieved a progression-free survival (PFS) of 10.5 months.

Conclusion: This case represents the first report of a favorable response to furmonertinib in a patient with the EGFR exon 20ins subtype P772_H773insGNP, a near-loop mutation. EGFR exon 20ins mutations are highly heterogeneous, and different subtypes exhibit varying sensitivities to targeted drugs. Exploring individualized treatment approaches is of great clinical importance.

Breast cancer (BC) surgery has been advanced through artificial intelligence (AI), which helps surgeons to gain more accurate results and apply surgical procedures. Despite the increasing focus on AI in BC management, there are knowledge gaps in the current understanding that can be readily identified from the existing works of literature. This narrative review aims to provide an update on the influencing role of AI technologies in precise and personalized clinical decision-making in BC surgery. We included articles published in English during the past 5 years from the major databases. Furthermore, this review used appropriate keywords with and without Boolean operators like "AND", "OR" and "NOT". We considered three major aspects for surgical practice: preoperative planning, intraoperative decision-making, and postoperative outcomes, while interpreting the studies. We found that AI-assisted BC surgery has advanced through the development of a new real-time, accurate tumor identifier, margin assessment, and robotic-assisted surgeries. Moreover, AI-based algorithms are gradually incorporated into the evaluation of the postoperative probability of reoccurrence, complications, and patient satisfaction. It is documented that integrating AI technologies into BC care is inevitable and set to expand further in all aspects. Furthermore, this review identified some major challenges in the algorithm and ethical aspects. The limitations, such as lack of external validation, integration barriers, and the "black box" nature of some AI models, remain unresolved. To fully utilize AI's capabilities, it is recommended that surgeons, AI developers, and policymakers collaborate on more advanced AI that is enhanced for personalized care by including patients' genetics, medical history, and lifestyle factors. Additionally, future prospective and exploratory cost-effective analysis studies are to be done.

Background: This study aimed to evaluate the survival predictability of preoperative systemic inflammation response index (SIRI), calculated as the absolute neutrophil count multiplied by the absolute monocyte count and divided by the absolute lymphocyte count, in patients with metachronous secondary primary head and neck squamous cell carcinoma (mspHNSCC) who had undergone prior radiotherapy for first primary HNSCC (fpHNSCC).

Methods: A total of 101 consecutive patients who underwent upfront surgery for mspHNSCC at a single institute between 2007 and 2016 were retrospectively reviewed between December 2023 and November 2024 and included in the analysis. The baseline leukocyte counts for the fpHNSCC and mspHNSCC were collected. Cox proportional hazards models were constructed using age and variables significant in univariate analysis to assess the impact of SIRI on overall survival (OS) and cancer-specific survival (CSS). Additionally, a SIRI-based nomogram was developed and validated.

Results: Statistically significant declines in baseline leukocyte counts were observed in mspHNSCC compared to fpHNSCC (p < 0.001). Among the inflammatory markers, the preoperative SIRI was the most predictive of survival outcomes for mspHNSCC. Higher SIRI values were significantly associated with poorer outcomes in both OS and CSS. The optimal SIRI cutoff for survival prediction was 1.383, as determined by receiver operating characteristic curve analysis with Youden's index; patients with SIRI ≥ 1.383 had significantly lower 5-year OS (32.9% vs 60.1%, p = 0.001) and CSS (64.7% vs 83.9%, p = 0.003). Multivariate analysis revealed lymphovascular invasion, extranodal extension, and high SIRI as independent adverse risk factors for CSS. The SIRI-based nomogram accurately predicted CSS, with a concordance index of 0.773.

Conclusion: Data from preoperative SIRI assessment, coupled with the presence of pathological adverse features, serve as valuable references for risk stratification in patients with previously irradiated mspHNSCC.

Hepatocellular carcinoma (HCC) ranks as the third leading cause of cancer-related death worldwide, and its complex tumor microenvironment (TME) presents significant challenges for the treatment of this disease. In recent years, tumor immunotherapy has emerged as one of the most successful strategies in cancer treatment, especially for advanced HCC. Programmed cell death protein-1 (PD-1) inhibitors have moderate efficacy as monotherapies for HCC. Tumor angiogenesis, a crucial factor in tumor growth and proliferation, plays a pivotal role in the immune regulation of HCC. The vascular and immune microenvironments of solid tumors engage in dynamic reciprocal crosstalk, forming a complex vascular-immune axis that critically shapes antitumor immune responses and drives therapy resistance. The high degree of angiogenesis observed in HCC leads to abnormal vascular structure and function, which not only promotes tumor growth but also induces hypoxia and acidosis within the TME, thereby suppressing the immune response through various mechanisms. Given the regulatory role of tumor blood vessels in the immune system, the integration of antiangiogenic therapy into current immunotherapy approaches provides a novel treatment option. This integration involves the inhibition of tumor angiogenesis, improvements in the TME, and enhancements of the immune response, among other mechanisms. This review summarizes the angiogenic mechanisms of HCC, the clinical applications of immunotherapy and the regulatory effects of angiogenesis on the immune response in HCC.