Cancer Management and Research最新文献

Background: The incidence of early-onset colorectal cancer (EOCRC), defined as diagnosis at age ≤50 years, is rising globally. Despite younger age and presumed clinical fitness, EOCRC often presents at advanced stages and displays distinct biologic and treatment profiles.

Methods: We conducted a retrospective cohort study of patients aged ≤50 years with histologically confirmed colorectal adenocarcinoma treated at a tertiary cancer center in Saudi Arabia from 2015 to 2021. Clinical, pathologic, molecular, and treatment data were extracted. Survival outcomes were analyzed using Kaplan-Meier methods, and prognostic factors were assessed via Cox regression models.

Results: Among 97 patients (mean age 43 ± 5 years; 56% male), 34% presented with metastatic disease and 75% had left-sided or rectal tumors. Obesity was prevalent in 24% of cases. Surgical resection was performed in 79% of patients, of whom 47% received adjuvant chemotherapy. First-line systemic therapy was administered in 39%, but attrition limited progression to subsequent lines. Median overall survival (OS) was 20 months (interquartile range [IQR], 11-30). Progression-free survival (PFS) declined from 8 months in first-line to 4 months in third-line therapy. On multivariable analysis, obesity was independently associated with worse OS (hazard ratio [HR] 6.63, p = 0.035).

Conclusion: Despite favorable performance status, EOCRC frequently presents with advanced disease and limited systemic therapy durability. Obesity emerged as an independent adverse prognostic factor. These findings reinforce EOCRC as a biologically distinct entity, underscoring the need for tailored screening strategies, early intensification of therapy, and molecularly guided care.

Purpose: Cancer and immunosuppressive medications used for its treatment increase the risk for herpes zoster (HZ) among adults. This study described the incidence of HZ and its complications among United States (US) adults with specific solid tumors and hematological malignancies following initiation of immunosuppressive therapy.

Patients and methods: This retrospective cohort study used administrative claims data from October 2015 to December 2022 and included US adults with ≥1 immunosuppressive medication claim, ≥12 months continuous enrollment (baseline) prior to the first immunosuppressive medication claim, a cancer diagnosis, and no HZ diagnosis or vaccination in the baseline period. HZ incidence rates (IRs) were calculated as the number of new HZ cases per 1000 person-years at risk, stratified by cancer type and medication class. The proportions of patients with HZ-related complications such as postherpetic neuralgia, herpes zoster ophthalmicus, disseminated HZ, and HZ-related meningoencephalitis were described. A time-dependent Cox proportional hazards regression estimated adjusted hazard ratios, controlling for patient age, sex, race and ethnicity, comorbidities, prior healthcare utilization, insurance type, region, and baseline immunosuppressive medication use.

Results: The overall IRs of new HZ cases in patients with a solid tumor or a hematological malignancy were 20.9 (95% confidence interval [CI]: 20.33‒21.52) and 31.1 (95% CI: 29.64‒32.52) per 1,000 person-years, respectively. HZ IR was highest in patients with non-Hodgkin lymphoma (35.4, 95% CI: 33.05‒37.77) or chronic lymphocytic leukemia (35.1, 95% CI: 31.24‒39.24). By medication class, the highest HZ IRs were associated with mycophenolic acid, azathioprine, and oral glucocorticoids. In adjusted analyses, patients were more likely to develop HZ during periods of immunosuppressive medication use versus periods without (adjusted hazards ratio [95% CI]: 3.2 [3.01‒3.39] for solid tumor, 3.2 [2.89‒3.57] for hematological malignancy).

Conclusion: HZ incidence among US adults with solid tumors and hematological malignancies following immunosuppressive therapy initiation was high, reinforcing the need to prioritize HZ vaccination in these populations.

SLC7A11 (xCT) is a key subunit of the cysteine/glutamate transporter (system xc ^-), which is crucial for maintaining cellular redox homeostasis (especially glutathione synthesis) and regulating Ferroptosis. It is highly expressed in various malignant tumors and is a key factor leading to treatment resistance, making it an important anti-cancer target. This review systematically summarizes the complex multi-level regulatory network of SLC7A11: at the transcriptional level, key factors form precise regulatory hubs: the KEAP1/NRF2 pathway directly activates SLC7A11 transcription, endowing cancer cells with antioxidant and anti ferroptotic abilities; P53 acts as a core inhibitory factor, and its activity state (activated by STEAP3 iron overload or regulated by Gankyrin/DM2 degradation) directly determines the intensity of inhibition of SLC7A11; ATF4 integrates endoplasmic reticulum stress, oxidative damage, and epigenetic signals (such as SIRT3/KDM3B/KDM4A), and bidirectionally regulates SLC7A11 transcription. Epigenetic regulation involves RNA m6A modification (ALKBH5/FTO reduces stability, METTL3/IGF2BP3 enhances stability) and histone modification (BAP1/PRC1 inhibits through H2Aub). After translation, the stability of SLC7A11 protein is strictly regulated by ubiquitination (SOCS2/HECTD3 promotes degradation, OTUB1/TCF12 inhibits degradation) and palmitoylation (ZDHHC8/DUXAP8 antagonizes degradation). Of particular importance is that non coding RNAs indirectly release their inhibition of SLC7A11 mRNA by acting as "molecular sponges" to adsorb specific miRNAs, profoundly affecting tumor progression and resistance to ferroptosis. This study reveals how cancer cells abnormally upregulate SLC7A11 by hijacking multi-level mechanisms, gaining strong antioxidant/anti ferroptotic abilities, which are the core basis for their survival, proliferation, and resistance to treatment. This study also identified SLC7A11 as a convergence point for multiple key pathways, making it an ideal hub target for intervening in cancer and overcoming drug resistance.

Background: Rising cancer incidence in reproductive-aged individuals, coupled with improved long-term survival, indicates an increasing need for fertility preservation (FP) in this population. However, limited evidence exists on the decision-making of FP from the perspectives of cancer patients in a Chinese context. This qualitative study aimed to examine the patient perceptions of the FP decision and to identify barriers and unmet needs, addressing a significant gap within evolving precision oncology and fertility care contexts.

Methods: Face-to-face, semi-structured interviews were conducted with 12 cancer patients from a tertiary hospital in Hunan Province, China, from March 2024 to June 2024. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Colaizzi's seven-step analysis.

Results: Three themes and nine subthemes were identified: insufficient information support (lack of information sources, inappropriate timing of information disclosure, and poor doctor-patient communication); personal and family concerns (impact on cancer treatment, impact on offspring health, marital and reproductive status, financial constraints); ethical dilemmas (conflicts with survival needs, and emotional challenges).

Conclusion: Young cancer patients predominantly aspire to preserve fertility but face multiple decision-making challenges. To address these challenges, healthcare professionals should fully understand the patients' needs, provide accurate and timely information tailored to their needs, and enhance communication skills to facilitate informed decision-making regarding FP, with important implications for clinical practice and public health.

Introduction: The majority of head and neck squamous cell carcinomas (HNSCC) are diagnosed at an advanced stage, often necessitating standard treatments such as surgery or concurrent chemoradiotherapy.

Methods: This was a real-world study conducted between January 2021 and October 2024. The study enrolled 42 previously untreated patients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Patients received induction chemotherapy (IC) with or without immunotherapy followed by radiotherapy at our hospital.

Results: The group receiving immunotherapy with IC (I+IC, N=26) demonstrated an 82.6% objective response rate (ORR) and a 92.3% disease control rate (DCR). In contrast, patients treated with IC (N=16) alone exhibited an ORR of 37.5% and a DCR of 93.8%. With a median follow-up of 28.9 months, the I+IC group showed a 100% 6-month progression-free survival (PFS) and an 88.5% 12-month PFS, with a 92.3% overall survival (OS) rate at 12 months.

Discussion: This real-world study suggests that the addition of immunotherapy to IC holds promise for improving treatment outcomes in locally advanced HNSCC. The findings underscore the need for further research involving a larger patient population to validate these preliminary results.

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.