Cancer Management and Research最新文献

Background & objective: Postoperative metastasis is the predominant cause of poor long-term survival in gastric cancer (GC), where the systemic inflammatory response plays a pivotal role. Most existing predictive models are derived from general populations, and their applicability to specific ethnic and high-risk cohorts, such as the multi-ethnic population in Western China, remains unverified. This study aimed to develop a preoperative predictive model for postoperative metastasis specifically for this population by investigating the predictive value of novel preoperative inflammatory and metabolic markers: the Systemic Immune-Inflammation Index (SII), Uric Acid-to-Albumin Ratio (UAR), and Urea-to-Hemoglobin Ratio (UHR).

Methods: Clinicopathological data from 656 GC patients who underwent surgery at Xinjiang Cancer Hospital between January 2018 and December 2023 were retrospectively collected. Based on the occurrence of postoperative metastasis, a 1:1 propensity score matching (matching factors: age, gender, BMI) was performed, resulting in 328 matched pairs (metastasis group vs non-metastasis group). Multivariable logistic regression analysis was used to identify independent predictors of postoperative metastasis, and a nomogram prediction model was constructed. The model's discrimination, calibration, and stability were internally validated using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test, and the Bootstrap method (1000 replicates).

Results: Multivariable analysis identified SII (Q3 vs Q1: OR=1.80, P=0.009; Q4 vs Q1: OR=1.64, P=0.040), UHR (Q2 vs Q1: OR=1.84, P=0.025), T stage (T2 vs T1: OR=3.32, P<0.001), and N stage (N2 vs N1: OR=1.73, P=0.004) as independent risk factors for postoperative metastasis. Conversely, UAR (Q2 vs Q1: OR=0.44, P=0.015) was identified as a protective factor. The nomogram prediction model demonstrated a training set AUC of 0.684 and a bootstrap-corrected AUC of 0.669 upon internal validation. The model showed good calibration (Hosmer-Lemeshow test P=0.142). At the optimal cutoff value (0.417), the model's sensitivity was 88.1%, and the negative predictive value was 77.5%.

Conclusion: This study successfully developed and validated a predictive model for postoperative metastasis in gastric cancer that integrates preoperative inflammatory markers (SII, UAR, UHR) and clinicopathological features (T stage, N stage) for the unique multi-ethnic population of Western China. The model exhibits good calibration and moderate discrimination, is particularly effective at identifying patients with low metastatic risk (high sensitivity), and serves as a useful auxiliary tool for individualized preoperative risk assessment and clinical decision support in this region.

Objective: We aimed to investigate the prognostic power of Platelet-to-Lymphocyte Ratio (PLR) and Ki-67 index in predicting progression-free survival (PFS) in patients with metastatic HR+/HER2- breast cancer treated with CDK4/6 inhibitors.

Materials and methods: In this retrospective study, 121 patients who received CDK4/6 inhibitors (palbociclib, ribociclib) at the Department of Medical Oncology, Dokuz Eylul University, between January 2015 and January 2025, were analyzed. PLR was calculated using baseline complete blood count parameters. The optimal cut-off value of 168.37 was determined using ROC analysis, and patients were stratified into low and high PLR groups. Survival analyses were performed using the Kaplan-Meier method and Cox regression.

Results: A lower progression rate was observed in the high PLR group (p=0.01), although PLR was not identified as an independent prognostic factor for PFS in multivariate analysis. Patients with lung metastases showed a higher proportion of low PLR (p=0.04).Although PLR was associated with PFS in univariate analysis, it did not retain independent prognostic significance in multivariate analysis.Conversely, Ki-67 was significantly associated with shorter PFS in both univariate (p<0.001) and multivariate analyses (p=0.007).

Conclusion: While PLR did not independently predict survival outcomes, it may provide complementary information regarding metastatic distribution and disease behavior. Ki-67 remains a strong and independent prognostic marker for PFS in metastatic HR+/HER2- breast cancer. Our findings indicate that Ki-67 is the strongest and most consistent independent prognostic marker in this patient population.

Anaplastic lymphoma kinase (ALK) rearrangement represents a rare molecular subtype of lung squamous cell carcinoma (LSCC). Although ALK tyrosine kinase inhibitors (TKIs) are established as first-line therapy for advanced ALK-rearranged non-small cell lung cancer (NSCLC), their efficacy in LSCC appears inferior to that in adenocarcinoma. Furthermore, the clinical benefit of chemoimmunotherapy in this rare population remains poorly defined. Here, we report a case of ALK-rearranged LSCC exhibiting primary resistance to ALK-TKI therapy but achieving a remarkable and durable response to combined chemotherapy and immunotherapy, leading to long-term disease control. This case highlights the potential therapeutic benefit of chemoimmunotherapy in ALK-rearranged lung squamous cell carcinoma and suggests that it may represent a viable priority option worthy of exploration in advanced settings.

Persistent lymphatic drainage and the subsequent formation of lymphatic retention cysts are common complications following radical surgery for gynaecological malignancies. Clinically asymptomatic lymphocysts do not necessitate treatment, whereas symptomatic lymphocysts should be managed through interventional or surgical approaches. However, there is currently no definitive therapeutic method for symptomatic lymphocysts, presenting a persistent challenge in clinical management. Polidocanol sclerotherapy has been utilized in the treatment of various conditions, yet there is a paucity of literature regarding its application in cases of persistent lymphatic drainage. In this study, we present a case involving lymphatic drainage persisting for one month following radical surgery of endometrial cancer. Initially, ultrasound-guided percutaneous tube drainage was employed, but the volume of drainage fluid remained substantial. For the first time, we attempted injection of polidocanol into the cavity of the lymphatic retention cyst. Fortunately, the cyst exhibited significant reduction in size and did not recur subsequently. Our findings suggest a novel therapeutic strategy for the management of symptomatic lymphocysts, and it appears to be a safe and effective approach.

Background: Patients with muscle-invasive bladder cancer (MIBC) frequently face delays before radical cystectomy (RC). Prolonged preoperative intervals may permit tumor progression and adversely affect outcomes. This study evaluated the association between preoperative wait time and prognosis in patients with MIBC.

Methods: In this retrospective cohort study, we analyzed 83 patients who underwent upfront radical cystectomy between 2017 and 2024. Patients were stratified by preoperative wait time into short-wait (≤14 days) and long-wait (>14 days) cohorts. The primary endpoint was cancer-specific survival (CSS); overall survival (OS) was analyzed as a key secondary endpoint. Clinicopathologic variables were compared between groups, and survival was assessed using Kaplan-Meier methods with Log rank tests and multivariable Cox proportional hazards models.

Results: The median preoperative waiting time was 14 days. No significant differences in baseline characteristics were observed between the two groups. In multivariable analysis, shorter wait times were independently associated with improved CSS (HR = 0.40, 95% CI 0.21-0.76; p = 0.005) and OS (HR = 0.41, 95% CI 0.22-0.78; p = 0.007). Smoking (HR = 5.50, p < 0.001), larger tumor size (HR = 1.84, p < 0.001), and ECOG score ≥ 1 (HR = 2.83, p = 0.022) were independent predictors of poorer outcomes.

Conclusion: Shorter intervals between diagnosis and surgery were associated with improved survival in MIBC, with the benefit appearing most pronounced in patients with mild-to-intermediate disease severity. Timely surgery remains essential, while individualized scheduling should consider both disease extent and overall patient fitness.

Objective: Breast cancer remains one of the leading causes of cancer-related death among women, and its incidence in Xinjiang is significantly higher than the national average. However, the extent to which breast cancer diagnosis and treatment are standardized in this region remains unclear, particularly with respect to key clinical decision-making processes such as surgical approach, pathological confirmation, and systemic treatment selection. This study aimed to identify factors associated with standardized breast cancer care within the Xinjiang Production and Construction Corps (XPCC).

Methods: A total of 670 patients who received their first breast cancer diagnosis at 11 XPCC hospitals between January 1, 2021, and January 1, 2022, were retrospectively included. Clinical and pathological variables were collected. According to the Chinese Anti-Cancer Association Guidelines for Breast Cancer (2021 Edition) and the AJCC Cancer Staging Manual (8th Edition), patients were classified into standardized and non-standardized care groups. Univariate and multivariate logistic regression analyses were performed to identify independent factors associated with standardized diagnosis and treatment.

Results: The median age at diagnosis was 53.27 years. The rate of standardized diagnosis was 76.12%. Multivariate analysis indicated that hospital location, ethnicity, and method of detection were independent predictors of standardized diagnosis (P < 0.05). Notably, low rates of preoperative core-needle biopsy and regional disparities in diagnostic capacity were observed. The rate of standardized treatment was 46.71%. Standardized diagnosis, hospital location, pathological type, and tumor stage were independently associated with standardized treatment (P < 0.05), with substantial variations in surgical modality selection, axillary management, neoadjuvant therapy use, and access to radiotherapy across hospitals.

Conclusion: The median age of breast cancer onset in the XPCC region is slightly younger than the national average. Significant disparities in standardized diagnosis and treatment exist between southern and northern Xinjiang, reflecting differences in healthcare infrastructure, availability of pathological testing, radiotherapy resources, and multidisciplinary decision-making capacity. Minority patients exhibited lower levels of disease awareness. These findings underscore the need to strengthen medical resources, optimize guideline-concordant clinical decision-making, and improve breast cancer management in this region.

Background: Growing research findings highlight the potential of inflammatory markers measured after surgery as prognostic indicators for survival outcomes in rectal carcinoma patients. However, their precise clinical significance remains inadequately explored within the specific population of locally advanced rectal carcinoma (LARC) patients receiving neoadjuvant chemoradiotherapy (NCRT), particularly regarding therapeutic response evaluation and long-term disease progression patterns.

Methods: This investigation enrolled 260 participants diagnosed with LARC who underwent NCRT from 2014 to 2024. The study measured postoperative neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) through ROC curve analysis to evaluate systemic inflammation. Participants were categorized into three cohorts based on inflammation-based postoperative biomarker score (IPBS): Score 0 (postoperative NLR <3.21 with MLR <0.345), Score 2 (NLR >3.21 and MLR >0.345), and Score 1 encompassing cases not meeting these thresholds. Survival outcomes were analyzed using Kaplan-Meier methodology stratified by inflammatory marker levels and IPBS classifications. Multivariate Cox regression models were employed to identify prognostic factors influencing OS and DFS.

Results: Initial univariate assessments revealed significant correlations between disease-free survival and several factors including ypTNM staging, histopathological evidence of vascular/lymphatic/perineural invasion, postoperative neutrophil-lymphocyte ratio, and the IPBS system. Subsequent multivariate modeling identified elevated ypTNM classification (HR=2.115, 95% CI:1.114-4.019, p=0.022) and increased IPBS (HR=1.798, 95% CI:1.049-3.083, p=0.033) as independent prognostic indicators for reduced DFS. Notably, postoperative NLR values failed to demonstrate statistical significance in multivariate evaluation (HR=1.588, 95% CI:0.910-2.772, p=0.104).

Conclusion: The composite inflammation-based postoperative biomarker score model demonstrated superior predictive accuracy for DFS outcomes in LARC patients undergoing NCRT compared to isolated biomarker analysis or select histopathological characteristics.

Purpose: Despite advances in breast cancer (BC) research, a significant research gap remains in understanding the interplay of ethnicity, Human Epidermal Growth Factor Receptor 2 (HER2) protein expression and age at BC diagnosis, particularly in underrepresented minority populations from Africa. We analyzed variations in HER2 protein expression and ethnic differences in age at BC diagnosis across indigenous Namibian and American women diagnosed with BC.

Methods: Using a mixed methods study, we analyzed case series cohort from 1,953 women all diagnosed with invasive BC, including 98 indigenous Namibian women and 1855 American women retrieved from the cBioPortal database. HER2 positivity rate was obtained by staining breast tissue biopsies and quantifying HER2 protein expression, with this study accessing the data retrospectively. We stratified participants by ethnicity and compared age at BC diagnosis and HER2 status to elucidate disparities. Chi-square test for proportions, t-test for independence and the cumulative probability analysis curves were used for statistical analysis. A p-value of <0.05 was considered significant.

Results: Indigenous Namibian women were diagnosed with BC significantly with a younger age compared to American women (White, p<0.0001, and African American p=0.0035). In a logistic regression analysis, African American women with BC had significantly lower odds of HER2-positive status compared to White women (OR = 0.52, p < 0.001). The cumulative probability analysis further delineated the probabilities for age at BC diagnosis according to ethnic disparities with indigenous Namibian, Asian, and African American women showing significant higher probabilities for younger ages at BC diagnosis compared to White women (p<0.0001, p=0.0035, and p=0.0057, respectively).

Conclusion: Ethnic disparities and the variations in HER2 protein expression and age at BC diagnosis between indigenous Namibian and American women diagnosed with BC necessitate tailored population genetics and geographical differences in BC screening approach to address global BC screening equity.

Ferroptosis, an emerging type of regulated cell death, continues to attract significant focus over recent years, especially within the areas of cancer therapy and acute kidney injury (AKI) research. In therapies that use platinum-based drugs, particularly cisplatin (Cisplatin), ferroptosis exhibits complex, dual role. In a certain context, ferroptosis enhances clinical effects in platinum-based chemotherapy through promoting tumor cell death, while in a different context, it induces excessive damage to kidney cells, potentially leading to onset as well as worsening of AKI. Consequently, gaining a more comprehensive grasp regarding ferroptosis in this context of platinum-based chemotherapy treatment proves essential, as it could improve the efficacy of cancer therapies while also reducing kidney damage. This knowledge forms the theoretical foundation for developing novel treatment strategies, which can enable precision therapies, reduce side effects, as well as eventually enhance well-being in individuals. This narrative review systematically outlines the role and mechanisms of ferroptosis in the anticancer effects of cisplatin and cisplatin-induced acute kidney injury, and discusses targeting ferroptosis as an important strategy for balancing cancer therapy and preventing kidney damage.

Background: Endometrial cancer (EC) is a common malignant tumor in the female reproductive system. Identifying patients with a high risk of recurrence is beneficial for formulating personalized follow-up and treatment plans. This study aims to develop a prediction model for evaluating the risk of recurrence of EC after treatment.

Methods: This study conducted a retrospective analysis on 486 patients with EC and randomly divided them into a training group (n = 389) and a validation group (n = 97). A nomogram was constructed after identifying predictors. The concordance index (C-index), receiver operating characteristic (ROC) curve, calibration plots, net reclassification index (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA) and Kaplan-Meier curves were used to evaluate the predictive model for EC recurrence.

Results: A predictive nomogram was constructed based on the six selected predictors. The ROC curve (area under the curve = 0.890) and calibration curve indicate that the model has high discrimination and calibration capabilities. The NRI in the training set was 0.321 (95% CI: 0.031-0.438), and the IDI was 0.133 (95% CI: 0.052-0.215), indicating a significant improvement compared to the ESGO-ESTRO-ESP pattern. The DCA curves indicated that this model exhibited excellent discriminative performance and clinical application value.

Conclusion: A nomogram based on pathological factors and immunohistochemical indicators was constructed and validated for predicting the recurrence of EC. Its predictive performance was superior to the ESGO-ESTRO-ESP pattern, and it can be used as a prognostic tool for clinical risk stratification.