Cancer Management and Research最新文献

Objective: This study aimed to develop and validate a prognostic nomogram integrating systemic immune-inflammatory index (SII) and key clinicopathological features for predicting 2-, 3-, and 5-year overall survival (OS, primary surgery to all-cause death) in patients with Endometrial Cancer (EC), subgrouped into Survivors or Non-survivors, so as to address the unmet need for low-cost, dynamic risk stratification tools in EC precision medicine.

Methods: A retrospective cohort of 341 patients with EC (per WHO 2020 criteria) from January 2015 to January 2023 was stratified randomly into training (60%, n=205) and validation (40%, n=136) sets (stratification factors: age). Independent prognostic factors were identified through LASSO and multivariate Cox regression analyses. A nomogram was constructed and evaluated using ROC curves, calibration plots, and decision curve analysis (DCA). Key indicators included pathological differentiation grade, lymphovascular space invasion (LVSI), and systemic immune-inflammatory index (SII).

Results: Four independent predictors were identified: age (HR = 1.039, 95% CI: 0.994-1.086, P = 0.002), pathological differentiation grade (HR = 0.384, 95% CI: 0.188-0.786, P = 0.001), LVSI (HR = 4.208, 95% CI: 1.523-11.625, P = 0.001), and SII (HR = 1.001, 95% CI: 1.001-1.002, P < 0.001). The nomogram demonstrated excellent discrimination, with AUCs of 0.881, 0.883, and 0.874 for 2-, 3-, and 5-year OS in the training cohort, and 0.870, 0.834, and 0.838 in the validation cohort.

Conclusion: This study successfully developed and validated a prognostic model for EC based on SII and pathological differentiation. The model significantly outperformed traditional clinical parameters and may serve as a valuable tool for early risk stratification and individualized management in clinical practice.

Purpose: To investigate independent risk factors and construct an internally validated risk prediction model for invasive pulmonary fungal infection (IPFI) in patients with lung cancer.

Patients and methods: Clinical data from 250 consecutive lung cancer inpatients admitted to Nanchong Central Hospital between February 2022 and March 2025 were retrospectively analyzed; 41 patients developed IPFI and 209 did not. Patients were randomly assigned to a training set (n=175) and a validation set (n=75) at a 7:3 ratio. Candidate predictors were screened by univariate logistic regression, reduced using least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation, and entered into multivariable logistic regression to construct a nomogram. Model performance was evaluated using bootstrap internal validation (1000 resamples), calibration curves and goodness-of-fit testing, receiver operating characteristic analysis, and decision curve analysis.

Results: Diabetes mellitus, invasive procedures, systemic glucocorticoid use, lower CD4+ T-cell count, and length of hospital stay >14 days were associated with IPFI and were retained as independent predictors in the final model. The model showed good discrimination, with an area under the curve of 0.876 (95% CI: 0.809-0.944) in the training set and 0.861 (95% CI: 0.750-0.973) in the validation set, and demonstrated clinical net benefit across threshold probability ranges of 0.03-0.90 (training) and 0.04-0.78 (validation).

Conclusion: This nomogram may support early risk stratification for IPFI among lung cancer inpatients, while confirmation in external, multi-center cohorts is needed before broader clinical application.

Background: Netrin-1 is a laminin-related glycoprotein involved in embryonic development and cancer progression. In breast cancer, increased Netrin-1 expression has been associated with lymph node positivity, metastatic disease, and treatment resistance. Given its potential role in tumor aggressiveness and response to therapy, we aimed to investigate the relationship between Netrin-1 expression and neoadjuvant treatment response in HER2-positive breast cancer.

Methods: A total of 90 patients were included in the study. Netrin-1 expression was evaluated immunohistochemically in formalin-fixed, paraffin-embedded tumor tissues retrieved from pathology archives. Netrin-1 expression was assessed using two scoring parameters: staining proportion and staining intensity. Patients were divided into two groups according to the netrin-1 staining intensity and strength. Clinicopathological features were compared statistically between groups.

Results: Pathological responses after neoadjuvant treatment were compared according to Netrin-1 staining proportion and intensity, and no statistically significant differences were observed. Miller-Payne Grades 4-5 were more frequent in the high staining proportion and intensity groups; however, these differences were not statistically significant (p = 0.69 and p = 0.38, respectively). Univariate logistic regression identified Ki-67, hormone receptor status, and tumor dimension as factors associated with pathological complete response. These variables remained independently associated with pCR in multivariate binary logistic regression analysis.

Conclusion: Netrin-1 expression was not associated with neoadjuvant treatment response in HER2-positive breast cancer. Nevertheless, considering its biological role and therapeutic relevance in multiple malignancies, further studies are warranted to clarify the predictive and therapeutic potential of Netrin-1.

Background: Immune checkpoint inhibitors (ICIs), particularly when combined with targeted therapies, have significantly improved outcomes in patients with advanced cancers; however, they are also associated with a broad spectrum of immune-related adverse events (irAEs). Among these, severe cutaneous adverse reactions (SCARs) such as Toxic Epidermal Necrolysis (TEN), though rare, pose considerable diagnostic and therapeutic challenges. This report details a case of TEN induced by the combination of pembrolizumab and regorafenib, with the aim of enhancing clinical awareness and management of this serious complication.

Case description: A 34-year-old woman diagnosed with hepatocellular carcinoma was treated with pembrolizumab every three weeks in combination with daily regorafenib. Approximately two months after initiating therapy, the patient developed generalized erythema, blistering, and subsequent epidermal detachment affecting >30% of her body surface area (BSA) with mucosal involvement, consistent with Toxic Epidermal Necrolysis (TEN). With a SCORTEN score of 4 indicating a high mortality risk, she was transferred to the Intensive Care Unit (ICU) due to the life-threatening nature of her condition. An initial misdiagnosis as a viral exanthem delayed appropriate management. The diagnosis was ultimately confirmed by clinical evaluation, drug causality assessment using ALDEN and Naranjo scales (Pembrolizumab: ALDEN 5, Naranjo 6; Regorafenib: ALDEN 5, Naranjo 5; both indicating "probable" causality for each drug), and exclusion of other potential causes. Treatment involved immediate discontinuation of both anticancer agents, high-dose intravenous methylprednisolone, intravenous immunoglobulin, and comprehensive supportive care. Marked clinical improvement was observed. Reintroduction of regorafenib as monotherapy did not result in recurrence, implicating pembrolizumab as the primary causative agent.

Conclusion: This case affirms that early recognition, a systematic protocol involving high-dose corticosteroids/intravenous immunoglobulin, and multidisciplinary collaboration are vital for managing life-threatening cutaneous irAEs, while also highlighting that robust pharmacovigilance and patient education are fundamental to the safe implementation of ICI-based combination therapies.

Cholangiocarcinoma (CCA) is a rare but aggressive malignancy with a rising global incidence and few therapeutic options for advanced disease. In recent decades, precision oncology for CCA has advanced rapidly, particularly through the development of targeted therapies for patients with actionable genetic alterations. These therapies have markedly prolonged survival and improved other clinical outcomes among patients with unresectable, advanced CCA. The implementation of precision oncology largely depends on detecting genetic mutations to guide patient selection and treatment, using tumor tissue biopsies or liquid biopsies, including circulating tumor DNA (ctDNA) from blood or bile. As a minimally invasive biomarker, ctDNA shows great promise for transforming the clinical management of CCA. This review provides a comprehensive overview of the roles of ctDNA in CCA, including early detection, prognostic stratification, minimal residual disease assessment, recurrence monitoring, therapeutic target identification, and treatment response evaluation. A synthesis of existing studies indicates that bile-derived ctDNA shows superior sensitivity compared with blood-based ctDNA in capturing the genetic profiles and heterogeneity of CCA. We also propose an integrative framework that illustrates how ctDNA profiling can inform diagnosis, treatment, and surveillance across the disease continuum. Because research on ctDNA in CCA remains in its infancy, we discuss current challenges and outline future directions for translating these findings into clinical practice. Collectively, the evidence positions ctDNA-particularly bile-derived ctDNA-as a dynamic tool for real-time genomic profiling, sensitive residual disease detection, and therapy monitoring. This integrative framework provides a roadmap for translating these capabilities into clinical practice, with the potential to enable earlier, more personalized interventions and improve outcomes for patients with CCA.

Patients undergoing treatment with immune checkpoint inhibitors (ICIs) for advanced lung cancer are at increased risk of viral reactivation and severe neuropathic pain. These complications exacerbate the overall symptom burden and psychological distress, underscoring the necessity for integrated nursing interventions aimed at enhancing both physical and psychological well-being. This constitutes a critical priority in contemporary clinical nursing research. We report a 63-year-old woman with stage IV lung adenocarcinoma (cT2aN2M1c, bone metastases) on sindilizumab and anlotinib, who developed severe cervical herpes zoster while carrying an implanted intrathecal drug delivery system (IDDS). She presented with explosive neuropathic pain (NRS 6-7), cancer pain (NRS 5-6), and severe anxiety (GAD-7 = 16). Guided by the Medication-Psychological-Nursing-Family-Support (MPNFS) framework, which underscores that nursing care should extend beyond routine medical management to incorporate integrated interventions, and in alignment with the integrative oncology guidelines from the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), we implemented a coordinated intervention. It encompassed antiviral therapy, multimodal analgesia, psychological support, family engagement, and structured WeChat follow-up. This led to lesion resolution, significant pain and anxiety reduction (NRS 2-3; GAD-7 = 8), and safe IDDS retention, enabling transition to community for sustained symptom control. This case achieved key outcomes: safe IDDS preservation, effective symptom management, and seamless care continuity. It demonstrates that the MPNFS-guided integrative nursing is a clinical framework for managing complex immunotherapy-related complications, highlighting its vital role in facilitating multidisciplinary coordination and supporting patients through high-risk care transitions.

Purpose: This study aims to explore the clinicopathological features related to extramedullary multiple myeloma (EMM) occurrence and evaluate prognosis differences between patients with primary EMM (PEMM) and those with relapsed or refractory EMM (R/REMM).

Patients and methods: The laboratory test results, clinical, histopathological and immunophenotypic characteristics, cytogenetic changes and prognosis of 203 patients with MM were obtained. The patients were categorized into EMM+ and EMM- groups. Patients in the EMM+ group were further categorized into the PEMM and R/REMM groups based on the time of EMM occurrence, for further comparison.

Results: The incidence of EMM was 24.6% (50/203). Further classification of EMM showed that the incidence of PEMM was 16.3% (33/203), that of R/REMM was 8.4% (17/203).The proportion of CD20+ was significantly lower than that in the EMM- group (2.0% vs 15.0%, P =0.013).In the EMM+ group,70% (35/50) of patients had elevated levels of β2-MG (≥ 5.5 mmol/L), and 24% (12/50) had elevated levels of serum calcium (> 2.65 mmol/L), higher than that in the EMM- group (41.2% and 12.4%, respectively), and the differences were statistically significant (P < 0.001 and P = 0.049, respectively).Patients with R/REMM were more likely to have plasma cell leukemia and lower albumin levels than those with PEMM (P = 0.021 and 0.014, respectively). The median OS of patients in the EMM- group was longer than that of patients in the EMM+ group (59.6 vs 47.0 months, P=0.197).The median OS of patients in the PEMM group was longer than that of patients in the R/REMM group and the difference was statistically significant (53.3 vs 30.5 months,P= 0.015). Univariate and multivariate survival analyses revealed that R/REMM is an independent adverse prognostic factor (P = 0.003 and P < 0.001 respectively),and PEMM was not associated with OS in patients with MM (P = 0.503 and P = 0.545, respectively).

Conclusion: R/REMM is an independent adverse prognostic factor for patients with MM. Patients with R/REMM are more likely to have plasma cell leukemia and lower albumin levels.

Purpose: Although emerging therapies for multiple myeloma (MM) have improved treatment options, long-term disease control in relapsed/refractory (r/r) MM remains a challenge. While the effect of natural killer cell alloreactivity in haploidentical allogeneic hematopoietic cell transplantation (HCT) with post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GvHD) prophylaxis is considered a standard treatment option for several hematologic neoplasms, its use in MM is controversial. In this retrospective analysis, we evaluated a small cohort of consecutive patients with MM who underwent haploidentical allogeneic HCT with PTCy.

Patients and methods: With a median follow-up of 68 months (range, 2-109 months), seven consecutive patients with r/r MM underwent haploidentical HCT. All were heavily pre-treated, having received proteasome inhibitors, anti-CD38 antibody, immunomodulatory drugs, and at least one autologous HCT. Three patients received a chemotherapy-based reduced-intensity conditioning regimen combined with radioimmunotherapy. GvHD prophylaxis in all patients consisted of PTCy in combination with tacrolimus and mycophenolate mofetil.

Results: All patients showed stable engraftment with complete donor chimerism. Haploidentical HCT resulted in initial response in all patients, with four patients achieving a complete remission (CR) and three a very good remission (VGPR) at first disease assessment post- HCT. All individuals surviving beyond day +100 experienced disease relapse or progression. Among the six surviving patients median time to relapse was 26.5 months (range, 5-81 months). At last follow-up, four of five surviving patients maintained a CR, while one patient remained in a very good partial remission, all following subsequent individualized therapies. Acute GvHD grades III-IV were observed in two patients, while four developed mild-to-moderate chronic GvHD, with no GvHD-related deaths at the last follow-up.

Conclusion: In this small, selected cohort, haploidentical allogeneic HCT with individualized pre-treatment and conditioning regimens was associated with disease control in heavily pretreated patients with r/r MM.

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity, accounting for the majority of oral cancers, and early detection is crucial for improving patient survival rates and prognosis. Traditional diagnostic methods have limitations, including invasiveness and diagnostic delays, and are insufficient for early detection and distinguishing between similar diseases. In recent years, with the rapid advancement of molecular biology and biotechnology, a variety of emerging non-invasive diagnostic approaches have provided new strategies for early screening and precise diagnosis of OSCC. This review summarizes the cutting-edge technologies in OSCC diagnosis in recent years, including biomarker-based detection (such as microRNA, circRNA, gene methylation, and salivary proteomics), oral microbiome analysis, optical imaging technologies combined with artificial intelligence, and more. These emerging methods not only offer non-invasive or minimally invasive advantages but also enable the detection of potential molecular changes in the early stages of the disease, allowing for early intervention. Despite the challenges in standardization, sensitivity, and specificity optimization that these new technologies face in clinical applications, they undoubtedly offer vast prospects for early detection and personalized treatment of OSCC. This review aims to achieve the following objectives: First, to systematically evaluate the latest research evidence on various emerging non-invasive diagnostic technologies; second, to comprehensively compare their advantages and limitations relative to traditional methods; and finally, to attempt constructing a clinical translation assessment framework for early-stage multimodal diagnostic technologies in OSCC, thereby guiding future translational strategies.

Purpose: The urinary microbiome may influence the development of radiation-induced complications in prostate cancer. However, its dynamics during and after radiotherapy (RT) remain unclear. This study aimed to use matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to characterize and monitor urinary microbiome changes during RT for prostate cancer.

Patients and methods: Eighty-eight patients with prostate cancer who underwent RT were included. Midstream urine and blood samples were collected at six time points: before gold fiducial implantation (t1), at the start (t2) and end of RT (t3), and at 1, 4, and 7 months post-RT (t4-t6). Microorganisms were cultured under diverse conditions and identified by MALDI-TOF MS. Statistical analyses were used to assess the associations between microbial profiles, RT stages, and biochemical parameters in the urine and blood.

Results: A total of 1773 microbial isolates were identified in 89% of urine samples, with 79% showing a polymicrobial composition. The microbiota was dominated by Staphylococcus (51.6%), Micrococcus, Enterococcus, Kocuria, and Corynebacterium. Biodiversity decreased at the end of RT but gradually recovered up to seven months post-treatment. Genera such as Actinomyces, Corynebacterium, Staphylococcus, and Streptococcus were significantly correlated with study time course, whereas the abundance of Kocuria rhizophila increased over time. Changes in microbiome composition were strongly associated with glucose levels in urine and blood.

Conclusion: RT triggers a dynamic response in the urinary microbiome, with an initial decline in diversity followed by progressive recolonization. Glucose levels in urine and blood significantly affect microbial composition, suggesting that metabolic factors modulate RT-related microbiome shifts. These findings highlight the interplay between RT, host metabolism, and urinary microbiota, supporting the potential value of glucose monitoring to maintain microbial balance after RT.