Cancer Management and Research最新文献

Background and purpose: Brain metastases from cervical cancer are exceedingly rare, with an incidence of 0.4% to 2.3%. Poorly differentiated histologic subtypes, particularly those with lymphovascular space invasion (LVSI) and parametrial involvement, may have a higher propensity for hematogenous spread. Current surveillance protocols do not routinely include brain imaging, potentially leading to delayed diagnosis in patients with early metastases. This case highlights an aggressive presentation of poorly differentiated squamous cell carcinoma (SCC) of the cervix with rapid brain metastases post-treatment, emphasizing the need for revised follow-up and therapeutic strategies.

Case presentation: A 46-year-old woman presented with postcoital bleeding and was diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIA1 poorly differentiated non-keratinizing SCC of the cervix. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy, followed by adjuvant chemoradiotherapy. Despite initial disease control, she developed progressive neurological symptoms five months post-treatment. Brain imaging revealed multiple intracranial metastases, confirmed histologically as metastatic SCC. She un-derwent craniotomy and tumor resection, followed by palliative care due to extensive systemic involvement, including lung metastases.

Conclusion: This case highlights the limitations of current surveillance and treatment paradigms in high-risk cervical cancer patients. Earlier imaging and innovative systemic therapies with improved blood-brain barrier penetration may enhance patient outcomes. Future research should focus on refining post-treatment follow-up protocols and integrating novel therapeutic ap-proaches for metastatic cervical cancer.

Purpose: This study aims to assess the knowledge, attitudes, and practices (KAP) of liver cancer patients and their family members regarding hepatitis B and liver cancer in hospitals in central and western China.

Patients and methods: A multicenter cross-sectional survey was conducted on liver cancer patients and their families between February 2023 and August 2024. Data were collected using a validated, self-developed questionnaire.

Results: A total of 810 valid questionnaires were analyzed, with 432 (53.33%) respondents being family members. The mean scores for knowledge, attitude, and practice were 7.19 ± 3.68, 43.71 ± 4.30, and 39.93 ± 6.06, respectively. Multivariate logistic regression identified education (OR = 3.009 for high school/technical school; OR = 6.771 for associate degree or above), hepatitis B diagnosis (OR = 1.530), and duration of liver cancer diagnosis (OR=1.690) as significant predictors of knowledge scores. Positive attitudes were linked to higher knowledge scores (OR=1.212), high school/technical school education (OR=1.831), and a monthly per capita income of 10,000-20,000 Yuan (OR=2.964). For practices, predictors included higher knowledge scores (OR=1.067), higher attitude scores (OR=1.241), non-disclosure of income (OR=3.311), current alcohol consumption (OR=0.303), and diabetes (OR=2.175).

Conclusion: Liver cancer patients and their family members demonstrated inadequate knowledge but relatively positive attitudes and proactive practices regarding hepatitis B and liver cancer in hospitals in central and western China. This knowledge-practice gap may reflect cultural norms, family support, or public health campaigns, yet improving knowledge remains essential to sustain positive behaviors. Targeted educational interventions should therefore be integrated into clinical and community care. In particular, future interventions should be tailored to address urban-rural disparities and to actively involve family members in supporting patients. These findings provide practical implications for enhancing health literacy, guiding policymaking, and improving counseling strategies to strengthen disease management and prevention.

Purpose: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy with limited evidence guiding systemic treatment in the advanced stages. This study evaluated the effectiveness of palliative chemotherapy and revealed the prognostic factors associated with survival in patients with metastatic or unresectable SBA.

Patients and methods: We conducted a retrospective cohort study of patients diagnosed with advanced SBA at a single tertiary center in Thailand between 2005 and 2024. The patients were treated with palliative systemic chemotherapy or best supportive care (BSC). Survival outcomes were assessed using Kaplan-Meier estimates and Cox regression analyses. Propensity score-matching (PSM) was performed to adjust for baseline imbalances.

Results: This study included 106 patients; of these, 39 (36.8%) received palliative chemotherapy. After 1:1 PSM, 39 matched pairs were analyzed. Chemotherapy significantly improved overall survival (OS) compared with that of the BSC, with a median OS of 10.4 vs 2.6 months (hazard ratio 0.36; 95% confidence intervals 0.22-0.59; P <0.001). Among chemotherapy-treated patients, the median progression-free survival was 5.95 months, and the objective response rate was 10.3% overall, increasing to 21.1% among evaluable patients receiving doublet regimens. Multivariate analysis revealed that poor Eastern Cooperative Oncology Group performance status (≥2), poorly differentiated histology, and duodenal tumor location independently predicted worse OS.

Conclusion: Palliative chemotherapy significantly prolongs survival in patients with advanced SBA compared with that of BSC, particularly in those with a good performance status. Doublet fluoropyrimidine-based regimens offered superior outcomes. These findings support the use of systemic chemotherapy for this rare malignancy, highlighting the significance of patient selection and performance status in guiding treatment decisions.

Purpose: To compare surgical outcomes between conventional laparoscopic and robotic-assisted laparoscopic approaches in the treatment of endometrial cancer.

Patients and methods: This retrospective, two-center case-control study analyzed data from patients undergoing total laparoscopic hysterectomy and lymphadenectomy for endometrial cancer between January 2020 and January 2025. Primary outcomes included estimated blood loss, hemoglobin and hematocrit decrease, operative time, and complication rates.

Results: A total of 136 patients were included (66 conventional laparoscopy, 70 robotic-assisted laparoscopy). No significant differences were observed in baseline demographics, comorbidities, or cancer staging. Robotic-assisted surgery was associated with lower blood loss (100 vs 200 mL, p<0.001), reduced hemoglobin and hematocrit decrease (p<0.05), less frequent peritoneal drainage (28.6% vs 80%, p<0.001) and greater number of pelvic nodes on pathology with the median [IQR] of 4 [3-7] vs 2 [1-6], (p<0.001). However, robotic procedures had longer operative times (146 vs 120 min, p<0.001). Conversion rates (2.9% vs 7.6%, p=0.264) and intraoperative/postoperative complications were comparable between groups.

Conclusion: Robotic-assisted laparoscopic surgery for endometrial cancer is a safe and effective alternative to conventional laparoscopy, offering advantages in blood loss reduction while requiring longer operative times. Further prospective studies are needed to validate these findings and assess cost-effectiveness.

Background: Radiotherapy combined with immunotherapy shows increasing efficacy in treating metastatic malignancies; however, positive outcomes may be negatively impacted by lymphocytopenia. Previous studies suggest thymosin α1 (Tα1) may mitigate radiation-induced lymphocytopenia. This study retrospectively evaluated the effects of a Tα1 loading dose on peripheral blood lymphocyte counts and assessed the safety and efficacy of radiotherapy combined with of PD-1 inhibitors in patients with advanced or refractory cancers.

Methods: A total of 48 patients received a 7-day loading dose of Tα1 (1.6 or 3.2 mg, once daily) followed by hypofractionated radiotherapy and PD-1 inhibitors. Peripheral blood T cells, B cells, and natural killer cells were quantified by flow cytometry before and after Tα1 treatment. The primary endpoint was the change from baseline in lymphocyte subset counts. Secondary endpoints included adverse events, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS).

Results: The median follow-up was 13.7 months. Tα1 treatment for 7 days significantly increased the median counts of peripheral blood total T cells (422.5/μL to 614.0 /μL, P<0.001), CD4⁺ T cells (244.5/μL to 284.5/μL, P<0.001), and CD8⁺ T cells (159.0/μL to 222.5/μL, P<0.001). Among the 36 patients with evaluable data, the ORR was 19.4% and DCR was 69.4%. The median PFS and OS were 5.1 months and 9.6 months, respectively. Two patients (4.2%) experienced grade ≥3 treatment-related adverse events.

Conclusion: A 7-day loading dose of Tα1 elevated lymphocyte counts in advanced cancer patients and was accompanied by satisfactory safety and efficacy profiles. It should be noted that the median follow-up of 13.7 months may be insufficient to fully assess long-term survival outcomes and the potential for late-onset toxicities. As this was an exploratory analysis across multiple tumor types, these findings warrant validation in larger, randomized studies with more homogenous cohorts.

Background: This study evaluated whether the glucocorticoid receptor α/β (GRα/GRβ) mRNA expression ratio in peripheral blood mononuclear cells (PBMCs) can serve as a predictive biomarker for treatment response and survival in patients with non-squamous non-small cell lung cancer (NSCLC) receiving pemetrexed-based chemotherapy.

Methods: Thirty-five patients with confirmed non-squamous NSCLC were prospectively enrolled and received platinum-pemetrexed chemotherapy with standard dexamethasone premedication. Quantitative PCR was used to measure GRα and GRβ mRNA levels in PBMCs, and patients were categorized into high- and low-ratio groups based on the median GRα/GRβ value. Tumor response was assessed per RECIST 1.1 criteria, and progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression methods.

Results: Compared with the high-ratio group, patients in the low GRα/GRβ group had a higher response rate (82.4% vs 44.4%, p = 0.035), greater tumor shrinkage (55% vs 42%, p = 0.027), and more pronounced lymph node regression (p = 0.039). Median PFS was longer in the low-ratio group (5.5 vs 3.5 months; log-rank p = 0.031; adjusted HR = 0.72, 95% CI: 0.53-0.91), whereas the OS benefit seen in unadjusted analysis (14.0 vs 11.6 months; log-rank p = 0.042) was not significant after adjustment.

Conclusion: A lower GRα/GRβ ratio in PBMCs was suggestively associated with improved tumor response and PFS in this small, exploratory cohort. However, the limited sample size, lack of an independent validation cohort, reliance on PBMC-derived measurements, potential confounding factors, and absence of multiple comparisons adjustment warrant cautious interpretation. These results should be considered hypothesis-generating, and validation in larger, multicenter, and adequately powered studies-including paired PBMC-tumor analyses-is essential before clinical implementation.

Selective delivery of imaging agents to target cells remains a major challenge for molecular imaging and targeted therapy. Folate-based targeting leverages the differential expression of folate receptors (FRs), which are frequently overexpressed in various malignancies and in activated macrophages compared with most normal tissues, to mediate selective cellular uptake. Folate and folate-conjugates offer several advantages for targeted delivery: 1) restricted normal-tissue distribution of FRs, 2) high affinity binding to FRs, and 3) straightforward conjugation chemistry that enables linkage to both therapeutic and imaging moieties. In this narrative review, we summarize recent advances in FR-targeted imaging across multiple modalities (PET, SPECT, MRI, and optical imaging), discuss strategies for probe design and pharmacokinetic optimization, and highlight translational progress from preclinical studies to early clinical applications. We also review emerging applications of folate-mediated delivery for gene therapy and immune modulation, and we identify remaining challenges including probe specificity, background uptake, and clinical validation and outline directions for future research and clinical translation.

Background: Alpha-fetoprotein-positive gastric cancer (AFPGC) is a rare subtype of gastric cancer characterized by high invasiveness and extremely poor prognosis. According to relevant studies, the median overall survival of such patients is significantly shorter than that of AFP-negative gastric cancer patients (14 months vs 40 months). Small cell lung cancer (SCLC), the most malignant type of lung cancer, has a median survival time of only 8-12 months in patients with extensive disease. To date, there have been no reported cases of dual primary cancers involving both AFPGC and SCLC, and the therapeutic role of immunotherapy in such dual primary tumors remains unclear.

Case presentation: This paper reports a case of a 72-year-old male patient who was diagnosed via imaging and pathology as having concurrent AFPGC (moderately to poorly differentiated adenocarcinoma, PD-L1 positive, Tumor mutation burden(TMB) 10.03Muts/Mb, PD-L1 Combined Positive Score (CPS)<1) combined with primary extensive-stage SCLC. The patient received CAPEOX regimen (capecitabine plus oxaliplatin) combined with tislelizumab therapy. After 4 cycles, partial response (PR) was observed in the gastric lymph nodes, and stable disease (SD) was noted in the pulmonary lesions. Following pathological confirmation of dual primary cancers, treatment continued with the original regimen, followed by maintenance therapy with tegafur gimeracil oteracil potassium capsule (teysuno) plus tislelizumab. During treatment, serum AFP levels decreased from baseline 502 μg/L to 1.56 μg/L. Both primary tumor lesions remained stably controlled for over 33 months, and the patient currently tolerates treatment well with an Eastern Cooperative Oncology Group (ECOG) performance status of 0.

Conclusion: Through the long-term treatment course of this case, we validated the therapeutic efficacy of chemotherapy combined with immunotherapy (CAPEOX plus tislelizumab) for the rare aggressive dual primary tumors AFPGC and SCLC, demonstrating significant long-term maintenance benefits from the immunotherapy. Concurrently, this case confirmed the efficacy and safety of tislelizumab during the maintenance therapy phase for both tumors, offering a new treatment option for managing such complex clinical presentations.

Purpose: Gastric cancer (GC) is the fifth most common type of cancer worldwide. Despite the growing interest in Helicobacter pylori (H. pylori) infection, targeted diagnostic and prognostic markers are yet to be fully developed. The purpose of this study is to explore potential biomarkers for the diagnosis and prognosis of GC associated with H. pylori infection.

Patients and methods: The differentially expressed long non-coding RNAs (lncRNAs) in H. pylori-related GC were acquired from the Gene Expression Omnibus (GEO) and a literature review. Clinicopathological features, tumors, and adjacent non-tumor tissues were collected from 80 patients with GC. Expression of hypoxia-inducible factor 1alpha antisense RNA 2 (HIF1A-AS2) and long intergenic non-protein coding RNA 511 (LINC00511) was determined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). The relationship between HIF1A-AS2 or LINC00511 expression and the clinicopathological features of GC patients was evaluated. Receiver operating characteristic (ROC) curves were created to assess the diagnostic values of HIF1A-AS2 or LINC00511. The Kaplan-Meier method was employed to evaluate the prognostic value of HIF1A-AS2 or LINC00511.

Results: HIF1A-AS2 and LINC00511 were identified as key lncRNAs in H. pylori-related GC. High expression of HIF1A-AS2 and LINC00511 was associated with large tumor size, advanced tumor node metastasis (TNM) stage, high levels of serum tumor biomarkers, and the incidence of H. pylori infection and lymph node metastasis. HIF1A-AS2 or LINC00511 indicated high diagnostic values for GC, and their combination showed higher sensitivity and specificity. Increased expression of HIF1A-AS2 and LINC00511 is related to poor 5-year overall survival rates, indicating that HIF1A-AS2 and LINC00511 are prognostic factors for GC.

Conclusion: HIF1A-AS2 and LINC00511 are related to H. pylori-related GC and serve as potential biomarkers for the diagnosis and prognosis of GC.

Objective: The maintenance treatment with anlotinib can improve the efficacy in advanced non-small cell lung cancer (NSCLC) patients, but the appropriate patient population are still undefined. This study aimed to evaluate the efficacy and safety of adding anlotinib treatment in advanced NSCLC patients who achieved disease stabilization after two cycles of first-line chemotherapy combined with immunotherapy (CIO).

Materials and methods: We retrospectively reviewed clinical data of patients with advanced NSCLC who received anlotinib treatment after achieving stable disease (SD) following two cycles of first-line CIO in our hospital. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints included objective response rate (ORR), disease control rate (DCR), and Adverse Events (AEs).

Results: A total of 38 patients were included in this study. The median age was 65 years (range, 47-77), with 73.68% male and 26.32% female. The median PFS and OS were 6.5 months and 12.0 months, respectively. The ORR and DCR were 34.21% and 68.42%, respectively. Subgroup analysis results showed that patients who experienced hypertension, proteinuria, and hand-foot syndrome during treatment had better efficacy. Mechanistic analysis further suggested that this regimen may enhance the anti-tumor immunity by depleting Tregs, thereby exerting a synergistic effect. Importantly, the overall AEs of this regimen were manageable, supporting the suitability of this treatment modality.

Conclusion: Adaptive use of Anlotinib could be a safe and effective option in advanced NSCLC patients who achieved SD after two cycles of first-line CIO. This regimen is expected to become an important option for precision and personalized treatment of NSCLC. However, due to the limitations of retrospective nature, its clinical value needs to be further confirmed by prospective studies.