Cancer Management and Research最新文献

[This retracts the article DOI: 10.2147/CMAR.S162670.].

Purpose: Lymph node involvement is critical for colorectal cancer (CRC) staging and prognosis. The lymph node ratio (LNR), defined as the ratio of metastatic to total examined lymph nodes, has shown promise as a superior prognostic metric compared to traditional TNM staging and total lymph node yield (LNY). This study compared the prognostic value of LNR, N staging, and LNY and developed an LNR-based survival risk score (LNR-SRS_CRC). Secondary objectives included evaluating the impact of multidisciplinary team (MDT) care and molecular markers (KRAS, NRAS, BRAF) on survival.

Patients and methods: A population-based cohort of 2013 CRC cases (2013-2018) from the Reggio Emilia Cancer Registry was analyzed. Prognostic models, including T-LNR-M, TNM, and T-LNY-M, were compared using Harrell's C-index, Akaike Information Criterion (AIC), and net reclassification improvement (NRI). Patients were randomly assigned to training (1026) and validation (987) cohorts. Multivariable analysis identified significant predictors, and a survival risk score (SRS_CRC) was validated. The study also assessed the independent prognostic role of MDT care and molecular markers.

Results: The T-LNR-M model outperformed TNM (C-index 71% vs 70%; NRI 4.7%, P = 0.002) and T-LNY-M (C-index 71% vs 70%) with the lowest AIC (8356). Predictors of mortality included T4 stage, LNR, metastasis, and age >78.6 years. LNR-SRS_CRC stratified patients into low, intermediate, intermediate-high, and high-risk groups with distinct survival probabilities. Validation confirmed its prognostic accuracy (C-index 71.4%). MDT care was associated with significantly improved survival (HR = 1.63; P = 0.047), while molecular markers (KRAS, NRAS, BRAF) were not significant.

Conclusion: LNR provides superior prognostic value compared to N staging or LNY. The LNR-SRS_CRC enhances risk stratification and, together with MDT care, may enhance personalized CRC management. Prospective validation is warranted.

Purpose: Cancer-related malnutrition (CRM) is characterized by nutrition impact symptoms (NIS), prominently reduced intake, and irreversible systemic inflammation (SI). This study aimed to use NIS as a phenotype to explore the etiological mechanisms of CRM and facilitate a more precise classification approach for CRM patients by symptomatic clusters.

Patients and methods: 147 CRM patients were included in this study. Exploratory factor analysis (EFA) was used to identify the NIS clusters, analyze their regression factor score (RFS), and explore potential patient groups. Spearman correlation, Kruskal-Wallis tests, and regression analysis were used to analyze the correlation and interaction between RFS and nutrition, SI, and intake status.

Results: EFA identified 4 factors: RFS-1 was significantly correlated with mid-arm circumference (MAC) (r = -0.28, p = 0.001), calf circumference (r = -0.32, CC) (p < 0.001), hand grip strength (r = -0.24, p = 0.004), hemoglobin (r = -0.19, p= 0.023), albumin (r = -0.18, ALB) (p = 0.026), pre-albumin (PAB) (r = -0.26, p = 0.002), C-reactive protein (CRP) (r = 0.33, p < 0.001), neutrophil-to-lymphocyte ratio (NLR) (r = 0.32, p < 0.001), and systemic immune-inflammation index (SII) (r = 0.28, p = 0.001). RFS-2 was also significantly correlated with MAC (r = -0.21, p =0.010), CC (r = -0.19, p = 0.030), ALB (r = -0.23, p = 0.010), and PAB (r = -0.21, p = 0.010). Two-step cluster analysis identified 3 patient groups: Group 1 and Group 2 had higher MAC than Group 3 (p = 0.001) and had higher CC than Group 3 (p = 0.029). Group 1 and Group 2 had lower CRP than Group 3 (p = 0.007), presented lower NLR than Group 3 (p = 0.004), and had lower SII than Group 3 (p = 0.014). Group 2 (p < 0.001) had a lower risk of developing anorexia than Group 3, and Group 2 (p = 0.010) had a lower risk of decreasing intake.

Conclusion: This exploratory study identified 4 NIS clusters, 2 significantly related to SI and intake status. Based on CAM etiological mechanisms, 3 potential patient groups were explored, which established a robust phenotypic framework for subsequent large-scale investigations, addressing a critical gap in CRM research and providing a standardized phenotypic tool for future multi-center analyses. These efforts will contribute significantly to enhancing the prevention, treatment, and clinical management of CRM.

[This corrects the article DOI: 10.2147/CMAR.S307424.].

Non-small cell lung cancer (NSCLC) harboring activating mutations in the Epidermal Growth Factor Receptor (EGFR) has been effectively treated with EGFR tyrosine kinase inhibitors (TKIs). However, the clinical efficacy of these targeted therapies is invariably limited by the development of acquired resistance. While secondary mutations like T790M and bypass pathway activation are well-documented mechanisms, there is a growing appreciation for the profound role of epigenetic regulators, particularly microRNAs (miRNAs), in orchestrating the resistant phenotype. This review provides a comprehensive and detailed analysis of the multifaceted roles of miRNAs in the emergence and maintenance of EGFR-TKI resistance in NSCLC, including their regulation of alternative receptor tyrosine kinase signaling pathways, driving phenotypic plasticity, specifically the epithelial-mesenchymal transition (EMT) and the acquisition of cancer stem cell (CSC) characteristics, as well as dysregulating core cellular processes, such as apoptosis. We further examine the complex interplay within competing endogenous RNA (ceRNA) networks, where long non-coding RNAs and circular RNAs sequester miRNAs, thereby modulating the expression of resistance-associated genes. Finally, the potential of specific miRNAs as circulating biomarkers for monitoring treatment response and as therapeutic targets to overcome resistance is discussed. This review underscores the central role of miRNA-mediated gene regulation as a critical layer of complexity in EGFR-TKI resistance, highlighting a sophisticated network that governs the fate of cancer cells under therapeutic pressure.

Background: Breast cancer has the highest incidence among women. Exercise interventions are increasingly recognized as key strategies to prevent and alleviate chemotherapy side effects. Pre-exercise health-related physical fitness (HRPF) assessments are critical forensuring safety. However, investigations on HRPF during chemotherapy and its influencing factors remain limited.

Purpose: To evaluate HRPF status and its influencing factors in breast cancer patients undergoing chemotherapy, informing tailored exercise rehabilitation programs.

Patients and methods: A cross-sectional study was conducted with 230 hospitalized breast cancer patients undergoing chemotherapy in a tertiary hospital in Tongling, China. Data included a general information questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and standardized physical measurements across five HRPF dimensions.

Results: Descriptive analysis indicated that HRPF levels were suboptimal among participants. Regression analysis identified significant predictors of HRPF, including age, physical activity level, sedentary time, hemoglobin level, menopausal status, breast cancer subtypes and chemotherapy regimen (P < 0.001).

Conclusion: The level of HRPF among breast cancer patients undergoing chemotherapy remains suboptimal. Healthcare professionals should develop individualized exercise rehabilitation programs based on each patient's HRPF status and implement early assessment and intervention strategies targeting modifiable factors to enhance HRPF outcomes.

Purpose: Digestive system cancers, including gastric, liver, pancreatic, and colorectal cancers, are the leading causes of cancer-related deaths worldwide. Conventional treatments, such as surgery and chemotherapy, have limited efficacy in the treatment of advanced digestive system cancers, necessitating the development of new and effective therapeutic strategies. This study review aimed to evaluate the potential of cancer vaccines in the treatment of digestive system cancers and explore the prospects for the clinical application of different vaccine types.

Methods: We analyzed data from clinical trials of cancer vaccines related to cancers of the digestive system. The screening criteria included data on the trial design, therapeutic targets, efficacy, and safety.

Results: A total of 165 clinical trials that met the inclusion criteria were screened, mainly investigating nucleic acid and peptide vaccines, with the largest number of vaccine studies targeting colorectal and pancreatic cancers. Trial results demonstrated that cancer vaccines have the potential to treat cancers of the digestive system, with the particular advantages of enhancing immune responses and reducing tumor resistance.

Conclusion: Cancer vaccines, particularly nucleic acid and peptide vaccines, demonstrate potential as therapeutic interventions for digestive system cancers. Nucleic acid vaccines offer advantages in scalability and rapid design; however, they face limitations in delivery efficiency and immune activation. In contrast, peptide vaccines are safer and more stable than nucleic acid ones; however, they often elicit comparatively weaker immune responses. Therefore, it is essential to address platform-specific challenges. Future clinical trials should be strategically designed to evaluate and optimize these distinct platforms to accelerate their translation to clinical applications.

Cryptorchidism is a well-established risk factor for testicular cancer. Among adult male patients, pure testicular yolk sac tumors (YSTs) are rare, and those arising from cryptorchidism in adult males are even less common. We report a case of a 35-year-old male with a giant YST originating from cryptorchidism, with no distant metastasis detected preoperatively. The initial treatment plan was radical orchiectomy combined with postoperative chemotherapy for curative intent, but direct surgery was extremely challenging due to the large tumor size. Therefore, we attempted neoadjuvant chemotherapy to facilitate surgical resection. To our knowledge, there are relatively few reports on the use of neoadjuvant chemotherapy to reduce tumor burden prior to testicular tumor resection. The patient received four cycles of neoadjuvant chemotherapy before surgery, after which the tumor volume decreased, and the levels of alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) also dropped. Unfortunately, Liver metastases were detected during the reexamination on the 28th post-operative day, and lung metastases were identified in another reexamination on the 85th post-operative day. Regrettably, the patient refused further treatment and discontinued it, and we eventually lost follow-up. Post-pubertal YSTs are highly aggressive, and early detection and intervention are crucial for patients suspected of having cryptorchidism. Neoadjuvant chemotherapy can be considered as an adjuvant therapeutic strategy for reducing tumor burden in testicular tumors.

Background: The impact of cervical lymph node biopsy on survival, distant metastasis, and local recurrence in nasopharyngeal carcinoma (NPC) patients remains controversial. This study aims to compare the effects of cervical lymph node biopsy and nasopharyngeal biopsy on these outcomes.

Methods: This retrospective study enrolled NPC patients treated at the First Affiliated Hospital of Soochow University between January 2013 and December 2021. Kaplan-Meier method was used to evaluate the overall survival (OS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), and progression-free survival (PFS), with comparisons using the Log rank test. Univariate and multivariate Cox regression models were used to identify independent prognostic factors.

Results: A total of 721 NPC patients who underwent radiotherapy were retrospectively analyzed. Among them, 591 were diagnosed with nasopharyngeal biopsy, and 130 patients with cervical lymph node metastasis suspected to originate from NPC underwent confirmatory nasopharyngeal biopsy. In cervical lymph node biopsy, 36 had excisional biopsies, 85 had fine needle aspirations, and 9 cases were unspecified. Survival was not significantly different between patients with nasopharyngeal biopsy and cervical lymph node biopsy (5-year OS: 81.1% vs 85.0%; DMFS: 75.2% vs 80.6%; LRFS: 79.5% vs 78.7%; NRFS: 80.4% vs 80.4%; PFS: 74.3% vs 74.3%; all p>0.05). Results were similar for the propensity-matched cohort of 260 patients.Additionally, survival was not significantly different between the fine needle aspiration and excision biopsy groups (5-year OS: 85.1% vs 83.5%; DMFS: 79.7% vs 80.3%; LRFS: 85.2% vs 74.8%; NRFS: 85.1% vs 77.7%; PFS: 79.8% vs 71.7%; all p>0.05). Targeted therapy and >3 cycles of chemotherapy were prognostic factors in NPC patients (p<0.05).

Conclusion: Cervical lymph node biopsy did not increase the risk of locoregional recurrence, distant metastasis, or death in NPC patients.

Objective: To investigate the level of fear of cancer recurrence (FCR) in bladder cancer patients across different age groups and to identify associated sociodemographic, clinical, and psychosocial factors. This study aims to provide an evidence base for developing age-specific psychological interventions.

Methods: A cross-sectional survey was conducted among 322 bladder cancer patients primarily diagnosed with non-muscle invasive bladder cancer (NMIBC) at Hebei General Hospital between January 2020 and December 2022. Patients were categorized into a younger group (18-59 years) and an older group (≥60 years). Data were collected using a general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (SCSQ). Descriptive statistics, t-tests, ANOVA, Pearson correlation, and multiple linear regression analyses were performed.

Results: The mean FCR scores were significantly higher in the younger group (33.46 ± 7.62) compared to the older group (28.93 ± 8.58) (P<0.001). Multiple linear regression analysis (R²=0.500, F=31.075, P<0.001) identified several significant predictors of FCR: younger age (β=-0.100, P=0.022), lower per capita monthly family income (β=-0.171, P<0.001), advanced tumor TNM stage (β=0.207, P<0.001), poorer doctor-patient communication (β=0.112 for "General" vs "Very Satisfied", P=0.013), more tumor recurrences (β=0.100, P=0.023), less use of positive coping strategies (β=-0.100, P=0.029), more use of negative coping strategies (β=0.241, P<0.001), and lower social support (β=-0.232, P<0.001).

Conclusion: Bladder cancer patients experience considerable FCR, with younger patients exhibiting significantly higher levels than older patients. Factors such as age, socioeconomic status, disease severity, communication, coping styles, and social support are crucial determinants of FCR. Early identification of these factors and the implementation of tailored, age-appropriate interventions are recommended to alleviate FCR in this population.