Cancer Management and Research最新文献

Introduction:  The optimal proximal margin length for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) remains debated. This study aimed to evaluate the effect of different proximal margin lengths on short- and long-term prognosis.

Methods: In this retrospective study, clinical data from patients undergoing surgery for Siewert type II/III AEJ between January 2019 and January 2024 were collected. Patients were stratified into three groups based on the length of the proximal margin (0.5-2 cm, 2-4 cm, and >4 cm). Short-term outcomes, including R0 resection rates and complications, along with long-term survival (OS and PFS), were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess prognostic impacts.

Results: A total of 173 patients were included (0.5-2 cm, n=57; 2-4 cm, n=60; >4 cm, n=56). The 0.5-2 cm group had significantly higher R1 resection (12.28% vs 1.67%/0%) and anastomotic recurrence rates but a lower anastomotic leak incidence compared to the other groups (P<0.05). The >4 cm group showed longer operative times and higher leak rates. Survival analysis revealed poorer overall survival (OS) and progression-free survival (PFS) for the 0.5-2 cm group versus other groups (P<0.05), with no significant difference between the 2-4 cm and >4 cm groups. Cox regression confirmed that a margin length >2 cm reduced progression risk (HR=0.793, 95% CI 0.641-0.981, P=0.033), particularly for tumors <4 cm, Siewert type II, and intestinal-type Lauren classification.

Conclusion: A 2-4 cm proximal margin appears to optimize the prognosis in Siewert type II/III AEJ, balancing oncologic safety and surgical outcomes. This margin length is especially beneficial for tumors <4 cm, Siewert II classification, and intestinal-type histology. A personalized surgical strategy is recommended.

Background: Immune checkpoint inhibitors (ICIs) have transformed cancer care but frequently cause immune-mediated diarrhea and colitis (IMDC), a clinically significant immune-related adverse event. Prompt diagnosis and severity assessment are essential but often rely on invasive endoscopic procedures. C-reactive protein (CRP), a widely available biomarker of systemic inflammation, has been suggested as a potential adjunct in evaluating IMDC. However, its diagnostic utility and clinical relevance remain unclear.

Methods: We conducted a scoping review in accordance with the PRISMA-ScR guideline to map existing evidence and identify knowledge gaps regarding the association between CRP and IMDC. A comprehensive literature search was performed across PubMed, Embase, and Web of Science (January 2010-April 2025). Eligible studies included adult patients receiving ICIs who developed gastrointestinal immune-related adverse events, with reported CRP levels. Data were extracted on study design, patient population, CRP measurement, and its relationship with IMDC diagnosis, severity, or outcomes.

Results: Of 538 records screened, five observational studies comprising 583 patients were included. Only one study specifically analyzed CRP levels in histologically confirmed IMDC, demonstrating a positive correlation with clinical and endoscopic severity but no validated diagnostic thresholds. The remaining studies assessed CRP as a general marker for immune-related adverse events without gastrointestinal-specific analyses or diagnostic accuracy metrics. No study provided sufficient data to establish sensitivity, specificity, or predictive values for CRP in IMDC.

Conclusion: This scoping review highlights the limited and heterogeneous evidence linking CRP to IMDC and underscores the absence of validated thresholds or diagnostic performance data. For generalist physicians, CRP may serve as a supportive marker to prompt further evaluation but cannot replace established diagnostic pathways. Future prospective studies should integrate CRP with organ-specific biomarkers and standardized endpoints to clarify its role in triage and severity assessment of IMDC.

Lung adenocarcinoma remains a leading cause of cancer mortality globally. While immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC), their efficacy in patients with acquired epidermal growth factor receptor (EGFR) T790M mutations following multiline therapy is poorly defined. This case report describes a 52-year-old Asian female never-smoker diagnosed with stage IIIA lung adenocarcinoma. She underwent lobectomy and received multiple lines of therapy. Initial genetic testing showed no EGFR T790M mutation, but subsequent testing after multiline treatment confirmed its acquired presence. Following multiline therapeutic failure, the patient received immunotherapy with cadonilimab (a PD-1/CTLA-4 bispecific antibody). This intervention resulted in disease control, and the patient achieved 9.4 months of progression free survival (PFS). This case suggests that immunotherapy with cadonilimab could be a potential consideration for advanced NSCLC harboring acquired EGFR T790M mutation post-multiline therapy.

[This retracts the article DOI: 10.2147/CMAR.S214826.].

Background: To address the heterogeneity in treatment responses and the lack of robust prognostic tools for unresectable esophageal squamous cell carcinoma (ESCC) patients undergoing immunochemotherapy, this study aimed to develop and validate an interpretable machine learning (ML) model for survival prediction and risk stratification.

Methods: A retrospective cohort of 323 unresectable ESCC patients treated with immunochemotherapy (2019-2025) was analyzed. Using the XGBoost algorithm, we integrated baseline clinical features (age, tumor location, TNM stage) and laboratory parameters (albumin, globulin, blood glucose) to construct a prognostic model. SHapley Additive exPlanations (SHAP) values were employed to quantify feature contributions, and external validation (n=48) was performed to assess generalizability. SHAP (SHapley Additive exPlanations) is a game theory-based framework that enables model interpretability by quantifying the contribution of each feature to predictions. The primary endpoint was overall survival (OS).

Results: The model achieved AUC values of 0.794 (internal test) and 0.689 (external test), with calibration curves demonstrating strong concordance between predicted and observed survival rates. Key prognostic factors included tumor response, age, hypoalbuminemia, hyperglobulinemia and hyperglycemia. Risk stratification using a nomogram-derived cutoff (total score ≥50) revealed significantly inferior 2-year OS in high-risk versus low-risk patients (21.3% vs 58.6%, P<0.001).

Conclusion: This interpretable ML model effectively predicts survival outcomes in unresectable ESCC patients receiving immunochemotherapy, offering a data-driven tool for personalized therapeutic decision-making. Multicenter prospective trials are warranted to validate its clinical utility.

Purpose: Sentinel lymph node biopsy (SLNB) is the standard for early breast cancer, but its necessity in small tumors with clinically node-negative (cN0) status remains debated. This study evaluated the incidence of lymph node metastasis in cN0 patients to explore the feasibility of omitting axillary surgery.

Methods: A cohort of 579 women with unilateral small breast cancer and cN0 were enrolled from three hospitals in Jiangsu Province (March 2023-June 2024). Clinical nodal status was determined by ultrasonography, while pathology and immunohistochemistry assessed tumor size, node status, and molecular subtypes. Chi-square tests and logistic regression were used for analysis.

Results: Lymph node metastasis was detected in 79 patients (13.64%). Tumors ≤20 mm and Ki-67 ≤14% showed significantly lower metastasis rates (P < 0.0001 and P = 0.013, respectively). Even in cN0 patients with both favorable factors, 6.15% still had nodal involvement. Logistic regression identified tumor size (T2) as an independent predictor of metastasis.

Conclusion: Small breast cancer with cN0 and low Ki-67 expression is associated with reduced but non-negligible nodal metastasis. These findings support caution in omitting axillary surgery and highlight the need for individualized risk stratification rather than universal omission.

Background: The global incidence and mortality of colorectal cancer are rising annually, posing a severe threat to public health. Studies have shown that patient navigation can significantly improve adherence to colorectal cancer screening, thereby reducing incidence and mortality rates. This review aims to summarize the existing evidence on the application of patient navigation in colorectal cancer screening, to provide an evidence-based foundation for subsequent research and clinical practice.

Methods: Based on Arksey and O'Malley's scoping review methodological framework, a search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang, and SinoMed for relevant studies published from database inception to May 20, 2025.

Results: 25 studies were included. The findings indicate that navigator types primarily include trained professional navigators, medical navigators, and novel navigators. Service delivery methods were diverse, with telephone navigation being the primary mode, often combined with SMS, face-to-face, email, and other multi-modal collaborative interventions. Navigation service content encompassed six main themes: colorectal cancer education, barrier assessment and resolution, guidance and reminders for guaiac fecal occult blood test/fecal immunochemical test and bowel preparation, colonoscopy process management, and post-examination follow-up. Efficacy evaluation demonstrated that patient navigation overall enhances colorectal cancer screening adherence, although heterogeneity existed in outcomes such as bowel preparation quality and patient satisfaction.

Conclusion: Current patient navigation services for colorectal cancer screening have formed a relatively mature intervention framework. However, there remains room for optimization in areas like the balance of service content and support for non-medical barriers. Future practice can draw upon existing research to implement full-cycle, culturally adapted, and cost-effective patient navigation interventions tailored to national contexts.

Myeloid-derived suppressor cells (MDSCs) arise from myeloid progenitors in the bone marrow and, under the influence of tumor- and immune-cell-derived cytokines, chemokines, and growth factors, enhance immunosuppressive activity within the tumor microenvironment (TME). Noncoding RNAs (ncRNAs)-including microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNAs (circRNAs)-have emerged as critical regulators of MDSCs biology. Recent evidence has shown that ncRNAs are intimately involved in MDSCs recruitment, differentiation, and suppressive function by modulating key signaling pathways, including STAT3, NF-κB, and PI3K/AKT. Mechanistically, ncRNAs act through epigenetic control (eg, histone modifications and chromatin remodeling), post-transcriptional regulation (eg, miRNA sponging), and fine-tuning of gene networks. These insights highlight RNA-based strategies that target ncRNAs to disrupt MDSCs-mediated immune suppression and potentiate antitumor immunity, while acknowledging ongoing challenges such as delivery specificity, stability, and off-target effects. This review synthesizes current understanding of how ncRNAs regulate MDSCs via major signaling axes and discusses implications for cancer progression and therapeutic development.

Background: Hypofractionated radiation therapy (HFRT) is increasingly accepted for prostate cancer. This prospective study compared clinical outcomes, early prostate-specific antigen (PSA) dynamics, and dosimetry between proton and photon HFRT for high-risk prostate cancer.

Methods: A total of 118 patients with high-risk prostate cancer were treated with HFRT (70Gy in 28 fractions) between 2022-2024, receiving either intensity-modulated proton therapy (IMPT, n = 36) or photon therapy (VMAT, n = 82). All patients received long-term androgen deprivation therapy (ADT). Primary endpoints included biochemical control, PSA nadir at 6 months post-treatment, and genitourinary (GU) and gastrointestinal (GI) toxicities. Dosimetric comparisons were performed in silico.

Results: While biochemical control rates were comparable, a significantly higher proportion of patients receiving proton therapy achieved a PSA nadir <0.1 ng/mL within 6 months. Proton therapy was associated with reduced GU toxicity compared to photon therapy, based on assessments from both physicians and patients. Dosimetric analysis confirmed that proton therapy provided excellent target coverage with superior organ-at risk (bladder and rectum) sparing. We further identified dosimetric parameter to determine the cuff-off value for GU events. The data revealed the percentage volume of bladder receiving ≥90% prescribed dose (V90%) ≥11% has the predictive value for the development of grade ≥2 genitourinary toxicity.

Conclusion: Two-year biochemical control was comparable between proton- and photon- based HFRT in high-risk prostate cancer. Proton therapy demonstrated improved early PSA kinetics and reduced GU toxicity, supported by favorable dosimetric profiles. The identification of bladder V90% <11% as a planning constraint may guide treatment optimization. Further studies with longer follow-up are warranted to validate these benefits.

Background: This study investigates the effectiveness of neo-adjuvant chemo-radiotherapy (neo-CRT) in patients with clinical stage II and III mucinous rectal adenocarcinoma (MRA) and compares clinical outcomes with those of non-mucinous rectal adenocarcinoma (NMRA).

Methods: A retrospective analysis was performed on patients diagnosed with clinical stage II or III rectal adenocarcinoma, confirmed via pelvic imaging, who underwent curative surgical procedures from January 2009 to December 2023. Exclusion criteria encompassed stage I and IV cases, those treated as emergencies, and patients with inflammatory bowel disease. Patients were classified into neo-adjuvant treatment groups and compared based on tumor type (MRA vs NMRA) using statistical analyses.

Results: Of 550 cases, 359 met inclusion. Most patients were young adults (58% aged 20-30), reflecting unusually early onset in Yemen. Neo-CRT was administered to 180 patients (93 MRA, 87 NMRA), while 179 (87 MRA, 92 NMRA) did not receive it. NMRA tumors were 3.24× more likely to downstage than MRA (P = 0.0007; OR = 3.235). After CRT, yp Stage II occurred in 40.23% of NMRA (95% CI: 30.68-50.68%) versus 17% of MRA (95% CI: 10.99-26.15%), while yp Stage III persisted in 60% versus 82.80% respectively (P = 0.0003). Pathological complete response (pCR) was seen in 11% of NMRA but <2% of MRA. Survival analysis showed MRA as the strongest adverse factor (CSS HR = 2.07, 95% CI: 1.39-3.09, P = 0.0002; OS HR = 1.79, 95% CI: 1.25-2.57, P = 0.0013), with advanced stage also predictive of poorer outcomes (CSS HR = 1.65, P = 0.043; OS HR = 1.87, P = 0.006). Neo-CRT itself conferred no survival benefit (CSS HR = 0.98, P = 0.91; OS HR = 1.24, P = 0.24). Disease-free survival (DFS) was lower in MRA (52% vs 72%, P = 0.004) and local recurrence higher (26% vs 5%, P = 0.0004), while Neo-CRT produced no significant survival benefit (15% vs 19%, P = 0.40).

Conclusion: Both MRA stages II and III showed inferior cancer-free and overall survival outcomes. The justification for neo-adjuvant therapy necessitates a careful evaluation of potential benefits versus risks in MRA patients. The younger age of Yemeni colorectal cancer patients warrants further epidemiological studies to explore genetic and environmental risk factors. It also highlights the urgent need for tailored screening protocols, public health interventions, and awareness campaigns.