Cancer Management and Research最新文献

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.

[This retracts the article DOI: 10.2147/CMAR.S236301.].

Purpose: Patients with non-small cell lung cancer (NSCLC) complicated by malignant pleural effusion (MPE) face a dismal prognosis. Existing biomarkers (eg, VEGF, CEA) show limited sensitivity, while nutritional indices (eg, PNI) are emerging as prognostic factors. This study aimed to develop a novel nomogram integrating lipid metabolism and nutritional indices to predict survival in NSCLC-MPE patients.

Methods: Multicenter retrospective cohort study enrolling patients with confirmed NSCLC combined with MPE who underwent thoracentesis from 2018 to 2024 from each of two centers. Univariate, multifactorial Cox regression analysis was used to identify five key clinical variables, and a nomogram model was developed. The predictive accuracy of the model was evaluated by calculating the area under the curve of the work characteristics of the recipients.

Results: A total of 250 patients with NSCLC combined with MPE were analyzed in this study, 195 in the training group and 55 in the validation group. The multifactorial COX test showed an interaction between ECOG PS, pleural lactate dehydrogenase (LDH), T stage, low/high-density lipoprotein cholesterol concentration ratio (LHR), and prognostic nutritional index (PNI). At 1, 2, and 3 years, the area under the curve (AUC) values were 0.899, 0.808, and 0.748 for the training set and 0.899, 0.798, and 0.669 for the validation set, respectively.

Conclusion: MPE carries a poor prognosis for NSCLC patients, and the clinical prediction model we constructed shows good promise in predicting OS in this patient, which can assist direct the selection of optimal treatment strategies.

[This retracts the article DOI: 10.2147/CMAR.S185789.].

Adult T-cell acute lymphoblastic leukemia (T-ALL) exhibits a dismal prognosis characterized by low remission rates, high relapse rates, and poor tolerance to conventional chemotherapy. The urgent development of novel therapeutic strategies is imperative to improve clinical outcomes. In this study, we propose a dual epigenetic targeting regimen combining Venetoclax with Chidamide and Azacitidine. Preclinical investigations demonstrated synergistic anti-proliferative effects of this triple-drug combination against Jurkat cells in vitro. Additionally, we retrospectively analyzed clinical data from five high-risk T-ALL patients to evaluate the regimen's efficacy and safety. Among the cohort (all male; median age 55 years, range 25-72), one patient had refractory T-ALL (R-TALL) following VDCP regimen induction failure, while four were newly diagnosed (ND-TALL). After one treatment cycle, four patients achieved complete remission (CR) or CR with incomplete hematologic recovery (CRi), with one additional patient attaining CR after the second cycle. Four patients achieved deep molecular remission (MRD-negative status) within two cycles, while two successfully underwent allogeneic hematopoietic stem cell transplantation (HSCT) during sustained remission. Myelosuppression emerged as the predominant treatment-related adverse event. These preclinical and clinical findings collectively support the therapeutic potential of the Combination of Venetoclax with Epigenetic Drugs as a promising option for high-risk T-ALL patients.

Background: Skin cancer is a major global health issue. Current literature focuses on Western countries whose characteristics of skin tone and cultures differ vastly from Saudi Arabia.

Objective: To analyze skin cancer patterns in Saudi Arabia, focusing on regional differences and cancer types in a country with high sun exposure.

Design: Retrospective cohort study utilizing the Saudi Health Council's Cancer Registry for the requisite data for this study.

Data source: Ethical approval (637/2024) was prior to the beginning of this study. The Saudi Health Council's Cancer Registry supplied the requisite data for this study.

Subjects and methods: We reviewed 6381 cases of skin cancer diagnosed in Saudi Arabia from 2010 to 2021. Inclusion Criteria was all histologically confirmed cases of primary skin cancer; exclusion criteria included tumors of secondary origin or cases with incomplete diagnostic data. Data on demographics, tumor types and regional trends were analyzed using IBM SPSS 27.0.1.

Main outcome measures: Tumor factors were collected along with demographic variables.

Results: A total of 6381 skin cancer cases were recorded. Skin cancer was more common in older men, who made up 62.7% of cases, with an average age of 62.5 years. Basal Cell Carcinoma was the most common type (49.5%), followed by Squamous Cell Carcinoma (25.6%). Most cases (76.6%) were caught early, with the Central region reporting the highest number of cases (31.8%), followed by the Western (26.3%) and Eastern (20.1%) regions.

Conclusion: This study reveals significant differences in skin cancer rates across Saudi Arabia, particularly among older men and in specific regions. The results can help establish awareness programs targeting vulnerable populations and focusing on early detection and intervention, such as initiating targeted skin cancer screening or sun-protection campaigns in high-burden regions. They emphasise the need for the allocation of resources in the Central and Western regions.

Limitations: The retrospective nature of the study does not allow for the full scope of patient behaviour or risk factors; there were also gaps in the data.