Chinese clinical oncology最新文献

Background: Eccrine poroma (EP) is a benign cutaneous neoplasm that originates from the acrosyringium of the eccrine sweat duct. EP can be found on any skin area with sweat glands and typically occurs on the palmoplantar areas. They usually present as solitary, asymptomatic, well-circumscribed, smooth or verrucous papules or nodules that range in color from skin-colored to red or brown. However, some cases may be difficult to diagnose clinically, especially when the distribution and morphology are not typical. The periungual region represents an uncommon localization for these neoplasms and can easily be misdiagnosed.

Case description: Here, we present a rare case of a 52-year-old man who presented with a 2-year history of a painless, slowly growing, erythematous nodule on the lateral nail fold of his right toe. The lesion was initially suspected to be an amelanotic melanoma, but histopathological revealed a tumor composed of broad anastomosing bands of cuboidal cells with eosinophilic cytoplasm and round nuclei within the dermis, confirmed to be an EP. After complete surgical excision of the lesion with 1 mm margins, the wound healed well and there was no recurrence or metastasis after 12 months of follow-up.

Conclusions: EPs in the periungual region are exceedingly rare. Their presentation and atypical appearance can lead to misdiagnosis and missed opportunities for early treatment. Clinicians should be aware of this possibility and perform biopsies of any suspicious periungual lesion to ensure timely and appropriate management.

Single-site robotic-assisted radical prostatectomy (ssRARP) has emerged as a promising advancement in urological surgery, driven by the development of advanced robotic instrumentation and single-port access technologies. Global researchers have extensively explored various techniques and approaches for ssRARP in carefully selected patient populations, yielding promising perioperative and oncological outcomes. This review aims to provide a comprehensive overview of the technical intricacies of ssRARP. We will delve into the evolution of single-port robotic surgery, highlighting key advancements and surgical techniques, including transperitoneal, extraperitoneal, and transvesical approaches. A detailed discussion of technical nuances, challenges, and potential pitfalls will be presented. Furthermore, we will analyze the available evidence regarding the perioperative and oncological outcomes of ssRARP. This includes examining factors such as operative time, blood loss, postoperative complications, length of hospital stay, continence recovery, and biochemical recurrence-free survival, and the challenges and management strategies for patients with specific preoperative situations, such as previous surgery, large median lobe and prostatectomy after focal therapy. The potential advantages of ssRARP, including improved cosmesis, reduced postoperative pain, and faster recovery, will be explored. By providing a comprehensive understanding of the technical aspects, clinical outcomes, and future directions of ssRARP, this review aims to contribute to the ongoing discourse on the role of single-port robotic surgery in prostate cancer management.

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with liver metastasis (LM) being the most common site of spread. The emergence of immunotherapy has changed the landscape of cancer treatment, providing therapeutic options for the management of CRC, especially in metastatic settings. Typically, CRC with microsatellite instability-high (MSI-H) status respond more favorably than those that are microsatellite stable (MSS). However, it has been observed that the presence of LMs limits the efficacy of immunotherapy irrespective of the microsatellite instability (MSI) status, which presents unique challenges in managing CRC with LMs (CRCLM). The exact mechanisms for resistance to immunotherapy in CRCLM are poorly understood. Several factors in the liver tumor microenvironment (TME) have been linked to therapeutic failures with immunotherapy in CRCLM. Novel agents that explore and target immunosuppressive elements in the liver TME, such as the lymphocyte activation gene 3 (LAG-3) and vascular endothelial growth factor receptor (VEGFR), in combination with anti-programmed death-1/ligand-1 (PD-1/PD-L1) have been found to improve immunotherapy response in CRCLM. Machine learning-based bioinformatics may provide further understanding of the several molecular mechanisms in the liver TME that may represent potential areas for therapeutic options and precision cancer medicine. This manuscript explores the challenges associated with immunotherapy in this subset of patients, focusing on TME, immune resistance mechanisms, and potential strategies to enhance immunotherapeutic outcomes.

Background: Radiotherapy plus temozolomide followed by adjuvant temozolomide was the standard treatment for high-grade gliomas. This study aimed to explore the effectiveness and safety of the addition of apatinib in patients with high-grade gliomas after surgery.

Methods: In this retrospective cohort study, patients with high-grade glioma [World Health Organization (WHO) grade III or IV] treated with apatinib and concurrent chemoradiotherapy (cCRT) after surgery from October 2017 to February 2021 were reviewed. High-grade glioma patients used cCRT alone in the same period were reviewed as the control group. Progression-free survival (PFS), overall survival (OS), the grade of peritumoral brain edema (PTBE) and safety profiles were recorded. Cox regression analyses were used to determine the associated factors of PFS and OS.

Results: A total of 60 patients with high-grade glioma were reviewed, with 30 patients in the apatinib plus cCRT group and 30 patients in the cCRT group. The median PFS of the apatinib plus cCRT group compared with the cCRT group was 8.53 vs. 7.33 months (P=0.62), and the median OS was 13.70 vs. 14.30 months (P=0.93). Multivariate analysis revealed that only pathological grade was independently associated with PFS [hazard ratio (HR) =4.445, 95% confidence interval (CI): 1.857 to 10.641, P<0.001] and OS (HR =3.737, 95% CI: 1.530 to 9.123, P=0.004). The apatinib plus cCRT also improved PTBE (P=0.001), and decrease the corticosteroids use than cCRT alone (P=0.002). No grade 3 or higher adverse event was observed in both groups.

Conclusions: Post-operative cCRT plus apatinib was feasible for patients with high-grade glioma, with manageable toxicities.

Background: The characteristics of tumor immune microenvironment are important factors affecting the efficacy of immunotherapy, and there are differences in the distribution of tumor-infiltrating lymphocyte (TIL) subsets in different types of tumors. This study aims to compare the distributions of cluster of differentiation (CD) 4+ and CD4+ T cell subsets of TILs and their clinical significance between lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC).

Methods: The tumor tissues of 78 LUAD and 56 LUSC patients who underwent surgery at The Second Affiliated Hospital of Zhengzhou University between October 2020 and October 2022 were collected, TIL level were detected by pathological observation, and the proportions of CD4+, CD4+ T cell subsets and CD4+/CD4+ ratio in TILs were detected by flow cytometry. These indicators were compared between LUAD and LUSC, and their correlations with clinicopathological characteristics and patient survival were analyzed.

Results: There was no significant difference in the TILs level between LUAD and LUSC (P>0.05). The CD4+/CD4+ ratio in LUSC was lower, and proportion of CD4+ T cells was higher than those in LUAD (all P<0.05). In LUAD, the proportions of CD4+, CD4+ T cells and CD4+/CD4+ were correlated with tumor size or tumor-node-metastasis (TNM) stage, while in LUSC, only the proportions of CD4+ and CD4+ T cells were correlated with tumor size, degree of differentiation or TNM stage. In LUAD patients, higher proportions of CD4+, CD4+ T cells and lower CD4+/CD4+ predicted longer survival, and high CD4+/CD4+ (>1.04) was an independent risk factor for PFS and OS (P<0.05); In LUSC patients, there was no correlation between the proportions of CD4+ T cells, CD4+ T cells and CD4+/CD4+ ratio, and patient prognosis (P>0.05).

Conclusions: There were differences in the distribution and balance of CD4+ and CD4+ TIL subsets between LUAD and LUSC, among which CD4/CD4+ ratio closely affected the prognosis of LUAD patients but had relatively weak prognostic value in LUSC patients due to the restriction of CD4+ T cells.

Background: The recurrence shortly after interventional therapy poses a great challenge in managing malignant central airway obstruction (MCAO). While cryotherapy has shown potential benefits when combined with immunotherapy in lung cancer, its effectiveness for improving local control of malignant central airway tumors is not well understood. This study aims to evaluate the clinical efficacy and safety of combining these strategies.

Methods: A total of 12 patients with MCAO who had been treated with a combination of cryotherapy and immune checkpoint inhibitors (ICIs) were compiled for analysis in a tertiary hospital in Shanghai East Hospital, China. The primary endpoint is the duration of efficacy (DoE) for MACO after the combined therapy, which was defined as the time interval of the airway stayed patency without additional repeated interventional treatment. Secondary endpoints encompassed an assessment of objective response rate, overall survival and the adverse events.

Results: Twelve patients received a combination therapy between January 2021 and December 2023. Median age was 66 years, 91.7% male. Fifty percent were squamous carcinoma. 50.0% had medium to low programmed cell death-ligand 1 (PD-L1) levels. 41.7% patients' performance status scored higher than 2. 91.7% (11/12) of the patients objectively respond to the combined therapy, with a median DoE of 10.0 (95% confidence interval: 3.7-21.7) months. The 6-, 12- and 18-month survival rate was 75.0%, 50.0% and 41.8%, respectively. The most common adverse event was granulation. Other events included mild rash, pneumonitis, and hypothyroidism. No severe procedure-related adverse events occurred.

Conclusions: In patients with endoluminal or mixed MCAO, our findings suggest that combining endobronchial cryotherapy with ICIs may help maintain airway patency, offering a promising preliminary signal for this therapeutic approach.