Chinese clinical oncology最新文献

Background: Small intestinal stromal tumors (SISTs) are mesenchymal neoplasms originating from the interstitial cells of Cajal in the small intestine. As a distinct subtype of gastrointestinal stromal tumors (GISTs), SISTs exhibit greater aggressiveness and poorer prognosis compared to gastric GISTs. Due to their anatomically ambiguous location and nonspecific symptoms, early diagnosis remains challenging. This study conducts a retrospective analysis of clinical data to systematically summarize their clinical characteristics and management experience, aiming to provide insights for addressing diagnostic challenges.

Methods: Clinical data from 119 patients with primary SIST who underwent surgical treatment at the Air Force Medical Center between November 2013 and March 2025 were retrospectively analyzed.

Results: The clinical presentation of SIST was often insidious, with intermittent gastrointestinal bleeding (melena or hematochezia) observed as the initial symptom in 84.9% of patients. Anemia was frequently observed during the disease course. Caution is warranted to avoid misdiagnosis as superficial gastritis. The tumors predominantly occurred in the jejunum and ileum. A significant correlation was identified between the risk of recurrence and Ki-67 expression levels. Through a precision medicine approach encompassing "symptom and sign evaluation, radiographic assessment, intraoperative dynamic decision-making, and surgical resection", a stratified surgical strategy was implemented. This approach prioritized both complete tumor eradication and minimal invasiveness.

Conclusions: The diagnosis and management of SIST require vigilance regarding overlapping symptoms and anatomical obscurity, emphasizing the integration of multimodal imaging and a minimally invasive-prioritized surgical strategy.

Background: How selective internal radiation therapy (SIRT) with personalized dosimetry fits with intermediate and advanced hepatocellular carcinoma (HCC) treatment remains unclear. The aims of our study were to investigate the efficacy and safety of SIRT in real-life settings within a nonsurgical HCC population and to identify prognostic factors for survival.

Methods: From January 2019 to December 2023, 73 consecutive HCC patients who underwent SIRT with personalized dosimetry at three French centers were retrospectively analyzed. A post-matched comparison with a large single-center cohort of HCC patients (n=1,049) enrolled from January 2007 to December 2023 and treated with other therapeutic modalities was performed. Overall survival (OS) was compared between the two patient groups.

Results: Patients treated with SIRT had mostly Child-Pugh (CP) grade A cirrhosis and multifocal and unilobar HCCs, which were classified as Barcelona Clinic Liver Cancer (BCLC) stage B or C with vascular invasion (49%) or metastases (5%). SIRT was a first-line therapy in half of the patients and was used in combination for nearly one-quarter of the patients. In total, 94% of the patients received a tumor dose of 205 Gy or higher. After a median follow-up of 11.9 (6.2-21.1) months, 53% of patients treated with SIRT died. Stage B and C HCC patients had median OS times of 35.2 (6.5-infinite) and 12.8 (6.8-infinite) months, respectively. A comparative analysis of the two cohorts revealed the superiority of SIRT in terms of OS for advanced-stage HCCs with unilateral intrahepatic portal vein tumor thrombosis and the similarity of SIRT for intermediate-stage HCCs compared with other modalities. No significant difference in OS was observed after matching BCLC B/C HCC patients who received SIRT with those who did not after a median follow-up of approximately 12 months. The independent prognostic variables for survival following SIRT therapy were CP grade, largest tumor size and hemoglobin level. No deaths occurred in the SIRT group.

Conclusions: This study revealed that SIRT following personalized dosimetry is used in current practice as a therapeutic solution for advanced and intermediate HCC, typically in combination therapies and beyond first-line treatment. Our results support SIRT as an alternative therapeutic option for intermediate-stage HCC and as an effective therapeutic solution for advanced HCC with intrahepatic vascular invasion, with a good safety profile.

Background: Prostate cancer (PCa) is one of the leading malignancies in males worldwide. Accurate assessment of Gleason scores (GSs) preoperatively is critical for making appropriate treatment decisions. However, GS discrepancies between biopsy and post-surgery pathology are common. This study aimed to evaluate the incidence of GS upgrading and downgrading and to identify related clinical and pathological factors. Understanding the clinical and pathological factors associated with GS upgrading and downgrading is essential to enhance predictive accuracy and optimize PCa management.

Methods: This study retrospectively analyzed 218 PCa patients diagnosed by transperineal prostate biopsy and subsequent treated with radical prostatectomy from January 2021 to February 2024. Patients were categorized into upgrading, downgrading, or concordant groups based on GS comparisons. Univariate analysis was adopted to identify predictive factors.

Results: Among the 218 patients included in this study, 80 (36.7%) exhibited pathological upgrading postoperatively, 39 (17.9%) showed pathological downgrading, and 99 (45.4%) maintained consistent pathological results. Pathological upgrading was more frequently observed in patients with a biopsy GS 3+3 (P<0.001) and was associated with the total number of biopsy cores (P=0.043). In contrast, pathological downgrading was more common in patients with biopsy GS 4+3, 5+3, 3+5, or 4+4 (P=0.03) and correlated with the number of positive biopsy cores (P=0.03) and the positive core percentage (P=0.02). Most discrepancies involved ±1 grade group shifts (89, 40.8%), with ≥2 grade group changes occurring in only 13.8% of cases. For patients with GS 3+3 in biopsy, univariate analysis revealed that prostate-specific antigen (PSA), PSA density (PSAD), and the total number of biopsy cores were factors influencing pathological upgrading. Furthermore, 7 (9.8%) of upgraded GS 3+3 cases presented with locally advanced PCa vs. 0% in non-upgraded patients.

Conclusions: These findings highlight significant limitations of pre-surgery biopsy-based grading evaluation. The high rate of upgrading or downgrading suggests current risk stratification systems may underestimate or overestimate clinical impact. This study identified several variables that may assist clinicians in accurately determining the true pathological GS of PCa. This may help to optimize clinical-decisions and improving cancer-specific outcomes in Chinese PCa patients.

Background and objective: Radiotherapy (RT) not only induces lethal DNA damage in tumor cells but also modulates the tumor immune microenvironment (TIME). It enhances the release of pro-inflammatory mediators and promotes infiltration of cytotoxic immune cells. However, RT can also lead to the accumulation of immunosuppressive cells, such as M2 macrophages, myeloid-derived suppressor cells (MDSCs), and regulatory T cells (Tregs), which may contribute to an immunosuppressive milieu. In this review, we aim to delineate the principal issues pertaining to the immunoregulatory effects of RT.

Methods: A PubMed search was conducted for articles from the past decade using the terms: (radiation therapy or conformal radiotherapy) AND (immunogenic cell death, cyclic GMP-AMP synthase, tumor immune microenvironment, anoxia, immune checkpoint inhibition, or low-dose radiotherapy).

Key content and findings: This review provides a comprehensive analysis of the immunostimulatory effects of RT, emphasizing its ability to induce immunogenic cell death (ICD), activate the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) pathway, and modulate immune cell populations within the tumor microenvironment (TME). It also explores how different radiation doses, fractionation schemes, and planning parameters influence these biological effects. Importantly, conformal RT remains integral to cancer treatment by enabling the delivery of higher radiation doses precisely to tumors while sparing surrounding healthy tissues.

Conclusions: RT exerts anti-tumor effects by triggering ICD, activating the cGAS/STING signaling pathway, and reshaping the TIME. These effects vary depending on radiation dose and fractionation. Conformal RT optimizes therapeutic outcomes by targeting tumors with high precision, minimizing toxicity to normal tissues.

Background: At present, the prognosis for patients with extensive-stage small cell lung cancer (ES-SCLC) has remained poor. If standard treatment for ES-SCLC fails, these patients face rapid disease progression and high mortality. Thus, current treatment strategies are limited, and new treatments are urgently needed. Apatinib, a novel tyrosine kinase inhibitor (TKI) specifically targeting vascular endothelial growth factor receptor-2 (VEGFR-2), has been increasingly reported as a treatment for ES-SCLC, showing different clinical efficacy and related adverse reactions. Therefore, we performed this meta-analysis on existing studies to evaluate the efficacy and safety of apatinib in patients with ES-SCLC.

Methods: PubMed/MEDLINE, Embase, Web of Science (WOS), and the Cochrane Central Register of Controlled Trials were searched for related studies. The main outcomes were objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Methodological Index for Non-Randomized Studies (MINORS) and Joanna Briggs Institute (JBI) were adopted for quality assessment, and STATA 16.0 for data analysis.

Results: This single-arm meta-analysis included 13 studies involving 489 Chinese patients with ES-SCLC treated with apatinib. Given substantial heterogeneity, random-effects models were used throughout. Subgroup analyses were performed by apatinib treatment line (first-line vs. second-line/later) and regimen type (monotherapy vs. combination therapy). The results of subgroup analysis showed that the ORR, DCR, median OS (mOS), and median PFS (mPFS) of apatinib used as first-line therapy (combination therapy or maintenance therapy) were 71%, 88%, 14.52 months, and 4.09 months, respectively. For second-line and beyond, the combined ORR was 17%, DCR was 82%, mOS was 8.01 months, and mPFS was 4.34 months. The ORR, DCR, and mPFS were superior when apatinib was combined with chemotherapy or immunotherapy compared to apatinib monotherapy (ORR: 43% vs. 17%, DCR: 87% vs. 82%, mPFS: 4.52 vs. 4.13 months), while there was no significant difference in mOS between the two groups (8.82 vs. 9.29 months). The primary AEs of apatinib included hypertension (45%), hand-foot syndrome (33%), proteinuria (31%), fatigue (30%), and anemia (31%). Only neutropenia (12%) and hypertension (11%) had grade 3 or higher AEs occurring at a rate exceeding 10%.

Conclusions: Apatinib has shown promising efficacy and tolerability in the treatment of ES-SCLC. Compared with monotherapy, apatinib combined with chemotherapy or immunotherapy may offer enhanced therapeutic benefits.

Background: Tyrosine kinase inhibitors (TKIs) are crucial targeted therapies for non-small cell lung cancer (NSCLC) patients harboring driver gene mutations. TKI-induced interstitial lung disease (TKI-ILD) is uncommon but potentially life-threatening, particularly when there is a poor response to initial corticosteroid treatment. Early identification of patients with refractory TKI-ILD is pivotal for effective management and prognosis. This study aimed to identify risk factors for refractory TKI-ILD.

Methods: We conducted a retrospective analysis of clinical records from 71 patients with TKI-ILD at our institution. Refractory TKI-ILD was defined as ILD unresponsive to initial steroid therapy as per therapeutic consensus. We evaluated clinical characteristics, peripheral blood biomarkers, radiological features, and treatment outcomes in both non-refractory and refractory TKI-ILD cases. Risk factors associated with refractory TKI-ILD were examined.

Results: Among 71 patients diagnosed with TKI-ILD, 10 (14.1%) developed refractory TKI-ILD. There was a significant disparity in gene mutations (P=0.02) between the two groups. Specifically, anaplastic lymphoma kinase (ALK) rearrangement was more prevalent in the refractory group than in the non-refractory group (40.0% vs. 9.8%). Shortness of breath (100% vs. 55.7%, P=0.02) and dyspnea (60% vs. 11.5%, P=0.001) were more frequent in the refractory group. At TKI-ILD onset, white blood cell count (WBC) [10.58 (8.21-15.38) vs. 6.94 (5.06-10.29) ×109/L, P=0.04] and absolute neutrophil count (ANC) [9.67 (5.71-13.36) vs. 4.53 (3.13-7.85) ×109/L, P=0.04] were significantly high in the refractory TKI-ILD group. Additionally, lactate dehydrogenase (LDH) levels in the refractory group were significantly elevated compared to those in the non-refractory group [422.00 (311.50-518.50) vs. 279.00 (206.00-332.00) U/L, P=0.03]. Radiographic patterns also differed significantly between the two groups (P<0.001), with diffuse alveolar damage (DAD)-like patterns being most prevalent in refractory TKI-ILD patients (80%). Multivariable logistic analysis identified dyspnea, LDH >420 U/L at TKI-ILD onset, and DAD radiographic pattern as independent risk factors for refractory TKI-ILD. The mortality rate of refractory TKI-ILD was 50% (5/10).

Conclusions: The mortality rate associated with refractory TKI-ILD is substantial. Dyspnea, LDH >420 U/L at TKI-ILD onset, and DAD radiographic pattern are independent risk factors that may aid in identifying refractory TKI-ILD cases.

Background: Neoadjuvant chemotherapy has been demonstrated as playing a key role in improving the prognosis of patients receiving surgical resection for local pancreatic ductal adenocarcinoma (PDAC) when compared to up-front surgery. However, the addition of radiation to chemotherapy remains controversial. As such, our study aims to characterize differences in characteristics and outcomes for patients receiving neoadjuvant chemotherapy with radiation (NCR) versus those receiving neoadjuvant chemotherapy alone (NC).

Methods: We conducted a retrospective analysis of the National Cancer Database (NCDB) from 2015 to 2020. Patients with localized PDAC (stages I-III) who received neoadjuvant chemotherapy and curative-intent resection were included. Individuals were classified into NC and NCR cohorts based on the treatment they received, with NCR being defined as radiation starting at least 30 days after chemotherapy commencement. Patients receiving adjuvant chemotherapy were included. Univariate models assessed for heterogeneity between cohorts for demographic and tumor characteristics. Multivariate logistic regressions and propensity-matched Cox proportional hazards models assessed for treatment outcomes and survival analysis, respectively. Kaplan-Meier curves were generated to visualize survival between cohorts. Linear regressions quantified utilization trends for these two cohorts as well.

Results: This study included 6,472 patients total (NCR: 2,117; NC: 4,355). The NCR patients were younger (64.6 vs. 65.8 years, P<0.001), had differences in tumor primary site (P<0.001), clinical and pathologic staging (P<0.001), and Charleson-Deyo comorbidity score (P<0.001). On multivariate analysis, the NCR cohort had higher odds of tumor downstaging [odds ratio (OR) =2.15, 95% confidence interval (CI): 1.70-2.71, P<0.001], lower odds for pathologic node status (OR =0.42, 95% CI: 0.38-0.48, P<0.001), and lower odds of receiving adjuvant chemotherapy (OR =0.56, 95% CI: 0.49-0.64, P<0.001) but no difference in R0 resection was noted (OR =0.95, 95% CI: 0.80-1.12, P=0.52). Propensity-matched models revealed that NCR was associated with improved overall survival (OS) when compared to NC [hazard ratio (HR) =0.88, 95% CI: 0.80-0.97, P=0.01]. Lastly, the NC cohort had an increase of +166.7 cases/year (P<0.001), but the NCR cohort did not show a significant trend (+35.1 cases/year, P=0.07) from 2015-2020.

Conclusions: In patients with localized PDAC who receive curative-intent resection, the addition of radiation to neoadjuvant chemotherapy is associated with improved tumor downstaging, negative node status, and superior survival outcomes. As such, our work supports the use of radiation in the neoadjuvant setting to supplement chemotherapy and highlights further evaluation of its benefits.

Background: Bladder cancer (BCa) and kidney cancer are increasingly significant public health concerns in China. However, comprehensive analyses of their long-term disease burden trends and future projections remain limited. This study analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for BCa and kidney cancer in China from 1990 to 2021 using Global Burden of Disease (GBD) data, and projected their future burden over the next two decades.

Methods: GBD 2021 data were used to evaluate age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years rate (ASDR). Trends were assessed using Joinpoint (v5.2.0) and R (v4.5.1) to calculate average annual percentage changes (AAPCs). Future burdens (2022-2041) were forecasted with an autoregressive integrated moving average (ARIMA) model.

Results: From 1990 to 2021, China experienced significant increases in BCa and kidney cancer incidence, prevalence, mortality, and DALYs. For BCa, ASIR and ASPR increased, while ASMR and ASDR decreased relative to 1990. Kidney cancer showed rising ASIR, ASPR, and ASMR, with ASDR slightly declining. AAPC analysis revealed BCa trends of ASIR (+0.12%), ASPR (+1.59%), ASMR (-1.60%), and ASDR (-1.74%); kidney cancer showed ASIR (+2.39%), ASPR (+3.47%), ASMR (+0.41%), and ASDR (-0.01%). Projections suggest BCa ASIR will keep rising in both sexes by 2041, while ASPR will decline, particularly in males. Kidney cancer ASIR is expected to rise in males but stabilize in females, with ASPR remaining steady.

Conclusions: Between 1990 and 2021, China faced growing burdens of BCa and kidney cancer, with notable sex-specific patterns. Projections highlight the need for targeted, age- and sex-specific prevention and control strategies.