Chinese clinical oncology最新文献

Background: Intestinal flora, or gut microbiota, has increasingly been recognized for its potential role in cancer development and progression. Beyond direct interactions with systemic organs, gut microbiota and its metabolites can modulate epigenetic processes such as DNA methylation, histone modification, and non-coding RNA regulation. This study aims to bridge this gap by conducting a bibliometric and visualization analysis of the scientific literature on cancer associated with intestinal flora.

Methods: We utilized bibliometric software to examine publication trends, citation patterns, and collaborative networks within the field. Visualization techniques were applied to pinpoint influential authors, institutions, and countries. The analysis encompassed a comprehensive search of relevant databases to gather data on publications related to intestinal flora and cancer.

Results: Our findings indicate a substantial rise in publications over recent decades, signifying an intensifying focus on the intestinal flora-cancer connection. Key research hotspots identified include the microbiota's role in colorectal cancer, the interplay between microbiota and the host immune system, the epigenetic impacts of gut microbiota on cancer development, and the promise of microbiota-targeted therapies for cancer treatment. The analysis also revealed a network of prominent researchers, leading institutions, and countries at the forefront of this research area.

Conclusions: This study offers a panoramic view of the current research on cancer associated with intestinal flora and underscores potential avenues for future exploration. The insights gleaned from our bibliometric and visualization analysis may guide the development of targeted strategies for cancer prevention and treatment, harnessing the power of the gut microbiota.

Background and objective: Immune checkpoint inhibitors (ICIs) have transformed the treatment of advanced urothelial carcinoma (UC) and renal cell carcinoma (RCC). Their expanding use in the adjuvant setting, aimed at eliminating micrometastatic disease post-surgery, holds significant promise. However, balancing potential survival benefits with the risk of immune-related adverse events (irAEs) in patients who are otherwise disease-free requires careful consideration. This review evaluates current evidence on adjuvant ICIs in UC and RCC, with emphasis on clinical efficacy, irAE profiles, and strategies for mitigating toxicity.

Methods: A targeted literature search was performed across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, supplemented by manual review of American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) conference abstracts, to identify relevant studies on adjuvant ICI therapy in urological malignancies between 24 September 2024 and 25 January 2025. Relevant data on efficacy, safety, and irAE management were synthesized to highlight critical findings and research gaps.

Key content and findings: Adjuvant ICIs have shown meaningful improvements in disease-free survival for patients with high-risk UC and RCC. Grade ≥3 irAEs, particularly endocrine toxicities such as hypothyroidism, adrenal insufficiency, and hypophysitis, are relatively frequent and often irreversible, necessitating lifelong hormone replacement and long-term follow-up. Although some trials have not demonstrated overall survival advantages, emerging evidence suggests biomarkers such as circulating tumour DNA (ctDNA) could guide more precise patient selection. Optimising irAE management is pivotal, as these events can significantly affect quality of life in a population that may remain disease-free.

Conclusions: Adjuvant immunotherapy represents a potentially significant advance in UC and RCC, offering improved outcomes for select patients. Yet, the persistent nature of irAEs calls for vigilant surveillance, robust biomarker development, and integration of patient-reported outcomes to ensure informed clinical decision-making. The next frontier will rely on better risk stratification and toxicity mitigation to translate disease-free gains into durable, life-extending benefits. Future research that refines patient selection criteria and irAE management will be crucial for translating these survival gains into long-term benefits and shaping evidence-based guidelines in urological oncology.

Background: Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy, ranking as the second most aggressive endocrine tumor after anaplastic thyroid cancer. ACC typically presents symptoms caused by the tumor mass and less often with signs of excess hormones. Due to its rarity, the diagnosis and management of ACC pose significant challenges, with limited clinical guidelines, a lack of large-scale randomized studies, and a paucity of treatment experience.

Case description: This report highlights the case of a 51-year-old male patient who presented with a giant intra-abdominal mass, which raised suspicion for ACC. He initially reported a history of abdominal discomfort associated with a large palpable abdominal mass. However, by the time of his presentation to our department, he was asymptomatic. After thorough imaging, a large tumor was resected, and histopathological examination confirmed the diagnosis of ACC. The tumor, measuring 31 cm in diameter and weighing 4.7 kg, is one of the largest reported cases of ACC.

Conclusions: This case is significant as it underscores the critical role of early detection and surgical intervention in potentially improving patient outcomes. Additionally, it highlights the need for continued research to better understand the pathophysiology, diagnosis, and therapeutic approaches to this rare and aggressive malignancy, which remains a considerable clinical challenge.

Malnutrition and cachexia in cancer patients, particularly those with lung cancer, represent a pervasive clinical challenge that compromises treatment outcomes, quality of life, and overall survival. This article analyzes the multifactorial etiology of oncological malnutrition, highlighting the chronic inflammatory state, tumor-induced anorexia, and metabolic abnormalities that accelerate muscle and weight loss. It underscores that rates of malnutrition can range from 30% to 80% across different tumor types, with lung cancer patients especially vulnerable due to their high inflammatory burden. The text reviews key tools for screening and diagnosing malnutrition, such as Nutriscore, Subjective Global Assessment (SGA), and Patient-Generated Subjective Global Assessment (PG-SGA), as well as the relevance of the Glasgow Prognostic Score in linking inflammation with poorer clinical outcomes. Strategies for early nutritional intervention include enteral and parenteral feeding, oral nutritional supplements (ONS), and customized dietary counseling. Additionally, specialized approaches such as immunonutrition, omega-3 fatty acids, and targeted micronutrient supplementation are discussed, reflecting evidence that multiple nutrients, including arginine and glutamine, can exert immunomodulatory and anti-inflammatory effects. Furthermore, the article emphasizes the importance of identifying and managing cancer-associated sarcopenia, in which screening tools like Strength, Assistance with walking, Rise from chair, Climb stairs, Falls (SARC-F)/calf circumference (CalF) offer early detection of muscle mass deficits. Psychological support and patient education are positioned as integral components of a holistic intervention plan, aimed at optimizing nutritional status and mitigating the side effects of chemotherapy and radiotherapy. Ultimately, the need for larger-scale randomized clinical trials is highlighted to refine best practices, establish standardized methodologies, and confirm the clinical benefits of comprehensive nutritional therapies in patients with lung cancer.

Background and objective: Most of newly diagnosed prostate carcinomas (PCas) present as non-metastatic disease, with approximately 15% of them presenting with characteristics predicting for a high-risk of relapse. Hence, specific focus has to be placed on patients affected by localised or locally advanced disease, whose chances of cure are notably higher than those of patients in advanced settings. With androgen receptor pathway inhibitors (ARPIs) and docetaxel chemotherapy improving treatment efficacy outcomes when compared to traditional androgen deprivation therapy (ADT) in the metastatic disease, clinical trials are currently investigating the activity of ARPI for clinical management of localised or locally advanced prostate patients, with the aim of preventing the cancer from spreading systemically. To provide further insight into the biological and clinical rationale of an early treatment intensification, here we review and enlist promising studies on the treatment of localised, locally advanced, and biochemically relapsed disease. Finally, we briefly review the latest experimental treatments for these early stages-including novel agents and combinations which are believed to shape the future practice.

Methods: PubMed and MEDLINE databases were searched for trials focusing on the treatment of localised/locally advanced PCa, and which included the use of second-generation ARPIs. Also, proceedings from major oncology and uro-oncology meetings were screened.

Key content and findings: Our analysis has not yielded significant results supporting the implementation of second-generation ARPIs in the perioperative or neoadjuvant treatment of localised PCa. However, the data suggest these drugs may offer benefits in the adjuvant setting, following both radical prostatectomy (RP) and primary radiotherapy (RT).

Conclusions: The design of clinical trials that explore surrogate endpoints like metastasis-free survival (MFS) or employing multi-arm trials with genomic testing could facilitate further advancements in this field, as well as research on combining ARPI treatment with inhibition of other pathways or exploiting the immune response beyond PD-1/CD276.

Background: Chemotherapy has played an essential role in nasopharyngeal carcinoma (NPC) management since the 1980s, when its radiosensitizing effects were first recognized. The landmark Intergroup 0099 trial established concurrent cisplatin-based chemoradiotherapy as the standard for locoregionally advanced NPC, demonstrating significant survival benefits over radiotherapy alone. As an Epstein-Barr virus (EBV)-associated malignancy with distinct geographical distribution (endemic in southern China and Southeast Asia), NPC presents unique therapeutic challenges. Subsequent studies refined chemotherapy sequencing, introducing induction approaches to address distant failure risks and adjuvant strategies for high-risk cases. The evolution of chemotherapy regimens has been particularly crucial given NPC's anatomical complexity and surgical limitations. Recent years have seen growing emphasis on balancing efficacy with toxicity reduction, especially for endemic populations where treatment-related morbidity significantly impacts quality of life. The published documents of the last 10 years were analyzed by bibliometrics and visualization in order to assess the focus and trend of chemotherapy research in NPC.

Methods: Based on Web of Science Core Collection (WoSCC) database, the relevant literatures during the period 2014-2024 were searched and visualized the countries, authors, institutions, and keywords through CiteSpace and VOSviewer to understand the hotspots and trends of chemotherapy in NPC treatment.

Results: In the past decade, chemotherapy has gained more and more attention in NPC, and the leading countries are China and the United States, and the author with the most publications is Jun Ma. Sun Yat-sen University is the institution with the most publications.

Conclusions: Our study has learned that combination chemotherapy and survival prognosis are the focus of attention in this field, and bibliometrics can help us to have a better understanding and management of it.