Chinese clinical oncology最新文献

Background: For patients with advanced hepatocellular carcinoma (HCC), it is emergent to focus on elucidating different classifications of intratumoral heterogeneity and understanding the mechanisms of treatment resistance to improve prognosis. This study aims to classify the sub-clusters of cancer cells in patients diagnosed with advanced HCC, and identify the genes, pathways and microenvironment associated with prognosis.

Methods: Single-cell transcriptomic profiling were conducted on advanced HCC samples. Bulk RNA-seq transcriptome data were obtained from The Cancer Genome Atlas (TCGA) database. Prognosis analysis was performed for survival stratification within the identified sub-clusters. Enriched genes and pathways were determined, and the association and underlying mechanism of the identified sub-cluster of cancer cells were elucidate with other cellular components within advanced HCC tumor tissue.

Results: A total of 26,800 cells were obtained from two patients with advanced HCC. Seven sub-clusters were identified, and only the CancerCell 6 cluster were exhibited significant disparities in both overall survival (OS) and progression-free survival (PFS) rates according to the 370 HCC patients from the TCGA database. The CancerCell 6 cluster was associated with adenosine triphosphate (ATP)-related pathways and the high expression of pyruvate kinase M (PKM). It also demonstrated a strong interaction ability with mononuclear phagocytes (MPs). The MPs_MMP9 cluster showed strong interactions between the CancerCell 6 cluster and related signaling pathways of EDN and NOTCH, indicating a tendency toward M2 polarization.

Conclusions: This study identified the CancerCell 6 cluster associated with a poor prognosis and characterized by ATP-related metabolism. This cluster demonstrated interactions with MPs inclined to M2 polarization.

Background: Pediatric radiotherapy (RT) presents unique challenges due to the need for young patients to remain still during treatment, often in unfamiliar and intimidating environments. To achieve compliance and immobilization, many children, particularly those under six, are routinely administered general anesthesia (GA) or sedation, despite the associated risks and complications. These include respiratory and neurocognitive side effects, increased healthcare costs, and the strain on clinical resources. To address these challenges, various preparatory strategies have been developed globally, aiming to reduce the need for GA by enhancing patient understanding, cooperation, and comfort through physical, psychological, and educational interventions. This scoping review examines the current landscape of pediatric RT preparation, focusing on identifying service gaps, evaluating the effectiveness of existing approaches, and exploring opportunities for improvement.

Methods: A scoping review was conducted using PubMed, Embase, Scopus, and ScienceDirect databases, covering literatures from 2000 to 2023. The search strategy focused on terms related to pediatric RT preparation. Studies were included if they detailed preparation services, and data extraction emphasized intervention types, outcomes, and identified service gaps.

Results: Of 593 papers identified, 73 met the inclusion criteria. Approximately 24% of the papers highlighted challenges faced by pediatric patients and their carers, including anxiety and misunderstandings about RT. Notably, for all paediatric patients aged under 21 years, 46% of them require GA or sedation for RT. For the age group below 3 years, 60% patients require GA or sedation for RT. For the age group above 3 years, 37% patients require GA or sedation for RT. Furthermore, 19% of papers reported rare but severe neurocognitive and respiratory complications associated with GA. Emerging strategies such as pre-treatment visits, virtual reality (VR) simulations, play therapy, and distraction techniques show promise in reducing GA reliance. However, significant gaps remain, including limited multidisciplinary collaboration and a lack of specialized pediatric facilities.

Conclusions: This review highlights the urgent need for enhanced preparatory strategies in pediatric RT. Emphasizing pre-treatment support, gamification, advanced technologies, multidisciplinary collaboration, and specialized facilities can foster more positive treatment experiences and potentially decrease the dependence on GA or sedation.

Background: zinc and selenium are essential trace elements that have been suggested to influence cancer development, but their relationship with breast cancer remains unclear. Additionally, biomarkers such as bilirubin, uric acid, and gamma glutamyl transferase (GGT) are associated with various metabolic processes that could affect cancer progression. This research aimed to examine the associations between zinc and selenium levels and breast cancer, and the extent to which bilirubin, uric acid and GGT mediate the effect on breast cancer.

Methods: In all, 25,244 females were enrolled from the 1999-2020 National Health and Nutrition Examination Survey (NHANES). The associations between zinc and selenium intake and prevalent breast cancer were explored through meticulous adjustments for covariates utilizing both multivariate and stratified logistic regression analyses. Furthermore, the mediation and interaction effects were performed by mediation analyses and generalized linear model.

Results: Prevalent breast cancer was associated with race, marital status and age. Additionally, participants with breast cancer showed lower zinc (10.2 vs. 12.0 mg, P=0.001) and selenium levels (95.7 vs. 114.4 µg, P<0.001) and higher incidence of diabetes (2.60% vs. 97.40%, P<0.001) and cardiovascular disease (CVD) (3.07% vs. 96.93%, P<0.001) comorbidities than the control group. Logistic regression analysis showed a strong linear protective association between zinc and selenium levels and breast cancer. After further adjustment in Model 3, statistical significance remained for each unit increase in selenium [odds ratio (OR), 0.66; 95% confidence interval (CI): 0.47-0.93; P=0.02], as well as for Q4 versus Q1 for zinc (OR, 0.48; 95% CI: 0.27-0.86; P=0.01). In addition, a significant age-effect modification was observed for zinc (Pinteraction=0.07) associations were stronger in women aged over 40 years compared to younger women. Finally, bilirubin potentially mediated the protective association between zinc and breast cancer, while bilirubin, uric acid, and GGT levels mediated approximately 10% of the relationship between selenium and breast cancer.

Conclusions: Our study highlighted negative correlations between zinc and selenium intake and breast cancer in women. The mediation analysis has shown that bilirubin, uric acid and GGT play an indirect role.

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.

Background: Liver resection (LR) remains the only curative approach for patients diagnosed with intrahepatic cholangiocarcinoma (ICC). Although margin-negative resection can be achieved, long-term oncological outcomes still need improvement. Recent studies from both single and multi-institutional settings have indicated that liver transplantation (LT) could be a feasible treatment option for ICC under particular conditions. While some research has compared LT with LR in treating ICC patients, the results of these comparisons remain controversial. This meta-analysis compares the surgical outcomes of LT and LR for ICC.

Methods: We conducted a thorough search of the Cochrane Library, Web of Science, and PubMed for articles comparing the ICC of LT and LR published from January 2000 to April 2024. The studies' relevance and quality were assessed independently by two investigators. Odds ratios (ORs) were utilized to evaluate dichotomous data, and fixed-effects were employed for meta-analyses.

Results: Five studies were analyzed in this meta-analysis, revealing no significant difference in 1-year overall survival rates between LT and LR. However, LT showed significantly higher 3-year, and 5-year overall survival rates compared to LR, with ORs of 1.39 [95% confidence interval (CI): 1.04-1.84, P=0.02] at 3 years, 1.71 (95% CI: 1.30-2.26, P<0.001) at 5 years. The advantage of LT over LR in terms of overall survival became evident at 3 years, 5 years, and post-operation, despite not being apparent in the first year. Additionally, the R0 resection rate was higher following LT than LR (P=0.006), potentially contributing to the superior long-term outcomes of LT. Subgroup analysis revealed no statistically significant difference in survival outcomes between the two treatment regimens when LT failed to achieve R0 resection.

Conclusions: For patients with ICC, LT seems to have optimistic survival results under certain conditions compared with curative hepatectomy. Since LT is a potential treatment for ICC, it is currently uncertain whether LT should be more considered in patients with ICC. Further prospective trials are required to demonstrate its efficacy in the future.

This paper analyzes the manuscripts in the field of gastric cancer (GC) prediction, guiding clinical work and prevention of GC. Using a search strategy, we retrieved research articles related to GC prognosis from the Web of Science (WOS) core database: topic search (TS) = ((gastric cancer OR stomach cancer) AND (survival rate OR survival analysis OR prognosis) AND (predict model)). We set the language to English, the document type to article and review, and completed the search on July 1, 2023. We obtained 1,598 relevant articles, and two researchers screened the search results again, excluding irrelevant, misclassified, and retracted articles. Any controversial articles were reviewed by a third researcher to make the final decision on the required literature. We finally selected 1,056 articles, excluding 542 articles, and extracted the required data from the WOS database for analysis. The extracted database included: title, publication year, author, country/region, institution, citation count, journal, keyword, and reference. We used R (4.3.0) to load the R package (bibliometrix) for bibliometric analysis. The 1,056 articles came from 273 sources (journals, books, etc.), and 3,661 authors conducted relevant research on GC prognosis models. Frontiers in Oncology published the most articles (N=72), and Gastric Cancer Journal had the most citations (N=1,130). The publication time span ranged from 1991 to 2023, with an average annual growth rate of 13.31%. The number of publications increased from 2017, with a sharp increase from 2020 to 2023. The five countries with the most publications were China (n=826), Japan (n=62), Korea (n=47), USA (n=42), Italy (n=19). China had the most citations (N=9,595), and USA had the highest average citation per article (44.9 times). The most common topic was GC survival (n=236), followed by expression (n=209). Multiple GC prediction models in this study describe the science of predicting GC incidence and prognosis. This work provides the most influential references related to GC prediction and serves as a guide for citable papers.

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.