Chinese clinical oncology最新文献

Background: Sparsely granulated (SG) growth hormone-secreting pituitary neuroendocrine tumors (GH-PitNETs) often present with a more aggressive clinical course compared to densely granulated (DG) tumors. These subtypes exhibit distinct biological and imaging characteristics. Thus, this study aims to differentiate between the histopathological subtypes of GH-PitNETs using pre-operative magnetic resonance imaging (MRI).

Methods: A retrospective analysis was conducted on 83 acromegalic patients treated at our institution between 2000 and 2010. Tumor volumes were segmented from preoperative MRIs, including T1-weighted, T2-weighted, T1 with contrast, and T2 fluid attenuated inversion recovery (FLAIR) sequences. Reference regions of interest (ROIs) were delineated using gray and white matter from the same sequences. Two pathologists reviewed pathology specimens for anti-cytokeratin (CAM 5.2) and Pit-1 expression. Clinical and radiological biomarkers were compared between SG and DG patients.

Results: A total of 83 patients with complete histopathology and 51 patients with complete MRIs were included in the analysis. SG PitNETs exhibited higher rates of supra-sellar invasion (61.5%, P<0.001), larger tumor sizes, lower pre-operative GH levels, and increased post-operative residual tumor (65.4%, P<0.001) compared to DG PitNETs. Additionally, SG PitNETs showed greater hyperintensity on T2-weighted images and enhanced contrast, whereas DG PitNETs exhibited less contrast enhancement. Utilization of these imaging biomarkers demonstrated an 94.1% accuracy in T2 FLAIR and overall of 78.7% predicting the histopathological subtypes of GH-PitNETs.

Conclusions: Distinct histopathological subtypes of GH-PitNETs represent crucial prognostic factors. Utilizing multimodal pre-operative MRIs, clinicians can accurately identify sparsely granulated GH-PitNETs, facilitating improved treatment planning strategies.

Background: Gliomas are the most common central nervous system (CNS) tumors in infant but with incidence rate only 1.38 per 100,000. Due to distinctive clinical, histologic, and molecular features, the current World Health Organization (WHO) CNS5 separate gliomas in children from adult as pediatric-type diffuse high-grade and low-grade gliomas. Infant hemispheric gliomas constitute a biologically and clinically distinct subgroup of pediatric-type diffuse high-grade. In this case we present clinical, radiographic, intraoperative, and methylation profiling of the first infant-type hemispheric glioma diagnosed in Indonesia.

Case description: This is a case report of infant operated at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia in February 2024. A 6-month-old male infant brought to regional hospital due to head enlargement compared to infant of the same age, head circumference was 50 cm [>2 standard deviation (SD)] with frontal bossing. Brain MRI showed large multi-loculated cystic lesion at left parietooccipital region, which appeared hypointense on T1-weithgted (T1W), hyperintense on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR), with irregular contrast enhancing border. There was isointense lesion on T1W with inhomogeneous contrast enhancement. The largest volume of cystic lesion was 216 cm. Intraoperatively, parietal bone was thinner than usual. The brain was tense, purplish, and non-pulsating, giving the impression of a tumor with indistinct borders with the normal cortex. Dark clear yellowish fluid was spurt after the cortex was incised. Histopathological findings revealed moderate to high cellularity tumor tissue with mitosis, microvascular proliferation, palisading necrosis. In collaboration with German Cancer Research Center (DKFZ), DNA methylation array analysis showed the tumor to match the Infant-type Hemispheric Glioma methylation class (calibrated score 0.94) with deletion of cyclin dependent kinase inhibitor 2A/B (CDKN2A/B).

Conclusions: Methylation class (MC) infant-type hemispheric glioma may present with macrocephaly. On magnetic resonance imaging (MRI) it may appear as large multi-loculated cystic lesion and irregular contrast enhancing border. The key diagnostic criteria for infant-type hemispheric glioma involve combination of clinical, pathological, and molecular feature.

Background: Brain cancer patients, especially those suffering from high-grade gliomas (HGGs) face a bleak future with very dismal long-term disease-free survival outcomes due to the limited treatment options currently available. Therefore, there is an unmet need for new therapeutic intervention that extends patients' progress-free survival and improves their quality of life. A significant hurdle is the inability of current chemotherapy agents to cross the blood-brain barrier (BBB). BBB acts as a protective shield that filters the blood to ensure nothing harmful makes it to the brain. This protection is usually good, but it becomes a problem if you want to deliver therapeutic cancer drugs through it. This barrier blocks 98% of drugs from entering the brain. Even the ones that cross BBB are unevenly distributed in the normal brain and tumour tissue, resulting in mediocre treatment and severe side effects.

Methods: We are developing drug delivery systems that can cross the BBB and facilitate the specific accumulation of drugs in the tumour tissue. This will significantly improve the efficacy of anticancer drugs in treating various brain cancers and reduce systemic toxicity. Our group has explored and developed BBB crossing and tumour targeting near infra-red dyes, which can be covalently attached to Food and Drug Administration (FDA)-approved chemotherapy agents (drug-dye conjugates), thereby delivering it to the tumour tissue.

Results: We synthesized such drug-dye conjugates to target various aberrant pathways in HGG and tested these conjugates against patient-derived HGG cell lines. One such conjugate was tested on a mouse model of glioblastoma, an aggressive form of HGG, and shown to cross the BBB and specifically accumulate in tumour tissue, bringing forth tumour burden reduction.

Conclusions: The results obtained from this work serve as proof of principle that enables tumour-specific drug delivery to treat HGG. This work also paves the way for treating other brain cancers and central nervous system (CNS) disorders like Parkinson's and Alzheimer's disease, for which no adequate therapy exists.

Background: Insular gliomas present significant challenges due to their deep-seated location and proximity to critical structures, including sylvian veins, middle cerebral arteries (MCAs), lenticulostriate arteries, long insular arteries, and functional cortices and white matter tracts. The Berger-Sanai classification categorizes them into four zones (I-IV), providing a framework for understanding insular gliomas. The key factors for successful insular glioma removal are achieving the greatest insular exposure and surgical freedom. There are two main types of approach methods, such as transsylvian approach with meticulous wider dissection of the sylvian fissure and transcorticosubcortical approach with intraoperative functional brain mapping under awake surgery to remove the functionally silent cortices and white matter tracts. Because splitting the distal sylvian fissure is more challenging, a transcortical approach through the parietorolandic operculum in awake patients has been reported to be more effective access to the posterior insular gliomas (Zone II and III) in the dominant hemisphere. The object of this study emphasize the importance of the transsylvian approach for radical resection of insular gliomas.

Methods: We retrospectively analyzed our experiences with radically resected insulo-opercular gliomas. Basically, we pursue the transsylvian approach for resecting insular gliomas without removal of any normal brain.

Results: Motor pathways running beneath the parietorolandic operculum can be damaged by ischemia caused by sacrificing the medullary arteries (MAs) arising from the pial arteries of the M3 and M4 portions of the MCA. Motor deficit after resection of this area was significantly found in the elderly patients. This phenomenon might be described by the age-associated decreasing the vascular reserve capacity. Autopsy brains showed that the sclerotic rate of the MAs increased with age and hypertension. Even with the intraoperative functional brain mapping, we cannot avoid the ischemic complication caused by sacrificing the MAs during stepwise removal of the functionally silent cortices and white matter tracts.

Conclusions: We make a suggestion not to remove the parietorolandic operculum in elderly patients with insular gliomas located at Zone II and III. Distal transsylvian approach should be applied.

Background: World Health Organization (WHO) grade 4 astrocytoma is a high-grade brain tumour in adults. Tumour treating fields (TTF) has been shown to improve overall survival (OS). Few studies have explored quality-of-life (QoL) in these patients. This study aims to assess the QoL of TTF patients and OS.

Methods: This was a prospective multicenter study of adult patients diagnosed with WHO grade 4 astrocytoma from 2018 to 2023 receiving TTF for >1 month after completing standard therapy. A propensity-score matched comparison with a 1:2 ratio with historical control was performed for OS analysis. The patients completed European Organisation for Research and Treatment of Cancer (EORTC) QLQ-30/BN20 questionnaires before TTF and at 3-month interval. Primary outcomes included OS, and secondary outcomes included QoL and TTF-associated adverse effects at 3 months.

Results: A total of 141 patients were reviewed, with TTF patients (n=47, 33%) and propensity-score matched controls (n=94). The mean duration of TTF use was 10±8 months. The mean age of the TTF group was 54±13 years, and for the control group 52±13 years. Sixty percent (n=28) were male, similar to the control group with 71% (n=67) (P=0.16). Seventy-two percent of TTF patients had preoperative Karnofsky Performance Scale (KPS) score ≥80, while controls had 70% (P=0.79). Five (11%) TTF patients and 8 (9%) controls were IDH1 mutant (P=0.70). Twenty (43%) TTF patients and 42 (45%) controls were O6-methylguanine-DNA methyltransferase promoter (pMGMT) methylated (P=0.81). Twenty-one (45%) of TTF patients and 55 (59%) of controls had gross total resection (P=0.72). After adjusting for independent predictors for OS, the median OS of the TTF group was 22.4 months [interquartile range (IQR): 18.6-26.5 months], significantly longer than the control group (17.2 months; IQR: 12.1-22.3 months) (log-rank test: P=0.01). Forty-seven TTF patients and 40 control patients completed EORTC questionnaires. There was no difference for EORTC functional and symptom scores between the TTF and control group [P=0.45, analysis of variance (ANOVA)] at 3 months. Thirty-two (67%) of TTF patients reported associated RTOG grade I scalp dermatitis.

Conclusions: TTF for WHO grade 4 astrocytoma patients is an independent predictor for OS. QoL between the groups was similar, and overall QoL over time for TTF patients was not affected. TTF is a novel and effective outpatient treatment with minimal adverse effects.

Background: The 2021 World Health Organization (WHO) classification has significantly enhanced the molecular diagnostics of diffuse gliomas, emphasizing the role of molecular features alongside histology. However, accurate classification remains challenging, particularly for high-grade gliomas, IDH-wildtype. DNA methylation profiling provides an unbiased diagnostic approach, offering valuable insights into tumor classification. Here, we present a case of a high-grade glioma, initially diagnosed as glioblastoma, IDH-wildtype based on histological and genetic analysis, but later reclassified as a diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype (RTK2 subtype) through methylation profiling.

Case description: A 7-year-old boy presenting with seizures was admitted to our hospital, where brain magnetic resonance imaging revealed a tumor in the right temporal lobe. Intraoperative histology indicated a high-grade glioma, prompting maximal resection. Diagnosis according to the 2021 WHO classification involved histological analysis, immunohistochemistry, testing for specific genetic alterations, and DNA methylation profiling. Histological and immunohistochemical assessment initially identified the tumor as a high-grade astrocytoma, IDH-wildtype. Specific genetic testing revealed IDH1-wildtype, IDH2-wildtype, and TERT promoter mutation, consistent with a diagnosis of glioblastoma, IDH-wildtype. However, methylation profiling yielded a classifier score of 0.99 for a diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype (RTK2 subtype).

Conclusions: Our case illustrated that conventional histological and genetic analysis classification can be reclassified according to the DNA methylation analysis, demonstrating that methylation profiling is useful to accurately classify high-grade gliomas, particularly those of the IDH-wildtype subtype.

Background: Ferredoxin 1 (FDX1) plays key roles in promoting elesclomol-induced cuproptosis against cancer, whether it has the potential to be a new therapeutic strategy against glioblastoma has not yet been clarified.

Methods: Glioblastoma cells were treated with elesclomol (20 nM/L) and copper chloride (2 μM/L), and then cell proliferation, migration, and invasion were evaluated by CCK-8, clonogenic and transwell assay. Western blot was performed to detect the expression of cuproptosis-relating proteins FDX1, lipoylated dihydrolipoamide S-acetyltransferase (DLAT), copper transport ATPase (ATP7A), heat shock protein 70 (HSP70), apoptotic markers B cell lymphoma-2 (BCL-2) associated X protein (Bax), and BCL-2, as well as the pan-apoptotic/death markers gasdermin D (GSDMD), solute carrier family 7 member 11 (SLC7A11). The effects of knockdown and overexpression of FDX1 on cell proliferation, migration, and invasion were observed. Bioinformatic analysis was performed to predict the corresponding transcription factors regulating FDX1 expression, and verified by dual luciferase assay. The regulatory relationship between FDX1 and its transcription factors was verified by rescue experiment and further evaluated in vivo.

Results: Elesclomol had obvious inhibitory effects on the proliferation, migration, and invasion capacities of tumor cells in a dose-dependent manner. When combined with copper chloride, the inhibitory effects on tumor cells were significantly higher both in vitro and in vivo. FDX1 expression was negatively correlated with overall survival of patients. Nuclear factor κ-light-chain enhancer of activated B cell 1 (NFκB1) was the transcription factor of FDX1 verified by dual luciferase assay. Both FDX1 and NFκB1 were highly expressed in glioblastoma. Knockdown of FDX1 or NFκB1 down-regulated proliferation, migration, and invasion abilities of tumor cells, and increased after FDX1 overexpression. FDX1 expression decreased correspondingly after NFκB1 knockdown. Up-regulation of FDX1 promoted elesclomol-induced cuproptosis against glioblastoma both in vitro and in vivo. FDX1 knockdown can reverse the inhibitory effect of elesclomol on tumor cells.

Conclusions: Elesclomol inhibits glioblastoma development via inducing cuproptosis, regulated by NFκB1/FDX1 axis.

Background: Current voxel-based morphometry (VBM) studies of chemoradiotherapy effects on healthy tissues of the glioblastoma multiforme (GBM) brain face a challenge with neuroanatomical distortions (tumor, tumor edema, and resection cavities) and limited comparisons can be drawn across studies due to lack of a universally accepted software package. Our aim is to compare current semi-automated segmentation methods and optimize them for reliability in investigating the effects of chemoradiotherapy on GBM patients.

Methods: A publicly available dataset was used based on predefined inclusion and exclusion criteria. VBM pipelines CAT12 and FSL were tested and optimized to reduce the impact of neuroanatomical distortions. T1-weighted images were screened, and post-processed with FSL and CAT12. Gray matter (GM) and white matter (WM), and cerebrospinal fluid (CSF) volumes of whole brain, tumour-containing and non-tumor containing hemispheres, pre- and post-chemoradiotherapy were calculated and analyzed with Wilcoxon signed-rank tests. Agreement and consistency between FSL and CAT12 were assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs).

Results: Post-chemoradiotherapy GM volumes were significantly reduced in whole brain with a compensatory significant increase in CSF volumes, while WM volumes had no significant changes. Similar trends were noted in tumor-containing and non-tumor-containing hemispheres. Bland-Altman plots showed good agreement between FSL and CAT12 processed GM and WM volumes of whole brain, tumor-containing, and non-tumor-containing hemispheres. ICC ≥0.70 was observed in GM [0.70 (0.53-0.82)] and WM [0.75 (0.60-0.85)] volumes of non-tumor-containing hemisphere, and WM [0.71 (0.55-0.83)] volumes of whole brain. GM volumes of tumor-containing hemisphere had good agreement but surprisingly, poor consistency [0.50 (0.25-0.68)]. CSF volumes in non-tumor-containing hemisphere had better agreement and consistency [0.55 (0.32-0.71)] than whole brain [0.49 (0.25-0.67)] and tumor-containing hemisphere CSF [0.36 (0.10-0.58)] volumes. Visual inspection revealed both CAT12 and FSL mis-segmented in the presence of neuroanatomical distortion although CAT12 was more susceptible in the presence of a hematoma.

Conclusions: VBM studies of chemoradiotherapy effects on the brain post-tumor resection remain challenging due to neuroanatomical distortions. A reliable alternative is to use non-tumor-containing hemispheres with no anatomical distortion. Should tumor-containing brains be used, FSL is a more suitable choice, especially in the presence of hematoma distortion.