Cancer statistics, 2024

Immunomodulatory effects of alexidine dihydrochloride on mammalian macrophages through the modulation of the JNK pathway

A plethora of the cancer drugs with high therapeutic potential cannot pass the clinical trials because of their immunotoxic activities. In this study, we tested the immunomodulatory and immunostimulatory effects of the anticancer agent alexidine dihydrochloride on J774.2 macrophage cell lines in vitro. The production levels of the pro-inflammatory cytokines (TNF-α, IL-6, GM-CSF, IL-12p40) were measured and compared by ELISA method. The activated (phosphorylated) JNK protein levels were measured by flow cytometer and the possible related intracellular signaling pathway was examined in this way. According to our results, alexidine dihydrochloride has an anti-inflammatory effect on the LPS-stimulated macrophage cell lines, as evidenced by reduced cytokine production compared to controls. Furthermore, its intracellular mechanism of action was found to be mediated partially through JNK signaling pathways. These findings suggest that alexidine dihydrochloride, while being an effective anticancer agent, may also modulate immune responses by dampening excessive inflammation. In this study, determining the anti-inflammatory effect of alexidine dihydrochloride on the immune system will seriously shed light on the role of this anticancer agent in future clinical studies and will provide a serious basis. In summary, the effects of the most drug-active ingredients on the inflammatory response in immune system cells have not been fully tested, and this creates the problem of many drugs failing in clinical studies or lack of knowledge on their side effects. Our study aimed to determine the effect of alexidine dihydrochloride, used as an anticancer agent, on the inflammatory response in J774.2 macrophage cell lines. Future studies with more immune system cells and a wider analysis of the intracellular signaling pathways will be informative about the immunotoxicity of the drug molecule. Future research involving a broader range of immune cell types and a more comprehensive analysis of intracellular signaling pathways will help clarify the immunotoxicity profile of this anticancer agent.

Second primary cancers among males with a first primary prostate cancer: a population-based study in Northern Portugal

Increased survival and life expectancy among patients with prostate cancer results in an increased risk of developing a second primary cancer (SPC). We aimed to describe the occurrence of SPCs in a population-based cohort with a prostate first primary cancer (FPC), in Northern Portugal. A cohort of 13,222 patients with a prostate FPC from the North Region Cancer Registry of Portugal, diagnosed between 2000 and 2009, was followed until 31 December 2021, for synchronous (within six months of FPC diagnosis) and metachronous SPCs (all others). We describe absolute and relative frequencies of SPCs, incidence rates and standardized incidence ratios of SPCs (compared to the male general population), and cumulative incidence of metachronous SPCs. A total of 1953 (14.8%) patients with a prostate FPC developed an SPC, mostly of the colon, lung and bladder; synchronous SPCs occurred mainly in the bladder. Compared to the general male population, patients with a prostate FPC had a globally lower incidence of all cancers, and lung and oesophagus cancers, but a higher incidence of bladder and pancreas cancers. Overall, the incidence of synchronous SPCs was also significantly higher, likely reflecting the incidental diagnosis of SPCs. The 20-year cumulative incidence of metachronous SPCs was 15.4%. Patients with a prostate FPC had a lower overall incidence of SPCs than the general male population, despite a higher incidence in the first six-months after the SPC diagnosis. After that period, one out of seven may be expected to develop an SPC within two decades. Continued cancer surveillance among survivors is needed.

Persistent Poverty and Pediatric Cancer Survival

BACKGROUND

Cancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage.

METHODS

In this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality.

RESULTS

In total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85).

CONCLUSIONS

Our study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.

Development and clinical evaluation of [68Ga]Ga-NODAGA-ADAPT6 as a novel HER2-targeted PET radiotracer for breast cancer imaging and treatment monitoring

PURPOSE

Accurate assessment of human epidermal growth factor receptor type 2 (HER2) expression is crucial for diagnosis, treatment planning, and monitoring of breast cancer patients. A 68Ga-labeled tracer based on the albumin-binding domain-derived affinity protein 6 (ADAPT6) was developed to evaluate HER2 expression in breast cancer.

METHODS

The gene encoding ADAPT6 was modified with N-terminal (GHEHEHEDANS) and C-terminal (GSSC) extensions to enhance its functionality. The precursor was synthesized, purified, and characterized, followed by radiolabeling with 68Ga to produce [68Ga]Ga-NODAGA-ADAPT6. In vivo metabolism and biodistribution studies were performed in HCC1954 (HER2-positive) and MDA-MB-468 (HER2-negative) tumor-bearing mice. Additionally, with ethical approval and informed consent, 22 breast cancer patients underwent [68Ga]Ga-NODAGA-ADAPT6 PET imaging to assess HER2 expression in primary and metastatic lesions.

RESULTS

The tracer was prepared with a radiochemical purity exceeding 99% and demonstrated high stability in vivo. Micro-PET/CT imaging revealed significant accumulation of the radiotracer in HCC1954 tumors, which was markedly reduced after HER2 blockade with trastuzumab. In contrast, MDA-MB-468 tumors showed minimal uptake. In the clinical study, [68Ga]Ga-NODAGA-ADAPT6 PET images displayed varying levels of radiotracer uptake in primary and metastatic lesions, which correlated well with the HER2 expression status determined by pathological analysis.

CONCLUSION

[68Ga]Ga-NODAGA-ADAPT6 exhibited excellent pharmacokinetic properties and high specificity for HER2-expressing lesions in PET imaging. These findings highlight its potential as a promising tool for distinguishing different levels of HER2 expression in breast cancer, aiding in personalized treatment strategies.

TRUB1 is a novel biomarker for promoting malignancy in colorectal cancer via NFκB signaling

Background

Colorectal cancer (CRC) is one of the most aggressive malignancies of the digestive tract, characterized by aberrant post-transcriptional RNA modifications, including pseudouridine (Ψ). TruB pseudouridine synthase family member 1 (TRUB1) is a key pseudouridine synthase but its role in CRC progression remains unclear.

Methods

Public databases and CRC cell lines were analysed to assess TRUB1 expression in CRC. Receiver-operating characteristic (ROC) curve analysis and survival analysis were performed to evaluate the diagnostic and prognostic significance of TRUB1. The impact of TRUB1 on tumor proliferation and Ψ modification was examined in TRUB1-knock-down HCT116 cell lines. Mechanistically, RNA sequencing of control and TRUB1-knock-down HCT116 cells was conducted to identify potential pathways, which were validated by using real-time polymerase chain reaction (PCR), Western blot, and immunofluorescence assays.

Results

TRUB1 was significantly upregulated in CRC tumor tissues and cell lines. ROC analysis showed that TRUB1 had strong diagnostic potential and its overexpression was associated with poorer overall survival in CRC patients. In TRUB1-knock-down HCT116 cells, apoptosis increased and tumor growth slowed in nude mice, with a corresponding increase in apoptosis-related proteins and decreased Ψ modification. Mechanistically, RNA sequencing indicated that tumor necrosis factor α signaling via the nuclear factor kappa B (NFκB) pathway was activated in TRUB1-knock-down HCT116 cells. Further analysis identified Baculoviral inhibitor of apoptosis proteins repeat-containing 3 (BIRC3) as a potential downstream target gene that was regulated by TRUB1 in the NFκB pathway.

Conclusions

TRUB1 serves as a potential biomarker for CRC diagnosis and prognosis, and it can inhibit apoptosis in CRC cells via BIRC3-mediated NFκB signaling.

Identifying environmental factors and biological metrics associated with cancer prevalence and mortality: An environment-wide association study

BACKGROUND

Present knowledge about determinants of oncogenesis and cancer mortality remains incomplete, inconsistent, and controversial. We aimed to conduct an environment-wide association study (EWAS) to systematically investigate and tentatively validate correlations of environmental factors and biological metrics with prevalence and mortality of cancer.

METHODS

All eligible participants were selected from the US National Health and Nutrition Examination Survey (NHANES) and randomly split into training and testing sets by survey years. Environmental and biological exposures were assessed through either physical examinations or laboratory tests. We conducted survey-weighted logistic regression and COX proportional hazards regression models to investigate the relationships of 398 factors with cancer prevalence and 380 factors with cancer mortality, respectively. To adjust for multiple comparisons, positive findings in the training set (false discovery rate [FDR] < 5 %) were tentatively validated in the testing set (P value < 0.05). Random forest models were further fitted to evaluate the importance and diagnostic value of identified factors in relation to cancer prevalence.

RESULTS

Overall, 55,021 general participants and 5163 cancer survivors were included in the study of cancer prevalence and mortality, respectively. After adjusting potential confounders, we identified 7 environmental or biological factors (e.g. total bilirubin, testosterone, and beta-cryptoxanthin) associated with cancer prevalence in the general population, as well as 21, 8, and 6 indicators associated with all-cause (e.g. C-reactive protein), cancer-specific (e.g. blood selenium), and noncancer mortality (e.g. albumin) among individuals with cancer, respectively. EWAS-identified factors contributed to better performance of random forest models in predicting cancer prevalence.

CONCLUSIONS

Employing an EWAS approach, this study provided novel insights into potential targets for prevention and control of cancer.

Regulation of Brain Metastatic Breast Cancer Cell Dormancy versus Proliferation on Hyaluronic Acid Hydrogels via Laminin and Laminin-Derived Peptides

Among the secondary target organs for metastatic breast cancer, brain metastasis is extremely aggressive in nature, resulting in lower survival rates. These metastatic cancer cells have the potential to enter a dormant state in the brain, allowing them to survive for extended time periods. The brain microenvironment plays a key role in controlling the dormant phenotype, yet how various components of this microenvironment influence dormancy is not well understood. In this work, we employed hyaluronic acid (HA)-based hydrogels as a mimetic of the brain tissue environment to study the role of biochemical cues, specifically, the impact of laminin and laminin-derived peptides IKVAV and YIGSR on the regulation of brain metastatic breast cancer cell dormancy versus proliferation. We applied varying protein/peptide concentrations and confirmed functionalization on HA hydrogel surfaces. We then seeded 10,000 cancer cells on the hydrogel surface and cultured them for 5 days. We found that in the presence of laminin or IKVAV, MDA-MB-231Br cells transitioned from a rounded to a spread morphology and exhibited enhanced proliferation as the laminin/IKVAV concentration increased. In contrast, in hydrogels functionalized with YIGSR, these cells maintained a rounded morphology, with no impact on proliferation with varying YIGSR concentrations. We confirmed the involvement of αVβ3 integrin in mediating tumor cell phenotype in hydrogels functionalized with laminin. By evaluating known markers of dormancy and proliferation, we found a direct correlation between the presence of laminin and IKVAV and increased phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK) positivity, along with decreased phosphorylated p38 (p-p38) positivity, while in hydrogels functionalized with YIGSR, the levels of both p-ERK and p-p38 remained unaltered. Finally, we demonstrated that when cells were transferred from IKVAV-deficient to IKVAV-rich hydrogels, the hydrogel induced cellular dormancy was reversible. Collectively, our findings provide insights into how laminin and laminin-derived cues regulate brain metastatic breast cancer cell dormancy versus proliferation.

Identification and validation of SLC16A8 as a prognostic biomarker in clear cell renal cell carcinoma: a six-gene solute carrier signature

Solute carrier (SLC) proteins are essential for nutrient transport, influencing tumor metabolism and growth while preserving cellular homeostasis. Despite the critical biological functions of these transporters, their applicability as therapeutic targets in clear cell renal cell carcinoma (ccRCC) remains largely unexplored. In the current study, we analyzed transcriptomic data and discovered 77 differentially expressed SLC genes in ccRCC, with 24 demonstrating predictive potential. Using Lasso regression, we developed a prognostic signature comprising six key genes: SLC2A3, SLC11A1, SLC14A1, SLC16A8, SLC22A6, and SLC28A1. This signature demonstrated strong diagnostic performance and served as an independent predictor of patient survival. Further analysis integrating clinical variables and risk scores enabled the construction of nomograms, which exhibited high predictive accuracy for patient outcomes. Immune profiling revealed distinct infiltration patterns between risk groups: high-risk patients showed elevated levels of memory B cells, activated CD4+ T cells, regulatory T cells (Tregs), M0 macrophages, and neutrophils. In contrast, their low-risk counterparts showed M1 macrophages, resting dendritic cells, and resting mast cells. Validation experiments confirmed that SLC16A8 was significantly overexpressed in ccRCC tissues compared to normal samples, correlating with poor prognosis. Functional studies demonstrated that SLC16A8 knockdown impaired tumor progression in vitro. Consistent with these findings, in vivo experiments demonstrated reduced tumor growth upon SLC16A8 knockdown. Mechanistically, decreased SLC16A8 attenuated PI3K/AKT signaling, suggesting a potential regulatory pathway in ccRCC progression. In summary, we established a six-gene SLC signature with significant prognostic value in ccRCC. Among these genes, SLC16A8 emerged as a promising biomarker and therapeutic target, warranting further investigation.

Foundation model-driven multimodal prognostic prediction in patients undergoing primary surgery for high-grade serous ovarian cancer

High-grade serous ovarian cancer (HGSOC) presents challenges in prognostic prediction. This study aimed to develop a universal foundation model-driven multimodal model (FoMu model) to assess the prognosis of HGSOC patients. We conducted a retrospective cohort study involving 712 eligible patients across four centers, collecting clinical, MRI, and hematoxylin and eosin (H&E)-stained whole slide images (WSIs) data. Pre-trained radiological and pathological foundation models were employed for feature precoding. Subsequently, we introduced unimodal and cross-modal adaptive aggregation networks to comprehensively model the features derived from each modality. Our findings revealed that both unimodal and cross-modal FoMu models exhibited superior and stable predictive capabilities for overall survival (OS) and progression-free survival (PFS). In summary, our study successfully developed a FoMu model that effectively integrates multimodal data to assess the prognoses of HGSOC patients, highlighting its potential for improving individualized patient management and clinical decision-making in future applications.

Trop-2 and Ephrin B2 expression in urothelial carcinoma with divergent differentiation and aggressive urothelial carcinoma subtypes

OBJECTIVES

Urothelial carcinomas (UCs) encompass a heterogeneous group of tumors. Several histopathologic features are associated with poor clinical outcomes and limited treatment options. With new rising therapeutic modalities, we aimed to determine the pattern of expression of Trop-2 and ephrin B2 in UC with aggressive subtype histology and/or divergent differentiation (SH/DD).

METHODS

We performed a retrospective analysis of 113 UC samples with SH/DD at our institution from 2011 to 2021. Immunohistochemical staining for Trop-2 and ephrin B2 expression was performed on all cases. Expression was determined by the percentage of samples with a moderate or strong H-score.

RESULTS

Our results show Trop-2 expression was the highest in squamous cell carcinoma and UC with squamous differentiation, adenocarcinoma and UC with glandular differentiation, and plasmacytoid subtype, while ephrin B2 expression was highest in adenocarcinoma, UC with glandular differentiation, and small cell carcinoma.

CONCLUSIONS

Expression of Trop-2 and ephrin B2 may demonstrate therapeutic possibilities for patients with SH/DD, who usually have limited treatment options, particularly in small cell carcinoma, in which few targets have been identified. Clinical trials to investigate the efficacy of these novel treatments are warranted.

Advances in the roles and molecular mechanisms of exosomal circular RNAs in regulating the pre-metastatic niche of tumors

Metastasis remains a major cause of morbidity and mortality in patients with malignant tumors. The pre-metastatic niche is a prerequisite for distant metastasis driven by primary tumors. Circular RNAs (circRNAs), a class of single-stranded closed non-coding RNAs, exhibit high stability, evolutionary conservation, and cell-type specificity. Exosomes, as natural carriers of circRNAs, mediate intercellular communication and contribute to the formation of the pre-metastatic niche; however, the mechanisms by which they do so remain incompletely understood. This review summarizes the biological characteristics and functions of exosomal circRNAs and outlines the molecular pathways through which they shape the tumor pre-metastatic microenvironment, with emphasis on immunosuppression, vascular permeability, extracellular matrix remodeling, and lymphangiogenesis. This is the first review to focus on the functional roles and molecular mechanisms of exosomal circRNAs in pre-metastatic niche regulation, providing a basis for the development of therapeutic strategies targeting metastatic progression.

Transforming treatment paradigms: Focus on personalized medicine for high-grade serous ovarian cancer

High-grade serous ovarian cancer (HGSOC) is the most common and aggressive subtype of ovarian cancer, accounting for approximately 70% of all ovarian cancer cases and contributing significantly to the high mortality rates associated with this disease. Because of the asymptomatic nature of early stage disease, most patients are diagnosed at advanced stages when the cancer has already spread into the abdominal cavity, requiring complex and intensive surgical and chemotherapeutic interventions followed by maintenance therapies. Although a minority of cases are associated with well defined genetic syndromes, specific risk factors and a clear etiology in many cases remain elusive. HGSOC tumors are characterized by a high frequency of somatic gene copy number alterations, often associated with defects in homologous recombination repair of DNA. All attempts to introduce an effective screening for HGSOC to date have been unsuccessful. This review elucidates the complexities surrounding HGSOC and encompasses its etiology, epidemiology, classification, pathogenesis, and the current array of treatment strategies. Understanding molecular underpinnings is crucial for the development of targeted therapies and personalized multimodal treatment approaches in centralized therapeutic structures. This review also examines the importance of the tumor microenvironment. In addition, the authors' objective is to underscore the critical importance of placing the patient's perspective and diversity at the forefront of therapeutic strategies, thereby fostering a genuinely participatory decision-making process and ultimately improving patient quality of life.

Exploring the functional and prognostic roles of EPHX4 in pancreatic cancer: Insights from bioinformatics and experimental validation

BACKGROUND

Epoxide hydrolase-4 (EPHX4) belongs to the epoxide hydrolase enzyme family, but its biological function remains unclear, especially its potential involvement in the development of pancreatic tumours. This research sought to examine the function of EPHX4 in pancreatic adenocarcinoma (PAAD).

METHODS

The expression of EPHX4 across cancers was examined through The Cancer Genome Atlas (TCGA). Bioinformatics was employed, leveraging multiple databases to investigate EPHX4 gene expression in pancreatic cancer and its association with survival prognosis, functional enrichment, immune infiltration, tumour mutation load, and drug sensitivity, among other variables. To evaluate EPHX4 expression in PAAD cells, Western blotting and reverse transcription quantitative PCR were used. A series of in vitro functional experiments was performed to assess the proliferation, migration, and invasion of PAAD cells.

RESULTS

EPHX4 expression was markedly elevated in a number of malignancies, including PAAD, and was associated with patient sex, clinical stage, and metastasis to the lymph nodes. High EPHX4 expression was significantly associated with a worse outcome in PAAD patients. According to functional and enrichment studies, EPHX4 is involved in many signalling pathways linked to cancer. The study of immune infiltration revealed that EPHX4 was connected to the existence of a variety of immune cells inside the tumour. Our study revealed that EPHX4 knockdown significantly decreased PAAD cell migration, proliferation, and invasion.

CONCLUSION

EPHX4 is highly expressed in PAAD and independently predicts poor survival. Functional experiments demonstrate its tumor-promoting effects. Its involvement in multiple cancer-related signaling pathways and immune regulation mechanisms highlights the dual prognostic and therapeutic potential of EPHX4 in PAAD.

Monitoring cellular human breast adenocarcinoma cells' response to xanthophylls by label-free Raman spectroscopy and imaging

For years, xanthophylls have been recognized for their potential in medicine. Evidence supports the role of diets rich in algae, fruits, and vegetables in preventing cancer. Due to the complexity of the human body, numerous mechanisms could explain the health benefits of xanthophylls. Various studies have explored their effects on specific diseases. However, the impact of certain xanthophylls, such as crocetin, crocin, and fucoxanthin, on aggressive breast cancer remains unclear. To address this, we examined their effects on human breast adenocarcinoma (MDA-MB-231 cells) using Raman spectroscopy and imaging. Our findings revealed that crocetin enhances cancer cell viability by increasing lipid and protein levels, suggesting it does not directly inhibit tumour growth. Crocin redirected cellular metabolism towards lipid accumulation, shown by increased Raman signals at 1444 cm-1 in lipid droplets/endoplasmic reticulum. Fucoxanthin demonstrated the greatest potential, reducing lipid and protein levels (Raman bands at 1254, 1444, 1654 cm-1), thereby inhibiting adenocarcinoma progression.

A new short pH-responsive anticancer peptide derived by intramolecular charge shielding strategy

The pH-responsive anticancer peptides (ACPs) have been regarded as a new generation of prospective antitumor candidates due to their selectivity. However, the successful utilizations have been hampered by their narrow therapeutic index, poor stability and long sequence. Here, a new type of short pH-responsive ACPs was constructed by smart intramolecular charge shielding in histidine-rich peptide LH. This design would not depend on the introduction of additional anionic binding peptide, which might be an effective method for appreciably shortening the sequence of pH-responsive ACPs while improving their safety and stability. As expected, 2E-K stood out from the acquired peptides as it exhibited a considerable pH-dependent antitumor activity concomitant with remarkably improved therapeutic selectivity (14.5-fold increase) and extended serum half-life (3.6-fold enhancement) compared to LH. Experimental results showed that acid-activated 2E-K could efficiently induce tumor cell death by rapid membrane damage. Notably, the in vivo experiments further confirmed its excellent antitumor efficacy and low toxicity when compared with PTX, which demonstrating its superiority for in vivo application. In conclusion, our work opened a new avenue for developing short pH-responsive ACPs as promising alternative drugs in cancer treatment.

Vaccination and personalized cancer vaccines focusing on common cancers in women: A narrative review

Immunotherapy has recently cast great attention on cancer vaccines in order to aim to decrease tumor growth, elicit persistent anti-tumor memory, and avert adverse reactions. Moreover, cancer vaccines employ tumor antigens to stimulate anti-tumor immunity using different platforms, for example, whole cells, nucleic acids, peptides, etc. Recent findings have classified cancer vaccines into cell-based, virus-based, peptide-based, and nucleic acid-based types. Personalized cancer vaccines, also known as neoantigens, have exhibited acceptable safety and efficacy in eliciting immune responses against melanoma and glioblastoma. Neoantigen-based vaccines, concentrating on tumor antigens present only in cancer cells, bring intriguing opportunities for different types of cancer, including melanoma, lung, bladder, breast, renal, head and neck, and colorectal cancers. Furthermore, breast cancer research underscores ongoing trials of vaccines targeting α-lactalbumin to prevent the recurrence of triple-negative breast cancer. Lung cancer studies have discovered interesting outcomes with liposomal vaccines and the potential of CIMAvax-EGF in the prevention of lung cancer. Studies on ovarian cancer highlight personalized cancer vaccines using dendritic cells and various tumor-associated antigens to elicit T-cell responses against cancer cells. Overall, such advancements suggest great promise for future clinical translation of cancer novel immunotherapy-based approaches to effectively counter various types of cancer.

MammOnc-DB, an integrative breast cancer data analysis platform for target discovery

Breast cancer (BCa), a leading malignancy among women, is characterized by morphological and molecular heterogeneity. While early-stage, hormone receptor, and HER2-positive BCa are treatable, triple-negative BCa and metastatic BCa remains largely untreatable. Advances in sequencing and proteomic technologies have improved our understanding of the molecular alterations that occur during BCa initiation and progression and enabled identification of subclass-specific biomarkers and therapeutic targets. Despite the availability of abundant omics data in public repositories, user-friendly tools for multi-omics data analysis and integration are scarce. To address this, we developed a comprehensive BCa data analysis platform called MammOnc-DB ( http://resource.path.uab.edu/MammOnc-Home.html ), comprising data from more than 20,000 BCa samples. MammOnc-DB facilitates hypothesis generation and testing, biomarker discovery, and therapeutic targets identification. The platform also includes pre- and post-treatment data, which can help users identify treatment resistance markers and support combination therapy strategies, offering researchers and clinicians a comprehensive tool for BCa data analysis and visualization.

Molecular and phenotypic characterization of 5-FU resistant colorectal cancer cells: toward enrichment of cancer stem cells

Cancer stem cells (CSCs) as a subgroup of cells within a tumor capable of self-renewal, thereby driving tumor initiation and spread. Addressing treatment failures in cancer, linked to CSCs and their resistance mechanisms, requires effective preclinical models for testing targeted therapies. Caco2- and HT-29-resistant cells were generated by repeated treatment of cells with growing concentrations of 5-fluorouracil (5-FU) anticancer drug for an extended time. The sensitivity of 5-FU-resistant cells was evaluated by cytotoxicity assay. Stemness, epithelial-mesenchymal transition (EMT), migration and drug resistance characteristics were assessed through gene expression investigation by real-time PCR. The expression of CD44, CD133, and CD66 were evaluated by flow cytometry. To end, the bioinformatic analysis estimated the molecular function and biological pathways considering the differential expression of selected genes and proteins. 5-FU-exposed cells displayed increased resistance to 5-FU. The gene expression analysis showed an upregulation of stemness genes (KLF4, SOX2, OCT4, C-MYC), enhanced scavenging system, and elevated expression of CSC surface markers (CD44 and CD133) compared to parental cells. Additionally, pro-EMT genes (TWIST1, SNAIL1, ZEB1, Vimentin, and N-cadherin) were significantly upregulated compared to parental cells, with the downregulation of E-cadherin as an EMT suppressor gene reflected in increased migration capacity. Moreover, increased expression of ABC transporter genes (ABCB1, ABCC1) was observed, correlating with enhanced drug resistance. The bioinformatic analysis highlighted pathways related to microRNAs in cancer, cells pluripotency, and proteoglycans. Methods of drug exposure take priority over spheroid formation, particularly due to their enhanced efficacy in stemness, EMT, and surface markers. This positions them as a promising protocol for establishing experimental models of CSCs.

Plasma Cell Enrichment and New Genomic Approaches in Multiple Myeloma: A Scoping Review

BACKGROUND

Multiple myeloma (MM) is a genetically heterogeneous disease where specific genetic abnormalities have a significant impact on a patient's prognosis. Diagnostic and prognostic tools like fluorescence in situ hybridization (FISH), PCR, microarrays, and next-generation sequencing (NGS) have transformed MM management. However, the effectiveness of these techniques is often limited by the low concentration of plasma cells in bone marrow samples, which makes enrichment methods necessary. This review aims to clarify how these techniques enhance the detection of genetic abnormalities, reduce false-negative results, and facilitate more precise risk stratification for MM patients.

CONTENT

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) guidelines, the literature on plasma cell separation methods used in genetic studies of MM was systematically identified and mapped. Searches were conducted in the Medline and Embase databases using a structured strategy, supplemented by manual searches on Google Scholar. Of 399 publications evaluated, 69 met the inclusion criteria; 37% utilized FISH and 19% demonstrated an increasing use of NGS. Plasma cell enrichment significantly improved diagnostic accuracy, increasing the detection rates of genetic abnormalities from 61% in non-enriched samples to 95.5% in enriched samples. While FISH remains the gold standard, emerging technologies such as NGS offer superior sensitivity and the ability to identify critical genetic alterations to refine molecular subtypes.

SUMMARY

Clinically significant genetic alterations are detected more frequently with plasma cell enrichment techniques, contributing to improved prognosis and treatment strategies for MM patients.

Exploring combinations of dihydroartemisinin for cancer therapy: A comprehensive review

Cancer remains a significant threat to human health due to its multifaceted causes and complex pathogenesis. While advancements in research have improved outcomes for many cancer patients, treatments for specific tumor types still face limitations. Dihydroartemisinin (DHA), an active metabolite of artemisinin and its derivatives, has proven to be an effective anti-malarial agent. Recently, its anticancer potential has garnered increasing interest as it acts through multiple molecular pathways, including anti-proliferation, induction of apoptosis, autophagy and endoplasmic reticulum (ER) stress, anti-metastasis, inhibition of angiogenesis, and modulation of immune function. This review aims to thoroughly explain and summarize the mechanisms of DHA against cancer and the latest progress in this field. Due to the insufficiency of monotherapy in effectively treating cancer, the use of chemotherapy in combination with alternative therapies has witnessed a notable increase in popularity. DHA has shown synergistic anti-tumor efficacy with a range of therapeutic drugs, but its co-delivery with chemotherapeutics has been limited by low solubility and bioavailability. Nanotechnology-assisted co-delivery of anti-tumor agents, utilizing advanced stimulus-triggered drug release systems in tumor cells, offers the potential to enhance selective delivery and increase antitumor efficacy. Additionally, this article provides suggestions for further research on the anticancer effects of DHA.

YTHDF1/RNF7/p27 axis promotes prostate cancer progression

Prostate cancer (PCa) is a prevalent malignant tumor of the urinary system and remains the most common cancer among males. In this study, we showed that YTHDF1, one of the reader proteins involved in the N6-methyladenosine (m6A) modification signaling pathway, is highly expressed in PCa cancerous tissues and cells, which correlates with poor clinical outcomes. Our study revealed that YTHDF1 knockdown inhibits tumor cell proliferation, migration, and xenograft tumor formation by decreasing p27 protein stability through proteasome degradation signaling. Consistently, YTHDF1 depletion markedly reduced the clonogenic growth of Pten or/and TP53-deficient organoids. Candidate p27-targeting E3 ubiquitin ligases screening identified RNF7 as the direct downstream target for YTHDF1 in an m6A-dependent manner. The subsequent high translation of RNF7 results in the efficient degradation of the cell cycle inhibitor p27 and malignant tumor cell growth. In addition, we provided evidence showing that YTHDF1 or RNF7 depletion sensitizes tumor cells to chemotherapy drug cisplatin by increasing cellular apoptosis. Our findings revealed that the neddylation inhibitor MLN4924 effectively inhibited prostate cancer progression in vitro and in vivo. Our study highlights the YTHDF1/RNF7/p27 axis as a crucial component in PCa, suggesting its potential as a novel therapeutic target.

METTL16/IGF2BP2 axis enhances malignant progression and DDP resistance through up-regulating COL4A1 by mediating the m6A methylation modification of LAMA4 in hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is the third most common malignant tumor after gastric cancer and esophageal cancer, which is a serious threat to human health. Methyltransferase-like protein 16 (METTL16) regulates the occurrence and development of various cancers, but its molecular mechanism in HCC has not been fully investigated.

METHODS

A series of databases were used to predict gene expression, methylation sites, correlation analysis, and protein interaction analysis. Gene expression levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR), western blot, and immunohistochemistry (IHC). What's more, drug-resistant cell lines were established for drug resistance analysis. Cell proliferation was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and 5-ethynyl-2'-deoxyuridine (EdU) staining. Flow cytometry, transwell and wound healing assays were used for apoptosis, invasion and migration, respectively. In addition, the regulatory mechanism of METTL16 in HCC was investigated by methylated RNA immunoprecipitation (MeRIP), RNA immunoprecipitation (RIP) and co-immunoprecipitation (Co-IP). Finally, constructing subcutaneous transplanted tumor in nude mice confirmed the effect of METTL16 in vivo.

RESULTS

METTL16 was up-regulated in HCC drug-resistant tissues and cells. Knockdown of METTL16 inhibited Cisplatin (DDP) resistance, proliferation, invasion and migration of HCC cells, but promoted apoptosis. Besides, laminin subunit alpha 4 (LAMA4), which was overexpressed in HCC drug-resistant tissues and cells, was selected as the target of METTL16. Mechanistically, METTL16 and m6A reader insulin like growth factor 2 mRNA binding protein 2 (IGF2BP2) co-regulated the m6A modification and mRNA stability of LAMA4, and LAMA4 weakened the effects of METTL16 knockdown on HCC drug-resistance. Meanwhile, LAMA4 bound to collagen type IV alpha 1 chain (COL4A1) and facilitated DDP resistance and HCC progression via COL4A1. Similarly, in vivo, METTL16 induced tumor growth, as well as LAMA4 and COL4A1 expression, and increased DDP resistance.

CONCLUSION

METTL16 and IGF2BP2 jointly mediated the m6A methylation modification of LAMA4, thereby promoting DDP resistance and malignant progression of HCC through regulation of COL4A1.

Chemical Affinity Capture of Plasma Extracellular Vesicles Enables Efficient and Large-Scale Proteomic Identification of Prostate Cancer Biomarkers

The serum prostate-specific antigen (PSA) testing is widely used for prostate cancer (PCa) screening but suffers from poor specificity, leading to unnecessary biopsies and overtreatment. The significant potential of extracellular vesicles (EVs) in cancer diagnosis has driven the development of efficient methods to isolate and identify EV biomarkers from large-scale clinical samples. Here, we systematically evaluate five commonly used EV isolation techniques through proteomic profiling of plasma-derived EVs, endorsing TiO2-based chemical affinity capture as a superior approach for analyzing EVs from complex clinical samples. This method demonstrates exceptional advantages in speed, throughput, reproducibility, and protein coverage. Using this optimized workflow, we analyzed plasma EVs from 80 patients with PCa and benign prostatic hyperplasia (BPH), identifying growth differentiation factor 15 (GDF15) as a compelling biomarker with a predictive power (AUC) of 0.908 for PCa. Extensive validation across independent cohorts comprising 457 samples, including plasma EVs and prostate tissues, confirmed GDF15's ability to distinguish PCa from BPH and stratify PCa stages. Notably, the combination of GDF15 with PSA further enhanced diagnostic efficiency, particularly for patients in the PSA diagnostic gray zone. This study establishes a robust workflow for EV protein analysis in large clinical cohorts and highlights EV-GDF15 as a promising biomarker for noninvasive PCa diagnosis.

Adjuvant treatment in elderly patients undergoing transoral surgery for HPV-related oropharyngeal cancer

OBJECTIVES

Older adults are an increasing proportion of patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC), and transoral surgery (TOS) remains a valid treatment option for this population. This study aimed to evaluate the impact of adjuvant therapy on survival outcomes in this group.

METHODS

This retrospective study analyzed data from the National Cancer Database (NCDB) for older adults (≥65 years) diagnosed with OPSCC and treated with primary TOS. Patients were stratified into low, intermediate, and high-risk groups according to specific pathological criteria. The survival benefit of adjuvant therapy was assessed using a multivariable Cox regression model.

RESULTS

A total of 998 patients undergoing primary TOS for HPV-related OPSCC were classified in low (N = 347, 34.8 %), intermediate (N = 261, 26.1 %) and high (N = 390, 39.1 %) risk groups. Adjuvant treatment showed no significant benefit in the low (adjusted HR: 0.70; 95 % CI: 0.33-1.47) and intermediate (HR: 0.73; 95 % CI: 0.36-1.48) risk groups. Adjuvant treatment was beneficial in the high risk group (adjusted HR: 0.40, 95 % CI: 0.25-0.62), with adjuvant chemoradiotherapy (adjusted HR: 0.28 95 % CI: 0.16-0.48; p < 0.001) showing a slight advantage compared to radiotherapy alone (adjusted HR: 0.61, 95 % CI: 0.36-1.03).

CONCLUSION

The findings suggest that adjuvant therapy should be selectively applied in older adults with OPSCC, with a significant survival benefit observed primarily in high-risk patients. Future studies are needed to confirm the safety and efficacy of treatment de-escalation strategies in this population.

Financial Toxicity and Psychosocial Challenges of Chinese Parents in Pediatric Cancer Treatment: A Phenomenological Study

BACKGROUND

Multimodal treatment and care for pediatric cancer can result in catastrophic medical expenses. However, the lived experiences of parents in navigating financial toxicity during their child's cancer treatment have not been fully explored.

OBJECTIVE

This study aims to explore the essence of the lived experiences of parents facing financial toxicity when their child undergoes cancer treatment.

METHODS

A descriptive phenomenological study was conducted, involving in-depth interviews with parents of children with cancer.

RESULTS

Four major themes emerged: (1) facing moments of complex challenges: risk factors for financial toxicity, (2) "everything for the child": existential guilt and embodied experiences, (3) "trapped time": the collapse of the future dimension and the life resistance in trauma, and (4) "overdrawing the entire family": the impact of financial toxicity on family functioning.

CONCLUSION

This study explored the subjective experiences of financial toxicity among 18 parents of children with cancer within the sociocultural context of China. The findings indicate that the impact of financial toxicity on some parents extends well beyond material hardship, reshaping their lived experiences through complex physical and psychological pathways. Notably, some participants demonstrated proactive family resilience in the context of posttraumatic growth by embracing a "living in the moment" mindset.

IMPLICATIONS FOR PRACTICE

Based on the findings of this study, nurses could consider assessing the financial toxicity of families in similar contexts and providing those in need with information on financial support.

Caerin 1.1 and 1.9 peptides induce acute caspase 3/GSDME-mediated pyroptosis in epithelial cancer cells

Caerin peptides exhibit a dual role in cancer treatment by directly killing cancer cells and modulating the tumour microenvironment to enhance anti-tumour immunity. This study investigates the mechanisms underlying caerin 1.1/1.9-induced acute cell death in epithelial cancer cells and explores their therapeutic potential. HeLa, A549, and Huh-7 cancer cell lines were treated with caerin 1.1/1.9 peptides. Morphological observations, flow cytometry, lactate dehydrogenase (LDH) release, and IL-18 secretion assays revealed the occurrence of pyroptosis following treatment. Specifically, a 1-h treatment with caerin 1.1/1.9 induced pyroptosis in HeLa, A549, and Huh-7 cells, characterised by cell swelling, membrane bubbling, and the release of IL-18 and LDH. Western blotting confirmed the upregulation of pyroptosis markers, including caspase-3, cleaved caspase-3, and GSDME-N fragments. These findings highlight the significant role of caerin peptides in inducing acute pyroptosis, a form of programmed cell death that enhances the immunogenicity of dying cancer cells, thus potentially improving the effectiveness of immunotherapies. This research underscores the therapeutic potential of caerin 1.1/1.9 peptides in cancer treatment, providing a foundation for developing new anti-cancer strategies that leverage both direct cytotoxic effects and immune modulation to achieve more effective and sustained anti-tumour responses.

Deep learning reconstruction of diffusion-weighted imaging with single-shot echo-planar imaging in endometrial cancer: a comparison with multi-shot echo-planar imaging

PURPOSE

To evaluate the efficacy of deep learning reconstruction (DLR) in diffusion-weighted imaging (DWI) with single-shot echo-planar imaging (SSEPI) for endometrial cancer, compared to multiplexed sensitivity-encoding (MUSE) DWI.

METHODS

We retrospectively reviewed 31 women with surgically confirmed endometrial cancer who underwent preoperative pelvic magnetic resonance imaging (MRI) including DWI. Qualitative analysis including overall image quality, susceptibility artifacts, sharpness of the uterine edge, and lesion conspicuity were compared among conventional SSEPI (SSEPI-C), SSEPI with DLR (SSEPI-DL), and MUSE using the Friedman's test. Quantitative analysis including the apparent diffusion coefficient (ADC) values, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also compared among three DWI sequences using the Friedman's test. In addition, the diagnostic accuracy for deep myometrial invasion was compared to three DWI sequences using Cochran's Q test.

RESULTS

The scores of overall image quality, sharpness of the uterine edge, and lesion conspicuity in SSEPI-DL were higher than SSEPI-C (p < 0.001) with no significant difference compared to MUSE (p > 0.05). Noise in SSEPI-DL was lower than SSEPI-C (p < 0.001), with no significant difference compared to MUSE (p > 0.05). SNR and CNR in SSEPI-DL were also superior to SSEPI-C (p < 0.001), and comparable to MUSE (p > 0.05). The diagnostic accuracy for detecting deep myometrial invasion showed no significant difference among SSEPI-C, SSEPI-DL and MUSE (p > 0.05).

CONCLUSION

DLR improves the image quality of DWI in endometrial cancer, demonstrating image quality equivalent to that of SSEPI-DL and MUSE. SSEPI-DL can be an alternative to MUSE in female pelvic MRI, with the benefit of significantly shortened scan time.

Higher density of compact B cell clusters in invasive front may contribute to better prognosis in pancreatic ductal adenocarcinoma

While the correlation between T cells and patient survival was widely investigated, the clinical significance of CD20+ B cells in pancreatic ductal adenocarcinoma (PDAC) is less clear. We hypothesized that the spatial pattern of B cells within tumor microenvironment (TME) are more informative, which may reveal the prognostic significance for PDAC patients. Therefore, we developed a computer-based workflow to analyze CD20+ B cells in whole slide images (WSI) from 45 cases of PDAC patients. Depending on this workflow, annotations of each case which were created by pathologists were subdivided for three regions, including invasive front (IF), cancer center (CT) and cancer island (CI) to explore the association between the spatial pattern of CD20+ B cells and patient prognosis outcomes. After that, occupancy rate (as area under curve, occupancy AUC), fractal dimension differences (ΔFD), cluster density and coverage ratio were used to quantify the spatial pattern of B cells in TME. We observed B cells were distributed across different regions, manifesting in both clustered and dispersed patterns. Compared to features of B cells spatial distribution in CT region, B cells in IF region exhibited higher occupancy AUC (p = 0.00004), cluster density (p = 0.000002) and coverage ratio (p = 0.000884). Patients with longer survivals had smaller ΔFD (p = 0.05), higher B-cell cluster density (p = 0.003) and lower coverage ratio (p = 0.02) in IF region. Our study indicated the spatial distribution of B cells in IF and CT was different and the higher density of compact B-cell clusters in IF region may be associated with better prognosis in PDAC.

Real-world application of targeted next-generation sequencing for identifying molecular variants in Asian non-small-cell lung cancer

BACKGROUND

The advent of novel therapeutic agents has advanced biomarker characterization in non-small-cell lung cancer (NSCLC), driving increased adoption of next-generation sequencing (NGS) technologies for molecular testing. However, comprehensive data addressing the clinical utility of different NGS platforms for NSCLC remains limited.

METHODS

This retrospective study analyzed real-world data from 478 Taiwanese NSCLC patients over five years, using the Oncomine Focus Assay (OFA) to assess genetic alterations. The evaluation focused on assay accuracy, limit of detection (LoD), sequencing performance, and the genetic landscape of NSCLC.

RESULTS

The OFA achieved an NGS success rate of 80.5% (385/478), with tumor cell percentage, specimen source and FFPE block age identified as key factors affecting success. Quality metrics demonstrated robust sequencing performance, including 97.0 ± 9.6% on-target alignment, 94.7 ± 6.4% uniformity, and ≥ 500 × coverage for 98.0 ± 6.6% of amplicons. Among the 385 patients analyzed, 86.8% (334/385) were found to harbor pathogenic or likely pathogenic variants, of which 78.4% (262/334) were SNVs/Indels, 41.6% (139/334) were CNVs, 2.7% (9/334) were exon skipping alterations, and 10.2% (34/334) were gene fusions. Actionable driver mutations included EGFR mutations (46.2%, 178/385), KRAS mutations (9.4%, 36/385), ERBB2 mutations (6.8%, 26/385), ALK fusions (4.4%, 17/385), MET exon 14 skipping (2.3%, 9/385), BRAF mutations (2.3%, 9/385), ROS1 and RET fusions (1.8%, 7/385 each), and NTRK1 fusions (0.5%, 2/385). Notably, KRAS G12 C mutation was detected in 2.8% (11/385) of cases.

CONCLUSIONS

This study demonstrates the robust performance of the OFA in identifying clinically relevant genetic alterations in NSCLC. The findings support its clinical utility in precision oncology and provide valuable insights into the genetic landscape of Asian NSCLC, enhancing personalized treatment strategies for lung cancer patients.

Crizotinib Inhibits Viability, Migration, and Invasion by Suppressing the c-Met/PI3K/Akt Pathway in the Three-Dimensional Bladder Cancer Spheroid Model

We aimed to evaluate the therapeutic potential of crizotinib, a broad-spectrum tyrosine kinase inhibitor against bladder cancer (BC) cells, based on a three-dimensional (3D) cell culture system. After proliferating cell masses (spheroids) using T24 cisplatin-naïve and T24R2 cisplatin-resistant human BC cell lines, the spheroids were exposed to various crizotinib concentrations in order to derive an ideal crizotinib concentration to suppress cell survival, migration, and invasion. Crizotinib suppressed cell proliferation, migration, and invasion in both T24 and T24R2 BC cell lines under a 3D spheroid model, which was more appropriate than the conventional two-dimensional cell culture model. Real-time quantitative polymerase chain reaction analysis revealed a reduced expression of E-cadherin and an enhanced expression of vimentin, suggesting EMT suppression and the subsequent suppression of tumor aggressiveness following crizotinib administration. Meanwhile, the expressions of apoptosis-related genes increased. Western blot analysis revealed that the expression levels of phosphorylated mesenchymal-epithelial transition factor (c-Met) and phosphorylated Akt decreased following crizotinib administration, suggesting that the antitumor effect of crizotinib can be associated with the inhibition of the phosphorylated activation of the c-Met/PI3K/Akt pathway. Crizotinib showed a potential antitumor effect on both cisplatin-naïve and cisplatin-resistant human BC cells, likely through c-Met-induced PI3K/Akt pathway inhibition.

N6-methyladenosine-modified circQKI inhibits prostate cancer docetaxel-sensitivity via miR-188-3p/Beclin-1 pathway

BACKGROUND

Docetaxel (DTX) is used in the first-line chemotherapy for advanced castration-resistant prostate cancer (CRPC), but resistance remains a major clinical challenge. Circular RNAs (circRNAs) play critical roles in DTX resistance. This study aimed to investigate the mechanism of a novel circRNA, circQKI, in DTX resistance and its regulatory network in CRPC.

METHODS

DTX-resistant cell lines (PC3/DR and 22RV1/DR) were established, and circQKI's circular structure was validated by Sanger sequencing. CircQKI expression was modulated via siRNA knockdown and overexpression plasmids. Cell viability, apoptosis, and colony formation were assessed by CCK-8, flow cytometry, and clonogenic assays. The interaction between circQKI and miR-188-3p was verified by dual-luciferase reporter, RIP, and RNA pull-down. Autophagy activation was analyzed via Western blot and TEM. Subcutaneous xenograft models evaluated in vivo drug resistance. M6A modification was investigated through m6A RIP-PCR, METTL3/IGF2BP2 knockdown, and stability assays.

RESULTS

CircQKI was significantly upregulated in resistant cells and promoted DTX resistance by sponging miR-188-3p, thereby enhancing Beclin-1 expression and autophagy activation. Inhibiting Beclin-1 or co-treatment with chloroquine (CQ) partially restored DTX sensitivity. Mechanistically, METTL3-mediated m6A modification stabilized circQKI via IGF2BP2 recognition, leading to its accumulation in resistant cells. In vivo studies confirmed that circQKI overexpression reduced tumor sensitivity to DTX by enhancing autophagy.

CONCLUSION

circQKI drives DTX resistance via the miR-188-3p/Beclin-1 axis and autophagy activation, with its expression regulated by METTL3-dependent m6A modification and IGF2BP2. Targeting circQKI or autophagy pathways may offer novel therapeutic strategies to overcome DTX resistance in prostate cancer.

Synthesis of carbon dots from spent coffee grounds: transforming waste into potential biomedical tools

Carbon dots (CDs) are small-sized, spherical nanoparticles presenting amorphous carbon cores with nanocrystalline regions of a graphitic structure. They show unique properties such as high aqueous solubility, robust chemical inertness, and non-toxicity and can be manufactured at a relatively low cost. They are also well known for outstanding fluorescence tunability and resistance to photobleaching. Together, these properties boost their potential to act as drug delivery systems (DDSs). This work presents a low-cost synthesis of CDs by upcycling spent coffee grounds (SCGs) and transforming them into value-added products. This synthetic route eliminates the use of highly toxic heavy metals, high energy-consuming reactions and long reaction times, which can improve biocompatibility while benefiting the environment. A series of physico-chemical characterisation techniques demonstrated that these SCG-derived CDs are small-sized nanoparticles with tunable fluorescence. In vitro studies with 120 h of incubation of SCG-derived CDs demonstrated their specific antiproliferative effect on the breast cancer CAL-51 cell line, accompanied by increased reactive oxygen species (ROS) production. Importantly, no impact was observed on healthy breast, kidney, and liver cells. Confocal laser scanning microscopy confirmed the intracellular accumulation of SCG-derived CDs. Furthermore, the drug efflux pumps P-glycoprotein (P-gp) and the breast cancer resistance protein (BCRP) did not impact CD accumulation in the cancer cells.

TP53 somatic evolution in the normal endometrium of Black and White individuals

BACKGROUND

TP53 mutations are the main drivers of aggressive, high-risk endometrial carcinomas commonly diagnosed in Black individuals. However, TP53 mutations have also been identified in benign, non-cancerous tissues. We sought to understand the TP53 mutational landscape in benign endometrium throughout the lifespan of Black and White individuals, accounting for structural socioeconomic context.

METHODS

Ultra-sensitive TP53 mutation detection was performed with high-depth duplex sequencing (∼13,000×) in DNA extracted from histologically normal endometrium collected at autopsy (69 % of cases) or surgery (31 % of cases) from 83 individuals ages 0 to 81 (31 Black and 52 White, median age 35 years) without endometrial cancer. Histologically normal endometrium was also collected from 10 White individuals with endometrial cancer.

RESULTS

We identified 266 coding TP53 mutations in the normal endometrium of individuals without endometrial cancer, 57 % of which were pathogenic. The number, pathogenicity, and size of TP53 mutant clones in normal endometrium increased with age. Multivariable models showed no significant association between race or socioeconomic metrics and TP53 mutation frequency in normal endometrium. An exploratory analysis on the histologically normal endometrium of White individuals with endometrial cancer identified the tumor mutations at low levels in the normal biopsy of 5 out of 6 cases.

CONCLUSIONS

Our study revealed prevalent TP53 somatic evolution in benign endometrium across human lifespan and no racial differences in this cohort of predominantly younger individuals. Future studies should consider the analysis of larger cohorts with older individuals to detect potential effects of racial disparities on TP53 somatic evolution later in life.

Comparative analysis of European guideline-based clinicopathological risk groups and the International Federation of Gynecology and Obstetrics staging system for endometrial cancer

OBJECTIVE

To investigate the correlation between endometrial cancer risk groups, as defined by the 2021 European guidelines, and the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system. Further, we aimed to evaluate the additional prognostic capability of the staging system within individual risk groups.

STUDY DESIGN

This retrospective cohort study included patients who underwent primary treatment for endometrial cancer at a single tertiary center. Each case was classified into a molecular-integrated risk group according to the 2021 joint guidelines from the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP). Staging was performed using the FIGO 2023 criteria with molecular classification.

RESULTS

Data from 1044 patients were analyzed. Median follow-up was 70 months. Stage IA2, stage IB, and stage IVB were the most prevalent stages among the ESGO-ESTRO-ESP low-risk, intermediate risk, and advanced-metastatic groups, accounting for 80 %, 75 %, and 54 % of the cases, respectively. The stage distribution was more heterogeneous in the high-intermediate risk and high-risk groups, with stage IIA comprising 36 % and stage IICmp53abn comprising 35 % of cases in these groups. The FIGO staging system further stratified survival outcomes especially in the high-intermediate and high-risk groups. Stage IIC included a substantial number of cases from the intermediate risk (n = 23), high-intermediate risk (n = 48), and high-risk (n = 27) groups. Risk groups were associated with survival within this stage.

CONCLUSIONS

ESGO-ESTRO-ESP high-intermediate risk and high-risk endometrial cancers exhibited the greatest variability in terms of stage distribution and survival outcomes. Stage IIC, the most heterogeneous stage concerning risk groups, showed an association between risk groups and survival.

Revealing the role of bisphenol A on prostate cancer progression and identifying potential targets: A comprehensive analysis from population cohort to molecular mechanism

Bisphenol A (BPA) is a widespread environmental pollutant whose exact effects on prostate cancer (PCa) progression remain understudied. This study aims to investigate the effect and underlying molecular mechanisms between BPA exposure and PCa in a comprehensive approach. The multicenter cohort study found that BPA exposure plays an important role in promoting biochemical recurrence and death of PCa. BPA exposure significantly promoted PCa progression in both the animal model and in vitro experiments. RNA sequencing revealed a disruption of mitochondrial energy homeostasis in BPA-treated cells. In multiple datasets, 17 prognostic genes such as PFKFB4 were obtained to construct and verify a mitochondrial energy metabolism Score system. Based on network toxicology methods and transcriptome sequencing data, ESR1 was identified as a potential transcription factor targeting glycolytic enzyme PFKFB4 under BPA exposure. With the support of lncRNA and circRNA sequencing data, a molecular regulatory network of BPA promoting prostate cancer through mitochondrial energy metabolism reprogramming was constructed. Further molecular docking revealed that BPA has higher binding free energy to ERα than its natural ligand estradiol. Given the widespread presence of BPA in the environment, minimizing exposure to this chemical could represent a feasible approach in improving clinical outcomes.

GLUT1 inhibition by BAY-876 induces metabolic changes and cell death in human colorectal cancer cells

BACKGROUND

Glucose transporter 1 (GLUT1) is known to play a crucial role in glucose uptake in malignant tumors. GLUT1 inhibitors reportedly exhibit anti-tumor effects by suppressing cancer cell proliferation. BAY-876, a selective GLUT1 inhibitor, has been shown to inhibit tumor growth in ovarian and breast cancers. In this study, we investigated the anti-proliferative effects of BAY-876 treatment in human colorectal cancer (CRC) cell lines.

METHODS

We investigated the metabolic changes and effects on proliferation from BAY-876 treatment in HCT116, DLD1, COLO205, LoVo, and Caco-2 cells in vitro. Additionally, a mouse xenograft model was established using HCT116 cells to examine the tumor-inhibitory effects of BAY-876 treatment in vivo.

RESULTS

BAY-876 treatment inhibited cell proliferation in HCT116, DLD1, COLO205, and LoVo cells. Reduced GLUT1 protein expression levels were observed through western blot analysis. Flux analysis indicated enhanced mitochondrial respiration, accompanied by increased reactive oxygen species levels and apoptosis rates. Tumor-inhibitory effects were also observed in the xenograft model, with the BAY-876-treated groups showing GLUT1 suppression.

CONCLUSIONS

BAY-876 treatment induced metabolic changes and inhibited cell proliferation in human CRC cell lines. Using BAY-876 is a potential novel approach for treating CRC.

Genome-wide association analysis identified inflammatory mechanisms mediating the effects of lipid metabolism on endometrial carcinoma in situ

BACKGROUND

While lipids and inflammation are recognized as key modulators of tumor progression, their causal interplay in endometrial carcinoma in situ (ECIS)-the precursor of endometrial cancer-remains mechanistically undefined. Despite broad associations between lipid metabolism and cancer, the specific pathways driving ECIS initiation through inflammatory mediators are unknown.

METHOD

We pioneer an integrative Mendelian randomization (MR) framework combining multivariable MR, Bayesian weighted MR (BWMR), and sensitivity analyses to address pleiotropy. This approach was systematically applied to 179 lipids and 91 inflammatory factors. Methodological novelty further includes mediation analysis quantifying inflammatory factors' role in lipid-ECIS pathways.

RESULTS

First evidence reveals a phosphatidylcholine (O-18:0_16:1)-TNFSF12-ECIS axis: TNFSF12 mediates 4.894 % of phosphatidylcholine's effect (OR: 2.925; beta: 1.073; 95 % CI: 1.752-4.884; p = 4.032E-05), attenuating the direct lipid-ECIS association. This represents the inaugural demonstration of an inflammation-mediated lipid pathway in ECIS pathogenesis.

CONCLUSION

As the first MR study decoding lipid-ECIS causality, we establish the following.

Integrated analysis of scRNA-seq and bulk RNA-seq data identifies BHLHE40 as a key gene in pancreatic cancer progression and gemcitabine resistance

OBJECTIVE

Pancreatic cancer is characterized by its high mortality rate and short survival periods, and novel therapeutic targets and tailor personalized strategies are urgently needed. In this study, we aim to investigate the molecular mechanisms underlying pancreatic ductal adenocarcinoma (PDAC) progression and chemoresistance, with a focus on identifying novel therapeutic targets.

METHODS

Multiomics approaches were integrated to identify novel actionable targets for PDAC. Public datasets such as TCGA and GEO were utilized to investigate the relationship between gene expression and clinical outcomes. Functional enrichment, cell-cell communication, and metabolic pathway analyses were performed to reveal PDAC heterogeneity and therapeutic resistance mechanisms.

RESULTS

BHLHE40 was identified as a hub gene linked to high-CNV PDAC cells, Gemcitabine resistance, and poor prognosis in PDAC. High BHLHE40 expression is significantly correlated with immunosuppressive tumor microenvironment (TME) features such as reduced CD8+ T infiltration, TCR richness, and lower tumor mutational burden (TMB). ChIP-seq data analysis confirmed BHLHE40 could directly bind to the SAT1 promoter, establishing a transcriptional axis promoting chemoresistance. Single-cell RNA-seq analysis further revealed that the BHLHE40+/SAT1+ subpopulation cells are resistant to Gemcitabine in PDAC.

CONCLUSIONS

BHLHE40 is significantly correlated with PDAC malignancy and chemoresistance via SAT1 regulation and immune evasion. Targeting BHLHE40 may sensitize PDACs to Gemcitabine and facilitate personalized treatment for BHLHE40+ PDAC patients.

Improved Survival and Prognostication in Melanoma Patients With Brain Metastases: An Update of the Melanoma Graded Prognostic Assessment

PURPOSE

Survival for patients with melanoma has recently improved. The propensity of melanoma to metastasize to the brain remains a common and serious feature of this disease. The purposes of this study were to evaluate prognostic factors for patients with newly diagnosed melanoma brain metastases (MBMs) in a large cohort treated with modern multimodal therapies, compare those results with those in prior eras, and update the Melanoma Graded Prognostic Assessment (GPA).

METHODS

Univariable and multivariable (MVA) analyses of prognostic factors and treatments associated with survival were performed on 1,796 patients with newly diagnosed MBM treated between January 01, 2015, and December 31, 2021, using a multi-institutional retrospective database. Multiple imputation was used to address missingness of potential predictors. Significant variables in combined MVA were used to update the Melanoma GPA. Comparisons were made with legacy cohorts.

RESULTS

Median survivals for cohorts A (1985-2007, n = 481), B (2006-2015, n = 823), and C (2015-2021, n = 1,796) were 6.7, 9.8, and 16.6 months and median follow-up times were 40.1, 43.6, and 48.8 months, respectively. In combined MVA, significant prognostic factors for survival were higher Karnofsky Performance Status, fewer MBMs, absence of extracranial metastases, lower serum lactate dehydrogenase, and no immunotherapy before MBM. These factors were incorporated into the updated Melanoma GPA. The combined median and 3-year survivals for patients with GPA 0-1, 1.5-2, and 2.5-4.0 were 5.4, 13.2, and 43.2 months and 12.4%, 28.8%, and 51.6%, respectively.

CONCLUSION

Prognostic factors have changed and survival has improved for patients with MBM but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.

Risk Factors for Lymph Node Metastasis in Stage pT1 Invasive Lung Adenocarcinoma

OBJECTIVE

To analyze the risk factors for lymph node metastasis (LNM) in patients with stage pT1 lung adenocarcinoma to select a more appropriate surgical option.

METHODS

In this retrospective study, 294 patients with postoperative pathologically confirmed stage pT1 invasive lung adenocarcinoma were collected and divided into two groups according to whether they had mediastinal or hilar LNM. Patient tumor imaging, pathological features and gene mutations were analyzed, and risk factors that might predict LNM were derived via univariate and multivariate logistic analyses. LNM-related variables were screened by Boruta and least absolute shrinkage and selection operator regression analysis.

RESULTS

Among the 294 patients, 45 (15.3%) had positive mediastinal or hilar lymph nodes. There were no significant differences between the two groups in terms of sex, age, or underlying disease. The difference in the percentage of solidity between the two groups was significant, with the higer percentage group showing a more significant difference. The results of multivariate logistic analysis revealed that a high percentage of solid components and wild-type epidermal growth factor receptor (EGFR) were risk factors for LNM. The nomogram for predicting LNM included the consolidation tumor ratio, tumor size, micropapillary and EGFR, with an area under the curve of 93.4% (95% CI: 88.7-99.1) in the derivation cohort and 92.3% (95% CI: 84.6-99.9) in the validation cohort.

CONCLUSIONS

A high proportion of solid components and wild-type EGFR were risk factors for pT1 stage lung adenocarcinoma, suggesting that the choice of lung segmentectomy needs to be evaluated and selected more cautiously.

Preoperative Chemoradiotherapy for Esophageal Carcinoma: A Single-Center 10-Year Experience of Low Versus High-Dose Neoadjuvant Chemoradiation

BACKGROUND

While neoadjuvant chemoradiotherapy (CRT) is considered the standard of care for patients with locally advanced esophageal or gastroesophageal junction (GEJ) cancer, the optimal radiation dosing remains undefined. We aimed to assess the perioperative and long-term outcomes comparing patients treated with low-dose (LD-RT) versus high-dose (HD-RT) radiation therapy.

METHODS

Our institutional database was queried for patients with cT2-T4 or node-positive esophageal or GEJ cancer, who underwent surgery with neoadjuvant chemoradiation from 2010 through 2019. LD-RT and HD-RT regimens were defined as receiving total radiation dose ≤45 Gy and ≥50 Gy, respectively. Kaplan-Meier analysis, Cox proportional hazard modeling, and logistical regression were utilized for statistical analysis.

RESULTS

A total of 287 patients were identified: 77 (27%) received LD-RT; 210 (73%) received HD-RT. Median follow-up from diagnosis to death or last contact was 37.1 months for the study cohort. Older age at diagnosis (odds ratio [OR] 1.03/year, p = 0.02) and year of diagnosis (OR 0.77/year, p < 0.001) were independently associated with receipt of HD-RT relative to LD-RT. Compared with HD-RT, LD-RT was associated with improved 5 year overall survival (OS; 55.1 vs. 44.1%, p = 0.03). On multivariate hazard modeling, receipt of HD-RT was independently associated with worse OS (hazard ratio [HR] 1.79, 95% 1.19-2.68, p = 0.005), disease-free survival (HR 1.78, 95% CI 1.09-2.88, p = 0.02), and recurrence-free survival (HR 1.68, 95% CI 1.11-2.55, p = 0.01) compared with those treated with LD-RT.

CONCLUSIONS

Despite less frequent utilization than HD-RT strategies, LD-RT is associated with improved survival in those treated with neoadjuvant CRT for esophageal or GEJ cancer.

HPV-unrelated oropharyngeal cancer has elevated risk of synchronous hepatobiliary second primary malignancies compared to HPV-related oropharyngeal cancer: a population-based study from SEER

BACKGROUND

Our aim was to compare risk of synchronous and metachronous hepatobiliary second primary malignancies (SPMs) in survivors of human papillomavirus (HPV)-related [i.e., p16(+)] and HPV-unrelated [i.e., p16(-)] oropharyngeal cancer (OPC).

METHODS

A retrospective study was conducted for cases with OPC diagnosis during years 2018-2021 who had known p16 status using data of USA from Surveillance, Epidemiology, and End Results (SEER) Program [Incidence - SEER Research Limited-Field Data, 22 Registries (excl IL and MA), Nov 2023 Sub (2000-2021)]. In the statistical analyses, death was considered as a competing event for the development of a hepatobiliary SPM. Bias due to unbalanced baseline characteristics was eliminated by adjustments using propensity score and inverse probability of treatment weighting (IPTW). Risk of development of a hepatobiliary SPM was assessed using propensity-score-adjusted time-varying Cox proportional hazard regression [adjusted hazard ratio (aHR) with 95 % confidence interval (95 % CI)].

RESULTS

Overall, 25759 cases with tumor status of p16(-) (6353) and p16(+) (19406) with median (interquartile range) follow-up times of 14 (6, 26) and 20 (9, 32) months, respectively, were included. From these, 48 had a hepatobiliary SPM. Compared to HPV-related OPC, HPV-unrelated OPC had significantly elevated risk of synchronous all hepatobiliary SPMs [aHR= 2.39 (95 % CI, 1.11-5.15); P = 0.026] and synchronous hepatocellular carcinoma (HCC) SPM [aHR= 2.86 (95 % CI, 1.18-6.92); P = 0.020], but not metachronous ones. Curves of cumulative incidence of a hepatobiliary (or HCC) SPM and cumulative survival probability for those with a hepatobiliary SPM, both stratified by p16 status and adjusted by IPTW, were generated. The median survival time among patients with a hepatobiliary SPM was shorter for HPV-unrelated OPC (0.8 years) compared to HPV-related OPC (2.6 years).

CONCLUSION

The observed elevated risk was likely due to heavy alcohol and tobacco use and the protective role of HPV infection against HCC development in carriers of hepatitis C virus.

Supportive Care Needs and Related Interventions in Patients with Pancreatic Cancer and Their Informal Caregivers: A Scoping Review

PURPOSE

This scoping review aims to provide a comprehensive literature review regarding supportive care needs and related interventions for patients with pancreatic cancer and/or their informal caregivers.

METHODS

Following the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted this review. In January 2025, we searched five English databases using the keywords "pancreatic cancer," "patients/caregivers," "supportive care," and "needs." We summarized the data employing the Supportive Care Framework.

RESULTS

Of the 4752 references identified, 43 articles were included in the review. Among the 33 descriptive studies, informational needs emerged as the most frequently reported supportive care need, identified in studies involving both patients and informal caregivers (n = 6), patients only (n = 13), and informal caregivers only (n = 5). These were followed by emotional needs (n = 4) for both patients and informal caregivers, physical needs (n = 8) for patients only, and emotional (n = 4) and practical needs (n = 4) for informal caregivers only. Psycho-educational interventions were the most frequently reported approach for addressing the needs of both patients and informal caregivers, while pain/symptom management interventions were the most frequently used to support patients alone. Four studies demonstrated statistically significant improvements in outcomes for intervention groups compared to control groups.

CONCLUSION

Patients with pancreatic cancer and their informal caregivers experienced a spectrum of supportive care needs, particularly informational needs. Intervention strategies have been developed to address their supportive care needs, but only a few studies demonstrated statistically significant improvements in outcomes. These findings advance our understanding of the supportive care needs and related interventions for patients with pancreatic cancer and/or their informal caregivers, providing a foundation for future research and targeted interventions to better address these needs.

Optimizing NCCN distress thermometer use in real-world settings: a systematic review and thematic synthesis of the literature

PURPOSE

This systematic review aims to examine the workflows in distress screening and referral using the NCCN distress thermometer (DT) in the US, aiming to identify key elements for flexible, organization-specific approaches.

METHODS

A systematic review of full-text manuscripts published from 2013 to May 2024 was conducted using MEDLINE, EMBASE, and CINAHL. Studies describing distress screening and referral protocols were included, while systematic reviews, commentaries, non-US studies, non-English publications, and studies on distress score-disease burden associations were excluded. Attributes of distress screening and referral pathways were extracted.

RESULTS

From an initial 1219 articles, 19 studies were included. Significant variability was observed in NCCN DT workflows, particularly in responder characteristics (e.g., cancer type, patient vs. caregiver). Nursing staff primarily administered screenings, varying by mode (paper vs. electronic), frequency, and location (home vs. clinic). A cut-off score of 4 or higher often triggered referrals, with some studies further stratifying distress levels for tailored follow-ups. Referral pathways included educational resources, behavioral and emotional health, social support, and rehabilitative and supportive care services. Caregiver distress screening was infrequent.

CONCLUSION

This review underscores the variability in NCCN DT workflows and the need for customizable protocols. While standardization is desirable, some variation is essential to accommodate the differing availability of resources and personnel for effective distress screening and referral.

IMPLICATIONS FOR CANCER SURVIVORS

Effective distress screening and referral pathways ensure survivors receive timely psychological, emotional, and social support, improving quality of life. Integrating caregiver distress screening into workflows could amplify overall support systems, fostering holistic survivorship care. A flexible yet structured approach enhances access to tailored interventions, promoting resilience in survivors and caregivers.

Utilizing complementary therapy to enhance quality of life and reduce stress and fatigue in pediatric cancer patients

The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing, especially in pediatric oncology. This is a promising field of investigation for clinical nurses and researchers, and when it is subsidized by medium-range theories, they corroborate the diagnoses and interventions of nursing in oncology, enhancing the science of nursing care. This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy, to enhance quality of life and reduce stress and fatigue in pediatric cancer patients. Overall, the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients, and that complementary therapy usage should be part of a health comprehensive care model, delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients' life span. The results of scientific investigations by nurses, particularly those linked to the basic sciences, play a critical role in advancing personalized care in pediatric integrative oncology.

Comparison of 18F-FDG PET image quality and quantitative parameters between DPR and OSEM reconstruction algorithm in patients with lung cancer

OBJECTIVES

The present study aimed to investigate the influence of the deep progressive learning reconstruction (DPR) algorithm on the 18F-FDG PET image quality and quantitative parameters.

METHODS

In this retrospective study, data were collected from 55 healthy individuals and 184 patients with primary malignant pulmonary tumors who underwent 18F-FDG PET/CT examinations. PET data were reconstructed using the ordered subset expectation maximization (OSEM) and DPR algorithms. The influence of DPR algorithm on quantitative parameters was explored, including the SUVmax, SUVmean, standard deviation of SUV (SUVSD), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor-to-background uptake ratio (TBR). Finally, the differences in image quality parameters, including signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), between the two reconstruction algorithms were evaluated.

RESULTS

DPR algorithm significantly reduced the SUVmax and SUVSD of background tissues (all, P < 0.001) compared to OSEM algorithm, while no statistical difference was observed in SUVmean between the two algorithms (all, P > 0.05). DPR algorithm notably increased the SUVmax, SUVmean, and TBR of lesions (all, P < 0.001) and reduced MTV (P = 0.005), with minimal differences in TLG noted between the reconstruction algorithms (P < 0.001). The percentage differences in SUVmax (P = 0.001), SUVmean (P = 0.005), and TBR (P = 0.001) between the two algorithms were significantly higher in solid nodules than in pure ground glass nodules (pGGNs). The ΔCNR between solid nodules (P = 0.031) and mixed ground glass nodules (P = 0.020) was greater than that between pGGNs. SNR and CNR obtained using the DPR algorithm were markedly improved compared to those determined using the OSEM algorithm (all, P < 0.001).

CONCLUSION

Under identical acquisition conditions, the DPR algorithm enhanced the accuracy of quantitative parameters in pulmonary lesions and potentially improved lesion detectability. The DPR algorithm increased image SNR and CNR compared to those obtained using the OSEM algorithm, significantly optimizing overall image quality. This advancement facilitated precise clinical diagnosis, underpinning its potential to significantly contribute to the field of medical imaging.

Machine learning predictions of tumor progression: How reliable are we?

BACKGROUND

Cancer continues to pose significant challenges in healthcare due to the complex nature of tumor progression. In this digital era, artificial intelligence has emerged as a powerful tool that can potentially transform multiple aspects of cancer care.

METHODS

In the current study, we conducted a comprehensive literature search across databases such as PubMed, Scopus, and IEEE Xplore. Studies published between 2014 and 2024 were considered. The selection process involved a systematic screening based on predefined inclusion and exclusion criteria. Studies were included if they focused on applying machine learning techniques for tumor progression modeling, diagnosis, or prognosis, were published in peer-reviewed journals or conference proceedings, were available in English, and presented experimental results, simulations, or real-world applications. In total, 87 papers were included in this review, ensuring a diverse and representative analysis of the field. A workflow is included to illustrate the procedure followed to achieve this aim.

RESULTS

This review delves into the cutting-edge applications of machine learning (ML), including supervised learning methods like Support Vector Machines and Random Forests, as well as advanced deep learning (DL). It focuses on the integration of ML into oncological research, particularly its application in tumor progression through the tumor microenvironment, genetic data, histopathological data, and radiological data. This work provides a critical analysis of the challenges associated with the reliability and accuracy of ML models, which limit their clinical integration.

CONCLUSION

This review offers expert insights and strategies to address these challenges in order to improve the robustness and applicability of ML in real-world oncology settings. By emphasizing the potential for personalized cancer treatment and bridging gaps between technology and clinical needs, this review serves as a comprehensive resource for advancing the integration of ML models into clinical oncology.

HSP90 inhibitor-loaded hollow mesoporous nanoparticles for enhanced synergistic mild photothermal/chemotherapy in triple negative breast cancer

The combination of mild-temperature photothermal and chemotherapy represents a promising therapeutic strategy capable of maximizing anti-cancer efficacy while minimizing adverse reactions, particularly when integrated with multi-modal treatments. Nevertheless, the increase in heat shock protein (HSP) expression induced by mild hyperthermia may significantly influence the therapeutic efficacy. In this study, Isoliensinine (Iso) and the heat shock protein 90 (HSP90) inhibitor ganetespib were loaded into MPDA nanoparticles (NPs) to form GI-MPDA@BSA NPs, establishing a multi-modal therapeutic nanoplatform. The synthesized GI-MPDA@BSA NPs exhibit excellent photothermal conversion performance and favorable biocompatibility. Under 808 nm laser irradiation, the mild photothermal therapy (PTT) generated by MPDA facilitates the rapid release of drugs from BSA, resulting in an effective synergistic cytotoxic effect on cancer cells. Concurrently, the released ganetespib suppressed HSP90 expression, thereby potentiating the effects of mild photothermal/chemotherapy. In vitro and in vivo experimental results indicate that GI-MPDA@BSA exhibits low cytotoxicity while conspicuously inhibiting tumor growth under laser irradiation and eliciting an immune response. Furthermore, the application of two-dimensional ultrasound (2D US) and contrast-enhanced ultrasound (CEUS) to monitor post- tumor treatment changes elucidates the evolutionary process following combined mild-temperature photothermal/chemotherapy, presenting a novel strategy for the treatment and monitoring of triple negative breast cancer (TNBC) in clinical practice.

Surgical Management of Endometrial Intraepithelial Neoplasia at Military Treatment Facilities: A Multicenter Retrospective Study

INTRODUCTION

Endometrial intraepithelial neoplasia (EIN), also known as atypical endometrial hyperplasia (AEH), is a precursor lesion of endometrial carcinoma (EC). In endometrial cancer patients, lymph node assessment with biopsy during hysterectomy is part of surgical staging. However, routine lymph node assessment for EIN is inconsistently utilized. This study aims to investigate the surgical management of EIN in the military to inform best-practice guidelines tailored for the Military Health System to avoid delays in care, manage cost, ensure military readiness and optimize clinical outcome.

MATERIALS AND METHODS

We performed a retrospective chart review of patients with EIN treated at 2 military treatment facilities over a 10-year period between July 1, 2013 and July 1, 2023. Pathology reports were queried to identify patients with a preoperative diagnosis of EIN. Patients not surgically managed were excluded. Statistical analysis was performed using chi-squared test and Wilcoxon rank-sum test. Independent associations were investigated using logistic regression modeling.

RESULTS

There were 95 evaluable patients with an EIN diagnosis, including 43 (45.3%) patients upstaged to EC based on final pathology (95% CI: 35.0-55.8). Older patients diagnosed with EIN ≥65 years old and those with endometrial thickness ≥15 mm exhibited the highest risk for upstaging EIN to an EC diagnosis. Of the 50 patients who underwent lymph node assessment, none had positive lymph nodes. Patients diagnosed with EIN via hysteroscopy vs. an endometrial biopsy had the lowest risk of being upstaged to EC.

CONCLUSIONS

Upstaging from EIN to EC occurred in 45.3% of the 95 patients emphasizing the value of performing surgicopathologic staging in this setting. In contrast, none of the 50 EIN patients who underwent lymph node resection had positive lymph nodes indicating morbidity risk with low likelihood of clinical benefit. We identified risk factors for upstaging to EC, including age ≥65 years and endometrial thickness ≥15 mm, and confirmed the diagnostic superiority of hysteroscopy. These findings have informed clinical practice guideline recommendations for the surgical management of EIN in the Military Health System.

A novel nomogram based on PET/CT to predict lymph nodal metastasis for lung adenocarcinoma with normal size lymph node

BACKGROUND

A precise assessment of lymph nodal status is essential for guiding an individualized treatment plan in lung adenocarcinoma patients. A novel nomogram using easily accessible indicators was developed and validated in this study to predict CT-negative lymph nodal metastasis.

METHODS

Between September 2020 and December 2023, data from 132 consecutive patients diagnosed with lung adenocarcinoma who underwent lung resection with systemic lymph node dissection or sampling were retrospectively reviewed. Risk factors associated with lymph nodal metastasis were identified using univariable and multivariable logistic regression analyses. Subsequently, a nomogram was developed on basis of these identified parameters. The performance and validity of the nomogram were evaluated using the area under the receiver operating characteristic (ROC) curve, calibration curve, and bootstrap resampling techniques.

RESULTS

Four predictors (primary tumor location, primary tumor SUVmax value, N1 lymph node SUVmax, and N2 lymph node SUVmax) were identified and incorporated into the nomogram. The nomogram exhibited notable discrimination, evidenced by an area under the ROC curve of 0.825 (95% CI: 0.749-0.886, P < 0.001). Excellent concordance between the predicted and observed probabilities of lymph nodal involvement was demonstrated by the calibration curve. Furthermore, decision curve analysis indicated a net benefit associated with the use of our nomogram.

CONCLUSION

The nomogram demonstrated efficacy and practicality in predicting CT-negative lymph node metastasis for lung adenocarcinoma patients. It holds potential to offer valuable treatment guidance for clinicians.