Prognostic Significance of the Royal Marsden Hospital (RMH) Score in Patients with Cancer: A Systematic Review and Meta-Analysis

Global research trends on biomarkers for cancer immunotherapy: Visualization and bibliometric analysis

The global burden of cancer continues to grow, posing a significant public health challenge. Although cancer immunotherapy has shown significant efficacy, the response rate is not high. Therefore, the objective of our research was to identify the latest research trends and hotspots on biomarkers from 1993 to 2023. Data were collected from the database Web of Science core collection. Bibliometric analysis and visualization were conducted with CiteSpace(6.3.1), VOSviewer (v1.6.20), R-bibliometrix(v4.3.3), and Microsoft Excel(2019). A total of 2686 literatures were retrieved. The sheer annual volume of publications has shown a rapid upward trend since 2015. The United States has generated the most publications and Harvard University ranked as a leading institution. The global biomarker research on immune checkpoint inhibitors (ICIs) revealed regional differences and in-depth explorations should be promoted in developing countries. Although China has become the second largest country in terms of publication, the average citation per paper and the total link strength were both lower than the other countries. The research on biomarkers mainly concentrated upon the following aspects: PD-1/PD-L1, CTLA-4, gene expression, adverse events, total mutational burden (TMB), body mass index (BMI), gut microbiota, cd8(+)/cd4(+) t-cells, and blood-related biomarkers such as lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), cytokines. Furthermore, "artificial intelligence" and "machine learning" have become the most important research hotspot over the last 2 y, which will help us to identify useful biomarkers from complex big data and provide a basis for precise medicine for malignant tumors.

Leveraging machine learning for integrative analysis of T-cell receptor repertoires in colorectal cancer: Insights into MAIT cell dynamics and risk assessment

This study investigates the T-cell receptor (TCR) repertoires in colorectal cancer (CRC) patients by analyzing three distinct datasets: one bulk sequencing dataset of 205 patients with various tumor stages, all newly diagnosed at Sheba Medical Center between 2017 and 2022, with minimal recruitment in 2014 and 2016, and two (public) single-cell sequencing datasets of 10 and 12 patients. Despite the significant variability in the TCR repertoire and the low likelihood of sequence overlap, our analysis reveals an interesting set of TCR sequences across these data. Notably, we observe elevated presence of mucosal-associated invariant T (MAIT) cells in both metastatic and non-metastatic patients. Furthermore, we identify nine identical TCR alpha and TCR beta pairs that appear in both single-cell datasets, with 13 out of 18 sequences from these sequences also appearing in the bulk data. Clinical risk analysis over the bulk dataset, using a subset of these unique sequences, demonstrates a correlation between TCR repertoire disease stage and risk. These findings enhance our understanding of the TCR landscape in CRC and underscore the potential of TCR sequences as biomarkers for disease outcome.

Enhancing outcomes in metastatic renal cell carcinoma: Integrating precision radiotherapy with targeted therapy and anti-PD-1 immunotherapy

PURPOSE

This study assesses the safety and disease control outcomes in metastatic renal cell carcinoma (mRCC) patients undergoing concurrent tyrosine kinase inhibitors (TKI), immune checkpoint inhibitors (ICIs), and high-dose stereotactic ablative body radiotherapy (SABR) .

PATIENTS AND METHODS

Between February 2020 to May 2023, 54 mRCC patients receiving vascular endothelial growth factor (VEGF) targeted therapy and ICIs with high-dose radiotherapy (RT) were included. Genetic testing was performed on 25 pathology samples using the Acornmed 70™ panel. Endpoints included progression-free survival (PFS) 1, PFS2 (time to progression to change systemic therapy), LRFS, OS, disease control rate (DCR) and safety. Kaplan‒Meier analysis was used for time-to-event endpoints. HRs and 95% CIs were calculated. R version 4.3.1 was used for statistical analysis RESULTS: In this study involving 54 patients, SABR was employed in 81% of cases, achieving a 98% DCR. Median PFS1 was 16.9 months, with 2-year PFS2 and OS rates of 53% and 81%, respectively. Subgroup analysis revealed that early RT significantly improved PFS1 (P = 0.023). VHL-driven mRCC demonstrated a trend toward improved PFS1, statistical significance was not reached due to the limited sample size (P = 0.3). Safety analysis indicated grade 3 or 4 treatment-related adverse events in 50% of patients, with no grade 5 events.

CONCLUSIONS

The investigated trimodality treatment strategy is both safe and effective, resulting in prolonged PFS without requiring a change in systemic treatment. Overall, early RT intervention may offer additional benefits. Future research should provide molecular-level insights into treatment response.

Comparison of monotherapy and combination therapy for older patients with advanced biliary tract cancer: a retrospective study

BACKGROUND

The current standard first-line treatment for patients with advanced biliary tract cancer (BTC) is a combination chemotherapy regimen. However, whether the efficacy of combination therapy is superior to that of monotherapy in older patients with BTC remains unclear. Therefore, in this study, we aimed to compare the efficacy and safety of monotherapy with those of combination therapy in such patients.

METHODS

We retrospectively enrolled 157 patients with unresectable or recurrent BTC aged ≥ 75 years who received systemic chemotherapy between August 2011 and November 2020. We compared the efficacy and safety of combination therapy (gemcitabine [GEM] + cisplatin and GEM + S-1) with those of monotherapy (GEM or S-1 alone). We assessed patients' characteristics, survival, adverse events, and dose intensity. Statistical significance was set at p < 0.05.

RESULTS

Patients who received monotherapy were older and had worse performance status (PS), lower albumin levels, and higher carcinoembryonic antigen (CEA) levels than those who received combination therapy. The median overall survival (OS) was 16.4 and 12.8 months in the combination therapy and monotherapy groups, respectively (Hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.47-1.01), with a trend towards longer OS observed with combination therapy. However, multivariable analysis did not show superior OS with combination therapy (HR, 1.05; 95% CI, 0.66-1.68). Multivariable analysis also revealed gallbladder cancer, CEA, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) levels as prognostic factors for OS. Regarding safety, the incidence of grade ≥ 3 adverse events was significantly higher in the combination therapy group than in the monotherapy group (79% vs. 53%, p = 0.001); however, the rate of treatment discontinuation was approximately 10% in both groups, with no treatment-related deaths, suggesting that toxicities are manageable even in older patients.

CONCLUSIONS

Combination therapy is not necessarily recommended for older patients with BTC. Selecting an appropriate chemotherapy regimen based on an individual's condition is important.

Evaluation of a novel ensemble model for preoperative ovarian cancer diagnosis: Clinical factors, O-RADS, and deep learning radiomics

BACKGROUND

Accurate early diagnosis of ovarian cancer is crucial. The objective of this research is to create a comprehensive model that merges clinical variables, O-RADS, and deep learning radiomics to support preoperative diagnosis and assess its efficacy for sonographers.

MATERIALS AND METHODS

Data from two centers were used: Center 1 for training and internal validation, and Center 2 for external validation. DL and radiomics features were extracted from transvaginal ultrasound images to create a DL radiomics model using the LASSO method. A machine learning model ensemble was created by merging clinical variables, O-RADS scores, and DL radiomics model predictions. The model's effectiveness was evaluated by measuring the area under the receiver operating characteristic curve (AUC) and analyzing its impact on improving the diagnostic skills of sonographers. Moreover, the model's additional usefulness was assessed through integrated discrimination improvement (IDI), net reclassification improvement (NRI), and subgroup analysis.

RESULTS

The ensemble model demonstrated superior diagnostic performance for ovarian cancer compared to standalone clinical models and clinical O-RADS models. Notably, there were significant improvements in the NRI and IDI across all three datasets, with p-values < 0.05. The ensemble model exhibited exceptional diagnostic performance, achieving AUCs of 0.97 in both the internal and external validation sets. Moreover, the implementation of this ensemble model substantially improved the diagnostic precision and reliability of sonographers. The sonographers' average AUC improved by 11 % in the internal validation set and by 7.7 % in the external validation set.

CONCLUSIONS

The ensemble model significantly enhances preoperative ovarian cancer diagnosis accuracy and improves sonographers' diagnostic capabilities and consistency.

Predictive factors of chemotherapy‑induced nausea and vomiting in elderly patients with gynecological cancer undergoing paclitaxel and carboplatin therapy: A retrospective study

Chemotherapy-induced nausea and vomiting (CINV) is a common and distressing adverse effect in elderly patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. The present study aimed to identify predictors of CINV in this population. A retrospective analysis was conducted of 209 elderly patients with gynecological cancer treated with paclitaxel and carboplatin chemotherapy at The Affiliated Hospital, Southwest Medical University (Luzhou, China) between May 2019 and July 2023. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) was used to assess the presence, frequency, and severity of CINV. Patients were categorized into the CINV group (n=76) and non-CINV group (n=133) based on the MAT results. Age, hypertension, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level were identified as significant predictors of CINV in the univariate analysis. In the multivariate analysis, age, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level remained significant predictors. In conclusion, age, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level are significant predictors of CINV in elderly patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. These findings could help in tailoring preventative strategies for CINV in this population.

The association between blood sodium levels and survival in patients treated with immune checkpoint inhibitors

BACKGROUND

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for solid tumors, offering substantial survival benefits. Despite this progress, many patients do not achieve durable responses, highlighting the need for novel prognostic biomarkers. This study investigates the association between serum sodium levels and survival outcomes in patients treated with ICIs.

RESEARCH DESIGN AND METHODS

We conducted a retrospective cohort study involving 509 patients with metastatic solid tumors treated with ICIs. We assessed overall survival (OS), progression-free survival (PFS), and response rates using Kaplan-Meier survival analysis and multivariate cox regression analysis.

RESULTS

The median age was 62 years (interquartile range (IQR): 54-69), and 76.6% of the patients were male. Multivariate analysis revealed that serum sodium levels between 135-140 mmol/L were an independent predictor of improved OS (HR: 0.58; 95% CI: 0.44-0.77) and PFS (HR: 0.76; 95%CI: 0.58-0.99) and those with levels > 140 mmol/L had an even lower HR of 0.43 (95% CI:0.31-0.62) for OS and HR of 0.62 (95% CI:0.45-0.86) for PFS.

CONCLUSION

This study highlights that ICI-treated patients with higher sodium levels had significantly better OS, PFS, and anti-tumor responses. Baseline serum sodium levels could be cost-effective and valuable predictive biomarker for ICIs across diverse tumor types and ICI agents.

Integrating Bulk and Single-Cell RNA Sequencing Data Reveals the Prognostic Significance of HOXC9-Related Immune Gene Signatures in Hepatocellular Carcinoma

Objective

This study aims to integrate bulk and single-cell RNA sequencing data to construct a risk score model based on HOXC9-related immune genes (HRIGs) and evaluate its prognostic value in hepatocellular carcinoma (HCC).

Materials and Methods

RNA sequencing data and clinical information of HCC were obtained from TCGA and GEO databases. HRIGs were identified and a risk score model was constructed using LASSO-Cox regression analysis. The association between the risk score and tumor microenvironment was analyzed using CIBERSORT and ESTIMATE algorithms. Single-cell RNA sequencing (scRNA-seq) data were used to assess cell type distribution. Cell experiments were conducted to verify the effects of HOXC9 knockdown on HCC cell proliferation and invasion.

Results

HOXC9 is highly expressed in HCC and associated with poor prognosis (p=0.031). The risk score model based on four HRIGs (EGLN3, IMPDH1, LPCAT1, and MARCKSL1) showed good prognostic discrimination in both TCGA and GEO cohorts, with significantly lower overall survival in the high-risk group (p<0.0001). The high-risk group exhibited higher immune scores and increased immune cell infiltration, as well as elevated immune checkpoint expression. scRNA-seq revealed increased hepatocytes and fibroblasts but decreased T/NK cells in HCC tissues. HOXC9 knockdown significantly inhibited HCC cell proliferation and invasion.

Conclusion

HOXC9 is overexpressed in HCC and correlates with poor prognosis. The HRIG-based risk score model effectively evaluates the prognosis and immune response in HCC patients, providing new insights for risk assessment and immunotherapy prediction.

Subsequent primary cancer risk and mortality among premenopausal breast cancer survivors

Patients with premenopausal breast cancer (preBC) usually have long-term survivorship. However, less is known about the risk pattern of subsequent primary cancer (SPC) and noncancer diseases among them. Here, this study aimed to evaluate the risk of developing SPCs and mortality among preBC survivors. In this population-based, retrospective cohort study, 5-year preBC survivors diagnosed at age 20-59 years during 1992-2014, in the 11 Surveillance, Epidemiology and End Result registries were included. Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) were estimated for SPCs and mortality by cause, respectively. Among 181,947 survivors (mean age at diagnosis, 49.1 years; 65.9% White), there were 12,503 SPC cases, 4,280 SPC-related deaths, and 10,591 noncancer-related deaths. SPC risk was increased compared with the general population (SIR 1.06, [95% CI, 1.04-1.08]). The elevated risk was primarily associated with soft tissue cancer, bones/joints cancer, and acute non-lymphocytic leukemia (SIRs 2.01 [95% CI, 1.73-2.33], 1.78 [95% CI, 1.21-2.53], and 1.68 [95% CI, 1.46-1.93], respectively). Young-onset, Asian survivors, those with hormone receptor-negative BC, and initially treated with chemo-radiotherapy were at high-risk. The risk of dying from SPCs was also increased (SMR 1.07, [95% CI, 1.04-1.10]) and featured with similarly vulnerable subpopulations. Survivors of non-White ethnicity had a higher risk of dying from noncancer diseases. This study highlighted the excess risk of developing and dying from SPCs among preBC survivors, suggesting that targeted healthcare is warranted. Strategies for SPCs and noncancer comorbidity management are in great demand to achieve better long-term survivorship among preBC patients.

The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer

BACKGROUND

Systemic inflammation has prognostic value in cancer and is considered aetiological of cachexia by the Global Leadership Initiative on Malnutrition (GLIM). Lactate dehydrogenase (LDH) also has recognized prognostic value. The present study aimed to evaluate the ability of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin, to identify cachexia and predict outcome in advanced lung cancer.

METHODS

Patients (n = 261) with serum LDH, CRP and albumin measurement receiving palliative radiotherapy for advanced lung cancer between 2009 and 2015 were identified. Subjects were stratified by LDH and LCAS. This was compared to GRIm and LIPI, two previously described LDH based prognostic scores, which do not incorporate CRP.

RESULTS

On follow up there were 201 deaths. LDH and LCAS were associated with 1-year survival independent of ECOG-PS, MUST, weight loss, BMI, SMI, SMD, metastases, mGPS or NLR (all p < 0.001). On multivariate analysis LCAS (1.36, 1.13-1.63, p = 0.001), LIPI (1.50, 1.17-1.92, p = 0.02), metastases (1.53, 1.15-2.04, p = 0.004) and ECOG-PS (1.28, 1.04-1.57, p = 0.019) were independently associated with poorer overall survival.

CONCLUSION

LCAS appears to identify cachexia and stratify survival. This may represent a useful aetiological criterion within the GLIM framework and a more powerful prognostic tool than the phenotypic criteria.

Genome-wide cell-free DNA methylation profiling in advanced stage ovarian cancer. Are we looking at the tumor or the patient's immune response to the tumor?

The aim of this study was to identify differentially methylated regions in cell-free DNA (cfDNA) between healthy persons and patients with advanced stage ovarian cancer (ASOC) and to identify differences in cfDNA methylation before and after cytoreductive surgery. Plasma-derived cfDNA was analyzed by a high-throughput genome wide DNA methylation sequencing technique: MeD-seq. A training set of therapy naïve cfDNA samples of patients with ASOC (≥FIGO stage IIIB, n=10) was compared with cfDNA of healthy controls (n=10) to define a ASOC specific cfDNA methylation signature. A cumulative hypermethylation score was constructed and a validation set of pre- and postoperative samples of 39 patients were compared using this score. MeD-seq results of tumor tissue samples were correlated with cfDNA results. Patients with ASOC showed a clear distinct cfDNA methylation signature from healthy controls (p<0.0001). This cfDNA-methylation signature resulted in preoperative hypermethylation scores (135; interquartile range 110-163) that were significantly higher than postoperative hypermethylation scores (91; interquartile range 76-101) (p<0.001). The cfDNA methylation signature at baseline differed from tumor tissue and was more closely related to DNA methylation of immune-related cells (T-lymphocytes, neutrophil granulocytes, monocytes, and B-lymphocytes) than to ASOC tissue. MeD-seq provides a promising method for genome wide methylation profiling of cfDNA. Patients with ASOC could clearly be distinguished from healthy controls and differed pre- and postoperatively.

A novel tumor-associated macrophage risk signature predicts prognosis and immunotherapy response in lung adenocarcinoma

OBJECTIVE

To systematically characterize tumor-associated macrophage (TAM) subsets in lung adenocarcinoma (LUAD) and establish a TAM-based prognostic risk signature for LUAD patients.

METHODS

Single-cell RNA sequencing (scRNA-seq) and bulk transcriptomic data were integrated to identify TAM subsets linked to LUAD prognosis. Prognostic genes were screened using univariate Cox regression, refined via Least Absolute Shrinkage and Selection Operator (LASSO) regression, and used to construct a 10-gene risk signature. The signature's performance was validated in independent cohorts through receiver operating characteristic curves, Kaplan-Meier survival analysis, and a nomogram. Its predictive ability for immune checkpoint inhibitor (ICI) therapy response was assessed in the IMvigor210 and GSE78220 datasets.

RESULTS

Six distinct TAM subpopulations were identified, with two subsets significantly correlated with poor prognosis. The 10-gene risk signature, derived from TAM-related genes, demonstrated strong prognostic performance in both training and validation cohorts. High-risk patients exhibited markedly worse overall survival compared to low-risk patients. Additionally, the signature effectively stratified patients based on their response to anti-PD-L1 therapy, with high-risk patients exhibiting reduced clinical benefit. A nomogram combining the risk signature with clinicopathological parameters further enhanced survival prediction accuracy, supporting its clinical applicability.

CONCLUSION

This study established a novel TAM-based prognostic risk signature with robust predictive power for both survival outcomes and immunotherapy response in LUAD. These findings enhance our understanding of TAMs' clinical significance and provide a foundation for personalized immunotherapy strategies in LUAD.

Liquid biopsy for guiding breast cancer immunotherapy

Liquid biopsy is a laboratory test used to detect and analyze circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and other tumor-derived components, in a blood sample. In the context of breast cancer (BC), liquid biopsies hold significant promise for guiding the use of immune checkpoint inhibitors and immune-based combinations, offering real-time insights into tumor dynamics, treatment response, and resistance mechanisms. This review explores the role of liquid biopsy in BC immunotherapy, focusing on its applications, benefits, issues, and current and future research directions.

Comprehensive clinical and genetic characterization of hyperprogressive biliary tract cancer during PD-1 blockade monotherapy: case report and literature review

BACKGROUND

Some genetically characterized patients show the rapid disease progression during immune checkpoint inhibitors (ICIs) monotherapy, a phenomenon known as hyperprogressive disease (HPD).

CASE PRESENTATION

Herein we report a relevant case of biliary tract cancer (BTC) that initially responded to gemcitabine plus oxaliplatin (GEMOX) and PD-1 blockade but subsequently developed HPD in the process of PD-1 blockade maintenance therapy, leading to death within two weeks. Genomic analysis revealed mutations in CDKN2A, PIK3CA, KRAS and EPHA2 in both baseline and hyperprogressive plasma and tumor samples. Notably, higher KRAS mutation abundance was observed in plasma and ascites after disease progression.

CONCLUSIONS

These findings suggest a potential association between these negative genes especially KRAS mutation and HPD. Therefore, administration of PD-1 blockade monotherapy in this subgroup of patients harboring KRAS mutation should be performed with caution. Further studies are warranted to confirm these results and explore the correlation between genomic mutations and HPD.

Prognostic role of STMN1 expression and neoadjuvant therapy efficacy in breast cancer

PURPOSE

breast cancer is common and highly malignant, currently, STMN1 was found to be associated with several human malignancies. The purpose of this study is to investigate STMN1 expression in breast cancer and explore its role in disease progression and its interaction with neoadjuvant therapy efficacy.

METHODS

we analyzed the tissue STMN1 mRNA expression in BC tissue samples from 105 patients received with neoadjuvant therapy using qPCR between 2019 and 2022.

RESULTS

Statistical analysis showed that a high expression of STMN1 before neoadjuvant chemotherapy (NACT) was a trend positively related to non-pCR in the ITT (Intention to Treat) population, while in patients with paclitaxel or docetaxel regimens, before-NACT STMN1 expression was obviously higher in non-pCR (failure to achieve pathologically complete response) patients. Additionally, compared to pCR, high expression of STMN1 after NACT was obviously related to non-pCR. Interestingly, Kaplan-Meier analysis demonstrated that patients with mid-high STMN1 expression before and post-NACT had a poorer PFS to compared to those with low expression.

CONCLUSIONS

STMN1 is the potential biomarker of NACT and prognosis for breast cancer.

The association between benign and malignant prostatic hyperplastic diseases and blood and urine biomarkers: A Mendelian randomization study

The identification of suitable biomarkers holds significant clinical importance for the early detection of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). This study aimed to conduct a comprehensive analysis of the relationship between BPH and blood and urine biomarkers (BUB), as well as PCa and BUB. Candidate single nucleotide polymorphisms associated with BPH or PCa were derived from recent genome-wide association studies. The UK Biobank cohort comprised 363,228 individuals with BUB test data, enabling the calculation of a polygenic risk score for BPH or PCa. Bidirectional 2-sample Mendelian randomization was employed to assess the potential causal association between candidate BUB and BPH, as well as between BUB and PCa. In this study, a notable correlation was observed between BPH and gamma-glutamyl transferase (r = 1.061658447, P = .028697428). PCa exhibited significant associations with insulin-like growth factor 1 (r = 1.119051258, P = .004101067), Lipoprotein A (r = 1.120348291, P = .038093372), total protein (r = 0.87643517, P = .01657563), and non-albumin protein (r = 0.905333153, P = .03103913). The findings offer valuable insights into the significance of BUB in the timely identification and management of BPH and PCa.

In silico research of coagulation- and fibrinolysis-related genes for predicting prognosis of clear cell renal cell carcinoma

Background

Coagulation- and fibrinolysis-related genes (CFRGs) are involved in tumor progression. However, their regulatory mechanisms in clear cell renal cell carcinoma (ccRCC) remain unclear. The aim of this study was to search for genes related to coagulation and fibrinolytic systems in ccRCC and to investigate their potential role in tumor pathogenesis and progression.

Methods

Differentially expressed genes (DEGs) between ccRCC and control samples, as well as key module genes associated with ccRCC, were extracted from The Cancer Genome Atlas-Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) dataset. Differentially expressed CFRGs (DE-CFRGs) were identified by intersecting these DEGs with CFRGs. Prognostic genes were identified through univariate Cox, least absolute shrinkage and selection operator (LASSO), and multivariate Cox analyses of DE-CFRGs. Additional independent prognostic and enrichment analyses were conducted, and potential therapeutic drugs were predicted. In addition, quantitative real-time polymerase chain reaction (RT-qPCR) was performed to validate the expression of prognostic genes.

Results

Sixteen DE-CFRGs were identified by intersecting 3,311 DEGs, 1,719 key module genes, and CFRGs. Four prognostic genes-TIMP1, RUNX1, BMP6, and PROS1-were found to be involved in complement and coagulation cascades and other functional pathways. The prognostic model demonstrated strong predictive power for ccRCC, with stage, risk score, and grade all correlating with prognosis. Additionally, 14 potential drugs, such as tamoxifen citrate and cytarabine, were predicted for therapeutic targeting of the identified prognostic genes. RT-qPCR confirmed that the expression levels of TIMP1, and RUNX1 were significantly upregulated in ccRCC samples, consistent with bioinformatics analysis.

Conclusions

A prognostic model incorporating TIMP1, RUNX1, BMP6, and PROS1 was constructed, offering new insights for prognostic evaluation and therapeutic strategies in ccRCC.

Role of cancer stem cell heterogeneity in intrahepatic cholangiocarcinoma

Background

Intrahepatic cholangiocarcinoma (ICC) is a highly invasive bile duct cancer with poor prognosis due to frequent recurrence and limited effective treatments. Cancer stem cells (CSCs) contribute to ICC's therapeutic resistance and recurrence, driven by distinct cellular subpopulations with variable tumorigenic properties. Recent advances in single-cell RNA sequencing (scRNA-seq) have enabled a deeper exploration of cellular heterogeneity in tumors, offering insights into unique CSC subgroups that impact ICC progression and patient outcomes. This study aimed to investigate the effect of CSC heterogeneity on the prognosis of ICC.

Methods

The scRNA-seq dataset GSE142784 was retrieved from the Gene Expression Omnibus (GEO) database, and Bulk RNA-seq data were obtained from The Cancer Genome Atlas (TCGA) databases. Hallmarks and AUCell R package were adopted for analyzing the signaling pathway activity, CellChat for observing cell communication between subgroups, and SCENIC for analyzing transcription factors expression. The immune cell infiltration and drug sensitivity of the model were analyzed using the CIBERSORT algorithm and the "pRRophetic" R packages, respectively. And immunohistochemistry (IHC) tests were used to evaluate expression of transcription factors in ICC patients.

Results

Based on scRNA-seq data, five clusters (DLK+, CD13+, CD90+, CD133+, and other cholangiocarcinoma cells) were observed in ICC, which presented different signaling pathway activities, such as HSF1 and STAT1 were highly expressed in the CD133 cluster, and consistent with the results of IHC tests. Pathways like Notch and Wnt/β-catenin signaling transferred among above subgroups. Further, subgroups favored varied immune response and drug sensitivity, and CD133+ subgroup patients showed significantly shortened recurrence-free survival (RFS).

Conclusions

Configuring the subgroup of ICC is helpful for predicting the prognosis and drug resistance in ICC and can provide new strategies for cancer treatment.

A retrospective study of radiotherapy combined with immunotherapy for patients with baseline brain metastases from non-small cell lung cancer

This multi-center retrospective study aimed to evaluate the safety and efficacy of first-line immunotherapy in non-small-cell lung cancer (NSCLC) patients with brain metastases (BM). The study included 138 patients treated with immune checkpoint inhibitors (ICIs), either alone or in combination with brain radiotherapy (BRT), from 2020 to October 2023. Intracranial overall response rate (iORR), overall response rate (ORR), progression-free survival (PFS), intracranial progression-free survival (iPFS), overall survival (OS) and treatment-related toxicities were evaluated. Although patients receiving ICIs plus BRT showed a trend toward longer OS compared with ICI alone, the difference was not statistically significant (P = 0.201). Among 82 patients with available data, the iORR was 49.1% (35-63) in the ICIs alone group, and 75.9% (56-90) in the ICIs + BRT group. Notably, in patients requiring corticosteroids or mannitol, combination therapy was associated with a better prognosis (P = 0.05). We found that the iORR of patients treated with ICIs + BRT was improved and did not increase the incidence of serious adverse events (SAEs). Besides, the combination of ICIs and BRT improved the survival rate of subgroups of patients using corticosteroids.

The relationship between body mass index and survival in patients with renal cell carcinoma treated with nivolumab

INTRODUCTION

Immunotherapies have increased the therapeutic options for patients with metastatic renal cell carcinoma (mRCC), but the absence of prognostic indicators remains unresolved. We assessed the potential association of BMI with the overall survival (OS) of patients treated with nivolumab.

METHODS

We performed a retrospective study of 126 patients with histologically confirmed mRCC who began systemic ICI therapy between January 2016 and April 2022 were included. BMI at the time of treatment start was calculated. Then patients were divided into two groups: high BMI (≥25) and low BMI (<25). Therapeutic responses were determined according to RECIST v1.1. OS was defined as the time from starting ICI treatment until death or last follow-up at the data cutoff.

RESULTS

The cohort was male 74.6%, with a median age of 62. The median follow-up time was 18.6 months. The patients were classified as low BMI (<25) and high BMI (≥25). The OS was 40.6 months (95% CI: 34.2-47.0) for patients with high BMI vs. 9.4 months (95% CI: 7.0-11.7) for patients with low BMI, and a significant association was found between BMI and OS (p < 0.001).

CONCLUSIONS

BMI was an independent prognostic factor in the patients with mRCC treated with nivolumab. Prospective and multicenter research is needed to confirm our findings.

ENTPD8 overexpression enhances anti-PD-L1 therapy in hepatocellular carcinoma via miR-214-5p inhibition

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, with poor prognosis due to late diagnosis and limited treatment options. In this study, we evaluated the expression of ectonucleoside triphosphate diphosphohydrolase 8 (ENTPD8) in HCC tissues and its clinical significance. Immunohistochemistry, The Cancer Genome Atlas (TCGA) data, and single-cell expression analysis revealed reduced ENTPD8 levels in liver cancer compared to adjacent tissues, with ENTPD8 primarily expressed in tumor cells within the tumor tissue. In vitro assays demonstrated that ENTPD8 inhibits HCC cell proliferation, invasion, and migration. Mechanistically, ENTPD8 regulates programmed death-ligand 1 (PD-L1) expression through miR-214-5p modulation. In vivo, ENTPD8 overexpression combined with anti-PD-L1 treatment enhanced therapeutic efficacy in HCC mouse models. These findings suggest that ENTPD8 may serve as a prognostic marker and therapeutic target for HCC, offering potential strategies for improving treatment outcomes.

Artificial intelligence for automatic diagnosis and pleomorphic morphological characterization of malignant biliary strictures using digital cholangioscopy

Diagnosing and characterizing biliary strictures (BS) remains challenging. Artificial intelligence (AI) applied to digital single-operator cholangioscopy (D-SOC) holds promise for improving diagnostic accuracy in indeterminate BS. This multicenter study aimed to validate a convolutional neural network (CNN) model using a large dataset of D-SOC images to automatically detect and characterize malignant BS. D-SOC exams from three centers-Centro Hospitalar Universitário de São João, Porto, Portugal (n = 123), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (n = 18), and New York University Langone Hospital, New York, USA (n = 23)-were included. Frames were categorized based on histopathology. The CNN's performance in detecting tumor vessels, papillary projections, nodules, and masses was assessed. The dataset was split into 90% training and 10% validation sets. Performance metrics included AUC, sensitivity, specificity, PPV, and NPV. Analysis of 96,020 images from 164 D-SOC exams (50,427 malignant strictures and 45,593 benign findings) showed the CNN achieved 92.9% accuracy, 91.7% sensitivity, 94.4% specificity, 95.1% PPV, 93.1% NPV, and an AUROC of 0.95. Accuracy rates for morphological features were 90.8% (papillary projections), 93.6% (nodules), 93.2% (masses), and 78.1% (tumor vessels). AI-driven CNN models hold promise for enhancing diagnostic accuracy in suspected biliary malignancies. This multicenter study contributes diverse datasets to ongoing research, supporting further AI applications in this patient population.

Novel Insights into PGM2L1 as a Prognostic Biomarker in Cholangiocarcinoma: Implications for Metabolic Reprogramming and Tumor Microenvironment Modulation

Cholangiocarcinoma (CCA) is a highly lethal malignancy and the most common adenocarcinoma of the hepatobiliary system. PGM2L1 belongs to the α-D-phosphohexomutase superfamily and functions as a glucose 1,6-bisphosphate (G16BP) synthase. There is growing evidence to provide an association its function to cancer metabolism and progression. However, the molecular mechanisms of PGM2L1 in CCA development remain lacking in evidence. In this study, we found that CCA patients with high PGM2L1 expression had the poorest prognosis. We identified two methylation sites (cg15214137 and cg03699633) within the PGM2L1 gene and their prognostic relevance. We further investigated the relationship between PGM2L1 expression and tumor-infiltrating immune cells, with a particular focus on neutrophils in CCA. Functional enrichment analyses further revealed that high PGM2L1 expression was associated with the Wnt signaling pathway, glycolytic metabolism, and the recruitment of neutrophils. Collectively, these findings suggest that PGM2L1 may serve as an independent prognostic biomarker and is closely linked to tumor immune infiltration and metabolic reprogramming in CCA.

Investigation and validation of neurotransmitter receptor-related biomarkers for forecasting clinical outcomes and immunotherapeutic efficacy in breast cancer

PURPOSE

The prognostic role of neurotransmitters and their receptors in breast cancer (BC) has not been fully investigated. The aim of this study was to construct a survival model for the prognosis of BC patients based on neurotransmitter receptor-related genes (NRRGs).

METHODS

BC-related differentially expressed genes (DEGs) were screened and intersected with NRRGs. GO, KEGG and PPI analyses were performed. Univariate Cox, Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate Cox regression analyses were used to construct prognostic models for biomarker expression levels. The model was validated using an external validation set. The receiver operating characteristic curves (ROC) for diagnostic value prediction and clinicopathologic characteristic nomogram were constructed. qRT-PCR was used for further in vitro validation experiments.

RESULTS

Forty-five overlapping genes were obtained by intersecting BC-related DEGs with 172 NRRGs. Univariate Cox, LASSO and multivariate Cox regression analyses were used to construct prognostic models for the expression levels of biomarkers including DLG3, SLC1A1, PSCA and PRKCZ. The feasibility of the model was validated by the GEO validation set. ROC curves were established for diagnostic value prediction. Patients in the high-risk group had a worse prognosis, higher TMB score, higher probability of gene mutation, and higher immune cell infiltration. RiskScore, M, N and Age were strongly correlated with survival. The mRNA expression levels of DLG3, PSCA and PRKCZ in the BC group were significantly higher than those in the control group.

CONCLUSION

Risk prediction model based on DLG3, SLC1A1, PSCA and PRKCZ, which are closely related to BC prognosis, was successfully constructed.

Machine learning assisted radiomics in predicting postoperative occurrence of deep venous thrombosis in patients with gastric cancer

BACKGROUND

Gastric cancer patients are prone to lower extremity deep vein thrombosis (DVT) after surgery, which is an important cause of death in postoperative patients. Therefore, it is particularly important to find a suitable way to predict the risk of postoperative occurrence of DVT in GC patients. This study aims to explore the effectiveness of using machine learning (ML) assisted radiomics to build imaging models for prediction of lower extremity DVT occurrence in GC patients after surgery.

METHODS

Included in this retrospective study were eligible patients who underwent surgery for GC. CT imaging data from these patients were collected and divided into a training set and a validation set. The least absolute shrinkage and selection operator (LASSO) algorithm was applied to reduce the dimensionality of variables in the training set. Four machine learning algorithms, known as random forest (RF), extreme gradient boosting (XGBoost), support vector machine (SVM) and naive Bayes (NB), were used to develop models for predicting the risk of lower extremity DVT occurrence in GC patients. These models were subsequently validated using the internal validation set and an external validation cohort.

RESULTS

LASSO analysis identified 10 variables, based on which four ML models were established, which were then incorporated with the clinical characteristics to predict lower extremity DVT occurrence in the training set. Among these models, RF and NB demonstrated the highest predictive performance, achieving an AUC of 0.928, while SVM and XGBoost achieved a slightly lower AUC of 0.915 and 0.869, respectively.

CONCLUSION

ML algorithms based on imaging information may prove to be novel non-invasive models for predicting postoperative occurrence of DVT in GC patients.

Evaluating the risk of underdiagnosis of invasive breast cancer in needle biopsy-diagnosed ductal carcinoma in situ eligible for radiofrequency ablation

BACKGROUND

Radiofrequency ablation (RFA) is considered a promising alternative to surgical excision for patients with small, unifocal early-stage breast cancer. A significant concern with the application of RFA in patients diagnosed with ductal carcinoma in situ (DCIS) via needle biopsy is the underdiagnosis of invasive cancer. The extent of this underdiagnosis in DCIS patients eligible for RFA has not been clearly defined.

METHODS

This retrospective study assessed lesions diagnosed as DCIS via needle biopsy and eligible for RFA at our institution from April 2009 to March 2024. The eligibility criteria for RFA included a lesion size of ≤ 1.5 cm, unifocality, and clinical node negativity. Underdiagnosis was defined as the presence of invasive cancer in surgical specimens. We evaluated the frequency and risk factors associated with underdiagnosis.

RESULTS

During the study period, 606 lesions were diagnosed as DCIS via needle biopsy. Of these, 209 lesions met the criteria for RFA, with underdiagnosis determined in 40 lesions (19.1%). The distribution of pathological T (pT) stages among these lesions was as follows: DCIS in 169 lesions (80.9%), pT1mi in 20 lesions (9.6%), pT1a in 5 lesions (2.4%), pT1b in 9 lesions (4.3%), pT1c in 5 lesions (2.4%), and pT2 in 1 lesion (0.5%). Multivariate logistic regression analysis identified lesion size ≥ 10 mm as a significant risk factor for underdiagnosis (p = 0.016). Adjuvant endocrine therapy and chemotherapy were administered to 26 (65.0%) and 6 (15.0%) of the underdiagnosed lesions, respectively.

CONCLUSIONS

Our findings highlight the risk of underdiagnosing invasive breast cancer in patients undergoing RFA for needle biopsy-diagnosed DCIS. It is crucial to acknowledge the potential for undertreatment when considering RFA as a treatment option.

Kinomic profiling to predict sunitinib response of patients with metastasized clear cell Renal Cell Carcinoma

INTRODUCTION

Treatment with Sunitinib, a potent multitargeted receptor tyrosine kinase inhibitor (TKI) has increased the progression-free survival (PFS) and overall-survival (OS) of patients with metastasized renal cell carcinoma (mRCC). With modest OS improvement and variable response and toxicity predictive and/or prognostic biomarkers are needed to personalize patient management: Prediction of individual TKI therapy response and resistance will increase successful treatment outcome while reducing unnecessary drug use and expense. The aim of this study was to investigate whether kinase activity analysis can predict sunitinib response and/or toxicity using tissue samples obtained from primary clear cell RCC (ccRCC) from a cohort of clinically annotated patients with mRCC receiving sunitinib as first-line treatment.

MATERIALS AND METHODS

EuroTARGET partners collected ccRCC and matched normal kidney tissue samples immediately after surgery, snap-frozen and stored at -80°C until use. Phosphotyrosine-activity profiling was performed using PamChip® peptide microarrays (144 peptides derived from known phosphorylation sites in Protein Tyrosine Kinase substrates) of lysed tissue samples (5 µg protein input) of 163 mRCC patients. Evolve software Was used to analyze kinome profiles and Bionavigator was used for unsupervised and supervised clustering. The kinexus kinase predictor (www.phosphonet.ca) was used to analyze the peptide lists within the clusters.

RESULTS

Kinome data was available from 94 patients who received sunitinib as 1st-line treatment and had complete follow-up of their clinical data (PFS, OS and toxicity) for at least 6 months. Matched normal tissue was available from 14 mRCC patients. Supervised clustering of basal kinome activity could correctly classify mRCC patients with PFS >9 months versus PFS<9 months with an accuracy of 61 %. Unsupervised hierarchical clustering revealed 3 major clusters related to immune signaling, VEGF pathway, and immune signaling/cell adhesion. Basal kinase activity levels of patients with short PFS were substantially higher compared to patients who experienced extended PFS.

DISCUSSION/CONCLUSION

Based on kinase levels ccRCC tumors can be subdivided into 3 clusters which may reflect the aggressiveness of these tumors. The accuracy of response prediction of 61 % based on basal kinase levels is too low to justify implementation. STK assays may help to predict sunitinib toxicity and guide clinical management. Additionally, it is possible that mRCC patients with an immune kinase signature are better checkpoint inhibitor candidates, but this needs to be studied.

Composition analysis and mechanism of Guizhi Fuling capsule in anti-cisplatin-resistant ovarian cancer

OBJECTIVE

Cisplatin is the main chemotherapy drug for advanced ovarian cancer, but drug resistance often occurs. The aim of this study is to explore the molecular mechanism by which Guizhi Fuling capsule inhibits cisplatin resistance in ovarian cancer.

METHODS

First, differences in cisplatin resistance, PA2G4 gene expression, migration, and invasion in A2780 cells and A2780/DDP cells were analyzed by qRT-PCR, scratch assay, transwell, immunofluorescence, and western blotting. Then, LC-MS/MS analysis of GFC chemical composition. qRT-PCR, scratch tests, transwell, pseudopodium formation, immunofluorescence, and western blotting were used to explore the mechanism by which GFC inhibited A2780/DDP cell migration and invasion. Finally, the anti-tumor efficacy of GFC was verified by in vivo experiments.

RESULTS

A2780/DDP cells had a greater ability to migrate and invade compared to their parents. Cell viability experiments showed that the migration and invasion ability of A278/DDP cells were significantly inhibited with the increase of GFC concentration. qRT-PCR results showed that compared with the blank control group, cisplatin group and GFC group, the transcription level of PA2G4 gene in the combination treatment group was significantly reduced. We also found that GFC combined with cisplatin inhibited the PI3K/AKT/GSK-3β signaling pathway by targeting PA2G4 gene expression, inhibited the epithelial-mesenchymal transition signaling pathway, decreased cell adhesion and inhibited the formation of cell pseudopodias.

CONCLUSION

GFC combined with cisplatin can target PA2G4 gene to regulate PI3K/AKT/GSK-3β Signaling pathway, inhibiting the invasion and migration of cisplatin resistant A2780/DDP cells in ovarian cancer.

Global Burden, Trends, and Inequalities of Gallbladder and Biliary Tract Cancer, 1990-2021: A Decomposition and Age-Period-Cohort Analysis

BACKGROUND

Gallbladder and biliary tract cancer (GBTC) increasingly aggravates the global malignancy burden. This study aimed to evaluate the updated condition of GBTC temporal burden trends and inequalities from 1990 to 2021.

METHODS

Data on GBTC were extracted from the Global Burden of Disease (GBD) 2021 study. Incidence, deaths, and disability-adjusted life years (DALYs) and their age-standardised rates (ASR) were quantified from 1990 to 2021, stratified by sex, age and sociodemographic index (SDI). The age-period-cohort (APC) model was used to elucidate the effects of age, period, and cohort. Decomposition analysis and cross-country inequality evaluation were performed to assess the contributing factors and disease imbalance, respectively. Bayesian APC analysis was used to estimate the future burden.

RESULTS

In 2021, the global incident cases of GBTC were 216 768, with 171 961 deaths and 3 732 121 DALYs lost. From 1990 to 2021, the ASR of incidence, mortality, and DALYs decreased slightly. Males showed a slight increase in ASR of incidence, while females experienced a significant decrease. High-income regions, particularly in Asia Pacific and Latin America, exhibited a higher burden, while Western Sub-Saharan Africa had the lowest. Low and low-middle SDI regions showed a gradual rise in all metrics despite lower absolute numbers. The APC analysis indicated that the global incidence of GBTC tended to rise with age, but gender differences existed. Besides, a deteriorating cohort effect was detected amongst individuals born between 1907 and 1917. Decomposition analysis revealed that population growth was the primary driver of the increased GBTC burden globally. Significant disparities in GBTC burden by SDI were observed, with a notable decline in inequality over time. Projections indicated a slow decline in the global ASR through 2040, with a more pronounced decrease in females.

CONCLUSIONS

There are significant regional and gender differences in the global burden of GBTC. Population growth remains a major contributor to the burden. Despite the overall decline, the increasing incidence in low and lower-middle SDI regions and the persistent male burden highlight the need for targeted interventions. Future efforts should focus on addressing socio-economic inequalities and reducing risk factors, particularly in vulnerable populations.

Exploring the Clinical Value of Perioperative ctDNA-Based Detection of Molecular Residual Disease in Patients With Esophageal Squamous Cell Carcinoma

OBJECTIVE

To explore the clinical value of molecular residual disease detection based on circulating tumor DNA (ctDNA-MRD) in the perioperative period of esophageal squamous cell carcinoma (ESCC) and to analyze the tumor escape mechanisms in MRD-positive cases.

METHODS

A total of 35 ESCC patients were prospectively enrolled. Preoperative and postoperative (1 month after surgery) blood and surgical tissue samples were analyzed. ctDNA variants were tracked in plasma to assess ctDNA-MRD, and whole-transcriptome sequencing was performed on MRD-positive and MRD-negative tissue samples.

RESULTS

Preoperative blood ctDNA was positive in 54.3% of patients, with a 31.6% positive predictive value for recurrence. One month postsurgery, the positive rate of ctDNA was 17.1%, with an 83.3% predictive value for recurrence. Both preoperative and postoperative ctDNA positivity were significant prognostic indicators (HR = 2.78, p < 0.05; HR = 4.42, p < 0.001). Multivariate analysis confirmed ctDNA as an independent prognostic factor (HR = 303.75, p < 0.001). Transcriptomic analysis revealed increased macrophage (W = 15 848; p < 0.01) and follicular helper T (Tfh) cell (W = 10 935; p < 0.01) levels in MRD-positive patients, suggesting a potential link to immune escape in tumors.

CONCLUSIONS

Plasma ctDNA measured 1 month postoperatively in ESCC patients can effectively detect MRD, and ctDNA-MRD serves as an independent risk factor for postoperative recurrence. The mechanism underlying MRD positivity may involve the polarization of Tfh cells and macrophages, aiding tumor cells in immune escape through the bloodstream.

Prognostic significance of perioperative circulating CD56bright NK cell and recovery of NK cell activity in patients with colorectal cancer undergoing radical surgery

INTRODUCTION

Natural killer (NK) cell activity (NKA) is downregulated in patients with colorectal cancer (CRC), and its dysfunction is possibly associated with increased risk of recurrence. However, its role in prognosis of CRC remains unclear. Prior research has shown that surgical stress can suppress NKA. This study explores the relationship between NK cell/NKA and clinicopathological factors during the perioperative period in patients with CRC.

METHODS

We prospectively enrolled 45 patients with CRC. Venous blood samples were collected preoperatively and on postoperative day 3 (POD3) and 30 (POD30). NKA was assessed by measuring the plasma levels of NK cell-secreted IFN-γ.

RESULTS

NKA was significantly reduced on POD3 compared with baseline levels before surgery but showed significant recovery by POD30. NKA on POD30 was considerably higher in patients with advanced disease stages or one or more high-risk preoperative factors. Additionally, a higher NKA recovery in patients with advanced stage exhibited improved recurrence-free survival (RFS) and progression-free survival (PFS) (hazards ratio (HR): 0.2442). Furthermore, an increased percentage of CD56bright NK cells and a higher CD56bright/CD56dim NK cell ratio postoperatively on POD30 were associated with better RFS/PFS (HR: 0.2732, P = 0.0433 and HR: 0.2193, P = 0.024, respectively).

CONCLUSIONS

Our findings indicate that a notable postoperative increase in CD56bright NK cells on POD30, both in percentage and ratio, correlates with a more favorable prognosis in CRC patients. Additionally, higher recovery rates of NKA in patients with advanced stages may offer potential applications in risk stratification and the development of treatment strategies for CRC.

Identification and validation of a prognostic risk model based on radiosensitivity-related genes in nasopharyngeal carcinoma

BACKGROUND

Despite advancements with intensity-modulated radiation therapy (IMRT), about 10 % of nasopharyngeal carcinoma (NPC) patients remain resistant to radiotherapy, leading to recurrence and poor prognosis. This study aims to identify radiosensitivity-related genes in NPC and develop a prognostic model to predict patient outcomes.

METHODS

We analyzed 179 NPC samples from Fujian Cancer Hospital using RNA sequencing. Differentially expressed genes (DEGs) were identified between radiotherapy-sensitive and resistant samples. Machine learning algorithms and Cox regression were used to construct a prognostic risk model, validated in the GSE102349 dataset. Additional analyses included functional pathway, immune infiltration, and drug sensitivity.

RESULTS

A risk model based on six genes (LCN8, IGSF1, RIMS2, RBP4, TBX10, ETV4) was developed. Kaplan-Meier analysis showed significantly shorter progression-free survival (PFS) in the high-risk group. The model's AUC values were 0.872, 0.807, and 0.802 for 1-year, 3-year, and 5-year predictions. A nomogram including clinical factors was created, and enrichment analysis linked the high-risk group to radiotherapy resistance mechanisms.

CONCLUSIONS

This study established a novel radiosensitivity-related prognostic model, offering insights into NPC prognosis and radiotherapy resistance mechanisms.

Chimeric antigen receptor-T cells targeting AFP-GPC3 mediate increased antitumor efficacy in hepatocellular carcinoma

BACKGROUND AND STUDY AIMS

As a novel immunotherapy, chimeric antigen receptor T (CAR-T) cell technology is successful in treating hematologic malignancies, and exhibits potential benefits in partial solid tumors. Therapies targeting one antigen have some weaknesses, and dual-targeted CAR-T cells may be a better option. Alpha-fetoprotein (AFP) and glypican-3 (GPC3) are both highly expressed in hepatocellular carcinoma (HCC) and serve as important markers. Our study aimed to compare the cytotoxicity effect of AFP and GPC3 dual-targeted CAR-T cells on HCC cells in vitro and its therapeutic effects on a SCID xenograft model with those of single-targeted CAR-T cells.

MATERIALS AND METHODS

pLVX lentivirus vectors loaded with AFP CAR, GPC3 CAR, or AFP-GPC3 CAR constructs were transfected into human T lymphocytes. Control T, AFP CAR-T, GPC3 CAR-T, and AFP-GPC3 CAR-T cells were used as effector cells, and HLE (AFP-GPC3-), Sh-GPC3-Huh-7 (AFP+), Sh-AFP-Huh-7 (GPC3+), and Huh-7 (AFP+GPC3+) cells were used as target cells. After their co-culture for 6 h, the LDH cytotoxicity assay was employed to estimate the cell-killing effects of CAR-T cells on the target HCC cells. SCID mice bearing Huh-7 cell-derived neoplasms were injected with CAR-T cells, after which the pathological changes, CD3ζ expression, and IL-2 and IFN-γ levels in mouse tumor tissues were determined.

RESULTS

AFP and GPC3 were highly expressed in Huh-7 cells. AFP-GPC3 CAR-T cells exerted significant cell-killing effects on the HCC cells that expressed specific targeting antigen molecules (AFP and GPC3). Besides, AFP-GPC3 CAR-T cells better promoted Th cytokine secretion by Huh-7 cells than AFP CAR-T and GPC3 CAR-T cells. In vivo results suggested that AFP-GPC3 CAR-T cells better inhibited the growth of Huh-7 cell (AFP+GPC3+)-derived neoplasms than AFP CAR-T and GPC3 CAR-T cells.

CONCLUSION

AFP and GPC3 dual-targeted CAR-T cells showed better anti-tumor effects in HCC than AFP or GPC3 single-targeted CAR-T cells.

Comparative efficacy of transarterial chemoembolization with and without PD-1 inhibitor in the treatment of unresectable liver cancer and construction and validation of prognostic models

Background

In recent years, therapeutic strategies for liver cancer have been continuously evolving, with transarterial chemoembolization (TACE) being widely applied. Although TACE has demonstrated good short-term efficacy, long-term prognosis remains a challenge. This study aimed to investigate the clinical efficacy and safety of TACE combined with tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 (PD-1) inhibitors versus TACE combined with TKIs alone. Additionally, we explored prognostic factors, constructed a prognostic model, and validated it.

Methods

A retrospective analysis was conducted on 174 patients with unresectable hepatocellular carcinoma at Lu'an Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Traditional Chinese Medicine from December 21, 2018, to January 15, 2023. Of these, 122 patients were treated with TACE + TKIs + PD-1, and 52 patients with TACE + TKIs. The objective was to compare overall survival (OS) and progression-free survival (PFS) between the two groups, analyze adverse events to assess the safety of the treatment regimen, explore risk factors affecting the prognosis of patients' OS and PFS, construct a prognostic model, and validate it through meta-analysis.

Results

The median OS in the TACE + TKIs + PD-1 group was significantly better than that in the TACE + TKIs group {20.8 months [95% confidence interval (CI): 13.6-28.0] vs. 14.7 months (95% CI: 11.6-17.8), P<0.001}. The median PFS in the TACE + TKIs + PD-1 group was also significantly better than that in the TACE + TKIs group [8.6 months (95% CI: 6.6-10.6) vs. 5.2 months (95% CI: 4.8-5.6), P<0.001]. The disease control rate (DCR) and objective response rate (ORR) were 82.8% and 37.7% in the TACE + TKIs + PD-1 group, and 57.7% and 28.9% in the TACE + TKIs group, respectively. The incidence of rash was significantly higher in the TACE + TKIs + PD-1 group than in the TACE + TKIs group. Multifactorial analysis identified treatment options (TACE + TKIs + PD-1 vs. TACE + TKIs) [hazard ratio (HR) =0.311, 95% CI: 0.192-0.503, P<0.001], Barcelona Clinic Liver Cancer (BCLC) stage (B/C) (HR =0.367, 95% CI: 0.235-0.574, P<0.001), and Eastern Cooperative Oncology Group performance status (ECOG PS) (1/0) (HR =1.974, 95% CI: 1.059-3.678, P=0.03) as independent prognostic factors for OS. Treatment options (HR =0.352, 95% CI: 0.221-0.559, P<0.001) and extrahepatic metastasis (yes/no) (HR =2.034, 95% CI: 1.201-3.444, P=0.008) were identified as independent prognostic factors for PFS. The results were confirmed through meta-validation. The area under the curve (AUC) for the 1-, 2-, and 3-year OS nomograms were 0.706, 0.775, and 0.741, respectively, indicating good predictive performance of the model.

Conclusions

The TACE + TKIs + PD-1 treatment regimen significantly outperformed TACE + TKIs in terms of OS, PFS, and DCR but increased the incidence of rash. An ECOG PS of 1 and BCLC-C stage were identified as risk factors for OS, while extrahepatic metastasis was an independent risk factor for PFS. The high accuracy of the survival prediction model constructed in this study provides a basis for clinical prognosis.

Low-grade mucinous neoplasm originating from intestinal duplication: a case report and review of the literature

BACKGROUND

Low-grade mucinous neoplasms typically originate from the appendix and are characterized by a lining of low-grade mucus-secreting columnar epithelial cells and smooth muscle. However, atypical origins can occur, as demonstrated in this case report.

CASE PRESENTATION

We present a case involving a 33-year-old male who, upon physical examination, was found to have an abdominal mass. A computed tomography (CT) scan revealed a cystic mass located between the pancreatic tail and the adjacent bowel duct, with significant enhancement of the cyst wall observed on contrast-enhanced imaging. The patient subsequently underwent laparoscopic surgical resection of the mass, and the resected specimen was sent for pathological evaluation. The pathology results were consistent with the histological morphology and immunohistochemical characteristics of low-grade mucinous tumors arising from intestinal duplication. Three and a half years post-resection, the patient returned for a follow-up examination, during which abdominal CT and blood tumor markers indicated no signs of tumor recurrence.

CONCLUSIONS

While low-grade mucinous tumors predominantly originate from the appendix, this case illustrates an unusual occurrence of such neoplasms arising from intestinal duplication. This report aims to enhance clinical awareness of low-grade mucinous tumors originating from intestinal duplication, thereby improving the rates of preoperative diagnosis and reducing instances of misdiagnosis.

Observation on the efficacy of TPO receptor agonists and platelet transfusion in chemotherapy-induced thrombocytopenia in malignant tumors

OBJECTIVE

To observe the clinical efficacy of TPO receptor agonists and platelet transfusion in chemotherapy-induced thrombocytopenia in malignant tumors.

METHODS

Clinical data from 120 patients with malignant tumors who developed thrombocytopenia following chemotherapy at our hospital were retrospectively collected and randomly divided into three groups: A, B, and C, with 40 patients in each group. Group A was treated with a TPO receptor agonist (avatrombopag), group B received autologous platelet transfusion, and group C received a combination of both treatments. The clinical efficacy of the three groups was compared, including platelet levels at different time points during treatment, platelet recovery time (time to reach < 50 × 109/L, ≥ 75-100 × 109/L, and ≥ 100 × 109/L), changes in serum cytokine levels (PF4, TPO, vWF) before and after treatment, and fluctuations in coagulation function indicators (APTT, PT, FIB) before and after treatment to analyze the effectiveness of each treatment regimen.

RESULTS

About clinical efficacy, the effectiveness in group A was comparable to that in group B (P > 0.05), while the effective rate in group C was significantly higher than that in groups A and B (P < 0.05). Regarding platelet counts, repeated measures analysis of variance showed significant differences in the time effect, group effect, and interaction effect for platelet counts (PLT) among the three groups (P < 0.05). Concerning platelet recovery time, the time to reach PLT < 50 × 109/L, the time to recover to 75-100 × 109/L, and the time to recover to ≥ 100 × 109/L were similar in groups A and B (P > 0.05). However, the time for these parameters in group C was significantly shorter than in groups A and B (P < 0.05). In terms of changes in platelet parameters, post-treatment levels of PF4, TPO, and vWF in all three groups were significantly higher than pre-treatment levels. The PF4, TPO, and vWF levels in groups A and B were similar (P > 0.05), whereas group C had significantly higher levels compared to groups A and B (P < 0.05). Regarding coagulation indices, post-treatment levels of APTT and PT decreased, while FIB levels increased in all three groups (P < 0.05). There were no significant differences in APTT and FIB levels between groups A and B (P > 0.05). However, group C had significantly lower APTT and higher FIB levels compared to groups A and B (P < 0.05). There were no significant differences in PT levels among the three groups post-treatment (P > 0.05).

CONCLUSION

Autologous platelet transfusion and TPO receptor agonists are effective clinical methods for treating chemotherapy-induced thrombocytopenia. The combined use of both treatments yields better therapeutic results.

Using XBGoost, an interpretable machine learning model, for diagnosing prostate cancer in patients with PSA < 20 ng/ml based on the PSAMR indicator

To create a diagnostic tool before biopsy for patients with prostate-specific antigen (PSA) levels < 20 ng/ml to minimize prostate biopsy-related discomfort and risks. Data from 655 patients who underwent transperineal prostate biopsy at the First Affiliated Hospital of Wannan Medical College from July 2021 to January 2023 were collected and analyzed. After applying the Synthetic Minority Over-sampling TEchnique class balancing on the training set, multiple machine learning models were constructed by using the Least Absolute Shrinkage and Selection Operator (LASSO) feature selection to identify the significant variables. The best-performing model was selected and evaluated through tenfold cross-validation to ensure interpretability. Finally, the performance was assessed using the test set data for validation. The age, prostate-specific antigen mass ratio (PSAMR), Prostate Imaging-Reporting and Data System, and prostate volume were selected as the variables for model construction based on the LASSO regression. The receiver operating characteristic (ROC) results for multiple models in the validation set were as follows: XGBoost: 0.93 (0.88-0.97); logistic: 0.89 (0.83-0.95); LightGBM: 0.87 (0.80-0.93); AdaBoost: 0.90 (0.85-0.96); GNB: 0.88 (0.82-0.95); CNB: 0.79 (0.71-0.87); MLP: 0.78 (0.69-0.86); and Support Vector Machine: 0.81 (0.73-0.89). XGBoost was selected as the best model and reconstructed with tenfold cross-validation on the training data, resulting in the following ROC scores: training set 0.995 (0.991-0.999), validation set 0.945 (0.885-0.997 ), and test set 0.920 (0.868-0.972). The Kolmogorov-Smirnov curve, calibration curve and learning curve yielded positive results; The decision curve demonstrates that patients with threshold probabilities ranging from 10 to 95% can benefit from this model. We developed an XGBoost machine learning model based on the PSAMR indicator and interpreted it using the SHapley Additive exPlanations method. The model offered a high-performance non-invasive technique to diagnose prostate cancer in patients with PSA levels < 20 ng/ml.

Machine learning Nomogram for Predicting endometrial lesions after tamoxifen therapy in breast Cancer patients

Objective Endometrial lesions are a frequent complication following breast cancer, and current diagnostic tools have limitations. This study aims to develop a machine learning-based nomogram model for predicting the early detection of endometrial lesions in patients. The model is designed to assess risk and facilitate individualized treatment strategies for premenopausal breast cancer patients. Method A retrospective study was conducted on 224 patients who underwent diagnostic curettage post-tamoxifen (TAM) therapy between November 2012 and November 2023. These patients exhibited signs of endometrial abnormalities or symptoms such as colporrhagia. Clinical data were collected and analyzed using R software (version 4.3.2) to identify factors influencing the occurrence of endometrial lesions and evaluate their predictive values. Three machine learning methods were employed to develop a risk prediction model, and their performances were compared. The best-performing model was selected to construct a nomogram of endometrial lesions. Internal validation was conducted using the bootstrap method, and the model's accuracy and fit were assessed using the concordance index (C-index) and calibration curves. Results Independent risk factors for endometrial lesions included ultrasound characteristics, duration of TAM therapy, presence of colporrhagia, and endometrial thickness (P < 0.05). Among the machine learning methods compared, the LASSO regression integrated with a multifactorial logistic regression model demonstrated strong performance, with a concordance index (C-index) of 0.874 and effective calibration (mean absolute error of conformity: 0.014). This model achieved an accuracy of 0.853 and a precision of 0.917, with a training set AUC of 0.874 (95% CI: 0.794-0.831) and a test set AUC of 0.891 (95% CI: 0.777-1.000), closely aligning the predicted risk with the actual observed risk. Conclusion The developed prediction model is effective in evaluating endometrial lesions in premenopausal breast cancer patients. This model offers a theoretical foundation for improving clinical predictions and devising tailored treatment strategies for this patient group.

Clinical benefits of central pancreatectomy for a patient with pancreatic schwannoma and diabetes

Schwannomas are tumors that originate from the glial cells of the nervous system and can occur on myelinated nerve fibers throughout the body, especially in the craniofacial region. However, pancreatic schwannomas are extremely rare. We report a case of a pancreatic schwannoma that was difficult to differentiate from other pancreatic tumors preoperatively. A 44-year-old female patient was found to have a pancreatic mass on Computed Tomography imaging and the preoperative diagnosis was a pancreatic solid pseudopapillary neoplasm. Meanwhile, the patient had type 2 diabetes and the blood glucose was controlled at 8-15mmol/L by taking oral antidiabetic drugs. During exploratory laparotomy, an 8 cm × 7 cm × 4 cm mass was discovered in the middle part of the pancreas. Considering the preoperative diabetes, the patient underwent a central pancreatectomy (CP) and Roux-en-Y pancreaticojejunostomy. Postoperative histopathological examination confirmed the diagnosis of a pancreatic epitheloid schwannoma. After surgery, the patient developed Grade B pancreatic fistula, which disappeared after treatment. At the same time, the patient's blood glucose remained basically stable by insulin therapy, which was adjusted to oral antidiabetic medications in about 40 days after surgery. At a 32-month follow-up after discharge, no tumor recurrence was observed, and the patient's blood glucose was controlled below 11.1mmol/L with only oral antidiabetic drugs. The radiological diagnosis of pancreatic schwannomas lacks specific features, and diagnosis primarily relies on histopathological examination and immunohistochemical testing. Although pancreatic schwannomas are extremely rare, they must be differentiated from other solid or cystic pancreatic lesions. For patients with pancreatic schwannoma and diabetes, CP may represent a favorable surgical option.

The correlation between LAG-3 expression and the efficacy of chemoimmunotherapy in advanced biliary tract cancer

In our previous phase II T1219 trial for advanced biliary tract cancer (ABTC), the combination of nivolumab with modified gemcitabine and S-1 exhibited promising efficacy, while the programmed-death-ligand-1 (PD-L1) expression did not predict chemoimmunotherapy efficacy. Lymphocyte-activation-gene-3 (LAG-3), a negative immune checkpoint, is frequently co-expressed with PD-L1. This study assessed the predictive value of LAG-3 expression in ABTC patients who received chemoimmunotherapy. We analyzed 44 formalin-fixed ABTC samples using immunohistochemical staining for PD-L1 and LAG-3 and correlated them with the clinical efficacy of chemoimmunotherapy. Digital spatial profiling was conducted in selected regions of interest to examine immune cell infiltration and checkpoint expression in six cases. Three public BTC datasets were used for analysis: TCGA-CHOL, GSE32225, and GSE132305. LAG-3 positivity was observed in 38.6% of the ABTC samples and was significantly correlated with PD-L1 positivity (P < 0.001). The objective response rate (ORR) was significantly higher in LAG-3-positive tumors than in LAG-3-negative tumors (70.6% vs. 33.3%, P = 0.029). The LAG-3 expression level was associated with an increased ORR (33%, 58%, and 100% for LAG-3 < 1%, 1-9%, and ≥ 10%, respectively; P = 0.018) and a deeper therapeutic response (20.1%, 38.6%, and 57.6% for the same respective groups; P = 0.04). LAG-3 expression is positively correlated with the expression of numerous immune checkpoints. Enrichment of CD8+ T cells was observed in LAG-3-positive BTC, indicating that LAG-3 expression may serve as a biomarker for identifying immune-inflamed tumors and predicting the therapeutic response to chemoimmunotherapy in ABTC.

Serological proteomic profiling uncovered CDK5RAP2 as a novel marker in benign prostatic hyperplasia

BACKGROUND

Benign prostatic hyperplasia (BPH) affects approximately half of men over the age of 50. Early detection and timely treatment facilitate disease intervention and achieve a better clinical outcome. However, current clinical methods, such as prostate specific antigen (PSA), lack the sensitivity to accurately distinguish between BPH and prostate cancer (PCa). Thus, optimal serum markers are warranted to complement existing diagnostic tests.

METHODS

In this study, we recruited 1987 BPH patients and characterized their clinical features. To explore BPH proteomic alterations, a data independent acquisition-based mass spectrometry proteomics approach was adopted for 66 serum samples from healthy males (n = 22), patients with BPH (n = 22) and prostate cancer (n = 22). Bioinformatic evaluations were performed for proteomic profiling and candidate selection. In addition, a promising candidate was further validated with ELISA assay.

RESULTS

Our findings revealed that the level of free PSA correlated with prostate volume. 7.95 % of BPH patients had a PSA value greater than 10 ng/mL, with elevated free PSA, prostate volume, PSA density, and decreased free to total PSA ratio. Mass spectrometry-based serum profiling demonstrated distinct differences between BPH and PCa. CDK5RAP2 was weighted most important in BPH patients' serum and achieved an area under the receiver operating characteristic curve of 0.900 in distinguishing BPH and PCa, which was further validated by publicly-available mRNA microarray analysis and cellular phenotype evaluation.

CONCLUSION

Our comprehensive analysis systematically explored BPH serum characteristics, proteomic profiles, and identified novel serum markers that may contribute to the understanding of BPH and facilitate early diagnosis and intervention.

The pathway alteration load is a pan-cancer determinant of outcome of targeted therapies: results from the Drug Rediscovery Protocol (DRUP)

BACKGROUND

Many patients with cancer exhibit primary or rapid secondary resistance to targeted therapy (TT). We hypothesized that a higher number of altered oncogenic signaling pathways [pathway alteration load (PAL)] would reduce the benefit of TT which only intervenes in one pathway. This hypothesis was tested in the Drug Rediscovery Protocol (DRUP).

PATIENTS AND METHODS

DRUP is a prospective, pan-cancer, non-randomized clinical trial (NCT02925234) that treats patients with therapy-refractory metastatic cancer and an actionable molecular profile using matched off-label targeted and immunotherapies. All patients treated with TT with available clinical outcomes and whole genome sequencing were included. PAL was determined based on driver gene alterations and correlated with clinical benefit rate (CBR), progression-free survival (PFS) and overall survival (OS). Outcomes were validated in the independent Hartwig Medical database of metastatic cancers.

RESULTS

In 154 patients treated with TT, the median PAL was 3. Patients with a PAL below median (n = 60) demonstrated a higher CBR (41.7% versus 25.5%, odds ratio 0.48, P = 0.051), longer PFS [median 4.7 versus 2.9 months, adjusted hazard ratio (aHR) 1.70, P = 0.020] and OS (median 13.7 versus 5.6 months, aHR 3.80, P < 0.001) compared with those with PAL ≥3. Two hundred and fifty-eight patients in the Hartwig database showed similar results for CBR (54.2% versus 36.7%, odds ratio 2.04, P = 0.009) and PFS (7.0 versus 4.2 months, aHR 1.55, P = 0.009).

CONCLUSIONS

In our population, PAL emerged as a pan-cancer determinant of outcome to TT. Our findings support refined patient selection for TT and highlight the rationale for combinatorial treatment strategies in patients with multiple affected pathways.

Insights into AI advances in immunohistochemistry for effective breast cancer treatment: a literature review of ER, PR, and HER2 scoring

Breast cancer is a significant health challenge, with accurate and timely diagnosis being critical to effective treatment. Immunohistochemistry (IHC) staining is a widely used technique for the evaluation of breast cancer markers, but manual scoring is time-consuming and can be subject to variability. With the rise of Artificial Intelligence (AI), there is an increasing interest in using machine learning and deep learning approaches to automate the scoring of ER, PR, and HER2 biomarkers in IHC-stained images for effective treatment. This narrative literature review focuses on AI-based techniques for the automated scoring of breast cancer markers in IHC-stained images, specifically Allred, Histochemical (H-Score) and HER2 scoring. We aim to identify the current state-of-the-art approaches, challenges, and potential future research prospects for this area of study. By conducting a comprehensive review of the existing literature, we aim to contribute to the ultimate goal of improving the accuracy and efficiency of breast cancer diagnosis and treatment.

Daidzein Inhibits Non-small Cell Lung Cancer Growth by Pyroptosis

INTRODUCTION

Non-small cell lung cancer (NSCLC) represents the leading cause of cancer deaths in the world. We previously found that daidzein, one of the key bioactivators in soy isoflavone, can inhibit NSCLC cell proliferation and migration, while the molecular mechanisms of daidzein in NSCLC remain unclear.

METHODS

We developed an NSCLC nude mouse model using H1299 cells and treated the mice with daidzein (30 mg/kg/day). Mass spectrometry analysis of tumor tissues from daidzein-treated mice identified 601 differentially expressed proteins (DEPs) compared to the vehicle-treated group. Gene enrichment analysis revealed that these DEPs were primarily associated with immune regulatory functions, including B cell receptor and chemokine pathways, as well as natural killer cell-mediated cytotoxicity. Notably, the NOD-like receptor signaling pathway, which is closely linked to pyroptosis, was significantly enriched.

RESULTS

Further analysis of key pyroptosis-related molecules, such as ASC, CASP1, GSDMD, and IL-1β, revealed differential expression in NSCLC versus normal tissues. High levels of ASC and CASP1 were associated with a favorable prognosis in NSCLC, suggesting that they may be critical effectors of daidzein's action. In NSCLC-bearing mice treated with daidzein, RT-qPCR and Western blot analyses showed elevated mRNA and protein levels of ASC, CASP1, and IL-1β but not GSDMD, which was consistent with the proteomic data.

CONCLUSION

In summary, this study demonstrated that daidzein inhibits NSCLC growth by inducing pyroptosis. Key pathway modulators ASC, CASP1, and IL-1β were identified as primary targets of daidzein. These findings offer insights into the molecular mechanisms underlying the anti-NSCLC effects of daidzein and could offer dietary recommendations for managing NSCLC.

Unraveling the Ferroptosis-inducing Potential of Methanol Leaves Extract of Prosopis Juliflora Via Downregulation of SLC7A11 and GPX4 mRNA Expression in A549 Lung Cancer Cells

INTRODUCTION

Prosopis juliflora has been employed in many traditional treatments. As evidenced by our earlier research, Prosopis juliflora leaf methanol extract (PJME) has a promising future in the fight against lung cancer. It may also be used in conjunction with other treatments to effectively manage lung cancer.

AIMS AND OBJECTIVE

The main objective of this study was to explore the potential of PJME to inhibit lung cancer in A549 cells, along with its underlying mechanisms of action.

METHODS

The antiproliferative effects were determined using MTT and LDH tests. Apoptosis- inducing capacity was evaluated using the DAPI staining, caspase-3 test, cytochrome C assay, PARP cleavage, and qRT-PCR. To investigate the mechanism of action of PJME in lung cancer, the levels of ROS, MMP, GSH, MDA, and specific ferroptosis indicators were measured.

RESULTS

The experimental data of the current study indicated that exposure of A549 cells to PJME reduced cell viability and increased cellular cytotoxicity. The apoptosis-inducing ability of PJME in A549 cells was validated by enhanced nuclear condensation, level of the caspase- 3, cytochrome C, and PARP release. In addition, qRT-PCR investigations verified that the administration of PJME led to a decrease in the expression of anti-apoptotic gene Bcl2 while enhancing the mRNA level of pro-apoptotic genes, such as Bax and caspase-3, in A549 cells.

CONCLUSION

The study also found that PJME has the ability to activate ferroptosis pathways, as evidenced by elevated reactive oxygen species (ROS) generation, changes in the levels of antioxidant markers (MDA and GSH), and decreased expression of SLC7A11 and GPX4. The results of the present study clearly showed that PJME inhibited the proliferation of A549 cells and induced ferroptosis by reducing the expression of the important targets SLC7A11 and GPX4. Further research is necessary to fully understand the clinical efficacy of PJME before it can be investigated as supplemental or adjuvant therapy for lung cancer.

Construction and validation of transcription‑factor‑based prognostic signature for TACE non‑response and characterization of tumor microenvironment infiltration in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Despite continuous development of treatment methods, overall survival rate of liver cancer is low. Transcatheter arterial chemoembolization (TACE) is a first-choice treatment for advanced liver cancer. Although it is generally effective, a number of patients do not benefit from it. Therefore, the present study was conducted to assess the response of patients following TACE. RNA-sequencing data and corresponding clinical information were extracted from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus databases. Models were constructed using weighted gene co-expression network analysis and least absolute shrinkage and selection operator-Cox regression analysis based on TCGA-LIHC and GSE104580 cohorts. The receiver operating characteristic curve was used for evaluation. Immunoassay, half-maximal inhibitory concentration analysis of risk groups, genomic enrichment analysis and nomogram construction were also performed. The predictive models were validated at the single-cell level using single-cell databases. Finally, the present study examined the expression of TACE refractoriness-related TFs (TRTs) in TACE-resistant and non-resistant cell lines in vitro. A risk categorization approach was created based on screening of four TRTs. The patients were split into high- and low-risk groups. There were significant variations in immune cell infiltration, medication sensitivity and overall survival (OS) between patients in the high-risk and low-risk groups. Multivariate Cox regression analysis showed that the risk score was an independent prognostic factor for OS. In the single-cell gene set, risk score was a good indicator of tumor microenvironment (TME). Reverse transcription-quantitative PCR revealed that three high-risk TRTs were upregulated in TACE-resistant cells. Prognosis and TME status of liver cancer patients following TACE could be assessed using a predictive model based on transcription factor correlation. This predictive model provided a reliable and simplified method to guide the clinical treatment of HCC.

The association between HALP score and survival in patients treated with immune checkpoint inhibitors

BACKGROUND

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score could be a prognostic biomarker in patients with cancer as a reflector of nutritional and inflammatory status, although the data is limited in patients treated with immune-checkpoint inhibitors (ICIs). Therefore, we sought to investigate the relationship between HALP score and survival in ICI-treated patients.

METHODS

We included adult patients with advanced cancer treated with ICIs between June 2016 and January 2024. Receiver operating characteristic (ROC) curve analysis was employed to identify the optimal HALP score cutoff point for survival prediction. The Kaplan-Meier method was utilized to create survival curves, and Cox regression was employed for multivariate analysis.

RESULTS

A total of 456 patients were included. The median age was 62 years, and 64.7% were male. The optimal HALP cutoff value for survival prediction was 22.8 in ROC analyses (AUC: 0.624, 95% CI: 0.570-0.679, p < 0.001). Multivariate analysis revealed that patients with low HALP scores had significantly shorter OS (HR: 1.394, 95% CI: 1.077-1.805, p = 0.012) and PFS (HR: 1.388, 95% CI: 1.129-1.706, p = 0.002).

CONCLUSIONS

Our study results pointed out the possible use of the HALP score as a prognostic marker in ICI-treated patients. If validated in prospective cohorts, the HALP score could enhance prognosis prediction in ICI-treated patients.

Development and validation of a nomogram for predicting venous thromboembolism risk in post-surgery patients with cervical cancer

OBJECTIVE

Postoperative venous thromboembolism (VTE) is a potentially life-threatening complication. This study aimed to develop a predictive model to identify independent risk factors and estimate the likelihood of VTE in patients undergoing surgery for cervical cancer.

METHODS

We conducted a retrospective cohort study involving 1,174 patients who underwent surgery for cervical carcinoma between 2019 and 2022. The cohort was randomly divided into training and validation sets at 7:3. Univariate and multivariate logistic regression analyses were used to determine the independent factors associated with VTE. The results of the multivariate logistic regression were used to construct a nomogram. The nomogram's performance was assessed via the concordance index (C-index) and calibration curve. Additionally, its clinical utility was assessed through decision curve analysis (DCA).

RESULTS

The predictive nomogram model included factors such as age, pathology type, FIGO stage, history of chemotherapy, the neutrophil-lymphocyte ratio (NLR), fibrinogen degradation products (FDP), and D-dimer levels. The model demonstrated robust discriminative power, achieving a C-index of 0.854 (95% CI: 0.799-0.909) in the training cohort and 0.757 (95% CI: 0.657-0.857) in the validation cohort. Furthermore, the nomogram showed excellent calibration and clinical utility, as evidenced by the calibration curve and decision curve analysis (DCA) results.

CONCLUSIONS

We developed a high-performance nomogram that accurately predicts the risk of VTE in cervical cancer patients undergoing surgery, providing valuable guidance for thromboprophylaxis decision-making.

Research trends of cellular immunotherapy for primary liver cancer: A bibliometric analysis

Cellular immunotherapy has shown considerable potential for the treatment of primary liver cancer (PLC), particularly hepatocellular carcinoma (HCC), although it is in the early stages of development. This study used bibliometric methods to delineate the evolution of research on cellular immunotherapy for PLC. Data were sourced from the Web of Science Core Collection (WoSCC) on April 22, 2024. Using the "Bibliometrix" R package, we examined primary bibliometric features, collaboration frequency between countries, and article output of the journals. Furthermore, we employed VOSviewer for coauthorship analysis and visualization and CiteSpace to assess keyword co-occurrence, as well as to spotlight keywords and references with the strongest citation bursts. Our analysis encompassed 492 publications focused on PLC and cellular immunotherapy, and we pinpointed China, Japan, and the USA as the foremost contributing nations and identified "Cancer Immunology Immunotherapy" as the journal with the most contributions in this area. Sun Yat-sen University emerged as the institution with the most significant output, and Li Zonghai authored the greatest number of leading articles. Prominent keywords that displayed a notable citation burst in the later years included "chimeric antigen receptor," "combination therapy", "CAR-T cells," "TCR-T cells," and "liver transplantation." This bibliometric study outlined a foundational knowledge framework, surveyed over three decades of research on cellular immunotherapy for PLC, and revealed the key players and trends, thereby offering a thorough understanding of the field, especially in relation to HCC.