Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by ...Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by Hu et al,which evaluated the survival outcomes of patients with metastatic CRC who received image-guided thermal ablation(IGTA).These findings provide valuable clinical evidence supporting IGTA as a feasible,minimally invasive approach and underscore the prognostic significance of metastatic distribution.However,the study by Hu et al has several limitations,including that not all pulmonary lesions were pathologically confirmed,postoperative follow-up mainly relied on dynamic contrast-enhanced computed tomography,no comparative analysis was performed with other local treatments,and the impact of other imaging features on efficacy and prognosis was not evaluated.Future studies should include complete pathological confirmation,integrate functional imaging and radiomics,and use prospective multicenter collaboration to optimize patient selection standards for IGTA treatment,strengthen its clinical evidence base,and ultimately promote individualized decision-making for patients with metastatic CRC.展开更多
The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unli...The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unlike most malignant tumors,patients with distant metastases can still achieve favorable prognoses if both the primary tumor and liver metastases are surgically resected.With ad-vances in systemic therapies,many patients with initially unresectable liver me-tastases from colorectal cancer can undergo systemic treatment to achieve con-version therapy,thereby gaining the opportunity for surgery.However,there is still no consensus on several issues,including the timing of systemic therapy before and after surgery,whether neoadjuvant therapy should be employed,and the choice between simultaneous or staged surgeries.This review aims to system-atically describe the current treatment landscape for colorectal cancer with liver metastases and highlight several unresolved controversial issues,providing valuable insights for the diagnosis and treatment of colorectal liver metastases.展开更多
It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN)...It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.展开更多
BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or syste...BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.展开更多
Objective:The aim of the study was to evaluate the feasibility of functional MR in predicting the clinical response to chemotherapy in patients with colorectal liver metastases(CLM).Methods:A total of 196 eligible pat...Objective:The aim of the study was to evaluate the feasibility of functional MR in predicting the clinical response to chemotherapy in patients with colorectal liver metastases(CLM).Methods:A total of 196 eligible patients were enrolled in the study between August 2016 and January 2023.Functional MR was performed at baseline and after one cycle of chemotherapy.The diffusion kurtosis radiomic texture features were extracted and a signature model was built using the R package.The initial 100 cases were designated as the training set,the following 48 cases were designated as the validation set,and the final 48 cases were designated as the intervention validation set.Results:Good performance for the response prediction(AUC=0.818 in the training set and 0.755 in the validation set)was demonstrated.The objective response rates(ORRs)in the high-risk subgroup were significantly lower than the low-risk subgroup in the training and validation sets.Worse progression-free survival and overall survival rates were noted in the high-risk population.In the intervention set 22.9%(11/48)of the chemotherapy regimens for patients were changed in response to the model-predicted results and the ORR reached 77.1%(37/48),which was significantly higher than the training and validation sets[47.97%(71/148);P=0.000].Conclusions:A functional MR signature effectively predicted the chemotherapy response and long-term survival.The adjustment of the regimen guided by the model significantly improved the ORR.展开更多
Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Met...Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Methods A comprehensive literature search was performed across Cochrane,PubMed,EMBASE(Ovid),CNKI,and Wanfang databases to identify original articles published between 2017 and 2023.Key words consisted of bone metastases,denosumab,and cost-effectiveness in the search strategy.The methodological quality of the included studies was assessed utilizing the revised Consolidated Health Economic Evaluation Reporting Standards(CHEERS 2022).Data was extracted regarding methodological characteristics and cost-effectiveness analyses.Results A total of 111 studies were retrieved,of which 6 met the inclusion criteria.All included studies were based on clinical trials and published literature data and exhibited high methodological quality.Up to 83%(5 out of 6)of comparisons demonstrated that denosumab was more cost-effective or dominant compared to zoledronic acid.The adjusted incremental cost-effectiveness ratios varied substantially by tumor type,ranging from CZK 436,339.09 to USD 136,234 per skeletal-related event avoided and from CZK 61,580.95 to USD 118,392.11 per quality-adjusted life year gained.Conclusions The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid tumors compared to zoledronic acid.The application of CHEER(2022)enhances the reliability of pharmacoeconomic evaluations.展开更多
Colorectal cancer(CRC)remains one of the leading causes of cancer-related mortality worldwide.Despite advances in early detection and treatment,approximately half of patients with CRC develop liver metastases(LM),comp...Colorectal cancer(CRC)remains one of the leading causes of cancer-related mortality worldwide.Despite advances in early detection and treatment,approximately half of patients with CRC develop liver metastases(LM),complicating therapeutic strategies and reducing survival rates.Radiological imaging is critical in managing colorectal LM by guiding detection,staging,treatment planning,and response evaluation.This letter to the editor provides a comprehensive overview of both traditional and emerging imaging modalities,including computed tomography,magnetic resonance imaging,and positron emission tomography,and their specific roles in clinical decision-making.It further explores advanced techniques such as radiomics,artificial intelligence,and radiogenomics,which integrate quantitative imaging features with genetic and clinical data to enhance prognostication and tailor personalized treatment approaches.Specific examples of how these innovations are applied in treatment response assessment and presurgical planning are highlighted.The discussion also emphasizes the need for large-scale prospective clinical trials and standardized protocols to validate current predictive models and fully integrate these advanced methodologies into clinical practice.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic ...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.展开更多
Background:Liver metastases are a leading contributor to death among patients with colorectal cancer.Current clinical treatments,such as resection and systemic chemotherapy,are only applicable in a portion of cases.Mo...Background:Liver metastases are a leading contributor to death among patients with colorectal cancer.Current clinical treatments,such as resection and systemic chemotherapy,are only applicable in a portion of cases.More effective medical interventions,including those involving traditional Chinese medicine,could be beneficial for patients with newly diagnosed colorectal cancer to prevent the progression to liver metastasis.Xiaoyaosan(XYS)is a classical prescription in traditional Chinese medicine with a history of hundreds of years.Despite its well-known protective effects against breast cancer,the understanding of its application in colorectal cancer metastases remains limited.The anti-metastasis mechanism of XYS remains to be elucidated.In this research,we explored the impact of XYS against liver metastases of colorectal cancer and its potential mechanisms.Methods:Thirty-six SPF male C57BL/6 mice were randomly assigned to six groups:a control group,a model group,a DNase I group,and three XYS treatment groups receiving high,medium,and low doses,respectively.A mouse model for colorectal cancer liver metastasis was established through the splenic injection of MC38 cells.Twenty-one days after the injection of cancer cells,the number of metastatic foci and the weights of the liver were calculated,and HE staining was performed to evaluate the effect of XYS.Neutrophil extracellular traps(NETs)formation in the liver was detected by immunofluorescence staining,and NETs formation in the serum was detected by ELISA.The levels of CXCL1,CXCL2,G-CSF,and HMGB1 were determined using ELISA kits.The expression levels of the proteins p-p38,p38,p-ERK,and ERK were assessed using Western blot analysis.Results:XYS treatment reduced the number of metastatic foci,the weights of metastatic livers,and the infiltration area of tumor-like cells.XYS could inhibit NETs formation in the liver and serum of mice with metastasis.The concentrations of CXCL1,CXCL2,G-CSF,and HMGB1 were significantly decreased in all XYS-treated groups.Moreover,XYS down-regulated the protein expression levels of phosphorylated p38 and ERK.Conclusion:XYS could attenuate liver metastases of colorectal cancer in vivo.The inhibitory mechanism of XYS may involve the reduction of NETs formation through the regulation of tumor-derived factors and the downstream MAPKs(p38,ERK)signaling pathway.展开更多
Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,techno...Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,technological advances in this field and immunotherapeutic strategies have revolutionized the treatment of HGGs and BM.Immunotherapies like immune checkpoint inhibitors,CAR-T targeting,oncolytic virus-based therapy,bispecific antibody treatment,and vaccination approaches,etc.,are emerging as promising avenues offering new hope in refining patient’s survival benefits.However,selective trafficking across the blood-brain barrier(BBB),immunosuppressive tumor microenvironment(TME),metabolic alteration,and tumor heterogeneity limit the therapeutic efficacy of immunotherapy for HGGs and BM.Furthermore,to address this concern,the NanoBioTechnology-based bioinspired delivery system has been gaining tremendous attention in recent years.With technological advances such as Trojan horse targeting and infusing/camouflaging nanoparticles surface with biological molecules/cells like immunocytes,erythrocytes,platelets,glioma cell lysate and/or integrating these strategies to get hybrid membrane for homotypic recognition.These biomimetic nanotherapy offers advantages over conventional nanoparticles,focusing on greater target specificity,increased circulation stability,higher active loading capacity,BBB permeability(inherent inflammatory chemotaxis of neutrophils),decreased immunogenicity,efficient metabolism-based combinatorial effects,and prevention of tumor recurrence by induction of immunological memory,etc.provide new age of improved immunotherapies outcomes against HGGs and BM.In this review,we emphasize on neuro-immunotherapy and the versatility of these biomimetic nano-delivery strategies for precise targeting of hard-to-treat andmost lethal HGGs and BM.Moreover,the challenges impeding the clinical translatability of these approaches were addressed to unmet medical needs of brain cancers.展开更多
Background:The rate of distant metastasis in patients with pancreatic neuroendocrine tumors(PNETs)is20%-50%at the time of initial diagnosis.However,whether tumor size can predict distant metastasis for PNETs remains u...Background:The rate of distant metastasis in patients with pancreatic neuroendocrine tumors(PNETs)is20%-50%at the time of initial diagnosis.However,whether tumor size can predict distant metastasis for PNETs remains unknown up to date.Methods:We used Surveillance,Epidemiology,and End Results(SEER)population-based data to collect6089 patients with PNETs from 2010 to 2019.The optimal cut-off point of tumor size to predict distant metastasis was calculated by Youden’s index.Multivariate logistic regression analysis was used to figure out the association between tumor size and distant metastasis patterns.Results:The most common metastatic site was liver(27.2%),followed by bone(3.0%),lung(2.3%)and brain(0.4%).Based on an optimal cut-off value of tumor size(25.5 mm)for predicting distant metastasis determined by Youden’s index,patients were categorized into groups of tumor size<25.5 mm and≥25.5 mm.Multivariate logistic regression analyses showed that,compared with<25.5 mm,tumor size≥25.5 mm was an independent risk predictor of overall distant metastasis[odds ratio(OR)=4.491,95%confidence interval(CI):3.724-5.416,P<0.001]and liver metastasis(OR=4.686,95%CI:3.886-5.651,P<0.001).Conclusions:Tumor size≥25.5 mm was significantly associated with more overall distant and liver metastases.Timely identification of distant metastasis for tumor size≥25.5 mm may provide survival benefit for timely and precise treatment.展开更多
The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advance...The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advancements in transplantation outcomes for CRLM have prompted the establishment of rigorous selection criteria to optimize patient survival and graft utilization.This review examines the key criteria used to select candidates for LT in this setting,with a focus on oncological factors,patient characteristics,and response to therapy.Eligible candidates are typically those with non-resectable liver-only CRLM,demonstrating controlled primary tumor disease.Tumor biology is a critical determinant,excluding patients exhibiting high-risk molecular features such as BRAF or RAS mutations.Furthermore,candidates must show a favorable response to systemic chemotherapy,with either tumor stability or reduction in size and no extrahepatic progression during a defined treatment period.Specific tumor burden scores,such as the Oslo score or criteria based on the number and size of lesions,aid in stratifying candidates with acceptable recurrence risks.Other factors,including age,performance status,and absence of significant comorbidities,are also pivotal.Long-term follow-up data highlight the importance of stringent patient selection,showing superior 5-year survival in patients meeting these criteria compared to those who do not.In conclusion,strict selection criteria based on tumor biology,systemic disease control,and patient-specific factors ensure optimized outcomes for LT in CRLM patients,marking a pivotal step toward broader clinical acceptance of this novel approach.展开更多
With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important ...With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important for managing BMs.Radiation therapy(RT),including photon therapy,has been essential in managing BMs.Recent technological advances have significantly enhanced the precision,efficacy,and safety of these treatments.This comprehensive review provides an in-depth examination of the latest advancements in radiation and photon therapy technologies for treating BMs,focusing on innovations such as stereotactic radiosurgery(SRS),whole-brain radiation therapy(WBRT),laser interstitial thermal therapy(LITT),and other radiation-related treatment modalities.Additionally,we discuss clinical outcomes,challenges,and future directions in this rapidly evolving field.While a detailed comparison of techniques is beyond the scope of this paper,this paper provides up-to-date technical information for physicians,medical physicists,patients,and researchers in related fields,potentially enhancing clinical outcomes.Among the treatment modalities,SRS has become a cornerstone of RT for BMs,with its implementation spanning multiple modalities over the past few decades.Given its inherent minimally invasive nature and growing clinical acceptance,SRS is positioned to further evolve as a key therapeutic tool in both neurosurgery and radiotherapy.展开更多
BACKGROUND The feasibility and safety of radiofrequency ablation(RFA)for oligometastatic colorectal liver metastases(CRLM)have been well established.However,the role of RFA in multiple metastases after first-line chem...BACKGROUND The feasibility and safety of radiofrequency ablation(RFA)for oligometastatic colorectal liver metastases(CRLM)have been well established.However,the role of RFA in multiple metastases after first-line chemotherapy failure remains underexplored.AIM To assess long-term survival and factors affecting outcomes of RFA in patients with multiple refractory CRLM.METHODS A retrospective study was conducted on patients who underwent ablation of CRLM at our institution between January 2015 and June 2024.A total of 80 patients were included,with 42 individuals receiving single-session ablation and 38 underwent repeat ablation.Enhanced computed tomography imaging was utilized to evaluate procedural efficacy 24 hours post-RFA,followed by follow-up scans every 3-4 months.Progression-free survival(PFS)and overall survival(OS)rates were compared at endpoint using Kaplan-Meier curves.Cox regression was used to identify the factors associated with OS and PFS.RESULTS The technical success rate was recorded at 98.7%.At endpoint,42(52.5%)patients achieved tumor-free survival,while 28(35%)remained alive with residual tumors present.No significant OS/PFS differences existed between single-session(median follow-up 29.5 months,median PFS 24.5 months)and repeat ablation(30 months,14 months)cohorts(P>0.05).Multivariate analysis showed that larger tumor size(P<0.001)and older age(P=0.01)were associated with worse OS.The median PFS was 13.5 months,with tumor size emerging as the only independent predictor(P=0.04).CONCLUSION For patients with multiple refractory CRLM,both single-session ablation and repeat ablation can increase the proportion of patients achieving tumor-free status.However,careful consideration is necessary for ablation of metastases larger than 2.7 cm.展开更多
Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metast...Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.展开更多
BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery....BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quali...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.展开更多
Objective:After percutaneous kyphoplasty(PKP),patients with pathological vertebral fractures of thoracolumbar metastases often have Qi and blood deficiency syndrome and hidden blood loss,resulting in postoperative deb...Objective:After percutaneous kyphoplasty(PKP),patients with pathological vertebral fractures of thoracolumbar metastases often have Qi and blood deficiency syndrome and hidden blood loss,resulting in postoperative debilitation syndrome.This study aimed to evaluate the clinical efficacy and mechanism of Shenqi Hexue Decoction on early postoperative recovery of such patients.Methods:36 Patients were randomly divided into an experimental group(Shenqi Hexue Decoction+conventional treatment)and a control group(conventional treatment).The changes of hemoglobin(HB),Karnofsky functional status(KPS)score,and TCM syndrome score on the 1st,4th,and 7th day after operation were observed.Results:The HB value of the experimental group was significantly higher than that of the control group on the 4th and 7th days after operation(p<0.01),and the maximum decline value of HB decreased by 42.1%(p<0.001);The improvement rate of KPS score in the experimental group was 94.4%on the 7th day after operation,which was significantly better than 66.7%in the control group(p<0.05).The total effective rate of TCM syndrome efficacy was 94.4%in the experimental group and 72.2%in the control group(p<0.05);No drug-related serious adverse reactions were found.Conclusion:Shenqi Hexue decoction can effectively improve the anemia state and activity ability of patients with Qi blood deficiency syndrome in the early stage after PKP,and its possible mechanism involves multi-target regulation such as hematopoietic regulation,microcirculation improvement and inflammation inhibition,with good safety.展开更多
BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker...BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.展开更多
文摘Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by Hu et al,which evaluated the survival outcomes of patients with metastatic CRC who received image-guided thermal ablation(IGTA).These findings provide valuable clinical evidence supporting IGTA as a feasible,minimally invasive approach and underscore the prognostic significance of metastatic distribution.However,the study by Hu et al has several limitations,including that not all pulmonary lesions were pathologically confirmed,postoperative follow-up mainly relied on dynamic contrast-enhanced computed tomography,no comparative analysis was performed with other local treatments,and the impact of other imaging features on efficacy and prognosis was not evaluated.Future studies should include complete pathological confirmation,integrate functional imaging and radiomics,and use prospective multicenter collaboration to optimize patient selection standards for IGTA treatment,strengthen its clinical evidence base,and ultimately promote individualized decision-making for patients with metastatic CRC.
基金Supported by the Project of Guizhou Provincial Department of Science and Technology,No.Qian Ke He Cheng Guo-LC[2024]109.
文摘The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unlike most malignant tumors,patients with distant metastases can still achieve favorable prognoses if both the primary tumor and liver metastases are surgically resected.With ad-vances in systemic therapies,many patients with initially unresectable liver me-tastases from colorectal cancer can undergo systemic treatment to achieve con-version therapy,thereby gaining the opportunity for surgery.However,there is still no consensus on several issues,including the timing of systemic therapy before and after surgery,whether neoadjuvant therapy should be employed,and the choice between simultaneous or staged surgeries.This review aims to system-atically describe the current treatment landscape for colorectal cancer with liver metastases and highlight several unresolved controversial issues,providing valuable insights for the diagnosis and treatment of colorectal liver metastases.
文摘It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.
文摘BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.
基金supported by the National Natural Science Foundation of China(Grant nos.82271946 and 82202101)Innovative Achievement Transformation of Shenkang MedicalEnterprise Integration(Grant no.SHDC2023CRD014)。
文摘Objective:The aim of the study was to evaluate the feasibility of functional MR in predicting the clinical response to chemotherapy in patients with colorectal liver metastases(CLM).Methods:A total of 196 eligible patients were enrolled in the study between August 2016 and January 2023.Functional MR was performed at baseline and after one cycle of chemotherapy.The diffusion kurtosis radiomic texture features were extracted and a signature model was built using the R package.The initial 100 cases were designated as the training set,the following 48 cases were designated as the validation set,and the final 48 cases were designated as the intervention validation set.Results:Good performance for the response prediction(AUC=0.818 in the training set and 0.755 in the validation set)was demonstrated.The objective response rates(ORRs)in the high-risk subgroup were significantly lower than the low-risk subgroup in the training and validation sets.Worse progression-free survival and overall survival rates were noted in the high-risk population.In the intervention set 22.9%(11/48)of the chemotherapy regimens for patients were changed in response to the model-predicted results and the ORR reached 77.1%(37/48),which was significantly higher than the training and validation sets[47.97%(71/148);P=0.000].Conclusions:A functional MR signature effectively predicted the chemotherapy response and long-term survival.The adjustment of the regimen guided by the model significantly improved the ORR.
文摘Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Methods A comprehensive literature search was performed across Cochrane,PubMed,EMBASE(Ovid),CNKI,and Wanfang databases to identify original articles published between 2017 and 2023.Key words consisted of bone metastases,denosumab,and cost-effectiveness in the search strategy.The methodological quality of the included studies was assessed utilizing the revised Consolidated Health Economic Evaluation Reporting Standards(CHEERS 2022).Data was extracted regarding methodological characteristics and cost-effectiveness analyses.Results A total of 111 studies were retrieved,of which 6 met the inclusion criteria.All included studies were based on clinical trials and published literature data and exhibited high methodological quality.Up to 83%(5 out of 6)of comparisons demonstrated that denosumab was more cost-effective or dominant compared to zoledronic acid.The adjusted incremental cost-effectiveness ratios varied substantially by tumor type,ranging from CZK 436,339.09 to USD 136,234 per skeletal-related event avoided and from CZK 61,580.95 to USD 118,392.11 per quality-adjusted life year gained.Conclusions The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid tumors compared to zoledronic acid.The application of CHEER(2022)enhances the reliability of pharmacoeconomic evaluations.
文摘Colorectal cancer(CRC)remains one of the leading causes of cancer-related mortality worldwide.Despite advances in early detection and treatment,approximately half of patients with CRC develop liver metastases(LM),complicating therapeutic strategies and reducing survival rates.Radiological imaging is critical in managing colorectal LM by guiding detection,staging,treatment planning,and response evaluation.This letter to the editor provides a comprehensive overview of both traditional and emerging imaging modalities,including computed tomography,magnetic resonance imaging,and positron emission tomography,and their specific roles in clinical decision-making.It further explores advanced techniques such as radiomics,artificial intelligence,and radiogenomics,which integrate quantitative imaging features with genetic and clinical data to enhance prognostication and tailor personalized treatment approaches.Specific examples of how these innovations are applied in treatment response assessment and presurgical planning are highlighted.The discussion also emphasizes the need for large-scale prospective clinical trials and standardized protocols to validate current predictive models and fully integrate these advanced methodologies into clinical practice.
基金Supported by National Clinical Key Specialty Major Research Project of Hunan Provincial Health Commission in 2023,No.Z2023165.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.
基金supported by Sichuan Science and Technology Program(grant number 2023NSFSC1809)Hospital of Chengdu University of Traditional Chinese Medicine(grant number 23ZYTS1004,21YY01).
文摘Background:Liver metastases are a leading contributor to death among patients with colorectal cancer.Current clinical treatments,such as resection and systemic chemotherapy,are only applicable in a portion of cases.More effective medical interventions,including those involving traditional Chinese medicine,could be beneficial for patients with newly diagnosed colorectal cancer to prevent the progression to liver metastasis.Xiaoyaosan(XYS)is a classical prescription in traditional Chinese medicine with a history of hundreds of years.Despite its well-known protective effects against breast cancer,the understanding of its application in colorectal cancer metastases remains limited.The anti-metastasis mechanism of XYS remains to be elucidated.In this research,we explored the impact of XYS against liver metastases of colorectal cancer and its potential mechanisms.Methods:Thirty-six SPF male C57BL/6 mice were randomly assigned to six groups:a control group,a model group,a DNase I group,and three XYS treatment groups receiving high,medium,and low doses,respectively.A mouse model for colorectal cancer liver metastasis was established through the splenic injection of MC38 cells.Twenty-one days after the injection of cancer cells,the number of metastatic foci and the weights of the liver were calculated,and HE staining was performed to evaluate the effect of XYS.Neutrophil extracellular traps(NETs)formation in the liver was detected by immunofluorescence staining,and NETs formation in the serum was detected by ELISA.The levels of CXCL1,CXCL2,G-CSF,and HMGB1 were determined using ELISA kits.The expression levels of the proteins p-p38,p38,p-ERK,and ERK were assessed using Western blot analysis.Results:XYS treatment reduced the number of metastatic foci,the weights of metastatic livers,and the infiltration area of tumor-like cells.XYS could inhibit NETs formation in the liver and serum of mice with metastasis.The concentrations of CXCL1,CXCL2,G-CSF,and HMGB1 were significantly decreased in all XYS-treated groups.Moreover,XYS down-regulated the protein expression levels of phosphorylated p38 and ERK.Conclusion:XYS could attenuate liver metastases of colorectal cancer in vivo.The inhibitory mechanism of XYS may involve the reduction of NETs formation through the regulation of tumor-derived factors and the downstream MAPKs(p38,ERK)signaling pathway.
文摘Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,technological advances in this field and immunotherapeutic strategies have revolutionized the treatment of HGGs and BM.Immunotherapies like immune checkpoint inhibitors,CAR-T targeting,oncolytic virus-based therapy,bispecific antibody treatment,and vaccination approaches,etc.,are emerging as promising avenues offering new hope in refining patient’s survival benefits.However,selective trafficking across the blood-brain barrier(BBB),immunosuppressive tumor microenvironment(TME),metabolic alteration,and tumor heterogeneity limit the therapeutic efficacy of immunotherapy for HGGs and BM.Furthermore,to address this concern,the NanoBioTechnology-based bioinspired delivery system has been gaining tremendous attention in recent years.With technological advances such as Trojan horse targeting and infusing/camouflaging nanoparticles surface with biological molecules/cells like immunocytes,erythrocytes,platelets,glioma cell lysate and/or integrating these strategies to get hybrid membrane for homotypic recognition.These biomimetic nanotherapy offers advantages over conventional nanoparticles,focusing on greater target specificity,increased circulation stability,higher active loading capacity,BBB permeability(inherent inflammatory chemotaxis of neutrophils),decreased immunogenicity,efficient metabolism-based combinatorial effects,and prevention of tumor recurrence by induction of immunological memory,etc.provide new age of improved immunotherapies outcomes against HGGs and BM.In this review,we emphasize on neuro-immunotherapy and the versatility of these biomimetic nano-delivery strategies for precise targeting of hard-to-treat andmost lethal HGGs and BM.Moreover,the challenges impeding the clinical translatability of these approaches were addressed to unmet medical needs of brain cancers.
基金supported by a grant from the National Natural Science Foundation of China(82173353)。
文摘Background:The rate of distant metastasis in patients with pancreatic neuroendocrine tumors(PNETs)is20%-50%at the time of initial diagnosis.However,whether tumor size can predict distant metastasis for PNETs remains unknown up to date.Methods:We used Surveillance,Epidemiology,and End Results(SEER)population-based data to collect6089 patients with PNETs from 2010 to 2019.The optimal cut-off point of tumor size to predict distant metastasis was calculated by Youden’s index.Multivariate logistic regression analysis was used to figure out the association between tumor size and distant metastasis patterns.Results:The most common metastatic site was liver(27.2%),followed by bone(3.0%),lung(2.3%)and brain(0.4%).Based on an optimal cut-off value of tumor size(25.5 mm)for predicting distant metastasis determined by Youden’s index,patients were categorized into groups of tumor size<25.5 mm and≥25.5 mm.Multivariate logistic regression analyses showed that,compared with<25.5 mm,tumor size≥25.5 mm was an independent risk predictor of overall distant metastasis[odds ratio(OR)=4.491,95%confidence interval(CI):3.724-5.416,P<0.001]and liver metastasis(OR=4.686,95%CI:3.886-5.651,P<0.001).Conclusions:Tumor size≥25.5 mm was significantly associated with more overall distant and liver metastases.Timely identification of distant metastasis for tumor size≥25.5 mm may provide survival benefit for timely and precise treatment.
文摘The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advancements in transplantation outcomes for CRLM have prompted the establishment of rigorous selection criteria to optimize patient survival and graft utilization.This review examines the key criteria used to select candidates for LT in this setting,with a focus on oncological factors,patient characteristics,and response to therapy.Eligible candidates are typically those with non-resectable liver-only CRLM,demonstrating controlled primary tumor disease.Tumor biology is a critical determinant,excluding patients exhibiting high-risk molecular features such as BRAF or RAS mutations.Furthermore,candidates must show a favorable response to systemic chemotherapy,with either tumor stability or reduction in size and no extrahepatic progression during a defined treatment period.Specific tumor burden scores,such as the Oslo score or criteria based on the number and size of lesions,aid in stratifying candidates with acceptable recurrence risks.Other factors,including age,performance status,and absence of significant comorbidities,are also pivotal.Long-term follow-up data highlight the importance of stringent patient selection,showing superior 5-year survival in patients meeting these criteria compared to those who do not.In conclusion,strict selection criteria based on tumor biology,systemic disease control,and patient-specific factors ensure optimized outcomes for LT in CRLM patients,marking a pivotal step toward broader clinical acceptance of this novel approach.
基金supported by the Natural Science Foundation of Zhejiang Province,China(Grant No.LTGY23H220001).
文摘With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important for managing BMs.Radiation therapy(RT),including photon therapy,has been essential in managing BMs.Recent technological advances have significantly enhanced the precision,efficacy,and safety of these treatments.This comprehensive review provides an in-depth examination of the latest advancements in radiation and photon therapy technologies for treating BMs,focusing on innovations such as stereotactic radiosurgery(SRS),whole-brain radiation therapy(WBRT),laser interstitial thermal therapy(LITT),and other radiation-related treatment modalities.Additionally,we discuss clinical outcomes,challenges,and future directions in this rapidly evolving field.While a detailed comparison of techniques is beyond the scope of this paper,this paper provides up-to-date technical information for physicians,medical physicists,patients,and researchers in related fields,potentially enhancing clinical outcomes.Among the treatment modalities,SRS has become a cornerstone of RT for BMs,with its implementation spanning multiple modalities over the past few decades.Given its inherent minimally invasive nature and growing clinical acceptance,SRS is positioned to further evolve as a key therapeutic tool in both neurosurgery and radiotherapy.
基金Supported by National Natural Science Foundation of China,No.82027803 and No.81971623Key Research and Development Project of Zhejiang Province,No.2024C03092.
文摘BACKGROUND The feasibility and safety of radiofrequency ablation(RFA)for oligometastatic colorectal liver metastases(CRLM)have been well established.However,the role of RFA in multiple metastases after first-line chemotherapy failure remains underexplored.AIM To assess long-term survival and factors affecting outcomes of RFA in patients with multiple refractory CRLM.METHODS A retrospective study was conducted on patients who underwent ablation of CRLM at our institution between January 2015 and June 2024.A total of 80 patients were included,with 42 individuals receiving single-session ablation and 38 underwent repeat ablation.Enhanced computed tomography imaging was utilized to evaluate procedural efficacy 24 hours post-RFA,followed by follow-up scans every 3-4 months.Progression-free survival(PFS)and overall survival(OS)rates were compared at endpoint using Kaplan-Meier curves.Cox regression was used to identify the factors associated with OS and PFS.RESULTS The technical success rate was recorded at 98.7%.At endpoint,42(52.5%)patients achieved tumor-free survival,while 28(35%)remained alive with residual tumors present.No significant OS/PFS differences existed between single-session(median follow-up 29.5 months,median PFS 24.5 months)and repeat ablation(30 months,14 months)cohorts(P>0.05).Multivariate analysis showed that larger tumor size(P<0.001)and older age(P=0.01)were associated with worse OS.The median PFS was 13.5 months,with tumor size emerging as the only independent predictor(P=0.04).CONCLUSION For patients with multiple refractory CRLM,both single-session ablation and repeat ablation can increase the proportion of patients achieving tumor-free status.However,careful consideration is necessary for ablation of metastases larger than 2.7 cm.
文摘Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
基金Supported by the Council for Science,Technology,and Innovation(CSTI)Cross-Ministerial Strategic Innovation Promotion Program(SIP)“Innovative AI Hospital System”(National Institute of Biomedical Innovation,Health and Nutrition),No.SIPAIH18C03the Japan Society for the Promotion of Science(JSPS)KAKENHI,No.JP19K09179 and No.JP23K08158.
文摘BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.
基金Supported by the National Natural Science Foundation of China,No.82302332 and No.82272100Guiding Science and Technology Research Project of Quzhou,No.ZD2022020.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.
基金the Guo Wei Expert Work station,Yunnan Province(202305AF-150151).
文摘Objective:After percutaneous kyphoplasty(PKP),patients with pathological vertebral fractures of thoracolumbar metastases often have Qi and blood deficiency syndrome and hidden blood loss,resulting in postoperative debilitation syndrome.This study aimed to evaluate the clinical efficacy and mechanism of Shenqi Hexue Decoction on early postoperative recovery of such patients.Methods:36 Patients were randomly divided into an experimental group(Shenqi Hexue Decoction+conventional treatment)and a control group(conventional treatment).The changes of hemoglobin(HB),Karnofsky functional status(KPS)score,and TCM syndrome score on the 1st,4th,and 7th day after operation were observed.Results:The HB value of the experimental group was significantly higher than that of the control group on the 4th and 7th days after operation(p<0.01),and the maximum decline value of HB decreased by 42.1%(p<0.001);The improvement rate of KPS score in the experimental group was 94.4%on the 7th day after operation,which was significantly better than 66.7%in the control group(p<0.05).The total effective rate of TCM syndrome efficacy was 94.4%in the experimental group and 72.2%in the control group(p<0.05);No drug-related serious adverse reactions were found.Conclusion:Shenqi Hexue decoction can effectively improve the anemia state and activity ability of patients with Qi blood deficiency syndrome in the early stage after PKP,and its possible mechanism involves multi-target regulation such as hematopoietic regulation,microcirculation improvement and inflammation inhibition,with good safety.
基金Supported by the National Natural Science Foundation of China,No.82072034.
文摘BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.
