Tumor Recurrence Research Articles

USP4-mediated CENPF deubiquitylation regulated tumor metastasis in colorectal cancer

Metastasis is a major challenge for colorectal cancer (CRC) treatment. In this study, we identified autophagy activation as a prognostic indicator in CRC and observed that the expression of key autophagy proteins is elevated in metastatic and recurrent cases. Our subsequent goal was to identify potential genes associated with the autophagy panel and assess their prognostic significance, biological roles, and mechanisms in CRC metastasis. Among the candidates, CENPF emerged as the top gene in our screening process. We found that CENPF expression was preferentially elevated in CRC tissues compared to adjacent normal tissues, with significantly higher levels in CRC patients with tumor recurrence. Furthermore, a multicenter cohort study demonstrated that upregulated CENPF expression was strongly associated with poorer disease-free survival in CRC. Functional experiments showed that CENPF knockdown inhibited CRC cell invasion and metastasis both in vitro and in vivo. Intriguingly, we found CENPF undergoes degradation in CRC via the ubiquitination-proteasome pathway. Mechanistically, we observed that USP4 interacted with and stabilized CENPF via deubiquitination. Furthermore, USP4-mediated CENPF upregulation was critical regulators of metastasis of CRC. Examination of clinical samples confirmed that USP4 expression positively correlates with CENPF protein expression, but not mRNA transcript levels. Taken together, this study describes a novel USP4-CENPF signaling axis which is crucial for CRC metastasis, potentially serving as a therapeutic target and a promising prognostic biomarker for CRC.

The Role of Gut Microbiota in Tumor Recurrence and Therapy Resistance in Colorectal Cancer: Molecular Mechanisms and Clinical Implications.

The Role of Gut Microbiota in Tumor Recurrence and Therapy Resistance in Colorectal Cancer: Molecular Mechanisms and Clinical Implications.

Toxicity of anti-cancer drugs: the imaging findings to watch out for in common cancers.

A multitude of drugs are used for the treatment of various types of cancers. They consist of conventional cytotoxic agents and newer targeted agents. Both types of agents produce a variety of side effects by their effect on normal cells of the body. Regardless of whether they produce any symptoms or not, a proportion of these side effects can be visualised on imaging and their identification is crucial for guiding further management. While some of the adverse effects are mild and tolerable, many others require dose reduction and even withdrawal of the drug. A few of these manifestations may resemble tumour progression or recurrence on imaging. Therefore, appropriate knowledge regarding the imaging manifestations of the adverse effects caused by the chemotherapeutic agents used for various types of cancers is an integral part of onco-radiology practice. In this review, the common adverse effects of various anti-cancer drugs have been described based on the type of malignancy in which they occur, rather than based on the organ affected. This would allow the radiologist to look for common side effects while reading the scan of a patient with a specific cancer.

Impact of 68Ga-FAPi PET/CT on Staging or Restaging Digestive System Tumors in Patients with Negative or Equivocal 18F-FDG PET/CT Findings.

This study aimed to evaluate the potential efficacy of 68Ga-fibroblast activation protein inhibitor (FAPi) positron emission tomography/computed tomography (PET/CT) for detecting, staging, and restaging digestive system malignancies that are 18F-fluorodeoxyglucose (18F-FDG) negative or show equivocal 18F-FDG uptake. We conducted a prospective analysis of 30 patients with pathologically confirmed primary tumors or metastases of the digestive system. Participants underwent 68Ga-FAPi PET/CT and 18F-FDG PET/CT imaging for staging or restaging purposes within the same week. The efficacy of 68Ga-FAPi PET/CT was assessed by comparing its ability to detect lesions and influence disease staging with that of 18F-FDG PET/CT. 68Ga-FAPi PET/CT imaging was performed in 30 patients with 18F-FDG-negative or indeterminate lesions. Of the 30 patients, 23 had gastric cancer and 7 had colorectal cancer. Among all patients, histopathological diagnosis of signet ring cell carcinoma was present in 15 (50%) patients. Primary tumor or local recurrence was detected in 19 (63%) patients, lymph node metastasis in 8 (27%) patients, visceral metastasis in 4 (13%) patients, peritoneal metastasis in 14 (47%) patients, and bone metastasis in 3 (10%) patients on 68Ga-FAPi PET/CT images. All patients underwent histopathological confirmation on 68Ga-FAPi PET/CT images. The disease stage was upgraded in 20 patients (67%) after 68Ga-FAPi PET/CT imaging. Of the 20 patients, 12 had no evidence of recurrence or metastasis on 18F-FDG PET/CT. Based on our study, 68Ga-FAPi PET/CT alters the disease stage in the majority of gastrointestinal malignancies with negative or equivocal 18F-FDG PET/CT findings. 68Ga-FAPi PET/CT appears to be effective in both staging and restaging of gastrointestinal malignancies, such as signet-ring cell carcinomas of the stomach that frequently show low 18F-FDG -avidity.

GNE-317 Reverses MSN-Mediated Proneural-to-Mesenchymal Transition and Suppresses Chemoradiotherapy Resistance in Glioblastoma via PI3K/mTOR.

Glioblastoma (GBM) resistance to chemoradiotherapy is a major factor contributing to poor treatment outcomes. This resistance markedly affects the effectiveness of surgery combined with chemoradiotherapy and leads to post-surgical tumor recurrence. Therefore, exploring the mechanisms underlying chemoradiotherapy resistance in GBM is crucial for understanding its progression and improving therapeutic options. This study found that moesin (MSN) acts as a key promotor of chemoradiotherapy resistance in glioma stem cells (GSCs), enhancing their proliferation and stemness maintenance. Mechanistically, MSN activates the downstream PI3K/mTOR signaling pathway, driving the proneural-to-mesenchymal transition (PMT) in GSCs. This process enhances the repair of DNA damage caused by radiotherapy (RT) and temozolomide (TMZ), thereby increasing the resistance of GSCs to chemoradiotherapy. Additionally, GNE-317, a small molecule drug capable of crossing the blood-brain barrier, specifically inhibits MSN and suppresses the activation of downstream PI3K/mTOR signaling. Importantly, the combination of GNE-317 with RT and TMZ exhibits a strong synergistic effect both in vivo and in vitro, achieving better efficacy compared to the traditional combination of RT and TMZ. This study not only advances understanding of the mechanisms underlying chemoradiotherapy resistance in GBM but also provides a promising new approach for enhancing treatment outcomes.

Dual photoacoustic/ultrasound technologies for preclinical research: current status and future trends.

Photoacoustic imaging (PAI), by integrating optical and ultrasound modalities, combines high spatial resolution with deep tissue penetration, making it a transformative tool in biomedical research. This review presents a comprehensive analysis of the current status of dual photoacoustic/ultrasound (PA/US) imaging technologies, emphasising their applications in preclinical research. It details advancements in light excitation strategies, including tomographic and microscopic modalities, innovations in pulsed laser and alternative light sources, and ultrasound instrumentation. The review further explores preclinical methodologies, encompassing dedicated instrumentation, signal processing, and data analysis techniques essential for PA/US systems. Key applications discussed include the visualisation of blood vessels, micro-circulation, and tissue perfusion; diagnosis and monitoring of inflammation; evaluation of infections, atherosclerosis, burn injuries, healing, and scar formation; assessment of liver and renal diseases; monitoring of epilepsy and neurodegenerative conditions; studies on brain disorders and preeclampsia; cell therapy monitoring; and tumour detection, staging, and recurrence monitoring. Challenges related to imaging depth, resolution, cost, and the translation of contrast agents to clinical practice are analysed, alongside advancements in high-speed acquisition, artificial intelligence-driven reconstruction, and innovative light-delivery methods. While clinical translation remains complex, this review underscores the crucial role of preclinical studies in unravelling fundamental biomedical questions and assessing novel imaging strategies. Ultimately, this review delves into the future trends of dual PA/US imaging, highlighting its potential to bridge preclinical discoveries with clinical applications and drive advances in diagnostics, therapeutic monitoring, and personalised medicine.

Advanced surgical techniques and considerations in carotid body tumor management: insights from a cohort study

BackgroundCarotid body tumors (also known as glomus tumors) represent the most prevalent paragangliomas found in the head and neck region. These neoplasms originate from the aggregation of chemoreceptor cells in the cervical area, stemming from the neural crest during embryonic development.Aims and objectivesThis study aims to delineate our singular institutional experience concerning the clinical characteristics, surgical strategies, and outcomes associated with carotid body tumors (CBTs).Materials and methodsSurgical intervention was administered to a cohort of 40 patients. Among them, 7 individuals were classified as Shamblin Type 1, 20 as Type 2, and 13 as Type 3. Only one patient necessitated a saphenous vein interposition graft for the right internal carotid artery. For Shamblin Type 3 lesions, we employed the RF (Rija-farooq) technique, a retrograde dissection method wherein we first delineated the tumor from the internal carotid artery, followed by the external carotid artery, and finally, at the carotid bifurcation.ResultsNotably, none of the patients exhibited any postoperative neurological or vascular complications. Furthermore, during the subsequent follow-up period, no instances of tumor recurrence or mortality were recorded.ConclusionSurgical resection stands as the optimal therapeutic approach for managing CBTs. Once the diagnosis of CBT is confirmed, prompt surgical intervention should be pursued. Essential considerations in treatment planning include meticulous assessment of imaging characteristics and cerebral collateral circulation, which guide the selection of appropriate surgical methods.

Surgical treatment of intramedullary spinal cord tumors: a systematic review

Intramedullary spinal cord tumors are a rare group of central nervous system tumors with special treatment approaches. The main problems are related to optimal time of surgery, invasiveness and recurrence of tumor. To review available literature data on the treatment of intramedullary spinal cord tumors, to summarize the main achievements and changes in treatment strategy over the past 5 years. We reviewed Russian- and English-language literature on the treatment of intramedullary spinal cord tumors over the past five years. The studies were selected in accordance with PRISMA recommendations. We analyzed literature data in the PubMed, eLibrary, Cochrane and Medline databases over the last 5 years. The studies were selected taking into account the relevance and quality of researches. Large-scale studies are rare due to rarity of intramedullary spinal cord tumors. The main changes in surgery for intramedullary spinal cord tumors in recent years have occurred due to changes in surgical tactics (emphasis on functional status rather total resection), improvement of equipment for adjustment of surgical approach (MRI, intraoperative monitoring, intraoperative ultrasound), more accurate and effective adjuvant therapy contributing to preoperative shrinkage of tumor and preservation of functionally important areas.

Sclerosing Odontogenic Carcinoma: A Unique Odontogenic Carcinoma with Metastatic Potential.

The recent World Health Organization (WHO) classification of odontogenic tumours defines Sclerosing Odontogenic Carcinoma (SOC) as a rare primary intraosseous carcinoma (PIOC) of the jaws. With the exception of one case, there have been no cases of SOC with metastatic disease. We report a unique case of SOC with neck node metastases, further expanding the clinical, radiological and histological spectrum of this rare intriguing tumour. A 52-year-old female presented with a destructive radiolucent lesion of right mandible. Incisional biopsy was interpreted as desmoplastic ameloblastoma. The segmental mandibulectomy specimen was histologically consistent with SOC with positive anterior margin. Further resection with neck dissection revealed positive right levels IB and IIA nodes. Immunohistochemistry and Fluroscent In Situ Hybridization (FISH) were performed to confirm the diagnosis. The tumour was positive for CK5, p63, p40 and negative for CK19, CK20, CK7, SOX-10, S100, ER, PR, BRAFV600E, and EWSR1 gene rearrangements. Ki67 was 15%. To avoid confusion with PIOC, a high grade squamous cell carcinoma of the jaws with poor prognosis, SOC may be best defined as a rare infiltrative and locally aggressive odontogenic carcinoma with metastatic potential but with a reasonably favourable outcome. SOC shares similar histologic features with many benign and malignant tumours. An appropriate panel of immunohistochemical markers, in conjunction with special stains and molecular studies can help refine the differential diagnosis. It appears that a Ki67 proliferation index of more than 10%, may pose a risk for nodal metastasis and may assist in planning the clinical management. To achieve lower rates of positive margins and tumour recurrence, a wider resection margin (more than a centimetre) is recommended.

MOHS MICROGRAPHIC SURGERY IN NON-MELANOMA SKIN CANCER

Mohs Micrographic Surgery (MMS) is an advanced technique used to treat non- melanoma skin cancers, especially basal cell carcinoma and squamous cell carcinoma. This study presents a literature review on the application of MMS, highlighting its indications, benefits, limitations and recent advances. MMS offers high cure rates, often over 99% for primary tumors, while preserving as much healthy tissue as possible, making it the gold standard for lesions in critical areas such as the face, hands and genitals. The method combines precise tumor excision with intraoperative microscopic mapping, guaranteeing cancer cell-free margins and reducing the need for reinterventions. The review included studies addressing clinical outcomes, efficacy and comparison with other therapeutic modalities. The results confirm the superiority of MMS in high-risk, recurrent tumors or those with poorly defined margins, as well as its effectiveness in reducing complications and preserving functionality and aesthetics. However, limitations include the need for specialized infrastructure and trained staff, restricting its widespread implementation. It is concluded that MMS is a safe and effective approach, and it is essential to encourage its dissemination and to carry out new research to optimize its clinical application.

Recurrent Borderline Ovarian Tumors in the Adolescent Population: Case Report

Background and Clinical Significance: Borderline ovarian tumors (BOTs) are a rare diagnosis, especially in the adolescent population. This can make initial management and surveillance strategies difficult, given the limited guidelines and experience in this young age group. Case Presentation: We present two cases of recurrent serous BOTs diagnosed in adolescent patients. Both patients were initially treated with fertility-sparing surgery and followed with transabdominal pelvic ultrasounds. Secondary surgical debulking of recurrent disease with uterine preservation was successful in both patients with a long-term disease-free status. Conclusions: Although rare, BOTs can occur in adolescent patients and should be on the differential for ovarian masses in this age group. Fertility-sparing surgical techniques, reproductive endocrinology consultation, surveillance strategies, and hormone replacement therapy should all be taken into consideration when treating adolescent patients with BOTs.

Bone-Adhesive Peptide Hydrogel Loaded with Cisplatin for Postoperative Treatment of Osteosarcoma.

The inhibition of residual tumor recurrence while repairing bone defects poses a challenging issue for postoperative osteosarcoma treatment. Here, we develop a self-assembling peptide hydrogel (GelA) for the targeted delivery of cisplatin (CDDP), aiming to integrate postoperative tumor inhibition with bone defect repair. GelA exhibits exceptional biocompatibility, high loading capacity for CDDP, and superior bone adhesion. After in situ injection to bone defects, CDDP-loaded hydrogel GelA-CDDP demonstrates a strong affinity for hydroxyapatite, thereby facilitating optimal bone adhesion and prolonging the retention time of CDDP in a postoperative wound. Furthermore, GelA-CDDP can regulate the distribution and release behavior of CDDP, minimizing off-target effects and optimizing the therapeutic outcomes of chemotherapy and osteogenesis. Finally, in the orthotopic osteosarcoma transplantation model in mice, postoperative treatment with GelA-CDDP significantly inhibits residual osteosarcoma recurrence as well as repair of bone defects through synergistic osteogenesis promotion and osteoclastic inhibition. We believe that this hydrogel-based therapy strategy holds great promise in achieving simultaneous tumor inhibition and bone defect repair for postoperative osteosarcoma treatment.

Cancer stem cell populations are resistant to 5-aminolevulinic acid-photodynamic therapy (5-ALA-PDT)

Photodynamic therapy (PDT) is a minimally invasive treatment approved for many types of cancers. PDT involves the administration of photoactive substances called photosensitizers (PS) that selectively accumulate in cancer cells and are subsequently excited/activated by irradiation with light at wavelengths of optimal absorbance. Activated PS leads to the generation of singlet oxygen and other reactive oxygen species (ROS), promoting cancer cell death. 5-aminolevulinic acid (5-ALA) is a naturally occurring PS precursor, which is metabolically converted to the PS, protoporphyrin IX (PPIX). Although 5-ALA-PDT is effective at killing cancer cells, in prior studies conducted by our group we normally observed in in vitro experiments that approximately 5–10% of cells survive 5-ALA-PDT, which served as an impetus for further investigation. Identifying the mechanisms of resistance to 5-ALA-PDT-mediated cell death is important to prevent tumor recurrence following 5-ALA-PDT. Previously, we reported that oncogenic activation of Ras/MEK promotes PPIX efflux and reduces cellular sensitivity to 5-ALA-PDT through increased expression of ABCB1 transporter. As cancer stem cells (CSCs) are known to drive resistance to other cancer treatments and have high efflux of chemotherapeutic agents via ABC-family transporters, we hypothesize that CSCs underlie 5-ALA-PDT resistance. In this study, we determined (1) if CSCs are resistant to 5-ALA-PDT and (2) if CSCs play roles in establishing resistant populations of 5-ALA-PDT. When we compared CSC populations before and after 5-ALA-PDT, we found that CSCs were less susceptible to 5-ALA-PDT. Moreover, we found that the CSC population was enriched in 5-ALA-PDT-resistant cell lines compared to the parental cell line. Our results indicate that CSCs are not sensitive to 5-ALA-PDT, which may contribute to establishment of 5-ALA-PDT resistance.

Diagnostic value and efficacy of multimodal magnetic resonance imaging in differentiating radiation necrosis from tumor recurrence in glioblastomas.

Distinguishing radiation necrosis (RN) from recurrent tumor (RT) in patients with gliomas treated with radiation therapy presents an important clinical dilemma. To evaluate the diagnostic performance of multiparametric magnetic resonance imaging (MRI) techniques in distinguishing RN from RT in patients with histologically confirmed glioma treated previously with radiotherapy and chemotherapy or without chemotherapy using a combination of dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion MRI, diffusion tensor imaging (DTI), and MR spectroscopy (MRS). Patients with glioma who developed a new enhancing mass after standard treatment were retrospectively evaluated. Conventional MRI, DTI, DSC, and MRS were performed. The region of interest (ROI) was manually drawn in the enhancing lesions, peri-lesional white matter edema, and the contralateral normal-appearing white matter. Apparent diffusion coefficient (ADC), fractional anisotropy (FA), relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), N-acetylaspartate (NAA), choline (Cho), creatine (Cr), NAA/Cr, Cho/NAA, and Cho/Cr were calculated. Two-tailed t-test and receiver operating characteristic (ROC) curve analysis were performed. In total, 34 patients with RT and 25 with RN met our inclusion criteria. FA, rCBF, rCBV, Cho/NAA, Cho/Cr were statistically significant between the two groups (P < 0.05). The sensitivity and specificity of FA, rCBF, rCBV, Cho/NAA, and Cho/Cr in the diagnosis of RT were 70.6%, 97.1%, 91.2%, 91.2%, and 82.4% and 64%, 100%, 100%, 96%, and 72% respectively. DTI, DSC, and MRS are of great value in the differential diagnosis of RN and RT of glioma. The diagnostic performance of DSC is better than DTI and MRS.

Multimodal near‐infrared molecular imaging of ex vivo endometrial carcinoma via CD47‐based targeted tracer

AbstractThe detection and complete eradication of early‐stage small tumors during hysteroscopy remains a significant clinical challenge in preserving fertility for young women with endometrial cancer (EC). The purpose of this study is to verify the feasibility of CD47 as an optical molecular imaging (OMI) target for human EC and to achieve precise localization and identification in hysteroscopic surgery. The results demonstrated that CD47 was overexpressed in EC through bioinformatics, immunohistochemistry, and qRT‐PCR. In EC cell lines, CD47‐targeted near‐infrared photoimmunotherapy (NIR‐PIT) induced cytotoxicity in a light dose‐dependent manner. Laser confocal microscopy revealed that CD47 intervention significantly increased the phagocytic effect of macrophages on EC cells. In the mice model of partial tumor resection mediated by CD47‐targeted OMI, compared to group A (immune therapy alone), group C (NIR‐PIT treatment) mice showed a reduced tumor recurrence rate after NIR‐PIT intervention. However, the difference did not reach statistical significance. We then evaluated the effect of CD47‐targeted NIR‐PIT maintenance therapy on tumor recurrence in mice. The results indicated that, compared to untreated animals, the tumor growth rate was slower in the NIR‐PIT group using CD47‐Alexa Fluor 790 (CD47‐AF790), allowing for more sustained tumor control. The freshly isolated whole uterus specimens from EC patients were co‐incubated with CD47‐AF790, and a significantly enhanced contrast of NIR visible images of tumor tissue was observed, demonstrating high sensitivity and specificity (tumor‐to‐background ratio &gt;5.05). Finally, under fluorescence microscopy, specific fluorescent signals are observed on tumor cells. In conclusion, accurate localization and excision of EC can be accomplished by employing CD47 optical molecular contrast agents with OMI technology. This method shows potential as a viable and promising approach for the precise diagnosis of EC.

Radiotherapy-Associated Cellular Senescence and EMT Alterations Contribute to Distinct Disease Relapse Patterns in Locally Advanced Cervical Cancer.

A notable number of locally advanced cervical carcinoma (LACC) patients experience local or distant disease relapse following radiotherapy. The contribution of tumor microenvironment (TME) to tumor recurrence at different sites remains unclear. Here, single-nucleus RNA sequencing data from 28 pre- and on-treatment LACC samples from patients with different disease relapse patterns is analyzed. The findings revealed opposing alterations in the expression levels of the cellular senescence pathway after radiotherapy in patients with local and distant relapses. In contrast, an increase in the expression of the epithelial-mesenchymal transition module after radiotherapy in both relapse groups is observed. Cell-cell interactions, drug-target expression analyses in malignant cells after radiation, and multiplex immunofluorescence of tumor tissue identified interleukin-1 receptor type I (IL1R1) as a potential therapeutic target. It is demonstrated that combining the IL1R1 inhibitor anakinra with radiation can mitigate the effects of radiation on tumor cells. This study highlights the distinct roles of cellular senescence and EMT in tumor recurrence.

COMBINED ENDOSCOPIC AND OPEN CRANIAL APPROACH FOR TREATMENT OF SKULL BASE LESIONS: A CASE SERIES

Background: Surgical treatment of skull base pathologies is frequently discussed in the context endoscopic endonasal or transcranial approaches. Combined endoscopic and open approaches have been utilized in staged or sequential fashion, with the goal of reducing risk of postoperative cerebrospinal fluid leak, morbidity, wound infection/complication, and failure to achieve adequate reconstruction. However, few studies have described concurrent use of endoscopic endonasal and transcranial approaches to safely address complex skull base pathologies. Methods: We treated 13 patients with primary skull base tumors (sinonasal undifferentiated carcinoma/esthesioneuroblastoma), recurrent tumors, infection, and skull base defect/encephalocele. 8/13 patients had undergone prior endoscopic and/or open transcranial approaches for resection of their pathologies. 3/13 patients underwent radiation or chemotherapy and radiation prior to the combined approach. Results: The desired clinical outcome (i.e. gross total tumor resection, resolution of infection, and skull base resection/repair) was achieved in 12/13 cases. One case had subtotal resection (Simpson Grade III) of an olfactory groove meningioma. Post-operatively, there was one 30-day-mortality due to pulmonary infarction, one case with hydrocephalus requiring ventriculoperitoneal shunt placement and one flap infection due to postoperative cocaine use resulting in revisions and hospice. Importantly, no patients experienced postoperative CSF leaks, including those who underwent postoperative chemotherapy/radiation. Conclusion: This case series suggests that a concurrent combined endoscopic transcranial approach, in carefully selected patients, can treat a wide range of complex and recurrent skull base pathologies resistant to previous treatment, with a reasonable rate of post-operative wound/ leak complications.

Inhibitory effect of streamer discharge on the local recurrence of B16F10 melanoma tumor in mice

Abstract Plasma-based cancer therapy presents a novel approach to treating oncologic diseases. One promising application is post-surgical plasma treatment to reduce the risk of local recurrence after tumor resection. However, a major challenge in the post-surgical treatment using plasma is the limited experimental evidence. This study provides in vivo evidence demonstrating that streamer discharge can significantly reduce the local recurrence rate of B16F10 melanoma tumors in mice. Ten-minute treatments of tumor resection sites reduced the recurrence rate by approximately 50%. No significant abnormalities related to plasma treatment were observed throughout the experiments. The cytotoxic effect of streamer discharge was also demonstrated in vitro, where apoptosis and necrosis were observed in B16F10 cells.

Giant and irregular pituitary neuroendocrine tumors surgery: comparison of simultaneous combined endoscopic endonasal and transcranial and purely endoscopic endonasal surgery at a single center

BackgroundSurgical management of giant and irregular pituitary neuroendocrine tumors (GIPitNETs) presents a significant challenge in neurosurgery. While endoscopic endonasal surgery (EES) is a widely used approach for PitNETs, GIPitNETs with extensive intracranial extension pose challenges for purely EES. We use simultaneous combined endoscopic endonasal and transcranial surgery (CECS) for the treatment of this type of tumor. Currently, there is limited research comparing CECS to EES for GIPitNETs. This study aims to compare the efficacy and short outcome of CECS and purely EES in the management of GIPitNETs to better understand the advantages and limitations of each surgical approach.MethodsThe data of GIPitNETs patients who underwent surgery between March 2018 and May 2023 at a single center were retrospectively reviewed. All included cases were divided into CECS and EES groups according to the treatment modality received. The baseline characteristics and tumor imaging features of patients were compared between the groups, as well as surgical results, perioperative complications, and last follow-up outcomes.ResultsA total of 50 patients met the inclusion criteria, with 27 undergoing CECS and 23 EES. CECS achieved a significantly higher GTR rate compared to EES (66.7% vs. 13.0%, p < 0.0001). CECS had longer operation times and hospital stays, but both approaches had similar rates of complications, including intracranial infection, CSF leakage, new pituitary dysfunction, postoperative diabetes insipidus, and vascular infarction. CECS reduces the risk of postoperative bleeding. Tumor recurrence and reoperation were significantly more common in the EES group.ConclusionsCECS is a safe and effective surgical approach for GIPitNETs, leading to higher rates of GTR, comparable complication rates, and reduced risk of postoperative bleeding when compared to purely EES. EES was associated with more tumor recurrence. Further long-term follow-up data is needed to validate these findings.

Autophagy induced by metabolic processes leads to solid tumor cell metastatic dormancy and recurrence.

A crucial cellular mechanism that has a complex impact on the biology of cancer, particularly in solid tumors, is autophagy. This review explores how metabolic processes trigger autophagy, which helps metastatic tumor cells go dormant and recur. During metastasis, tumor cells frequently encounter severe stressors, such as low oxygen levels and nutritional deprivation, which causes them to activate autophagy as a survival tactic. This process allows cancer stem cells (CSCs) to withstand severe conditions while also preserving their features. After years of dormancy, dormant disseminated tumor cells (DTCs) may reappear as aggressive metastatic cancers. The capacity of autophagy to promote resistance to treatments and avoid immune detection is intimately related to this phenomenon. According to recent research, autophagy promotes processes, such as the epithelial-to-mesenchymal transition (EMT) and helps build a pre-metastatic niche, which makes treatment strategies more challenging. Autophagy may be a promising therapeutic target because of its dual function as a tumor suppressor in early-stage cancer and a survival promoter in advanced stages. To effectively treat metastatic diseases, it is crucial to comprehend how metabolic processes interact with autophagy and affect tumor behavior. In order to find novel therapeutic approaches that can interfere with these processes and improve patient outcomes, this study highlights the critical need for additional investigation into the mechanisms by which autophagy controls tumor dormancy and recurrence.