Tumor Size Research Articles

Differential diagnosis between low-risk and high-risk thymoma: Comparison of diagnostic performance of radiologists with and without deep learning model.

There are few CT-based deep learning (DL) studies on thymoma according to the World Health Organization classification. To develop a CT-based DL model to distinguish between low-risk and high-risk thymoma and to compare the diagnostic performance of radiologists with and without the DL model. 159 patients with 160 thymomas were included. A fine-tuning VGG16 network model with Adam optimizer was used, followed by k-fold cross validation. The dataset consisted of three axial slices, including the maximum tumor size from the CT volume data. The data were augmented 50 times by rotation, zoom, shear, and horizontal/vertical flip. Three independent networks for the CT dataset were considered, and the result was determined by voting. Three radiologists independently diagnosed thymomas with and without the model. The area under the curve (AUC) of the diagnostic performance was compared using receiver operating characteristic analysis. Accuracy of the DL model was 71.3%. Diagnostic performance of the radiologists was as follows: AUC and accuracy without the DL model, 0.61-0.68 and 61.9%-69.3%; and with the DL model, 0.66-0.69 and 68.1%-70.0%, respectively. AUC of the diagnostic performance showed no significant differences between radiologists with and without the DL model. The DL model tended to increase the diagnostic accuracy, but AUC was not significantly improved. Diagnostic performance of the DL was comparable to that of radiologists. The DL model assistance tended to increase diagnostic accuracy.

Changes in Incidence of Cirrhotic and Noncirrhotic Hepatocellular Carcinoma in the United States

IntroductionHepatocellular carcinoma (HCC) occurs most often in a background of cirrhosis. Patients with noncirrhotic HCC represent a distinct population, which has been characterized in single-center studies, but has not been fully evaluated on a population level in the United States. Materials and methodsHCC cases from Surveillance, Epidemiology, and End-Results diagnosed between 2000 and 2020 were categorized as cirrhotic or noncirrhotic. Clinical and pathologic factors, age-adjusted incidence rates (AAIR), and the overall HCC-specific survival were compared between groups. ResultsThere were 18,592 patients with cirrhosis (80.4%) and 4545 without (19.6%). AAIRs for noncirrhotic HCC remained relatively unchanged from 2010 to 2020, with a mean incidence of 0.35 per 100,000. The AAIR for cirrhotic HCC declined from 1.59 to 0.85 per 100,000 during the same period. Patients with cirrhosis were younger (median age 62 versus 65 y, P < 0.001). Patients without cirrhosis, compared to those with cirrhosis, were less likely to have elevated alpha fetoprotein (53.9% versus 62.0%, P < 0.001), had larger tumors (median tumor size 5.0 versus 3.5 cm, P < 0.001), presented more frequently with localized disease (59.9% versus 55.8%, P < 0.001), were more likely to undergo surgery (OR 2.21, 95% CI 2.07-2.36), and had better HCC-specific survival (median 40 versus 27 mo, P < 0.001). ConclusionsThe relative increase in the proportion of noncirrhotic HCC in the Untied States may be due to a decline in the incidence of cirrhotic HCC. Patients with noncirrhotic HCC have larger tumors, are more likely to undergo surgical resection, and have improved cancer-specific survival.

Rare Yet Relevant: Adult Onset Cervical Lymphangioma - Our Experience and Comprehensive Review.

Cervical lymphangiomas are anomalies that arise from lymphatic vessels, characterized by gradual and painless growth. While predominantly located in the neck, they may also manifest in the axilla, mediastinum, groin, and abdominal organs. Cervical lymphangioma usually occurs in children and is relatively rare in adults. The purpose of this study was to investigate the characteristics of cervical lymphangiomas in adults. We reviewed the medical records and analysed clinical data obtained from fifteen adult patients who suffered from cervical lymphangioma and were operated from January 2021 to January 2023. Out of 15 cases, 73.3% were females and 26.7% were males. All tumours were unilaterally located. Five patients had prior history of associated dyspnoea / dysphagia. All 15 cervical lymphangiomas (100%) were adjacent to the carotid sheath .Tumour size ranged from 6cm to 15cm, with the maximum diameter of ≥ 15cm in two cases, between 6cm and 10cm in eight cases and less than 6cm in five cases. Further, in this study all cervical lymphangiomas were surgically excised. Postoperative courses were uneventful, and histo-pathological examinations confirmed all cases to be cystic lymphangiomas. A 6 -month follow-up in all 15 cases showed no recurrences. Overall, this study underscores the importance of a multidisciplinary approach involving clinicians, radiologists, and surgeons in the management of adult cervical lymphangiomas, with an emphasis on accurate diagnosis, appropriate classification, and tailored treatment strategies to optimize patient outcomes and minimize complications.

Association of Hashimoto thyroiditis with papillary thyroid carcinoma and its clinical features – A retrospective study in a tertiary care hospital

Background: Papillary thyroid carcinoma (PTC) is the most widespread endocrine malignancy. Among the several risk factors, Hashimoto thyroiditis (HT) is one of the factors associated with increased incidence of PTC. Both HT and PTC share several epidemiologic features including high prevalence, female predominance, and increased incidence in iodine-sufficient areas. Aims and Objectives: The aim of the study was to assess the incidence of HT and PTC coexistent in endemic population. The study also aimed to determine the association of various prognostic parameters of PTC in patients with coexistent HT. Materials and Methods: This was a retrospective study done from May 2019 to May 2024 over a period of 5 years in a tertiary care hospital of West Bengal. A total of 54 patients with primary PTC who underwent total thyroidectomy with cervical lymph node dissection (LND) were studied. Patients with primary PTC with neck LND and complete medical history were included in this study. Patients with previous thyroidectomy surgery or patients with incidental PTC diagnosed in thyroidectomy specimens done for a benign neoplasm (without LND) were excluded from the study. Results: A total of 54 cases of PTC were studied out of which 23 cases were PTC associated with HT and 31 cases were PTC without HT constituting 42.59% and 57.4%, respectively. PTC associated with HT had a greater incidence in females. In this study, our results showed that PTC with HT had a greater tendency of tumor multifocality, greater mean lymph node size, and increase rate of extranodal tumor extension. At the same time, patients of PTC associated with HT had smaller tumor size and low clinical stage. Conclusion: PTC associated with HT had a female preponderance, larger metastatic lymph node, a tendency for multifocality, and extranodal extension. At the same, they also had smaller tumor size and low clinical stage indicating a complex and controversial effect of HT on PTC.

The Utility of Immuno-Nutritional Scores in Patients with Testicular Germ Cell Tumors

Background: Hemoglobin, Albumin, Lymphocyte, and Platelet Score (HALP) is an accessible score that is easily reproducible from routine laboratory testing while also reflecting patients’ immune-nutritional status. Along with other immuno-nutritional scores, such as the Prognostic Nutrition Index (PNI), HALP has been associated with a number of clinical and pathological features. The goal of our study was to evaluate the prognostic utility of HALP and PNI scores in testicular germ cell cancer (GCT) patients. Methods: This case-only study included 203 testicular GCT patients who were classified according to the disease stage and HALP and PNI cut-offs. Complete blood count and albumin concentration were routinely determined. Results: The values of HALP and PNI significantly differed among different clinical stages (p &lt; 0.05). Moreover, they clearly exposed a significantly higher risk of advanced clinical stage development for those testicular GCT patients with lower values of HALP and PNI (p &lt; 0.05). Finally, lower score levels were associated with larger tumor size (p &lt; 0.05). Conclusion: Our investigation could provide evidence that specific immune-nutritional scores can help distinguish individuals diagnosed with testicular GCT who are more likely to be identified with advanced disease stages.

Advanced artificial intelligence framework for T classification of TNM lung cancer in 18FDG-PET/CT imaging

Abstract The integration of artificial intelligence (AI) into lung cancer management offers immense potential to revolutionize diagnostic and treatment strategies. The aim is to develop a resilient AI framework capable of two critical tasks: firstly, achieving accurate and automated segmentation of lung tumors and secondly, facilitating the T classification of lung cancer according to the ninth edition of TNM staging 2024 based on PET/CT imaging.&amp;#xD;This study presents a robust AI framework for the automated segmentation of lung tumors and T classification of lung cancer using PET/CT imaging. The database includes axial DICOM CT and 18FDG-PET/CT images. A modified ResNet-50 model was employed for segmentation, achieving high precision and specificity. Reconstructed 3D models of segmented slices enhance tumor boundary visualization, which is essential for treatment planning. The Pulmonary Toolkit facilitated lobe segmentation, providing critical diagnostic insights.&amp;#xD;Additionally, the segmented images were used as input for the T classification using a CNN ResNet-50 model. Our classification model demonstrated excellent performance, particularly for T1a, T2a, T2b, T3 and T4 tumors, with high precision, F1 scores, and specificity. The T stage is particularly relevant in lung cancer as it determines treatment approaches (surgery, chemotherapy and radiation therapy or supportive care) and prognosis assessment. In fact, for Tis-T2, each increase of one centimeter in tumor size results in a worse prognosis. For locally advanced tumors (T3-T4) and regardless of size, the prognosis is poorer.&amp;#xD;This AI framework marks a significant advancement in the automation of lung cancer diagnosis and staging, promising improved patient outcomes.&amp;#xD;

7312 Tumor Size and Mutation Prevalence in Black Americans with Primary Aldosteronism

7312 Tumor Size and Mutation Prevalence in Black Americans with Primary Aldosteronism

Necrosis area, Tumor Size, and Lymph Node of Breast Cancer

Background: Breast cancer is the leading cause of cancer deaths in women worldwide in 2020. The high mortality rate is often influenced by various reasons, one of which is patients's prognosis. One of the prognostic factors is necrosis area, caused by hypoxic tumor tissue that can affect tumor growth and metastasis. Therefore, this study aims to determine the relationship between necrosis area with tumor size and lymph node metastasis in breast cancer patients. Methods: This study was an observational analytic with a cross-sectional approach. This research was conducted at the Anatomical Pathology Laboratory of Dr Soedarso Pontianak General Hospital and the Microscopy Laboratory of the Faculty of Medicine Tanjungpura University from September until November 2022. The study sample was 55 slides of Formalin-Fixed Paraffin-Embedded (FFPE). The study was conducted by observing the preparations under a microscope and then analyzed using ImageJ and SPSS software. The independent variable in this study was the necrosis area in the tumor microenvironment, and the dependent variables were tumor size and lymph node metastasis in breast tissue. Results: All study samples were female patients with invasive ductal carcinoma. Breast cancer tends to occur in patients aged 48-55 years. The highest percentage of necrosis area was 21% and the most diagnosed breast tumor size and lymph node metastasis were stage T4 and stage N2. Spearman's rho correlation test showed that there was no relationship between necrosis area and tumor size (p = 0.122; r = 0.16) and lymph node metastasis (p = 0.637; r = 0.18). Conclusions: There is no correlation between necrosis area with tumor size and lymph node metastasis of breast cancer patients in the Anatomical Pathology Laboratory at Dr Soedarso Pontianak General Hospital.

Evaluation of the clinical significance of lymphocyte subsets and myeloid suppressor cells in patients with renal carcinoma

PurposeThe purpose of this study was to analyze the expression patterns of immune cells in renal cancer patients, including myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), CD3 + /CD4 + T cells, CD3 + / CD8 + T cells, and CD3- CD16 + CD56 + cells. In addition, this study will explore the correlation between these immune markers and the progression of renal cell carcinoma and evaluate their potential application in predicting the therapeutic effect of renal cell carcinoma.MethodsIn this study, 80 renal cancer patients who received treatment in our hospital from October 2022 to December 2023 were selected as the research object and 50 healthy people who underwent a physical examination at the same time were selected as the control group. All participants had a 3 ml venous blood sample taken in the morning on an empty stomach. All patients with renal cell carcinoma have been confirmed by histopathological diagnosis. Clinicopathological data including age, gender, BMI, clinical stage, tumor size and pathological type were collected.MDSC, Treg, CD3 + /CD4 + T cells, CD3 + /CD8 + T cells, the ratio of CD3 + /CD4 + T cells/CD3 + /CD8 + T cell and the expression level of CD3-CD16 + CD56 + cells were detected by flow cytometry.ResultsThrough the detection of flow cytometry, we observed that there was no significant difference in gender, age, BMI and other baseline characteristics between renal cancer patients and healthy controls, and the P value was greater than 0.05. However, in the analysis of peripheral blood immune cell subsets, including CD3 + /CD4 + , CD3 + /CD8 + , CD3 + /CD4 + /CD3 + /CD8 + ratio, NK cells, regulatory T cells (T-reg), polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) and mononuclear myeloid-derived suppressor cells (M-MDSC) were significantly different between renal cell carcinoma group and normal control group (P < 0.05). Specifically, the expression levels of CD3 + /CD4 + and CD3 + /CD8 + cells in renal cancer patients were lower than those in normal subjects, while the expression levels of T-reg, PMN-MDSC and M-MDSC were relatively high. (2) In the flow cytometry analysis, the expression level of immune cell subsets in the peripheral blood of renal cancer patients was detected.The results showed that there was no significant correlation between the expression of CD3 + /CD4 + , CD3 + /CD8 + , CD3 + /CD4 + /CD3 + /CD8 + ratio, NK cells, T-reg cells, PMN-MDSC and M-MDSC and the sex, age, BMI and pathological type of the patients. These differences were not statistically significant (P > 0.05).At the same time, CD3 + /CD8 + T cells, the ratio of CD3 + /CD4 + /CD3 + /CD8 + and the expression level of NK cells were not significantly correlated with tumor size and clinical stage (P > 0.05). However, the expression levels of CD3 + /CD4 + cells, M-MDSC, PMN-MDSC, and T-reg cells were statistically significantly different with tumor size and clinical stage (P < 0.05).There was a significant difference between these indexes and lymph node metastasis (P < 0.05). (3) The results of Logistic regression analysis showed that the low expression of CD3 + /CD4 + lymphocytes and the high expression of T-reg, PMN-MDSC and M-MDSC in peripheral blood may be related to the clinical stage of renal cell carcinoma.Conclusion(1) Compared with healthy individuals, patients with renal cell carcinoma showed a significant decrease in CD3 + /CD4 + T cells, CD3 + /CD8 + T cells and CD3-CD16 + CD56 + cells, while the CD4 + /CD8 + ratio increased. In addition, the number of PMN-MDSC, M-MDSC and T-reg cells was significantly increased compared with the normal population, indicating that the immune system function of patients was impaired. (2) The expression levels of CD3 + /CD4 + , PMN-MDSC, M-MDSC and T-reg were different in tumor size and clinical stage. Specifically, the expression levels of PMN-MDSC, M-MDSC, and T-reg increased correspondingly with the increase in tumor diameter and the progression of the clinical stage.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma: Survival Outcomes and Development of a Machine Learning Prognostic Model.

The effectiveness of radiofrequency ablation (RFA) in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma (HCC) measuring 5 cm or less remains uncertain. This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA. This study was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017, focusing on patients diagnosed with a solitary HCC lesion ≤5 cm in size. We compared the overall survival (OS) and cancer-specific survival (CSS) rates of these patients with those of patients who received hepatectomy, radiotherapy, or chemotherapy or who were part of a blank control group. To enhance the reliability of our findings, we employed stabilized inverse probability treatment weighting (sIPTW) and stratified analyses. Additionally, we conducted a Cox regression analysis to identify prognostic factors. XGBoost models were developed to predict 1-, 3-, and 5-year CSS. The XGBoost models were evaluated via receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA) curves and so on. Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs, the 5-year OS (46.7%) and CSS (58.9%) rates were greater in the RFA group than in the radiotherapy (27.1%/35.8%), chemotherapy (32.9%/43.7%), and blank control (18.6%/30.7%) groups, but these rates were lower than those in the hepatectomy group (69.4%/78.9%). Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years. Age, race, marital status, grade, cirrhosis status, tumor size, and AFP level were selected to construct the XGBoost models based on the training cohort. The areas under the curve (AUCs) for 1, 3, and 5 years in the validation cohort were 0.88, 0.81, and 0.79, respectively. Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts. RFA can improve the survival of patients diagnosed with a solitary HCC lesion ≤5 cm. In certain clinical scenarios, RFA achieves survival outcomes comparable to those of hepatectomy. The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

Machine learning-driven survival prediction in gestational trophoblastic neoplasms: a focus on PSTT and ETT prognosis

IntroductionThe clinicopathological characteristics and prognosis of placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) have not been well summarized. Consequently, we conducted the largest to date series of samples of both types and employed machine learning (ML) to assess treatment effectiveness and develop accurate prognostic models for patients with GTN. Gestational choriocarcinoma (GCC) was used as the control group to show the clinical features of PTSS and ETT.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database provided the data used for this study’s analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using the Kaplan-Meier survival analysis. ResultsThe study population comprised 725 patients. Among them, 139 patients had ETT, 107 had PSTT, and 479 had GCC. There were no significant differences in survival between the different tumor groups. Multivariate Cox regression analysis revealed that metastasis was a significant prognostic factor for GCC, while older age and radiotherapy were significant prognostic factors for PTSS and ETT. ML models revealed that the Gradient Boosting classifier accurately predicted the outcomes, followed by the random forest classifier, K-Nearest Neighbors, Logistic Regression, and multilayer perceptron models. The most significant contributing factors were tumor size, year of diagnosis, age, and race.DiscussionOur study provides a method for treatment and prognostic assessment of patients with GTN. The ML we developed can be used as a convenient individualized tool to facilitate clinical decision making.

Current trends in vestibular schwannoma management at a referral center in Indonesia: A cross-sectional study with retrospective data collection

Background. Vestibular schwannoma (VS) is the most common benign brain tumor of the cerebellopontine angle. Due to its location, this pathology can create both focal and general deficits. The registry system for VS in Indonesia is developing, including in the author’s institution, which eventually shows a changing trend in managing VS. Methods. We retrospectively collected data from all patients diagnosed with vestibular schwannoma, based on histological or radiological results. Treatments included craniotomy and/or Gamma Knife Radiosurgery (GKRS) from 2018 to 2023. Results. Data from 88 patients were analyzed. The number of treated patients has increased annually. VS predominantly affects females (64%). The proportion between GKRS and craniotomy procedures also shifted throughout the year. Common symptoms included hearing loss (63.6%), disequilibrium (50%), and headaches (39.7%). The most common tumor size was medium (15-30 mm; n=37; 42%). Tumors that fell into the intrameatal and small (&lt;15 mm) categories were all treated with GKRS, whereas the other groups were divided into GKRS and craniotomy. GKRS demonstrated high efficacy in tumor control and favorable hearing and facial nerve preservation, whereas craniotomy remained crucial for larger tumors. Conclusion. The number of VS diagnosed each year has increased in our center, accompanied by a noticeable shift in preference from GKRS to craniotomy, which is influenced by the integration of intraoperative monitoring. Treatment preference was further determined based on the clinical profile and tumor size. In the future, there is a need to develop a national registry to better reflect the true incidence of VS within the Indonesian population.

HECTD2 as a target for veratric acid in the regulation of ferroptosis in renal cell carcinoma

Function of HECTD2 in renal cell carcinoma malignant progression is undefined. Molecular mechanism behind anti-cancer effects of veratric acid (VA) from traditional Chinese medicine (TCM) is underexplored. The Cancer Genome Atlas was leveraged to study HECTD2 expression in renal cell carcinoma and its relationship with histological grading. Kaplan–Meier survival analysis was performed. HECTD2 expression was detected in cancer cells and tissues via qRT-PCR and immunohistochemistry. GPX4 and SLC7A11 expression in tumor samples with high or low HECTD2 expression was examined by immunohistochemistry, cell viability by CCK8, cell proliferation by colony formation assay, lipid ROS and mitochondrial superoxide levels by flow cytometry, Fe2+ and MDA content by assay kits, and GPX4 and SLC7A11 proteins by western blot. SeeSAR software screened TCM small molecule compounds with highest affinity to HECTD2, confirmed with cellular thermal shift assay. VA IC50 was measured by CCK8. Xenograft model was developed and treated with VA. Tumor size and weight were monitored, with immunohistochemistry to detect HECTD2 expression in tumors and assess ferroptosis-related markers. HECTD2 was overexpressed in tumor tissues and cells, which positively correlated with histological grading. HECTD2 depletion inhibited cell vitality and proliferation, raised intracellular lipid ROS, mitochondrial superoxide, Fe2+, and MDA. HECTD2 was a target with highest VA affinity. In vitro and vivo experiments concurred that VA treatment hindered malignancy of renal cell carcinoma and enhanced its susceptibility to ferroptosis. HECTD2 supports ferroptosis resistance in renal cell carcinoma, but VA, through its targeting of HECTD2, initiates ferroptosis, showcasing its anti-cancer efficacy.

Rethinking the prognosis model of differentiated thyroid carcinoma

BackgroundThe prediction efficiency of long-term cancer-specific survival (CSS) in guiding the treatment of differentiated thyroid carcinoma (DTC) patients is still unsatisfactory. We need to refine the system so that it more accurately correlates with survival.MethodsThis is a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database, and included patients who underwent surgical treatment and were diagnosed with DTC from 2004 to 2020. Patients were divided into a training cohort (2004–2015) and validation cohort (2016–2020). Decision tree methodology was used to build the model in the training cohort. The newly identified groups were verified in the validation cohort.ResultsDTC patient totals of 52,917 and 48,896 were included in the training and validation cohorts, respectively. Decision tree classification of DTC patients consisted of five categorical variables, which in order of importance were as follows: M categories, age, extrathyroidal extension, tumor size, and N categories. Then, we identified five TNM groups with similar within-group CSS. More patients were classified as stage I, and the number of stage IV patients decreased significantly. The new system had a higher proportion of variance explained (PVE) (5.04%) and lower Akaike information criterion (AIC) (18,331.906) than the 8th TNM staging system (a PVE of 4.11% and AIC of 18,692.282). In the validation cohort, the new system also showed better discrimination for survival.ConclusionThe new system for DTC appeared to be more accurate in distinguishing stages according to the risk of mortality and provided more accurate risk stratifications and potential treatment selections.

Sorafenib plus memory-like natural killer cell immunochemotherapy boosts treatment response in liver cancer

BackgroundHeterogeneity of hepatocellular carcinoma (HCC) presents significant challenges for therapeutic strategies and necessitates combinatorial treatment approaches to counteract suppressive behavior of tumor microenvironment and achieve improved outcomes. Here, we employed cytokines to induce memory-like behavior in natural killer (NK) cells, thereby enhancing their cytotoxicity against HCC. Additionally, we evaluated the potential benefits of combining sorafenib with this newly developed memory-like NK cell (pNK) immunochemotherapy in a preclinical model.MethodsHCC tumors were grown in SD rats using subcapsular implantation. Interleukin 12/18 cytokines were supplemented to NK cells to enhance cytotoxicity through memory activation. Tumors were diagnosed using MRI, and animals were randomly assigned to control, pNK immunotherapy, sorafenib chemotherapy, or combination therapy groups. NK cells were delivered locally via the gastrointestinal tract, while sorafenib was administered systemically. Therapeutic responses were monitored with weekly multi-parametric MRI scans over three weeks. Afterward, tumor tissues were harvested for histopathological analysis. Structural and functional changes in tumors were evaluated by analyzing MRI and histopathology data using ANOVA and pairwise T-test analyses.ResultsThe tumors were allowed to grow for six days post-cell implantation before treatment commenced. At baseline, tumor diameter averaged 5.27 mm without significant difference between groups (p = 0.16). Both sorafenib and combination therapy imposed greater burden on tumor dimensions compared to immunotherapy alone in the first week. By the second week of treatment, combination therapy had markedly expanded its therapeutic efficacy, resulting in the most significant tumor regression observed (6.05 ± 1.99 vs. 13.99 ± 8.01 mm). Histological analysis demonstrated significantly improved cell destruction in the tumor microenvironment associated with combination treatment (63.79%). Interestingly, we observed fewer viable tumor regions in the sorafenib group (38.9%) compared to the immunotherapy group (45.6%). Notably, there was a significantly higher presence of NK cells in the tumor microenvironment with combination therapy (34.79%) compared to other groups (ranging from 2.21 to 26.50%). Although the tumor sizes in the monotherapy groups were similar, histological analysis revealed a stronger response in pNK cell immunotherapy group compared to the sorafenib group.ConclusionsExperimental results indicated that combination therapy significantly enhanced treatment response, resulting in substantial tumor growth reduction in alignment with histological analysis.

Emergency Surgical Management of Meningiomas: Factors Affecting Early Outcomes and Complications

Abstract Objective Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications. Materials and Methods All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison. Results Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of &lt; 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95–80.72, p 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65–249.2, p 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes (p 0.20). Conclusion Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.

The Synergistic Combination of Curcumin and Polydatin Improves Temozolomide Efficacy on Glioblastoma Cells

Glioblastoma (GBL) is one of the more malignant primary brain tumors; it is currently treated by a multimodality strategy including surgery, and radio- and chemotherapy, mainly consisting of temozolomide (TMZ)-based chemotherapy. Tumor relapse often occurs due to the establishment of TMZ resistance, with a patient median survival time of &lt;2 years. The identification of natural molecules with strong anti-tumor activity led to the combination of these compounds with conventional chemotherapeutic agents, developing protocols for integrated anticancer therapies. Curcumin (CUR), resveratrol (RES), and its glucoside polydatin (PLD) are widely employed in the pharmaceutical and nutraceutical fields, and several studies have demonstrated that the combination of these natural products was more cytotoxic than the individual compounds alone against different cancers. Some of us recently demonstrated the synergistic efficacy of the sublingual administration of a new nutraceutical formulation of CUR+PLD in reducing tumor size and improving GBL patient survival. To provide some experimental evidence to reinforce these clinical results, we investigated if pretreatment with a combination of CUR+PLD can improve TMZ cytotoxicity on GBL cells by analyzing the effects on cell cycle, viability, morphology, expression of proteins related to cell proliferation, differentiation, apoptosis or autophagy, and the actin network. Cell viability was assessed using the MTT assay or a CytoSmart cell counter. CalcuSyn software was used to study the CUR+PLD synergism. The morphology was evaluated by optical and scanning electron microscopy, and protein expression was analyzed by Western blot. Flow cytometry was used for the cell cycle, autophagic flux, and apoptosis analyses. The results provide evidence that CUR and PLD, acting in synergy with each other, strongly improve the efficacy of alkylating anti-tumor agents such as TMZ on drug-resistant GBL cells through their ability to affect survival, differentiation, and tumor invasiveness.

Clinical Outcomes and Complications of Parotidectomy for Pleomorphic Adenoma Tumour

Objective: To evaluate the clinical and surgical outcomes in patients treated for pleomorphic adenoma (PA) of the parotid gland. Methods: This retrospective study covered 100 PA cases from 2000 to 2018, all confirmed by histopathology and with at least 24 months of follow-up. Statistical analysis was performed using Student’s t-test, Pearson’s Chi-square test, and Fisher’s exact test, with a significance level of 0.05. Results: The average patient age was 42±12 years, with an even sex ratio. Parotid swelling was the main symptom (94%), with an average tumor size of 2.5cm. Most tumors were in the superficial lobe (94 cases), and there were 3 bilateral cases. Surgical approaches included superficial exofacial parotidectomy (55 cases), total parotidectomy (25 cases), partial exofacial parotidectomy (14 cases), and enucleation (6 cases). Complications occurred in 49 patients, with postoperative facial paralysis (FP) being the most common (20%). Total parotidectomy had a higher transient FP rate (24%) compared to exofacial parotidectomy (11%). Four recurrences were noted, mainly after enucleation or exofacial parotidectomy. Statistical analysis showed significant associations: exofacial parotidectomy had the highest complication rate (47%) and was linked to permanent FP (p=0.02). Total parotidectomy was associated with Frey’s syndrome (p=0.01), partial exofacial parotidectomy with salivary fistula (p&lt;0.001), and enucleation with tumor recurrence (p&lt;0.001). Conclusions: Superficial exofacial parotidectomy is common but associated with complications. Total parotidectomy is linked to Frey’s syndrome, while partial exofacial parotidectomy and enucleation have specific risks of salivary fistula and recurrence. Careful selection of surgical technique is crucial to minimize complications and recurrence.

Excessive autophagy-inducing and highly penetrable biomineralized bacteria for multimodal imaging-guided and mild hyperthermia-enhanced immunogenic cell death

The tumor microenvironment, characterized by hypoxia, supports the efficacy of anaerobic bacteria like attenuated S. typhimurium in cancer therapies. These bacteria target and penetrate deep tumor regions, significantly reducing tumor size but often lead to tumor regrowth due to limited long-term efficacy. To enhance the therapeutic impact, a novel biohybrid system, S@UIL, has been developed by coating S. typhimurium with a zirconium-based nanoscale metal–organic framework (UiO-66-NH2) loaded with indocyanine green (ICG) and luteolin (LUT). This system maintains the bacteria’s tumor-targeting ability while increasing the penetration and therapeutic effectiveness through excessive autophagy and mild hyperthermia. In a subcutaneous colon cancer model, the integration of LUT and ICG promotes autophagic cell death and photothermal sensitization, leading to the release of damage-associated molecular patterns (DAMPs). These DAMPs activate immune responses through dendritic cells and T-cells, enhancing immunogenic cell death (ICD) and potentially reducing immune evasion by tumors. This single-administration approach also integrates multimodal imaging capabilities, providing a promising strategy for improved tumor ICD induction and cancer progression inhibition.

Predictive Biomarkers of Lymph Node Metastasis in Early Gastric Cancer: A Reference of Clinicopathological Characteristics, Protein Expression, Epstein-Barr Virus Status, and Microsatellite Instability.

Predicting lymph node metastasis (LNM) in early gastric cancer (EGC) is crucial for making treatment decisions. This study aimed to confirm risk factors for LNM and identify novel auxiliary biomarkers for predicting LNM in EGC. We established a training set, comprising 63 patients with LNM-EGC and 274 patients with non-LNM EGC, and a test set, comprising 19 patients with LNM-EGC and 146 non-LNM EGC. Immunohistochemistry for lymphangiogenic and related pathway components (VEGF-C, TGF-β1, SMAD2/3, VEGF-D, pSTAT3, E-cadherin, CD44, c-MET, YAP, and HER2), in situ hybridization for Epstein-Barr virus-encoded small RNAs, and multiplex PCR for microsatellite instability were conducted. In the training set, Lauren's diffuse/mixed classification, stromal desmoplasia, submucosal invasion ≥500 μm, lymphatic invasion, and high VEGF-C and SMAD2/3 expression were independent risk factors for LNM (p<0.05). A large tumor size, mixed histology, submucosal invasion, perineural invasion, and ulceration were determined as risk factors using univariate analysis (p<0.05). The tumor cutoff size for predicting LNM was 2.65 cm, based on a ROC analysis. The test set study verified that stromal desmoplasia, submucosal invasion, and high VEGF-C expression were independent risk factors for LNM (p<0.05). Moreover, mixed histology, lymphatic invasion, ulceration, and high SMAD 2/3 expression were identified as additional risk factors using univariate analysis (p<0.05). Stromal desmoplasia, submucosal invasion, and high VEGF-C expression are potential biomarkers for LNM in EGC. VEGF-C expression might serve as an adjunct biomarker for predicting LNM on forceps-biopsy tissue at initial diagnosis.