Cancer Stage Research Articles

Prostate cancer treatment recommendation study based on machine learning and SHAP interpreter.

This study utilized data from 140,294 prostate cancer cases from the Surveillance, Epidemiology, and End Results (SEER) database. Here, 10 different machine learning algorithms were applied to develop treatment options for predicting patients with prostate cancer, differentiating between surgical and non-surgical treatments. The performances of the algorithms were measured using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value. The Shapley Additive Explanations (SHAP) method was employed to investigate the key factors influencing the prediction process. Survival analysis methods were used to compare the survival rates of different treatment options. The CatBoost model yielded the best results (AUC = 0.939, sensitivity = 0.877, accuracy = 0.877). SHAP interpreters revealed that the T stage, cancer stage, age, cores positive percentage, prostate-specific antigen, and Gleason score were the most critical factors in predicting treatment options. The study found that surgery significantly improved survival rates, with patients undergoing surgery experiencing a 20.36% increase in 10-year survival rates compared with those receiving non-surgical treatments. Among surgical options, radical prostatectomy had the highest 10-year survival rate at 89.2%. This study successfully developed a predictive model to guide treatment decisions for prostate cancer. Moreover, the model enhanced the transparency of the decision-making process, providing clinicians with a reference for formulating personalized treatment plans.

A log odds of positive lymph nodes-based predictive model effectively forecasts prognosis and guides postoperative adjuvant chemotherapy duration in stage III colon cancer: a multi-center retrospective cohort study

BackgroundThe log odds of positive lymph nodes (LODDS) was considered a superior staging system to N stage in colon cancer, yet its value in determining the optimal duration of adjuvant chemotherapy for stage III colon cancer patients has not been evaluated. This study aims to assess the prognostic value of a model that combines LODDS with clinicopathological information for stage III colon cancer patients and aims to stratify these patients using the model, identifying individuals who could benefit from varying durations of adjuvant chemotherapy.MethodA total of 663 consecutive patients diagnosed with stage III colon cancer, who underwent colon tumor resection between November 2007 and June 2020 at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University, were enrolled in this study. Survival outcomes were analyzed using Kaplan–Meier, Cox regression. Nomograms were developed to forecast patient DFS, with the Area Under the Curve (AUC) values of time-dependent Receiver Operating Characteristic (timeROC) and calibration plots utilized to assess the accuracy and reliability of the nomograms.ResultsMultivariate analysis revealed that perineural invasion (HR = 1.776, 95% CI: 1.052–3.003, P = 0.032), poor tumor differentiation (HR = 1.638, 95% CI: 1.084–2.475, P = 0.019), and LODDS groupings of 2 and 1 (HR = 1.920, 95% CI: 1.297–2.842, P = 0.001) were independent predictors of disease-free survival (DFS) in the training cohort. Nomograms constructed from LODDS, perineural invasion, and poor tumor differentiation demonstrated robust predictive performance for 3-year and 5-year DFS in both training (3-year AUC = 0.706, 5-year AUC = 0.678) and validation cohorts (3-year AUC = 0.744, 5-year AUC = 0.762). Stratification according to this model showed that patients in the high-risk group derived significant benefit from completing 8 cycles of chemotherapy (training cohort, 82.97% vs 67.17%, P = 0.013; validation cohort, 89.49% vs 63.97%, P = 0.030).ConclusionThe prognostic model, integrating LODDS, pathological differentiation, and neural invasion, demonstrates strong predictive accuracy for stage III colon cancer prognosis. Moreover, stratification via this model offers valuable insights into optimal durations of postoperative adjuvant chemotherapy.

The innovation of mediastinal staging in lung cancer with artificial intelligence

The innovation of mediastinal staging in lung cancer with artificial intelligence

Outcomes of patients with active cancer after transcatheter aortic valve replacement: an updated meta-analysis

BackgroundPatients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown.MethodsWe searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2.ResultsWe included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15–1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80–2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70–2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15–2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34–2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years.ConclusionPatients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention.Graphical

Extracting lung cancer staging descriptors from pathology reports: A generative language model approach

BackgroundIn oncology, electronic health records contain textual key information for the diagnosis, staging, and treatment planning of patients with cancer. However, text data processing requires a lot of time and effort, which limits the utilization of these data. Recent advances in natural language processing (NLP) technology, including large language models, can be applied to cancer research. Particularly, extracting the information required for the pathological stage from surgical pathology reports can be utilized to update cancer staging according to the latest cancer staging guidelines. ObjectivesThis study has two main objectives. The first objective is to evaluate the performance of extracting information from text-based surgical pathology reports and determining pathological stages based on the extracted information using fine-tuned generative language models (GLMs) for patients with lung cancer. The second objective is to determine the feasibility of utilizing relatively small GLMs for information extraction in a resource-constrained computing environment. MethodsLung cancer surgical pathology reports were collected from the Common Data Model database of Seoul National University Bundang Hospital (SNUBH), a tertiary hospital in Korea. We selected 42 descriptors necessary for tumor-node (TN) classification based on these reports and created a gold standard with validation by two clinical experts. The pathology reports and gold standard were used to generate prompt-response pairs for training and evaluating GLMs which then were used to extract information required for staging from pathology reports. ResultsWe evaluated the information extraction performance of six trained models as well as their performance in TN classification using the extracted information. The Deductive Mistral-7B model, which was pre-trained with the deductive dataset, showed the best performance overall, with an exact match ratio of 92.24% in the information extraction problem and an accuracy of 0.9876 (predicting T and N classification concurrently) in classification. ConclusionThis study demonstrated that training GLMs with deductive datasets can improve information extraction performance, and GLMs with a relatively small number of parameters at approximately seven billion can achieve high performance in this problem. The proposed GLM-based information extraction method is expected to be useful in clinical decision-making support, lung cancer staging and research.

Nuclear Imaging Modalities in the Diagnosis and Management of Thyroid Cancer.

In this review we have brought forward various nuclear imaging modalities used in the diagnosis, staging, and management of thyroid cancer. Thyroid cancer is the most common endocrine malignancy, accounting for approximately 3% of all new cancer diagnoses. Nuclear imaging plays an important role in the evaluation of thyroid cancer, and the use of radioiodine imaging, FDG imaging, and somatostatin receptor imaging are all valuable tools in the management of this disease. Radioiodine imaging involves the use of Iodine-123 [I-123] or Iodine-131 [I-131] to evaluate thyroid function and detect thyroid cancer. I-123 is a gamma-emitting isotope that is used in thyroid imaging to evaluate thyroid function and detect thyroid nodules. I-131 is a beta-emitting isotope that is used for the treatment of thyroid cancer. Radioiodine imaging is used to detect the presence of thyroid nodules and evaluate thyroid function. FDG imaging is a PET imaging modality that is used to evaluate the metabolic activity of thyroid cancer cells. FDG is a glucose analogue that is taken up by cells that are metabolically active, such as cancer cells. FDG PET/CT can detect primary thyroid cancer and metastatic disease, including lymph nodes and distant metastases. FDG PET/CT is also used to monitor treatment response and detect the recurrence of thyroid cancer. Somatostatin receptor imaging involves the use of radiolabeled somatostatin analogues to detect neuroendocrine tumors, including thyroid cancer. Radiolabeled somatostatin analogues, such as Indium-111 octreotide or Gallium-68 DOTATATE, are administered to the patient, and a gamma camera is used to detect areas of uptake. Somatostatin receptor imaging is highly sensitive and specific for the detection of metastatic thyroid cancer. A comprehensive search of relevant literature was done using online databases of PubMed, Embase, and Cochrane Library using the keywords "thyroid cancer," "nuclear imaging," "radioiodine imaging," "FDG PET/CT," and "somatostatin receptor imaging" to identify relevant studies to be included in this review. Nuclear imaging plays an important role in the diagnosis, staging, and management of thyroid cancer. The use of radioiodine imaging, thyroglobulin imaging, FDG imaging, and somatostatin receptor imaging are all valuable tools in the evaluation of thyroid cancer. With further research and development, nuclear imaging techniques have the potential to improve the diagnosis and management of thyroid cancer and other endocrine malignancies.

Uso de la medicina complementaria y alternativa y enfoques para hacer frente al estrés en las mujeres con cáncer de mama: un estudio transversal

ObjectiveThe study aimed to reveal the approaches to coping with stress of women with breast cancer and the factors predicting these approaches, to determine the prevalence and characteristics of Complementary and Alternative Medicine (CAM), and to examine the relationship between use of CAM and approaches to coping with stress. MethodsA descriptive and cross-sectional study was conducted among 328 women with breast cancer at a training and research hospital in Türkiye. Data were collected with the Descriptive Information Form and the Stress Coping Styles Scale (SCSS). ResultsWomen's SCSS score was 47.26±6.39 (effective) and 37.76±6.33 (ineffective). The SCSS score were not significantly different between CAM users and non-CAM users (P>.05). The prevalence of CAM use was 36%, the most common types of CAM were herbal products (55.1%) and prayer (33.8%) and the reasons for using CAM were for relaxation (symptomatic) (43.2%). As a result of multivariate logistic regression analysis, level of income, working, number of living children, receiving chemotherapy, receiving surgery, having a family history of cancer, and the interest of their partner after the disease were associated with effective coping with stress (P<.05, adjusted R2=.08, .05, and .33 respectively). Working, receiving chemotherapy, receiving surgery, stage of cancer, and having a history of cancer in a social environment were associated with ineffective coping with stress (P<.05, adjusted R2=.14 and .11 respectively). ConclusionsOne-third of women were using CAM and had a good level of approaches to coping with stress. Healthcare providers, especially gynecology-oncology nurses, should provide counseling on CAMs and develop strategies for coping with stress for women with breast cancer.

Expression and functional analyses of TERF2 in esophageal carcinoma

BackgroundEsophageal cancer (ESCA) is a prevalent malignancy with a high incidence of morbidity and mortality, particularly in Asia. Telomeric Repeat-binding Factor 2 (TERF2) is a crucial component of the telomere-binding protein complex that maintains telomere stability. Aberrant TERF2 expression has been implicated in tumorigenesis, however, its specific role in ESCA remains largely unexplored. MethodsThe expression levels of TERF2 were assessed in esophageal squamous cell carcinoma (ESCC) samples using RT-PCR, IHC, and Western blotting (WB). Serum tumor marker concentrations were determined via electrochemiluminescence immunoassay (ECLIA) and chemiluminescent microparticle immunoassay (CMIA). Bioinformatics analyses were employed to elucidate TERF2's function in EC. The impact of TERF2 on ESCC cell proliferation was evaluated through cell counting kit-8 (CCK8) assays and flow cytometry. ResultsTERF2 protein and mRNA expression were elevated in ESCC tissues and correlated with age, sex, cancer stage, tumor grade, lymph node metastasis (LNM), and tumor histology. Univariate Cox regression analysis indicated TERF2 was an independent prognostic factor for overall survival (OS). TERF2 mRNA levels were associated with serum levels of carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), and tissue polypeptide antigen (TPA) in patients with ESCC. Immune infiltration and chemokine profiles were linked to TERF2 expression in ESCA. TERF2 is involved in regulating ESCC cell proliferation may through the DDR/P53 signaling way. ConclusionsTERF2 is overexpressed in ESCA and contributes to ESCC cell proliferation may via DDR/TP53 signaling pathway. These results suggest that TERF2 may serve as a potential target for developing treatments and diagnostic biomarker for ESCA.

Long non-coding RNA LINC-PINT is associated with favorable prognosis in cancer patients: a systematic review and meta-analysis.

There is growing evidence that long non-coding RNA long iatrogenic non-protein-coding RNA p53-induced transcript (LINC-PINT) is highly expressed in cancer tissue and is associated with the prognosis of cancer patients. The present study systematically analyzed the prognostic significance of LINC-PINT expression in cancer patients. We aimed to reveal the association between LINC-PINT expression and survival in cancer patients. We collected eligible studies through the PubMed, Embase, and Cochrane library searches until February 1, 2024. We collected the following data from the enrolled studies: first author, publication year, country, cancer type, case number, cancer stage, detection method and cut-off value of LINC-PINT expression, follow-up period, and survival outcome. The prognostic significance of LINC-PINT expression was evaluated by conducting a meta-analysis. StataSE17 (Stata, College Station, TX, USA) was used for all analyses. Eleven eligible studies with 2,876 cancer patients were collected. The pooled results revealed that LINC-PINT expression was associated with favorable overall survival (OS) and disease-free survival (DFS) in cancer patients [for OS, hazard ratio (HR) =0.72, 95% confidence interval (CI): 0.64-0.80, P<0.001; for DFS, HR =0.70, 95% CI: 0.60-0.82, P<0.001]. LINC-PINT expression was associated with favorable OS and DFS, and it may serve as a valuable prognostic marker in cancer patients.

431. DISSECTION OF THE SUPRACARINAL MESOESOPHAGUS RECURRENTIAL LYMPHADENECTOMY AND RECURRENT NERVE DAMAGE

Abstract Background Currently, an extended mediastinal lymphadenectomy is considered paramount for an accurate cancer staging as well as to improve the oncologic outcomes of patients with locally advanced esophageal cancer. Following the recently described supracarinal mesoesophagus (Cuesta et. al. 2023) allows a complete lymphadenectomy, including the left recurrential area. However, this dissection represents a considerable challenge and could be associated with significant complications. The aim of this study is to analyse if the extended lymphadenectomy guided by the anatomy of the superior mesoesophagus enables a more careful dissection of the recurrent nerves in order to avoid an injury of these structures. Methods We prospectively studied all patients in our centre with advanced esophageal cancer, from 2018 to 2023, who underwent esophagectomy and recurrent lymphadenectomy following the surgical plane of the supracarinal mesoesophagus (both unilateral and bilateral). All procedures were performed as curative intent by the same surgeon. We analysed all patients with recurrent nerve lesions and their severity, as well as their implication through the postoperative period and the treatment needed for their repair. In addition, we also studied the number of adenopathies included in the specimen, specifying those that belonged to the recurrential area and its positivity for tumoral cells. Results We included 40 patients in our study, 30 men and 10 women with an average age of 65 years. All of them received neoadyuvant therapy previous to the surgery (mostly CROSS and FLOT schemes). There were only 2 patients (5%) who suffered from permanent recurrent palsy, both needing surgical treatment for its correction. Two other patients had mild dysphonia that could be resolved with phoniatric rehabilitation. No fatal outcome occurred secondary to recurrent nerve injury. The median number of adenopathies resected in total was 35, while the median number of adenopathies corresponding to the recurrential area was 5. Conclusions In this study we have observed that, following the landmarks of the supracarinal mesoesophagus allows us to perform an extended mediastinal lymphadenectomy reducing the recurrent nerves injury down to only 5%. Even though a lesion of the recurrent nerves could imply a major influence on the quality of life, performing this dissection meticulously could improve the quality of cancer staging, overall and disease-free survival without significantly increasing the risk of recurrent nerve damage. For this reason, the proper knowledge of these anatomical planes of dissection may help improve lymphadenectomies without increasing or even reducing the rate of recurrent nerve injury.

Multifaceted Understandings of Cancer: A Review of Disease Mechanisms and Therapies

Abstract: Cancer is a condition in which aberrant cells continue to divide uncontrollably, causing tissue to be destroyed. Different cancer stages have been identified by researchers, suggesting that a number of gene alterations are involved in the etiology of cancer. Unusual cell proliferation is brought on by these gene alterations. A crucial role in the acceleration of cell proliferation is played by genetic diseases brought on by heredity or hereditary factors. Its diagnosis and treatment have historically been regarded as two of the most important and significant clinical concerns. Depending on the nature and stage of the tumor, numerous ways to its corrective therapy have been established. Numerous biomolecules derived from plants are crucial for the treatment of the disease. In this review, we focus on specific aspects to give a brief overview of the major problems, including their etiology, therapies that are available, herbal alternates, available vaccines and relevant biomarkers. It was felt that much work needs to be done on combination therapy development and platform optimization.

Weekly Image Guidance in Patients With Cervical Cancer Treated With Intensity-Modulated Radiation Therapy: Results of a Large Cohort Study.

Image guidance is recommended for patients undergoing intensity-modulated radiation therapy (IMRT) for cervical cancer. In this study, we evaluated the feasibility of a weekly image guidance pattern and analyzed the long-term outcomes in a large cohort of patients. The study enrolled patients with Stage IB-IVA cervical cancer who received definitive radiotherapy or concurrent chemoradiotherapy. IMRT was delivered at a dose of 50.4 Gy in 28 fractions, with weekly cone-beam computed tomography (CBCT). Physicians advised patients on rectum and bladder preparation to help them prepare on nonimaging guidance days. When significant tumor regression was observed, a second computed tomography simulation and replanning were performed. The median follow-up periods were 63.4 months. The incidence rates of loco-regional and distant failure were 9.9% and 13.6%. The 5-year overall survival (OS), disease-free survival (DFS), loco-regional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 80.1%, 72.9%, 78.3%, and 74.8%, respectively. For patients with different stages, the 5-year OS, DFS, LRFS, and DMFS rates were statistically significant. For patients with and without positive regional lymph nodes, the 5-year OS, DFS, LRFS, and DMFS rates were 64.5% and 86.0%, 56.8% and 78.8%, 62.7% and 84.3%, and 58.8% and 81.0%, respectively. Multivariate analysis showed that age, histology, tumor size, cancer stage, pretreatment squamous cell carcinoma antigen level, and para-aortic metastatic lymph nodes were independent prognostic factors of OS. Fifty-six (4.0%) patients experienced late Grade 3/4 chronic toxicities. IMRT with weekly CBCT is an acceptable image guidance strategy in countries with limited medical resources.

Prognostic Impact of Each Item of the SARC-F Questionnaire in Patients Undergoing Major Surgery for Urologic Cancer.

We aimed to evaluate the association between scores on each item of the SARC-F questionnaire and life expectancy in patients undergoing major surgery for urologic cancer. This retrospective study included 1018 patients undergoing elective major urologic cancer surgery. All patients completed the SARC-F questionnaire preoperatively. Demographic and clinical data were collected. The primary endpoint was an association between SARC-F scores and overall survival (OS). Of the 1018 patients, the median age was 72 years and 920 (90%) were male. Multivariate analysis revealed four factors significantly and independently associated with shorter OS: assistance with walking score ≥1 (Hazard ratio: HR=2.18, P=0.044), cancer stages ≥ III (HR=7.98, P<0.001), high blood loss ≥78 ml or blood transfusion during surgery (HR=4.53, P=0.007 and HR=2.41, P=0.037, respectively). This study found that among the items of the SARC-F questionnaire, assistance with walking was a strong predictor of life expectancy. Incorporating such a simple screening tool into the preoperative assessment would help to ensure more appropriate perioperative care for urologic cancer patients.

Emerging Trends in Lung Cancer Presentation at a Leading Tertiary Oncology Center and the Need for Lung Cancer Screening in Pakistan.

Background Lung cancer is a significant global health concern, with Pakistan lacking a national cancer registry. Methods A retrospective study analyzed 345 lung cancer patients at Shifa International Hospital from 2018 to 2020. Demographics, symptoms, cancer stage, site, and histological types were assessed using descriptive statistics and Pearson'schi-square test. Results Most patients were male (267, 77.4%) with a mean age of 45-75 years. Common symptoms included patients with cough (168, 49%), blood in sputum (114, 33%), and chest pain (120, 35%). Most cases presented at advanced stages (81% at stage 4). Adenocarcinoma (131, 38%) was the most common histological type, with significant differences noted between smokers and non-smokers. Conclusion Gender disparities exist in lung cancer incidence, with a higher proportion of male patients. Both smokers and non-smokers are affected, emphasizing the need for comprehensive screening. Early detection and intervention strategies are crucial, especially considering the advanced stage of presentation. Tailored approaches considering histological types are essential for effective management. This study underscores the urgency of implementing screening programs and raising awareness to mitigate the burden of lung cancer in Pakistan.

Clinicopathologic Characteristics Influencing Overall Survival of Patients With Early- Versus Average-Onset Colorectal Cancer at a Tertiary Care Center in Indonesia.

There has been a global increase in early-onset colorectal cancer (EOCRC), yet there has been very limited exploration of its impact in Indonesia. This study aimed to determine the clinicopathologic characteristics and the overall survival (OS) of EOCRC compared with those of average-onset colorectal cancer (AOCRC). Medical records were retrospectively reviewed from all patients presenting with colorectal cancer (CRC) at Dr Sardjito General Hospital (Yogyakarta, Indonesia) between 2016 and 2019. Sociodemographic, clinicopathologic, and treatment variables were extracted. t Tests were used to compare characteristics of EOCRC and AOCRC patient groups. The Cox proportional hazards regression model was used to analyze age and other potential prognostic factors. The total population (N = 1,276) comprised EOCRC (n = 149; 11.7%) and AOCRC (n = 1,127; 88.3%) patients. EOCRC patients were more likely to have a higher education level, be single, have out-of-pocket insurance, be underweight, and have signet ring histology (all P values <.05), compared with AOCRC patients. EOCRC and AOCRC groups had a comparable estimated 5-year OS of 34.2% and 36.9%, respectively. In multivariable analyses, performance status (Eastern Cooperative Oncology Group), hemoglobin level, cancer stage, and treatment intention were independent prognostic factors for OS (all P values <.05). To our knowledge, this first major study of EOCRC in Indonesia highlights its role in the overall burden of CRC and its connection with social determinants of health. Patients with EOCRC are more commonly underweight and generally have a higher proportion of signet ring histology than AOCRC, yet OS in both groups is similar. Future research is required to identify risk factors to inform the content and focus of public health education activities, alongside delineating the biology and causes of early and average onset of the disease.

42P Correlation of circulating tumor cells with cancer stage

42P Correlation of circulating tumor cells with cancer stage

Hypoxic Regulation of the KLK4 Gene in two Different Prostate Cancer Cells Treated with TGF- β.

The human kallikrein-related peptidase (KLK) family which consists of 15 members is associated with prostate cancer and other cancers. It has been reported that overexpression of KLK4 in prostate cancer correlates with bone metastasis or advanced stage. Hypoxia occurs in the early stages of prostate cancer due to the accumulation of acidic metabolites or reactive oxygen species (ROS). In our study, KLK4 gene expression in hypoxic conditions in PC-3 and LNCaP cells which are treated with TGF-β was evaluated with mRNA, protein, and promoter activity levels. A chemical hypoxia model was created and confirmed at mRNA and protein level. No statistically significant cytotoxic effect of CoCl2 and TGF-β was observed in PC-3 and LNCaP cells with the MTT test. Four different truncated KLK4 gene promoter constructs were cloned in pmetLuc expression vector and basal activities of all promoter fragments were analyzed. The activities of P1 (-447/ + 657), P2 (-103/ + 657), and P3 (-267/ + 657) promoter fragments increased in hypoxic conditions except P4 (+555/ + 657), which does not contain the SMAD and HRE region. KLK4 mRNA levels in both PC-3 and LNCaP cells increased in the hypoxia and hypoxia/TGF groups compared to the non-treated groups. The stimulating effect of TGF-β is correlated with the increase in SMAD2/3 mRNA levels. KLK4 expression is up-regulated by TGF-β, especially under hypoxic conditions, and its interaction with the SMAD pathway is determined with different inhibitor experiments. HIF-1α and SMAD transcription factors bind to the KLK4 promoter showing the direct interaction of HIF-1α (-80/-52) and SMAD (+163/+194) regions with EMSA.

Clinical impact of pancreatic invasion in T1-stage distal bile duct cancer and prognostic factors associated with long-term survival: A multicenter study.

The eighth edition of the AJCC staging system introduced a shift in the staging of distal bile duct cancer (DBC), emphasizing the depth of invasion over adjacent organ invasion. This study aimed to evaluate the clinical impact of pancreatic invasion in pT1-stage DBC and identify prognostic factors for long-term survival. This multicenter retrospective analysis encompassed DBC patients who underwent pancreaticoduodenectomy between 2009 and 2019 in six Korean tertiary centers, specifically those with final pathology confirming AJCC eighth edition T1 stage and intrapancreatic bile duct tumor origin. Primary endpoints were five-year recurrence-free survival (RFS) and overall survival (OS). Secondary objectives included the identification of prognostic determinants. This study involved 287 patients, comprising 190 without and 97 with pancreatic invasion. Pancreatic invasion did not significantly influence five-year OS and RFS rates (OS: without pancreatic invasion 69.9% vs. with pancreatic invasion 54.1%, p = .25; RFS: 56.3% vs. 55.4%, p = .97). Multivariate analysis highlighted male gender, age, lymphovascular invasion, and N stage as significant OS determinants. Notably, male gender, ampulla of Vater invasion, lymphovascular invasion, and N1 stage were also associated with RFS. In pT1 DBC, pancreatic invasion demonstrates no substantial impact on long-term prognosis, in accordance with the depth-based paradigm of the eighth edition AJCC staging system. The prognostic factors influencing OS were identified as male gender, age, lymphovascular invasion, and nodal metastasis.

Recent advances in the diagnosis of rectal cancer and evaluation of clinical treatment efficacy using magnetic resonance imaging

Accurate preoperative tumor staging is essential for precise treatment of rectal cancer, and magnetic resonance imaging (MRI) is the preferred method. In addition to accurately determining tumor (T) and stages node (N), MRI can also be used to evaluate factors related to the prognosis of rectal cancer, such as depth of tumor invasion into the muscular layer, extramural vascular invasion of the tumor, and distance to the circumferential resection margin. MRI is also an important method for evaluating tumor regression after neoadjuvant therapy, and quantitative biomarkers of functional MRI can objectively reflect treatment efficacy. Moreover, MRI can predict response after neoadjuvant therapy, local recurrence rate, and disease-free survival before treatment. The present article reviews recent advances in the preoperative diagnosis and staging of rectal cancer, reassessment after neoadjuvant therapy, and evaluation of clinical treatment efficacy using MRI.

Exploring the Usefulness of Tumor Budding as a Histopathological Marker Compared to Tumor-Node-Metastasis (TNM) Staging in Breast Cancer.

Tumor budding, defined as small clusters of tumor cells at the invasive front of carcinomas, has gained attention as a potential prognostic marker in various cancers. This study aimed to evaluate the utility of tumor budding as a histopathological marker in breast cancer and compare it to traditional prognostic markers such as histological grading, tumor-node-metastasis (TNM) staging, and molecular subtypes. A prospective, cross-sectional study was conducted over two years (June 2022 to May 2024) in the Department of Pathology at Jawaharlal Nehru Medical College, Wardha. Seventy-two female patients diagnosed with breast carcinoma who underwent modified radical mastectomy were included. Tumor budding was assessed through histopathological analysis and categorized as high or low. Statistical correlations were established between tumor budding and tumor size, histological grade, lymph node involvement, vascular invasion, and molecular subtypes (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and triple-negative breast cancer, TNBC). The chi-square test and multiple regression analyses were applied to assess significance. High tumor budding was observed in 68.1% of patients and was significantly associated with larger tumor size (p = 0.040), higher histological grade (p = 0.009), lymph node metastasis (p = 0.002), and vascular invasion (p = 0.003). The postmenopausal age group (>55 years) demonstrated a higher prevalence of high budding (p = 0.010). No significant correlation was found between tumor budding and molecular subtypes (p = 0.39), although high budding was more frequent in TNBCcases. Tumor budding is significantly associated with more aggressive tumor characteristics in breast cancer. Incorporating tumor budding into routine pathological assessments alongside TNM staging and histological grading may enhance the ability to identify high-risk patients and guide treatment strategies. Further large-scale, multicenter studies are warranted to confirm its prognostic value.