Tumor Location Research Articles

Comparison of outcomes between single-port and multiport retroperitoneal robotic partial nephrectomy

IntroductionSingle-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches. MethodsThis is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ2 test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions. ResultsA total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups. ConclusionOur study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.

Expression, Characteristics, and Clinical Target Prediction of PIK3C3/ vps34 in Gastric Cancer.

This study aimed to investigate the expression pattern of phosphatidylinositol 3-kinase class III (PIK3C3/vps34) in gastric cancer (GC) tissues and their juxtaposed normal counterparts and its correlation with the clinicopathological attributes and prognostic outlook of afflicted individuals. Immunohistochemical (IHC) staining was used to ascertain the expression levels of PIK3C3/vps34 across 60 GC tissues juxtaposed with their normal counterparts. Statistical methodologies were used to scrutinize the correlation between PIK3C3/vps34 expression and clinicopathological features, along with prognostic implications for GC patients. In GC tissues, the positive expression rate of PIK3C3/vps34 was 23.3% (14/60), which contrasted sharply with the markedly elevated rate of 66.7% (40/60) observed in adjacent tissues. The positive expression proportion of PIK3C3/vps34 within GC tissues exhibited a notable decrease than in adjacent tissues (P<0.05). The expression of PIK3C3/vps34 inverse-ly correlated with tumor size, degree of tissue differentiation, depth of tumor infiltration, and incidence of lymph node metastasis (P<0.05), whereas no significant associations were found with patient sex, age, tumor location, TNM staging, or distant metastasis (P > 0.05). As the tumor diameter increases, the degree of tissue differentiation diminishes, tumor infiltration depth intensifies, lymph node metastasis emerges, the TNM stage progresses, and PIK3C3/vps34 expression level within GC tissues declines correspondingly. Kaplan-Meier survival analysis unveiled a prolonged survival duration among GC patients exhibiting heightened PIK3C3/vps34 expression than in their counterparts with diminished expression (HR=0.66, 95% CI: 0.55-0.80), demonstrating statistical significance (P<0.05). Protein interaction analysis revealed noteworthy interactions involving PIK3C3 with Beclin 1, UVRAG, and ATG14. PIK3C3/vps34 is downregulated in GC tissues, exerting a pivotal role in tumorigenesis, and is intimately linked with the prognostic trajectory of GC patients. It may serve as a significant biomarker for prognostic evaluation and a promising molecular therapeutic target for GC.

Histopathological features of subcutaneous and cutaneous mast cell tumors in dogs

BackgroundMast cell tumors (MCTs) are the most common malignant skin neoplasms in dogs. In the past, the distinction between cutaneous MCTs (cMCTs), originating from the dermis, and subcutaneous MCTs (scMCTs), originating from the subcutaneous tissue, was not made. Histopathological differentiation, including grading, is important for prognosis. However, the Patnaik and Kiupel grading systems were proposed for cMCTs only. The objective of our study was to describe and compare the signalment of dogs with scMCTs and cMCTs and histopathological features, anticipating similarities in both groups. Data of dogs histologically diagnosed with scMCTs or cMCTs between September 2020 and July 2023 were analyzed retrospectively. Signalment, tumor location, histopathological features, completeness of removal and lymph node status were recorded.ResultsData on 305 scMCTs and 1291 cMCTs were collected. Breed distribution was different between scMCTs and cMCTs (P < 0.0001). Mitotic count (MC) was not different between scMCTs (1.63) and cMCTs (1.58) (P = 0.8490). Compared to cMCTs, scMCTs more often had anisokaryosis, bizarre nuclei and multinucleation. Kiupel high grade was more often assigned to scMCTs (51/292, 17.5%) than cMCTs (154/1291, 11.9%) (P = 0.009). The odds of MCTs being assigned a high grade in scMCT was 1.578 higher than in cMCTs (95% confidence interval [1.116–2.232]).ConclusionsHistopathological differences between scMCTs and cMCTs were observed. A Kiupel high grade was more often assigned to scMCTs than cMCTs. Whether these histopathological findings correlate with clinical outcome has to be established in additional studies.

The Prognostic Impact of Minimally Invasive Esophagectomy on Survival After Esophagectomy Following a Delayed Interval After Chemoradiotherapy: A Secondary Analysis of the DICE Study.

To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12wk) following chemoradiotherapy (CRT). Previously, we established that a prolonged interval after CRT before esophagectomy was associated with poorer long-term survival. This was an international multicenter cohort study involving 17 tertiary centers, including patients who received CRT followed by surgery between 2010 and 2020. Patients undergoing MIE were defined as thoracoscopic and laparoscopic approaches. A total of 428 patients (145 MIE and 283 OE) had surgery between 12 weeks and 2 years after CRT. Significant differences were observed in American Society of Anesthesiologists grade, radiation dose, clinical T stage, and histologic subtype. There were no significant differences between the groups in age, sex, body mass index, pathologic T or N stage, resection margin status, tumor location, surgical technique, or 90-day mortality. Survival analysis showed MIE was associated with improved survival in univariate ( P =0.014), multivariate analysis after adjustment for smoking, T and N stage, and histology (HR=1.69; 95% CI: 1.14-2.5) and propensity-matched analysis ( P =0.02). Further subgroup analyses by radiation dose and interval after CRT showed survival advantage for MIE in 40 to 50Gy dose groups (HR=1.9; 95% CI: 1.2-3.0) and in patients having surgery within 6 months of CRT (HR=1.6; 95% CI: 1.1-2.2). MIE was associated with improved overall survival compared with OE in patients with a prolonged interval from CRT to surgery. The mechanism for this observed improvement in survival remains unknown, with potential hypotheses including a reduction in complications and improved functional recovery after MIE.

Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study

BackgroundNo national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting. MethodsThis study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy. ResultsThe observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01–1.56) than patients who underwent spleen preservation. ConclusionThe OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.

Endoscope-Assisted Transcervical Resection of Parapharyngeal Space Tumors.

We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches. Retrospective chart review. Single tertiary care center. This was a single-institution, retrospective analysis of all patients undergoing TC approach for resection of PPS tumors over a 10-year period. We describe unique advantages of our surgical approach utilizing a 0° endoscope for improved surgical access, visualization, and efficiency. χ2 and Student's t test were used to compare perioperative outcomes between cases in which an endoscope was utilized EA for resection versus standard TC approach. Our cohort included 77 patients (n = 40 EA, n = 37 TC). There was no difference in patient age, sex, tumor laterality, tumor size, or tumor location between groups. The EA approach was associated with significantly shorter operative times (median [range] for EA 73 [33-270] minutes vs TC 112 [56-362] minutes, P < .01) and reduced rates of immediate postoperative marginal mandibular nerve paresis (EA: n = 5 [12.5%] vs TC: n = 16 [43.2%], P < 0.01). EA TC approach for resection of PPS tumors offers improved surgical access and is associated with reduced surgical time and rates of marginal mandibular nerve paresis compared to standard transcervical approaches.

Depth of Invasion Threshold for Recommending Elective Neck Dissection in T1 or T2 Oral Squamous Cell Carcinoma

BackgroundThere is variability in the literature on the role of the depth of invasion (DOI) for recommending an elective neck dissection (END). PurposeThe purpose of the study is to estimate the DOI threshold for recommending an END. Study Design/Setting/SampleA retrospective cohort study was performed at McGill University Health Centre from 2008-2018 with 5 years of follow-up. The sample was subjects with clinical T1/T2 oral squamous cell carcinoma (OSCC) and clinically negative neck. Subjects with previous head and neck cancer were excluded. Predictor VariableThe primary predictor variable was DOI measured from the basement membrane of the adjacent normal mucosa on final pathology, coded as <4mm or ≥4mm. DOI is a continuous variable converted to a binary variable. Main Outcome VariableThe main outcome variable was time to development of neck disease (RD+) defined as the time from surgery to development of pathologic nodes. Time to RD+ for pathologic nodes discovered from the END was considered 0 months. The secondary outcome variable was overall survival. CovariatesDemographics (age, sex, smoking/alcohol history) and tumor characteristics (tumor location, clinical T, tumor differentiation, perineural invasion, lymphovascular invasion) were analyzed. AnalysesTime to RD+ and survival were analyzed using Cox hazard ratio, Kaplan-Meier curves, and log-rank test. Student T-test and Chi-square test were used for bivariate analyses; p≤0.05 was statistically significant. ResultsThe final sample were 64 subjects (average age 65.25 (SD 13.06) years and 36 (56.2%) males). Twenty-nine subjects had DOI<4mm, and the 5-year RD+ was 3.4% (the 1 occurrence of RD+ was at 5.3 months). Thirty-five subjects had DOI≥4mm, and the 5-year RD+ was 45.7% (15 subjects had RD+ discovered from the END, and 1 subject had RD+ at 7.6 months). DOI≥4mm had significantly higher risk of RD+ than DOI<4mm (HR 17.91; 95% CI 2.37-135.3; p=0.01), which remained significant after adjusting for clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion (HR 9.53; 95% CI 1.12-81.44; p<0.05). The shallowest DOI with >20% risk of RD+ was in the DOI 4-4.9mm group. Conclusions/Relevance: Among patients with OSCC of T1 or T2 and clinically negative necks, END should be considered with DOI≥4mm.

Inequalities in colon cancer treatment in Uruguay: Does age have a say?

125 Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women in Uruguay. Survival from CRC is known to be worse in those aged 65 years and older, despite more than 70% of cases occurring in this age group. It has been said that elderly cancer patients are often under-treated compared to younger ones, and that this unequal access to treatment in practice, despite universal access in theory, accounts for at least some of the reported survival difference. A better understanding of age-related inequalities in treatment would help to inform interventions to improve cancer control, therefore a retrospective study was undertaken to investigate if there are age-related inequalities in CRC care in Uruguay. Methods: Data on age, sex, tumor site and stage and treatments received (cancer-directed surgery and chemotherapy) were obtained for 1372 patients diagnosed with CRC. Likelihood of receipt of 1) cancer-directed surgery, 2) chemotherapy in surgical patients, 3) chemotherapy in non-surgical patients by age, adjusting for sex, cancer stage, was examined. Results: More than two-thirds (67%) of our population were aged 60 years or older at diagnosis and a slightly higher proportion were men (53%). Seventy six percent received cancer directed surgery, either in a curative or palliative intent. When analyzing patients with stage I-III cancers, 81% of patients received curative intent surgery. Those in the oldest age group (80+ years) were significantly less likely to be operated than those in the &lt;60 years age group (p 0.002) specially if the tumor was in the sub peritoneal rectum. In relation to receipt of chemotherapy in surgical patients, similar age patterns were observed, although in a much more extreme manner (p &lt;0.001). Increasing age was also strongly associated with reduced likelihood of receiving systemic therapy, with a higher percentage of patients &lt;60 years old receiving at least palliative chemotherapy in comparison to the 80+ year age group (p &lt;0,001). No differences in relation to gender or tumour location were observed. Conclusions: Age remains a major factor in treatment decisions. Research is needed both to identify the most effective treatment for colon cancer in older populations and to understand clinicians’ decision-making processes to ensure equitable access.

Verification of mean dose in a tumor using 3D-printed tumor-model scintillators in anthropomorphic phantoms and a spherical phantom

To enhance treatment outcomes of radiotherapy, accurate verification of dosimetric parameters such as the mean, minimum, and maximum doses is essential. This study aimed to measure the mean absorbed dose in a tumor-shaped target and compare the results with the calculated value of the treatment planning system. Tumor model scintillators (TMSs) mimicking brain tumors were fabricated with a commercial 3D printer based on stereolithography files of tumors. The TMSs were irradiated following treatment plans made with the Leksell Gamma Plan® (Elekta AB, Stockholm, Sweden), and the mean dose in each TMS was measured three times and compared with the calculated value. Eleven TMSs were set at the center of a spherical solid water phantom. Two additional TMSs were fabricated according to images of vestibular schwannomas and were set at the tumor location in head model phantoms following each patient's head shape. The mean relative differences between the measured and calculated mean doses were less than one percent. This method provides an independent parameter for evaluating the accuracy of the treatment planning system.

8598 Heterogeneous course of ectopic Cushing's syndrome (EAS) - does the location of the primary tumor affect the clinical picture and the outcome?

8598 Heterogeneous course of ectopic Cushing's syndrome (EAS) - does the location of the primary tumor affect the clinical picture and the outcome?

Interventional radiology procedures for metastatic spine tumors

ObjectiveInterventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function. FindingsMultiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization. ConclusionAblation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.

The impact of economic crisis, COVID-19, and the Beirut Blast on colorectal cancer patients in Lebanon: A trend to operate more late-stage complex cases.

The convergence of the economic crisis, COVID-19 pandemic, and Beirut Blast has precipitated unprecedented challenges for the healthcare system in Lebanon, particularly for cancer patients. Amidst these crises, our study evaluates its contribution to a concerning trend of operating on more late-stage and complex colorectal cancer (CRC) cases. We included 155 patients operated for CRC between 2017 and 2023. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; tumour, node, metastasis stage; lymphatic, vascular and perineural invasions; American Society of Anesthesiologists (ASA) score, presentation and previous history, and complications were examined. Surgical outcomes remained relatively consistent before and after the crisis. However, there was a notable increase, with patients being 3.59 times more likely to undergo resection of adjacent organs in metastatic disease post-crisis. Patient characteristics also exhibited notable shifts, with a 9.60-fold increase in the likelihood of having an ASA score of at least 2 after the crisis. Additionally, there was a 5.36-fold decrease in the odds of patients undergoing a colonoscopy before their diagnostic one post-crisis. Preoperative carcinoembryonic antigen levels were significantly elevated post-crisis compared to pre-crisis levels. Pathological findings revealed increased odds of perineural, vascular, and lymphatic invasion post-crisis. Additionally, there was a notable increase in the likelihood of hepatic synchronous metastases post-crisis. Furthermore, a trend to operate on complicated diseases was noted with an increased number of colostomies. The economic crisis in Lebanon has profoundly affected early intervention and comprehensive treatment for CRC patients, resulting in a concerning rise in late-stage cases requiring surgical intervention.

The impact of oncology nutrition services on weight change among patients with head and neck or pancreatic cancers.

86 Background: Weight loss is prevalent among cancer patients and correlates with lower health-related quality of life and overall survival rates. Individuals diagnosed with head and neck (HN) and pancreatic cancers face a heightened risk of weight loss due to tumor location and treatment-related side effects. Although guidelines advocate early interventions such as referral to a dietitian for tailored nutritional support, the precise impact of oncology nutrition services (ONS) on weight loss remains unclear. In this study, we investigated the longitudinal association between weight change and ONS among patients diagnosed with HN or pancreatic cancers. Methods: A retrospective chart review was conducted for patients diagnosed with HN or pancreatic cancers visited between January 2019 and December 2023. Inclusion criteria encompassed patients who had weight measurements taken within 30 days of their cancer diagnosis. Patient demographics, clinical characteristics, all recorded body weights, and receipt of ONS were extracted from electronic health records. Weight change (%) from the baseline was calculated at each measurement by subtracting the initial weight value. A mixed-effects model was employed to evaluate the impact of ONS on weight change, with time to weight measurement and ONS serving as interaction terms, after adjusting for demographics and clinical characteristics. Results: A cohort of 1305 patients was identified, predominantly comprising males (n=1014, 63%) and individuals of White race (n=1358, 85%), with a diverse ethnic distribution (Hispanic: n=620, 39%). Of these patients, 947 (73%) received ONS at any point following cancer diagnosis. Significant weight loss over time was noted among all patients (-0.53% per 6 months, p&lt;0.001). Baseline weight, sex, ethnicity, receipt of percutaneous endoscopic gastrostomy, total parenteral nutrition, radiation, chemotherapy, and ONS were significantly associated with weight loss. Following adjustment for the covariates, patients receiving ONS showed significantly less weight loss compared to those without ONS (-0.06% [95% confidence interval (CI): -0.10, -0.03] vs. -0.04% [95% CI: -0.38, -0.23] per 6 months, p&lt;0.001). Conclusions: The findings indicate that ONS plays a significant role in attenuating weight loss among patients diagnosed with HN or pancreatic cancer, irrespective of baseline demographics or clinical status. While the magnitude of weight change may appear modest, its implications are substantial long term. Early referrals to ONS should be recommended for HN or pancreatic cancer patients to mitigate weight loss.

A DTI-based radiomics model for predicting epidermal growth factor receptor (EGFR) amplification in adult IDH1-wild glioblastomas.

Molecular alteration events are common in glioblastomas, the isocitrate dehydrogenase (IDH)-wild of which have had poor survival results so far. The progress of radiomics-based model provides novel sights for its preoperatively noninvasive prediction. To develop a radiomics-based model for predicting epidermal growth factor receptor (EGFR) amplification status in IDH1-wild glioblastomas of adults by pretreatment diffusion tensor imaging (DTI). A total of 124 patients with diagnosed glioblastomas were retrospectively collected. Six conventional magnetic resonance imaging (MRI) features of all the tumors were evaluated visually. Patients were divided into the training (n = 87) and the test set (n = 37) with a ratio of 7:3. Radiomics features were extracted from two regions of the glioblastomas, which were the total tumor (ROI_1) and the solid portion of tumor (ROI_2). The radiomics features extracted from the DTI and T1-contrast-enhanced (T1C) images were selected using the least absolute shrinkage and selection operator (LASSO) regression algorithm. Logistic regression analysis was conducted to develop models for EGFR amplification prediction in the training set. The radiomics model based on ROI_1 demonstrated favorable discrimination in both the training (area under the curve [AUC] = 0.86) and the test set (AUC = 0.82) (P < 0.05). Combining the radiomics features and the conventional feature tumor location, no significant improvement of AUCs was achieved (AUC = 0.86 and 0.81). The radiomics model derived from pretreatment DTI may have potential in differentiating the EGFR mutation status in glioblastomas.

A New Approach to Ultra-Low Anterior Resection-Intersphincteric Dissection With Total Hiatal Ligament Excision for Very Low Rectal Cancer Located in the Posterior Wall of the Rectum: A More Satisfactory Technique for Local Recurrence Control.

The hiatal ligament, as the anatomical landmark for the completion of total mesorectal excision (TME) for ultra-low rectal cancer, represents a continuation of the longitudinal muscle of the rectum. It receives vascular supply from the median sacral artery and contains lymphatic vessels. In cases where ultra-low rectal cancer is located in the posterior rectal wall, the hiatal ligament may theoretically serve as an anatomical region susceptible to direct tumor cell spread or distant metastasis. To evaluate the effect of circumferential tumor location (CTL) on postoperative survival of low rectal cancer and to determine the effect of total hiatal ligament excision (THLE) on the prognosis of patients with posterior rectal cancer. Patients with ultra-low rectal cancer who underwent laparoscopic surgery between March 2014 and October 2021 were enrolled in this study. Propensity score matching (PSM) analysis was used to compare the clinicopathological characteristics and prognosis of patients in the posterior group and the non-posterior group. Prognostic factors were identified using COX regression. PSM analysis was also used in the posterior tumor subgroup to compare the clinicopathological characteristics and prognosis of patients in the hiatal ligament traditional transection (HLTT) and THLE groups. After PSM, OS, and DFS were comparable between the posterior and non-posterior groups. Similarly, no difference was noted in the local recurrence rate between the two groups (p = 0.23). The prognosis of ultra-low rectal cancer was not affected by CTL. However, the local recurrence rate was significantly lower in the THLE group compared with the HLTT group (p = 0.023). Multivariate analysis of the posterior group identified CRM, TNM stage III, and HLTT as independent risk factors for local recurrence-free survival. CTL is not a prognostic risk factor for low rectal cancer. In posterior wall tumors, THLE significantly reduces the local recurrence rate for low rectal cancer.

Transarterial Chemoembolization Combined with Microwave Ablation in Elderly Patients with Recurrent Medium or Large Hepatocellular Carcinoma.

There are insufficient data about the optimal treatment for older patients with recurring medium or large hepatocellular carcinoma (HCC). The study intended to assess the effect of transcatheter arterial chemoembolization combined with microwave ablation (TACE-MWA) in an elderly cohort through a retrospective analysis. From 2011 to 2018, a cohort of individuals (age ≥70 years) with recurrent HCC tumors ranging from 3.1 cm to 7 cm underwent either a combination treatment of TACE and MWA (n = 43) or surgical intervention (n = 33). Using the Inverse Probability of Treatment Weighting (IPTW) technique, factors of disease-free survival (DFS), overall survival (OS), and rates of major adverse events were analyzed, retrospectively. The group that underwent surgery had a greater history of alcohol use before treatment (P= 0.001), as well as a higher Barcelona Clinic Liver Cancer (BCLC) stage for the primary tumor before treatment (P= 0.014) and a higher primary tumor location before treatment (P= 0.045). The TACE-MWA group had DFS rates of 86.2%, 68.8%, and 60.4% at 1, 3, and 5 years, while the surgery group had rates of 53.0%, 42.2%, and 25.8% at the same time points. In the TACE-MWA treatment group, survival rates at 1 year, 3 years, and 5 years post-treatment were recorded as 93.0%, 80.8%, and 65.7%, respectively, while in the surgery group, they were 62.7%, 46.9%, and 42.6%. In the univariate analysis using IPTW, the type of treatment was found to have a significant correlation with disease progression (hazard ratio [HR] 0.41, 95% CI 0.20-0.86, P=0.017). IPTW multivariate analysis showed that treatment modality (HR, 0.35; 95% CI, 0.17 to 0.79; P= 0.011) was the only significant prognostic factor for OS. In elderly patients with recurrent 3.1 cm≤ HCC ≤ 7 cm, TACE-WMA was superior to surgery in the respects of DFS and OS.

A multifunctional nanosystem catalyzed by cascading natural glucose oxidase and Fe3O4 nanozymes for synergistic chemodynamic and photodynamic cancer therapy

The significance of the tumor microenvironment (TME) in tumor initiation and progression is increasingly acknowledged. Conventional therapeutic approaches face limitations within the complex TME, including the restrictions imposed by hypoxia on photodynamic therapy (PDT) and the deficiency of endogenous H₂O₂ affecting chemodynamic therapy (CDT). In response to the TME's characteristics of high metabolism, hypoxia, and weak acidity, a multifunctional nanosystem MNPs/GOD@CS/IR820, which synergistically integrates CDT and PDT, has been developed. This system can actively accumulate at tumor sites under an external magnetic field and release active components in response to the weakly acidic TME. It mitigates the limitations imposed by hypoxia and endogenous H₂O₂ deficiency on PDT and CDT, respectively, thereby enabling synergistic treatment. Additionally, the system's multimodal imaging capabilities facilitate precise tumor localization and real-time, non-invasive in vivo assessment via fluorescence imaging and MRI. In vitro and in vivo evaluations demonstrate significant antitumor efficacy, effectively inhibiting tumor growth and improving survival rates. By comprehensively addressing the challenges posed by the complex TME and enhancing real-time monitoring capabilities, our nanosystem paves the way for personalized and precise cancer treatment. Statement of significanceThis study introduces an innovative MNPs/GOD@CS/IR820 nanosystem that represents a significant advancement in cancer nanomedicine by addressing critical limitations of conventional photodynamic therapy (PDT), particularly in hypoxic tumor microenvironments. By synergistically integrating chemodynamic therapy (CDT) with PDT and incorporating MRI and fluorescence dual-modal imaging capabilities, this multifunctional platform offers enhanced therapeutic efficacy and real-time monitoring. The system's ability to generate oxygen in situ overcomes hypoxia-induced limitations, while its multimodal mechanism of action induces tumor cell apoptosis through multiple pathways. In vitro and in vivo studies demonstrate remarkable antitumor efficacy across diverse cancer types, significantly inhibiting tumor growth and improving survival rates. This comprehensive approach to cancer diagnosis and treatment not only advances precision medicine for targeted, multimodal cancer management but also provides a promising foundation for future clinical applications, potentially transforming cancer treatment strategies and improving patient outcomes.

Identification of CDH4 Gene Copy Number Alteration and Its Association with Clinical Profile of Colorectal Cancer Patient

Background: The genes cadherin 4 (CDH4), Kirsten rat sarcoma viral oncogene homolog (KRAS), V-Raf murine sarcoma viral oncogene homolog B (BRAF), and microsatellite instability (MSI) each play a role in the development of colorectal cancer (CRC). CDH4 gene is located in chromosome 20q13.33 and its amplification or gain is the earliest mutational event found in the majority of CRC and colon polyps. This study aimed to identify copy number alteration in the CDH4 gene and its association with the clinical profile of CRC patients, including gender, age, tumor location and differentiation, frequency of BRAF and KRAS mutations, and MSI status. Methods: The DNA was extracted from 50 tumors and adjacent normal tissues based on the manufacturer’s instructions. Detection of MSI status was carried out by pentaplex polymerase chain reaction (PCR) and PCR products were size separated by capillary electrophoresis (CE) using an ABI 310 Genetic Analyzer. Both KRAS and BRAF mutations were identified by PCR and sequencing while CDH4 copy measurement was measured using TaqManTM Copy Number Assay. Results: Our findings showed 22 (44%) samples with no changes in the copy number of CDH4 gene. Interestingly, 21 (42%) cases had an amplification of the CDH4 gene or CDH4 gene gain, and seven (14%) cases decreased in CDH4 gene expression or CDH4 gene loss. We found an association between changes in the CDH4 gene and gender (p=0.001). However, there was no association between changes in the CDH4 gene and age (p=0.979), tumor location (p=0.145) and differentiation (p=0.648), the frequency of BRAF (p=0.171) and KRAS mutations (p=0.184) and MSI status (p=0.923). Conclusions: Copy number alteration in CDH4 gene in CRC patients and this alteration is significantly associated with gender. Further studies with a larger number of samples are essential to confirm this result and to identify the cause of CDH4 copy number alteration and its biological significance.

Image-Guided Superficial Radiation Therapy for Basal and Squamous Cell Carcinomas Produces Excellent Freedom from Recurrence Independent of Risk Factors

Background/Objectives: Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are non-melanoma skin cancers (NMSCs) and the most prevalent cancers in the United States. Image-guided superficial radiotherapy (IGSRT) is a relatively new treatment option that uses high-resolution dermal ultrasound integrated with superficial radiotherapy to improve tumor visualization. IGSRT is a clinically equivalent non-surgical alternative to Mohs micrographic surgery at 2 years of follow-up in early-stage NMSC, but larger cohort studies with longer follow-up periods that allow for analysis of patient outcomes by demographic and disease characteristics are needed. Methods: This large, retrospective cohort study was conducted to determine the effect of risk factors (tumor location, tumor stage, and sex) on 2-, 4-, and 6-year freedom from recurrence rates in 19,988 NMSC lesions treated with IGSRT, including lesions with complete treatment courses. Results: Overall freedom from recurrence rates were 99.68% at 2 years, 99.54% at 4 years, and 99.54% at 6 years; rates did not differ significantly by tumor location (head/neck versus other locations, p = 0.9) or sex (male versus female, p = 0.4). In contrast, there was a significant difference in freedom from recurrence rates when analyzed by tumor stage (p = 0.004). Conclusions: There was no significant effect of tumor location or sex on freedom from recurrence in IGSRT-treated NMSC. Although there was a significant difference according to tumor stage, freedom from recurrence rates exceeded 99% at all stages.

Assessment of tumor location in adjuvant treatment decision for stage II colon cancer

Aims: In stage II colon cancer, the aim is to evaluate the impact of tumor location and other clinicopathological factors on prognosis and survival. Methods: The study included a total of 93 patients diagnosed with stage II colon cancer between January 2018 and December 2022, comprising 41 females and 52 males. Clinicopathological factors related to the patients were retrospectively investigated. Factors found to be significant in univariate analysis were further evaluated through multivariate analysis to identify independent factors. Results: As a result of univariate analysis, variables such as tumor location (right-left colon), perineural invasion, surgical margin, intestinal obstruction, and lymph node dissection were found to be statistically significant for the risk of death (p