Tumor Recurrence Research Articles

Surgical treatment of intramedullary spinal cord tumors: a systematic review

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

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

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

MOHS MICROGRAPHIC SURGERY IN NON-MELANOMA SKIN CANCER

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

Recurrent Borderline Ovarian Tumors in the Adolescent Population: Case Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Skull base osteoradionecrosis: from pathogenesis to treatment.

This review aims to provide a comprehensive analysis of skull base osteoradionecrosis (ORN), a severe and rare complication of radiotherapy for head and neck malignancies. It explores pathogenesis, clinical presentation, diagnostic strategies, and management approaches, emphasizing the importance of multidisciplinary care in addressing this challenging condition. Skull base ORN results from radiotherapy-induced tissue damage, characterized by hypovascularity, hypoxia, and necrosis, often compounded by secondary infections. Advances in radiotherapy techniques, such as intensity-modulated radiotherapy and heavy particles, have reduced ORN incidence, though cases persist, particularly in high-dose radiotherapy fields. Emerging treatments, including hyperbaric oxygen therapy and the pentoxifylline-tocopherol protocol, show promise but lack robust evidence for standardized use. Surgical interventions, especially those incorporating vascularized tissue reconstruction, have demonstrated favorable outcomes in refractory cases. Recent studies underscore the utility of multimodal imaging techniques, including MRI and PET/CT, for distinguishing ORN from tumor recurrence. Skull base ORN represents a complex and potentially life-threatening condition requiring tailored, multidisciplinary management. Although advancements in diagnostics and therapeutics have improved outcomes, significant challenges remain, particularly in developing standardized protocols. Further research is needed to refine treatment strategies and improve evidence-based practices for this entity.

Molecular subtypes of adamantinomatous craniopharyngiomas.

Adamantinomatous craniopharyngioma (ACP) is the most common benign tumor in the sellar region of children and originates from embryonic remnants. Owing to its unique location and frequent tight adhesion to and invasion of surrounding structures, the ACP poses significant challenges for neurosurgical treatment. Traditionally, the core treatment for ACPs has been surgical resection supplemented with radiotherapy in cases of residual or recurrent tumors. As a result, ACP classification has been based primarily on the tumor's relationship with surrounding anatomical and histological structures, guiding the selection of surgical approaches and the prevention of complications. Moreover, efforts to explore pharmacological treatments for ACP have yielded varying results across different cases, creating confusion among researchers. This variability also suggests the possibility of different molecular subtypes within ACPs, despite being driven by a single gene mutation. With advancements in molecular biological studies, such as ACP RNA sequencing, whole-exome sequencing, and methylation analysis, along with the discovery of interactions between different molecular pathways within ACP, researchers have been continuously exploring the molecular subtyping of ACP and predicting the efficacy of targeted therapies on the basis of these subtypes. This review focuses on summarizing and synthesizing the molecular mechanisms and potential subtypes of ACP, aiming to provide theoretical support for future research on the molecular subtyping of ACP.

Microwave Ablation of T1a and T1b Renal Masses: A Retrospective Study

AbstractThe aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of T1a and T1b renal masses, with size ranges between 1.2 and 6.5 cm. A retrospective review was performed at a single tertiary comprehensive cancer center between June 2019 and June 2023 of 49 consecutive patients (53 total procedures) who underwent MWA for renal masses. The Solero microwave tissue ablation system (Angiodynamics, Latham, NY, United States) was utilized. Patient demographics, renal mass characteristics, and procedural outcomes were collected. Serum creatinine and estimated glomerular filtration rate (eGFR) were utilized to assess renal functional outcomes. Oncologic outcomes were assessed using evidence of local tumor recurrence on contrast-enhanced cross-sectional imaging, local recurrence-free probability at 1 and 2 years, and overall survival (OS) using the Kaplan–Meier analysis.Forty-nine patients (57% males and 43% females) with a median age of 72 years (range, 38–84 years) underwent 53 MWA procedures. The mean renal mass size was 2.8 ± 0.94 cm (range, 1.2–6.5 cm). Most of the renal tumors were T1a. Three of the 53 total renal tumors were larger than 4 cm (T1b) and the remaining 50 were less than 4 cm in size (T1a). The largest tumor that was ablated was 6.5 cm in size. All the patients were placed under general anesthesia (intubated) before the MWA procedure. A median microwave energy of 100 W (range, 60–140 W) was used. The mean duration of the MWA was 3.9 ± 1.5 minutes, with a 100% technical success rate. Four patients (8.2%) experienced complications, two (4.1%) of whom experienced a major complication. There was no clinically significant change in renal function from pre- to postablation on day 1 or at 3 months. Furthermore, local tumor recurrence was observed in three (6.1%) patients at 2.5, 15, and 25 months postablation. Local recurrence-free probability was 98 and 93% at 1 and 2 years, respectively. The OS was 98 and 87% at 1 and 2 years, respectively. MWA continues to prove to be an effective technique that can be used to treat small renal masses including oncocytomas, with high technical success, low complication rate, low risk of adverse renal functional outcomes, and encouraging results for sustained tumor control.

Clinicopathological and molecular characterization of astrocytoma

IntroductionAstrocytoma is a rare tumour of the central nervous system that often manifests with non-specific clinical symptoms and lacks distinct histological features. There is a pressing need for further understanding of the clinicopathological and molecular characteristics of astrocytoma. Identifying mutant genes can aid in reliable and early diagnosis, as well as provide insights for the development of targeted therapies.MethodsThis study aims to investigate the clinicopathologic and molecular characteristics of astroblastoma. A total of four patients diagnosed with astroblastoma were included in the analysis. Clinical features, histological findings, and immunohistochemistry results were reviewed and analyzed. Genetic alterations were identified using fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS), followed by patient follow-up.ResultsThe study included four female patients, ranging in age from 8 to 44 years. One patient had a tumour in the right parietal lobe, while the other three had tumours in the spinal cord. Histology is usually characterized by pseudorosettes of astroblasts and hyalinization of blood vessels. These tumors showed a growth pattern similar to traditional intracranial astroblastoma, and the histological manifestations of the four patients were all high-grade, showing features of high-density areas of tumor cells or necrosis. Immunohistochemical staining revealed that all four patients expressed OLIG2, EMA, and vimentin, while three patients also expressed GFAP and S-100. The Ki-67 positivity index was approximately 15% in three cases and 10% in one case. Fluorescence in situ hybridization (FISH) using break-apart probes showed EWRS1 breaks in three patients and MN1 breaks in one. Further DNA or RNA-targeted biallelic sequencing identified an EWSR1(Exon1-7)-BEND2(Exon2-14) fusion in case 1, and an EWSR1(Exon1-7)-BEND2(Intergenic) fusion in case 2. In case 3, an EWSR1(Exon1-7)-NUDT10(Intergenic) fusion was present, and in case 4, an MN1(Exon1)-BEND2(Exon2) fusion was identified. The EWSR1-NUDT10 gene fusion is a new fusion type in astroblastoma. The patients were followed up for 76.5, 17.6, 33.7, and 61.3 months, respectively. Three cases experienced tumour recurrences at the spinal cord site, with multiple recurrences in case 4.DiscussionOur study unveiled the distinctive clinicopathological and molecular mutational characteristics of astrocytoma, while also identifying rare mutated genes. Additionally, the detection of MN1 or EWSR1 gene fusion through FISH or next-generation sequencing can provide valuable insights into the molecular mechanisms and aid in the differential diagnosis of astrocytoma.

Prognostic evaluation of non-muscle invasive bladder cancer with P-CRP and its nomogram

PurposeTo investigate the impact of the product of preoperative platelet count and C-reactive protein (P-CRP) on the postoperative prognosis of patients with non-muscle invasive bladder cancer (NMIBC), and to construct a Nomogram to predict the recurrence-free survival (RFS) of NMIBC patients based on pathological data.MethodsA retrospective analysis was conducted on the clinical data of 164 NMIBC patients who underwent transurethral resection of bladder tumors (TURBT) at the Second Affiliated Hospital of University of South China from January 2013 to December 2019. The endpoint of the study was the RFS. Kaplan-Meier (KM) method and Cox regression were used for analysis to identify independent factors affecting RFS. Then, the Nomogram was used to visualize the results of the multivariate analysis that were statistically significant and related to the RFS of NMIBC patients. Finally, the predictive ability of the model was evaluated using the concordance index (C-index) and calibration curves.ResultsBefore the end of the follow-up, the RFS was 88.3% at 1 year, 75.5% at 2 years, and 58.5% at 3 years. KM curves showed that P-CRP (HR=0.357, 95% CI: 0.204-0.625, P&amp;lt;0.001), number of tumors (HR=2.658, 95% CI: 1.572-4.494, P&amp;lt;0.001), tumor size (HR=2.271, 95% CI: 1.377-3.745, P=0.001), T stage of the tumor (HR=2.026, 95% CI: 1.233-3.329, P=0.005), and tumor G grade (G2: HR=1.615, 95% CI: 0.48-5.433, G3: HR=3.361, 95% CI: 1.022-11.054) were independent factors affecting the RFS of NMIBC patients after TURBT. The Nomogram could estimate the risk of tumor recurrence at 1, 2, and 3 years postoperatively. The Nomogram model incorporating P-CRP parameters had a higher predictive accuracy than the classic model that only included EORTC risk group parameters.ConclusionPreoperative P-CRP has a certain impact on the RFS of NMIBC patients after TURBT. The Nomogram incorporating P-CRP, number of tumors, tumor size, T stage, and tumor pathological grading can better predict the postoperative recurrence risk of NMIBC patients.

A case of multiple bone metastases during the course of non‐invasive bladder and prostate cancer

IntroductionSecondary bladder tumor is rare. We report a case of a bladder tumor initially thought to be a recurrence of non‐muscle invasive bladder cancer that was ultimately identified as metastasis from gastric cancer treated 16 years prior.Case presentationA 75‐year‐old male with a history of gastric, prostate, and recurrent non‐muscle invasive bladder cancer was diagnosed to have multiple bone metastases. Open bone biopsy and cancer gene panel testing identified the primary origin of the metastases as gastric cancer. Retrospective evaluation revealed that what was initially suspected as recurrent bladder tumors were actually metastases from the gastric cancer.ConclusionIn cases of metastases with an unknown primary origin, detailed evaluation, including biopsy of the metastatic lesion and genomic testing, is recommended.

Efficacy evaluation of postoperative adjuvant TACE in preventing HCC recurrence within Milan criteria: A multi-center propensity score matching analysis based on pathological indicators.

Malignant biological behaviors such as microvascular invasion (MVI), satellite nodule formation and poor differentiation can appear in the postoperative pathology of early hepatocellular carcinoma (HCC), which often indicates that it has entered the stage of malignant evolution earlier. This study aimed to evaluate tumor recurrence in HCC patients meeting the Milan criteria who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE) based on postoperative pathological indices. A retrospective study was conducted on 790 HCC patients within the Milan criteria who underwent hepatectomy across four medical centers, comprising 366 patients treated with PA-TACE and 424 patients without PA-TACE. To reduce selection bias, propensity score matching (PSM) at a 1:1 ratio was applied, achieving balanced clinical characteristics between the two groups. Patients receiving PA-TACE did not experience more severe adverse events or toxicity-related deaths. After PSM of each subgroup, it was found that patients with MVI (Median time: 37 months vs 17 months, p = 0.010), satellite nodules (Median time: NA vs 14 months, p = 0.018), and Edmondson-Steiner grade III-IV (Median time: NA vs 13 months, p = 0.004) who received PA-TACE had higher recurrence-free survival (RFS). However, patients who were MVI-negative, satellite nodule-negative, and Edmondson-Steiner grade I-II did not benefit from PA-TACE in terms of RFS (All p > 0.05). Patients who received PA-TACE were more likely to undergo liver transplantation, re-hepatectomy, and local ablation after tumor recurrence, whereas patients who did not receive PA-TACE were more likely to receive TACE, chemoradiotherapy, and immunotargeted therapy after tumor recurrence (All p < 0.05). Postoperative pathological indicators can guide the selection of PA-TACE for patients with HCC within the Milan criteria. Patients with MVI, satellite nodules, and Edmondson-Steiner grade III-IV are more suitable for receiving PA-TACE to improve RFS. PA-TACE may alter the recurrence pattern of tumors, rendering them more localized.