Residual gastric cancer with a mixed small cell neuroendocrine and keratinizing squamous cell carcinoma: A case report

BACKGROUND

Despite advancements in early detection and treatment, the prognosis and histological types for residual gastric cancer (GC) remains poor.

CASE SUMMARY

This case report presents a rare occurrence of residual GC featuring a combination of small cell neuroendocrine carcinoma (SCNEC) and squamous cell carcinoma (SCC) in a 60-year-old male patient. The patient, with a history of Billroth II gastrectomy for duodenal ulcer bleeding, presented with gastrointestinal bleeding. Preoperative computed tomography and positron emission tomography-computed tomography indicated adenocarcinoma with tumor and abdominal lymph node metastasis. The patient underwent laparoscopic total gastrectomy and lymph node dissection for residual GC. Histological examination of the resected tumor confirmed the presence of both SCNEC and SCC. Postoperatively, the patient underwent adjuvant chemotherapy four times. Two years later, the patient was found to occur esophageal cancer and was performed a small bowel stoma and radical esophagectomy.

CONCLUSION

In this case report, we detail a rare instance of residual GC with mixed SCNEC and SCC, emphasizing the complexity of diagnosis and treatment, and the need for ongoing research.

Transmembrane channel-like 5 drives hepatocellular carcinoma progression by regulating epithelial-mesenchymal transition

BACKGROUND

Hepatocellular carcinoma (HCC) is a difficult cancer to manage due to its highly invasive and metastatic nature.

AIM

To investigate the molecular function of transmembrane channel-like 5 (TMC5) in vitro and in vivo, with the objective of identifying novel diagnosis and treatment targets for HCC.

METHODS

The expression of TMC in cancer and normal tissues, along with its correlation with HCC prognosis, was analyzed using the GENT2, GEPIA database, and Human Protein Atlas. COX analysis was conducted to assess the relationship between TMC5 expression and overall survival in TCGA-LIHC patients. Further experiments were conducted to investigate the effect of TMC5 in cancer progression through loss- and gain-of-function assays in vitro and in vivo.

RESULTS

Bioinformatics revealed that TMC5 expression was generally higher in tumors than in normal tissues, and its expression was associated with poorer patient survival outcomes. TMC5 expression in HCC tissues and cells was consistent with the results of the bioinformatics analysis. Suppression of TMC5 expression reduced migration, invasion, and proliferation, while also decreasing the expression of epithelial-mesenchymal transition (EMT)-associated molecules in MHCC97-LM3 cells. Conversely, higher TMC5 expression significantly increased cell migration, invasion, proliferation, and EMT in MHCC97 L cells. TMC5 knockdown significantly decreased both the formation and spread of nodules in liver tissue, whereas TMC5 overexpression promoted them.

CONCLUSION

Our study provides compelling evidence that TMC5 is highly expressed in HCC and drives cancer progression through the activation of EMT-mediated invasion. TMC5 could represent a valuable molecular target for the diagnosis and treatment of HCC.

Therapeutic potential of kakkatin derivatives against hepatocellular carcinoma

In this article, we commented on the work done by Jiang et al, where they synthesized a kakkatin derivative, 6-(hept-6-yn-1-yloxy)-3-(4-hydroxyphenyl)-7-methoxy-4H-chromen-4-one (HK), and investigated its antitumor activities and mechanism in gastric cancer MGC803 and hepatocellular carcinoma (HCC) SMMC-7721 cells. HK was evaluated for its antitumor activity as compared to kakkatin and cisplatin. This article focused on various risk factors of HCC, the mechanism of HCC progression and molecular targets of the kakkatin derivative, and limitations of available treatment options. HCC is a predominant form of primary liver cancer characterized by the accumulation of multiple gene modifications, overexpression of protooncogenes, altered immune microenvironment, and infiltration by immune cells. Puerariae flos (PF) has been used in traditional medicine in China, Korea, and Japan for lung clearing, spleen awakening, and relieving alcohol hangovers. PF exerts antitumor activity by inhibiting cancer cell proliferation, invasion, and migration. PF induces apoptosis in alcoholic HCC via the estrogen-receptor 1-extracellular signal-regulated kinases 1/2 signaling pathway. Kakkatin isolated from PF is known as a hepatoprotective bioflavonoid. The kakkatin derivative, HK, exhibited anticancer activity against HCC cell lines by inhibiting cell proliferation and upregulating nuclear factor kappa B subunit 1 and phosphodiesterase 3B. However, further preclinical and clinical studies are required to establish its therapeutic potential against HCC.

Therapeutic insights into epidermal growth factor receptor/reactive oxygen species proto-oncogene 1-receptor co-mutated non-small cell lung cancer: Crizotinib as a promising option

This letter provides a review of the report by Peng et al on a unique case of non-small cell lung cancer (NSCLC), specifically lung adenocarcinoma, featuring reactive oxygen species proto-oncogene 1-receptor (ROS1) co-mutation. The case involves a 64-year-old patient who exhibited both epidermal growth factor receptor (EGFR) L858R mutation and ROS1 rearrangement, achieving significant disease stabilization following treatment with crizotinib. This rare EGFR/ROS1 co-mutation poses distinct challenges for clinical management and highlights the necessity of personalized treatment strategies. While third-generation EGFR tyrosine kinase inhibitors (TKIs), such as osimertinib, are commonly regarded as first-line therapies, recent studies indicate that crizotinib may offer superior disease control in certain EGFR-mutant patients, particularly those who exhibit poor responses to EGFR TKIs. The case also examines the influence of tumor cell genetic heterogeneity on treatment response, underscoring the importance of evaluating tumor characteristics. In patients with EGFR/ROS1 co-mutation, gefitinib is generally effective as a first-line treatment; however, its efficacy can be limited, whereas crizotinib has demonstrated improved disease control. Future research should focus on identifying optimal treatment strategies for patients with EGFR/ROS1 co-mutation to enhance patient outcomes. In conclusion, this case report not only illustrates the effectiveness of crizotinib in managing patients with EGFR/ROS1 co-mutation but also underscores the importance of personalized treatment approaches, offering valuable insights for improving clinical outcomes in NSCLC patients with complex genetic profiles.

Diagnosis and treatment of lung cancer: A molecular perspective

This editorial comments on the review by Da Silva et al, published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer. With the rapid development of molecular technology, new diagnostic methods are constantly emerging, including liquid biopsy, the identification of gene mutations, and the monitoring biomarkers, thus providing precise information with which to identify the occurrence and development of lung cancer. Biomarkers, such as circulating tumor cells, circulating tumor DNA, and circulating RNA can provide helpful information for clinical application. Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor, anaplastic lymphoma kinase, c-ROS proto-oncogene 1, programmed death-1 and cytotoxic T-lymphocyte-associated protein. According to specific biomarkers, targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints. The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.

Predicting preoperative lymph node metastasis in esophageal cancer: Advancement and challenges

Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer. In this letter, we present our insights and opinions on a new nomogram proposed by Xu et al. Although this research has great potential, there are still concerns regarding the small sample size, limited consideration of biological complexity, subjective image segmentation, incomplete image feature extraction and statistical analyses. Furthermore, we discuss how to achieve more robust and accurate predictive performance in future research.

Validation of the prognostic model for palliative radiotherapy in older patients with cancer

BACKGROUND

Older patients are more likely to have a poor performance status and comorbidities. There is a reluctance to extensively investigate and treat older patients. As elderly individuals and patients with neoplasms each increase in number, palliative treatment of older patients is expected to grow as an issue.

AIM

To investigated the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a therapeutic effect.

METHODS

From February 2019 to February 2022, 33 patients aged ≥ 80 years underwent palliative radiotherapy. The prognosis in palliative care study predictor (PiPS), palliative prognostic index (PPI), and delirium-palliative prognostic score (D-PaP) models were used for prognosis prediction. D-PaP scores calculated according to the doctor's prediction of clinical prediction of survival (CPS) were excluded and then analyzed for comparison. Radiation was prescribed at a dose of 2.5-7 Gy per fraction, up to a median of 39 Gy₁₀ (range, 28-75 Gy₁₀).

RESULTS

The median follow-up was 2.4 months (range, 0.2-27.5 months), and 28 patients (84.8%) showed subjective symptom improvements following treatment. The 2- and 6-month survival rates of all patients were 91.5% and 91.5%, respectively. According to regression analysis, the performance status index, symptom type, and radiation dose all showed no significant correlation with the treatment response. When survival was expected for > 55 days in the PiPS model, the 2-month survival rate was 94.4%. For patients with PPI and D-PaP-CPS values of 0-3.9 points, the 2-month survival rates were 90.0% and 100%, respectively. For patients with a score of ≥ 4 points, the 2-month survival rates were 37.5% and 0%, respectively.

CONCLUSION

This study shows that the prognosis prediction model used in palliative care can be used to identify patients suitable for treatment.

Targeted maintenance therapy for a young woman with cervical rhabdomyosarcoma: A case report and review of literature

BACKGROUND

Rhabdomyosarcoma of the uterine cervix is a rare form of soft-tissue sarcoma predominantly affecting young women, with no established standard treatment protocol.

CASE SUMMARY

This report presents a case of a 17-year-old female patient presenting with intermittent, non-cyclical vaginal bleeding and associated lower abdominal pain. Pelvic magnetic resonance imaging and additional examinations led to the diagnosis of cervical rhabdomyosarcoma. The primary treatment options for uterine cervical rhabdomyosarcoma include surgery, with or without adjuvant chemotherapy and radiotherapy. This patient underwent surgery followed by a postoperative chemotherapy regimen of gemcitabine combined with docetaxel and bevacizumab. After 19 months of follow-up, the patient showed no signs of recurrence and maintained good overall health. Given the rarity of cervix rhabdomyosarcoma, this case is presented to provide insights into the diagnosis and treatment of this condition.

CONCLUSION

This suggests that bevacizumab may demonstrate potential efficacy in the treatment of cervical rhabdomyosarcoma. In the future, targeted therapy is expected to play an increasingly significant role in the management of rhabdomyosarcoma.

Overall survival with frontline vs subsequent anti-epidermal growth factor receptor therapies in unresectable, RAS/BRAF wild-type, left-sided metastatic colorectal cancer

BACKGROUND

The combination of anti-epidermal growth factor receptor (EGFR) therapy and chemotherapy is currently a preferred first-line treatment for patients with unresectable, RAS and BRAF wild-type, left-sided metastatic colorectal cancer (mCRC). Several studies have also demonstrated the benefit of anti-EGFR therapy in subsequent line settings for this patient population. However, direct evidence comparing the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited, leaving a crucial gap in guiding optimal treatment strategies.

AIM

To compare overall survival (OS) between frontline and subsequent anti-EGFR treatment in patients with unresectable, RAS and BRAF wild-type, left-sided mCRC.

METHODS

We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital, Thailand, between January 2013 and April 2023. Patients were classified into two groups based on the sequence of their anti-EGFR treatment. The primary endpoint was OS.

RESULTS

Among 222 patients with a median follow-up of 29 months, no significant difference in OS was observed between the frontline and subsequent-line groups (HR 1.03, 95%CI: 0.73-1.46, P = 0.878). The median OS was 35.53 months (95%CI: 26.59-44.47) for the frontline group and 31.60 months (95%CI: 27.83-35.37) for the subsequent-line group. In the subsequent-line group, 71 patients (32.4%) who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months (95%CI: 12.87-26.53).

CONCLUSION

Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable, RAS/BRAF wild-type, left-sided mCRC patients, but early exposure is vital for those unlikely to receive subsequent therapy.

Scoring system supporting suture decision-making for duodenal submucosal tumors

BACKGROUND

In recent years, endoscopic resection (ER) has been employed for the excision of submucosal tumors (SMTs). Nonetheless, ER in the duodenum is linked to elevated risks of both immediate and delayed hemorrhagic complications and perforations. Satisfactory suturing is crucial for reducing the occurrence of complications.

AIM

To establish a clinical score model for supporting suture decision-making of duodenal SMTs.

METHODS

This study included 137 individuals diagnosed with duodenal SMTs who underwent ER. Participants were evenly divided into two groups: A training cohort (TC) comprising 95 cases and an internal validation cohort (VC) with 42 cases. Subsequently, a scoring system was formulated utilizing multivariate logistic regression analysis within the TC, which was then subjected to evaluation in the VC.

RESULTS

The clinical scoring system incorporated two key factors: Extraluminal growth, which was assigned 2 points, and endoscopic full-thickness resection, which was given 3 points. This model demonstrated strong predictive accuracy, as evidenced by the area under the receiver operating characteristic curve of 0.900 (95% confidence interval: 0.823-0.976). Additionally, the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test (P = 0.404). The probability of purse-string suturing in low (score 0-2) and high (score > 3) categories were 3.0% and 64.3% in the TC, and 6.1% and 88.9% in the VC, respectively.

CONCLUSION

This scoring system may function as a beneficial instrumentality for medical practitioners, facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.

Checkpoint kinase 1 in colorectal cancer: Upregulation of expression and promotion of cell proliferation

BACKGROUND

Colorectal cancer (CRC) is a prevalent malignant tumor characterized by a high mortality rate, with significant challenges persisting in the identification and management of its metastatic stage. The role of checkpoint kinase 1 (CHEK1), a cell cycle checkpoint kinase, in CRC has not been fully clarified. We hypothesize that the upregulation of CHEK1 may enhance the proliferation of CRC cells, indicating its potential as a novel therapeutic target for CRC therapy.

AIM

To investigate the expression and function of CHEK1 in CRC, this study utilizes single-cell RNA sequencing and tissue microarray data.

METHODS

Single-cell RNA sequencing technology was employed to analyze CRC cells from the GSE144735 dataset, and immunohistochemistry was conducted to confirm the expression of CHEK1 in CRC and adjacent tissues. We also integrated mRNA expression data from multiple public databases to assess global CHEK1 expression in CRC. Molecular docking experiments were performed to explore the interaction between CHEK1 and the potential drug nitidine chloride (NC), as well as to investigate the influence of CHEK1 on CRC cell proliferation.

RESULTS

We found comparatively elevated CHEK1 expression in the malignant epithelial cells of CRC, with marked upregulation of its mRNA levels in CRC tissues. Immunohistochemical analysis further confirmed the high expression of CHEK1 in CRC tissues, and the receiver operating characteristic curve demonstrated high accuracy (area under the curve = 0.964) for CHEK1 as a biomarker. Analysis of global datasets indicated a statistically significant overexpression of CHEK1 in CRC (standard mean difference = 1.81, P < 0.01), with summary receiver operating characteristic analysis yielding sensitivity and specificity values of 0.83 and 0.88, respectively. Molecular docking studies indicated that NC specifically targeted CHEK1, while clustered regularly interspaced short palindromic repeats knockout experiments demonstrated that CHEK1 promoted CRC cell proliferation.

CONCLUSION

Upregulation of CHEK1 promotes CRC cell proliferation. However, the dataset's diversity is limited, requiring further investigation into its specific mechanisms.

Efficacy of disitamab vedotin-containing therapy in metastatic colorectal cancer: A case report

BACKGROUND

Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. In cases of metastatic CRC (mCRC) that are resistant to conventional chemotherapy-based treatments, the efficacy of available therapeutic options is typically low. CRC exhibiting overexpression or amplification of the human epidermal growth factor receptor 2 (HER2) gene has shown responsiveness to HER2-targeted therapies.

CASE SUMMARY

We present the case of a 69-year-old woman diagnosed with mCRC with an NRAS p.G12V mutation and microsatellite stability, identified through tumor sequencing, along with HER2 overexpression detected by immunohistochemistry. She exhibited an excellent response to disitamab vedotin-containing therapy. To our knowledge, this is the first reported case of mCRC with HER2 overexpression and an NRAS p.G12V mutation achieving a remarkable clinical response to anti-HER2 therapy.

CONCLUSION

Disitamab vedotin demonstrates promising anti-tumor effects in HER2-overexpressing mCRC, offering patients an additional treatment option.

Furmonertinib re-challenge for epidermal growth factor receptor-mutant lung adenocarcinoma after osimertinib-induced interstitial lung disease: A case report

BACKGROUND

Most non-small cell lung cancer patients have epidermal growth factor receptor (EGFR) activating mutations, such as exon 19 deletion and exon 21 replacement mutations. Osimertinib is a third-generation EGFR-tyrosine kinase inhibitors approved for the treatment of lung cancer patients carrying EGFR activating mutations. Osimertinib-induced interstitial lung disease (ILD) is a rare and potentially fatal pulmonary toxic manifestation of drug therapy. At present, there is no international consensus on the risks and treatment of the osimertinib-induced ILD.

CASE SUMMARY

We report a case of a 56-year-old woman who was diagnosed with lung adenocarcinoma with lung hilum, mediastinal lymph nodes and brain metastases (T4N3M1c stage IVB). The patient received targeted treatment with osimertinib after radiotherapy and chemotherapy. But she developed ILD after osimertinib treatment. Following active symptomatic treatment and hormone treatment, the lung injury alleviated. The patient was retreated with furmonertinib combined with prednisone and did not experience ILD again. So far, she has survived for 14 months without disease progression.

CONCLUSION

Retreatment with furmonertinib under prednisone could be considered as an effective therapeutic option after risk-benefit assessment for EGFR-mutant lung adenocarcinoma patients.

Advances in radiotherapy in the treatment of esophageal cancer

Recent advancements in radiotherapy for esophageal cancer have significantly improved treatment outcomes and patient quality of life. Traditional radiotherapy techniques have been enhanced by the integration of advanced imaging and precision targeting technologies, such as intensity-modulated radiotherapy and proton therapy, which allow for more accurate tumor targeting while minimizing damage to surrounding healthy tissues. Additionally, combining radiotherapy with immunotherapy has shown promising results, leveraging the body’s immune response to enhance the effectiveness of cancer treatment. Studies have also highlighted the benefits of neoadjuvant chemoradiation followed by surgical resection, which has been associated with improved overall survival rates compared to radiotherapy alone. These innovations are paving the way for more effective and personalized treatment strategies, offering new hope for patients with esophageal cancer.

Tankyrase 2 as a therapeutic target in non-small cell lung cancer: Implications for apoptosis and migration

This letter addresses Wang and Zhang's investigation into the role of tankyrase 2 (TNKS2) as a pivotal driver of malignancy in non-small cell lung cancer (NSCLC) through mechanisms including apoptosis inhibition, enhanced cellular migration, and β-catenin pathway activation. Their study in NSCLC cell lines demonstrates that TNKS2 overexpression stabilizes β-catenin, subsequently triggering oncogenic gene expression and facilitating cellular migration-key attributes of metastatic potential. These insights position TNKS2 as a compelling target for therapy and a potential prognostic marker in NSCLC. Nevertheless, translating these in vitro findings to clinical practice requires validation in in vivo models. Additionally, further research should investigate TNKS2 expression in patient samples and assess its implications in therapy resistance and combination treatment strategies.

Safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy in esophageal squamous cell carcinoma

BACKGROUND

Esophageal squamous cell carcinoma (ESCC) is a common malignancy in China, often diagnosed at an advanced stage, with poor prognosis. Standard treatments such as definitive chemoradiotherapy offer limited survival benefits. Recent advances in immune checkpoint inhibitors combined with chemotherapy have shown promise, but their effectiveness and safety in conjunction with radiotherapy for unresectable ESCC require further exploration.

AIM

To assess the safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy (CCRT) in locally advanced unresectable ESCC.

METHODS

This retrospective study included 80 patients with locally advanced unresectable ESCC who underwent induction chemoimmunotherapy followed by definitive radiotherapy, recruited from Zhejiang Cancer Hospital. All patients received 2-4 cycles of chemotherapy plus programmed cell death 1/programmed cell death ligand 1 inhibitor, were re-evaluated to be inoperable, then received definitive radiotherapy or CCRT. Primary endpoint was treatment safety and tolerance. SPSS 26.0 software was used for data analysis. Th Kaplan-Meier method was used for survival analysis.

RESULTS

Thirty-seven (46.3%) patients received CCRT and 43 (53.7%) received radiotherapy alone. The most common treatment-related adverse events included radiation esophagitis (32/80, 40.0%) and anemia (49/80, 61.3%), with 22 (27.5%) experiencing grade ≥ 3 adverse events. No treatment-related deaths occurred. After median follow-up of 16.5 months, the median progression-free survival (PFS) was 14.2 months, and median overall survival (OS) was 19.9 months. The 1-year and 2-year PFS and OS were 55.8% and 31.6%, and 67.5% and 44.1%, respectively. Patients with partial response had better outcomes than those with stable disease: 1-year PFS 69.4% vs 43.9% (P = 0.011) and OS 83.2% vs 48.8% (P = 0.007). Induction therapy effectiveness and immunotherapy maintenance were independent prognostic factors for OS.

CONCLUSION

Chemotherapy combined with programmed cell death 1/programmed cell death ligand 1 inhibitor followed by definitive radiotherapy or CCRT in patients with locally advanced ESCC was safe and effective.

Surgical resection of a recurrent retroperitoneal paraganglioma: A case report

BACKGROUND

Paraganglioma (PGL) is a neuroendocrine tumor originating from paraganglia that can occur in various locations, such as the head, neck, chest, abdomen, and pelvis. Retroperitoneal PGLs are rare, and recurrent cases in this area are particularly uncommon, posing considerable surgical complexities. Owing to their neuroendocrine activity, PGLs are capable of secreting hormones like catecholamines, thereby presenting significant challenges in hemodynamic management during the perioperative period.

CASE SUMMARY

We report a 64-year-old man with a recurrent retroperitoneal PGL. The patient underwent retroperitoneal mass resection in 2013, with postoperative pathology revealing a PGL. Regular follow-up was not conducted until April 2024, when a computed tomography scan revealed a huge mass in the retroperitoneum, closely adjacent to the abdominal aorta. Laboratory examinations revealed elevated levels of catecholamines in the patient's blood serum. Upon admission, volume expansion and blood pressure (BP) monitoring were carried out for one week, with catecholamine levels reviewed and normalized. Adequate preoperative preparation was conducted, including central venous access, arterial BP monitoring, and the preparation of vasoactive agents. During tumor resection, the patient experienced acute, significant fluctuations in BP. The timely intervention of the anesthesiologist stabilized the BP, facilitating the successful resection of the tumor which was confirmed as a recurrent PGL. Postoperative follow-up revealed no evidence of tumor residual or recurrence.

CONCLUSION

PGL recurrence is rare but non-negligible. PGLs adjacent to major arteries complicate surgery, and perioperative hemodynamic stability demands meticulous attention.

Incorporation of human β-defensin-1 into immunoliposomes to facilitate targeted autophagy therapy of colon carcinoma

Based on the discovery that human β-defensin-1 (hBD-1) triggers autophagy in colon cancer cells and inhibits proliferation, we proposed the consideration of its druggability. As a protein, its stability, targetability and bioavailability must be improved. Compared with the traditional medicinal chemistry technology, nanotechnology is more economical for increasing the druggability of hBD-1 and can be readily scaled up. Here, we propose an immunoliposome system containing hBD-1 to improve its stability and bioavailability. To enhance its targetability, anti-epidermal growth factor receptor (EGFR) antibodies were conjugated to the liposomal bilayer to produce immunoliposomes that can target EGFR, which is highly expressed in colon cancer cells. Although more studies are needed to support clinical trials and large-scale manufacturing, these immunoliposomes have great potential as therapeutics. Thus, immunoliposomes are suitable nanovesicles to improve the druggability of hBD-1; however, additional basic and translational research of these systems is warranted.

Hepatic arterial infusion pump chemotherapy for colorectal liver metastases: Revisiting traditional techniques to explore new frontiers

Hepatic arterial infusion (HAI) chemotherapy, first introduced in the 1980s, has gained recognition as an effective locoregional treatment for colorectal liver metastasis (CRLM). Initially used for unresectable liver metastases, HAI’s application has expanded to the adjuvant setting following hepatic resection, with early studies indicating improved hepatic disease-free survival. Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival, even in heavily pretreated patients with diverse RAS mutational statuses. Personalization through approaches like microsatellite instability status and dose modifications further optimize outcomes. However, the complexity of HAI requires expertise across multidisciplinary teams, limiting its widespread adoption to specialized centers. Ongoing clinical trials continue to investigate HAI’s role in CRLM management, highlighting its potential to become a cornerstone of liver-directed therapy. We explore how HAI chemotherapy, in combination with personalized medicine, can advance treatment strategies for metastatic colorectal cancer.

Primary hepatic neuroendocrine tumor with a suspicious pulmonary nodule: A case report and literature review

BACKGROUND

Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare tumors originating from neuroendocrine cells. Due to lack of neuroendocrine symptoms and specific radiographic characteristics, PHNETs are challenging to differentiate from other liver tumors.

CASE SUMMARY

This case involved a 67-year-old male who was admitted with a discovered hepatic mass and a suspicious lung lesion. Primary hepatic carcinoma was initially speculated based on the characteristic magnetic resonance imaging findings. The patient underwent a laparoscopic right partial hepatectomy, and subsequent immunohistochemical examination revealed a HNET. To exclude other potential origins, a positron emission tomography-computed tomography scan and gastrointestinal endoscopy were performed, leading to a final diagnosis of PHNETs. Then we conducted a literature review using the PubMed database, identifying 99 articles and 317 cases related to PHNETs. The characteristics, diagnostic methods, and treatment of PHNETs have been described. Finally, we elaborate on the presumed origins, pathological grades, clinical features, diagnosed methods, and treatments associated with PHNETs.

CONCLUSION

The diagnosis of PHNETs was primarily an exclusionary process. A definitive diagnosis of PHNETs relied mainly on immunohistochemical markers (chromogranin A, synaptophysin, and cluster of differentiation 56) and exclusion of primary foci in other organs. Radical surgery was the preferred treatment for early-stage tumors.

Efficacy and safety of C-arm computed tomography-guided microwave ablation with percutaneous osteoplasty for flat bone metastases

BACKGROUND

Flat bone metastases are common in patients with advanced cancers, often resulting in severe pain, limited mobility, and reduced quality of life (QOL). Traditional treatment options, such as radiotherapy or systemic therapies, often fail to provide sufficient pain relief or improve functional outcomes in these patients. Microwave ablation (MWA) offers advantages, such as shorter procedure times and larger ablation zones, while percutaneous osteoplasty (PO) enhances bone stability and prevents pathological fractures. Despite these benefits, the combination of these techniques for treating flat bone metastases remains underexplored.

AIM

To evaluate the efficacy and safety of C-arm computed tomography (CT)-guided MWA combined with PO for managing painful flat bone metastases, focusing on pain relief, functional improvement, and QOL enhancement.

METHODS

A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included. The efficacy of the procedure was assessed by changes in the visual analog scale (VAS), Oswestry disability index (ODI), and QOL, as well as the occurrence of complications. Tumor response was evaluated using RECIST v1.1 and mRECIST criteria, with overall response rate (ORR) and disease control rate (DCR) as the primary endpoints.

RESULTS

No serious complications were observed in any of the patients. A significant reduction in VAS and ODI was noted at 1 week, 1 month, and 3 months post-procedure. A marked improvement in QOL was observed at all follow-up points. Bone cement extravasation was observed in 10 patients; however, none exhibited significant clinical symptoms. Based on RECIST v1.1, the ORR was 26.7% and the DCR was 88.9%. The mRECIST evaluation revealed a higher ORR of 51.1% and DCR of 88.9%.

CONCLUSION

C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases. It demonstrates significant pain relief, improved functional outcomes, and enhanced QOL. This treatment combination also shows promising tumor response rates with a low complication profile.

Role of octamer transcription factor 4 in proliferation, migration, drug sensitivity, and stemness maintenance of pancreatic cancer cells

BACKGROUND

Pancreatic cancer (PC) is one of the most aggressive malignancies characterized by rapid progression and poor prognosis. The involvement of cancer stem cells (CSCs) and Octamer transcription factor 4 (OCT4) in PC pathobiology is being increasingly recognized.

AIM

To investigate the role of OCT4 in pancreatic CSCs and its effect on PC cell proliferation, migration, drug sensitivity, and stemness maintenance.

METHODS

We analyzed OCT4 and CD133 expression in PC tissues and cell lines. BxPC-3 cells were used to assess the effects of OCT4 modulation on cellular behavior. Proliferation, migration, and stemness of BxPC-3 cells were evaluated, and the PI3K/AKT/mTOR pathway was examined to gain mechanistic insights.

RESULTS

OCT4 and CD133 were significantly overexpressed in PC tissues. OCT4 modulation altered BxPC-3 cell proliferation, invasion, and stemness, with OCT4 overexpression (OV-OCT4) enhancing these properties and OCT4 interference decreasing them. OV-OCT4 activated the PI3K/AKT/mTOR pathway, which correlated with an increase in PC stem cells (PCSC).

CONCLUSION

OCT4 plays a crucial role in PCSCs by influencing the aggressiveness and drug resistance of PC cells, thus presenting itself as a potential therapeutic target.

Pembrolizumab-induced Guillain-Barré syndrome in triple-negative breast cancer: A case report

BACKGROUND

The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers, including triple-negative breast cancer. However, it is associated with immune-related adverse events, including rare but serious neurological complications such as Guillain-Barré syndrome (GBS). GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis. We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.

CASE SUMMARY

A 69-year-old woman with a medical history of hypertension, anxiety, depression, and stage IIIB triple-negative breast cancer treated with pembrolizumab, carboplatin, and paclitaxel, presented to the emergency department with a 1-month history of tingling, lower extremity weakness, and shooting pain. Symptoms progressed to global weakness, ascending paralysis, and double vision. Neurological examination revealed significant lower extremity weakness and sensory deficits. Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS. Initial treatment with intravenous immunoglobulin led to relapse, requiring additional intravenous immunoglobulin and high-dose glucocorticoids. The patient's condition improved, pembrolizumab therapy was permanently discontinued, and she was discharged to a rehabilitation facility.

CONCLUSION

Pembrolizumab can induce GBS, necessitating early recognition, prompt diagnosis, and multidisciplinary management to prevent serious complications.

Nomogram for overall survival in ampullary adenocarcinoma using the surveillance, epidemiology, and end results database and external validation

BACKGROUND

Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract. Currently, only a few cases have been reported, resulting in limited information on survival.

AIM

To develop a dynamic nomogram using internal and external validation to predict survival in patients with ampullary adenocarcinoma.

METHODS

Data were sourced from the surveillance, epidemiology, and end results stat database. The patients in the database were randomized in a 7:3 ratio into training and validation groups. Using Cox regression univariate and multivariate analyses in the training group, we identified independent risk factors for overall survival and cancer-specific survival to develop the nomogram. The nomogram was validated with a cohort of patients from the First Affiliated Hospital of the Army Medical University.

RESULTS

For overall and cancer-specific survival, 12 (sex, age, race, lymph node ratio, tumor size, chemotherapy, surgical modality, T stage, tumor differentiation, brain metastasis, lung metastasis, and extension) and 6 (age; surveillance, epidemiology, and end results stage; lymph node ratio; chemotherapy; surgical modality; and tumor differentiation) independent risk factors, respectively, were incorporated into the nomogram. The area under the curve values at 1, 3, and 5 years, respectively, were 0.807, 0.842, and 0.826 for overall survival and 0.816, 0.835, and 0.841 for cancer-specific survival. The internal and external validation cohorts indicated good consistency of the nomogram.

CONCLUSION

The dynamic nomogram offers robust predictive efficacy for the overall and cancer-specific survival of ampullary adenocarcinoma.

Denosumab combined with immunotherapy, radiotherapy, and granulocyte-macrophage colony-stimulating factor for the treatment of metastatic nasopharyngeal carcinoma: A case report

BACKGROUND

Bone is a major site of metastasis in nasopharyngeal carcinoma (NPC). Recently, nuclear factor kappa-beta ligand (RANKL) inhibitors have garnered attention for their ability to inhibit osteoclast formation and bone resorption, as well as their potential to modulate immune functions and thereby enhance the efficacy of programmed cell death protein 1 (PD-1) inhibitor therapy.

CASE SUMMARY

We present a case of a patient with NPC who developed sternal stalk metastasis and multiple bone metastases with soft tissue invasion following radical chemoradiotherapy and targeted therapy. Prior to chemotherapy, the patient experienced severe bone marrow suppression and opted out of further chemotherapy sessions. However, the patient received combination therapy, including RANKL inhibitors (denosumab) alongside PD-1, radiotherapy, and granulocyte-macrophage colony-stimulating factor (PRaG) therapy (NCT05435768), and achieved 16 months of progression-free survival and more than 35 months of overall survival, without encountering any grade 2 or higher treatment-related adverse events.

CONCLUSION

Denosumab combined with PRaG therapy could be a new therapeutic approach for the second-line treatment in patients with bone metastases.