Barriers to implementation of preoperative urostomy site marking in nurse-physician cooperation: A qualitative study based on the Theoretical Domains Framework

Objective

This study aimed to understand the barriers to nurse-physician collaboration in implementing preoperative stoma site marking using qualitative research methods following Theoretical Domain Framework.

Methods

A qualitative descriptive study using semi-structured interviews was conducted from March to June 2023 in the urology departments of nine tertiary hospitals in China. Twelve urologists and eight enterostomal therapists (ETs) were recruited using purposive sampling. Audio recordings were transcribed verbatim and data were analyzed using content analysis.

Results

Five themes were identified in the study: shortage of manpower and stoma care products, lack of standard and regulations, lack of motivation and intention, inconsistency of expectation on consequences, and difficulties in cooperation.

Conclusion

This study indicated that the barriers to implementation of preoperative urostomy localization among urologists and ETs. Institutions, resources, clear career plans, and performance feedback can increase motivation and intention. In addition, the lack of cooperation between urologists and ETs is a key factor for poor urostomy localization implementation, which calls for effective and equal communication between doctors and nurses.

Pelvic floor muscle training for the prevention and management of low anterior resection syndrome in patients with rectal cancer: An evidence-based summary

Objective

This study aims to summarize the best available evidence on the effectiveness of pelvic floor muscle training (PFMT) in preventing and managing low anterior resection syndrome (LARS) among patients with rectal cancer, with the goal of enhancing quality of care.

Methods

A systematic search was conducted across databases, including BMJ Best Practice, UpToDate, WHO, GIN, UK NICE, NGC, SIGN, RNAO, NCCN, JBI Library, Cochrane Library, CINAHL, Web of Science, Embase, OVID, PubMed, Chinese Wanfang, CNKI, SinoMed, and VIP, covering publications from inception through June 30, 2024. We targeted clinical decisions, guidelines, evidence summaries, expert consensus statements, systematic reviews, and randomized controlled trials related to PFMT for LARS in patients with rectal cancer. Two independent reviewers assessed the quality of the literature and extracted key findings.

Results

A total of 15 articles were included, yielding 21 pieces of evidence across six core areas: multidisciplinary management, bowel function risk screening and assessment, the purpose and target population for PFMT, pre-exercise instructions, exercise regimens, and exercise feedback.

Conclusions

The summarized 21 recommendations provide guidance for integrating PFMT into care plans for patients with rectal cancer and LARS. However, given that evidence originates from diverse clinical settings, considerations such as the local health care environment should be evaluated before implementation. Future research should focus on optimizing PFMT regimens to improve bowel function outcomes in patients with rectal cancer, refining exercise protocols, and gathering further data to enhance clinical application.

Systematic review registration

Registered with the Fudan University Centre for Evidence-Based Nursing, registration number ES20245385.

Addressing challenges in the implementation of precision oncology: An in-depth examination of limitations and disparities in the treatment of non-small cell lung cancer in the Brazilian public healthcare system (SUS)

Precision oncology (PO) has significantly advanced lung cancer treatment by enabling personalised therapy based on genetic mutations. However, equitable access to molecular testing and targeted therapies remains a challenge, particularly in resource-limited settings such as the Brazilian Public Health System (SUS). To identify the challenges faced by SUS in caring for patients with non-small cell lung cancer (NSCLC) in terms of access to Precision Oncology. Retrospective study with data from e-medical records of NSCLC treated between 2015-2021. 174 patients with NSCLC were included, of which 56% were females and 63% had non-squamous histology - 80% of early-stage patients and 32% of advanced-stage patients missed access to genomic testing, primarily due to short life expectancy or insufficient sample size. Only one participant underwent testing for all recommended biomarkers. Among patients with actionable mutations, 40% did not receive targeted therapy; however, regarding EGFR mutations, only 8% did not get it. Access to targeted therapy was associated with improved survival outcomes. The study highlights critical challenges and missed opportunities in the implementation of precision oncology for NSCLC management within the SUS and underscores the need for strategies to improve access to genomic testing in the public health setting.

Reporting and representation of participant race and ethnicity in phase III clinical trials for solid tumors

BACKGROUND

Including racial and ethnic minorities in clinical trials is essential for advancing health equity. Despite progress, trials often do not mirror patient population demographics.

METHODS

The National Library of Medicine's Clinical Trials database was queried for phase III trials of lung, colorectal, breast, and prostate cancers. A reference population was identified from the Surveillance, Epidemiology, and End Result (SEER) database, covering 48% of the US population.

RESULTS

Among 181 trials, race and ethnicity data were included in 86.7% and 60.2% of trials, respectively, with improving reporting over time. Participants were predominantly White (76.3%), followed by Asian/Pacific Islander (14.1%), Black/African American (4.5%), and American Indian/Alaska Native (0.6%). Hispanic/Latino constituted 6.4% of participants. The proportion of non-White groups increased from 19.4% in trials started before 2011 to 26.2% after 2015. Compared with SEER data, the percentages were lower for Asian/Pacific Islander across all cancers, Black/African American in breast and prostate cancers, American Indian or Alaska Native in colorectal, breast, and prostate cancers in US solely trials.

CONCLUSIONS

Reporting and enrollment of racial and ethnic minorities in trials remain inadequate but improving. To enhance diversity, real-world data are warranted to identify recruitment goals by better assessing the geographic distribution within the patient population.

Latent profiles of problem-solving skills and their association with depressive symptoms in parents of children with cancer: A cross-sectional study

OBJECTIVE

Depressive symptoms are prevalent among parents of children with cancer, significantly impacting their well-being. Problem-solving skills, strongly linked to depressive symptoms, offer a promising avenue for intervention. This study aimed to identify latent profiles of parental problem-solving skills and evaluate differences in depressive symptoms across these profiles.

METHODS

A cross-sectional survey was conducted with 318 parents of children with cancer in mainland China. Self-reported data on demographics, problem-solving skills, and depressive symptoms were collected. Latent profile analysis was used to classify parental problem-solving skills into distinct profiles, and multiple logistic regression identified predictors of profile membership.

RESULTS

Three profiles of problem-solving skills were identified: (1) problem-oriented and constructive (n ​= ​94, 29.6%), (2) impulsivity-oriented and irrational (n ​= ​76, 23.9%), and (3) emotion-oriented and avoidant (n ​= ​148, 46.5%). Parents with higher education, greater income, and urban residency were more likely to belong to the problem-oriented group. Fathers predominated in the impulsivity-oriented group, while mothers were more represented in the emotion-oriented group. Significant differences in depressive symptoms were observed across profiles, with the problem-oriented group reporting the lowest levels.

CONCLUSIONS

This study highlights the heterogeneity of problem-solving skills among parents of children with cancer and underscores the need for tailored interventions. Addressing specific characteristics of each profile can improve parental well-being and provide targeted support for this vulnerable population.

TRIAL REGISTRATION

ChiCTR2300071828.

Identification of pyrimidine metabolism-based molecular subtypes and prognostic signature to predict immune landscape and guide clinical treatment in prostate cancer

BACKGROUND

We previously described the enrichment of plasma exosome metabolites in CRPC, PCa, and TFC cohorts, and found significant differences in pyrimidine metabolites. The PMGs is associated with the clinical prognosis of several cancers, but its biological role in PCa is still unclear.

METHODS

This study extracted 98 reliable PMGs, and analyzed their somatic mutations, expression levels, and prognostic significance. Unsupervised clustering was applied to classify patients with PCa into clusters based on six PMGs that were related to the prognosis of PCa. The TME, gene mutations, and immune escape ability were compared among the clusters. A scoring algorithm based on prognostic PMGs, referred to as the PMGscore, was developed. TK1 was identified and the biological functions of TK1 were determined using loss-of-function experiments. RNA sequencing was subsequently performed to determine the molecules associated with the underlying mechanisms of TK1 function.

RESULTS

In total, six out of 98 PMGs simultaneously exhibited differential expression in PCa and were correlated with BCR. Patients were clustered into two clusters according to the expression levels of these six PMGs, which reflected distinct clinical outcomes and immune cell infiltration characteristics. Clinical features, tumor prognosis, and functional annotation were analyzed. Subsequently, we constructed a prognostic signature using these six PMGs. In combination with other clinical traits, we found that the six PMGs' prognostic signature was an independent prognostic factor for patients with PCa. Finally, we found that the expression of TK1 was higher in CRPC tissues than in PCa tissues in three GEO datasets. The results indicated that TK1 promotes the growth and metastasis of PCa cells.

CONCLUSIONS

We provide evidence for a PMG signature for PCa patients to accurately predict clinical prognosis. TK1 plays crucial roles in the progression of PCa cells and can be used as a potential therapeutic target for CRPC.

NVP-2, in combination with Orlistat, represents a promising therapeutic strategy for acute myeloid leukemia

Cell cycle dysregulation and the corresponding metabolic reprogramming play significant roles in tumor development and progression. CDK9, a kinase that regulates gene transcription and cell cycle, also induces oncogene transcription and abnormal cell cycle in AML cells. The function of CDK9 for gene regulation in AML cells requires further exploration. In this study, we knocked down the CDK9 to investigate its effects on the growth and survival of AML cells. Through RNA-seq analysis, we identified that in U937 cells CDK9 regulates numerous genes involved in proliferation and apoptosis, including mTOR, SREBF1, and Bcl-2. Furthermore, our results demonstrated that both CDK9 and FASN are crucial for the proliferation and survival of Kasumi-1 and U937 cells. Mechanistically, MCL1, c-Myc, and Akt/mTOR/SREBF1 may be critical factors and pathways in the combined therapy of NVP-2 and Orlistat. In summary, our study revealed that CDK9 and FASN are vital for maintaining AML cell survival and proliferation. Treatment with NVP-2 and Orlistat may be a promising clinical candidate for patients with AML.

Current landscape and future prospects of interleukin-2 receptor (IL-2R) agonists in cancer immunotherapy

Immune checkpoint blockade (ICB) has significantly improved the survival for many patients with advanced malignancy. However, fewer than 50% of patients benefit from ICB, highlighting the need for more effective immunotherapy options. High-dose interleukin-2 (HD IL-2) immunotherapy, which is approved for patients with metastatic melanoma and renal cell carcinoma, stimulates CD8+ T cells and NK cells and can generate durable responses in a subset of patients. Moreover, HD IL-2 may have potential efficacy in patients whose disease has progressed following ICB and plays a vital role in expanding tumor-infiltrating lymphocyte (TIL) in TIL therapy. Despite its potential, the use of HD IL-2 is limited by severe toxicities such as hypotension and vascular leak syndrome. Additionally, only a few patients achieve a good outcome after HD IL-2 therapy. To address these challenges, numerous next-generation IL-2 receptor (IL-2 R) agonists have been developed to exhibit treatment effects while minimizing adverse events. This review will explore IL-2 biology, the clinical application of HD IL-2 therapy, and the development of novel IL-2 R agonists for cancer immunotherapy.

Perspectives on advanced care planning of adolescent and young adult cancer patients, families, and healthcare providers: A qualitative study based on the health belief model

Objective

Adolescents and young adults (AYAs) cancer patients face higher long-term and late-stage risks, so advance care planning (ACP) is an important way for them to participate autonomously in healthcare decision-making. However, in Chinese culture, discussing ACP with AYAs is challengeable due to their role as their family's hope, contributing to insufficient attention to this group in cancer care. This study aimed to explore the perceptions of AYA patients, their families, and healthcare providers about ACP based on the health belief model.

Methods

This study was a qualitative descriptive research using a phenomenological approach. 7 AYA patients and their 7 family members, as well as 8 healthcare providers from Hunan Province, China, underwent three focus group interviews. In addition, 15 AYA patients were recruited for semi-structured interviews, with data saturation being achieved. NVivo Pro 12.0 software was used for data management, and thematic analysis method was used for data analysis.

Results

Six main themes emerged from the data: perceived severity, perceived susceptibility, perceived benefits, perceived barriers, perceived self-efficacy, and action cues. These themes highlight how AYA cancer patients, their families, and healthcare providers perceive the threats of cancer, the potential advantages of engaging in ACP, the challenges they were facing, and the supportive actions needed to facilitate ACP discussions.

Conclusions

ACP can enhance patient autonomy, alleviate anxiety, improve family communication, and optimize resource utilization. However, promoting ACP in China need overcome cultural barriers, enhance education, and provide strong family and social support to encourage more active participation among young patients.

Diagnosing pulmonary MALT lymphoma: a case of unilateral cystic lesions

We present an atypical case of a 62-year-old female diagnosed with pulmonary mucosa-associated lymphoid tissue (p-MALT) lymphoma, which uniquely manifested as a singular cystic lesion in the lung. Diagnostic evaluations, including comprehensive imaging, bronchoscopy, and CT-guided lung biopsy, revealed this uncommon radiological presentation. Detailed histopathological and immunohistochemical assessments further supported the diagnosis. To determine the extent of the disease, systemic evaluations, such as whole-body PET-CT, gastroscopy, colonoscopy, and bone marrow biopsy, were conducted, confirming its localized nature. Following the definitive diagnosis, the patient underwent a rituximab-centric therapeutic regimen, which yielded significant clinical improvement. This case highlights the importance of recognizing distinctive cystic lung features in p-MALT lymphoma and the indispensable role of holistic diagnostic approaches in guiding precise therapeutic and prognostic decisions.

Understanding East-West differences in subsolid nodules: prevalence and overdiagnosis implications in lung cancer screening

BACKGROUND

Owing to the widespread opportunistic LDCT screening leading to increased overdiagnosis in Asian countries, such as South Korea, mainland China, and Taiwan, this study seeks to analyze the divergence in SSN prevalence between Eastern and Western nations, focusing on the influence of SSN on the growing overdiagnosis trend, notably among females.

METHODS

This retrospective study collected data from 4166 participants who underwent baseline LDCT in a hospital-based cohort between January 2014 and August 2021. Clinical parameters, including age, sex, lung imaging reporting and data system (Lung-RADS) categories, smoking history, pack-year dose, and SSN characteristics, were extracted from electronic medical records. Additionally, a narrative review and pooled analysis integrated relevant published studies on the prevalence of subsolid nodules and sex disparities.

RESULTS

The study encompassed 4166 participants, with females accounting for 49.3% and males for 50.7%, with a mean age of 53.38 ± 10.89. The prevalence of SSNs was significantly higher in females (20.1%) than in males (12.6%). Pooled analysis across seven studies revealed a significantly higher prevalence of SSN in Eastern countries (12.6%) compared to the prevalence in Western countries (3.6%) (test for subgroup differences: p < 0.01; I2 = 100%). Additionally, a notable sex difference was observed in the prevalence of SSNs (risk ratio = 0.489, 95% CI: 0.301-0.796, p < 0.01; reference group: male group).

CONCLUSIONS

Apart from differences in clinical management and health literacy regarding SSNs between Eastern and Western countries, the high prevalence of SSNs in Asian nations, particularly among females, significantly contributes to the issue of overdiagnosis in opportunistic lung cancer screening in Asian countries. Tailored sex-specific strategies and risk prediction models are essential for effective screening optimization.

Mechanism of action of genistein on breast cancer and differential effects of different age stages

CONTEXT

Genistein, a soy-derived isoflavone, exhibits structural similarities with 17β-estradiol and demonstrates antioxidant, anti-inflammatory, and estrogenic properties. Despite its low bioavailability limiting its clinical application, it shows potential for breast cancer prevention and treatment.

OBJECTIVE

This review aims to summarize the pharmacological effects and molecular mechanisms of genistein in breast cancer, focusing on its therapeutic potential, strategies to overcome bioavailability limitations, and its role in personalized medicine. Differential impacts among population subgroups are also discussed.

METHODS

A systematic review was conducted using PubMed, ScienceDirect, and Google Scholar databases. Studies were selected based on their focus on genistein's mechanisms of action, strategies to enhance its bioavailability, and interactions with other therapies.

RESULTS

Genistein exerted anticancer effects by modulating estrogen receptor β (ERβ), inhibiting angiogenesis, arresting the cell cycle, and inducing apoptosis. Its antioxidant properties help mitigate tumor-associated oxidative stress. Bioavailability enhancement strategies, such as nanoparticle and lipid-based formulations, show promise. Age-dependent effects were evident, with distinct responses observed in prepubertal, menopausal, and postmenopausal populations, underscoring its potential for personalized therapies. Furthermore, genistein influences epigenetic modifications, including DNA methylation and miRNA expression, bolstering its anticancer efficacy.

CONCLUSION

Genistein is a promising candidate for breast cancer therapy, particularly for personalized treatment. Strategies to enhance bioavailability and further clinical research are essential to optimize its therapeutic potential and evaluate its efficacy in combination therapies.

Malnutrition defined by Controlling Nutritional Status score was independently associated with prognosis of diffuse large B-cell lymphoma primarily on elderly patients

OBJECTIVES

Controlling Nutritional Status (CONUT) Score is an effective tool for the assessment of malnutrition and proved to be associated with survival of Diffuse large B-cell lymphoma (DLBCL) patients. We investigated the impact of CONUT score on specific subgroups of DLBCL patients, including age and International prognostic Index (IPI) risk groups.

METHODS

Data of 287 newly diagnosed DLBCL in the Third Affiliated Hospital of Soochow University were retrospectively collected. Baseline CONUT score, clinical data and survival information were recorded.

RESULTS

With the standard cut-off value of 4 points, 88 (30.7%) patients were clarified as malnourished. During a median follow-up of 34 months, malnourished patients exhibited significant reduction in both progression-free survival (PFS) and overall survival (OS). The 3-year PFS rates for malnourished and well-nourished patients were 51.4% and 70.9% (p = 0.001), while the 3-year OS rates were 62.4% and 84.0% (p < 0.001). Malnutrition was demonstrated an independent predictor of OS in DLBCL patients (HR 2.220, 95% CI 1.307-3.772, p = 0.003). It could effectively identify patients with inferior OS in both low/intermediate-low risk and intermediate-high/high risk IPI groups. In the group of elderly patients aged over 60 years, malnutrition was independently associated with OS (HR 2.182, 95% CI 1.178-4.040, p = 0.024), but not PFS (HR 1.709, 95% CI 1.016-2.875, p = 0.070) after adjustment using the Benjamini-Hochberg procedure. Conversely, for younger patients, malnutrition did not demonstrate an independent impact on either PFS or OS.

CONCLUSION

Malnutrition evaluated by CONUT score was an independent predictor for the outcome of DLBCL patients, which is exclusively caused by its effect on elderly patients.

Relationship between perceived depression, suicidal ideation, and return to work among cancer survivors in South Korea: A national survey analysis

Objective

This study aimed to investigate the relationship between perceived depression, suicidal ideation, and return to work among cancer survivors in South Korea, with a focus on sociodemographic and employment-related factors.

Methods

A secondary analysis of data from 874 cancer survivors, retrieved from the 2015, 2017, and 2019 Korean National Health and Nutrition Examination Surveys, was conducted. Key variables included employment status, household income, marital status, perceived depression, and suicidal ideation. Data were analyzed using descriptive statistics and chi-square tests.

Results

Female cancer survivors reported higher rates of perceived depression compared to male survivors. Survivors with lower household incomes or without spouses experienced elevated levels of both perceived depression and suicidal ideation. Those in the nonworking group exhibited significantly higher rates of these psychological challenges compared to those who had returned to work. However, the type of job performed was not associated with perceived depression or suicidal ideation.

Conclusions

Returning to work, regardless of job type, is associated with improved psychological health among cancer survivors, emphasizing the importance of employment in fostering social interaction and emotional stability. Interventions supporting the return-to-work process and addressing the specific needs of vulnerable groups are critical for improving the overall well-being of cancer survivors.

Identifying the heterogeneity of self-advocacy in Chinese patients with breast cancer using latent profile analysis and symptom networks

Objective

This study aims to identify subgroups of self-advocacy in patients with breast cancer, assess the heterogeneity among different subgroups, and further delineate symptom networks within each subgroup.

Methods

A cross-sectional survey was conducted among 320 patients with breast cancer in Wuxi, China, from September 2023 to March 2024, who completed questionnaires about their demographic and clinical characteristics, the M.D. Anderson Symptom Inventory, and the Female Self Advocacy in Cancer Survivorship scale. Latent profile analysis was conducted to identify subgroups of self-advocacy. Multinomial logistic regression was employed to reveal the heterogeneity of each subgroup in demographics and clinical characteristics. Network analysis was performed to unveil the network structure of clinical symptoms within each subgroup.

Results

Three subgroups were identified: "Profile 1: low self-advocacy", "Profile 2: moderate self-advocacy", and "Profile 3: high self-advocacy". Compared with patients in Profile 3, those in Profile 1 and Profile 2 showed a higher tendency to have more severe symptoms. Network analysis further revealed that "lack of appetite" emerged as the core symptom in Profile 1, while the core symptom in Profile 2 and Profile 3 was "distress".

Conclusions

Patients in different subgroups manifest individualized self-advocacy. The severity of clinical symptoms might serve as an important risk factor for those with low levels of self-advocacy. Conducting symptom networks of diverse subgroups can facilitate tailored symptom management by focusing on core symptoms, thereby enhancing the effectiveness of interventions and improving patients' self-advocacy and overall quality of life.

Latent profile analysis of fear of cancer recurrence in patients with prostate cancer: Insights into risk factors and psychological interventions

Objective

To explore fear of cancer recurrence (FCR) profiles in prostate cancer survivors, identify heterogeneous subgroups, and examine influencing factors to provide a reference for improving mental well-being and overall quality of life.

Methods

A convenience sample of 389 patients completed a questionnaire that assessed general and disease-related data, including the Fear of Progression Questionnaire-Short Form, Perceived Social Support Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Statistical analysis involved latent profile analysis (LPA), Bolck-Croon-Hagenaars methods and multinomial logistic regression.

Results

Three FCR profiles were identified: "Adapted" (25.7%), "Struggling" (42.2%), and "Dysregulated" (32.1%). Compared to the Adapted group, factors associated with the Struggling group included age, social support, and employment status, while factors associated with the Dysregulated group included age, social support, and time since diagnosis. From Adapted to Dysregulated, physical, cognitive, emotional, and social function declined, while dyspnea, insomnia, and financial difficulties increased.

Conclusions

The psychological problems caused by the FCR in patients with prostate cancer seriously affect their physical, emotional, cognitive and social functions. Targeted intervention strategies should be developed for different categories of patients with prostate cancer to improve the FCR and promote the health-related quality of life.

Design, synthesis and biological activity of novel Xuetongsu derivatives as potential anticancer agents by inducing apoptosis

Xuetongsu (XTS, Schisanlactone E) is one of the main active compounds and considered as the star molecule isolated from Kadsura heteroclita (Roxb.) Craib. In order to improve XTS anti-tumour bioactivities, a series of novel XTS derivatives were designed and synthesised by introducing an amide bond at the parent. Anti-proliferative assays on four different human tumour cell lines (BGC-823, HepG-2, HCT-116, and MCF-7) showed that the anti-tumour activities of most derivatives increased greatly compared to the parent XTS, and especially, compounds A-7, A-14, and A-18 exhibited multiple anti-tumour effects. Among them, compound A-7 has the best biological activities on the four tumour cell lines with the IC50 values ranging from 13.86 to 20.71 μM, which could significantly increase the fraction of apoptotic cells according to flow cytometry experience. Further study demonstrated that A-7 could induce apoptosis on HepG-2 cells through influencing the key apoptotic related proteins, such as Bcl-2, Bax, and cleaved Caspase-3.

Glutamate promotes CCL2 expression to recruit tumor-associated macrophages by restraining EZH2-mediated histone methylation in hepatocellular carcinoma

Glutamate is well-known as metabolite for maintaining the energy and redox homeostasis in cancer, moreover it is also the primary excitatory neurotransmitter in the central nervous system. However, whether glutamatergic signaling can regulate hepatocellular carcinoma (HCC) progression and the specific regulatory mechanisms are unknown. In the present study, we found that glutamate and its receptor NMDAR2B were significantly elevated in HCC patients, which predicts poor prognosis. Glutamate could upregulate CCL2 expression on hepatoma cells and further enhance the capability of tumor cells to recruit tumor-associated macrophages (TAMs). Mechanistically, glutamate could facilitate CCL2 expression through NMDAR pathway by decreasing the expression of EZH2, which regulates the H3K27me3 levels on the CCL2 promoter, rather than affecting DNA methylation. Moreover, inhibiting glutamate pathway with MK801 could significantly delay tumor growth, with reduced TAMs in implanted Hepa1-6 mouse HCC models. Our work suggested that glutamate could induce CCL2 expression to promote TAM infiltration by negatively regulating EZH2 levels in hepatoma cells, which might serve as a potential prognostic marker and a therapeutic target for HCC patients.

Advancing precision medicine in hepatocellular carcinoma: current challenges and future directions in liquid biopsy, immune microenvironment, single nucleotide polymorphisms, and conversion therapy

Hepatocellular carcinoma (HCC) remains a health concern characterized by heterogeneity and high mortality. Surgical resection, radiofrequency ablation, trans-arterial chemoembolization, and liver transplantation offer potentially curative treatments for early-stage disease, but recurrence remains high. Most patients present with advanced-stage HCC, where locoregional therapies are less effective, and systemic treatments-primarily multi-kinase inhibitors and immune checkpoint inhibitors-often yield limited responses. Precision medicine aims to tailor therapy to molecular and genetic profiles, yet its adoption in HCC is hindered by inter-/intra-tumoral heterogeneity and limited biopsy availability. Advances in molecular diagnostics support reintroducing tissue sampling to better characterize genetic, epigenetic, and immunological features. Liquid biopsy offers a minimally invasive method for capturing real-time tumor evolution, overcoming spatial and temporal heterogeneity. Artificial intelligence and machine learning are revolutionizing biomarker discovery, risk stratification, and treatment planning by integrating multi-omics data. Immunological factors such as tumor-infiltrating lymphocytes, natural killer cells, macrophages, and fibroblasts have emerged as determinants of HCC progression and treatment response. Conversion therapy-combining systemic agents with locoregional treatments-has showndemonstrated promise in downstaging unresectable HCC. Ongoing efforts to refine biomarker-driven approaches and optimize multi-modality regimens underscore precision medicine's potential to improve outcomes. PubMed (January 2002-February 2025) was searched for relevant studies.

Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis

BACKGROUND

Numerous meta-analyses have identified various risk factors for hepatocellular carcinoma (HCC), prompting a comprehensive study to synthesize evidence quality and strength.

METHODS

This umbrella review of meta-analyses was conducted throughout PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. Evidence strength was evaluated according to the evidence categories criteria.

RESULTS

We identified 101 risk factors throughout 175 meta-analyses. 31 risk factors were classified as evidence levels of class I, II, or III. HBV and HCV infections increase HCC risk by 12.5-fold and 11.2-fold, respectively. These risks are moderated by antiviral treatments and virological responses but are exacerbated by higher HBsAg levels, anti-HBc positivity, and co-infection. Smoking, obesity, non-alcoholic fatty liver disease, diabetes, low platelet, elevated liver enzymes and liver fluke infection increase HCC risk, while coffee consumption, a healthy diet, and bariatric surgery lower it. Medications like metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), aspirin, statins, and selective serotonin reuptake inhibitors reduce HCC risk, while acid suppressive agents, particularly proton pump inhibitors, elevate it. Blood type O reduces the risk of HCC, while male gender and older age increase the risk.

CONCLUSIONS

HBV and HCV are major HCC risk factors, with risk mitigation through antiviral treatments. Lifestyle habits such as smoking and alcohol use significantly increase HCC risk, highlighting the importance of cessation. Certain drugs like aspirin, statins, GLP-1 RAs, and metformin may reduce HCC occurrence, but further research is needed to confirm these effects.

Prognostic signature based on mitochondria- and angiogenesis-related genes associated with immune microenvironment of multiple myeloma

INTRODUCTION

Mitochondria and angiogenesis play key roles in multiple myeloma (MM) development, but their interrelated genes affecting MM prognosis are under-studied.

METHODS

We analyzed TCGA_MMRF and GSE4581 datasets to identify four genes - CCNB1, CDC25C, HSP90AA1, and PARP1 - that significantly correlate with MM prognosis, with high expression indicating poor outcomes.

RESULTS

A prognostic signature based on these genes stratified patients into high- and low-risk groups, with the latter showing better survival. The signature was validated as an independent prognostic factor. Biological function analysis revealed differences in cell cycle processes between risk groups, and immune microenvironment analysis showed distinct immune cell infiltration patterns.

CONCLUSION

This mitochondria- and angiogenesis-related prognostic signature could enhance MM prognosis assessment and offer new therapeutic insights.

HPV vaccination willingness among 3,081 secondary school parents in China's capital

Assessing knowledge of HPV and HPV vaccine and vaccine willingness among Beijing secondary school parents, and identifying decision-influencing factors. Selected via multi-stage stratified sampling, 3,081 Chaoyang secondary school students' parents participated in a June-August 2024 study. They completed a questionnaire assessing HPV knowledge, vaccine awareness, and vaccination willingness. Although 56.4% of parents showed a high awareness of HPV and its vaccine, only 13.7% had actually vaccinated their children, indicating a low vaccination rate. Moreover, 59.9% of parents indicated a willingness to vaccinate their children against HPV. Factors influencing this willingness included having daughters (OR: 2.873, 95% CI: 2.403-3.436), the school's street location (OR: 1.279, 95% CI: 1.056-1.550), personal HPV vaccination (OR: 2.153, 95% CI: 1.726-2.686), comprehensive knowledge about HPV and its vaccine (OR: 1.956, 95% CI: 1.595-2.398), awareness of vaccine price (OR: 1.500, 95% CI: 1.143-1.968), perceiving the price as reasonable (OR: 1.265, 95% CI: 1.029-1.533), and challenges in scheduling HPV vaccine appointments (OR: 3.909, 95% CI: 2.692-5.675). Notably, there was a negative correlation between parents' education levels and their willingness to vaccinate their children: junior college (OR: 0.690, 95% CI: 0.527-0.902), undergraduate (OR: 0.626, 95% CI: 0.482-0.813), postgraduate and above (OR: 0.686, 95% CI: 0.475-0.989). Therefore, relevant sectors must implement varied health campaigns, focusing on parental health needs, particularly HPV education for men, and advocate for HPV vaccines in immunization programs to boost secondary school students' vaccination rates.

Research progress on the mechanism of tumor cell ferroptosis regulation by epigenetics

Cancer remains a significant barrier to human longevity and a leading cause of mortality worldwide. Despite advancements in cancer therapies, challenges such as cellular toxicity and drug resistance to chemotherapy persist. Regulated cell death (RCD), once regarded as a passive process, is now recognized as a programmed mechanism with distinct biochemical and morphological characteristics, thereby presenting new therapeutic opportunities. Ferroptosis, a novel form of RCD characterized by iron-dependent lipid peroxidation and unique mitochondrial damage, differs from apoptosis, autophagy, and necroptosis. It is driven by reactive oxygen species (ROS)-induced lipid peroxidation and is implicated in tumorigenesis, anti-tumor immunity, and resistance, particularly in tumors undergoing epithelial-mesenchymal transition. Moreover, ferroptosis is associated with ischemic organ damage, degenerative diseases, and aging, regulated by various cellular metabolic processes, including redox balance, iron metabolism, and amino acid, lipid, and glucose metabolism. This review focuses on the role of epigenetic factors in tumor ferroptosis, exploring their mechanisms and potential applications in cancer therapy. It synthesizes current knowledge to provide a comprehensive understanding of epigenetic regulation in tumor cell ferroptosis, offering insights for future research and clinical applications.

Fusobacterium mortiferum and its metabolite 5-aminovaleric acid promote the development of colorectal cancer in obese individuals through Wnt/β-catenin pathway by DKK2

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, with high incidence and mortality rates. An increasing body of research suggests that obesity is a significant risk factor for the development of CRC. Moreover, recent findings have highlighted the close association between the gut microbiota and both obesity and CRC. Despite this, the specific mechanisms by which the gut microbiota influences obesity and CRC remain unclear. This study aims to explore the role of the gut bacterium Fusobacterium mortiferum and its metabolite 5-aminovaleric acid (5-AVA) in the development of obesity and CRC. Our study found that the metabolite 5-aminovaleric acid produced by Fusobacterium mortiferum significantly inhibits the expression of the tumor suppressor DKK2. This inhibition leads to enhanced proliferation of CRC cells. Furthermore, we discovered that Fusobacterium mortiferum and 5-AVA can activate the Wnt/β-catenin signaling pathway by inhibiting DKK2, thereby promoting tumor growth. This finding was validated in CRC mouse models and in vitro experiments. Additional mechanistic studies revealed that 5-AVA interacts with the demethylase KDM6B, affecting the demethylation process of DKK2 and subsequently activating the Wnt/β-catenin signaling pathway. Our study retrospectively collected fecal samples from patients who underwent gastrointestinal endoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University over the past five years. Participants were stratified into a healthy control group and an adenoma group based on the outcomes of their colonoscopies. Following this, we conducted metagenomic analysis to identify differential bacteria, and based on the results, we performed bacterial cultivation and metabolomic profiling. The roles of the targeted bacteria and their metabolites were further validated through animal models and cellular assays, employing techniques such as Western Blot, qPCR, immunohistochemistry, molecular docking simulations, and gene overexpression studies. This study uncovers the potential carcinogenic effects of Fusobacterium mortiferum and 5-AVA in the development of obesity and CRC. Our research emphasizes the complex interplay between the gut microbiota and host metabolism and suggests new directions for future research to explore how modulation of the gut microbiota could prevent and treat CRC.

Pan-cancer analysis reveals PRRT4 is a potential prognostic factor of AML

BACKGROUND

Proline-rich transmembrane protein 4 (PRRT4) has been infrequently studied, with limited literature suggesting its potential as a prognostic marker for gastric cancer. This study aims to investigate the prognostic value of the PRRT4 gene in pan-cancer.

METHODS

We acquired and analyzed data from several platforms, including The Cancer Genome Atlas (TCGA), Genotype Tissue Expression Project (GTEx), Cancer Cell Line Encyclopedia (CCLE), cBioPortal, HPA, and TIMER 2.0. In addition, we have further analyzed the data using multivariate analyzes and RT-qPCR. In vitro experiments were performed to detect the proliferation and apoptosis of AML cells before and after PRRT4 knockdown.

RESULTS

PRRT4 exhibited low expression in 10 types of cancers and high expression in 3 types, and this expression was significantly correlated with tumor stage, age, and gender across various cancer types. PRRT4, identified as a potential independent prognostic factor for overall survival (OS) in several cancers including LAML, PAAD, SKCM, STAD, THYM, and UVM, and exhibited a high frequency of mutation in UCEC. Moreover, PRRT4 was found to be correlated with DNA methylation and immune infiltration in various cancers. Ultimately, in the multivariate analysis model, PRRT4 was discerned as an independent prognostic biomarker for AML, predicated on the statistics based from our institution. After PRRT4 knockdown, the proliferation ability of THP1 cells was significantly enhanced, and the apoptosis ratio was significantly decreased.

CONCLUSION

PRRT4 may serve as a potential therapeutic target and prognostic marker for various malignancies.

Assessing the potential for in vivo modulation of FTH1 gene expression with small peptides to restore and enhance androgen receptor pathway inhibition in prostate cancer

Increased levels of intratumoral free iron drive more aggressive behavior with the development of treatment resistance and spread in a range of cancers including prostate cancer (PCa). This phenotype is associated with an increase in TFRC expression and a decrease in FTH1, a profile supporting increased iron acquisition. In this study we investigated the anti-oncogenic effects of two small peptides (FT-002 and FT-005) that upregulate FTH1 expression and downregulate TFRC expression when combined with standard androgen receptor pathway inhibitors (ARPIs) in xenograft models of PCa in male athymic nude mice. The PC3 cell line was used to establish xenografts representing highly aggressive, androgen-resistant PCa and the LNCaP cell line as a model of androgen-sensitive PCa. Both peptides enhanced the anti-tumor efficacy of ARPI therapy. Efficacy was more marked with the combination of the second-generation APRI enzalutamide than the first-generation agent bicalutamide, a result consistent with known resistance mechanisms to different ARPI therapy. Further, the FT-peptide/enzalutamide combination drove tumor regression whereas enzalutamide monotherapy only slowed growth, even in the hormone-sensitive xenograft. The FT-002a-enzalutamide combination was more effective than FT-005 in reducing tumor mass and volume and modulating FTH1 and TFRC expression. The reversal by the peptides of this oncogenic expression pattern points to a reduction in the tumor free iron via increased iron storage in ferritin and a reduction in iron influx via the transferrin receptor. Peptide-mediated modulation of tumor iron metabolism may therefore offer a novel means to enhance ARPI efficacy and delay resistance in advanced prostate cancer.

Tobacco and alcohol use are the risk factors responsible for the greatest burden of head and neck cancers: a study from the Global Burden of Disease Study 2019

BACKGROUND

The risk factors associated with cancers of the larynx, nasopharynx, lips, and oral cavity, as well as other pharyngeal cancers, share many similarities. To better understand how these risk factors manifest differently across various head and neck tumor types, we utilized data from the GBD database to conduct an in-depth analysis.

METHODS

Our study employed the 2019 GBD dataset to scrutinize trends in incidence, mortality, and DALYs related to these cancers. This analysis covered the period from 1990 to 2019 and was stratified by sex, age, geographical region, and the socio-demographic index.

FINDINGS

In 2019, lip and oral cavity cancers were found to have the highest incidence rates, with notably higher ASIRs observed in males compared to females. Interestingly, the ASIRs for laryngeal cancer showed a decreasing trend over the studied time frame from 1990 to 2019. Our findings revealed that smoking posed a significantly greater risk for laryngeal and lip and oral cavity cancers, whereas alcohol consumption was more strongly linked to NPC. Central Europe exhibited the ASDR for laryngeal cancer. For lip and oral cavity cancer, the impact of tobacco chewing on female ASDR was most pronounced in South Asia. In contrast, nasopharyngeal cancer had its highest ASDR in Asia.

CONCLUSION

Our investigation underscores that smoking and alcohol consumption are leading risk factors for cancers of the head and neck, although their effects vary depending on the specific type of cancer, the sex of the patient, age group, and regional demographics. While occupational exposure to carcinogenic substances does not appear to be a predominant factor, it remains an important consideration that should not be overlooked in the comprehensive assessment of risk for these malignancies.

Dysregulation of gut microbiota stimulates NETs-driven HCC intrahepatic metastasis: therapeutic implications of healthy faecal microbiota transplantation

The stringent regulation of intrahepatic metastases is essential for improving survival outcomes in patients with hepatocellular carcinoma (HCC). This study investigated the impact of gut microbiota on intrahepatic metastasis of HCC and evaluated the therapeutic potential of healthy fecal microbiota transplantation (FMT). Dysregulation of the gut microbiota, characterized by a significant reduction in the abundance of beneficial bacteria, such as Anaerotruncus colihominis and Dysosmobacter welbionis, was observed in patients with intrahepatic metastatic HCC. A human flora-associated (HFA) intrahepatic metastatic HCC mouse model was successfully established through consecutive 4 weeks of human-mouse FMT. Dysregulation of gut microbiota promoted intrahepatic metastasis in the mouse model, primarily by enhancing neutrophil-mediated inflammatory responses and lead to excessive formation of neutrophil extracellular traps (NETs). Consequently, it promoted tumor vascular growth and tissue necrosis, resulting in intrahepatic metastasis of HCC. Notably, FMT from healthy donors mitigated these pathological processes. This study elucidated the role and mechanism of dysregulated gut microbiota in promoting intrahepatic metastasis of HCC. Healthy FMT emerges as a promising novel therapeutic strategy for preventing and treating intrahepatic metastasis of HCC.

Correlation between ultrasonography and elastography parameters and molecular subtypes of breast cancer in young women

OBJECTIVE

To explore the differences of conventional ultrasound characteristics, elastic imaging parameters and clinicopathological characteristics of distinct molecular subtypes of breast cancer in young women, and to identify imaging parameters that exhibited significant associations with each molecular subtype.

METHODS

We performed a retrospective analysis encompassing 310 young women with breast cancer. Observations were made regarding the ultrasonography and elastography characteristics of the identified breast lesions. Subsequently, based on immunohistochemistry results patients were classified into five distinct molecular subtypes: luminal A, luminal B (HER2-), luminal B (HER2+), HER2+, and triple-negative breast cancer (TNBC). Clinical, pathological, and ultrasound imaging features were compared among these subtypes using binary logistic regression analysis.

RESULTS

Statistically significant differences were observed in various parameters across the five molecular subtypes (p < 0.05), including tumor size, morphology, margins, calcification, posterior echo features, blood flow (Adler grading), and tumor hardness. Specifically, luminal A subtype exhibited propensity for spiculated margins, lower blood flow grading, and decreased hardness; luminal B subtype was characterized by angular margins; HER2+ subtype manifested higher blood flow grading, calcification, and elevated hardness. Conversely, TNBC subtype displayed smooth margins, absence of calcification, and heightened hardness.

CONCLUSION

Specific molecular subtypes of breast cancer have unique ultrasonic and elastic imaging characteristics.

Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators

OBJECTIVES

Develop risk-adapted conditional biopsy pathways utilizing MRI in combination with prostate-specific antigen (PSA) density (PSAD) and the ratio of free to total PSA (f/tPSA), respectively, to enhance the detection of clinically significant prostate cancer (csPCa) while minimizing 'negative' biopsies in low-risk patients.

METHODS

The Prostate Imaging Reporting and Data System (PI-RADS) category, PSAD, f/tPSA and biopsy-pathology of 1018 patients were collected retrospectively. Subsequently, PSAD and f/tPSA were divided into four intervals, which were then combined with the MRI findings to construct two risk stratification matrix tables. Six biopsy decision pathways were established: three clinical pathways based solely on PSAD and f/tPSA, and three MRI-combined pathways incorporating both PI-RADS and PSA-derived indicators. The biopsy and clinically insignificant PCa (ciPCa) avoidance, csPCa detection rate, and 'negative' biopsies proportion were assessed. Decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.

RESULTS

When reporting PI-RADS 1 - 2, PSAD ≥ 0.20 ng/ml/cm3 or f/tPSA ≤ 0.10 were found to be useful for patient stratification. When reporting PI-RADS 3, PSAD ≥ 0.10 - 0.15 ng/ml/cm3 and f/tPSA ≤ 0.16 - 0.25 were helpful in distinguishing the risk of csPCa. The three MRI-combined pathways showed higher csPCa detection rates (94% to 96%) than the three clinical pathways (85% to 91%); 'MRI + PSAD + f/tPSA' demonstrated a high csPCa detection rate of 94% while maintaining the maximum biopsy avoidance and lowest 'negative' biopsy proportion of 40% and 25%, respectively. The DCA showed significantly higher net benefits for three MRI-combined pathways compared to all clinical pathways.

CONCLUSIONS

The integration of MRI and PSA-derived indicators enables effective patient risk stratification, thereby providing valuable decision-making pathways to enhance the management of csPCa while minimizing 'negative' biopsies.

Research progress of Chinese medicinal monomers in the process of melanoma occurrence

CONTEXT

Melanoma's aggressiveness and resistance to radiotherapy highlight an urgent need for innovative treatments. Traditional Chinese medicine (TCM) offers a unique approach through its 'four natures' theory-cold, cool, warm, and hot.

OBJECTIVE

This review aims to explore the potential of TCM's 'four natures' herbal monomers in melanoma treatment, providing an alternative to conventional therapies.

MATERIALS & METHODS

A systematic literature review was conducted by accessing various databases, including Baidu Scholar, PubMed, Science Citation Index Expanded (SCIE), and China National Knowledge Infrastructure (CNKI), to synthesize the most recent findings on traditional Chinese medicine monomers. Furthermore, this review elucidated the mechanisms underlying their role in melanoma retention.

RESULTS

TCM's multi-component, multi-target approach has shown promise in addressing melanoma's complexity, with specific monomers demonstrating the ability to modulate tumor behavior.

DISCUSSION AND CONCLUSIONS

The 'four natures' theory in TCM presents a novel perspective for melanoma treatment, warranting further investigation into its clinical applications and potential integration with modern oncology.

Overexpression of ST8Sia1 inhibits tumor progression by TGF-β1 signaling in rectal adenocarcinoma and promotes the tumoricidal effects of CD8+ T cells by granzyme B and perforin

BACKGROUND

Rectal adenocarcinoma (READ) involves the dysregulated expression of alpha 2,8-Sialyltransferase1 (ST8Sia1) although its role during READ's progression is unclear.

METHODS

The mRNA level of ST8Sia1 was analyzed based on The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and Tumor Immune Estimation Resource (TIMER) 2.0. Furthermore, the prognostic and significance of ST8Sia1 in READ was assessed through Kaplan-Meier curve, univariate, multivariate Cox regression, and receiver operating characteristic (ROC) methods. The role of ST8Sia1 in the READ immune microenvironment was explored using ESTIMATE analysis and TIMER databases. Furthermore, the expression of ST8Sia1 in tissues was analyzed using real-time quantitative polymerase chain reaction (RT-qPCR), western blotting (WB), and immunohistochemistry (IHC). Perforin and Granzyme B secretion by CD8+ T cells, as well as tumor cell apoptosis, were detected after co-culturing CD8+ T cells with READ tumor cells and ST8Sia1-overexpression (ST8Sia1-OE) tumor cells. Furthermore, we examined the interaction between ST8Sia1 and TGF-β1 in READ cells.

RESULTS

ST8Sia1 exhibited excellent diagnostic capability for READ, with positive correlations to immune response and negative correlations to tumor purity. Increased levels of perforin and Granzyme B from CD8+ T cells were observed in vitro, enhancing tumor cell apoptosis. ST8Sia1 interacts with TGF-β1, mediating its inhibitory effects on READ development.

CONCLUSIONS

ST8Sia1 is a potential diagnostic biomarker and therapeutic target for READ, enhancing CD8+ T cell function and possibly improving patient outcomes through cellular immunotherapy.

Prevalence and risk factors of H. pylori infection among outpatient in Karaganda city (Kazakhstan)

BACKGROUND

To better understand the factors associated with Helicobacter pylori infection, it is important to quantify the prevalence of H. pylori and identify the clinical and demographic characteristics of individuals with the infection.

METHOD

In this cross-sectional study 369 participants underwent a structured questionnaire, urease breath test, and endoscopy to determine their H. pylori status.

RESULTS

The frequency of H. pylori in the sample was 27.64%, and erosive antral gastritis, gastric ulcers, and duodenal ulcers were found to be significantly associated with infection. However, no differences were found in social status, family size, or shared utensil use between individuals with and without the infection.

CONCLUSION

These findings suggest that H. pylori is a significant risk factor for gastrointestinal conditions.

Prognostic indicators and survival rates in vulvar cancer: insights from a retrospective study

BACKGROUND

This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients.

METHODS

A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes.

RESULTS

In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget's disease (p = .008); lymphovascular space invasion (LVSI; p = .011); pelvic or paraaortic lymph node metastases (p = .042); and positive p53 status (p = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (p = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419-6.480; p = .004) and 2.421 (95% CI = 1.120-5.232; p = .025), respectively.

CONCLUSIONS

Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes.

Mechanisms underlying delayed loss of HBeAg and HBV DNA following HBsAg seroclearance in PEG-IFNα treated patients of chronic hepatitis B

BACKGROUND & AIMS

A notable proportion of CHB patients undergoing PEG-IFNα based therapy experience lagged serum HBeAg and/or HBV DNA disappearance in patients achieving HBsAg loss. In this study, we explored the molecular mechanisms behind this clinical phenomenon, offering novel insights into the sustainability of chronic HBV infection.

METHODS

Two independent clinical cohorts were enrolled to validate this phenomenon. Then comprehensive analysis was performed using public datasets, coupled with a series of molecular biology experiments.

RESULTS

Approximately 17-20% CHB patients underwent PEG-IFNα based therapy experienced seroclearance of HBsAg, while serum HBeAg and/or HBV DNA remained positive. These patients are more prone to serum HBsAg reappearance compared to those achieving complete virological response. Analysis of public datasets revealed that compared to the PC/BCP, the SP1/SP2 promoter displayed more pronounced inhibitory epigenetic modifications in HBeAg-negative patients and SP1/SP2 in-frame mutation peaked in immune active patients. In vitro experiments demonstrated that introduced SP1/SP2 inactive mutations would enhance PC/BCP transcriptional activity by a mechanism known as adjacent transcriptional interference. Furthermore, the deletion of L-HBsAg facilitated intracellular cccDNA replenishment.

CONCLUSION

This study elucidates that under IFNα treatment and low viral load, transcriptional suppression of SP1/SP2 promoters through mutations and/or epigenetic changes would favour the maintenance of sustain chronic HBV infection, via enhancing the transcription activity of BCP to promote cccDNA replenishment.

IMPACT AND IMPLICATIONS

In clinical practice with IFNα antiviral treatment for CHB patients, a "paradoxical" phenomenon is observed where serum HBsAg disappears while HBV DNA or/and HBeAg remains at low positive levels, with delayed disappearance. Our study confirms this clinical phenomenon using two independent clinical cohorts and explores the potential mechanisms behind the persistence of chronic HBV infection under IFNα treatment and low viral load. Transcriptional suppression of SP1/SP2 promoters through mutations and/or epigenetic changes supports the maintenance of chronic HBV infection by enhancing the transcriptional activity of the BCP, which in turn promotes cccDNA replenishment.

HighlightsApproximately 20% of patients with CHB who have just achieved HBsAg loss under IFNα treatment show positive serum HBV DNA and/or HBeAg.During disease progression, in frame indel mutations accumulate in the HBV genome's SP1 and SP2 promoters, with epigenetic modifications contributing to their suppression.In frame indel mutations in the HBV genome's SP1 and SP2 promoters inhibit the transcription of HBV S mRNA and promote the transcription of 3.5 kb HBV RNA.The loss of L-HBs and envelop proteins leads to an increase in intracellular cccDNA, promoting the maintenance of chronic infection.

State of the art of adjuvant immunotherapy in urothelial cancer: New developments and upcoming changes

In recent years, several clinical trials focused on the potential role of immune-checkpoint inhibitors (ICIs) in the adjuvant treatment of muscle-invasive urothelial cancer (UC). Heretofore, only the anti-programmed death protein 1 (anti-PD1) nivolumab received European Medical Agency (EMA) approval for cisplatin-unfit patients. In our work, we deeply analyzed the results of the three pivotal studies in view of the rapidly evolving therapeutic advanced UC's scenario. Furthermore, there are several ongoing research to investigate ICIs and other emerging immune agents in this setting; results are awaited. Additionally, current efforts have been made to assess the role of these agents in earlier disease settings, particularly in high-risk non-muscle-invasive bladder cancer (NMIBC). In our review, we analyzed the potential role of predictive and/or prognostic biomarkers that may improve patient selection and treatment efficacy. To conclude, we highlighted the upcoming changes that could redefine the standard of care for patients with early-stage UC.

Pyridine indole hybrids as novel potent CYP17A1 inhibitors

Prostate cancer (PCa) is one of the most prevalent malignancies affecting men worldwide, and androgen deprivation therapy (ADT) is a primary treatment approach. CYP17A1 inhibitors like abiraterone target the steroidogenic pathway to reduce androgen levels, but their clinical efficacy is limited by drug resistance and adverse effects. This study reports the synthesis and evaluation of novel CYP17A1 inhibitors derived from a previously identified hit compound. Several analogs were synthesised, including an unexpected di-cyano derivative, which demonstrated increased potency against CYP17A1 compared to abiraterone. Biological assays revealed that these compounds significantly inhibited CYP17A1 enzymatic activity and altered steroid biosynthesis. Among the newly synthesised inhibitors, compound 11 showed the highest potency (IC50 = 4 nM) and the related compound 14 presented a template for further development. A combined docking and molecular dynamics approach was used to identify the possible target binding modes of the compounds.

Alpha-linolenic acid-mediated epigenetic reprogramming of cervical cancer cell lines

Cervical cancer, the fourth most common cancer globally and the second most prevalent cancer among women in India, is primarily caused by Human Papilloma Virus (HPV). The association of diet with cancer etiology and prevention has been well established and nutrition has been shown to regulate cancer through modulation of epigenetic markers. Dietary fatty acids, especially omega-3, reduce the risk of cancer by preventing or reversing the progression through a variety of cellular targets, including epigenetic regulation. In this work, we have evaluated the potential of ALA (α linolenic acid), an ω-3 fatty acid, to regulate cervical cancer through epigenetic mechanisms. The effect of ALA was evaluated on the regulation of histone deacetylases1, DNA methyltransferases 1, and 3b, and global DNA methylation by ELISA. RT-PCR was utilized to assess the expression of tumor regulatory genes (hTERT, DAPK, RARβ, and CDH1) and their promoter methylation in HeLa (HPV18-positive), SiHa (HPV16-positive) and C33a (HPV-negative) cervical cancer cell lines. ALA increased DNA demethylase, HMTs, and HATs while decreasing global DNA methylation, DNMT, HDMs, and HDACs mRNA expression/activity in all cervical cancer cell lines. ALA downregulated hTERT oncogene while upregulating the mRNA expression of TSGs (Tumor Suppressor Genes) CDH1, RARβ, and DAPK in all the cell lines. ALA reduced methylation in the 5' CpG island of CDH1, RARβ, and DAPK1 promoters and reduced global DNA methylation in cervical cancer cell lines. These results suggest that ALA regulates the growth of cervical cancer cells by targeting epigenetic markers, shedding light on its potential therapeutic role in cervical cancer management.

Research hotspots and trends of immunotherapy and melanoma: A bibliometric analysis during 2014-2024

Over the last decade, the increasing global prevalence of melanoma has sparked growing interest in immunotherapies, which show significant potential against this form of skin cancer. This research aims to offer a framework to guide future studies and inspire new research directions. In this study, we used the Web of Science Core Collection to collect papers on immunotherapy and melanoma published between 2014 and 2024. With Excel and visualization tools like VOSviewer, COOC 13.2, Citespace, and Bibliometrix (R-Tool of R-Studio), we analyzed the data to spot trends and new focuses in the research. Our findings indicate a substantial surge in research activity concerning immunotherapy and melanoma between 2014 and 2024. The USA and China emerged as leading contributors, engaging in extensive and close collaborative efforts with European counterparts. Furthermore, seven of the top 10 research institutions are located in the USA, with the MD Anderson Cancer Center in Texas being the most productive. In addition, the Journal of Cancer Immunotherapy is the journal with the most articles published in the field. Professor Georgina V. Long from the Melanoma Institute at the University of Sydney was one of the most productive scholars. Keyword analysis shows that immune checkpoint inhibitors, tumor microenvironment and targeted therapies are key areas of interest for the research community. This paper uses bibliometric analysis to outline research trends and key points in immunotherapy and melanoma from 2014 to 2024, which helps understand the current research and guides future research directions.

Fractionated radiotherapy initiated at the early stage of bone metastasis is effective to prolong survival in mouse model

BACKGROUND AND PURPOSE

Bone metastasis is common for breast cancer and associated with poor prognosis. Currently, radiotherapy (RT) serves as the standard treatment for patients exhibiting symptoms of bone metastasis to alleviate pain. Whether earlier application of RT will better control bone metastasis remains unclear.

METHODS

We utilized a mouse model of breast cancer bone metastasis by intra-femoral injection of 4T1-luc breast tumor cells. The bone metastasis was treated by RT using various doses, timings, and modalities. Tumor growth was assessed through bioluminescence imaging, and lung metastases was quantified following lung tissue fixation. Flow cytometry was employed to analyze alterations in immune cell populations.

RESULTS

Single high-dose RT suppressed tumor growth of bone metastases, but caused severe side effects. Conversely, fractionated RT mitigated tumor growth in bone metastases with fewer adverse effects. Fractioned RT initiated at the early stage of bone metastasis effectively inhibited tumor growth in the bone, suppressed secondary lung metastases, and prolonged mouse survival. In line with the known pro- and anti-metastatic effects of neutrophils and T cells in breast cancer, respectively, earlier fractioned RT consistently decreased the proportions of neutrophils while increased the proportions of T cells in both the bone and the lung tissues.

CONCLUSION

The data suggest that fractionated RT can inhibit the progression of early stage of bone metastasis and reduce secondary lung metastasis, leading to favorable outcomes. Therefore, these findings provide preclinical evidence to support the application of fractionated RT to treat patients with bone metastasis as earlier as possible.

A novel glycogene-related signature for prognostic prediction and immune microenvironment assessment in kidney renal clear cell carcinoma

BACKGROUND

Kidney Renal Clear Cell Carcinoma (KIRC) is a prevalent urinary malignancies worldwide. Glycosylation is a key post-translational modification that is essential in cancer progression. However, its relationship with prognosis, tumour microenvironment (TME), and treatment response in KIRC remains unclear.

METHOD

Expression profiles and clinical data were retrieved from The Cancer Genome Atlas and Gene Expression Omnibus databases. Consensus clustering, Cox regression, and LASSO regression analyses were conducted to develop an optimal glycogene-related signature. The prognostic relevance of this molecular signature was rigorously analyzed, along with its connections to tumour microenvironment (TME), tumour mutation burden, immune checkpoint activity, cancer-immunity cycle regulation, immunomodulatory gene expression patterns, and therapeutic response profiles. Validation was performed using real-world clinical specimens, quantitative PCR (qPCR), and immunohistochemistry (IHC), supported by cohort analyses from the Human Protein Atlas (HPA) database.

RESULTS

A glycogene-associated prognostic scoring system was established to categorize patients into risk-stratified subgroups. Patients in the high-risk cohort exhibited significantly poorer survival outcomes (p < 0.001). By incorporating clinicopathological variables into this framework, we established a predictive nomogram demonstrating strong calibration and a concordance index (C-index) of 0.78. The high-risk subgroup displayed elevated immune infiltration scores (p < 0.001), upregulated expression of immune checkpoint-related genes (p < 0.05), and an increased frequency of somatic mutations (p = 0.043). The risk score positively correlated with cancer-immunity cycle activation and immunotherapy-related signals. The high-risk groups also showed associations with T cell exhaustion, immune-activating genes, chemokines, and receptors. Drug sensitivity analysis revealed that low-risk patients were more sensitive to sorafenib, pazopanib, and erlotinib, whereas high-risk individuals responded better to temsirolimus (p < 0.01). qPCR and IHC analyses consistently revealed distinct expression patterns of MX2 and other key genes across the risk groups, further corroborated by the HPA findings.

CONCLUSION

This glycogene-based signature provides a robust tool for predicting prognosis, TME characteristics, and therapeutic responses in KIRC, offering potential clinical utility in patient management.

Acyl-CoA dehydrogenase long chain acts as a tumor-suppressive factor in lung adenocarcinoma progression

This study investigated the role of long-chain acyl-CoA dehydrogenase (ACADL) in lung adenocarcinoma (LUAD). ACADL was significantly downregulated in human LUAD tissues compared to normal lung tissues. In vitro, ectopic expression of ACADL in murine LLC cells decreased cell viability, migration, and invasion, while ACADL knockdown exhibited the opposite effect. In vivo, ACADL overexpression impeded tumor growth and metastasis. Mechanistically, ACADL hindered tumor progression by inducing cell cycle arrest, promoting apoptosis, and suppressing the epithelial-mesenchymal transition (EMT) process. These findings suggest ACADL acts as a tumor suppressor in LUAD progression.

Hotspots evolution and frontiers of immunotherapy for the treatment of acute myeloid leukemia: A bibliometric analysis

Given the growing significance of immunotherapy in addressing the limitations of conventional acute myeloid leukemia (AML) treatments, this study aimed to elucidate the hotspot evolution and frontiers of immunotherapy in AML using bibliometric analysis. With a strict retrieval strategy applied in the Web of Science Core Collection, 2411 publications were obtained and exported. The temporal and geographical distributions of these publications and the countries, institutions, journals, and authors who contributed to the field were investigated. An in-depth content analysis was performed. The United States had various research institutions dedicated to AML immunotherapy. Frontiers in Immunology had the highest number of publications, but Blood had the highest H-index. Marion Subklewe was the most productive author. The current research hotspots of AML immunotherapy included chimeric antigen receptor-T-cell therapy, antibody-based immunotherapies, immune checkpoint blockade, and combination therapy, highlighting the key aspects of immunotherapy for AML treatment and providing comprehensive insights into the research status and advances in this field. Novel immunotherapies combined with chemotherapy may become the primary focus of AML treatment.

Biomarkers in metastatic castration-resistant prostate cancer for efficiency of immune checkpoint inhibitors

Almost all patients with prostate cancer progress to metastatic castration-resistant prostate cancer (mCRPC) despite initial responses. In cases where traditional first-line treatments prove ineffective, the potential of immune checkpoint blockade (ICB) therapy emerges as a promising approach for managing mCRPC. However, while immune checkpoint inhibitor monotherapy or combination therapy targeting cytotoxic T lymphocyte antigen 4 (CTLA-4) and/or programmed cell death-1 (PD-1)/PD-1 ligand 1 (PD-L1) axis has been regarded as the standard therapy in many solid tumours, mCRPC as 'cold' tumours are considered to be relatively resistant to ICB treatment. Encouragingly, recent evidence suggests that ICB therapy may be particularly beneficial in specific subgroups of patients with high PD-L1 tumour expression, high tumour mutational burden or high tumour microsatellite instability/mismatch repair deficiency. Better understanding of these predictive biomarkers could screen which patients are most likely to benefit. This review article examines biomarkers for screening patients potentially effective in immune checkpoint inhibitor therapy.

Exploring the relationship between illness perception, self-transcendence, and demoralization in patients with lung cancer: A latent profile and mediation analysis

Objective

This study examined the heterogeneity of illness perceptions in patients with lung cancer and evaluated the mediating role of self-transcendence in the relation between illness perception and demoralization.

Methods

A convenience sample of 477 patients with lung cancer was selected from three tertiary hospitals in Wuhan, China, between January and June 2024. Participants completed the Brief Illness Perception Questionnaire, Self-Transcendence Scale, and Demoralization Scale. Data were analyzed using Mplus 8.3 and SPSS 25.0.

Results

Three latent illness perception profiles were identified among patients with lung cancer: low (27.25%), moderate (40.04%), and high (32.71%). Mediation analyses revealed a partial mediation effect in the relation between illness perception and demoralization in the low versus moderate (SE ​= ​1.56, 95% CI ​= ​14.71, 20.86) and high versus low illness perception groups (SE ​= ​1.71, 95% CI ​= ​35.44, 42.71).

Conclusions

Patients with lung cancer exhibited heterogeneous illness perceptions, and self-transcendence partially mediated the relation between illness perception and demoralization. Promoting self-transcendence may help mitigate the negative impact of illness perceptions on demoralization. Clinical interventions aimed at reducing negative illness perceptions and enhancing self-transcendence should be prioritized in the care of patients with lung cancer.

Microbiota and metabolite-based prediction tool for colonic polyposis with and without a known genetic driver

Despite extensive investigations into the microbiome and metabolome changes associated with colon polyps and colorectal cancer (CRC), the microbiome and metabolome profiles of individuals with colonic polyposis, including those with (Gene-pos) and without (Gene-neg) a known genetic driver, remain comparatively unexplored. Using colon biopsies, polyps, and stool from patients with Gene-pos adenomatous polyposis (N = 9), Gene-neg adenomatous polyposis (N = 18), and serrated polyposis syndrome (SPS, N = 11), we demonstrated through 16S rRNA sequencing that the mucosa-associated microbiota in individuals with colonic polyposis is representative of the microbiota associated with small polyps, and that both Gene-pos and SPS cohorts exhibit differential microbiota populations relative to Gene-neg polyposis cohorts. Furthermore, we used these differential microbiota taxa to perform linear discriminant analysis to differentiate Gene-neg subjects from Gene-pos and from SPS subjects with an accuracy of 89% and 93% respectively. Stool metabolites were quantified via 1H NMR, revealing an increase in alanine in SPS subjects relative to non-polyposis subjects, and Partial Least Squares Discriminant Analysis (PLS-DA) analysis indicated that the proportion of leucine to tyrosine in fecal samples may be predictive of SPS. Use of these microbial and metabolomic signatures may allow for better diagnostric and risk-stratification tools for colonic polyposis patients and their families as well as promote development of microbiome-targeted approaches for polyp prevention.

Identification and mechanism analysis of biomarkers related to butyrate metabolism in COVID-19 patients

BACKGROUND

Butyrate may inhibit SARS-CoV-2 replication and affect the development of COVID-19. However, there have been no systematic comprehensive analyses of the role of butyrate metabolism-related genes (BMRGs) in COVID-19.

METHODS

We performed differential expression analysis of BMRGs in the brain, liver and pancreas of COVID-19 patients and controls in GSE157852 and GSE151803. The differentially expressed genes (DEGs) and module genes between COVID-19 patients and healthy controls in GSE171110 were screened through 'limma' and 'WGANA' R package, respectively, followed by an intersection with BMRGs via 'ggvenn' R package. Six machine learning algorithms were employed to determine the best model for identifying biomarkers, and receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of the biomarkers in COVID-19. Moreover, the differences in immune-infiltrating cells between the COVID-19 and control groups were compared using CIBERSORT. The differences in immune cells and expression levels of biomarkers in immune cells among different tissues were analysed using GSE171668.

RESULTS

The BMRGs were the most different in the brain between the COVID-19 and control groups, including 21 upregulated and 16 downregulated genes. Five important common BMRGs were screened as biomarkers for COVID-19 using XGBoost, namely CCNB1, CCNA2, BRCA1, HBB and HSPA5, with increased diagnostic performance. Enrichment analysis revealed that these five genes were related to the cell cycle, cell proliferation and cell senescence. The infiltrating abundance of 12 immune cells was different between the COVID-19 and control groups. Finally, the expression levels of HSPA5, BRCA1 and HBB were higher in annotated cells than in CCNB1 and CCNA2, and there were four different types of immune cells in the liver, heart, lungs and kidneys.

CONCLUSIONS

These five genes may be potential biomarkers of butyrate metabolism in COVID-19 patients. These findings provide a direction for further studies on the molecular mechanisms underlying COVID-19.

XL888 and pembrolizumab modulate the immune landscape of colorectal tumors in a phase Ib/II clinical trial

We conducted a phase Ib/II clinical trial to evaluate the safety, feasibility, and clinical activity of combining pembrolizumab (anti-PD-1) with XL888 (Hsp90 inhibitor) in patients with advanced colorectal cancer (CRC). We hypothesized that this regimen would modulate soluble and cellular immune mediators and enhance clinical outcomes. The trial employed a 3 + 3 open-label design, with an expansion cohort at the recommended phase II dose (RP2D) in treatment-refractory, mismatch repair-proficient CRC patients. Comprehensive analyses of plasma cytokines, peripheral blood mononuclear cells (PBMCs), and spatial immune cell patterns in liver biopsies were performed to identify unique immune signatures resulting from the combined therapy. The combination of pembrolizumab and XL888 proved to be safe and feasible, with a subset of patients achieving stable disease, although no objective responses were observed in this heavily pre-treated population. Correlative studies revealed immunomodulatory effects in tumors and circulation, including a reduction in IL6+ cells and macrophages (CD68+) within metastatic liver tissue, alterations in blood CD3+ cells, and upregulation of numerous inflammatory plasma cytokines. These findings suggest local and systemic immune activation by the combination of pembrolizumab and XL888. While clinical activity was modest in treatment-refractory CRC patients, there were notable effects on the tumor immune environment and systemic immune modulation.

Time to progression predicts outcome of patients with multiple myeloma that can be influenced by autologous hematopoietic stem cell transplantation

OBJECTIVES

Currently, there is limited understanding regarding the prognostic significance of time to progression (TTP) after first remission in multiple myeloma (MM).

METHODS

We conducted a retrospective analysis of clinical data from 209 patients with MM. These patients were categorized into ≤ 6 months, ≤ 12 months, ≤ 24 months, > 24 months, 6-12 months, and 12-24 months subgroups based on TTP.

RESULTS

Patients in ≤ 12 months group exhibited shorter median overall survival (OS) and OS-1 compared to those in ≤ 24 months group (61.73 vs 96.10 months, P = 0.02; 54.00 vs 74.17 months, P = 0.048). ≤ 6 months group exhibited shorter median OS and OS-1 compared to 6-12 months group (33.63 vs 79.60 months, P = 0.022; 19.93 vs 65.17 months, P = 0.015). Patients in 6-12 months group had shorter median OS and OS-1 compared to those in 12-24 months group (79.60 vs 100.43 months, P < 0.001; 65.17 vs 77.17 months, P = 0.012).No significant difference in OS was observed between patients in 12-24 months and > 24 months groups. For patients who experienced progression within 12 or 24 months after remission, undergoing autologous hematopoietic stem cell transplantation (ASCT) after progression conferred a median OS and OS-2 advantage over receiving post-progression chemotherapy. Multivariable analysis confirmed that TTP was an independent predictor for OS in patients with MM.

CONCLUSION

Patients with MM who experience earlier disease progression within 12 months after remission have a worse prognosis, and post-progression ASCT can improve their survival outcomes.

Total flavonoids of litchi seed inhibit breast cancer metastasis by regulating the PI3K/AKT/mTOR and MAPKs signaling pathways

CONTEXT

Total flavonoids from Litchi chinensis Sonn. (Sapindaceae) seeds (TFLS) effectively attenuate stem cell-like properties in breast cancer cells. However, their pharmacological effects and mechanisms in suppressing breast cancer metastasis remain unclear.

OBJECTIVE

This study aimed to elucidate the inhibitory effects and underlying mechanisms of TFLS on breast cancer metastasis.

MATERIALS AND METHODS

The antiproliferative, migratory, and invasive activities of breast cancer cells following TFLS treatment were evaluated using CCK-8, wound-healing, and transwell assays. The epithelial-mesenchymal transition (EMT) biomarkers were evaluated via Western blot analysis. The anti-metastatic effects of TFLS were further validated in vivo using zebrafish and mouse models. Network pharmacology methodology was utilized to predict potential targets and signaling pathways, which were subsequently corroborated by Western blot. Potential active compounds were identified through molecular docking, and the chemical constituents of TFLS were analyzed and characterized using UPLC-QTOF/MS.

RESULTS

TFLS suppressed the proliferation of MDA-MB-231 and MDA-MB-468 cells, with IC50 values of 44.47 μg/mL and 37.35 μg/mL at 72 h, respectively. It effectively suppressed breast cancer metastasis in vitro, demonstrated by a marked reduction in cellular motility and invasiveness, alongside the reversal of EMT. Consistent with pathway enrichment analysis, network pharmacology revealed that TFLS reduced the phosphorylation levels of PI3K, AKT, mTOR, JNK, ERK, and p38 in breast cancer cells. Molecular docking identified seven potential active ingredients, and UPLC-MS/MS confirmed the presence of key compounds, including procyanidin A2.

DISCUSSION AND CONCLUSION

TFLS effectively inhibits breast cancer cell proliferation, migration, and invasion in vitro by reversing the EMT phenotype, while suppressing metastasis in vivo. These effects are likely mediated via the attenuation of the PI3K/AKT/mTOR and MAPK signaling pathways.