Global cancer statistics, 2012

Histone crotonylation in tumors (Review)

Lysine crotonylation (Kcr) refers to a type of modification in which crotonyl groups are transferred to lysine residues by histone crotonyltransferase (HCT) using crotonyl-coenzyme A (CoA) as a substrate. Kcr is distributed in core histones and in some nonhistone proteins. Histone crotonylation is a newly discovered epigenetic modification with a significant ability to regulate gene expression. Crotonylation occurs on the ε-amino group of lysine residues and results in a modification of the histone charge. Similar to acetylation, the substrate for crotonylation is a donor molecule, crotonyl-CoA, which is linked to the sulfhydryl group of CoA by a thioester bond. Crotonylation is involved in regulating a wide range of biological processes and diseases. With advances in detection technologies, the impact of histone crotonylation on tumors has been revealed. The present review examines the recent discoveries of histone crotonylation, its function in tumors and its regulatory mechanism, which will aid in elucidating the mechanisms of malignant tumor development and provide a theoretical foundation for the development of new targeted cancer therapies.

Quality of prostate MRI in early diagnosis-a national survey and reading evaluation

OBJECTIVES

The reliability of image-based recommendations in the prostate cancer pathway is partially dependent on prostate MRI image quality. We evaluated the current compliance with PI-RADSv2.1 technical recommendations and the prostate MRI image quality in the Netherlands. To aid image quality improvement, we identified factors that possibly influence image quality.

MATERIALS AND METHODS

A survey was sent to 68 Dutch medical centres to acquire information on prostate MRI acquisition. The responding medical centres were requested to provide anonymised prostate MRI examinations of biopsy-naive men suspected of prostate cancer. The images were evaluated for quality by three expert prostate radiologists. The compliance with PI-RADSv2.1 technical recommendations and the PI-QUALv2 score was calculated. Relationships between hardware, education of personnel, technical parameters, and/or patient preparation and both compliance and image quality were analysed using Pearson correlation, Mann-Whitney U-test, or Student's t-test where appropriate.

RESULTS

Forty-four medical centres submitted their compliance with PI-RADSv2.1 technical recommendations, and 26 medical centres completed the full survey. Thirteen hospitals provided 252 usable images. The mean compliance with technical recommendations was 79%. Inadequate PI-QUALv2 scores were given in 30.9% and 50.6% of the mp-MRI and bp-MRI examinations, respectively. Multiple factors with a possible relationship with image quality were identified.

CONCLUSION

In the Netherlands, the average compliance with PI-RADSv2.1 technical recommendations is high. Prostate MRI image quality was inadequate in 30-50% of the provided examinations. Many factors not covered in the PI-RADSv2.1 technical recommendations can influence image quality. Improvement of prostate MRI image quality is needed.

CRITICAL RELEVANCE STATEMENT

It is essential to improve the image quality of prostate MRIs, which can be achieved by addressing factors not covered in the PI-RADSv2.1 technical recommendations.

KEY POINTS

Prostate MRI image quality influences the diagnostic accuracy of image-based decisions. Thirty to fifty percent of Dutch prostate MRI examinations were of inadequate image quality. We identified multiple factors with possible influence on image quality.

Comparison of the diagnostic accuracy of enhanced-CT and double contrast-enhanced ultrasound for preoperative T-staging of gastric cancer: a meta-analysis

BACKGROUND

Accurate preoperative staging of gastric cancer (GC) depends on effective diagnostic methods. Enhanced computed tomography (enhanced-CT) is a widely used and reliable preoperative assessment tool for GC, Double Contrast-Enhanced Ultrasound (DCEUS) can display the structure and layers of the gastric wall more accurately, and has high sensitivity (SE) and specificity (SP).

OBJECTIVE

The present study aims to conduct a comprehensive meta-analysis comparing the preoperative T-staging accuracy of DCEUS and enhanced-CT.

METHODS

A systematic literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library to identify eligible articles from inception to February 19, 2024. The study included both prospective and retrospective studies involving patients with GC who underwent DCEUS or enhanced-CT. This encompassed studies utilizing comparative diagnostic test accuracy (CDTA) with both DCEUS and enhanced-CT, as well as studies employing single diagnostic test accuracy (SDTA) with either DCEUS or enhanced-CT alone. Risk of bias was assessed using the Quality Assessment Of Diagnostic Accuracy Studies-C (QUADAS-C) and Assessment Of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The quality of evidence for each outcome was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

A total of 39 studies involving 6,374 patients were included in this meta-analysis. Among these, 3 studies (319 patients) directly compared dynamic contrast-enhanced ultrasound (DCEUS) and enhanced computed tomography (CT), while 31 studies (5,180 patients) evaluated enhanced CT alone, and 5 studies (875 patients) assessed DCEUS alone. For the direct comparison studies (CDTA), DCEUS demonstrated higher sensitivity (SE) and specificity (SP) for T1-T4 staging compared to enhanced CT, with moderate to low certainty of evidence. Specifically, DCEUS showed superior performance in detecting early-stage (T1) and advanced-stage (T4) tumors. Enhanced CT, while effective, had lower sensitivity across all stages, particularly for T1 tumors. In the single-modality studies (SDTA), DCEUS consistently showed higher sensitivity for T2-T4 staging compared to enhanced CT, with comparable specificity. However, the certainty of evidence for indirect comparisons was very low, highlighting the need for further high-quality comparative studies. Overall, DCEUS appears to be a promising modality for gastric cancer T staging, particularly for early-stage detection, but the limited number of direct comparative studies underscores the need for more robust evidence.

CONCLUSION

Current evidence indicates that DCEUS significantly outperforms enhanced-CT in terms of SE and diagnostic accuracy for preoperative T-staging of GC, while maintaining comparable SP. However, these findings require further validation through rigorous studies with larger sample sizes and improved methodological quality.

Application of Fourier Transform Infrared Spectroscopy on Breast Cancer Diagnosis combined with multiple algorithms: A Systematic Review

INTRODUCTION

Fourier transform infrared (FT-IR) spectroscopy is an innovative diagnostic technique for improving early detection and personalized care for breast cancer patients. It allows rapid and accurate analysis of biological samples. Therefore, the purpose of this study was to assess the diagnostic accuracy of FT-IR spectroscopy for breast cancer, based on a comprehensive literature review.

METHODS

An online electronic database systematic search was conducted using PubMed/Medline, Cochrane Library, and hand databases from March 28, 2024, to April 10, 2024. We included peer-reviewed journal articles in which FT-IR spectroscopy was used to acquire data on breast cancers and manuscripts published in English. All eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

RESULTS

Serum, breast biopsies, blood plasma, specimen, and saliva samples were included in this study. This study revealed that breast cancer diagnosis using FT-IR spectroscopy with diagnostic algorithms had sensitivity and specificity of 98% and 100%, respectively. Almost all studies have used more than one algorithm to analyze spectral data. This finding showed that the sensitivity of FT-IR spectroscopy reported in six included studies was greater than 90%.

CONCLUSION

Employing multivariate analysis coupled with FT-IR spectroscopy has shown promise in differentiating between healthy and cancerous breast tissue. This review revealed that FT-IR spectroscopy will be the next gold standard for breast cancer diagnosis. However, to draw definitive conclusions, larger-scale studies, external validation, real-world clinical trials, legislative considerations, and alternative methods such as Raman spectroscopy should be considered.

Development of pyrazolo[1,5-a]pyrimidine-grafted coumarins as selective carbonic anhydrase inhibitors and tubulin polymerization inhibitors with potent anticancer activity

This study presents the design, synthesis, and evaluation of a novel series of coumarin-based compounds (9a-t) as potential anticancer agents. The compounds were strategically designed to inhibit cancer-related carbonic anhydrase (CA) isoforms IX and XII and tubulin polymerization. Two approaches were employed for CA inhibition: utilizing the coumarin motif to occlude the CA active site entrance and incorporating zinc-binding groups (sulfonamide, carboxylic acid, and thiol) to interact with the catalytic zinc ion. The target compounds were also designed to inhibit tubulin polymerization by combining the privileged coumarin and pyrazolo[1,5-a]pyrimidine scaffolds. Biological evaluation of the target compounds (9a-t) revealed that sulfonamide-containing derivatives 9h and 9r exhibited potent inhibitory activity in the low nanomolar range against CA IX (Ki = 23 and 14 nM, respectively) and CA XII (Ki = 6 and 17 nM, respectively). In NCI-60 human tumor cell line screening, compounds 9k, 9m, and 9q demonstrated broad-spectrum anti-proliferative activity in the five-dose assay with MG-MID values of 7.31 μM, 10.68 μM, and 5.92 μM, respectively. Compound 9m showed significant tubulin polymerization inhibition with an IC50 = 5.28 μM, surpassing the efficacy of colchicine. Cell cycle analysis in MDA-MB-231 breast cancer cells revealed G2/M phase arrest for 9m, which induced significant apoptosis and modulated apoptotic markers. Molecular docking studies provided insights into the binding modes of the compounds with CA IX, CA XII, and tubulin. ADMET and toxicity predictions were performed to assess the drug-like properties of the compounds. These findings pave the way for further optimization of the coumarin scaffold to develop dual inhibitors of carbonic anhydrase IX/XII and tubulin polymerization.

[Gender-specific differences in urological tumours]

Gender differences in medicine are playing an increasingly important role in diagnostic testing as well as therapy choices. Risk factors and mortality vary depending on gender. Diseases often manifest differently depending on gender. In diagnostic testing, gender-specific aspects need to be taken into consideration. For instance, bladder cancer diagnosis is often delayed in women compared to men as haematuria is frequently attributed to benign conditions like urinary tract infections. In therapy, decisive gender disparities should also be considered. To state an example, immune-checkpoint inhibitors have shown better response in men than in women when treating renal cell carcinoma. Furthermore, outcomes after treatment for urological tumours differ depending on gender.

Inhibition of proliferation, migration and invasion of RM-1 cells by roemerine: Insights from in vitro and in vivo studies

Prostate cancer is the second leading cause of cancer-related among men globally, with a rising incidence rate, particularly in developing countries. This highlights the urgent need to identify novel therapeutic agents. Roemerine, a naturally abundant alkaloid, has demonstrated antibacterial and antitumor properties, suggesting its potential utility in prostate cancer treatment. This study evaluates the effects of roemerine on RM-1 prostate cancer cells using in vitro assays and an in vivo nude mouse subcutaneous xenograft tumor model. Through Cell Counting Kit-8(CCK8), MTT, Wound-Healing, and Transwell assays, we assessed roemerine's impact on RM-1 cell proliferation, migration, and invasion. Additionally, the antitumor efficacy of roemerine was evaluated in nude mice bearing subcutaneous RM-1 tumors. Our findings reveal that roemerine significantly inhibits RM-1 cell activity, migration, invasion, and tumor growth. These results highlight the potential of roemerine as a novel antitumor agent for prostate cancer, providing a foundation for further mechanistic and pharmacological investigations.

The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: A systematic review and meta-analysis

AIM

The present systematic review and meta-analysis aims to compare adult patients receiving enteral immunonutrition prior to elective colorectal surgery with those receiving conventional preoperative nutrition.

METHODS

MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from database inception to March 2024. Articles were included if they were randomized controlled trials or cohort studies evaluating adult patients undergoing elective colorectal surgery comparing preoperative enteral immunonutrition with conventional preoperative nutrition protocols. Main outcomes of interest included surgical site infection, anastomotic leak, overall postoperative morbidity and postoperative length of stay. An inverse variance random effects meta-analysis was performed. Risk of bias was assessed with Cochrane risk of bias assessment tools. The GRADE approach was conducted to assess quality of evidence.

RESULTS

After reviewing 2508 relevant citations, 10 studies met inclusion criteria. Overall, 1521 patients (mean age 64.9 ± 10.0 years, 49.4% women) received preoperative immunonutrition and 1816 patients (mean age 64.1 ± 11.0 years, 52.1% women) received conventional preoperative nutrition. Across seven studies, there was a non-significant 30% relative risk reduction of surgical site infection (risk ratio 0.70, 95% CI 0.44-1.11, P = 0.13, I2 = 33%) and a non-significant 44% relative risk reduction of anastomotic leak (risk ratio 0.56, 95% CI 0.28-1.10, P = 0.09, I2 = 0%) in the immunonutrition group. Across eight studies, postoperative length of stay was 0.48 days shorter in the immunonutrition group (mean difference -0.48, 95% CI -0.84 to -0.12, P = 0.01, I2 = 53%). GRADE certainty of evidence was low or very low for all outcomes.

CONCLUSION

While point estimates suggest a likely benefit associated with preoperative enteral immunonutrition, wide corresponding 95% CIs suggest uncertainty remains. Further prospective study is warranted.

[Cancer of the cervix management in Reunion Island from 2016 to 2020]

INTRODUCTION

In Réunion Island, the standardized mortality rate for cervical cancer is 4.8/100,000 women, while it is 2.2/100,000 in France. A previous study, before 2016, showed that the absence of brachytherapy and non-compliance with recommendations could contribute to this increased mortality. The objective of the study was to analyze the management of invasive cervical cancers since 2016 in Reunion.

METHODS

Women diagnosed with invasive cervical cancer in one of our health centers in La Réunion, between January 1st, 2016, and December 31st, 2020. The recommendations of the French society of onco-gynecologists (SFOG) were considered as the reference to assess professional practices.

RESULTS

During the study period, 236 women were diagnosed with cervical cancer, 94% of whom underwent an MRI and 54.8% a PET scan during the initial assessment. Compared to previous years, there has been an improvement in the management of these patients with 99% of the files presented in multidisciplinary consultation meetings and more than 80% of the treatments administered which complied with the recommendations including with the use of brachytherapy.

CONCLUSION

Since the implementation of brachytherapy in Reunion in 2016, the treatment of invasive cervical cancer in Reunion has improved. Soon, a shared medical file should harmonize the transmission of information between the care centers of Reunion and contribute to improve our practices.

AKT activation participates in Fascin-1-induced EMT in hepatoma cells

High expression of Fascin-1 involves high metastasis, high recurrence, and poor prognosis of cancers. However, the related regulatory mechanism in hepatocellular carcinoma (HCC) remains elusive. In this study, Fascin-1 was highly expressed in HCC tissues and cell lines. Fastin-1 protein levels and p-Akt1/Akt1 rate were increased by Akt activator SC79 and were decreased by Akt inhibitor LY294002. Silenced Fascin-1 suppressed cell proliferation, promoted cell apoptosis, suppressed cell invasion and epithelial-mesenchymal transition (EMT) in HCC cell lines. Also, silenced Fascin-1 induced cell cycle arrest in the G1 phase. Moreover, silenced Fascin-1 repressed invasion of HCC cells by inhibiting EMT. Besides, interference with Fascin-1 inhibited HCC cell growth, reduced Vimentin expressions and p-Akt1/Akt1 rate in vivo, while these impacts were abolished after injection of SC79. In conclusion, silencing Fascin-1 reduced the malignant growth of HCC, and this process was closely related to AKT inactivation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-025-00707-9.

Safety assessment of cabozantinib in patients with renal cell carcinoma: retrospective pharmacovigilance study based on FAERS database

OBJECTIVE

This study was designed to conduct data mining through the Food and Drug Administration Adverse Event Reporting System (FAERS) to assess adverse events (AEs) associated with cabozantinib in the treatment of renal cell carcinoma.

METHODS

Reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS) algorithms were used to detect drug-related AEs signals from reporting data in FAERS database from 2016 to 2024.

RESULTS

A total of 32,129 AE reports identifying cabozantinib as a 'primary suspect' were retrieved from the FAERS database. Among them, there were 21,549 reports of renal cell carcinoma as an indication. AEs induced by cabozantinib were observed in 23 system organ classes (SOCs). 215 AE signals were detected in 16 SOCs after four algorithms were simultaneously met. Among them, signals related to gastrointestinal disorders, general disorders and administration site conditions, and skin and subcutaneous tissue disorders were the most common. Of note, the median time to onset of AEs was 38 days (interquartile range (IQR) 14-116 days).

CONCLUSION

This study provides new insights into the monitoring, surveillance, and management of cabozantinib-related adverse drug reactions and provides a comprehensive long-term post-marketing safety assessment of cabozantinib.

TPPP3, a Good Prognostic Indicator, Suppresses Cell Proliferation and Migration in OSCC

INTRODUCTION AND AIMS

Oral squamous cell carcinoma (OSCC) is one of the most prevalent malignancy of the head and neck. Early diagnosis of OSCC is difficult and the prognosis has not improved significantly. This study aims to explore the role of tubulin polymerisation promoting protein 3 (TPPP3) in the occurrence and development of OSCC and discover new diagnostic and prognostic markers for OSCC.

METHODS

Using UALCAN, GEPIA, western blot, and quantitative real-time polymerase chain reaction, we studied TPPP3 expression and its relationship with tumour stage. Then, we detected the effect of TPPP3 on OSCC biological functions by CCK-8 and cell scratch assays, as well as correlations between TPPP3 expression and survival of different kinds of head and neck squamous cell carcinoma (HNSC) patients through Kaplan-Meier plotter. Besides, we explored coexpressed genes associated with TPPP3 in HNSC using LinkedOmics and protein-protein interaction networks of TPPP3 using STRING and Cytoscape. Furthermore, we explored possible molecular mechanisms that TPPP3 functions in HNSC using UALCAN, Kaplan-Meier plotter, and TIMER. Finally, we analysed promoter methylation level by UALCAN and mutation by cBioPortal of TPPP3 in HNSC.

RESULTS

TPPP3 was less expressed in OSCC. The TPPP3 expression level was negatively correlated with tumour stage. Furthermore, TPPP3 significantly inhibited OSCC proliferation and migration. Besides, TPPP3 high expression was significantly associated with good prognosis in different kinds of HNSC patients. Additionally, TPPP3 may regulate the occurrence and development of OSCC through the PALMD/PI3K pathway. TPPP3 methylation level in HNSC decreased. Finally, we found that TPPP3 genetic alteration was involved in TPPP3 mRNA expression change in HNSC.

CONCLUSION

TPPP3 functions as a tumour suppressor in OSCC and is associated with good prognosis in HNSC patients. TPPP3 can be used as a potential biomarker for prognosis and diagnosis of OSCC.

CLINICAL RELEVANCE

TPPP3 can be used as a potential biomarker for prognosis and diagnosis of OSCC in clinical practice.

Comprehensive analysis of GDFs as therapeutic targets and prognosis biomarkers in gastric cancer

Growth/differentiation factors (GDFs, GDF1-3, GDF5-7, GDF9-11, and GDF15) belong to a subfamily of the transforming growth factor-β. GDFs play an important role in morphogenetic and developmental activities in many tissues. And many GDFs family numbers have been observed to be correlated with various types of tumors. However, the diverse expression patterns and prognostic values of ten GDFs in gastric cancer (GC) have yet to be analyzed. Herein we investigated the transcriptional and survival data of GDFs in patients with GC from the Gene Expression Profiling Interactive Analysis, The Cancer Genome Atlas, cBioPortal, Tumor Immune Estimation Resource, Tumor Immune Syngeneic Mouse, UALCAN, Human Protein Atlas Gene Expression Omnibus and The Database for Annotation, Visualization and Integrated Discovery databases. We found that multiple GDF family members are highly expressed in GC, which can prompt diagnosis and evaluate prognosis, and can be used as target points for GC immunotherapy.

Metformin suppresses breast cancer cell proliferation and liver metastasis by up-regulating miR-34a

BACKGROUND

The incidence of breast cancer is on the rise, and metastasis remains a major challenge. Metformin has demonstrated anti-cancer effects, yet its mechanism remains unclear. miR-34a is a tumor-suppressing microRNA. This study explored the relationship between metformin and miR-34a in breast cancer, aiming to clarify the anti-cancer mechanism of metformin.

AIM

To study the effect of metformin on breast cancer cell proliferation and liver metastasis and to explore the possible mechanism involved.

METHODS

Breast cancer cells were transfected with pre-miR-34a or empty virus vector (negative control [NC] group) using the liposome transfection method. Real-time PCR was used to detect the expression of miR-34a in MDA-MB-231 and T-47-D cell lines, and the stably transfected cell lines were determined. Metformin (0, 5, 10, and 20 mM) was then administered. Breast cancer cell proliferation was detected by MTT assay. Apoptosis assay was used to determine the apoptosis in breast cancer cells. The invasive ability of cells was detected by scratch test and Transwell cell assay. Meanwhile, TA2 breast cancer cells were inoculated into the inguinal region of mice. On day 4 after tumor cell inoculation, mice were given metformin at 5 mM, 10 mM, and 20 mM by intragastric administration. The growth of tumors and liver and spleen metastases were observed at 18 and 30 days after tumor cell inoculation. Western blotting was used to detect the expression of miR-34a and the expression of E-cadherin and Vimentin in cell lines and tumor tissues.

RESULTS

Metformin significantly inhibited the proliferation, migration, and invasion of MDA-MB-231 and T-47-D cells (P < 0.05), and significantly promoted the expression of E-cadherin protein and inhibited the expression of Vimentin protein (P < 0.05). With the increase of metformin concentration, the expression of miR-34a increased (P < 0.05). Compared with the NC group, the expression of miR-34a was increased after transfection with pre-miR-34a (P < 0.05), and decreased after transfection with miR-34a inhibitor (P < 0.05). Compared with untreated breast cancer cells with low expression of miR-34A, the content of miR-34a was significantly increased after treatment with metformin at a concentration of 10 mM (P < 0.05). Compared with the NC group, cells with high expression of miR-34a grew slowest, while those with low expression of miR-34a grew fastest; the difference began to exhibit a statistically significant difference from day 3 (P < 0.05). The number of cells migrating and invading into the lower compartment in the high expression group was significantly decreased (P < 0.05), while that of the low expression group was significantly increased (P < 0.05). The number of cells migrating and invading into the lower compartment in the low expression group after metformin treatment was in the middle and significantly lower than that in the low expression group (P < 0.05). The expression of E-cadherin increased and Vimentin decreased in cells with high expression of miR-34a, but showed opposite trends in cells with low expression of miR-34a. After treatment with metformin at 10 mM, the expression of E-cadherin increased and Vimentin decreased in cells with low expression of miR-34a (P < 0.05). The tumor volume in the experimental group was significantly smaller than that in the control group (P < 0.05). There was a significant difference in the liver metastasis rate between the experimental group and the control group (P < 0.05), but there was no significant difference in the spleen metastasis rate (P > 0.05). The expression of miR-34a in tumor tissues of experimental mice was higher than that of the control group (P < 0.05). The expression of E-cadherin protein was increased and Vimentin protein was decreased in tumor tissues (P < 0.05).

CONCLUSION

Metformin may down-regulate the expression of miR-34a to inhibit the proliferation, invasion, and migration of breast cancer cells, as well as the liver and spleen metastasis of breast cancer in mice.

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.

Prognostic Value of 18F-FDG PET/CT Metabolic Parameters in Resectable Non-small Cell Lung Cancer Treated With Neoadjuvant Immunotherapy Plus Chemotherapy

OBJECTIVE

This study investigates the predictive value of 18F-FDG PET/CT metabolic parameters in patients with non-small cell lung cancer (NSCLC) undergoing neoadjuvant immunotherapy plus chemotherapy.

METHODS

We conducted a retrospective analysis of clinical data from 131 patients with pathologically confirmed NSCLC who were deemed resectable after 3 cycles of neoadjuvant immunotherapy plus chemotherapy. Pretreatment and post-treatment PET metabolic parameters were evaluated. CT assessments based on immune response evaluation criteria in solid tumors (iRECIST) were compared with PET/CT assessments using the response criteria in solid tumors (PERCIST). ROC curve analysis and Kaplan-Meier survival analysis, including univariate and Cox multivariate analyses, were employed to assess the prognostic value of PET metabolic parameters after treatment.

RESULTS

The PET/CT assessment based on PERCIST showed high consistency with prognosis, while the CT assessment based on iRECIST demonstrated low consistency. Statistically significant differences were observed between the iRECIST and PERCIST criteria (P<0.001). ROC curve analysis revealed significant differences in post-treatment PET metabolic parameters (postSUVmax, postSUVmean, postSUVpeak, postMTV, and postTLG) as well as the percentage changes in metabolic parameters before and after treatment(Δ) (ΔSUVmax, ΔSUVmean, ΔSUVpeak, ΔMTV, and ΔTLG) (P<0.05). Optimal cutoff values enabled stratification into high-risk and low-risk groups. Univariate analysis showed significantly higher survival in the low-risk group for all parameters except ΔMTV (P=0.311), while Cox multivariate analysis identified ΔSUVmax as the most predictive.

CONCLUSIONS

The PERCIST is more accurate than iRECIST in evaluating prognosis for NSCLC neoadjuvant immunotherapy plus chemotherapy. PET metabolic parameters, particularly ΔSUVmax, effectively predict prognosis and support clinical decision-making.

A randomized phase II/III trial of rosuvastatin with neoadjuvant chemo-radiation in patients with locally advanced rectal cancer

Aim

Statins have been shown to improve the possibility of a pathological complete response (pCR) in patients with locally advanced rectal cancer when given in combination with neo-adjuvant chemo-radiation (NACTRT) in observational studies. The primary objective of this phase II randomized controlled trial (RCT) is to determine the impact of rosuvastatin in improving pCR rates in patients with locally advanced rectal cancer who are undergoing NACTRT. The secondary objectives are to compare adverse events, postoperative morbidity and mortality, disease-free survival (DFS), and overall survival in the two arms and to identify potential prognostic and predictive factors determining outcomes. If the study is positive, we plan to proceed to a phase III RCT with 3-year DFS as the primary endpoint.

Methods

This is a prospective, randomized, open-label phase II/III study. The phase II study has a sample size of 316 patients (158 in each arm) to be accrued over 3 years to have 288 evaluable patients. The standard arm will receive NACTRT while the intervention group will receive 20 mg rosuvastatin orally once daily along with NACTRT for 6 weeks followed by rosuvastatin alone for 6-10 weeks until surgery. All patients will be reviewed after repeat imaging by a multidisciplinary tumor board at 12-16 weeks after starting NACTRT and operable patients will be planned for surgery. The pathological response rate, tumor regression grade (TRG), and post-surgical complications will be recorded.

Conclusion

The addition of rosuvastatin to NACTRT may improve the oncological outcomes by increasing the likelihood of pCR in patients with locally advanced rectal cancer undergoing NACTRT. This would be a low-cost, low-risk intervention that could potentially lead to the refinement of strategies, such as "watch and wait", in a select subgroup of patients.

Clinical trial registration

Clinical Trials Registry of India, identifier CTRI/2018/11/016459.

Chemosensitizer Loaded NIR-Responsive Nanostructured Lipid Carriers: A Tool for Drug-Resistant Breast Cancer Synergistic Therapy

Although numerous technical advances have been made in cancer treatment, chemotherapy is still a viable treatment option. However, it is more effective when used in combination with photothermal therapy for resistant breast cancer cells. This study introduces a smart drug delivery system, (DOX-OA+VERA+AuNRs)@NLC, which is designed for dual chemo/photothermal therapy of multiple-drug-resistant breast cancer. Type-III nanostructured lipid carriers (NLCs) were used as drug delivery systems, where nano-in-nano structures offer several advantages. Doxorubicin (DOX) was used as the antitumor agent by ion-pairing it with oleic acid (OA) to increase the DOX loading capacity, as well as to reduce the burst release of the drug. Verapamil (VERA), which was used as a chemosensitizer to overcome the multiple-drug resistance, was co-loaded with DOX-OA. Gold nanorods (AuNRs) were exploited as the photothermal therapy agent in photothermal therapy (PTT) application, which would have a synergistic relation with chemotherapy. The release of DOX-OA and VERA from NLCs was studied in vitro by triggering with NIR laser irradiation. Thus, an all-in-one drug delivery system was designed to release the active pharmaceutical ingredients (APIs) at higher concentrations in the desired region and provide both chemo/PTT. Besides, the application of a folic acid-chitosan (FA-CS) coating to NLCs has facilitated the development of systems capable of targeting and specifically releasing their cargo within cancerous tissues while preserving their surrounding environment.

Transmembrane protein 176B promotes epithelial-mesenchymal transition in colorectal cancer through inflammasome inhibition

BACKGROUND

Activation of the epithelial-mesenchymal transition (EMT), a pivotal process in tumor metastasis and evasion, as well as the NLRP3 inflammasome, both promote colorectal cancer (CRC) progression. Recent studies have shown that Transmembrane protein 176B (TMEM176B) regulates NLRP3 and promotes CRC malignant phenotypes.

AIM

To investigate the role of TMEM176B in modulating NLRP3 inflammasome and its implications on EMT and tumor progression in CRC.

METHODS

CRC in situ mouse and co-cultured cell models were established using CT26 cells, BALB/c mice, and primary cultured mouse natural killer (NK) cells. Short hairpin RNA knocked down TMEM176B and NLRP3 expression in CT26 cells. Fluorescence imaging, Terminal deoxynucleotidyl transferase dUTP nick end labeling assays, immunohistochemistry staining, flow cytometry, and molecular assays were used to investigate the effects of TMEM176B knockdown on the NLRP3 inflammasome in NK cells to assess tumor metastasis, apoptosis, and EMT indicators.

RESULTS

Silencing TMEM176B in CRC mice significantly reduced tumor metastasis, proliferation, and EMT, while activating apoptosis, NLRP3 inflammasome, and NK cell activity. Furthermore, silencing TMEM176B in co-cultured cell models inhibited cell migration and invasion, and promoted apoptosis. The interference of NLRP3 reversed these effects by modulating key proteins such as phosphorylated nuclear factor kappa B subunit 1 p65, matrix metallopeptidase 9, and transforming growth factor-β.

CONCLUSION

This study highlights the critical role of TMEM176B/NLRP3 in CRC progression and provides a basis for targeting this axis as a novel therapeutic approach to manage CRC progression and metastasis.

Doxorubicin prodrug for γ-glutamyl transpeptidase imaging and on-demand cancer therapy

The γ-glutamyl transpeptidase (γ-GGT) is an important tumor marker, which has been reported to be firmly associated with the developmental stage of liver cancer. Therefore, it makes sense to image and monitor γ-GGT level and design γ-GGT-responsive prodrug for integrated diagnosis and treatment of liver cancer. Herein, we prepare a doxorubicin (Dox) prodrug for imaging γ-GGT and on-demand treating liver cancer. When γ-GGT exists, the γ-glutamyl group will be cut off to liberate free Dox for monitoring cancer progression and killing tumor cells. Fortunately, little Dox is released due to the low level of γ-GGT in normal cells, which improves the safety and efficiency of chemotherapy. To further improve the tumor targeted ability, Dox prodrug is loaded in hyaluronic acid modified liposome nanoparticles to form the nano-prodrug. Then nano-prodrug is enriched in the tumor by binding to the high expressed CD44 on cancer cells. With the assistance of anti-PD-L1, nano-prodrug effectively inhibits the growth of proximal and distal tumors.

Brachytherapy as a Cancer Therapy Tool

Brachytherapy (BT) is a core cancer treatment modality that delivers targeted radiotherapy through the placement of radioactive sources inside or near the area to be treated. This provides a very conformal distribution of dose that minimizes radiation exposure to normal organs. This review introduces healthcare professionals (nurses, nurse navigators, public health practitioners, family physicians, and others) to the principles, applications, and future directions of BT. It covers the intent of treatment in oncology, the different types of BT, conditions that are treated with BT and the characteristics of common BT radioactive isotopes. BT's unique characteristics allow physicians to use it in curative and palliative settings for a wide range of malignant and benign indications. Despite its importance, there are still challenges in terms of accessibility and awareness, highlighting the need for comprehensive education and specialized training in this area. In view of the rising incidence of cancer, the demand for qualified brachytherapists is expected to rise accordingly, given its essential role in cancer care. Furthermore, emerging areas in BT such as the implementation of artificial intelligence and 3-dimensional (3D) printing technology hold promise for improving the accuracy and efficiency of this modality.

Next-Gen Cancer Treatment: Nanotechnology-Driven siRNA Delivery Solutions

RNA interference through small interfering RNA (siRNA) has shown great promise as a potential cancer treatment strategy in recent years. However, the delivery of siRNA to target cancer cells efficiently remains a significant challenge. This review aims to highlight the recent advances in nanotechnology-enabled siRNA delivery for cancer treatment, bridging the gap between bench research and clinical application. A comprehensive literature search was conducted to identify recent studies focused on the utilization of nanotechnology for siRNA delivery in cancer treatment. Key databases, including PubMed, Scopus, and Web of Science, were used, and relevant articles were screened. Several nanotechnology-based platforms for siRNA delivery have emerged in recent years, providing enhanced selectivity, improved stability, and controlled release profiles. The primary types of nanocarriers discussed include lipid-based nanoparticles, inorganic nanoparticles, polymeric nanoparticles, and exosomes. Nanotechnology-based siRNA delivery systems represent a promising avenue for cancer treatment. Although significant progress has been made in preclinical studies, translating these findings to clinical applications poses several challenges, including scale-up production, safety, and targeted delivery. Nevertheless, the recent developments in this field hold great promise in revolutionizing cancer therapy, providing hope for more effective and personalized treatment options in the future.

Breast cancer characteristics in low- and middle-income countries: An umbrella review

Breast cancer presents significant challenges in low- and middle-income countries (LMICs) due to disparities in healthcare access and outcomes. This umbrella review synthesizes data on breast cancer characteristics-age at diagnosis, staging, and molecular subtypes-to guide targeted healthcare strategies in LMICs. Our umbrella review was conducted following PRISMA 2020 and JBI guidelines. Systematic reviews from 2009 to 2024 were sourced from PubMed, Google Scholar, and Cochrane. Reviews were assessed with AMSTAR 2, and only those rated moderate or higher were included. Data synthesis and meta-analyses were performed using R. From 1165 records, 35 systematic reviews met initial criteria; nine were included in the final synthesis, representing 305 primary studies (195 relevant to LMICs). Of those, 50 % were hospital-based and 22 % population-based, limiting the generalizability of the data and the importance of promoting more population-based studies. The overall quality of systematic reviews was variable, with only a few meeting high standards. Geographic analysis revealed a significant underrepresentation of high-quality reviews in sub-Saharan Africa and Latin America. Age at diagnosis varied: sub-Saharan Africa (45-52 years), Middle East (36-56 years), and Latin America (∼49-53 years). Advanced-stage diagnoses (stages III and IV) were common, worsening prognostic outcomes. Molecular subtype analysis indicated a predominance of luminal A but highlighted treatment challenges due to limited targeted therapy access. The results emphasize a pressing need to enhance the availability and quality of primary data, including both hospital-based and population-based studies, particularly in underrepresented regions like sub-Saharan Africa and Latin America. Addressing these gaps with rigorous, locally focused studies is essential for improving breast cancer prevention, diagnosis, and treatment. Enhancing methodological standards and expanding research in these areas will be crucial to bridging global breast cancer outcomes disparities.

Effect of Helicobacter pylori eradication on gastric cancer risk in patients with intestinal metaplasia or dysplasia: a meta-analysis of randomized controlled trials

Background

Observational studies suggest that Helicobacter pylori (H. pylori) is associated with an increased risk of gastric cancer, yet the effect of H. pylori eradication on gastric cancer risk in patients with intestinal metaplasia (IM) or dysplasia remains controversial. The purpose of this study was to summarize the evidence from randomized controlled trials (RCTs) investigating H. pylori eradication on gastric cancer risk in patients with IM or dysplasia to determine the evidence base.

Methods

PubMed, Embase, Cochrane Library, Web of science and China National Knowledge Internet database were searched for RCTs published through May 2024 in adults with IM or dysplasia comparing the risk of gastric cancer following H. pylori eradication versus no eradication therapy. Relative risk (RR) with its 95% confidence interval (CI) using random-effects model were employed for the effect estimate. Sensitivity, meta-regression, and subgroup analyses were also calculated.

Results

Sixteen RCTs involving 15,027 patients with IM or dysplasia met the inclusion criteria. In a pooled analysis, H. pylori eradication resulted in a 45% reduction in RR for gastric cancer risk relative to no eradication (RR: 0.55; 95% CI: 0.46-0.67; p < 0.001). H. pylori eradication significantly reduced the risk of gastric cancer in patients with dysplasia (RR: 0.51; 95% CI: 0.32-0.82; p = 0.005), and IM (RR: 0.61; 95% CI: 0.40-0.93; p = 0.022). Further, if the study conducted in countries other than those in Asia, sample size <500, percentage of male <50.0%, follow-up duration <5.0 years, and low study quality, then there was no significant association between H. pylori eradication and a decreased risk of gastric cancer.

Conclusion

H. pylori eradication is protective against gastric cancer in patients with IM or dysplasia.

Systematic review registration

INPLASY202530010, https://inplasy.com/.

Breast cancer awareness, knowledge and self-screening intention among females in Northern Border of Saudi Arabia, Arar City

BACKGROUND

Breast cancer is the most common cancer among females, and early detection plays a crucial role in disease management. This study aimed to assess the knowledge, practices, and barriers related to breast self-examination (BSE) and mammography among Saudi women in Arar City, Saudi Arabia.

METHOD

A cross-sectional observational study was conducted using an online Google Form distributed to women in Arar City. The survey collected sociodemographic data and assessed knowledge, practices, and barriers related to BSE and mammography. Statistical analyses were performed using IBM SPSS Statistics version 27.0.1, with significance set at p < 0.05.

RESULTS

The study included 385 females, with women aged 19-25 constituting nearly one-third of the population (n = 118; 30.6%). Most participants were married (n = 217; 56.4%) and held a bachelor's degree (n = 281; 73%). While 84.2% (n = 324) had heard of BSE and 80% (n = 308) demonstrated good knowledge, only 33.5% (n = 129) reported performing BSE. Regarding mammography, only 19.5% (n = 75) reported undergoing screening, despite 65.1% (n = 247) recognizing it as a safe procedure. Educational level (p = 0.018), prior knowledge of BSE (p = 0.009), and history of breast problems (p = 0.027) were significantly associated with higher knowledge scores.

CONCLUSION

While women demonstrated good awareness and knowledge of BSE, its practice remains low, with many unaware of proper techniques, timing, and frequency. Mammography awareness and utilization were also limited, emphasizing the need for targeted educational campaigns to promote early detection and improve screening behaviours.

Tumor protein 53 gene polymorphism, demographic attributes and associated risk factors among liver cancer patients in Calabar, Nigeria

Mutations in the TP53 gene had been attributed to the development of liver cancer. Hepatocellular carcinoma (HCC) and liver tumour are liver diseases having high mortality rates in several populations. There is no information on the TP53 gene polymorphism among liver diseases patients in Calabar, Nigeria. This study investigated the genetic polymorphism of TP53 among HCC and liver tumour in Calabar. This research was carried out in the University of Calabar Teaching Hospital, Calabar. Blood samples were collected from 35 clinically diagnosed hepatocellular carcinoma and 10 tumour patients and 10 healthy controls. DNA was extracted from all blood samples and Polymerase Chain Reaction (PCR) was performed using specific primers. The PCR amplicons were digested using Hae III restriction enzyme and the genotypic and allelic frequencies was determined. Demographic data among participants showed that males were 68.9% (31), females (31.1%; 14), sex ratio (2.2: 0.5), mean age was 41.51 ± 2.13 years with an odds ratio of 1.25. The distribution of participants according to marital status were 33(73.3%), 10(22.2%), and 2(4.4%) for married, single, and widowed respectively. The participants were from different extractions with varied representations of Yakurr (22.2%, 10), Efik (20%, 9), Boki (13.3%, 6), Ogoja (13.3%, 6), Annang (8.8%, 4), Ibibio (2.2%, 1) and Igbo (2.2%, 1) and respectively. Approximately, 64.7% (30) of the chronic liver diseases were from the Central and Northern part of Cross River State. The risk factors were HCV infection, HBsAg+, alcoholism, smoking, consumption of groundnuts that may have been contaminated with aflatoxin and family history of the disease. PCR product yielded 254 bp and digested PCR product showed homozygous TT mutation (27), heterozygous GT mutation (17) and homozygous GG wild type (1) in cases. The overall TP53 gene mutation frequency was 46.32% (44). The frequency of G allele, T allele, GG, GT and TT were 0.21, 0.79, 0.04, 0.33 and 0.62 respectively among cases, while GG (wild type) was only detected among controls in the study population. The genotypic and allelic frequencies conform to Hardy-Weinberg equilibrium meaning that the forces of evolution were not acting on the locus. There were significant differences in the genotypic proportions of the TP53 gene polymorphism among patients and controls. This study on the TP53 gene polymorphism will serve as baseline information on the molecular etiology of hepatocellular carcinoma and liver tumour in Cross River State.

Perioperative versus adjuvant chemotherapy for resectable gastric cancer: a meta-analysis of randomized controlled trials

Objectives

To report the latest systematic review and meta-analysis of randomized controlled trials (RCT) to compare perioperative versus adjuvant chemotherapy for resectable gastric cancer.

Methods

We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April, 2024 for RCT which compared perioperative versus adjuvant chemotherapy for resectable gastric cancer. Outcomes measured were overall survival (OS) and progression-free survival (PFS).

Results

5 RCTs including 2,735 patients were included for meta-analysis. Meta-analysis revealed a significant longer PFS in the neoadjuvant chemotherapy (NAC) group (HR: 0.77; 95% CI: 0.69, 0.85; P<0.00001) compared with adjuvant chemotherapy (AC) group. Subgroup analysis found that there was still a significant superiority of NAC in female (HR: 0.53; 95% CI: 0.40, 0.70; P<0.0001) and cN+ (HR: 0.77; 95% CI: 0.67, 0.89; P=0.0005) patients, while the superiority disappeared in male (HR: 0.87; 95% CI: 0.74, 1.01; P=0.07) and cN- patients (HR: 0.91; 95% CI: 0.46, 1.78; P=0.77). In addition, meta-analysis observed a trend towards improved OS with NAC (HR: 0.86; 95% CI: 0.70, 1.07; P = 0.17), and sensitivity analysis demonstrated instability in OS.

Conclusions

NAC can significantly prolong PFS in patients with resectable gastric cancer compared to AC, and the benefit is more significant in women and cN+ patients. Besides, our analysis indicated that NAC has a potential to improve OS compared with AC.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024546165.

Does robotic assisted surgery mitigate obesity related systemic inflammatory response and clinical outcomes in left sided colorectal cancer resections?

Obesity (BMI > 30 kg/m2) is rapidly increasing worldwide with 26% of the UK population being obese and 38% being overweight. Obesity is intimately related to several life-limiting conditions including colorectal cancer (CRC). Obese patients have a higher degree of perioperative systemic inflammatory response (SIR) and an increased risk of perioperative complications. The aim of this current study was to investigate whether robotic-assisted surgery mitigates the effects of obesity in left sided CRC resections on the SIR and clinical outcomes. All patients undergoing left-sided colorectal cancer resections from May 2021 to May 2023 were, prospectively, entered into a database with patient characteristics and perioperative short-term outcomes recorded. CRP was considered a surrogate for SIR. The relationship between obesity and complications were examined using Chi Square for linear association, Kruskal-Wallis for continuous data and multivariate binary logistic regression model. 221 patients who underwent RAS for left-sided CRC were analysed. Obesity was associated with more comorbidity (ASA, p < 0.01) and SSI (p < 0.05) but not with age, sex, procedure or pathology. POD3 CRP < 150 mg/l was also associated with obesity (p < 0.01). In turn, greater comorbidity was associated with age (p < 0.001), site of resection (p < 0.05), SSI (p < 0.05), postoperative blood transfusion (p < 0.01) and LOS (p < 0.001). On multivariate analysis, only greater ASA (p < 0.05) and surgical procedure (p < 0.01) were associated with the development of an SSI independently. Greater comorbidity but not obesity was independently associated with postoperative SIR and clinical outcomes in patients undergoing RAS. These results support the use of RAS for left sided CRC resections, particularly in the obese.

Bioinspired Materials for Controlling Mineral Adhesion: From Innovation Design to Diverse Applications

The advancement of controllable mineral adhesion materials has significantly impacted various sectors, including industrial production, energy utilization, biomedicine, construction engineering, food safety, and environmental management. Natural biological materials exhibit distinctive and controllable adhesion properties that inspire the design of artificial systems for controlling mineral adhesion. In recent decades, researchers have sought to create bioinspired materials that effectively regulate mineral adhesion, significantly accelerating the development of functional materials across various emerging fields. Herein, we review recent advances in bioinspired materials for controlling mineral adhesion, including bioinspired mineralized materials and bioinspired antiscaling materials. First, a systematic overview of biological materials that exhibit controllable mineral adhesion in nature is provided. Then, the mechanism of mineral adhesion and the latest adhesion characterization between minerals and material surfaces are introduced. Later, the latest advances in bioinspired materials designed for controlling mineral adhesion are presented, ranging from the molecular level to micro/nanostructures, including bioinspired mineralized materials and bioinspired antiscaling materials. Additionally, recent applications of these bioinspired materials in emerging fields are discussed, such as industrial production, energy utilization, biomedicine, construction engineering, and environmental management, highlighting their roles in promoting or inhibiting aspects. Finally, we summarize the ongoing challenges and offer a perspective on the future of this charming field.

Tumour protein p53-activated lncRNA PGM5-AS1 suppresses lung cancer growth and stemness by targeting R-spondin1 via microRNA-1247-5p

OBJECTIVE

This study was to investigated the inhibitory role of the tumour protein p53 (TP53)-activated PGM5-AS1 in lung cancer (LC) cell proliferation, invasion, and CSC-like properties and its underlying mechanisms.

METHODS

The effect of PGM5-AS1 on LC cell development was determined. Stem cell markers, aldehyde dehydrogenase activity in cells were tested, as well as the ability of stem cells to form spheroids. The interaction of PGM5-AS1 and TP53 was determined. The binding link of PGM5-AS1, miR-1247-5p, and R-spondin1 (RSPO1) was verified.

RESULTS

PGM5-AS1 was elevated by a combination of TP53 and PGM5-AS1 promoters. PGM5-AS1 was a molecular sponge of miR-1247-5p in LC cells, and miR-1247-5p targeted RSPO1. Elevating PGM5-AS1 or repressing miR-1247-5p restrained LC cell growth and stemness, which were reversed by depression of RSPO1.

CONCLUSION

This study conveys that TP53-elevated PGM5-AS1 mediates miR-1247-5p to target RSPO1, thereby inhibiting LC growth and stemness, representing a novel avenue for LC therapy.

Epigenetic downregulation of the proapoptotic gene HOXA5 in oral squamous cell carcinoma

Homeobox A5 (HOXA5) has been identified as a tumor suppressor gene in breast cancers, but its role in oral squamous cell carcinoma (OSCC) has not been confirmed. The Illumina GoldenGate Assay for methylation identified that DNA methylation patterns differ between tumorous and normal tissues in the oral cavity and that HOXA5 is one of the genes that are hypermethylated in oral tumor tissues. The present study obtained more‑complete information on the methylation status of HOXA5 by using the Illumina Infinium MethylationEPIC BeadChip and bisulfite sequencing assays. The results indicated that HOXA5 hypermethylation has great potential as a biomarker for detecting OSCC. Comparing HOXA5 RNA expression between normal oral tissue and OSCC tissue samples indicated that its median level was 2.06‑fold higher in normal tissues that in OSCC tissues. Moreover, treatment using the demethylating agent 5‑aza‑2'‑deoxycytidine can upregulate HOXA5 expression in OSCC cell lines, verifying that the silencing of HOXA5 is primarily regulated by its hypermethylation. It was also found that upregulation of HOXA5 expression can not only increase OSCC cell death but that it can also enhance the therapeutic effect of cisplatin both in vitro and in vivo, suggesting that HOXA5 is an epigenetically downregulated proapoptotic gene in OSCC.

Unraveling the molecular landscape of non-small cell lung cancer: Integrating bioinformatics and statistical approaches to identify biomarkers and drug repurposing

Non-small-cell lung cancer (NSCLC) is one of the most malignant tumors and the leading cause of death from cancer worldwide and is increasing at a massive rate every year. Most NSCLC patients are diagnosed at advanced stages, which is associated with a poor prognosis and a very low 5-year survival rate. Therefore, the purpose of this study is to investigate molecular markers for early diagnosis, prognosis and therapy of NSCLC through the integration of bioinformatics and statistical methods. A total of 93 overlapping differentially expressed genes (oDEGs) were identified between NSCLC and normal samples through Linear Models for Microarray (LIMMA) and Significance Analysis of Microarrays (SAM) methods. Six top-degree oDEGs (CCNA2, CDC6, AURKA, CCNB1, MKI67, and PRC1) were identified as key genes (KGs) through the protein-protein interaction (PPI) network. The predictive accuracy analysis of the identified KGs revealed an accuracy of 96.92 %, with a sensitivity of 91.73 % and a specificity of 98.15 %. KGs associated with 3 molecular functions (MFs), 5 cellular components (CCs), 3 biological processes (BPs), and 4 pathways were identified through FunRich software. Analysis of expression levels using the UALCAN database revealed that KGs are significantly associated with potential early diagnostic biomarkers. Survival analysis using the GEPIA database demonstrated that the KGs possessed strong prognostic power for NSCLC. Finally, seven repurposed candidate drugs ENTRECTINIB, SORAFENIB, CHEMBL1765740, TOZASERTIB, NERVIANO, AZD-1152-HQPA, and SELICICLIB were proposed through molecular docking analysis. In conclusion, the findings of this study have the potential to significantly impact the early diagnosis, prognosis, and treatment of NSCLC.

Efficacy and safety of neoadjuvant therapy for hepatocellular carcinoma with portal vein thrombosis: A meta‑analysis

Hepatocellular carcinoma (HCC) with coexisting portal vein tumor thrombus (PVTT) is associated with poor patient outcomes. The efficacy and safety of neoadjuvant therapy in patients with HCC with PVTT remain a subject of debate. In the present study, a comprehensive search of electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, was conducted to identify studies evaluating the outcomes of neoadjuvant therapy in patients with HCC and PVTT. The primary outcomes assessed were overall survival (OS) and relapse-free survival (RFS), with complication rates as a secondary outcome. A total of six studies comprising 750 patients were included in the present meta-analysis. The neoadjuvant therapy group exhibited significantly superior OS [hazard ratio (HR), 0.39; P<0.001] and RFS (HR, 0.31; P<0.001) compared with the primary hepatectomy control group. Compared with the control group, neoadjuvant radiotherapy improved OS (HR, 0.34; P<0.001) and RFS (HR, 0.24; P=0.004). While the neoadjuvant intervention subgroup exhibited an improved OS compared with controls (HR, 0.37; P=0.001), no significant difference in RFS was observed (HR, 0.11; P=0.095). Geographical analysis revealed that the Chinese subgroup demonstrated a significantly improved OS and RFS (HR, 0.41 for both; P<0.001), compared with the control group. However, the Japanese and Korean subgroups showed no improvement in OS (HR, 0.25; P=0.057) compared with the control group, and the results did not reach statistical significance. There were no significant differences between the groups in terms of blood transfusion, blood loss, operation time, bile leakage, ascites, peritoneal infection, postoperative bleeding, complications or mortality (all P>0.05). Overall, neoadjuvant therapy significantly improved survival outcomes in patients with HCC and PVTT without increasing complication rates, supporting its efficacy and manageable safety profile.

Comparative efficacy and safety of first‑line PD‑1/PD‑L1 inhibitors in immunotherapy for non‑small cell lung cancer: A network meta‑analysis

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. The emergence of programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors offers new therapeutic options for patients with advanced NSCLC, but a comprehensive evaluation of their efficacy and safety is still lacking. In the present study randomized controlled trials (RCTs) published from January 2005 to May 2023 were identified through searches of PubMed, the Cochrane Library and Embase. Analysis focused on 10 PD-1/PD-L1 inhibitors for stages III and IV NSCLC in studies evaluating overall survival (OS), progression-free survival (PFS), the objective response rate, the disease control rate (DCR) and the incidence of severe treatment-related and immune-related adverse events. A total of 37 RCTs involving 31,779 patients were included in the analysis. Compared with chemotherapy, tislelizumab, pembrolizumab and nivolumab all significantly improved OS, with tislelizumab showing the highest probability of being the best treatment for improving OS and DCR. While cemiplimab and tislelizumab had the highest probabilities of improved PFS, no significant differences were observed across all PD-1/PD-L1 inhibitors. Combination therapies, such as nivolumab or cemiplimab with chemotherapy, increased OS and PFS but also increased the incidence of severe treatment-related adverse events. In particular, cemiplimab and pembrolizumab were associated with a greater risk of severe immune-related adverse events. In conclusion, PD-1/PD-L1 inhibitors, especially tislelizumab, pembrolizumab and nivolumab, were effective first-line treatments for NSCLC, providing survival benefits. However, the combination of PD-1/PD-L1 inhibitors with chemotherapy increased the risk of severe adverse events. Further research is needed to optimize treatment strategies.

A Comprehensive Analysis of Epoxide Hydrolase 2 (EPHX2) in Pan-Cancer

BACKGROUND AND AIMS

Epoxide hydrolase 2 (EPHX2) regulates lipid signaling across various metabolites by encoding soluble epoxide hydrolase. However, its mechanisms and implications in human malignancies remain unknown. This research aimed to detail the prognostic landscape of EPHX2 in pan-cancer and explore its potential relationship with immune infiltration in the tumor microenvironment.

METHODS

Herein, multiple bioinformatics tools were used to comprehensively evaluate the expression, diagnostic, and prognostic significance of EPHX2 and its roles in the tumor immune microenvironment in human cancers. The underlying EPHX2-associated signaling pathways in cancers were investigated by gene set variation analysis (GSVA). TIDE, GDSC, and CTRP databases were applied to predict the response of EPHX2 to immunotherapy and sensitivity to small molecule drugs. Furthermore, EPHX2 expression was also validated by qPCR experiments in various cancer cell lines.

RESULTS

Overall results revealed significant down-regulation of EPHX2 mRNA expression in most tumors. Despite its high predictive significance across cancers, EPHX2 played a protective or detrimental effect in distinct types of cancers. EPHX2 proved to be a valuable diagnostic biomarker in a range of tumor types, particularly in kidney renal clear cell carcinoma, cervical squamous cell carcinoma, and endocervical adenocarcinoma. Genetic alterations of EPHX2 in 33 tumors were also investigated. EPHX2 expression was significantly linked to immune cell infiltrations (particularly tumor-associated macrophages), tumor mutation burden, microsatellite instability, immune modulators, and immunotherapeutic biomarkers. Single-cell sequencing and GSVA highlighted the relevance of EPHX2 in regulating various cancer-related biological processes, including cell cycle and apoptosis. In this view, targeting EPHX2-dependent signaling could be a promising therapeutic strategy for tumor immunotherapy.

CONCLUSION

EPHX2 may serve as a potential molecular biomarker for diagnosis and prognosis in pan-cancer and could become a novel therapeutic target for various cancers.

Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis

BACKGROUND AND AIMS

The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing. Various cleansing solutions are currently available, but their comparative efficacy remains uncertain. This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy.

METHODS

MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations. The primary outcome was cleansing success (CS), and the secondary outcome was adenoma detection rate (ADR).

RESULTS

On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations), 2 L PEG + simethicone (RR = 1.25 [95 %CI = 1.13-1.37]), 2 L PEG + lactulose (RR = 1.22 [95 %CI = 1.10-1.38]) and 1 L PEG + ascorbate (ASC) (RR = 1.03 [95 %CI = 1.01-1.06]) were significantly superior to 2 L PEG + ASC. Overall, 2 L PEG + lactulose resulted as the best product (SUCRA 0.94), followed by 2 L PEG + simethicone (SUCRA 0.93). On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations), only 2 L PEG + simethicone (RR = 1.60 [95 %CI = 1.05-2.43]) resulted significantly superior to 2 L PEG + ASC.

CONCLUSIONS

2 L PEG + simethicone, 2 L PEG + lactulose, and 1 L PEG + ASC seemed to provide high rates of CS, albeit only 2 L PEG + simethicone was associated with significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR.

Identification and Validation of Four Serum Biomarkers With Optimal Diagnostic and Prognostic Potential for Gastric Cancer Based on Machine Learning Algorithms

BACKGROUND

Gastric cancer (GC) is considered a highly heterogeneous disease, and currently, a comprehensive approach encompassing molecular data from various biological levels is lacking.

METHODS

This study conducted different analyses, including the identification of differentially expressed genes (DEGs), weighted correlation networks (WGCNA), single-cell RNA sequencing (scRNA-seq), mRNA expression-based stemness index (mRNAsi), and multiCox analysis, utilizing data from Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. Subsequently, the machine learning algorithms including least absolute shrinkage and selection operator (LASSO) regression and random forest (RF), combined with multiCox analysis were exploited to identify hub genes. These findings were then validated through the receiver operating characteristic (ROC) curve and Kaplan-Meier analysis, and were experimentally confirmed in GC samples by reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA).

RESULTS

Integrated analysis of TCGA and GEO databases, coupled with LASSO regression and RF algorithms, allowed us to identify 18 hub genes encoding differentially expressed secreted proteins in GC. The results of RT-PCR and bioinformatics analysis revealed four promising biomarkers with optimal diagnostic and prognostic potential. ROC analysis and Kaplan-Meier curves highlighted CHI3L1, FCGBP, VSIG2, and TFF2 as promising biomarkers for GC, offering superior modeling accuracy. These findings were further confirmed by RT-PCR and ELISA, affirming the clinical utility of these four biomarkers. Additionally, CIBERSORT analysis indicated a potential correlation between the four biomarkers and the infiltration of B memory cells and Treg cells.

CONCLUSION

This study unveiled four promising biomarkers present in the serum of patients with GC, which could serve as powerful indicators of GC and provide valuable insights for further research into GC pathogenesis.

Radiotracer Accumulation in the Pyelocaliceal System of Transplanted Kidney: A Potential Pitfall in Lymphoscintigraphy of Pelvic Malignancies

A 34-year-old woman with a history of renal transplantation and cervical cancer underwent lymphoscintigraphy using 99mTc-phytate before surgery. Initial planar images revealed multiple foci of uptake, which were later precisely localized using SPECT/CT imaging. Notably, uptakes in the right lower quadrant were attributed to the pyelocalyceal system of the transplanted kidney, highlighting a potential pitfall in patients with ectopic or transplanted kidneys. This case report emphasizes the importance of recognizing the limitations of lymphoscintigraphy in patients with complex anatomy and the value of hybrid imaging in ensuring accurate sentinel lymph node localization.

Tislelizumab plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy for elderly patients with inoperable locally advanced esophageal squamous cell carcinoma: a multicenter, randomized, parallel-controlled, phase II clinical trial

BACKGROUND

The standard treatment for elderly patients with unresectable locally advanced esophageal squamous cell carcinoma (ESCC) is definitive chemoradiotherapy with S-1. However, the 3-year overall survival (OS) is limited to approximately 40%. Tislelizumab is the first- and second-line standard treatment for advanced ESCC with tolerable toxicity. In this study, we aimed to explore a new curative strategy for locally advanced unresectable ESCC in the elderly by combining tislelizumab with chemoradiotherapy.

METHODS

This study is an open-label, multicenter, investigator-initiated phase II clinical trial in older patients with inoperable locally advanced ESCC evaluating tislelizumab plus concurrent chemoradiotherapy compared with concurrent chemoradiotherapy. The main inclusion criteria were pathological confirmation of locally advanced inoperable ESCC at clinical cT1N2-3M0 or cT2-4bN0-3M0 (stage II-IVA), age ≥ 70 years, absence of previous systemic anti-tumor therapy, and adequate organ function. A total of 136 patients will be recruited from approximately seven centers (in Tianjin, Chengdu, Taiyuan, Zhengzhou, Shijiazhuang, Changsha, Nanjing) over a period of 18 months and randomized in a 1:1 ratio to receive tislelizumab in combination with concurrent chemoradiotherapy (tislelizumab + S-1 + radiotherapy) or concurrent chemoradiotherapy (S-1 + radiotherapy). The efficacy and safety of the treatment will be evaluated during the therapy and follow-up period until disease progression, death, or the end of the trial. The primary study endpoint was investigator-assessed progression-free survival (PFS), and secondary study endpoints were OS, objective response rate (ORR), duration of remission (DOR), and safety. Fresh or archival tumor tissues and peripheral blood samples will be used in exploratory studies.

DISCUSSION

This study is the first "programmed death-1 (PD-1) inhibitor combined with concurrent chemoradiotherapy" for elderly patients with inoperable locally advanced ESCC (NCT06061146). The synergistic efficacy of combined definitive concurrent chemoradiotherapy with tislelizumab is expected to result in survival benefits for elderly patients with inoperable locally advanced ESCC. Because S-1 plus concurrent radiotherapy is the standard treatment option for locally advanced ESCC in older patients, the combination of definitive concurrent chemoradiotherapy and tislelizumab has the potential to change the standard ESCC therapeutic strategy with comparable safety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06061146.Registered 9/10/2023.

Discovery of a new mitophagy-related gene signature for predicting the outlook and immunotherapy in triple-negative breast cancer

Mitophagy is an essential cellular process that is conserved and crucial for maintaining cellular balance by selectively eliminating malfunctioning mitochondria. However, there is still limited knowledge regarding the influence of mitophagy-related genes (MRGs) on the prognosis and response to treatment of triple-negative breast cancer (TNBC). In here, the TCGA and GEO databases were used to acquire the transcriptomic and clinical information of patients with TNBC, correspondingly. Using LASSO and multivariable Cox regression analyses, a risk signature related to mitophagy was established based on the prognostic MRGs. The prognostic signature associated with mitophagy consisted of five genes (BSG, JMJD6, DNAJA3, DISC1, and SQSTM1) and independently predicted the prognosis of patients with TNBC, regardless of clinical factors (p < 0.05). Patients classified within the high-risk group demonstrated significantly lower overall survival rates when contrasted with those in the low-risk group. The model exhibited excellent performance in predicting survival and risk stratification, as evidenced by the receiver operating characteristic and C-index. The findings stayed unchanged following external validation. Moreover, we observed a notable variation in the tumor immune microenvironment among the different risk categories. Patients with a low risk of TNBC demonstrated a more favorable response to immunotherapy compared to patients with a high risk. In conclusion, our study uncovered the possible impacts of MRGs on the tumor microenvironment, clinical and pathological characteristics, and outlook of TNBC. The CRG-related signature was strongly linked to the immune response against TNBC and has the potential to serve as a valuable tool in predicting the prognosis and immunotherapy response of patients.

Emerging engineered nanozymes: current status and future perspectives in cancer treatments

Composite nanozymes are composed of enzymes with similar or different catalytic capabilities and have higher catalytic activity than a single enzyme. In recent years, composite nanozymes have emerged as novel nanomaterial platforms for multiple applications in various research fields, where they are used to produce oxygen, consume glutathione, or produce toxic reactive oxygen species (ROS) for cancer therapy. The therapeutic approach using composite nanozymes is known as chemo-dynamic therapy (CDT). Some composite nanozymes also show special photothermal conversion effects, enabling them to be combined with pioneering cancer treatments, such as photodynamic therapy (PDT), photothermal therapy (PTT) and sonodynamic therapy (SDT), and enhance the anti-cancer effects. In this study, the classification and catalytic performances of composite nanozymes are reviewed, along with their advantages and synthesis methods. Furthermore, the applications of composite nanozymes in the treatment of cancers are emphasized, and the prospective challenges in the future are discussed.

Polycyclic Aromatic Hydrocarbons (PAHs) in the Environment: Occupational Exposure, Health Risks and Fertility Implications

Polycyclic aromatic hydrocarbons (PAHs) are a group of organic compounds with fused aromatic rings, primarily derived from combustion processes and environmental pollutants. This narrative review discusses the most relevant studies on PAHs, focusing on their sources, environmental and occupational exposure, and effects on human health, emphasizing their roles as carcinogenic, mutagenic, and teratogenic agents. The primary pathways for human exposure to PAHs are through the ingestion of contaminated food (mainly due to some food processing methods, such as smoking and high-temperature cooking techniques), the inhalation of ambient air, and the smoking of cigarettes. Coke oven workers are recognized as a high-risk occupational group for PAH exposure, highlighting the need for appropriate strategies to mitigate these risks and safeguard worker health. PAHs are metabolized into reactive intermediates in the body, which can lead to DNA damage and promote the development of various health conditions, particularly in environments with high exposure levels. Chronic PAH exposure has been linked to respiratory diseases, as well as cardiovascular problems and immune system suppression. Furthermore, this review underscores the significant impact of PAHs on reproductive health. The results of the reported studies suggest that both male and female fertility can be compromised due to oxidative stress, DNA damage, and endocrine disruption caused by PAH exposure. In males, PAHs impair sperm quality, while, in females, they disrupt ovarian function, potentially leading to infertility, miscarriage, and birth defects. Fetal exposure to PAHs is also associated with neurodevelopmental disorders. Given the extensive and detrimental health risks posed by PAHs, this review stresses the importance of stringent environmental regulations, occupational safety measures, and public health initiatives to mitigate exposure and safeguard reproductive and overall health.

Identification and validation of an m5C-related lncRNA signature for predicting prognosis and immune response in clear cell renal cell carcinoma

This study investigated whether m5C-related Long non-coding RNAs (lncRNAs) can predict clear cell renal cell carcinoma (ccRCC) patient prognosis. Co-expression and Cox regression analyses identified 9 prognostic lncRNAs, which were closely associated with tumor immune characteristics and immune escape. The model also predicted the sensitivity of drugs, including Entinostat, SB216763, and Sapitinib. In vitro experiments showed that GNG12-AS1 inhibited ccRCC cell proliferation and migration by reducing the activity of the ERK/GSK-3β/β-catenin pathway. Overall, these findings suggest that the 9 m5C-related lncRNAs can accurately predict ccRCC patient prognosis, providing potential applications for clinical and immunotherapy approaches. GNG12-AS1 emerges as a promising prognostic biomarker for predicting survival outcomes in ccRCC, potentially influencing cell migration through the activation of the ERK/GSK-3β/β-catenin signaling pathway.

Prognostic and Predictive Value of Systemic Inflammatory Markers in Epithelial Ovarian Cancer

Background and Objectives: Epithelial ovarian cancer (EOC) remains a significant global health challenge. While traditional prognostic factors are well established, emerging biomarkers continue to gain attention. Materials and Methods: This retrospective study evaluated the impact of systemic inflammatory markers on progression-free survival (PFS) and overall survival (OS) in 154 EOC patients. Pre-treatment neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory index (SII) were calculated and categorized into low and high groups. Univariate and multivariate analyses were conducted to identify independent prognostic factors, while logistic regression analysis was used to determine predictors of platinum resistance. Results: In the univariate analysis, elevated NLR and PLR were associated with poorer PFS and OS. However, these markers did not maintain statistical significance in the multivariate analysis. Although SII demonstrated a trend toward worse outcomes, it did not reach statistical significance. Histopathological type, PLR, and surgical approach were identified as independent predictors of platinum resistance. Conclusions: Our findings indicate that systemic inflammatory markers may hold prognostic value in EOC; however, further validation through larger prospective studies is necessary.

Cognitive remediation in breast cancer survivors: A study protocol

Cancer treatment-related cognitive impairment, also known as "Chemobrain," is frequently reported among cancer survivors. This condition can persist for months after the end of cancer treatment and can affect various aspects of a patients' quality of life. Despite growing evidence, research into effective treatments remains an emerging field. This project aims to assess the effectiveness of a cognitive remediation protocol called Oncogite in reducing cancer treatment-related cognitive impairment. The primary outcomes are self-reported functional and emotional well-being. The secondary outcomes include measures of executive function (working memory, inhibition, shifting), episodic memory, perceived cognitive function and perceived quality of life. One hundred sixty-four breast cancer survivors will be recruited from an existing cohort. Patients will be randomized to either a cognitive remediation group or a no intervention group. Participation in the workshops will be via videoconferencing, led by a neuropsychologist. Patients in the experimental group will also have access to an internet platform with the exercises practiced between the group workshops. The intervention will last four months at a rate of one workshop per week. The following data will be collected: emotional and functional well-being, neurocognitive performance, switching, inhibition, cognitive complaints, episodic memory, fatigue and depression. We will conclude that the intervention is effective if there is 4-month improvement in both emotional and functional well-being to find in the experimental group in their cognitive functioning. This research will contribute to the development of new clinical tools for cancer treatment-related cognitive impairment and facilitate the return to work in cancer survivors.

Association of composite dietary antioxidant index with high risk of prostate cancer in middle-aged and elderly men: insights from NHANES

Objectives

In the US, the most common type of cancer and the second leading cause of cancer-related death in men is prostate cancer (PCa). Food and lifestyle factors may influence the risk of developing prostate cancer. Therefore, research on dietary components associated with prostate cancer is essential for its prevention. Data from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2010 was used for this cross-sectional investigation involving 5,658 middle-aged and older American men.

Methods

Dietary antioxidant vitamins A, C, E, total carotenoids, zinc, and selenium were subtracted from the total mean, divided by the standard deviation, respectively, and then summed to become the CDAI. Participants were categorized as high risk for PCa if they had tPSA greater than 10 ng/mL or tPSA levels between 4 and 10 ng/mL with f/t PSA ratios of 25% or below; the remaining subjects were classified as being at low risk for PCa.

Results

The sample represented approximately 75,984,602 American men. After multivariate logistic regression, dose-effect analysis and stratified analysis, CDAI was significantly and linearly negatively associated with a high risk of prostate cancer (OR=0.95, P=0.002, P for linear=0.0021). Age moderation analysis showed a significant effect on the inverse relationship between CDAI and prostate cancer risk (B = -0.0097, SE = 0.0034, t = -2.85, P = 0.004). Among the independent effects of CDAI components, zinc and selenium were more strongly negatively associated with prostate cancer (zinc, OR = 0.80, P = 0.008; selenium, OR = 0.78, P< 0.001).

Conclusions

CDAI serves as a dietary indicator of prostate cancer risk in middle-aged and older men, and high dietary antioxidant intake has a significant protective effect on prostate cancer risk, especially in the older population of men.

A phase III randomized study of first-line NUC-1031/cisplatin vs. gemcitabine/cisplatin in advanced biliary tract cancer

BACKGROUND & AIMS

The previous first-line standard of care for advanced biliary tract cancer (aBTC), gemcitabine/cisplatin, has modest efficacy. NUC-1031 is a phosphoramidate modification of gemcitabine. We report final analyses of the NuTide:121 study, designed to compare the efficacy of NUC-1031/cisplatin to gemcitabine/cisplatin in aBTC.

METHODS

In this open-label, multicenter study, adult patients with treatment-naïve aBTC were randomized (1:1) to NUC-1031/cisplatin (n = 388) or gemcitabine/cisplatin (n = 385) on Days 1 and 8 of 21-day cycles until disease progression or intolerance. Primary endpoints were overall survival (OS) and objective response rate (blinded independent central review). Three interim analyses (IA) and a final analysis were planned.

RESULTS

Baseline characteristics were balanced; median age 65 years, 53% male, primary tumors: intrahepatic cholangiocarcinoma (CCA) (54%), extrahepatic CCA (21%), gallbladder cancer (21%) and ampullary cancer (5%). Enrollment stopped at IA1 as the OS futility boundary was crossed. At final data cut-off, median OS for NUC-1031/cisplatin vs. gemcitabine/cisplatin was 9.2 months (95% CI 8.3-10.4) vs. 12.6 months (95% CI 11.0-15.1) (HR 1.79) and median PFS was 4.9 months (95% CI 4.4-6.0) vs. 6.4 months (95% CI 6.1-7.4) (HR 1.45). Objective response rate was higher for NUC-1031/cisplatin (18.7% vs. 12.4%; OR: 1.59; p = 0.049). The adverse event profile was similar between arms, except for hepatobiliary disorders (25% vs. 11%; higher with NUC-1031/cisplatin) and hematological events (48% vs. 65%; higher with gemcitabine/cisplatin). More patients met criteria for potential drug-induced liver injury (27% vs. 7%) and Hy's law (1.6% vs. 0.5%) with NUC-1031/cisplatin. Treatment exposure was lower for NUC-1031/cisplatin, likely due to early discontinuation for AEs (30% vs. 18%).

CONCLUSIONS

NuTide:121 was terminated early due to futility. NUC-1031/cisplatin did not set a new standard in first-line aBTC.

IMPACT AND IMPLICATIONS

Although clinical practice guidelines identified gemcitabine plus cisplatin as standard of care for advanced biliary tract cancer (aBTC) based on clinical studies, the modest efficacy observed with this regimen highlighted the urgent need for more effective therapies. NuTide:121, one of the largest randomized interventional studies conducted in the first-line aBTC population to date, compared the combination of cisplatin with NUC-1031, a phosphoramidate form of gemcitabine, with the standard of care regimen. Despite a higher response rate in the NUC-1031/cisplatin arm, the study was terminated early based on a futility assessment for OS. Early toxicity and in particular liver injury likely contributed to the regimen's failure. This study emphasized some important challenges in study design and further confirmed the difficulties of advancing treatment options in this vulnerable patient population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04163900.

A Preliminary Study of CircRNA Expression Characteristics in the Progression of Colorectal Cancer

Colorectal cancer (CRC) progression involves complex genetic changes. This study examines circRNA expression in CRC to identify biomarkers for improved diagnosis and staging. The objective of this study is to explore the role of circular RNA (circRNA) in CRC progression and identify specific circRNA biomarkers. Using high-throughput circRNA chip technology, cancerous and adjacent tissues from three CRC patients (staged as T1-3N0M0) were analyzed to identify differentially expressed circRNAs. Bioinformatics analyses, including co-expression network construction, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations, were performed to evaluate circRNA function and pathways. A total of 404 differentially expressed circRNAs were identified, with significant variations between cancerous and adjacent tissues. Trend analysis revealed that circRNA expression decreased progressively with CRC advancement. Co-expression network analysis highlighted eight key circRNAs, including hsa_circ_0000007, associated with CRC progression. GO and KEGG analyses indicated these circRNAs are involved in ribosome biogenesis, metabolism, and the regulation of G1-S phase transcription through the RB1 gene. The expression of hsa_circ_0000007, hsa_circ_0023608, hsa_circ_0026694, and hsa_circ_0029903 decreased as CRC progressed, suggesting their potential as biomarkers for CRC diagnosis and staging. These findings offer insights into the molecular mechanisms underlying CRC progression.

Site-specific follow-up strategy for surgically resected patients with NSCLC based on ten-year follow-up data

OBJECTIVES

There is currently no consensus regarding the optimal site-specific postoperative follow-up duration for patients with completely resected non-small cell lung cancer. Long-term surveillance for recurrence may lead to psychological distress or economic burdens for patients.We aimed to propose an appropriate site-specific follow-up strategy for patients with non-small cell lung cancer based on 10-year follow-up data.

MATERIALS AND METHODS

We analyzed recurrence patterns in 2,359 patients with non-small cell lung cancer who underwent surgical resection from 2008 to 2013. We established potential site-specific follow-up endpoints when the subsequent recurrence rates fell below 5% and proposed a corresponding follow-up strategy.

RESULTS

With a median follow-up of 111.0 months, postoperative recurrences were observed in 985 patients (41.8 %). We identified several factors associated with site-specific recurrence recurrence patterns, including ground-glass opacity component, sex, histology type, and pathological TNM stage. No recurrence was observed in patients with pure ground-glass nodules, a consolidation-to-tumor ratio less than 0.5, or a pathological type classified as lepidic pattern-predominant adenocarcinoma. In thorax, brain and bone, patients with non-squamous cell carcinoma exhibited higher recurrence rates than those with squamous cell carcinoma. In abdomen and neck, male patients have a higher recurrence rate than female patients, particularly within the pathological stage III group.

CONCLUSIONS

The follow-up strategy was developed based on the recurrence patterns analyzed from ten-year follow-up data. The online tool may assist in determining the optimal site-specific duration for surveillance based on clinicopathologic features.

Knowledge, attitudes, behaviors, and information needs of women vaccinated with the HPV vaccine regarding cervical cancer prevention: a cross-sectional study

Background

Cervical cancer poses a serious threat to women's health globally, especially in China. HPV vaccination and screening are crucial prevention and control measures. However, the screening coverage among Chinese women remains low, and there is a need to better understand the knowledge, attitudes, behaviors, and information needs of Chinese HPV-vaccinated women regarding cervical cancer prevention to optimize prevention and control strategies.

Objectives

To explore the knowledge, attitudes, behaviors, and information needs of women vaccinated with the HPV vaccine regarding cervical cancer prevention.

Methods

This cross-sectional study was conducted using a convenience sampling method from October 1 to December 30, 2023. A questionnaire survey was administered to 439 women vaccinated with the HPV vaccine at the Shu Shan District Community Health Service Center in Hefei, Anhui Province. The survey tool was self-designed. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression.

Results

The average age of the 439 participants was 27.82 ± 6.42 years. The average cervical cancer prevention knowledge score was 35.01 ± 5.76. 434 (98.9%) women held a positive attitude towards cervical cancer screening, and 320 (72.9%) women had undergone cervical cancer screening after receiving the HPV vaccine. Educational levels such as college (OR = 2.995, 95%CI: 1.233-7.279, p = 0.015), bachelor's degree (OR = 3.694, 95%CI: 1.718-7.943, p = 0.001), and postgraduate and above (OR = 4.826, 95%CI: 2.176-10.707, p < 0.001), as well as occupation as medical workers (OR = 4.660, 95%CI: 2.292-9.474, p < 0.001), were associated with higher knowledge of prevention and treatment scores. Individuals aged 26-35 years (OR = 7.431, 95%CI: 2.856-19.331, p < 0.001), 36-45 years (OR = 11.466, 95%CI: 2.279-57.694, p = 0.003), married individuals (OR = 4.307, 95%CI: 1.455-12.750, p = 0.008), and participants who had received health education related to cervical cancer prevention (OR = 2.125, 95%CI: 1.169-3.863, p = 0.013) and possessed good knowledge of prevention (OR = 16.770, 95%CI: 8.667-32.451, p < 0.001) were more inclined to undergo cervical cancer screening. Among the 254 participants who had received health education, 34.2% still had unmet information needs regarding cervical cancer prevention, and 29.5% hoped to receive health education services from professionals.

Conclusion

Chinese HPV-vaccinated women have a good understanding of cervical cancer prevention and a positive attitude and behavior towards cervical cancer screening. However, their knowledge of cervical cancer screening is not sufficient, and their information needs have not been fully met.