Current oncology最新文献

{"title":"Soft Tissue Reconstruction and Integration to Implant After Bone-Tumor Resection: A Current Concept Review.","authors":"Elisa Pesare, Raffaele Vitiello, Tommaso Greco, Giuseppe Solarino, Giulio Maccauro, Antonio Ziranu","doi":"10.3390/curroncol31110531","DOIUrl":"10.3390/curroncol31110531","url":null,"abstract":"<p><strong>Introduction: </strong>With the advancements in chemotherapy for malignant bone tumors, the number of patients eligible for limb salvage surgery has increased. Surgeons face a subsequent challenge in limb-sparing resection due to the need for reconstructing soft tissue coverage. The aim of this review is to focus on the present state of the field in these areas, highlighting recent advancements.</p><p><strong>Methods: </strong>A literature research was conducted using keywords such as \"soft tissue\", \"integration\", \"reconstruction\", \"megaprosthesis\", and \"soft tissue coverage\", on different databases, and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria, a total of 35 studies were selected.</p><p><strong>Results: </strong>In recent times, there has been a growing emphasis on different techniques such mesh application, allograft-prosthesis composites, allograft reconstruction, a polyethylene terephthalate (PET) tube, prosthesis itself and certain metals utilized for implant coatings are used in soft tissue reconstruction.</p><p><strong>Conclusion: </strong>While tissue-engineered constructs and advancements in biological and cellular approaches have shown potential for enhancing osseointegration and interactions with soft tissues and implants, the actual clinical outcomes have frequently fallen short of expectations. The success of soft tissue integration is crucial for achieving functional outcomes, minimizing complications, and ensuring the long-term stability of orthopedic implants.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7190-7203"},"PeriodicalIF":2.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Pharmacokinetics of Tamibarotene in Pediatric and Young Adult Patients with Recurrent or Refractory Solid Tumors.","authors":"Takuya Azechi, Yutaka Fukaya, Chika Nitani, Junichi Hara, Hiroshi Kawamoto, Tomoaki Taguchi, Kenichi Yoshimura, Akihiro Sato, Naoko Hattori, Toshikazu Ushijima, Toshimi Kimura","doi":"10.3390/curroncol31110527","DOIUrl":"10.3390/curroncol31110527","url":null,"abstract":"<p><p>Tamibarotene is a synthetic retinoid that inhibits tumor cell proliferation and promotes differentiation. We previously reported on the safety and tolerability of tamibarotene in patients with recurrent or refractory solid tumors. Therefore, in this study, we aimed to evaluate the pharmacokinetic properties of tamibarotene and construct a precise pharmacokinetic model. We also conducted a non-compartmental analysis and population pharmacokinetic (popPK) analysis based on the results of a phase I study. Targeted pediatric and young adult patients with recurrent or refractory solid tumors were administered tamibarotene at doses of 4, 6, 8, 10, and 12 g/m²/day. Serum tamibarotene concentrations were evaluated after administration, and a popPK model was constructed for tamibarotene using Phoenix NLME. During model construction, we considered the influence of various parameters (weight, height, body surface area, and age) as covariates. Notably, 22 participants were included in this study, and 109 samples were analyzed. A two-compartment model incorporating lag time was selected as the base model. In the final model, the body surface area was included as a covariate for apparent total body clearance, the central compartment volume of distribution, and the peripheral compartment volume of distribution. Visual prediction checks and bootstrap analysis confirmed the validity and predictive accuracy of the final model as satisfactory.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7155-7164"},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11592880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitation of Enrollment onto Cancer Clinical Trials Using a Novel Navigator-Assisted Program: A Cross-Sectional Study.","authors":"Mahmoud Hossami, Rhonda Abdel-Nabi, Farwa Zaib, Kayla Touma, Renee Nassar, Sanghyuk Claire Rim, Milica Paunic, Olla Hilal, Pratham Gupta, Roaa Hirmiz, Michael Touma, Govana Sadik, Emmanuel Akingbade, Depen Sharma, Swati Kalia, Rija Fatima, Anthony Luginaah, Ibrahim Mohamed, Rong Luo, Megan Delisle, Caroline Hamm","doi":"10.3390/curroncol31110526","DOIUrl":"10.3390/curroncol31110526","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical trials are essential to the advancement of clinical therapies that improve the outcomes of people with cancer. However, enrollment in clinical trials remains a challenge. The Clinical Trial Navigator [CTN] Program was designed to address the current gap in the cancer care journey by assisting with the clinical trials search process.</p><p><strong>Methods: </strong>Between March 2019 and July 2024, applicants of the CTN program included people with cancer, their family members, and/or their care team. Applicants entered the CTN program through a REDCap^® survey that collected the patient's medical history. A final curated list of potential clinical trials was provided to the applicant. Metrics of success included clinical trial referral and enrollment, and we examined the factors that impacted these outcomes.</p><p><strong>Results: </strong>A total of 445 people with cancer applied to the CTN program during the study. Of the 262 patients with referral and enrollment information, a trial referral occurred in 27.5% [n = 72]. Of the 72 patients who were referred to a clinical trial, 13 [18.1%] were enrolled, 9 [12.5%] are pending enrollment, and 50 [69.4%] were not enrolled. We identified a potential trial for 88% of applicants, with a median of one potential trial per patient. Physicians were highly involved as applicants.</p><p><strong>Interpretation: </strong>The CTN program is successful in searching for clinical trials for people with cancer. Ongoing implementation into other Canadian sites, assessments of patient-reported outcomes, website and social media campaigns, and research into the factors that impact referral and enrollment are underway.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7144-7154"},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibody-Drug Conjugates: A Start of a New Era in Gynecological Cancers.","authors":"Samir Fasih, Stephen Welch, Ana Elisa Lohmann","doi":"10.3390/curroncol31110522","DOIUrl":"10.3390/curroncol31110522","url":null,"abstract":"<p><p>Antibody-drug conjugates (ADCs) are a new class of therapeutic agents designed to target specific antigens on tumor cells, combining the specificity of monoclonal antibodies with the cytotoxicity of chemotherapy agents. ADCs have been available for over a decade, but in gynecological cancers, these agents are relatively new with great promise ahead. More than 80% of ongoing trials in gynecological cancers are evaluating ADCs' safety and efficacy, of which 40% are early-phase trials. Around twenty ADCs are currently under investigation, either alone or in combination with chemotherapies or immune checkpoint inhibitors. Among them, mirvetuximab soravtansine has been recently approved by the Food and Drug Administration (FDA) in platinum-resistant ovarian cancer with high folate-α receptor expression, as a single agent or in combination. Tisotumab vedotin and trastuzumab deruxtecan are also now approved by the FDA in patients with pre-treated cervical and uterine cancers and further investigation is ongoing. Overall, the toxicity profiles of ADCs are acceptable. Ocular toxicity is one of the specific side effects of some ADCs, but most of the cases are manageable with the use of prophylactic steroids and dose adjustments. This review aims to provide an overview of the fundamental and operational features of ADCs and examine the latest and most promising data, with a particular focus on the Canadian viewpoint.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7088-7106"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Therapy for Cutaneous Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report and Review of the Literature.","authors":"Masashi Taka, Shinichiro Toyoshima, Shigeyuki Takamatsu, Satoshi Kobayashi","doi":"10.3390/curroncol31110524","DOIUrl":"10.3390/curroncol31110524","url":null,"abstract":"<p><p>Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a clinically aggressive hematologic malignancy derived from plasmacytoid dendritic cells. It commonly presents as cutaneous lesions. To date, no standard treatment protocol for BPDCN exists. Traditionally treated similarly to acute leukemia or lymphoma, its prognosis remains poor. Radiation therapy is employed for isolated skin lesions, for patients that are ineligible for chemotherapy due to age or comorbidities and for post-chemotherapy recurrence. However, very limited reports are available on radiotherapy for BPDCN. We present a case involving a 94-year-old BPDCN patient treated with radiation therapy, highlighting an atypical situation of two separate radiotherapy sessions with different dosages for isolated skin lesions. Initially, 45 Gy was administered in 15 fractions (45 Gy/15 Fr), followed by a second session of 30 Gy in 10 fractions (30 Gy/10 Fr) after disease recurrence. This case is unique in detailing radiation therapy for the exceedingly rare BPDCN, particularly dose fractionation. The findings indicate that 45 Gy/15 Fr can provide adequate local control, while even a lower dose of 30 Gy/10 Fr may be effective. This case report contributes to the limited literature by proposing potential therapeutic approaches and dosage guidelines to refine future BPDCN treatment protocols.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7117-7128"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Diversion Can Improve the Chance of Implementing New Therapeutic Lines in Patients with Malignant Ureteral Obstruction: A Multicenter Study.","authors":"Marcelo Cartapatti, Roberto Dias Machado, José Carlos Mesquita, Raphael Freua, Diego Cáceres, Rodolfo Borges Dos Reis","doi":"10.3390/curroncol31110523","DOIUrl":"10.3390/curroncol31110523","url":null,"abstract":"<p><strong>Purpose: </strong>Malignant ureteral obstruction is generally associated with a poor disease prognosis; therefore, managing these cases is challenging. We describe our experience in treating malignant ureteral obstruction with urinary diversion and the impact of these procedures on the indication for new antineoplastic therapy and survival.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the data of patients with advanced cancer associated with malignant ureteral obstruction who underwent urinary diversion at three tertiary institutions between January 2013 and July 2022.</p><p><strong>Results: </strong>This study included 420 patients (mean age, 58.7 years (range, 18-90 years) with a mean follow-up of 20.3 months. Cervical (36.2%) and bladder cancers (18.6%) were the most prevalent primary neo-plastic sites. The mean creatinine values measured before diversion, 30 days after surgery, and most recently were 3.45, 1.84, and 2.59 mg/dL, respectively. In total, 300 patients (71.4%) received antineoplastic treatment, 195 received palliative treatment, and 105 received curative treatment. After an average of 251.87 postoperative days, 265 (64%) patients died. The mean overall survival was 610.76 days. Patients with prostate and cervical neoplasms had the most prolonged overall survival (573.13 and 549.28 days, respectively), whereas patients with bladder and colorectal cancer had the worst overall survival (480.25 and 370.53 days, respectively).</p><p><strong>Conclusions: </strong>Urinary diversion improves kidney function and opens a therapeutic window for a new line of antineoplastic therapy that provides a cure or increases patient survival.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7107-7116"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors of Immune-Mediated Hepatotoxicity Induced by Immune Checkpoint Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis.","authors":"Ying Jiang, Ranyi Li, Xiaoyu Li, Ningping Zhang","doi":"10.3390/curroncol31110525","DOIUrl":"10.3390/curroncol31110525","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) significantly improve survival, while immune-mediated hepatotoxicity (IMH) has been reported. To evaluate the incidence and potential risk factors of IMH among cancer patients treated by ICIs, PubMed/Medline, Web of Science, Cochrane, and Embase were searched before 30 March 2024 for systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Quality assessment was completed using the Newcastle-Ottawa scale. Of 1217 articles identified, 24 consisting of 9076 patients were included, with one study being prospective and the rest retrospective. The overall incidence of any grade IMH and grade ≥ 3 secondary to ICIs was 14% and 7%, respectively. The cholestatic pattern was more prevalent than the hepatocellular and mixed patterns. The meta-analysis revealed that ICI treatment was related to reduced risk of IMH in older patients (SMD: -0.18; 95% CI: -0.33 to -0.04), individuals with higher body mass index (WMD: -2.15; 95% CI: -3.92 to -0.38), males (OR: 0.44; 95% CI: 0.27 to 0.72), and patients with lung cancer (OR: 0.58, 95%CI 0.41 to 0.83). On the other hand, patients with liver metastasis (OR: 1.80; 95% CI: 1.47 to 2.20), history of ICI treatment (OR: 3.09; 95% CI: 1.21 to 7.89), diabetes (OR: 2.19; 95% CI: 1.36 to 3.51), chronic HBV (OR: 3.06; 95% CI: 1.11 to 8.46), and concomitant use of ICIs (OR: 8.73; 95% CI: 2.41 to 31.59) increased the risk of developing IMH. This study will provide clinicians with information on potentially high-risk groups for IMH, who need to be cautiously monitored for liver function when receiving immunotherapy.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7129-7143"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Role of Pre-Treatment Neutrophil-to-Lymphocyte Ratio in an Asian Cohort of Patients with Oropharyngeal Squamous Cell Carcinoma.","authors":"Isabelle J H Jang, Hanis B Abdul Kadir, Kok Hing Lim, Wen Chao Daniel Chew, Jacqueline S G Hwang, Chwee Ming Lim","doi":"10.3390/curroncol31110521","DOIUrl":"10.3390/curroncol31110521","url":null,"abstract":"<p><strong>Purpose: </strong>The neutrophil-to-lymphocyte ratio is a simple biomarker that reflects the balance between the systemic inflammatory and immunity status. Here we investigate the prognostic role of pre-treatment neutrophil-to-lymphocyte ratio (NLR) in an Asian cohort of oropharyngeal squamous cell carcinoma (OPSCC) patients.</p><p><strong>Methods: </strong>A retrospective review of OPSCC patients from a tertiary institution was conducted. The NLR was calculated from the haematological specimen taken within a month before treatment. Survival rates were estimated via the Kaplan-Meier method, and Cox proportional hazards regression was performed for univariable and multivariable analyses. The NLR cutpoint was determined using maximally selected log-rank statistics.</p><p><strong>Results: </strong>In a cohort of 148 OPSCC patients, 43% were p16-positive and 44% were p16-negative, with a median follow-up of 24 months. The p16-positive patients were younger (median age 62 vs. 67 years) and exhibited a lower prevalence of heavy smoking (47% vs. 69%). The p16-negative cases frequently presented at an advanced disease stage (74% vs. 41%), with a history of previous radiotherapy (26% vs. 3%). The p16-negative patients displayed a higher median NLR (2.91 vs. 2.49). The 3-year disease-specific survival (DSS) in p16-positive was higher compared to p16-negative patients (89.9% vs. 41.6%). The optimal NLR cutpoint was determined as 3.56 and predicted for decreased DSS (hazard ratio [HR] 2.59, <i>p</i> = 0.004). Multivariable analysis revealed smoking, high NLR ≥ 3.56, and p16-negativity as independent variables associated with poorer DSS and overall survival (OS) across the cohort.</p><p><strong>Conclusion: </strong>A high NLR is independently prognostic of poorer DSS in OPSCC, independent of p16 and smoking status. A NLR of more than 3.56 was highly prognostic for poorer survival and warrants further validation in larger cohorts of OPSCC.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7074-7087"},"PeriodicalIF":2.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11592546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist.","authors":"Panthea Pouramin, Susan E Allen, Joseph L Silburt, Boris L Gala-Lopez","doi":"10.3390/curroncol31110519","DOIUrl":"10.3390/curroncol31110519","url":null,"abstract":"<p><p>Liver transplants (LTs) are prioritized by mortality risk, which is estimated by MELD scores. Since hepatocellular carcinoma (HCC) patients present with lower MELD scores, they are allocated MELD exception points. Concerns persist that HCC recipients are over-prioritized, resulting in disproportionate waitlist mortality among non-HCC patients. We assessed whether the Median Meld at Transplant minus 3 (MMaT-3) scoring system would balance waitlist mortality and transplantation rates between HCC and non-HCC patients. We reviewed 266 patient charts listed for an LT from 2015 to 2023; 46.2% were listed in the MMaT-3 era. Amongst non-HCC patients, MMaT-3 implementation significantly increased 1-year transplant rate and reduced 1-year waitlist mortality among non-HCC patients (<i>p</i> = 0.003). Pre-MMaT-3 gaps in transplantation (<i>p</i> = 0.004) and waitlist dropout (<i>p</i> = 0.01) were eliminated post-implementation (<i>p</i> > 0.05). Amongst HCC patients, MMaT-3 implementation had no impact on the 1-year transplant rate (<i>p</i> = 0.92) or 1-year waitlist mortality (<i>p</i> = 0.66). Fine-gray proportional hazard multivariable analysis revealed that MMaT-3 significantly reduced waitlist mortality among non-HCC patients (asHR: 0.44, 95% CI [0.23, 0.83], <i>p</i> = 0.01) and limited impact on HCC patients (<i>p</i> = 0.31). MMaT-3 allocation did not significantly alter 2-year post-transplant survival for both populations. We show that the MMaT-3 system decreased the waitlist mortality of non-HCC patients with limited impacts on outcomes for HCC patients listed for an LT.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7051-7060"},"PeriodicalIF":2.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11592907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modification and Validation of the System Causability Scale Using AI-Based Therapeutic Recommendations for Urological Cancer Patients: A Basis for the Development of a Prospective Comparative Study.","authors":"Emily Rinderknecht, Dominik von Winning, Anton Kravchuk, Christof Schäfer, Marco J Schnabel, Stephan Siepmann, Roman Mayr, Jochen Grassinger, Christopher Goßler, Fabian Pohl, Peter J Siska, Florian Zeman, Johannes Breyer, Anna Schmelzer, Christian Gilfrich, Sabine D Brookman-May, Maximilian Burger, Maximilian Haas, Matthias May","doi":"10.3390/curroncol31110520","DOIUrl":"10.3390/curroncol31110520","url":null,"abstract":"<p><p>The integration of artificial intelligence, particularly Large Language Models (LLMs), has the potential to significantly enhance therapeutic decision-making in clinical oncology. Initial studies across various disciplines have demonstrated that LLM-based treatment recommendations can rival those of multidisciplinary tumor boards (MTBs); however, such data are currently lacking for urological cancers. This preparatory study establishes a robust methodological foundation for the forthcoming CONCORDIA trial, including the validation of the System Causability Scale (SCS) and its modified version (mSCS), as well as the selection of LLMs for urological cancer treatment recommendations based on recommendations from ChatGPT-4 and an MTB for 40 urological cancer scenarios. Both scales demonstrated strong validity, reliability (all aggregated Cohen's K > 0.74), and internal consistency (all Cronbach's Alpha > 0.9), with the mSCS showing superior reliability, internal consistency, and clinical applicability (<i>p</i> < 0.01). Two Delphi processes were used to define the LLMs to be tested in the CONCORDIA study (ChatGPT-4 and Claude 3.5 Sonnet) and to establish the acceptable non-inferiority margin for LLM recommendations compared to MTB recommendations. The forthcoming ethics-approved and registered CONCORDIA non-inferiority trial will require 110 urological cancer scenarios, with an mSCS difference threshold of 0.15, a Bonferroni corrected alpha of 0.025, and a beta of 0.1. Blinded mSCS assessments of MTB recommendations will then be compared to those of the LLMs. In summary, this work establishes the necessary prerequisites prior to initiating the CONCORDIA study and validates a modified score with high applicability and reliability for this and future trials.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"31 11","pages":"7061-7073"},"PeriodicalIF":2.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}