Klinicka Onkologie最新文献

{"title":"Contribution of bone scintigraphy and PET/CT in the differential diagnosis of bone involvement in a patient with fibrous dysplasia and monoclonal gammopathy of undetermined significance and fibrous dysplasia treatment with denosumab.","authors":"Zdeněk Řehák, Václav Ptáčník, Zdeněk Adam, Renata Koukalová, Jan Straub, Tomáš Křiva, Zuzana Adamová, Andrea Křivanová, Ivanna Boichuk, Luděk Pour","doi":"10.48095/ccko2026294","DOIUrl":"https://doi.org/10.48095/ccko2026294","url":null,"abstract":"<p><p>We describe a patient who has both fibrous dysplasia (FD) and monoclonal gammopathy of undetermined significance (MGUS). The simultaneous occurrence of these two pathological conditions is rare, and it is necessary to distinguish whether the bones are being affected by FD or multiple myeloma. The patient's problems began with a non-healing tooth extraction, raising suspicion of osteomyelitis. Later, he was also examined for fever of unknown origin, as he had elevated inflammatory markers, low-grade fever, and headaches. According to skeletal scintigraphy, the patient had a craniofacial skeleton affected by FD. Given the presence of IgG lambda type MGUS, it was necessary to rule out transformation of MGUS into multiple myeloma. PET/CT examination with the radiopharmaceuticals sodium fluoride (18F-NaF) and fluorodeoxyglucose (18F-FDG) was used to differentiate this. In the craniofacial skeleton area, the CT image corresponded to FD, and these lesions showed significant NaF accumulation. 18F-FDG accumulation was less pronounced, and none of the lesions with a high 18F-NaF uptake had an osteolytic character, which is indicative of skeletal involvement by FD rather than multiple myeloma. The patient was treated with denosumab, with an initial administration at 28-day intervals and a planned extension of the intervals to 3 months after stabilization of the condition. Immediately after the first denosumab injection, the headaches caused by craniofacial skeletal involvement due to FD disappeared. In the coexistence of MGUS and FD, it is necessary to precisely determine whether the bones are affected by FD or multiple myeloma by using PET/CT imaging and radiopharmaceuticals 18F-NaF and 18F-FDG. The text provides an overview of the drug treatment of FD from a 2026 perspective.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 4","pages":"294-301"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for utilizing Ki67 and multigene assays as a window of opportunity in the treatment of HR+/HER2- early breast cancer in clinical practice.","authors":"Zuzana Bielčiková, Martina Zimovjanová, Jan Kindl","doi":"10.48095/ccko2026266","DOIUrl":"https://doi.org/10.48095/ccko2026266","url":null,"abstract":"<p><strong>Introduction: </strong>Window of Opportunity (WoO) is a strategy for testing tumor sensitivity to endocrine therapy (ET) by comparing proliferative activity (Ki-67) before treatment (from a biopsy) and after short-term ET (from a surgical specimen). In addition to standard clinicopathological parameters and multigene assays (MGAs), WoO represents an additional prognostic marker for assessing recurrence risk in early luminal breast cancer. Here, we report partial results of a study focused on the practical implementation of the WoO strategy in routine clinical practice.</p><p><strong>Methods: </strong>This is a prospective, non-randomized academic study initiated in January 2025 at the General University Hospital in Prague. Patients with early luminal breast cancer indicated for primary surgical treatment were offered short-term preoperative ET in the form of an aromatase inhibitor (AI), tamoxifen (TMX), or a combination of TMX or AI with an LHRH analogue for 10-30 days. The primary objective of the study was to establish a workflow for incorporating the WoO strategy into clinical practice, to develop a protocol for the indication of preoperative ET, and to create a protocol for evaluating Ki-67 dynamics alongside standard clinicopathological parameters, and when applicable, MGA results.</p><p><strong>Results: </strong>Between January 1, 2025 and December 31, 2025, a total of 49 women were enrolled, with a median age of 59 years; 15 were premenopausal. The median duration of preoperative ET was 21 days. Patients were stratified into low-clinical risk (C_low; group 1, N = 29) and high-clinical risk (C_high; group 2, N = 20) categories according to Adjuvant! Online. The aggressiveness of clinicopathological parameters correlated with clinical risk and treatment response (no statistical analysis was performed). Proportion of responders (RES), defined as patients demonstrating a decrease in Ki-67 within the WoO strategy, was higher among patients with C_low disease. MGA testing was performed in 11 patients and had the greatest relevance in the C_high group. Contribution of the WoO strategy to adjuvant treatment decision-making was highest among RES. Replacement of MGA by the WoO strategy requires further validation; the greatest potential appears to be in C_low patients with a concomitant decrease in Ki-67. The need for adjuvant chemotherapy in non-responders (non-RES) with C_low disease requires further investigation.</p><p><strong>Conclusion: </strong>The WoO strategy assists in assessing recurrence risk and guiding adjuvant therapy decisions. The study continues with the enrollment of patients with a higher baseline Ki-67 at diagnosis.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 4","pages":"266-275"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer screening programmes in the Czech Republic and their results.","authors":"K Hejcmanová, O Ngo, R Chloupková, M Ambrožová, P Dvořák, V Rybenská, J Daneš, Š Suchánek, V Dvořák, M Koziar Vašáková, R Zachoval, K Hejduk, L Dušek, O Májek","doi":"10.48095/ccko2026S6","DOIUrl":"https://doi.org/10.48095/ccko2026S6","url":null,"abstract":"<p><strong>Background: </strong>Screening programmes are a key component of secondary prevention, with the aim of detecting disease at an early stage. In the Czech Republic, five cancer screening programmes are currently fully covered by public health insurance. These include screening for breast cancer, colorectal cancer and cervical cancer, early detection of lung and prostate cancer is also being piloted. The aim of this communication is to present nationwide programmes and the results of the evaluation of key performance indicators.</p><p><strong>Material and methods: </strong>Based on the data from the National Health Information System, screening programmes are regularly monitored and evaluated. The basic indicators are epidemiological characteristics, such as incidence and mortality, but also indicators of the quality of the screening programme, such as coverage of the target population or the proportion of people with abnormal screening test results.</p><p><strong>Results: </strong>Analytical outputs show that the incidence and mortality of colorectal and cervical cancer, where the goal is to detect precancerous lesions, are continuously decreasing. Breast cancer mortality is also declining, while incidence has been increasing over the long term, as the role of screening here is to detect cancer at an early stage. Coverage of the target population for breast and cervical cancer screening reaches up to 60%, while for colorectal cancer screening it is above 30%. As part of early detection of lung cancer, nearly 20,000 current or former smokers were examined over 3.5 years, and in more than 3% of cases, a positive finding was detected radiologically during the first screening episode, requiring further investigation. Approximately 250,000 men participated in early detection of prostate cancer over 1.5 years, and just under 9% were found to have elevated prostatic specific angigen levels.</p><p><strong>Conclusion: </strong>Screening programmes are available to the target population and fully covered by public health insurance. However, continuous monitoring and evaluation are essential, as are following international recommendations, developing the digitalization of healthcare, and providing ongoing education to both the lay and professional public. Available data demonstrate the effectiveness and positive population impact of screening programs.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 Supplementum 1","pages":"6-11"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of obesity on the development of malignant tumors - metabolic syndrome.","authors":"L Gescheidtová, Z Čermáková","doi":"10.48095/ccko2026S36","DOIUrl":"https://doi.org/10.48095/ccko2026S36","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major and modifiable risk factor influencing both the incidence and prognosis of malignant tumors.</p><p><strong>Aim: </strong>This review aims to summarize current evidence on the relationship between obesity, metabolic syndrome, and cancer risk, with a focus on underlying pathophysiological mechanisms, epidemiological data, and potential interventions. According to the International Agency for Research on Cancer, obesity is causally linked to at least 13 types of cancer, with risk increasing in proportion to body fat. Key mechanisms include chronic inflammation, hormonal activity of adipose tissue, hyperinsulinemia and insulin resistance, and alterations in adipokine profiles, all of which contribute to a tumor-promoting microenvironment. We discuss diagnostic criteria for metabolic syndrome and highlight the concept of metabolically healthy obesity, which carries a lower - but not negligible - risk of malignancy and represents a dynamic state that can progress to metabolically unhealthy obesity. Evidence also indicates that obesity negatively affects cancer recurrence and long-term outcomes, particularly in breast, endometrial, and colorectal cancers. Achieving sustainable, long-term weight reduction is challenging and requires a multidisciplinary strategy, incorporating pharmacotherapy, structured physical activity, behavioral interventions, and individualized nutritional counseling. Successful weight loss not only reduces the risk of developing cancer but may also improve prognosis and decrease the likelihood of recurrence. Therefore, integrating obesity management strategies into both primary and secondary cancer prevention, as well as survivorship care, should be considered a critical component of comprehensive oncology care.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 Supplementum 1","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term response to immunotherapy in a patient with low PD-L1 expression, high tumor mutational burden, and STK11 mutation.","authors":"Michal Kysela, Ondřej Bílek, Radka Lordick Obermannová, Peter Grell","doi":"10.48095/ccko2026364","DOIUrl":"https://doi.org/10.48095/ccko2026364","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors are an integral part of the treatment of a wide range of malignancies, including non-small cell lung cancer (NSCLC). With the expanding indications for immunotherapy in recent years, clinical experience has increased exponentially, encompassing both its therapeutic efficacy and associated adverse events. In an effort to rationalize the use of immunotherapy, considerable attention is currently focused on identification of predictive biomarkers that would allow for more precise selection of patients likely to benefit from this treatment.</p><p><strong>Case: </strong>The authors present a case report of a patient with lung adenocarcinoma characterized by low PD-L1 expression, high tumor mutational burden (37 muts/Mb), and an STK11 mutation. This represents a combination of two predictors of poor response to immunotherapy (low PD-L1 expression and STK11 mutation) along with a high tumor mutational burden, which is conversely considered a predictor of sensitivity to immunotherapy. The patient was treated according to the currently well-established standard of first-line systemic therapy, consisting of pembrolizumab in combination with chemotherapy. This treatment resulted in a durable response, which given its current duration, may be considered sustained with minimal adverse effects.</p><p><strong>Conclusion: </strong>Immune checkpoint inhibitor therapy, as illustrated by this case, may lead to durable responses and prolonged survival even in patients with unfavorable predictive biomarkers. Within the decision-making algorithm prior to initiation of systemic therapy in metastatic NSCLC, it is beneficial to perform a comprehensive and readily available predictive and molecular analysis.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 5","pages":"364-367"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149325299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-associated EGFR-mutant lung adenocarcinoma in a TB-endemic region - diagnostic bias and therapeutic barriers.","authors":"Muhammad Hafiz, Aziza G Icksan, Sita Laksmi Andarini D, Nur M Karim, Annisa Dian Hari Hasari, Farhana Ibrahim Syuaib, Retno Widyawati, Tati Herdawati","doi":"10.48095/ccko2026372","DOIUrl":"https://doi.org/10.48095/ccko2026372","url":null,"abstract":"","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 5","pages":"372-377"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149325301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of immunological markers in the diagnosis of colorectal cancer.","authors":"A Erbenová, P Horák, M Slavíková Červinková, J Čížková, P Šuhaj","doi":"10.48095/ccko20262S126","DOIUrl":"https://doi.org/10.48095/ccko20262S126","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) remains one of the most common solid malignancies in the Western population. Despite advances in screening, diagnostics, and treatment, there are still no highly specific tests for early diagnosis or biomarkers that can reliably identify high-risk patients or monitor disease progression more effectively than currently established tumor markers. The pathogenesis of CRC is closely associated with chronic inflammation, oxidative stress, and remodeling of the tumor microenvironment. The present study focuses on several biomarkers selected based on available literature data and their close association with these processes. LOX-1 (lectin-like oxidized low-density lipoprotein receptor-1), RAGE (receptor for advanced glycation end products), HMGB1 (high mobility group box 1), and matrix metalloproteinase-19 (MMP-19) are involved in the regulation of inflammatory signaling pathways, angiogenesis, and extracellular matrix degradation. The aim of this study was to test the hypothesis that the expression of these markers is significantly increased in patients with CRC compared with healthy controls.</p><p><strong>Methods: </strong>The study included intestinal tissue samples obtained from 34 patients with CRC and 21 control subjects who underwent intestinal resection at our institution for non-neoplastic and non-inflammatory conditions. In CRC patients, three tissue compartments were analyzed - macroscopically normal tissue, the tumor transition zone, and tumor tissue. Samples were processed using immunohistochemical methods, and marker positivity was assessed across several cellular populations.</p><p><strong>Results: </strong>Statistically significant differences in the expression of selected markers were identified between the control group and patients with CRC. LOX-1 demonstrated increased expression in the epithelial and vascular structures of tumor tissue. RAGE expression was elevated in vascular structures and within the tumor transition zone, suggesting its involvement in the inflammatory tumor microenvironment. MMP-19 expression was most pronounced at the tumor-normal tissue interface, consistent with its role in extracellular matrix remodeling and tumor invasion.</p><p><strong>Conclusions: </strong>Our findings support the involvement of the investigated markers in the pathogenesis of CRC. Their expression may contribute not only to a better understanding of CRC biology but also to the identification of potential prognostic biomarkers and therapeutic targets.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 Supplementum 2","pages":"126-129"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a negative PSMA PET/CT limit the indication for lymphadenectomy in patients with localized moderate- and high-risk prostate cancer?","authors":"Kristýna Dianová, Vladimír Šámal, Vít Paldus","doi":"10.48095/ccko2026320","DOIUrl":"https://doi.org/10.48095/ccko2026320","url":null,"abstract":"<p><p>The aim is to summarize recent findings on the diagnostic value of Ga-68 PSMA PET/CT imaging in patients with intermediate- and high-risk prostate cancer scheduled for radical prostatectomy and its impact on decision-making regarding simultaneous performance of pelvic lymphadenectomy. The focus is on sensitivity, specificity, and negative predictive value of this imaging modality in detecting lymph node metastases; the limitations of the examination are discussed, and situations in which the results may influence therapeutic management are outlined. Based on currently available data, a negative PSMA PET/CT result significantly reduces the probability of lymph node involvement. However, despite a negative PSMA PET/CT scan, risk of lymph node involvement remains approximately 10% in intermediate-risk tumors and 20-40% in high-risk tumors. Nomograms for estimating the risk of lymph node involvement are already available and incorporate PSMA PET/CT findings into their calculations. Therefore, the decision to perform lymphadenectomy should be individualized according to the patient's risk profile.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 5","pages":"320-324"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149325363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDG-PET/CT: metabolically active solitary lesion in the gluteal region subcutaneously in a patient with breast cancer - granuloma or metastasis?","authors":"Z Řehák, M Palácová, S Soboličová, P Fabian","doi":"10.48095/ccko2026122","DOIUrl":"https://doi.org/10.48095/ccko2026122","url":null,"abstract":"","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 2","pages":"122-124"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second recurrence of breast cancer 36 years after initial surgery and 18 years after the first recurrence - an extremely rare case.","authors":"Y Maezawa, T Terada, H Kobayashi, G Ohara, T Saito, N Takayashiki, H Satoh","doi":"10.48095/ccko2026117","DOIUrl":"10.48095/ccko2026117","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is a one of the most common causes of cancer death in the world. Late recurrence is a notable characteristic of this disease.</p><p><strong>Case: </strong>We experienced an extremely rare case of breast cancer that developed a second recurrence 36 years after the initial surgery and 18 years after the first recurrence, manifesting as bilateral pleural effusion and multiple bone metastases.</p><p><strong>Conclusion: </strong>This report highlights that it is important for both patients and doctors to be aware that such patients exist.</p>","PeriodicalId":35565,"journal":{"name":"Klinicka Onkologie","volume":"39 2","pages":"117-121"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}