Cancers最新文献

{"title":"Dosimetric Advantage of Scanning Beam Proton Therapy in Gynecologic Patients Receiving Adjuvant Radiotherapy.","authors":"Rachel B Ger, Jarrod M Lentz, Joshua S Niedzielski, Sujay A Vora, Martin Bues, Danairis Hernandez Morales, Justin D Anderson, Christopher J Kutyreff, Christie A Schulz, Pedro R Lara, Ana K Ridgway, Pamela R Lemish, Justin D Gagneur, Aman Anand","doi":"10.3390/cancers17122010","DOIUrl":"10.3390/cancers17122010","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Adjuvant radiation for gynecologic malignancies often exposes organs at risk (OARs), such as the bone marrow, bowel, rectum, and bladder, to radiation, leading to toxicities that impact treatment tolerance and patient quality of life. Scanning proton beam therapy, particularly with Individual Field Simultaneous Optimization (IFSO), may offer dosimetric and biological advantages over volumetric modulated arc therapy (VMAT). This study evaluates the clinical impact of IFSO-based proton planning in post-operative gynecologic cancer patients. <b>Materials and Methods:</b> Fourteen patients receiving adjuvant proton therapy to 45 Gy in 25 fractions were retrospectively analyzed. Comparison VMAT plans were generated on the same datasets. Dose-volume metrics for key OARs and normal tissue complication probabilities (NTCPs) were compared using paired statistical tests. Robustness evaluations accounted for setup and range uncertainties. <b>Results:</b> Proton plans significantly reduced dose to bone marrow (V10Gy: 58% vs. 86%, <i>p</i> < 0.00001; V20Gy: 47% vs. 58%, <i>p</i> < 0.00001), small bowel (V20Gy: 21% vs. 56%, <i>p</i> < 0.00001), and femoral heads (left femoral head mean: 11Gy vs. 13Gy, <i>p</i> = 0.032; right femoral head mean: 11Gy vs. 13Gy, <i>p</i> = 0.022). NTCP modeling predicted significantly lower rates of bowel urgency (9.4% vs. 3.3%, <i>p</i> < 0.001) and hematologic toxicity (10.2% vs. 4.9%, <i>p</i> < 0.001) with proton therapy. Plans remained robust across uncertainty scenarios. <b>Conclusions:</b> IFSO-based scanning proton therapy provides clinically meaningful sparing of bone marrow and bowel, with the potential to reduce hematologic and gastrointestinal toxicities. These findings support its use in patients receiving adjuvant pelvic radiotherapy, particularly those undergoing extended field treatment or chemotherapy.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Multi-Kinase Inhibitors in Adrenocortical Carcinoma: A Systematic Review and Single-Arm Meta-Analysis.","authors":"Fabiano Flauto, Vincenzo Damiano","doi":"10.3390/cancers17122004","DOIUrl":"10.3390/cancers17122004","url":null,"abstract":"<p><p><b>Background:</b> Advanced adrenocortical carcinoma (ACC) remains a challenging malignancy with limited therapeutic options. Multi-kinase inhibitors (MKIs), either alone or in combination with immuno-oncology (IO) agents, have been investigated in recent single-arm clinical trials and retrospective series. <b>Methods:</b> We conducted a systematic review and single-arm meta-analysis of studies evaluating MKIs in advanced ACC. Objective response rate (ORR) and disease control rate (DCR) were pooled using random-effects models for single-arm proportions. Overall survival (OS) and progression-free survival (PFS) were summarized descriptively due to limited variance data. Subgroup analyses compared MKI monotherapy versus MKI + IO combinations, and meta-regression was performed to assess the impact of prior mitotane exposure. <b>Results:</b> Eleven studies (<i>n</i> = 208 patients) were included. The pooled ORR was 21% (95%CI, 11-36%), and the DCR was approximately 57%. Subgroup analysis revealed a higher ORR with MKI + IO regimens (26%; 95%CI, 12-48%) compared to MKI monotherapy (15%; 95%CI, 3-47%). Median OS ranged from 5.4 to 30.6 months, and PFS from 2.8 to 13.3 months, both favouring MKI + IO combinations. Meta-regression identified prior mitotane exposure as a significant predictor of ORR (<i>p</i> = 0.0279), particularly within the MKI + IO subgroup. <b>Conclusions:</b> MKI-based regimens, especially when combined with IO, demonstrate promising efficacy in advanced ACC, a disease with few established second-line options. While limited by the non-comparative design of available studies, these findings support further investigation in prospective, randomized clinical trials.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Central Neurocytoma.","authors":"Anna Michel, Jan Rodemerk, Laurèl Rauschenbach, Pikria Ketelauri, Oleh Danylyak, Ramazan Jabbarli, Philipp Dammann, Anne-Kathrin Uerschels, Marvin Darkwah Oppong, Oliver Gembruch, Yahya Ahmadipour, Andreas Junker, Ulrich Sure, Karsten Henning Wrede","doi":"10.3390/cancers17122005","DOIUrl":"10.3390/cancers17122005","url":null,"abstract":"<p><p><b>Objective:</b> Central neurocytomas (CNs), classified as CNS (central nervous system) grade 2 tumors, are exceptionally rare tumors, accounting for approximately 0.1-0.5% of all intracranial neoplasms, and are typically characterized by a benign clinical course and frequent association with hydrocephalus. This study aims to present a comprehensive analysis of surgical and adjuvant therapies for CN. <b>Methods:</b> The study comprised all patients who underwent microsurgical tumor removal in our center over the past decade (2013-2023). Clinical manifestations, surgical and adjuvant therapy approaches, MRI and histological findings, clinical outcomes, and recurrence-free survival were evaluated. <b>Results:</b> A total of eleven patients (six men, mean age of 28.0 years; five women, mean age of 53.6 years) underwent surgical treatment. Intraventricular tumors were the most common (72.7%, n = 8). The predominant presenting symptoms were headache and visual disturbances. All tumors exhibited contrast enhancement on MRI. Hydrocephalus was present in five patients. The Ki67 proliferation index ranged from 2% to 10%, with nine patients exhibiting Ki67 > 3%. The median recurrence-free survival was 38.0 months (IQR: 25.0-53.0). The most severe postoperative complications included aphasia, hemiparesis, and memory impairment, resulting in a postoperative Karnofsky Performance Status (KPS) below 70% in five patients. Follow-up assessments showed significant symptomatic improvement in all affected patients. <b>Conclusions:</b> Gross total resection is the recommended first-line therapy with favorable neurological outcomes and for atypical CN as well. Adjuvant radiotherapy should be reserved for tumor progression and recurrence. The role of adjuvant chemotherapy remains unclear, but it may be an option for CN with a high proliferation index.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated COVID-19 Vaccination as a Poor Prognostic Factor in Pancreatic Cancer: A Retrospective, Single-Center Cohort Study.","authors":"Makoto Abue, Mai Mochizuki, Rie Shibuya-Takahashi, Kensuke Ota, Yuta Wakui, Wataru Iwai, Jun Kusaka, Masashi Saito, Shinichi Suzuki, Ikuro Sato, Keiichi Tamai","doi":"10.3390/cancers17122006","DOIUrl":"10.3390/cancers17122006","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The COVID-19 vaccine is a significant technological advancement with widespread global use. However, its effect on cancer immunity, particularly with repeated vaccinations, remains unclear. We aimed to investigate the relationship between repeated vaccinations and pancreatic cancer (PC) prognosis. Additionally, we examined serum IgG4 levels, known to be an immune suppressor which increases with repeated vaccinations. <b>Methods</b>: We retrospectively examined the effect of vaccination on survival in 272 PC patients diagnosed at our hospital from January 2018 to November 2023 and analyzed prognostic factors, including IgG4 levels in 96 PC patients. Immunohistochemistry for Foxp3 in the tumor tissue was performed, and the serum IgG4 level was measured. Serum samples from 79 patients with benign and malignant diseases, including PC, were collected between September and November 2023, and the spike-specific IgG4 level was determined using an enzyme-linked immunosorbent assay. <b>Results</b>: The overall survival (OS) of PC patients was shortened in those vaccinated three times or more, and the total serum IgG4 levels increased with the number of vaccinations. Of note, OS was significantly shorter in the high IgG4 group, and Foxp3-positive cells in the tumor tissues were increased. Repeated vaccinations increased the spike-specific IgG4 levels, and a positive correlation was observed between spike-specific IgG4 and the total IgG4. <b>Conclusions</b>: These findings highlight repeated vaccination as a poor prognostic factor in PC patients and suggest that IgG4 is induced by repeated vaccination and may be associated with a poor prognosis in these patients.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-Based Biomarkers as Predictive and Prognostic Factors in Immunotherapy-Treated Patients with Solid Tumors-Currents and Perspectives.","authors":"Franciszek Kaczmarek, Anna Marcinkowska-Gapińska, Joanna Bartkowiak-Wieczorek, Michał Nowak, Michał Kmiecik, Kinga Brzezińska, Mariusz Dotka, Paweł Brosz, Wojciech Firlej, Paulina Wojtyła-Buciora","doi":"10.3390/cancers17122001","DOIUrl":"10.3390/cancers17122001","url":null,"abstract":"<p><p>Immunotherapy has revolutionized cancer treatment; however, the availability of cost-effective blood-based biomarkers for prognostic and predictive factors of immune treatment in patients with solid tumors remains limited. Due to low cost and easy accessibility, blood-based biomarkers should constitute an essential component of studies to optimize and monitor immunotherapy. Currently available markers that can be measured in peripheral blood include total monocyte count, myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), relative eosinophil count, cytokine levels (such as IL-6, IL-8, and IL-10), lactate dehydrogenase (LDH), C-reactive protein (CRP), soluble forms of CTLA-4 and PD-1 or PD-L1, as well as circulating tumor DNA (ctDNA). In our mini-review, we discuss the latest evidence indicating that routinely accessible peripheral blood parameters-such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and rheological parameters, which so far have been rarely considered for such an application, may be used as non-invasive biomarkers in cancer immunotherapy. Rheological parameters such as whole blood viscosity are influenced by several factors, such as hematocrit, aggregability and deformability of erythrocytes, and plasma viscosity, which is largely dependent on plasma proteins. Especially in cases where the set of symptoms indicates a high probability of hyperviscosity syndrome, blood rheological tests can lead to early diagnosis and treatment. Both biochemical and rheological parameters are prone to become novel and future standards for assessing immunotherapy among patients with solid tumors.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iterative Situated Engagement Perspective: Meaning-Making Challenges Across Cancer Screening Phases.","authors":"Daniela Lemmo, Maria Luisa Martino, Roberto Bianco, Anna Rosa Donizzetti, Maria Francesca Freda, Daniela Caso","doi":"10.3390/cancers17122007","DOIUrl":"10.3390/cancers17122007","url":null,"abstract":"<p><p><b>Background/Objectives:</b>Breast and cervical cancer screening programs are essential for early detection and timely treatment, yet participation rates remain suboptimal. Within a patient-centered care approach, engagement is increasingly viewed as a dynamic and emotionally grounded process. The literature conceptualizes three phases of engagement in healthcare decision-making: 'recruit', 'retain', and 'sustain'. When these phases intersect with the structured pathway of cancer screening, they generate specific meaning-making challenges that shape how women relate to prevention and care. This study adopts the lens of Iterative Situated Engagement (ISE) to explore how women experience and negotiate these challenges, differentiating them across the three engagement phases. <b>Methods</b>: A theory-driven qualitative design was adopted. Data were collected through semi-structured interviews with 40 women aged 25-69 years participating in public breast and cervical cancer screening programs. Thematic analysis was conducted using the Framework Method. <b>Results</b>: In the 'recruit' phase, engagement was driven by Cancer Risk Monitoring, Self-care Motivation, Fear of Death Management, and Coincidence. The 'retain' phase emphasized Trust in Healthcare Providers, Accessibility of Services, Recurrent Invitations, and Informal Result Previews. About the 'sustain' phase, Continuity of Healthcare Providers, Driving Best Practices Dissemination, Flexible Organization of Healthcare Services, and Shorter Waiting Times for Results were highlighted as key factors in maintaining engagement over time. <b>Conclusions</b>: Women's engagement in cancer screening emerges as a dynamic, multi-phase process shaped by psychological, emotional, and organizational levels. These findings contribute to the development of the ISE conceptual proposal, which frames participation as an iterative, situated, and meaning-making trajectory. Strengthening personalized health communication and improving the coordination of primary care services could enhance sustained participation in screening programs, supporting strategies to reduce health disparities and promote preventive practices<b>.</b></p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Radiotherapy for Complicated Bone Metastases: SHARON Bone Randomized Phase III Trial Shows Non-Inferiority Compared to Standard Palliative Fractionation (NCT03503682).","authors":"Alice Zamagni, Giambattista Siepe, Dino Gibertoni, Costanza M Donati, Francesco Cellini, Francesco Fiorica, Donato Pezzulla, Francesco Deodato, Filippo Candoli, Silvia Bisello, Erica Scirocco, Stefania Manfrida, Milena Gabbani, Savino Cilla, Gabriella Macchia, Alessio G Morganti","doi":"10.3390/cancers17122000","DOIUrl":"10.3390/cancers17122000","url":null,"abstract":"<p><p><b>Objective:</b> The SHARON (Short course RadiatiON therapy for palliative treatment) Bone trial is a phase III randomized non-inferiority multicentric study comparing symptom relief for complicated bone metastases (BMs) achieved through hypofractionated accelerated palliative radiotherapy (RT) to a standard RT regimen. <b>Methods</b>: Eligible participants were adults with ECOG PS ≤ 3 who were referred for palliative RT for painful BMs. Patients were assigned to receive either 30 Gy delivered in 10 daily fractions or 20 Gy in 4 fractions over two consecutive days. The primary outcome was pain relief one month post-treatment. Pain relief and adverse events were also evaluated at 2, 3, 6, and 12 months after RT. This trial was registered at clinicaltrials.gov (NCT03503682). <b>Results:</b> Between February 2018 and November 2021, 83 patients were enrolled (30 Gy: 41; 20 Gy: 42). In the standard RT group, five patients did not complete the prescribed RT, while none in the experimental arm discontinued treatment (<i>p</i> = 0.026). Due to early mortality, the primary endpoint was evaluable in 73 patients (35 and 38 in the standard and experimental arms, respectively). The rate of complete pain response at one month was 22.9% and 28.9% in the 30 Gy and 20 Gy arms, respectively (<i>p</i>: 0.571). The overall pain response rates, which included complete and partial responses, were 74.3% and 78.9% in the 30 Gy and 20 Gy arms, respectively (<i>p</i> = 0.638), when considering at least a 2-point reduction in the numerical rating scale. In both arms, 4.8% of patients experienced Grade >2 toxicity. <b>Conclusions</b>: Administering 20 Gy in four fractions twice a day is non-inferior to the standard 30 Gy delivered in 10 fractions for pain relief in the context of complicated BMs. Furthermore, this regimen demonstrated comparable safety in terms of acute toxicity, with a lower incidence of definitive interruptions of radiotherapy.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Post-Mastectomy Breast Reconstruction: A Comprehensive Retrospective Study.","authors":"Kella L Vangsness, Ronald M Cornely, Andre-Philippe Sam, Naikhoba C O Munabi, Michael Chu, Mouchammed Agko, Jeff Chang, Antoine L Carre","doi":"10.3390/cancers17122002","DOIUrl":"10.3390/cancers17122002","url":null,"abstract":"<p><strong>Background and objectives: </strong>Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care.</p><p><strong>Materials and methods: </strong>The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013-2021 and 2000-2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson's chi-square analysis was performed.</p><p><strong>Results: </strong>We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40-49 age group received significantly less MO (38.1%) compared to the 70-74 age group (94.8%, (<i>p</i> = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, <i>p</i> = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, <i>p</i> = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (<i>p</i> = <0.001).</p><p><strong>Conclusions: </strong>Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Policy and Screening for Colorectal Cancer in the United States.","authors":"Maryam R Hussain, Faisal S Ali, Scott A Larson, Soham Al Snih","doi":"10.3390/cancers17122003","DOIUrl":"10.3390/cancers17122003","url":null,"abstract":"<p><p>The landscape for the screening of colorectal cancer (CRC) has witnessed multiple triumphs over the past decades from policy-level interventions. In the United States (US), the most prominent intervention of this nature is the Patient Protection and Affordable Care Act (ACA), enacted more than a decade ago. Since its enactment, the ACA has seen multiple legal challenges, and its impact on CRC screening has been relatively well studied. However, a consolidated, concise analysis of the data on this subject is lacking. Herein, we evaluate the impact of the ACA on CRC screening through the lens of a policy analysis, highlighting its strengths and shortcomings, and suggest policy-level interventions to address these shortcomings and improve CRC screening adoption.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Assessment of Surgical Outcomes in Malignant Peripheral Nerve Sheath Tumors: A Systematic Review and Meta-Analysis of Surgical Interventions.","authors":"Abdel-Hameed Al-Mistarehi, Khaled J Zaitoun, Jawad Khalifeh, Max A Saint-Germain, Melanie Alfonzo Horowitz, Abdul Karim Ghaith, Chase H Foster, Shoshana Braverman, Avi N Albert, Usama AlDallal, Allan Belzberg, Sang Lee, Nicholas Theodore, Ilya Laufer, Daniel Lubelski","doi":"10.3390/cancers17121997","DOIUrl":"10.3390/cancers17121997","url":null,"abstract":"<p><strong>Background/objectives: </strong>Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive malignancies with a challenging prognosis, especially for patients with Neurofibromatosis type 1 (NF1). Their low incidence necessitates comprehensive studies to investigate the survival outcome.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis, including data from 16 studies and 4265 patients, to explore surgical outcomes and survival rates, focusing on time-related outcomes, including overall survival (OS), progression-free survival (PFS), and recurrence rate.</p><p><strong>Results: </strong>The analysis revealed that the OS rate was 86% [95% CI: 75-97%] at 1 year, decreasing to 60% [95% CI: 45-75%] at 3 years, and further declining to 47% [95% CI: 35-58%] by 5 years. For PFS, the 1-year rate was 61% [95% CI: 25-98%], which remained similar at 62% [95% CI: 35-89%] for 3 and 5 years. In NF1-associated MPNSTs, the 1-year OS was relatively high at 93% [95% CI: 83-100%], but it dropped to 68% [95% CI: 53-84%] at 3 years and further to 50% [95% CI: 31-68%] at 5 years. Additionally, the hazard ratio indicated a 38% lower survival rate in NF1 patients than those with sporadic MPNSTs when data were presented in the same study. Recurrence rates were high, with 56% of patients experiencing a relapse, primarily as local recurrences (70.6%). Mortality was significant, with over 50% of patients dying within an average follow-up period of 33.45 months.</p><p><strong>Conclusions: </strong>MPNSTs, particularly in NF1 patients, are associated with poor prognosis and high recurrence rates. These results underline the necessity of targeted therapeutic strategies and improved programs for screening, mainly through a multidisciplinary approach to optimize management.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 12","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}