Cancers最新文献

{"title":"Meeting Cancer Detection Benchmarks in MRI/Ultrasound Fusion Biopsy for Prostate Cancer: Insights from a Retrospective Analysis of Experienced Urologists.","authors":"Fabian Utzat, Stefanie Herrmann, Matthias May, Johannes Moersler, Ingmar Wolff, Johann Lermer, Mate Gregor, Katharina Fodor, Verena Groß, Anton Kravchuk, Thomas Elgeti, Stephan Degener, Christian Gilfrich","doi":"10.3390/cancers17020277","DOIUrl":"10.3390/cancers17020277","url":null,"abstract":"<p><strong>Background: </strong>The relationship between case volume and clinical outcomes is well established for most urological procedures but remains underexplored in prostate ultrasound/MRI fusion biopsy (UMFB). UMFB aims to detect clinically significant prostate cancer (csPCa) by adhering to cancer detection benchmarks for PI-RADS lesions identified via multiparametric MRI (mpMRI). These benchmarks, defined by Ahmed et al., include cumulative cancer detection rate (C-CDR) targets of >80% for PI-RADS 5, >50% for PI-RADS 4, and <20% for PI-RADS 1-3.</p><p><strong>Methods: </strong>This retrospective, single-center study analyzed the case volumes required for two experienced urologists (U1 and U2, each with >15 years of practice) to consistently achieve the Ahmed-defined C-CDR benchmarks for csPCa (ISUP grade ≥ 2) using UMFB. Both transrectal and transperineal approaches were included to enable comprehensive learning curve analysis. Data from 2017 to 2023 were reviewed, encompassing 157 UMFBs performed by U1 and 242 by U2, with a transrectal-to-perineal ratio of 7:3.</p><p><strong>Results: </strong>Both urologists achieved Ahmed-defined C-CDR targets from the outset. Over a median follow-up of 30 months, patients with initial PI-RADS 4 or 5 ratings and negative primary biopsies remained prostate cancer-free in 77% of cases for U1 and 91.2% for U2 (<i>p</i> = 0.152).</p><p><strong>Conclusions: </strong>This study demonstrates that experienced urologists can achieve high diagnostic accuracy and maintain patient safety immediately upon implementing UMFB, meeting established benchmarks without requiring additional procedural learning.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037061","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":"Phase II Study of Atezolizumab and Bevacizumab Combination Therapy for Patients with Advanced Hepatocellular Carcinoma Previously Treated with Lenvatinib.","authors":"Takeshi Terashima, Hidenori Kido, Noboru Takata, Tomoyuki Hayashi, Akihiro Seki, Hidetoshi Nakagawa, Kouki Nio, Tadashi Toyama, Noriho Iida, Shinya Yamada, Tetsuro Shimakami, Hajime Takatori, Kuniaki Arai, Tatsuya Yamashita, Eishiro Mizukoshi, Taro Yamashita","doi":"10.3390/cancers17020278","DOIUrl":"10.3390/cancers17020278","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Atezolizumab and bevacizumab combination therapy has been established as a standard of care for first-line treatment; however, its efficacy and safety have not been fully evaluated for patients previously treated with systemic therapy. <b>Methods</b>: In this phase II trial, patients with advanced hepatocellular carcinoma previously treated with lenvatinib were enrolled to receive a dose of 1,200 mg of atezolizumab and 15 mg/kg of bevacizumab every 3 weeks. The primary endpoint was progression-free survival. The secondary endpoints included overall survival, objective response rate, disease control rate, subsequent therapy, and frequency of adverse events. The threshold and expected progression-free survival were 3 and 6.8 months, respectively. Considering a one-sided significance level of 0.05 and a statistical power of 80%, the minimum required sample size was 26 patients. <b>Results</b>: The median progression-free survival from the start of treatment was 9.70 [90% confidence interval, 5.10-14.24] months, and the lower limit of the 90% CI was above the predefined threshold. The objective response and disease control rates were 34.6% and 73.1%, respectively. Sixteen patients (61.5%) received subsequent therapies, and the median overall survival was 17.23 [90% confidence interval, 13.18-27.85] months. Severe adverse events, adverse events leading to treatment delays, and adverse events leading to treatment discontinuation occurred in eight (30.8%), fourteen (53.8%), and five (19.2%) patients, respectively, and no treatment-related deaths occurred. <b>Conclusions</b>: Atezolizumab and bevacizumab combination therapy is effective and can safely be administered to patients with advanced HCC previously treated with lenvatinib.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037227","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":"DNA Repair Capacity and Clinicopathological Characteristics in Puerto Rican Hispanic/Latino Patients with Metastatic Castration-Resistant Prostate Cancer.","authors":"Jaime Matta, Carmen Ortiz-Sánchez, Jarline Encarnación-Medina, Stephanie Torres-Caraballo, Jose Oliveras, Jong Park, Monica M Arroyo, Gilberto Ruiz-Deya","doi":"10.3390/cancers17020279","DOIUrl":"10.3390/cancers17020279","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer (PCa) accounts for 22% of the new cases diagnosed in Hispanic/Latino (H/L) men in the US. PCa has the highest incidence (38.3%) and mortality (16.4%) among all types of cancer diagnosed in Puerto Rico. We previously showed that PCa patients (<i>n</i> = 41) have a significant reduction of 59% in their levels of DNA repair capacity (DRC) when compared to controls (<i>n</i> = 14). This study aimed to evaluate DRC levels through the nucleotide excision repair (NER) pathway for the first time in 16 Puerto Rican H/L men with metastatic castration-resistant PCa (mCRPCa) while establishing comparisons with controls and PCa patients with indolent and aggressive disease.</p><p><strong>Methods: </strong>Blood samples and clinicopathological data from PCa cases (<i>n</i> = 71) and controls (<i>n</i> = 25) were evaluated. PCa cases were stratified into mCRPCa (<i>n</i> = 16), aggressive (<i>n</i> = 31), and indolent (<i>n</i> = 24). DRC levels through NER were measured in lymphocytes with the CometChip assay. The stratification by Gleason score (GS) was GS6 (<i>n</i> = 7), GS7 (<i>n</i> = 23), GS ≥ 8 (<i>n</i> = 20), and mCRPCa patients (<i>n</i> = 16).</p><p><strong>Results: </strong>Significant statistical differences were found when comparing the DRC values of the controls with any other of the four PCa patient groups. mCRPCa patients had the lowest mean DRC level of all four patient groups studied. The mean DRC level of mCRPCa patients was 6.65%, and compared to the controls, this represented a statistically significant reduction of 62% (<i>p</i> < 0.0001). Further analysis was performed to evaluate the contributions of age, anthropometric measurements, and prostate-specific antigen (PSA) levels to the DRC. Kaplan-Meier curves of mCRPCa revealed that survival probability decreased by approximately 50% by 30 months. This pilot study uses a blood-based phenotypic assay to present the first report of mCRPCa in Puerto Rican men and at a global level of DRC levels of mCRPCa patients.</p><p><strong>Conclusions: </strong>This study evaluated DRC levels through the NER pathway for the first time in 16 Puerto Rican H/L men with mCRPCa. Significant differences in DRC values were found between the controls and the three PCa patient groups. Kaplan-Meier curves revealed that survival probability decreased by approximately 50% by 30 months, and only 20% of the cohort was alive at 50 months, confirming the lethality of mCRPCa in this H/L population. This pilot study represents the first report of metastatic PCa in Puerto Rican men at a global level of DRC levels of mCRPCa patients using a blood-based phenotypic assay.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036792","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":"Resection of Meningiomas Invading the Cavernous Sinus: Treatment Strategy and Clinical Outcomes.","authors":"Takashi Sugawara, Taketoshi Maehara","doi":"10.3390/cancers17020276","DOIUrl":"10.3390/cancers17020276","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes. <b>Methods</b>: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated. <b>Results</b>: The mean patient age was 59.1 years (range, 23-73 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1. <b>Conclusions</b>: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037047","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 Whole-Body MRI Reporting and Data System Guidelines for Prostate Cancer (MET-RADS-P), Multiple Myeloma (MY-RADS), and Cancer Screening (ONCO-RADS).","authors":"Marco Parillo, Carlo Augusto Mallio","doi":"10.3390/cancers17020275","DOIUrl":"10.3390/cancers17020275","url":null,"abstract":"<p><p>Whole-body magnetic resonance imaging (WB-MRI) is being employed with increasing frequency to evaluate a broader spectrum of patients with diverse types of cancer and for cancer screening purposes. While clinical guidelines support its use, a standardized radiological approach is still lacking. To improve consistency in the acquisition, interpretation, and reporting of WB-MRI examinations, three reporting and data systems (RADSs) have been recently suggested: METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P), Myeloma Response Assessment and Diagnosis System (MY-RADS), and Oncologically Relevant Findings Reporting and Data System (ONCO-RADS). MET-RADS-P was developed to stage and monitor men with advanced prostate cancer using WB-MRI. It has emerged as a reliable imaging biomarker for predicting metastatic disease progression and assessing treatment response. MY-RADS was developed to stage and monitor patients with multiple myeloma using WB-MRI, emerging as a prognostic imaging biomarker. However, the evidence regarding inter-reader agreement for MY-RADS is currently limited. ONCO-RADS was developed to standardize the use of WB-MRI for cancer screening in individuals with cancer predisposition syndromes and in the general population. While initial findings are promising, the evidence supporting its use remains limited. To further validate and expand upon these promising preliminary findings, additional large-scale, prospective, multicenter studies are necessary.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037339","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":"A Novel Nomogram for Estimating a High-Risk Result in the EndoPredict^® Test for Estrogen Receptor-Positive/Human Epidermal Growth Factor Receptor 2 (HER2)-Negative Breast Carcinoma.","authors":"Víctor Macarrón, Itsaso Losantos-García, Alberto Peláez-García, Laura Yébenes, Alberto Berjón, Laura Frías, Covadonga Martí, Pilar Zamora, José Ignacio Sánchez-Méndez, David Hardisson","doi":"10.3390/cancers17020273","DOIUrl":"10.3390/cancers17020273","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The EndoPredict^® assay has been widely used in recent years to estimate the risk of distant recurrence and the absolute chemotherapy benefit for patients with estrogen (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. However, there are no well-defined criteria for selecting patients who may benefit from the test. The aim of this study was to develop a novel nomogram to estimate the probability of obtaining a high-risk EndoPredict^® result in clinical practice. <b>Methods</b>: The study cohort comprised 348 cases of T1-3/N0-1a/M0 ER-positive/HER2-negative breast carcinoma. A multivariate analysis was conducted using a training cohort (n = 270) based on clinicopathological features that demonstrated a statistically significant correlation with the EndoPredict^® result in a univariate analysis. The predictive model was subsequently represented as a nomogram to estimate the probability of obtaining a high-risk result in the EndoPredict^® assay. The predictive model was then validated using a separate validation cohort (n = 78). <b>Results</b>: The clinicopathological features incorporated into the nomogram included tumor size, tumor grade, sentinel lymph node status, pN stage, and Ki67. The internal validation of the model yielded an area under the curve (AUC) of 0.803 (95% CI = 0.751, 0.855) in the receiver operating characteristic (ROC) curve for the training cohort, with an optimal sensitivity and specificity at a threshold of 0.536. The external validation yielded an AUC of 0.789 (95% CI = 0.689, 0.890) in its ROC curve, with optimal sensitivity and specificity achieved at a threshold of 0.393. <b>Conclusions</b>: This study presents, for the first time, the development of a clinically accessible nomogram designed to estimate the probability of obtaining a high-risk result in the EndoPredict^® assay. The use of easily available clinicopathological features allows for the optimization of patient selection for the EndoPredict^® assay, ensuring that those who would most benefit from undergoing the test are identified.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037313","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 HOX Gene Family's Role as Prognostic and Diagnostic Biomarkers in Hematological and Solid Tumors.","authors":"Kaci Kopec, Danielle Quaranto, Nicole R DeSouza, Tara Jarboe, Humayun K Islam, Augustine Moscatello, Xiu-Min Li, Jan Geliebter, Raj K Tiwari","doi":"10.3390/cancers17020262","DOIUrl":"10.3390/cancers17020262","url":null,"abstract":"<p><p>The HOX gene family encodes for regulatory transcription factors that play a crucial role in embryogenesis and differentiation of adult cells. This highly conserved family of genes consists of thirty-nine genes in humans that are located in four clusters, A-D, on different chromosomes. While early studies on the HOX gene family have been focused on embryonic development and its related disorders, research has shifted to examine aberrant expression of HOX genes and the subsequent implication in cancer prediction and progression. Due to their role of encoding master regulatory transcription factors, the abnormal expression of HOX genes has been shown to affect all stages of tumorigenesis and metastasis. This review highlights the novel role of the HOX family's clinical relevance as both prognostic and diagnostic biomarkers in hematological and solid tumors.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037333","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":"Chimeric Antigen Receptor-T Cells in the Modern Era of Chronic Lymphocytic Leukemia Treatment.","authors":"Alycia Hatashima, Mazyar Shadman, Vikram Raghunathan","doi":"10.3390/cancers17020268","DOIUrl":"10.3390/cancers17020268","url":null,"abstract":"<p><p>Pathway inhibitors targeting Bruton tyrosine kinase (BTK) and B-cell lymphoma-2 (BCL-2) have dramatically changed the treatment landscape for both treatment-naïve and relapsed/refractory chronic lymphocytic leukemia (CLL). However, with increased utilization, a growing number of patients will experience progressive disease on both agents. This subgroup of \"double refractory\" patients has limited treatment options and poor prognosis. Chimeric antigen receptor (CAR)-T cells have transformed the treatment of relapsed/refractory B-cell malignancies. Although the earliest success of CAR-T cell therapy was in CLL, the clinical application of this modality has lagged until the recent approval of the first CAR-T cell product for CLL. In this review, we describe the current treatment options for upfront and subsequent therapies and the unmet need for novel agents highlighted by the burgeoning role and challenges of CAR-T cell therapy.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037172","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":"Multiple Myeloma Cells Shift the Fate of Cytolytic ILC2s Towards TIGIT-Mediated Cell Death.","authors":"Fabiana Drommi, Alessia Calabrò, Gaetana Pezzino, Grazia Vento, Josè Freni, Gregorio Costa, Riccardo Cavaliere, Irene Bonaccorsi, Alessandro Allegra, Guido Ferlazzo, Claudia De Pasquale, Stefania Campana","doi":"10.3390/cancers17020263","DOIUrl":"10.3390/cancers17020263","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence attests to the multifaceted roles of group 2 innate lymphoid cells (ILC2s) in cancer immunity. They exhibit either pro- or anticancer activity depending on tumor type but their function in Multiple Myeloma (MM) is still not elucidated.</p><p><strong>Methods: </strong>The bone marrow (BM) and peripheral blood (PB) of patients (pts) with MM or precancerous conditions were collected, and specific properties of ILC2 subsets were assessed by flow cytometry.</p><p><strong>Results: </strong>By dissecting ILC2s according to c-Kit marker, we observed that NKp30 and NKG2D were mainly confined to c-Kit^hi ILC2s, while levels of DNAM-1 was significantly higher in fully mature c-Kit^lo cells. Among the total MM-associated ILC2s (MM-ILC2s), we observed a significant increase in c-the Kit^lo subset, but the expression of DNAM-1 in these cells was significantly reduced, especially in BM. Interestingly, MM-ILC2s from PB expressed granzyme B (GZMB), but its expression was impaired in BM-ILC2s. Accordingly, MM cells were susceptible to killing by MM-ILC2s derived from PB while eluding ILC2 surveillance in BM. Indeed, in MM-ILC2s derived from BM, the downregulation of DNAM-1 is accompanied by the upregulation of TIGIT, which mediate cell death in ILC2s upon recognition of the cognate ligands expressed by MM cells. These ILC2 changes appeared in clinical precursor conditions and eventually accumulated with disease progression.</p><p><strong>Conclusions: </strong>MM-ILC2s can act as cytolytic immune effectors that are fully competent in PB. However, MM cells shift ILC2 fate towards cell death in BM via the upregulation of TIGIT, thereby representing a potential therapeutic target to restore ILC2 antitumor activity.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037082","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":"Endovascular Downstaging: A New Method for Managing Renal Cell Carcinoma Tumor Thrombus Invading the Inferior Vena Cava Above the Hepatic Veins (Level III) or into the Heart (Level IV).","authors":"John A Libertino, Malik Ahmed, Thomas Piemonte, Jason Gee","doi":"10.3390/cancers17020264","DOIUrl":"10.3390/cancers17020264","url":null,"abstract":"<p><strong>Background: </strong>Renal cell carcinoma tends to invade venous structures, frequently extending beyond the inferior vena cava and into the heart itself, such as into the right atrium or right ventricle. Resection of tumor burden, particularly tumor thrombus, often requires cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), which is not feasible for all patients.</p><p><strong>Methods: </strong>Described in this study is a novel, minimally invasive endovascular approach involving endovascular thrombectomy as a viable approach in these select patients.</p><p><strong>Results: </strong>There were no surgical complications, shorter operating times, less blood loss and an average length of stay of 5.5 days in the four patients undergoing this procedure.</p><p><strong>Conclusions: </strong>We demonstrate that this technique can eliminate the need for cardiac bypass and deep hypothermic cardiac arrest and its associated risks, thereby making surgery safer and more accessible for patients with advanced kidney cancers with an inferior vena cava tumor thrombus. Furthermore, it allows for this life-saving surgery to be carried out in medical centers or hospitals where cardiac surgery is unavailable, or when cardiopulmonary bypass is medically contraindicated.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036993","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}