Cancer Research and Treatment

Original Articles

Chemotherapy-Free Salvage Therapy with Rituximab, Lenalidomide, and Poseltinib in Relapsed or Refractory Primary Central Nervous System Lymphoma: A Multi-Center, Phase II Study: Dong Hyun Kim, Sanyeowool An, Hongyul Ahn, Han Song, Ka-Won Kang, Sang Eun Yoon, Seok Jin Kim, Hyo Jung Kim, Youngil Koh, Deok-Hwan Yang, Consortium for Improving Survival of Lymphoma (CISL); Received September 6, 2025 Accepted November 11, 2025 Published online November 12, 2025; DOI: https://doi.org/10.4143/crt.2025.977 [Accepted]

Abstract PDF: Purpose
Relapsed or refractory (R/R) primary central nervous system lymphoma (PCNSL) is an aggressive malignancy for which salvage chemotherapy has limited efficacy. We conducted an investigator-initiated, single-arm, multicenter phase II trial to evaluate the efficacy and safety of a chemotherapy-free salvage regimen comprising rituximab, lenalidomide, and poseltinib (R2P) in patients with R/R PCNSL.
Materials and Methods
The R2P regimen consisted of two phases: six cycles of induction with rituximab, lenalidomide, and poseltinib, followed by three cycles of consolidation with lenalidomide and poseltinib. The primary endpoints were complete response rate (CRR) and overall response rate (ORR). Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS).
Results
A total of 10 patients were enrolled (one withdrew before cycle 1; nine were evaluable for efficacy). The median age was 70 years (range, 53–75), and all had received methotrexate-based first-line chemotherapy. The ORR was 55.6%, and the CRR was 33.3%. The median PFS was 5.6 months, and the median OS was not reached. Next-generation sequencing was performed in four patients (three responders and one non-responder). CD79B missense mutations were identified in all three responders. A total of 11 adverse events (AEs) were observed in six patients. The most common AE was neutropenia (30.0%). The only grade ≥3 AE was a single case of grade 3 neutropenia. No dose modifications were required due to toxicity.
Conclusion
Poseltinib in combination with lenalidomide and rituximab showed activity in patients with R/R PCNSL, warranting further investigation in larger studies.

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Real World Efficacy of 1st-Line Nivolumab Plus Ipilimumab and its Practical Predictive Biomarkers in Advanced Renal Cell Carcinoma: First Analysis from RENOIR Study (KCSG GU22-13): Jwa Hoon Kim, Sang Joon Shin, Woo Kyun Bae, Se Hyun Kim, Jin Young Kim, Hyeon-Su Im, In-Ho Kim, Il Hwan Kim, Kwonoh Park, Eo Jin Kim, Mihong Choi, Joo Han Lim, Hyunho Kim, Kyoungmin Lee, Hyo-Jeong Kim, Jungmin Jo, Hyo Jin Lee, Dalyong Kim, Byeong Seok Sohn, Inkeun Park, Ji Hyun Park; Received August 8, 2025 Accepted October 11, 2025 Published online October 13, 2025; DOI: https://doi.org/10.4143/crt.2025.846 [Accepted]

Abstract PDF: Purpose
We investigated the real-world efficacy of first-line nivolumab plus ipilimumab (NI) and its predictive clinicopathological biomarkers in patients with advanced renal cell carcinoma(aRCC).
Materials and Methods
We retrospectively analyzed 466 patients with aRCC who started first-line NI between 2019 and 2023 at 21 Korean tertiary hospitals. The primary outcome was objective response rate (ORR). Secondary outcomes were duration of response (DoR), progression-free survival (PFS), overall survival (OS), and identification of practical clinicopathological biomarkers.
Results
Median age of patients was 65 years, and 77.7% were male. ORR was 44.8% including 5.2% of complete response, and median DoR was 39.8 months. Male sex and lung metastasis were predictive markers of objective response, and achieving complete response was significantly associated with a longer DoR (p=0.03). With a median follow-up duration of 23.7 months, the median PFS and OS were 11.5 and 44.2 months, respectively. Full exposure to four cycles of ipilimumab was significantly associated with better PFS and OS. Durable response could significantly predict better OS, whereas multiple metastatic sites (≥4) and poor IMDC risk were two independent predictors for inferior OS. Among the 50 patients who completed 2 years of NI treatment, continuation of nivolumab beyond 2 years has marginally improved OS (p=0.09).
Conclusion
First-line NI showed comparable and competent efficacy in Korean patients with aRCC. We suggest completing full exposure to ipilimumab and durable response as practical predictors of enriched benefits of NI in our real-world.

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Effectiveness of CAR-T Cell Therapies for Relapsed/Refractory Follicular Lymphoma: An External Control Arm Study: Hee-Jin Seo, Ju Hwan Kim, Sang Eun Yoon, Won Seog Kim, Dong Keon Yon, Ju-Young Shin, Seok Jin Kim; Received December 10, 2024 Accepted September 15, 2025 Published online September 17, 2025; DOI: https://doi.org/10.4143/crt.2024.1181 [Accepted]

Abstract PDF: Purpose
Axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabactagene maraleucel (liso-cel) have received regulatory approval for relapsed or refractory follicular lymphoma (r/r FL). However, the data are scare on their comparative effectiveness against the salvage therapies available in real-world settings. This study aimed to indirectly compare treatment outcomes of axi-cel, tisa-cel, and liso-cel versus usual care in South Korean patients with FL.
Materials and Methods
To assess effectiveness in real-world data, aggregate data from the ZUMA-5, ELARA, and TRANSCEND FL studies were compared with individual patient data from the Samsung Medical Center – Lymphoma Cohort Study (SMC-LCS). Patients meeting ZUMA-5, ELARA, and TRANSCEND FL eligibility criteria were selected as the external control arm. All eligible treatment lines per patient were analyzed as independent episodes and weighted using the matching-adjusted indirect comparison (MAIC) method. Time-to-event outcomes were assessed with weighted Kaplan-Meier analysis, and adjusted hazard ratios (aHR) were estimated using Cox proportional hazards models.
Results
Axi-cel included 127 patients, tisa-cel included 94, liso-cel included 101, and 121 episodes from 49 patients were analyzed in the external control arm. The weighted hazard ratios for overall survival (OS) and progression-free survival (PFS) for axi-cel versus the external control were 0.37 (95% CI, 0.21-0.64), 0.35 (95% CI, 0.20-0.59), respectively. For tisa-cel, the HRs were 0.24 (95% CI, 0.11-0.53), and 0.35 (95% CI, 0.20-0.60), respectively. For liso-cel, the HRs were 0.38 (95% CI, 0.13-1.04), and 0.36 (95% CI, 0.15-0.88), respectively.
Conclusion
All three CAR-T therapies showed outstanding effectiveness compared to conventional treatments in usual care in South Korea.

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Clinicopathological Factors Influencing PD-L1 Expression and The Effect of Immune Checkpoint Inhibitors on Survival Outcomes in Patients with Gastric Cancer Depending on Sex in a Tertiary Hospital in South Korea: Jeong hwan Lee, Nayoung Kim, Ji-Hyun Kim, Hyeon Jeong Oh, Yeejin Kim, Yonghoon Choi, Hyemin Jo, Ho-Kyoung Lee, Jinju Choi, Yu Kyung Jun, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Dong Ho Lee, Hye Seung Lee, So Hyun Kang, Young Suk Park, Sang-Hoon Ahn, Yun-Suhk Suh, Do Joong Park, Hyung Ho Kim, Ji-Won Kim, Jin Won Kim, Keun-Wook Lee, Won Chang, Yoon Jin Lee, Kyoung Ho Lee, Young Hoon Kim, Soyeon Ahn; Received January 31, 2025 Accepted August 5, 2025 Published online August 13, 2025; DOI: https://doi.org/10.4143/crt.2025.126 [Accepted]

Abstract PDF: Purpose
Programmed cell death ligand-1 (PD-L1) negatively regulates T-cell activation, and exhibits sex-based differences in expression and immune responses. This study investigated sex-related differences in clinicopathological factors influencing PD-L1 expression and the effect of immune checkpoint inhibitors (ICIs) on survival in gastric cancer (GC) patients in South Korea.
Materials and Methods
We analyzed a prospective cohort of 468 GC patients who underwent PD-L1 immunohistochemistry. Age, tumor characteristics, molecular features, and survival outcomes were compared by sex. Multivariate analyses, including Cox proportional hazards modeling with an interaction term for sex, were performed.
Results
Among 468 patients, 280 (59.8%) were PD-L1 positive. In the overall cohort, PD-L1 positivity was significantly associated with Epstein-BarrVirus (EBV) infection (odd ratio [OR]=7.46, p<0.001), antral location of GC (OR=1.84, p=0.027), and macrosatellite instability-High (MSI-H) (OR=5.04, p=0.027). Diffuse-type histology was inversely associated (OR=0.22, p=0.041). In males, EBV (OR=36.27) and antral location (OR=2.38) were significant. In females, only MSI-H was significant (OR=11.63). ICI-containing therapy significantly improved survival in males (p=0.012) but not in females (p=0.415). Cox regression showed a survival benefit from ICIs (HR=0.70, p=0.080), with a borderline-significant interaction by sex (p=0.073).
Conclusion
PD-L1 expression and therapeutic efficacy of ICIs differ by sex in GC. EBV infection and antral tumor location were independent factors in males, while MSI-H status was significant in females. These findings highlights the importance of sex-based immunobiology in tailoring GC treatment strategies.

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DNA damage and Nuclear Anaplasia Induced by Trastuzumab Deruxtecan in Cancer Cells with Variable HER2 Expression and Homologous Recombination Deficiency Status: So Hyeon Kim, Yoonjung Park, Ahrum Min, Hye Yeon Park, Yu-Jin Kim, Sujin Ham, Jiwon Koh, Seongyeong Kim, Dae-Won Lee, Han Suk Ryu, Jin-Soo Kim, Kyung-Hun Lee, Seock-Ah Im; Received February 21, 2025 Accepted June 2, 2025 Published online August 4, 2025; DOI: https://doi.org/10.4143/crt.2025.201 [Accepted]

Abstract PDF: Purpose
Human epidermal growth factor receptor 2 (HER2) is amplified or overexpressed in various malignancies, including breast and gastric cancers, and is associated with poor prognosis. Although HER2-targeted therapies, such as trastuzumab, improve outcomes in HER2-positive tumors, resistance often develops, and HER2-low tumors remain largely untargeted. Trastuzumab deruxtecan (T-DXd; DS-8201a) is a HER2-targeted antibody-drug conjugate with potent activity in HER2-positive and HER2-low tumors. This study evaluates its antitumor mechanisms and efficacy in HER2-positive, HER2-low, and homologous recombination deficiency (HRD)-associated models.
Materials and Methods
Effects of T-DXd were assessed in cancer cell lines with diverse HER2 expression and HRD status. In vivo efficacy was evaluated using a xenograft model derived from HER2-low SNU-601 gastric cancer cells.
Results
T-DXd reduced HER2 phosphorylation and downstream signaling (AKT, ERK) in HER2-positive cells. It induced DNA damage accumulation, as evidenced by increased γH2AX and p-Chk1 expression, and triggered apoptosis through cleaved PARP and caspase-3 activation, confirmed by annexin V staining. Similar effects were observed in HER2-low cells, with greater sensitivity in HRD cells. In xenografts, T-DXd reduced tumor volume by up to 80% at 4 mg/kg and 10 mg/kg. Histological analyses showed decreased Ki-67 and increased apoptosis. Furthermore, T-DXd induced G2/M cell cycle arrest and nuclear anaplasia, suggesting disruption of chromosomal stability as a potential antitumor mechanism. No significant toxicity, including body weight loss, was observed.
Conclusion
These findings highlight T-DXd’s effectiveness in HER2-low and HRD tumors, supporting its broader clinical application, including strategies targeting DNA damage repair pathways.

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Case Report

Detection of HIV RNA after CAR-T Cell Therapy in A Relapsed/refractory Diffuse Large B-cell Lymphoma Patient: Possibility of False Positivity and Clinical Implications: Sang Eun Yoon, Kyungmin Huh, Tae Yeul Kim, Hee Jae Huh, Seok Jin Kim, Won Seog Kim; Received May 8, 2025 Accepted June 26, 2025 Published online June 30, 2025; DOI: https://doi.org/10.4143/crt.2025.491 [Accepted]

Abstract PDF: CAR-T cell therapy using lentiviral vectors can lead to false-positive HIV RNA detection, making distinguishing true infection from vector-related signals challenging. A 64-year-old male with relapsed/refractory DLBCL (RR-DLBCL) underwent multiple lines of treatment, including R-CHOP, R-ICE, autologous stem cell transplantation (ASCT), and tisagenlecleucel (tisa-cel, Kymriah). Infectious disease screening before CAR-T therapy was negative for HIV. However, four months post-infusion, during evaluation for second-line CAR-T therapy targeted CD20, HIV RNA was detected in Roche Cobas HIV-1 assay targeted dual target, 5'LTR and gag gene (48 copies/mL). Serial testing showed persistent but low-level positivity of HIV RNA. Retrospective analysis of stored serum samples revealed HIV RNA negativity before tisa-cel infusion but positivity post-infusion in Roche Cobas HIV-1 assay. Additional testing using the Alinity m HIV-1 assay (dual target: 5'LTR and pol gene) and the Abbott RealTime HIV-1 assay (single-target: pol gene) confirmed that only the dual-target assay yielded positive results, suggesting lentiviral vector cross-reactivity rather than actual HIV infection. This case underscores the potential for false-positive HIV-1 RNA detection in CAR-T cell treatment recipients due to vector-derived sequences, emphasizing the need for cautious interpretation of HIV-1 testing.

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Review Article

Advances in T-Cell–Directed Immunotherapy for Adult Mature B-Cell Lymphoma: A Comprehensive Review of CAR T-Cell and Bispecific Antibody Therapies: Jinchul Kim, Seok Jin Kim; Cancer Res Treat. 2025;57(4):905-922. Published online June 26, 2025; DOI: https://doi.org/10.4143/crt.2025.440

Abstract PDF PubReader ePub: B-cell lymphomas are a heterogeneous group of malignancies with a high relapse rate after conventional therapies. T-cell–mediated immunotherapies, notably chimeric antigen receptor (CAR) T-cell therapies and T-cell–engaging bispecific antibodies (BsAbs), have transformed treatment paradigms by harnessing the immune system to target malignant cells. This review analyzes the efficacy and safety profiles of several CD19-targeted CAR T-cell therapies and emerging CD20×CD3 BsAbs across various B-cell lymphoma subtypes. While these therapies have demonstrated high response rates and potential for durable remissions, challenges such as cytokine release syndrome, neurotoxicity, and infections remain significant. Understanding these mechanisms and managing adverse effects are crucial for optimizing clinical outcomes and guiding future research in personalized treatment strategies.

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Original Articles

Programmed Death-Ligand 1 Expression Across Multiple Assays in Ovarian Cancer: A Comparative Analysis: Eun Bi Jang, Kyeong A So, Wook Youn Kim, So Dug Lim, Tae Jin Kim, Heejin Bang, Wan Seop Kim; Received February 21, 2025 Accepted June 5, 2025 Published online June 9, 2025; DOI: https://doi.org/10.4143/crt.2025.202 [Accepted]

Abstract PDF: Purpose
Ovarian cancer presents significant treatment challenges due to its aggressive nature and poor response to immune checkpoint inhibitors (ICIs). The lack of standardized programmed cell death-ligand 1 (PD-L1) assays and cut-off values complicates clinical decision-making. We evaluated the concordance among commonly used PD-L1 assays and assessed changes in the expression of PD-L1 following chemotherapy.
Materials and Methods
Tissue samples from 29 patients with ovarian cancer were analyzed using five validated PD-L1 immunohistochemistry assays: Dako 22C3, Ventana SP263, Ventana SP142, Dako 28-8, and Ventana 22C3. PD-L1 positivity was assessed using a combined positive score (CPS), immune cell (IC), or tumor proportion score (TPS) at 1%, 5%, and 10% cut-offs. Concordance rates, including overall percent agreement (OPA) and Cohen’s kappa coefficient, were analyzed. In addition, changes in the expression of PD-L1 pre- and post-chemotherapy were evaluated.
Results
Positivity rates ranged from 15.8% (SP142) to 29.8% (Dako 22C3 and SP263) at the 1% CPS cut-off. SP142 consistently exhibited the lowest concordance, whereas Dako 22C3 displayed high agreement with SP263, 28-8, and Ventana 22C3. Chemotherapy increased PD-L1 positivity, with 28% of patients converting from negative to positive.
Conclusion
The expression of PD-L1 in ovarian cancer varies across assays and scoring methods, emphasizing the need for standardized testing protocols. Increased PD-L1 expression post-chemotherapy underscores the importance of assessing its status at appropriate times to guide ICI therapy. Larger studies are required to validate these findings and refine clinical applications.

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Non-Operative Management of Rectal Cancer with Adjuvant Chemotherapy after Chemoradiotherapy (NORMANDY): Prospective Study: Hyebin Lee, Hyung Ook Kim, Jason Joon Bock Lee, In-Gu Do, Heon-Ju Kwon, Mi Sung Kim, Soo-Kyung Park, Hyo-Joon Yang, Yoon Suk Jung, Jung Ho Park, Dong-Il Park, Kyung Uk Jung, Eo Jin Kim, Dong-Hoe Koo, Hungdai Kim, Ho-Kyung Chun, KBSMC Colorectal Cancer Team, Gastrointestinal Cancer Center; Received February 8, 2025 Accepted May 13, 2025 Published online May 15, 2025; DOI: https://doi.org/10.4143/crt.2025.148 [Epub ahead of print]

Abstract PDF Supplementary Material: Purpose
Non-operative management (NOM) has emerged as a promising organ-preserving strategy for patients with rectal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (CRT). However, no standardized treatment protocol has been established for watch-and-wait strategies.
Materials and Methods
This prospective study evaluated oncological outcomes of NOM combined with 4 months of adjuvant capecitabine. Patients with resectable rectal cancer (≤ 8 cm from the anal verge, cT2-4 or N+) underwent CRT (50-54 Gy in 25-27 fractions with capecitabine). Eight weeks post-CRT, a multidisciplinary team assessed cCR. Patients achieving cCR received six cycles of capecitabine (2 weeks on/1 week off) and were actively monitored.
Results
Among 89 patients receiving CRT (2018-2023), 17 (19.1%) achieved cCR and were included. The median age was 65 years, and 64.7% were male. Eleven (64.7%) completed all six cycles of adjuvant therapy. After a median follow-up of 31.4 months, 11 patients (64.7%) remained disease-free. Local regrowth occurred in six patients (35.3%) with 2- and 4-year rates of 34.5% and 47.6%, respectively. Five underwent radical surgery, and one received transanal excision with systemic chemotherapy. At the time of assessment, 15 patients (88.2%) showed no evidence of disease, while two (11.8%) received palliative chemotherapy. All patients were alive.
Conclusion
NOM with adjuvant capecitabine showed promising oncological outcomes, offering an alternative to passive watch-and-wait approaches. Further refinement through multidisciplinary strategies is warranted.

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Elimusertib, a Novel ATR Inhibitor, Induces Anti-tumor Effects through Replication Catastrophe in Breast Cancers: Mudong Kim, Ahrum Min, Sohyeon Kim, Seongyeong Kim, Yu-jin Kim, Sujin Ham, Miso Lee, Eunice Yoojin Lee, Jinyong Kim, Dae-Won Lee, Kyung-Hun Lee, Seock-Ah Im; Received December 6, 2024 Accepted April 1, 2025 Published online April 7, 2025; DOI: https://doi.org/10.4143/crt.2024.1105 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Purpose
Sustained cell proliferation and cell cycle acceleration in cancer cells inherently increase DNA damage, which interferes with homeostatic replication and transcription. Ataxia telangiectasia and Rad3-related (ATR) is crucial for initiation of the DNA damage response, and ATR inhibitors, such as elimusertib, induce increased replication stress and DNA damage. We investigated the anti-tumor effects of elimusertib and its mechanism of action in relation to replication stress.
Materials and Methods
Anti-tumor effects were evaluated by MTT assay and colony formation assay in breast cancer cell lines in vitro, in breast cancer cell xenografts in vivo, and in patient-derived xenograft models. Cell cycle was assessed by flow cytometry and BrdU assay was used to measure replicating cells and S-phase progression. Alkaline and neutral comet assay was used to measure single and double-stranded DNA damages, respectively.
Results
Elimusertib delayed S-phase progression in MDA-MB-453 and MDA-MB-231 cells and induced caspase-7–dependent apoptosis. Furthermore, the increase in sub-G1 population in the fluorescence-activated cell sorting analysis and Annexin V assay also confirmed apoptotic cell death. In the BrdU assay, single-stranded DNA (ssDNA) increased in sensitive cells and aberrant ssDNA induced DNA damage in S-phase and eventually caused replication catastrophe. Finally, these anti-tumor effects were proven in in vivo xenograft and patient-derived xenograft models.
Conclusion
Elimusertib had anti-tumor effects and induced replication catastrophe in breast cancer cells with a high replication rate. Moreover, cells under high DNA replication stress were sensitive to elimusertib. Further studies and treatment strategies with elimusertib are warranted for cancers with a high replication rate.

Citations

Citations to this article as recorded by

The comet assay: A contemporary approach for detecting genomic instability
Xingkai He, Feng Chen, Linmin Zhou, Yuanqing Sun, Qi Liu, Weicheng Chen, Luyao Zhu, Jun Zhang, Wei-Guo Zhu
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Special Articles

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2022: Eun Hye Park, Kyu-Won Jung, Nam Ju Park, Mee Joo Kang, E Hwa Yun, Hye-Jin Kim, Jeong-Eun Kim, Hyun-Joo Kong, Kui Son Choi, Han-Kwang Yang, The Community of Population-Based Regional Cancer Registries; Cancer Res Treat. 2025;57(2):312-330. Published online March 11, 2025; DOI: https://doi.org/10.4143/crt.2025.264

Abstract PDF Supplementary Material PubReader ePub

Purpose
The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2022, with international comparisons.
Materials and Methods
Cancer incidence, survival, and prevalence rates were calculated using the Korea National Cancer Incidence Database (1999-2022), with survival follow-up until December 31, 2023. Mortality data obtained from Statistics Korea, while international comparisons were based on GLOBOCAN data.
Results
In 2022, 282,047 newly diagnosed cancer cases (age-standardized rate [ASR], 287.0 per 100,000) and 83,378 deaths from cancer (ASR, 65.7 per 100,000) were reported. The proportion of localized-stage cancers increased from 45.6% in 2005 to 50.9% in 2022. Stomach, colorectal, and breast cancer showed increased localized-stage diagnoses by 18.1, 18.5, and 9.9 percentage points, respectively. Compared to 2001-2005, the 5-year relative survival (2018-2022) increased by 20.4 percentage points for stomach cancer, 7.6 for colorectal cancer, and 5.6 for breast cancer. Korea had the lowest cancer mortality among countries with similar incidence rates and the lowest mortality-to-incidence (M/I) ratios for these cancers. The 5-year relative survival (2018-2022) was 72.9%, contributing to over 2.59 million prevalent cases in 2022.
Conclusion
Since the launch of the National Cancer Screening Program in 2002, early detection has improved, increasing the diagnosis of localized-stage cancers and survival rates. Korea recorded the lowest M/I ratio among major comparison countries, demonstrating the effectiveness of its National Cancer Control Program.

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Prediction of Cancer Incidence and Mortality in Korea, 2025: Kyu-Won Jung, Mee Joo Kang, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Jeong-Eun Kim, Hyun-Joo Kong, Kui Son Choi, Han-Kwang Yang; Cancer Res Treat. 2025;57(2):331-338. Published online March 11, 2025; DOI: https://doi.org/10.4143/crt.2025.263

Abstract PDF PubReader ePub

Purpose
This study aimed to project cancer incidence and mortality for 2025 to estimate Korea’s current cancer burden.
Materials and Methods
Cancer incidence data from 1999 to 2022 were obtained from the Korea National Cancer Incidence Database, while cancer mortality data from 1993 to 2023 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and then by multiplying the projected age-specific rates by the anticipated age-specific population for 2025. A joinpoint regression model was applied to identify significant changes in trends, using only the most recent trend data for predictions.
Results
A total of 304,754 new cancer cases and 84,019 cancer deaths are expected in Korea in 2025. The most commonly diagnosed cancer is projected to be thyroid cancer, followed by the colorectal, lung, breast, prostate and stomach cancers. These six cancers are expected to account for 63.8% of the total cancer burden. Lung cancer is expected to be the leading cause of cancer-related deaths, followed by liver, colorectal, pancreatic, stomach, and gallbladder cancers, together comprising 66.6% of total cancer deaths.
Conclusion
The increasing incidence of female breast cancer and the rise in prostate and pancreatic cancers are expected to continue. As aging accelerates, cancer commonly found in older adults are projected to rise significantly.

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The volume of Gleason grade group 1 prostate cancer at biopsy predicts unfavorable pathology but not upgrading after radical prostatectomy
Tae Ho Hwang, Young Dong Yu, Kyung Hwa Choi, Seung Ryeol Lee, Young Kwon Hong, Dong Soo Park, Tae Heon Kim
International Urology and Nephrology.2025;[Epub] CrossRef
Factors That Impact the Quality of Life of Breast Cancer Patients: A Cross-Sectional Study
Kyung-Sook Cha, Dohyun Lee, Su-Mi Im
AJN, American Journal of Nursing.2025; 125(10): 20. CrossRef
Association of plant-based diet indices with all-cause and cause-specific mortality among Korean adults in the KNHANES
Heejin Lee, Jung Eun Lee, Minji Kang
Scientific Reports.2025;[Epub] CrossRef

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Original Article

Lung and Thoracic cancer

Tracing Metastatic Evolutionary Patterns in Lung Adenocarcinoma: Prognostic Dissection Based on a Multi-state Model: Geewon Lee, Yang-Jin Kim, Insuk Sohn, Jong Hoon Kim, Ho Yun Lee; Cancer Res Treat. 2025;57(4):1019-1029. Published online January 24, 2025; DOI: https://doi.org/10.4143/crt.2024.700

Abstract PDF Supplementary Material PubReader ePub

Purpose
After surgery for lung adenocarcinoma, a patient may experience various states of recurrence, with multiple factors potentially influencing the transitions between these states. Our purpose was to investigate the effects of clinical and pathological factors on tumor recurrence, death, and prognosis across various metastasizing pathways.
Materials and Methods
Our study group included 335 patients with all demographic and pathologic data available who underwent surgical resection for lung adenocarcinoma for more than 10 years. The following states of disease were defined: initial state, operation (OP); three intermediate states of local recurrence (LR), metastasis (Meta), and concurrent LR with metastasis (LR+Meta); and a terminal state, death. We identified eight transitions representing various pathways of tumor progression. We employed a multi-state model (MSM) to separate the impacts of multiple prognostic factors on the transitions following surgery.
Results
After surgery, approximately half of patients experienced recurrence. Specifically, 142 (42.4%), 54 (16.1%), and seven (2.1%) patients developed Meta, LR+Meta, and LR, respectively. Clinical and pathological factors associated with the transitions were different. Impact of pathological lymph node remained a risk factor for both OP to Meta (λ02, p=0.001) and OP to LR+Meta (λ03, p=0.001).
Conclusion
Lung adenocarcinoma displays a broad spectrum of clinical scenarios even after curative surgery. Incidence, risk factors, and prognosis varied across different pathways of recurrence in lung adenocarcinoma patients. The greatest implication of this MSM is its ability to predict the timing and type of clinical intervention that will have the greatest impact on survival.

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A‐to‐I RNA Edited miR‐3167 Restrains Malignant Behaviors of Lung Adenocarcinoma by Influencing SSR2‐Meditated Hippo Signaling
Dawei Qian, Dongsheng Zha, Yuanyao Sang, Jiangquan Tao, Bufeng Zhuang, Youshuang Cheng
Molecular Carcinogenesis.2025; 64(9): 1552. CrossRef

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Special Article

Identifying Trends in Oncology Research through a Bibliographic Analysis of Cancer Research and Treatment: Choong-kun Lee, Jeong Min Choo, Yong Chan Ahn, Jin Kim, Sun Young Rha, Chai Hong Rim, On behalf of the 50th Anniversary Committee of the Korean Cancer Association; Cancer Res Treat. 2025;57(1):11-18. Published online December 5, 2024; DOI: https://doi.org/10.4143/crt.2024.688

Abstract PDF PubReader ePub: During the celebration of the 50th anniversary of the founding of the Korean Cancer Association, articles published in Cancer Research and Treatment from 2004 to 2023 were assessed based on the subject and design of each study. Based on this analysis, trends in domestic cancer research were inferred and directions were suggested for the future development of Cancer Research and Treatment.

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Original Articles

General

Low-Dose Cyclophosphamide Enhances the Tumoricidal Effects of 5-Day Spacing Stereotactic Ablative Radiotherapy by Boosting Antitumor Immunity: Hyunkyung Kim, Seok-Joo Chun, Sojung Sun, Haeun Cho, Tae-Jin Kim, Yoon-Jin Lee, Eui Kyu Chie, Kwangmo Yang, Mi-Sook Kim; Cancer Res Treat. 2025;57(3):678-692. Published online November 8, 2024; DOI: https://doi.org/10.4143/crt.2024.807

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to investigate the potential role of low-dose cyclophosphamide (Cy) as a radiosensitizer by evaluating its impact on the immune response and the abscopal effect of stereotactic ablative radiotherapy through preclinical models.
Materials and Methods
CT26 tumors (immunologically hot) and 4T1 tumors (immunologically cold), grown in immunocompetent BALB/c and immunodeficient BALB/c–nude mice, were irradiated with 20 Gy in two fractions with 5-day spacing followed by intraperitoneal injections of 9 mg/kg Cy every 3 days. Immunological changes in CT26 tumors caused by the treatments were assessed using flow cytometry. Changes in the expression of hypoxia-inducible factor-1α (HIF-1α) in tumors were also assessed. Splenocytes and bone marrow–derived dendritic cells (DCs) were exposed to various concentrations of Cy to assess T cell proliferation and DC differentiation.
Results
The combination of Cy with radiotherapy (RT+Cy) significantly suppressed tumor growth compared to RT alone in immunocompetent mice, while that effect was not observed in immunodeficient mice. Additionally, RT+Cy effectively induced abscopal effects in hot and cold tumors, with increased CD8+ T cells in blood and tumors. Significantly higher expression levels of granzyme B, interferon γ, and tumor necrosis factor α were observed in RT+Cy group compared to the RT alone group. In vitro data indicated that low-dose Cy promotes DC differentiation. Low-dose Cy suppressed the radiation-induced upregulation of HIF-1α in the tumors.
Conclusion
Low-dose Cy enhances tumoricidal effects of 5-day spacing high-dose RT by increasing antitumor immune responses.

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Regulatory T cells in cancer: from immunosuppression to therapeutic targeting
Paola Basurto-Olvera, Hector Serrano, Carmen Maldonado-Bernal
Frontiers in Immunology.2025;[Epub] CrossRef

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1 Crossref

Lung and Thoracic cancer

Histological Assessment and Interobserver Agreement in Major Pathologic Response for Non–Small Cell Lung Cancer with Neoadjuvant Therapy: Sungjin Kim, Jeonghyo Lee, Jin-Haeng Chung; Cancer Res Treat. 2025;57(2):401-411. Published online September 9, 2024; DOI: https://doi.org/10.4143/crt.2024.670

Abstract PDF Supplementary Material PubReader ePub: Purpose
Major pathologic response (MPR), defined as ≤ 10% of residual viable tumor (VT), is a prognostic factor in non–small cell lung cancer (NSCLC) after neoadjuvant therapy. This study evaluated interobserver reproducibility in assessing MPR, compared area-weighted and unweighted VT (%) calculation, and determined optimal VT (%) cutoffs across histologic subtypes for survival prediction.
Materials and Methods
This retrospective study included 108 patients with NSCLC who underwent surgical resection after neoadjuvant chemotherapy or chemoradiation at Seoul National University Bundang Hospital between 2009-2018. Three observers with varying expertise independently assessed tumor bed and VT (%) based on digital whole-slide images.
Results
Reproducibility in tumor bed delineation was reduced in squamous cell carcinoma (SqCC) with smaller tumor bed, although overall concordance was high (Dice coefficient, 0.96; intersection-over-union score, 0.92). Excellent agreement was achieved for VT (%) (intraclass correlation coefficient=0.959) and MPR using 10% cutoff (Fleiss’ kappa=0.911). Shifting between area-weighted and unweighted VT (%) showed only one case differing in MPR status out of 81 cases. The optimal cutoff was 10% for both adenocarcinoma (ADC) and SqCC. MPR+ was observed in 18 patients (17%), with SqCC showing higher MPR+ rates (p=0.044), lower VT (%) (p < 0.001), and better event-free survival (p=0.015) than ADC. MPR+ significantly improved overall survival (p=0.023), event-free survival (p=0.001), and lung cancer-specific survival (p=0.012).
Conclusion
While MPR assessment demonstrated robust reproducibility with minimal impact from the tumor bed, attention is warranted when evaluating smaller tumor beds in SqCC. A 10% cutoff reliably predicted survival across histologic subtypes with higher interobserver reproducibility.

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Hematologic malignancy

Clinical Impact of Microbiome Characteristics in Treatment-Naïve Extranodal NK/T-Cell Lymphoma Patients: Sang Eun Yoon, Woorim Kang, Junhun Cho, Mauricio Chalita, Je Hee Lee, Dong-Wook Hyun, Hyun Kim, Seok Jin Kim, Won Seog Kim; Cancer Res Treat. 2025;57(2):597-611. Published online August 16, 2024; DOI: https://doi.org/10.4143/crt.2024.675

Abstract PDF Supplementary Material PubReader ePub: Purpose
Extranodal natural killer/T-cell lymphoma (ENKTL) predominantly manifests in East Asia and Latin America. Despite shared intrinsic factors, such as ethnic and genetic backgrounds, the progression of ENKTL can be influenced by extrinsic factors related to changing lifestyle patterns.
Materials and Methods
This study collected stool samples from newly diagnosed (ND)–ENKTL patients (n=40) and conducted whole genome shotgun sequencing.
Results
ND-ENKTL revealed reduced alpha diversity in ND-ENKTL compared to healthy controls (HCs) (p=0.008), with Enterobacteriaceae abundance significantly contributing to the beta diversity difference between ENKTL and HCs (p < 0.001). Functional analysis indicated upregulated aerobic metabolism and degradation of aromatic compounds in ND-ENKTL. Enterobacteriaceae were associated not only with clinical data explaining disease status (serum C-reactive protein, stage, prognosis index of natural killer cell lymphoma [PINK], and PINK-E) but also with clinical outcomes (early relapse and short progression-free survival). The relative abundance of Enterobacteriaceae at the family level was similar between ENKTL and diffuse large B-cell lymphoma (DLBCL) (p=0.140). However, the ENKTL exhibited a higher abundance of Escherichia, in contrast to the prevalence of Enterobacter and Citrobacter in DLBCL. Linear regression analysis demonstrated a significant association between Escherichia abundance and programmed cell death-ligand-1 (PD-L1) levels in tissue samples (p=0.025), whereas no correlation with PD-L1 was observed for Enterobacteriaceae at the family level (p=0.571).
Conclusion
ND-ENKTL exhibited an abundance of Enterobacteriaceae and a dominant presence of Escherichia. These microbial characteristics correlated with disease status, treatment outcomes, and PD-L1 expression, suggesting the potential of the ENKTL microbiome as a biomarker and cause of lymphomagenesis, which warrants further exploration.

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Nivolumab in Relapsed or Refractory Primary Central Nervous System Lymphoma: Multicenter, Retrospective Study: Jun Ho Yi, Seok Jin Kim, Sang-A Kim, Jongheon Jung, Dok Hyun Yoon; Cancer Res Treat. 2025;57(2):590-596. Published online August 16, 2024; DOI: https://doi.org/10.4143/crt.2024.531

Abstract PDF PubReader ePub

Purpose
Given that 40%-50% of primary central nervous system lymphoma (PCNSL) tissues exhibit aberrancy on 9p24.1, immune checkpoint inhibitors (ICI) may work for the disease.
Materials and Methods
To define the role of ICIs in PCNSL, we carried out a nationwide retrospect analysis for 22 patients who had been treated with nivolumab monotherapy for relapsed or refractory PCNSL.
Results
The median age at diagnosis was 66, and male: female ratio was 1:1. Patients received nivolumab after a median of 3 lines (range, 2 to 6) of therapy and at the median age of 67 years (range, 37 to 82 years). Eleven patients (50%) were refractory to the last treatment prior to nivolumab. With a median follow-up duration of 22.3 months (95% confidence interval [CI], 13.1 to 31.5), nine patients (41%) had an objective response (6 complete responses, 3 partial responses), and the median duration of response was 20.9 months (95% CI, 1.7 to 40.0). The median progression-free survival and overall survival were 2.1 months (95% CI, 0.2 to 4.0) and 18.9 months (95% CI, 5.0 to 32.8), respectively. Nivolumab was generally well-tolerated as no patients required dose reduction and only two patients required delay of treatment.
Conclusion
Our study suggests that nivolumab can be a reasonable option with the durable response for RR PCNSL.

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Targeting PD-L1 for PCNS-DLBCL: from molecular effects to clinical translation
Jiajia Cao, Shuzhen Xiong, Shuni Zhang, Ningning Yue, Chongyang Wu
Frontiers in Immunology.2025;[Epub] CrossRef
Relapsed or refractory central nervous system lymphoma successfully treated by glofitamab combined with lenalidomide
Yin-yin Peng, Xiao-qiong Tang
Frontiers in Oncology.2025;[Epub] CrossRef
Immunotherapy in central nervous system tumors
Yutao Huang, Yi Liu, Hui Zeng, JingJing Yang, Zongping Li, Jianguo Xu, Liyuan Jin, Xiaoyin Liu, Liangxue Zhou
International Journal of Surgery.2025; 111(11): 8301. CrossRef

2,738 View
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Assessing the Efficacy of Bortezomib and Dexamethasone for Induction and Maintenance Therapy in Relapsed/Refractory Cutaneous T-Cell Lymphoma: A Phase II CISL1701/BIC Study: Yoon Seok Choi, Joonho Shim, Ka-Won Kang, Sang Eun Yoon, Jun Sik Hong, Sung Nam Lim, Ho-Young Yhim, Jung Hye Kwon, Gyeong-Won Lee, Deok-Hwan Yang, Sung Yong Oh, Ho-Jin Shin, Hyeon-Seok Eom, Dok Hyun Yoon, Hong Ghi Lee, Seong Hyun Jeong, Won Seog Kim, Seok Jin Kim; Cancer Res Treat. 2025;57(1):267-279. Published online July 16, 2024; DOI: https://doi.org/10.4143/crt.2024.479

Abstract PDF Supplementary Material PubReader ePub

Purpose
This multicenter, open-label, phase II trial evaluated the efficacy and safety of bortezomib combined with dexamethasone for the treatment of relapsed/refractory cutaneous T-cell lymphoma (CTCL) in previously treated patients across 14 institutions in South Korea.
Materials and Methods
Between September 2017 and July 2020, 29 patients with histologically confirmed CTCL received treatment, consisting of eight 4-week cycles of induction therapy followed by maintenance therapy, contingent upon response, for up to one year. The primary endpoint was the proportion of patients achieving an objective global response.
Results
Thirteen of the 29 patients (44.8%) achieved an objective global response, including two complete responses. The median progression-free survival (PFS) was 5.8 months, with responders showing a median PFS of 14.0 months. Treatment-emergent adverse events were generally mild, with a low incidence of peripheral neuropathy and hematologic toxicities. Despite the trend toward shorter PFS in patients with higher mutation burdens, genomic profiling before and after treatment showed no significant emergence of new mutations indicative of disease progression.
Conclusion
This study supports the use of bortezomib and dexamethasone as a viable and safe treatment option for previously treated CTCL, demonstrating substantial efficacy and manageability in adverse effects. Further research with a larger cohort is suggested to validate these findings and explore the prognostic value of mutation profiles.

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Influence of Hypoxia on Tumor Heterogeneity, DNA Repair, and Cancer Therapy: From Molecular Insights to Therapeutic Strategies
Dominika Kunachowicz, Paulina Tomecka, Mikołaj Sędzik, Jarosław Kalinin, Jacek Kuźnicki, Nina Rembiałkowska
Cells.2025; 14(14): 1057. CrossRef

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Special Article

The Cancer Clinical Library Database (CCLD) from the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) Project: Sangwon Lee, Yeon Ho Choi, Hak Min Kim, Min Ah Hong, Phillip Park, In Hae Kwak, Ye Ji Kang, Kui Son Choi, Hyun-Joo Kong, Hyosung Cha, Hyun-Jin Kim, Kwang Sun Ryu, Young Sang Jeon, Hwanhee Kim, Jip Min Jung, Jeong-Soo Im, Heejung Chae; Cancer Res Treat. 2025;57(1):19-27. Published online July 15, 2024; DOI: https://doi.org/10.4143/crt.2024.218

Abstract PDF PubReader ePub

The common data model (CDM) has found widespread application in healthcare studies, but its utilization in cancer research has been limited. This article describes the development and implementation strategy for Cancer Clinical Library Databases (CCLDs), which are standardized cancer-specific databases established under the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) project by the Korean Ministry of Health and Welfare. Fifteen leading hospitals and fourteen academic associations in Korea are engaged in constructing CCLDs for 10 primary cancer types. For each cancer type-specific CCLD, cancer data experts determine key clinical data items essential for cancer research, standardize these items across cancer types, and create a standardized schema. Comprehensive clinical records covering diagnosis, treatment, and outcomes, with annual updates, are collected for each cancer patient in the target population, and quality control is based on six-sigma standards. To protect patient privacy, CCLDs follow stringent data security guidelines by pseudonymizing personal identification information and operating within a closed analysis environment. Researchers can apply for access to CCLD data through the K-CURE portal, which is subject to Institutional Review Board and Data Review Board approval. The CCLD is considered a pioneering standardized cancer-specific database, significantly representing Korea’s cancer data. It is expected to overcome limitations of previous CDMs and provide a valuable resource for multicenter cancer research in Korea.

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Exploring PIXE Applications in Oncology: A Comprehensive Review
G. J. Naga Raju
International Journal of Advanced Research in Science, Communication and Technology.2025; : 261. CrossRef
Disparities in the Diagnosis and Treatment of Breast Cancer Among People With Disabilities
Hea Lim Choi, Jin-Hyung Jung, Hwa-Young Lee, Kyungdo Han, Dong Wook Shin
JAMA Network Open.2025; 8(11): e2543559. CrossRef
Predictive Mortality and Gastric Cancer Risk Using Clinical and Socio-Economic Data: A Nationwide Multicenter Cohort Study
Seong Uk Kang, Seung-Joo Nam, Oh Beom Kwon, Inhyeok Yim, Tae-Hoon Kim, Na Young Yeo, Myoung Nam Lim, Woo Jin Kim, Sang Won Park
Cancers.2024; 17(1): 30. CrossRef

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Original Article

Pediatric cancer

The Effect of Hematopoietic Stem Cell Transplantation on Treatment Outcome in Children with Acute Lymphoblastic Leukemia: Hee Young Ju, Na Hee Lee, Eun Sang Yi, Young Bae Choi, So Jin Kim, Ju Kyung Hyun, Hee Won Cho, Jae Kyung Lee, Ji Won Lee, Ki Woong Sung, Hong Hoe Koo, Keon Hee Yoo; Cancer Res Treat. 2025;57(1):240-249. Published online July 5, 2024; DOI: https://doi.org/10.4143/crt.2024.155

Abstract PDF PubReader ePub: Purpose
Hematopoietic stem cell transplantation (HSCT) has been an important method of treatment in the advance of pediatric acute lymphoblastic leukemia (ALL). The indications for HSCT are evolving and require updated establishment. In this study, we aimed to investigate the efficacy of HSCT on the treatment outcome of pediatric ALL, considering the indications for HSCT and subgroups.
Materials and Methods
A retrospective analysis was conducted on ALL patients diagnosed and treated at a single center. Risk groups were categorized based on age at diagnosis, initial white blood cell count, disease lineage (B/T), and cytogenetic study results. Data on the patients’ disease status at HSCT and indications of HSCT were collected. Indications for HSCT were categorized as upfront HSCT at 1st complete remission, relapse, and refractory disease.
Results
Among the 549 screened patients, a total of 418 patients were included in the study; B-cell ALL (n=379) and T-cell ALL (T-ALL) (n=39). HSCT was conducted on a total of 106 patients (25.4%), with a higher frequency as upfront HSCT in higher-risk groups and specific cytogenetics. The overall survival (OS) was significantly better when done upfront than in relapsed or refractory state in T-ALL patients (p=0.002). The KMT2A-rearranged ALL patients showed superior event-free survival (p=0.002) and OS (p=0.022) when HSCT was done as upfront treatment.
Conclusion
HSCT had a substantial positive effect in a specific subset of pediatric ALL. In particular, frontline HSCT for T-ALL and KMT2A-rearranged ALL offered a better prognosis than when HSCT was conducted in a relapsed or refractory setting.

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182 Download

Special Article

Data Resource Profile: The Cancer Public Library Database in South Korea: Dong-Woo Choi, Min Yeong Guk, Hye Ri Kim, Kwang Sun Ryu, Hyun-Joo Kong, Hyo Soung Cha, Hyun-Jin Kim, Heejung Chae, Young Sang Jeon, Hwanhee Kim, Jipmin Jung, Jeong-Soo Im, Kui Son Choi; Cancer Res Treat. 2024;56(4):1014-1026. Published online April 30, 2024; DOI: https://doi.org/10.4143/crt.2024.207

Abstract PDF Supplementary Material PubReader ePub

This paper provides a comprehensive overview of the Cancer Public Library Database (CPLD), established under the Korean Clinical Data Utilization for Research Excellence project (K-CURE). The CPLD links data from four major population-based public sources: the Korea National Cancer Incidence Database in the Korea Central Cancer Registry, cause-of-death data in Statistics Korea, the National Health Information Database in the National Health Insurance Service, and the National Health Insurance Research Database in the Health Insurance Review & Assessment Service. These databases are linked using an encrypted resident registration number. The CPLD, established in 2022 and updated annually, comprises 1,983,499 men and women newly diagnosed with cancer between 2012 and 2019. It contains data on cancer registration and death, demographics, medical claims, general health checkups, and national cancer screening. The most common cancers among men in the CPLD were stomach (16.1%), lung (14.0%), colorectal (13.3%), prostate (9.6%), and liver (9.3%) cancers. The most common cancers among women were thyroid (20.4%), breast (16.6%), colorectal (9.0%), stomach (7.8%), and lung (6.2%) cancers. Among them, 571,285 died between 2012 and 2020 owing to cancer (89.2%) or other causes (10.8%). Upon approval, the CPLD is accessible to researchers through the K-CURE portal. The CPLD is a unique resource for diverse cancer research to investigate medical use before a cancer diagnosis, during initial diagnosis and treatment, and long-term follow-up. This offers expanded insight into healthcare delivery across the cancer continuum, from screening to end-of-life care.

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Sang Won Park, Na Young Yeo, Tae-Hoon Kim, Myoung Nam Lim, Inhyeok Yim, Oh Beom Kwon, Seung-Joo Nam, Hui-Young Lee, Woo Jin Kim
International Journal of Medical Informatics.2026; 205: 106125. CrossRef
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Byeong-Chan Oh, Sun-Kyeong Park, Sokbom Kang
Journal of Gynecologic Oncology.2026;[Epub] CrossRef
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Woorim Kim, Boram Kim, Minju Kim, Jin Young Choi
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Chel Hun Choi, Ha kyun Chang, Gi Hwan Bae, Jong Ha Hwang
Journal of Obstetrics and Gynaecology Research.2025;[Epub] CrossRef
Long-term Survival Following Endoscopic Submucosal Dissection Versus Gastrectomy in Early Gastric Cancer Patients Aged 75 Years and Above: A National Retrospective Cohort Study in Korea
Sangwon Lee, Yoon Jin Choi, Bang Wool Eom, Il Ju Choi, Choong-Kun Lee, Jungeun Park, Dong Ah Park, Kui Son Choi
Journal of Gastric Cancer.2025; 25(4): 569. CrossRef
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Uisuk Kim, Byeong-Chan Oh, Jaekyung Bae, Sokbom Kang
Gynecologic Oncology.2025; 202: 146. CrossRef
Chronic Obstructive Pulmonary Disease and Inhaled Treatment Effects on Mortality in Patients with Lung Cancer
Jinwoo Lee, Jiyu Sun, Hyun Woo Lee
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Disparities in the Diagnosis and Treatment of Breast Cancer Among People With Disabilities
Hea Lim Choi, Jin-Hyung Jung, Hwa-Young Lee, Kyungdo Han, Dong Wook Shin
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Prognostic factors in gastric cancer survivors comparing Cox proportional hazards and machine learning using a Korean National cohort
Joonki Lee, Aesun Shin
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Cardiovascular disease risk following radiotherapy among breast cancer survivors: a nationwide cohort study in South Korea
Jeeyoung Lee, Eun Young Park, Won Jin Lee
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Risk Factors and Prevention of Stomach Cancer, Excluding Helicobacter pylori
Seung-Woo Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(3): 243. CrossRef
Prediction model for survival of younger patients with breast cancer using the breast cancer public staging database
Ha Ye Jin Kang, Minsam Ko, Kwang Sun Ryu
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Predictive Mortality and Gastric Cancer Risk Using Clinical and Socio-Economic Data: A Nationwide Multicenter Cohort Study
Seong Uk Kang, Seung-Joo Nam, Oh Beom Kwon, Inhyeok Yim, Tae-Hoon Kim, Na Young Yeo, Myoung Nam Lim, Woo Jin Kim, Sang Won Park
Cancers.2024; 17(1): 30. CrossRef

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Original Articles

Gastrointestinal cancer

Longitudinal Comparative Analysis of Circulating Tumor DNA and Matched Tumor Tissue DNA in Patients with Metastatic Colorectal Cancer Receiving Palliative First-Line Systemic Anti-Cancer Therapy: Seung-been Lee, Ji-Won Kim, Hong-Geun Kim, Sung-Hyun Hwang, Kui-Jin Kim, Ju Hyun Lee, Jeongmin Seo, Minsu Kang, Eun Hee Jung, Koung Jin Suh, Se Hyun Kim, Jin Won Kim, Yu Jung Kim, Jee Hyun Kim, Nak-Jung Kwon, Keun-Wook Lee; Cancer Res Treat. 2024;56(4):1171-1182. Published online April 29, 2024; DOI: https://doi.org/10.4143/crt.2024.016

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to compare tumor tissue DNA (ttDNA) and circulating tumor DNA (ctDNA) to explore the clinical applicability of ctDNA and to better understand clonal evolution in patients with metastatic colorectal cancer undergoing palliative first-line systemic therapy.
Materials and Methods
We performed targeted sequencing analysis of 88 cancer-associated genes using germline DNA, ctDNA at baseline (baseline-ctDNA), and ctDNA at progressive disease (PD-ctDNA). The results were compared with ttDNA data.
Results
Among 208 consecutively enrolled patients, we selected 84 (41 males; median age, 59 years; range, 35 to 90 years) with all four sample types available. A total of 202 driver mutations were found in 34 genes. ttDNA exhibited the highest mutation frequency (n=232), followed by baseline-ctDNA (n=155) and PD-ctDNA (n=117). Sequencing ctDNA alongside ttDNA revealed additional mutations in 40 patients (47.6%). PD-ctDNA detected 13 novel mutations in 10 patients (11.9%) compared to ttDNA and baseline-ctDNA. Notably, seven mutations in five patients (6.0%) were missense or nonsense mutations in APC, TP53, SMAD4, and CDH1 genes. In baseline-ctDNA, higher maximal variant allele frequency (VAF) values (p=0.010) and higher VAF values of APC (p=0.012), TP53 (p=0.012), and KRAS (p=0.005) mutations were significantly associated with worse overall survival.
Conclusion
While ttDNA remains more sensitive than ctDNA, our ctDNA platform demonstrated validity and potential value when ttDNA was unavailable. Post-treatment analysis of PD-ctDNA unveiled new pathogenic mutations, signifying cancer’s clonal evolution. Additionally, baseline-ctDNA’s VAF values were prognostic after treatment.

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Eylül Özgü, Ünal Metin Tokat, Ashkan Adibi, Şevval Nur Bilgiç, Esranur Aydın, Onur Tutar, Mutlu Demiray
JCO Precision Oncology.2025;[Epub] CrossRef
Evolution of Neo-RAS-WT in Circulating Tumor DNA from First-Line to Subsequent Therapies in Metastatic Colorectal Cancer
Marco Siringo, Michela De Meo, Irene Bottillo, Paola Grammatico, Enrico Cortesi, Chiara Nicolazzo, Paola Gazzaniga
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Liquid biopsy in gastrointestinal oncology: clinical applications and translational integration of ctDNA, CTCs, and sEVs
Rita Palieri, Maria De Luca, Francesco Balestra, Giorgia Panzetta, Claudio Lotesoriere, Federica Rizzi, Angela Dalia Ricci, Rita Mastrogiacomo, Maria Lucia Curri, Luigi Andrea Laghi, Gianluigi Giannelli, Nicoletta Depalo, Maria Principia Scavo
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Head and Neck cancer

Analysis of Response and Progression Patterns of Tyrosine Kinase Inhibitors in Recurrent or Metastatic Adenoid Cystic Carcinoma: A Post Hoc Analysis of Two KCSG Phase II Trials: Youjin Kim, Bhumsuk Keam, Eun Joo Kang, Jin-Soo Kim, Hye Ryun Kim, Keun-Wook Lee, Jung Hye Kwon, Kyoung Eun Lee, Yaewon Yang, Yoon Hee Choi, Min Kyoung Kim, Jun Ho Ji, Tak Yun, Moon Young Choi, Ki Hyeong Lee, Sung-Bae Kim, Myung-Ju Ahn; Cancer Res Treat. 2024;56(4):1068-1076. Published online April 15, 2024; DOI: https://doi.org/10.4143/crt.2024.008

Abstract PDF Supplementary Material PubReader ePub: Purpose
In this study, we evaluated 66 patients diagnosed with adenoid cystic carcinoma (ACC) enrolled in two Korean Cancer Study Group trials to investigate the response and progression patterns in recurrent and/or metastatic ACC treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs).
Materials and Methods
We evaluated 66 patients diagnosed with ACC who were enrolled in the Korean Cancer Study Group trials. The tumor measurements, clinical data, treatment outcomes, and progression patterns of therapy were analyzed.
Results
In the 66 patients (53 receiving axitinib and 13 receiving nintedanib), the disease control rate was 61%, and three patients achieved partial response. The median follow-up, median progression-free survival (PFS), overall survival, and 6-month PFS rate were 27.6%, 12.4%, and 18.1% months and 62.1%, respectively. Among 42 patients who experienced progression, 27 (64.3%) showed target lesion progression. Bone metastasis was an independent poor prognostic factor.
Conclusion
Overall, most patients demonstrated stable disease with prolonged PFS; however, prominent target lesion progression occurred in some patients. Thus, PFS may capture VEGFR-TKI efficacy better than the objective response rate.

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Special Articles

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2021: Eun Hye Park, Kyu-Won Jung, Nam Ju Park, Mee Joo Kang, E Hwa Yun, Hye-Jin Kim, Jeong-Eun Kim, Hyun-Joo Kong, Jeong-Soo Im, Hong Gwan Seo, The Community of Population-Based Regional Cancer Registries; Cancer Res Treat. 2024;56(2):357-371. Published online March 13, 2024; DOI: https://doi.org/10.4143/crt.2024.253

Abstract PDF Supplementary Material PubReader ePub

Purpose
The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2021.
Materials and Methods
Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2021, with survival follow-up until December 31, 2022. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea.
Results
The number of new cancer diagnoses in 2021 increased by 27,002 cases (10.8%) compared to 2020. In 2021, newly diagnosed cancer cases and deaths from cancer were reported as 277,523 (age-standardized rate [ASR], 289.3 per 100,000) and 82,688 (ASR, 67.6 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% from 2012 to 2015, thereafter, followed by non-significant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.8% from 2002 to 2013; 3.2% from 2013 to 2021). The 5-year relative survival between 2017 and 2021 was 72.1%, which contributed to prevalent cases reaching over 2.4 million in 2021.
Conclusion
In 2021, the number of newly diagnosed cancer patients increased as healthcare utilization recovered from the coronavirus disease 2019–related declines of 2020. Revised cancer registration guidelines expanded the registration scope, particularly for stomach and colorectal cancer. Survival rates have improved over the years, leading to a growing population of cancer survivors, necessitating a comprehensive cancer control strategy. The long-term impact of the pandemic on cancer statistics requires future investigation.

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Prediction of Cancer Incidence and Mortality in Korea, 2024: Kyu-Won Jung, Mee Joo Kang, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Jeong-Eun Kim, Hyun-Joo Kong, Jeong-Soo Im, Hong Gwan Seo; Cancer Res Treat. 2024;56(2):372-379. Published online March 11, 2024; DOI: https://doi.org/10.4143/crt.2024.252

Abstract PDF PubReader ePub

Purpose
This study aimed to report the projected cancer incidence and mortality for the year 2024 to estimate Korea’s current cancer burden.
Materials and Methods
Cancer incidence data from 1999 to 2021 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2022 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and multiplying the projected age-specific rates by the anticipated age-specific population for 2024. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend for prediction.
Results
In total, 292,221 new cancer cases and 83,770 cancer deaths are expected to occur in Korea in 2024. The most common cancer site is expected to be the thyroid, followed by the colon and rectum, lung, breast, and stomach. These five cancers are expected to represent 55.7% of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and stomach cancers.
Conclusion
The age-standardized incidence rates for female breast and prostate cancers are estimated to continue to increase. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

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Original Articles

Hematologic malignancy

Feasibility of Circulating Tumor DNA Analysis in Patients with Follicular Lymphoma: Sang Eun Yoon, Seung-Ho Shin, Dae Keun Nam, Junhun Cho, Won Seog Kim, Seok Jin Kim; Cancer Res Treat. 2024;56(3):920-935. Published online January 16, 2024; DOI: https://doi.org/10.4143/crt.2023.869

Abstract PDF Supplementary Material PubReader ePub

Purpose
The feasibility of sequencing circulating tumor DNA (ctDNA) in plasma as a biomarker to predict early relapse or poor prognosis in patients with follicular lymphoma (FL) receiving systemic immunochemotherapy is not clear.
Materials and Methods
We sequenced DNA from cell-free plasma that was serially obtained from newly diagnosed FL patients undergoing systemic immunochemotherapy. The mutation profiles of ctDNA at the time of diagnosis and at response evaluation and relapse and/or progression were compared with clinical course and treatment outcomes.
Results
Forty samples from patients receiving rituximab-containing immunochemotherapy were analyzed. Baseline sequencing detected mutations in all cases, with the major detected mutations being KMT2C (50%), CREBBP (45%), and KMT2D (45%). The concentration of ctDNA and tumor mutation burden showed a significant association with survival outcome. In particular, the presence of mutations in CREBBP and TP53 showed poor prognosis compared with patients without them. Longitudinal analysis of ctDNA using serially collected plasma samples showed an association between persistence or reappearance of ctDNA mutations and disease relapse or progression.
Conclusion
Analysis of ctDNA mutations in plasma at diagnosis might help predict outcome of disease, while analysis during follow-up may help to monitor disease status of patients with advanced FL. However, the feasibility of ctDNA measurement must be improved in order for it to become an appropriate and clinically relevant test in FL patients.

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Feasibility of Circulating Tumor DNA Detection in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement in Large B-Cell Lymphoma
Seok Jin Kim, Jin Ju Kim, Mi Ri Park, Bon Park, Kyung Ju Ryu, Sang Eun Yoon, Won Seog Kim, Saeam Shin, Seung-Tae Lee
Annals of Laboratory Medicine.2025; 45(1): 90. CrossRef
Circulating tumor DNA in lymphoma: technologies and applications
Lina Fu, Xuerong Zhou, Xiaoyu Zhang, Xuhua Li, Fan Zhang, Hongcang Gu, Xiaoxue Wang
Journal of Hematology & Oncology.2025;[Epub] CrossRef
Molecular pathology of lymphoma and its treatment strategies: from mechanistic elucidation to precision medicine
Zhongyu Wang, Shuai Feng, Xiangmei Yao, Renbin Zhao, Yujin Li, Maofeng Zheng, Zengzheng Li, Yajie Wang
Frontiers in Immunology.2025;[Epub] CrossRef
Combined PET and ctDNA response as a predictor of POD24 for follicular lymphoma after first-line induction treatment
Alexis Claudel, Anne-Ségolène Cottereau, Emmanuel Bachy, Emmanuel Itti, Pierre Feugier, Cedric Rossi, Francois Lemonnier, Vincent Camus, Nicolas Daguindau, Guillaume Cartron, Emmanuelle Nicolas-Virelizier, Diana-Laure Mboumba, Christophe Cardoso, Côme Bom
Blood.2025; 146(8): 913. CrossRef
Metabolic-immune axis in the tumor microenvironment: a new strategy for prognostic assessment and precision therapy in DLBCL and FL
Chengqian Chen, Wei Guo, Haotian Wang, Luming Cao, Ou Bai
Frontiers in Immunology.2025;[Epub] CrossRef
Genetic analysis of cell-free DNA in follicular lymphoma in comparison with tissue-derived DNA
Yoshikazu Hori, Hiroki Hosoi, Mitsuo Osuga, Ryuta Iwamoto, Fumiyo Maekawa, Tadashi Okamura, Shogo Murata, Toshiki Mushino, Motomi Osato, Hitoshi Ohno, Nobuyuki Yamamoto, Shin-Ichi Murata, Yasuhiro Koh, Sonoki Takashi
Leukemia & Lymphoma.2025; : 1. CrossRef
Clinical applications of circulating tumor DNA in hematological malignancies: From past to the future
Jun-Ying Li, Li-Ping Zuo, Jian Xu, Chun-Yan Sun
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Molecular Biomarkers in Prediction of High-Grade Transformation and Outcome in Patients with Follicular Lymphoma: A Comprehensive Systemic Review
Marie Hairing Enemark, Jonas Klejs Hemmingsen, Maja Lund Jensen, Robert Kridel, Maja Ludvigsen
International Journal of Molecular Sciences.2024; 25(20): 11179. CrossRef

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8 Crossref

Lung and Thoracic cancer

Genomic Landscape of Pulmonary Sarcomatoid Carcinoma: Hyun Jung Kwon, Sejoon Lee, Yeon Bi Han, Jeonghyo Lee, Soohyeon Kwon, Hyojin Kim, Jin-Haeng Chung; Cancer Res Treat. 2024;56(2):442-454. Published online November 14, 2023; DOI: https://doi.org/10.4143/crt.2023.764

Abstract PDF Supplementary Material PubReader ePub

Purpose
Pulmonary sarcomatoid carcinoma (PSC) is a rare aggressive subtype of non–small cell lung cancer (NSCLC) with limited therapeutic strategies. We attempted to elucidate the evolutionary trajectories of PSC using multiregional and longitudinal tumor samples.
Materials and Methods
A total of 31 patients were enrolled in this study and 11 longitudinal samples were available from them. Using whole exome sequencing data, we analyzed the mutational signatures in both carcinomatous and sarcomatous areas in primary tumors of the 31 patients and longitudinal samples obtained from 11 patients. Furthermore, digital droplet polymerase chain reaction (ddPCR), and programmed death-ligand 1 (PD-L1) immunohistochemistry using the Ventana SP263 assay were performed.
Results
TP53 was identified as the most frequently altered gene in the primary (74%) and metastatic (73%) samples. MET exon 14 skipping mutations, confirmed by ddPCR, and TP53 mutations were mutually exclusive; whereas, MET exon 14 skipping mutations frequently co-occurred with MDM2 amplification. Metastatic tumors showed dissimilar genetic profiles from either primary component. During metastasis, the signatures of APOBEC decreased in metastatic lesions compared with that in primary lesions. PSC showed higher MET and KEAP1 mutations and stronger PD-L1 protein expression compared with that recorded in other NSCLCs.
Conclusion
Decreased APOBEC signatures and subclonal diversity were detected during malignant progression in PSC. Frequent MET mutations and strong PD-L1 expression distinguished PSC from other NSCLCs. The aggressiveness and therapeutic difficulties of PSC were possibly attributable to profound intratumoral and intertumoral genetic diversity. Next-generation sequencing could suggest the appropriate treatment strategy for PSC.

Citations

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Pulmonary pleomorphic carcinoma associated with cystic airspace and recurrent spontaneous pneumothorax: A case report
Qiangsheng Li, Jing Zhang, Youjie Gong, Xudong Wan, Song Zhang, Zhongwang Li, Jun Liu
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Ruoyu Deng, Jialing Lv, Fang Wang, Yanqiong Chen, Junfeng Wang, Lin Wang, Lixia Mu, Zhijun Zhang, Wen Zhang, Chao Zhang
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Abigayle Wyer, Mena Louis, Richard Adams, Raven Richardson, Ezra Ellis, Brian Gibson
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Lingzhi Hong, Alessandro Di Federico, Bolun Liu, Alissa J. Cooper, Joao V. Alessi, Phoebe Clark, Waree Rinsurongkawong, Chingyi Young, Hui Li, Kang Qin, Muhammad Aminu, Valentina Santo, Yasir Elamin, Boris Sepesi, Jeff Lewis, Don L. Gibbons, Ara A. Vaporc
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Exceptional Response to Immunotherapy-based Treatment in Compound EGFR-Mutated Oligometastatic Pulmonary Sarcomatoid Carcinoma: A Case Report
Ayushi Gianchandani, Darshana Desai, Janani Sambath, Darshana Patil, Prashant Kumar, Shambhavi Singh, Chetan Madre, Ruturaj Deshpande, Anjali Parab, Niyati Shah, Darshit Shah, Pritam Kataria, Shrikanth Atluri, Marzi Mehta, Aditya Shreenivas, Rajan Datar,
Journal of Immunotherapy and Precision Oncology.2025; 8(3): 206. CrossRef
A Phase II Study of Durvalumab, Doxorubicin, and Ifosfamide in Recurrent and/or Metastatic Pulmonary Sarcomatoid Carcinoma (KCSG LU-19-24)
Miso Kim, Jeonghwan Youk, Tae Min Kim, Gyeong-Won Lee, Dong-Wan Kim, Bhumsuk Keam
Clinical Lung Cancer.2025;[Epub] CrossRef
Immune Checkpoint Inhibitor Monotherapy for Patients With Pulmonary Sarcomatoid Carcinoma—The Optimal Therapeutic Strategy for This Rare Lung Cancer Subtype?
Jennifer M. Boland, Ying-Chun Lo, Aaron S. Mansfield
Journal of Thoracic Oncology.2025; 20(12): 1735. CrossRef
PD-L1 Expression and Its Modulating Factors in Anaplastic Thyroid Carcinoma
Shipra Agarwal, Chan Kwon Jung, Pranitha Gaddam, Mitsuyoshi Hirokawa, Takuya Higashiyama, Jen-Fan Hang, Wei-An Lai, Somboon Keelawat, Zhiyan Liu, Hee Young Na, So Yeon Park, Junya Fukuoka, Shinya Satoh, Zhanna Mussazhanova, Masahiro Nakashima, Kennichi Ka
American Journal of Surgical Pathology.2024; 48(10): 1233. CrossRef

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8 Crossref

Hematologic malignancy

Pembrolizumab for Patients with Relapsed or Refractory Extranodal NK/T-Cell Lymphoma in Korea: Ji Yun Lee, Ji Hyun Kwon, Joon Young Hur, Jun Ho Yi, Ji Hyun Lee, Hyungwoo Cho, Young Rok Do, Jae-Cheol Jo, Hye Jin Kang, Yougil Koh, Won Sik Lee, Sung Nam Lim, Sang Eun Yoon, Seok Jin Kim, Jeong-Ok Lee; Cancer Res Treat. 2024;56(2):681-687. Published online November 10, 2023; DOI: https://doi.org/10.4143/crt.2023.1042

Abstract PDF PubReader ePub

Purpose
Programmed death-1 blockade with pembrolizumab has shown promising activity in relapsed/refractory (R/R) extranodal natural killer/T-cell lymphoma (NKTCL), but studies are limited, with small patient numbers.
Materials and Methods
Thirteen institutes involved with the Consortium for Improving Survival of Lymphoma, a Korean lymphoma study group, collected the clinical data of 59 patients treated with pembrolizumab as salvage therapy between 2016 and 2022.
Results
The median age of the patients was 60 years (range, 22 to 87 years), and 76.3% had advanced Ann Abor stage disease. Pembrolizumab was given to 35.6%, 40.7%, and 23.7% of the patients as second-, third-, and fourth- or higher-line chemotherapy, respectively. The overall response rate was 40.7%, with 28.8% having complete response. The estimated 2-year progression-free survival (PFS) and overall survival rates for all patients were 21.5% and 28.7%, respectively; for responders, the rates were 53.0% and 60.7%, respectively. Although not statistically significant, Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR], 1.91; 95% confidence interval [95% CI], 0.93 to 3.94; p=0.078) and stage III or IV disease (HR, 2.59; 95% CI, 0.96 to 6.96; p=0.060) were associated with a trend toward shorter PFS in multivariate analysis. Grade 3 or 4 adverse events (AEs) were noted in 12 patients (20.3%); neutropenia (10.2%), fatigue (6.8%), and pneumonitis (5.1%) were most common AEs.
Conclusion
In conclusion, while pembrolizumab had a modest effect on patients with R/R NKTCL, it may be a useful salvage therapy for patients with localized disease and good performance status.

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An evaluation of sugemalimab for the treatment of relapsed or refractory extranodal natural killer T-cell lymphoma
Yingfang Feng, Xia Liu, Jingwei Yu, Zheng Song, Lanfang Li, Lihua Qiu, Shiyong Zhou, Zhengzi Qian, Xianhuo Wang, Huilai Zhang
Expert Opinion on Biological Therapy.2025; 25(1): 9. CrossRef
Early growth response 1 as a key regulator of PD-L1 expression and immune evasion in extranodal NK/T-cell lymphoma
Ji Yun Lee, Kui-Jin Kim, Woochan Park, Jeongmin Seo, Minsu Kang, Eun Hee Jung, Sang-A Kim, Koung Jin Suh, Ji-Won Kim, Se Hyun Kim, Jeong-Ok Lee, Jin Won Kim, Yu Jung Kim, Keun-Wook Lee, Jee Hyun Kim, Soo-Mee Bang, Tae Min Kim, Jin Ho Paik
Blood Cancer Journal.2025;[Epub] CrossRef
Efficacy of combined CD38 and PD-1 inhibition with isatuximab and cemiplimab for relapsed/refractory NK/T-cell lymphoma
Seok Jin Kim, Jing Quan Lim, Sang Eun Yoon, Deok-Hwan Yang, Ji Hyun Lee, Sung Yong Oh, Yoon Seok Choi, Seong Hyun Jeong, Min Kyoung Kim, Sung Nam Lim, Junhun Cho, Bon Park, Kyung Ju Ryu, Seunghyun Choi, Yoon Park, Kerry May Huifen Lim, Nur Ayuni Binte Muh
Blood.2025; 146(2): 155. CrossRef
Pembrolizumab

Reactions Weekly.2024; 2025(1): 390. CrossRef

5,448 View
237 Download
3 Web of Science
4 Crossref

Gastrointestinal cancer

Risk Stratification of Pancreatic Ductal Adenocarcinoma Patients Undergoing Curative-Intent Surgery after Neoadjuvant Therapy: Hyun Kyung Yang, Mi-Suk Park, Kyunghwa Han, Geonsik Eom, Yong Eun Chung, Jin-Young Choi, Seungmin Bang, Chang Moo Kang, Jinsil Seong, Myeong-Jin Kim; Cancer Res Treat. 2024;56(1):247-258. Published online August 22, 2023; DOI: https://doi.org/10.4143/crt.2023.586

Abstract PDF Supplementary Material PubReader ePub

Purpose
Clinical prognostic criteria using preoperative factors were not developed for post–neoadjuvant therapy (NAT) surgery of pancreatic ductal adenocarcinoma (PDAC). We aimed to identify preoperative factors associated with overall survival (OS) in PDAC patients who underwent post-NAT curative-intent surgery and develop risk stratification criteria.
Materials and Methods
Consecutive PDAC patients who underwent post-NAT curative-intent surgeries between 2007 and 2020 were retrospectively analyzed. Demographic, laboratory, surgical, and histopathologic variables were collected. Baseline, preoperative, and interval changes of computed tomography (CT) findings proposed by the Society of Abdominal Radiology and the American Pancreatic Association were analyzed. Cox proportional hazard analysis was used to select preoperative variables associated with OS. We developed risk stratification criteria composed of the significant preoperative variables, i.e., post-NAT response criteria. We compared the discrimination performance of post-NAT response criteria with that of post-NAT pathological (yp) American Joint Cancer Committee TNM staging system.
Results
One hundred forty-five PDAC patients were included. Stable or increased tumor size on CT (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.58 to 4.21; p < 0.001) and elevated preoperative carbohydrate antigen 19-9 (CA19-9) level (HR, 1.98; 95% CI, 1.11 to 3.55; p=0.021) were independent factors of OS. The OS of the patient groups stratified by post-NAT response criteria which combined changes in tumor size and CA19-9 showed significant difference (p < 0.001). Such stratification was comparable to ypTNM staging in discrimination performance (difference of C-index, 0.068; 95% CI, –0.012 to 0.142).
Conclusion
“Any degree of decrease in tumor size on CT” and CA19-9 normalization or staying normal were independent favorable factors of OS. The combination of the two factors discriminated OS comparably to ypTNM staging.

Citations

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Prognostic factors in localized pancreatic ductal adenocarcinoma after neoadjuvant therapy and resection: a systematic review and meta-analysis
Ammar A Javed, Alyssar Habib, Omar Mahmud, Asad Saulat Fatimi, Mahip Grewal, Nabiha Mughal, Jin He, Christopher L Wolfgang, Lois Daamen, Marc G Besselink
JNCI: Journal of the National Cancer Institute.2025; 117(5): 840. CrossRef

4,333 View
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