Cancer Research and Treatment

The Application of Contrast-Enhanced Ultrasound Combined with Indocyanine Green Lymphography in the Management of Secondary Upper Limb Lymphedema: Xilong Gong, Lina Wang, Fang Liu, Jiao Zhang, Hui Xiao, Ying Hou, Xuhui Guo, Zhenzhen Liu; Received August 1, 2025 Accepted November 17, 2025 Published online November 18, 2025; DOI: https://doi.org/10.4143/crt.2025.813 [Accepted]

Abstract PDF: To assess the clinical efficacy of contrast-enhanced ultrasound (CEUS) combined with indocyanine green (ICG) lymphography for the treatment of breast cancer–related lymphedema (BCRL).
Materials and Methods
Fifty-two patients with BCRL who underwent lymphaticovenous anastomosis between March 2022 and March 2024 were enrolled, of whom 22 underwent preoperative functional lymphatic vessel localization using ICG lymphography alone and 30 received CEUS combined with ICG lymphography. Treatment efficacy was evaluated using bioimpedance spectroscopy for segmental water content analysis, calculation of the upper extremity lymphedema (UEL) index, and administration of the Lymphedema Quality of Life Questionnaire (LYMQOL). Surgical parameters were also analyzed.
Results
Baseline characteristics were comparable between the groups. However, at both 6 and 12 months postoperatively, patients in the CEUS+ICG group demonstrated significantly improved outcomes compared to those in the ICG-only group, including: Reduced segmental water differences (6 months: 344.3 vs. 474.6 mL, p=0.0221; 12 months: 284.3 vs. 403.6 mL, p=0.0156); Lower UEL index (6 months: 124.2 vs. 134.1, p=0.0010; 12 months: 123.8 vs. 131.9, p=0.0105); Improved LYMQOL scores (6 months: 48.7 vs. 56.6, p=0.0029; 12 months: 47.6 vs. 54.2, p=0.0065). Additionally, the CEUS+ICG group achieved a significantly higher anastomosis success rate (83.2% vs. 63.3%, p<0.001) and reduced procedural time per anastomosis (48.9 vs. 61.6 minutes, p=0.0021).
Conclusion
The combination of CEUS and ICG-L is associated with precise preoperative lymphatic mapping, a reduction in unnecessary incisions, as well as better anastomosis success rates and postoperative decongestion outcomes.

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Changes in Uptake, Participant Disparities, and Screening Outcomes of the Korean National Lung Cancer Screening Program: A Five-Year Experience: Chang Kyun Choi, Na-Young Lee, Mina Suh, Kui Son Choi, Yeol Kim; Received January 15, 2025 Accepted November 6, 2025 Published online November 10, 2025; DOI: https://doi.org/10.4143/crt.2025.067 [Accepted]

Abstract PDF: Purpose
Low-dose computed tomography (LDCT) is effective in reducing lung cancer mortality among high-risk smokers. The Korean National Lung Cancer Screening Program (KNLCS), the world’s first nationwide lung cancer screening initiative using LDCT, was launched in 2019. This study aimed to evaluate the KNLCS uptake rates in relation to participants’ economic status and changes in positive screening rates across screening rounds.
Materials and Methods
Data from the National Health Insurance Service (NHIS) and National Cancer Screening Information System for 2019–2023 were analyzed. Eligible participants in the KNLCS were current smokers aged 54–74 years with a smoking history of at least 30 pack-years. The KNLCS provides counseling by physicians on screening results and smoking cessation. Screening uptake rates, counseling rates, and Lung CT Screening Reporting and Data System (Lung-RADS) distributions were assessed.
Results
Screening uptake rates increased from 24.7% in 2019 to 51.2% in 2023 (p < 0.001). Economic disparities were observed, with higher-income groups showing consistently higher uptake rates than lower-income group. Screening positive rates has been decreased from 9.1% in 2019 to 7.0% in 2023 according to increasing the proportion of subsequent screening participants. The inter-institutional variance in Lung-RADS category 4 decreased significantly over the years (p < 0.001).
Conclusion
The KNLCS rapidly increased screening uptake rates by systematically inviting eligible participants. Positive screening rates decreased primarily due to a reduction in Lung-RADS category 3 findings in subsequent rounds.

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Real World Efficacy and Safety of First Line Chemo Immunotherapy in Extensive Stage Small Cell Lung Cancer and its association with molecular subtype: Miran Han, Sehhoon Park, Se-Hoon Lee, Junkyu Kim, Jin-yong Kim, Jong-Mu Sun, Jin Seok Ahn, Myung-Ju Ahn; Received September 3, 2025 Accepted November 4, 2025 Published online November 5, 2025; DOI: https://doi.org/10.4143/crt.2025.971 [Accepted]

Abstract PDF: Purpose
Small cell lung cancer (SCLC) is an aggressive malignancy with poor outcomes. IMpower133 and CASPIAN established platinum–etoposide plus anti–PD-L1 antibody as standard first-line therapy for extensive-stage SCLC (ES-SCLC). Real-world data in Korean patients are scarce. We evaluated the effectiveness and safety of first-line chemo-immunotherapy in ES-SCLC and compared outcomes with pivotal trials.
Materials and Methods
We retrospectively reviewed patients diagnosed with ES-SCLC between 2018 and 2021. Overall survival (OS), progression-free survival (PFS), and time to next treatment (TTNT) were analyzed using Kaplan–Meier methods. Multivariate Cox regression identified prognostic factors. Objective response rate (ORR) was assessed by RECIST v1.1, and histological subtypes evaluated.
Results
Among 177 patients, median age was 66 years (range, 42–91), with 63.8% aged ≥65; most were male (92.7%) and ECOG 0–1 (91.5%). Smoking history was present in 80.8%. Baseline brain and liver metastases occurred in 27.7% and 26%. Median follow-up was 27.2 months (range, 3.9–43.2). ORR was 74.5% (95% CI, 67.1–81.1). Median OS, PFS, and TTNT were 12.4 (95% CI, 11.6–14.9), 5.3 (95% CI, 5.1–5.87), and 5.6 months (95% CI, 1.43–38.27). In 49 patients with brain metastases, ORR was 63.2%, with no difference in efficacy. Local therapy for brain metastases improved OS (HR 0.42; p=0.012), while PFS was not different. Treatment-related adverse events occurred in 90%, primarily grade ≥2 cytopenias; the most common immune-related event was grade 1 rash.
Conclusion
In this real-world Korean cohort, first-line chemo-immunotherapy achieved outcomes comparable to pivotal trials, supporting its role as standard care for ES-SCLC in clinical practice.

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Disease Burden and Treatment Pattern of Advanced or Recurrent Endometrial Cancer in Korea: A Nationwide Database (DIRECTION) Study: Hyun-Woong Cho, Se Ik Kim, Min-Ji Bae, Kyoung-Eun Kwon, ChoungWon Jung, YoungEun Lee, JiYoon Ahn, Kidong Kim; Received January 15, 2025 Accepted October 16, 2025 Published online October 20, 2025; DOI: https://doi.org/10.4143/crt.2025.065 [Accepted]

Abstract PDF: Purpose
Advanced/recurrent endometrial cancer (EC) patients has a poor prognosis, with higher recurrence and mortality than early-stage. However, as the real-world disease burden in these patients remains unclear, we aimed to investigate systemic anticancer therapy (SACT) patterns, healthcare resource utilization (HCRU), and costs in advanced/recurrent EC patients.
Materials and Methods
This nationwide population-based study used Korean claims data from 2008 to 2022. Adult patients with advanced/recurrent EC who received first-line SACT were included. For advanced EC, first-line SACT was defined as the initial therapy following EC diagnosis, while for recurrent EC it was defined as the initial therapy after recurrence following completion of primary therapy. We analyzed SACT patterns, prognosis, all cause- and EC-related HCRU, and costs.
Results
A total of 2,704 EC patients were included. The most commonly used SACT was platinum-based regimen. From the first to third line, median values of SACT-free interval (18.40, 5.03, and 3.22 months) and time to next treatment (TTNT, 25.43, 9.27 and 6.44 months) showed decreasing trends. All-cause/EC-related HCRU and costs were increased with SACT progression; all-cause inpatient visits and total costs increased from 0.58 to 1.04 times per-patient-per-month (PPPM) and from $1,197.96 to $2,354.37 USD PPPM.
Conclusion
This study demonstrated significant variability in SACT regimen sequence, highlighting the lack of consensus on standard treatment after disease relapse. Shorter TTNT and SACT-free intervals and higher HCRU and costs in later lines indicate worsening prognosis and increasing disease burden. These findings suggest the urgent need for more effective treatments, including new therapeutic agents, to address the unmet clinical needs of advanced/recurrent EC patients.

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Prognostic Impact of Organ-Specific Metastasis in Non-Small-Cell Lung Cancer: Woo Kyung Ryu, Munkhtsatsral Ganbaatar, Nuri Park, Hyun Young Lee, Hwan-Cheol Kim, Jeong-Seon Ryu, Jun Hyeok Lim; Received March 3, 2025 Accepted October 2, 2025 Published online October 10, 2025; DOI: https://doi.org/10.4143/crt.2025.238 [Accepted]

Abstract PDF: Purpose
Prognostic stratification is essential in non-small-cell lung cancer (NSCLC) to guide treatment decisions. While the TNM staging system has evolved to refine the M category based on metastatic burden, it does not account for differences in prognosis based on the specific organ affected. This study evaluates whether incorporating organ-specific metastasis improves prognostic discrimination in stage IV NSCLC.
Materials and Methods
We conducted a retrospective cohort study using data from the Korean Central Cancer Registry (2014–2018). Patients with stage IV NSCLC were classified according to the 9th edition TNM classification: M1b (single-organ, single metastasis), M1c1 (multiple metastases within a single organ), and M1c2 (multiple organ metastases). Survival outcomes were compared across groups using Kaplan-Meier analysis and Cox proportional hazards modeling.
Results
Among 3,165 patients, 56.5% had single-organ metastases, while 43.5% had multiple organ metastases. Median overall survival (OS) was longest in M1b (8.0 months), followed by M1c1 (6.0 months), and shortest in M1c2 (5.9 months) (p<0.001). However, survival varied by metastatic organ. Liver, adrenal, and uncommon-site metastases were associated with significantly worse OS, even among M1b patients. Some M1b and M1c1 patients with high-risk organ metastases had worse survival than M1c2 patients, challenging the TNM-defined prognostic hierarchy.
Conclusion
The current TNM M category does not fully capture the prognostic impact of metastatic organ involvement. Incorporating organ-specific metastases into staging and prognostic models could refine risk stratification and improve personalized treatment approaches for stage IV NSCLC.

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Response to Neoadjuvant Systemic Therapy May Serve as an Indicator for Omitting Post-BCS Radiation Therapy in Women with Early-Stage Breast Cancer: Chaofan Li, Yusheng Wang, Mengjie Liu, Shiyu Sun, Yiwei Jia, Jingkun Qu, Shuqun Zhang, Chong Du; Received June 1, 2025 Accepted September 7, 2025 Published online September 10, 2025; DOI: https://doi.org/10.4143/crt.2025.584 [Accepted]

Abstract PDF: Abstract Purpose To avoid unnecessary toxicities and optimize the allocation of healthcare resources, it is crucial to adequately select patients with extremely low recurrence risk to downgrade or eliminate radiation therapy.
Materials and Methods
From the SEER database, clinical data of 7,291 female patients with early-stage breast cancer who underwent neoadjuvant systemic therapy (NST) and breast-conserving surgery (BCS) were collected for this study. The patients were stratified by their response to NST, and the long-term survival, and risk of recurrence were assessed using Cox regression analysis and Fine-gray competing risk models for those with and without post-BCS RT, respectively.
Results
Our results showed that female with early-stage breast cancer who achieved complete response (CR) to NST, omitting post-BCS RT achieved the same OS and DFS as those who received the post-BCS RT, and the omission did not increase the risk of recurrence or BCSD. For patients who did not achieve CR to NST, five clinical indicators (including age, N stage, grade, response to NST, and molecular subtype) were employed to construct a nomogram for clinical prediction of the risk of recurrence. The validated results affirmed our model’s ability to accurately discriminate high- and low-risk patients and its promising clinical application value.
Conclusion
Post-BCS RT can be omitted for women with early-stage breast cancer who achieved CR to NST. For those who failed to achieve CR to NST, a nomogram was constructed for clinicians to decide whether to omit post-BCS RT or not based on the individualized assessment.

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Analysis of T Cell Subsets Using Multiplex Immunohistochemistry and Clinical Outcomes of Immune Checkpoint Inhibitors in Advanced Gastric Cancer Patients: Tae-Yong Kim, Jeesun Yoon, Dae-Won Lee, Yoonjin Kwak, Hye Seung Lee, Do-Youn Oh; Received April 28, 2025 Accepted September 7, 2025 Published online September 9, 2025; DOI: https://doi.org/10.4143/crt.2025.458 [Accepted]

Abstract PDF: Purpose
As immunotherapy has become essential in the treatment of gastric cancer (GC), there has been growing interest in T-cells, which play a key role in immunotherapy. In this study, we evaluated the impact of T-cell subsets on immune responsiveness to immune checkpoint inhibitors (ICIs) in GC using multiplex immunohistochemistry (mIHC).
Materials and Methods
Eighty-four GC patients treated with ICIs were enrolled, and we repeated the staining-scanning-stripping procedure nine times to assess different kinds of T-cells or cell-surface immune checkpoints in a single tissue section.
Results
The proportions of patients with microsatellite instability-high (MSI-H), Epstein-Barr virus (EBV), and non-MSI/non-EBV were 8.3%, 3.6% and 88.1%. A high cytotoxic T-cell (T_cyto) density was related to longer overall survival (OS). GC with a high ratio of T_cyto/total T-cells (T_total) and a low ratio of regulatory T-cells (T_reg)/T_total showed better OS. A high density of PD-1- or TIM-3- expressing T_cyto were also associated with longer OS than a low density of those. Among memory T-cells (T_mem) subsets, GC with a high ratio of memory T_cyto/T_mem and a low ratio of memory T_reg/T_mem showed prolonged OS. Better tumor responses were observed in GC with a high ratio of T_cyto/T_total and memory T_cyto/T_mem.
Conclusion
T-cell subsets within the tumor microenvironment were associated with the clinical efficacy of ICIs in GC. PD-1- or TIM-3 expressing T-cells were also associated with response to ICIs, while memory T-cells subsets were associated with survival. mIHC is a feasible method for evaluating T-cell subsets in archival gastric tumor tissue.

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Preferential Sensitivity of the EGFR L858M/L861R Mutation to Second-Generation EGFR Tyrosine Kinase Inhibitors in Non-small Cell Lung Cancer: Chaelin Lee, Sheehyun Kim, Soyeon Kim, Taekeun Park, Miso Kim, Bhumsuk Keam, Tae Min Kim, Dong-Wan Kim, Jeonghwan Youk; Received March 11, 2025 Accepted August 19, 2025 Published online August 20, 2025; DOI: https://doi.org/10.4143/crt.2025.279 [Accepted]

Abstract PDF

Purpose
Non-small cell lung cancer (NSCLC) frequently harbors targetable EGFR mutations. However, rare variants such as EGFR L858M or L861R remain poorly characterized. This study aimed to elucidate the oncogenic potential and EGFR tyrosine kinase inhibitors (TKIs) sensitivity of the EGFR L858M/L861R mutation to inform personalized treatment strategies.
Materials and Methods
Tumor samples from a NSCLC patient were analyzed using targeted panel sequencing and confirmed with the FoundationOne Liquid CDx assay. EGFR-mutant constructs, including L858M, L858R, L861R, L861Q, L858M/L861R, and L858R/L861Q, were generated and transduced into various cell lines. Cell viability, immunoblot, and soft agar colony formation assays were conducted to assess the oncogenicity and drug sensitivity, while computational protein modeling and docking simulations evaluated the drug-binding affinities of EGFR TKIs.
Results
Ba/F3 cells expressing the EGFR L858M/L861R mutation exhibited robust IL-3–independent proliferation accompanied by markedly increased EGFR phosphorylation, while NIH-3T3 cells showed anchorage-independent colony formation. Compared to other mutations, cells expressing EGFR L858M/L861R mutation were less sensitive to first-generation EGFR TKIs (gefitinib, erlotinib) and third-generation EGFR TKIs (osimertinib, lazertinib), whereas second-generation EGFR TKIs (afatinib, poziotinib) demonstrated potent inhibitory effects. Computational modeling revealed a narrower drug-binding efficiency of first-generation inhibitors.
Conclusion
The EGFR L858M/L861R mutation drives strong oncogenic signaling and exhibits preferential sensitivity to second-generation EGFR TKIs. These findings underscore the importance of accurate molecular diagnosis for guiding effective, personalized therapeutic strategies in NSCLC.

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Real-World Outcomes and Subsequent Treatment Patterns in Patients with Advanced Non-Small Cell Lung Cancer and Atypical EGFR Mutations Receiving First-Line Osimertinib Monotherapy
Jorge J. Nieva, Xuejun Wang, Deborah Doroshow, Leslie Servidio, Miranda Cooper, Yan Kwan Lau, Pritesh S. Karia, Jacqulyne Robichaux
Oncology and Therapy.2025;[Epub] CrossRef

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Impact of High Lymph Node Burden on Brain Metastases in Patients Who Achieved Pathological Complete Response after Neoadjuvant Chemotherapy in HER2-Positive Breast Cancer: Seung Ah Lee, Ki Jo Kim, Do Youn Woen, Su Min Lee, Kawon Oh, Cho Eun Lee, Woong Ki Park, Ji Won Yoo, Dong Seung Shin, Jai Min Ryu, Se Kyung Lee, Byung Joo Chae, Jonghan Yu, Seok Won Kim, Seok Jin Nam, Ji-Yeon Kim, Yeon Hee Park, Eun Young Ko, Eun Sook Ko, Jeong Eon Lee; Received February 24, 2025 Accepted July 6, 2025 Published online July 8, 2025; DOI: https://doi.org/10.4143/crt.2025.219 [Accepted]

Abstract PDF: Purpose
This study aims to investigate the clinical characteristics, outcomes, and predictors of brain metastases in HER2-positive advanced breast cancer patients who achieved pathological complete response (pCR) following neoadjuvant chemotherapy (NAC). This research seeks to inform surveillance strategies and optimize management for high-risk subgroups.
Materials and Methods
A retrospective analysis of 1,757 patients (2008–2022) classified them into pCR (n=914) and non-pCR (n=843) groups post-NAC. Collected data included demographics, clinical features, and metastasis parameters. Survival outcomes and brain metastasis predictors were assessed using Kaplan-Meier curves, Cox models, and logistic regression.
Results
Among pCR patients, brain metastases accounted for 54.2% of distant metastases, significantly affecting OS (p<0.001). Median DMFS was shorter for brain metastases (13.4 months) compared to extracranial metastases (31.1 months) in the pCR group (p=0.005). Positive supraclavicular node (SCN) fine needle aspiration (FNA) and clinical N3 (cN3) stage were the strongest predictors of brain metastases (SCN FNA: OR=12.9, p<0.001; cN3: OR=12.1, p<0.001). Multivariable Cox regression analysis revealed that positive SCN FNA and cN3 stage were strong predictors of reduced DMFS (SCN FNA: HR=2.5, 95% CI: 1.3–3.6, p < 0.001; cN3: HR=11.3, 95% CI: 4.9–33.0, p<0.001).
Conclusion
This study highlights the challenges of brain metastases in HER2-positive pCR patients, emphasizing the need for tailored therapeutic strategies and enhanced surveillance. High lymph node burden prior to NAC is a significant factor in risk assessment. Therefore, it may be advisable to recommend post-surgery surveillance for high-risk patients.

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Nivolumab Plus Chemotherapy Versus Placebo Plus Chemotherapy in Korean Patients with HER2-Negative, Untreated, Unresectable Advanced or Recurrent Gastric or Gastroesophageal Junction Cancer: Subgroup Analysis of a Randomized, Multicenter, Double-Blind Phase 3 Trial (ATTRACTION-4): Yoon-Koo Kang, Min-Hee Ryu, Do-Youn Oh, Sang Cheul Oh, Sun Young Rha, Keun-Wook Lee, Ik Joo Chung, Sung Yong Oh, Sun Jin Sym, Won Ki Kang, Jong Gwang Kim, Byoung Yong Shim, In-Ho Kim, Jin Young Kim, Eun-Kee Song, Hyo-Jin Lee, Seok Yun Kang, Dong-Hoe Koo, So Yeon Oh; Received September 13, 2024 Accepted July 1, 2025 Published online July 2, 2025; DOI: https://doi.org/10.4143/crt.2024.913 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Purpose
We report the safety and efficacy of nivolumab+chemotherapy for first-line treatment of advanced or recurrent gastric or gastroesophageal junction cancer in the Korean subpopulation of the ATTRACTION-4 clinical trial.
Materials and Methods
ATTRACTION-4 (NCT02746796) was a double-blind, randomized, placebo-controlled clinical trial of patients aged ≥ 20 years with histologically confirmed unresectable advanced or recurrent gastric or gastroesophageal junction cancer. Patients received nivolumab or placebo, both combined with physician-choice chemotherapy (oxaliplatin plus oral S-1 [tegafur–gimeracil–oteracil] [SOX] or oral capecitabine [CAPOX]).
Results
Overall, 464 patients were initially screened in Korea and 291 were randomized to nivolumab+chemotherapy (total/SOX/CAPOX: 148/66/82 patients) or placebo+chemotherapy (total/SOX/CAPOX: 143/61/82 patients). Centrally assessed progression-free survival (median, 14.75 vs. 8.34 months; hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39 to 0.73; p < 0.001), overall survival (19.7 vs. 14.9 months; HR, 0.78; 95% CI, 0.60 to 1.02; p=0.065), overall response rate (54.7% vs. 47.6%), and duration of response (16.03 vs. 9.86 months) favored nivolumab+chemotherapy vs. placebo+chemotherapy. Grade ≥ 3 treatment-related adverse events (TRAEs) (56.1% vs. 44.1%), and any-grade endocrine (9.5% vs. 4.2%), hepatic (23.0% vs. 14.7%), hypersensitivity and infusion reactions (15.5% vs. 7.0%), renal (4.1% vs. 0.7%), and skin (44.6% vs. 23.1%) TRAEs tended to be more frequent in the nivolumab+chemotherapy group.
Conclusion
These findings demonstrate the clinical benefit of nivolumab combined with chemotherapy (either SOX or CAPOX) for first-line treatment of gastric cancer/gastroesophageal junction cancer in Korean patients.

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Overcoming diagnostic pitfalls in primary gastric squamous cell carcinoma: the imperative of adequate sampling in an elderly female patient, case report
Wanhui Dong, Li Cheng, Jing Xu, Sheng Xu, Yuling Yin, Qingming Sun, Yong Wu, Yuling Leng
Frontiers in Oncology.2025;[Epub] CrossRef

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Anticancer Treatment Influences TREM2 in Tumor-Associated Macrophages in Lung Cancer: Yoon Jin Cha, Eun Hye Lee, Chi Young Kim, Yong Jun Choi, Min Kyung Park, Sang Hoon Lee, Eun Young Kim, Yoon Soo Chang; Received December 26, 2024 Accepted June 22, 2025 Published online June 23, 2025; DOI: https://doi.org/10.4143/crt.2024.1245 [Accepted]

Abstract PDF: Purpose
The triggering receptor expressed on myeloid cells (TREM2) creates an immunosuppressive environment, but the effects of anticancer treatment on TREM2 and the tumor microenvironment (TME) are not well established. This study investigates the impact of chemotherapy on TREM2-expressing macrophages within the lung adenocarcinoma TME.
Materials and Methods
Using single-cell RNA sequencing datasets of paired normal-appearing lung tissue (NL) and tumor (Tu), human and mouse lung cancer tissue, and THP-1 cells, we observed the effects of anticancer drugs on them.
Results
Myeloid cells (MY) were the second-most abundant non-epithelial component in the Tu, though less prevalent than in NL. Specific MY subclusters abundant in Tu showed overexpression of TREM2. In lung cancer-induced Kras-G12D mice, M2 proportion increased in Tu compared to NL; cisplatin increased TREM2+ M2 proportion in Tu. TREM2+ cells in Tu showed interactions with cell clusters showing characteristics of interstitial macrophage such as mo-lineage, mono-Mc, and CD163/LGMN cells via FN:CD44 and MIF:CD74+CXCR4, suggesting that they influence the recruitment of those cells to Tu and TME reshape. In M0-state THP-1 cells, cisplatin and osimertinib treatments induced polarization towards M1 and M2 states and increased TREM2 expression. Cisplatin promoted uptake of phosphatidylserine-coated latex beads by M0 cells, whereas osimertinib reduced uptake by polarized macrophages. These findings suggest anticancer treatments impact the lung immune microenvironment by altering the TREM2+ cells.
Conclusion
Given TREM2's central inhibitory role in the tumor immune environment, effects of chemotherapeutic agents should be considered in developing TREM2-targeting therapies.

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Awareness and Practice of Dietary Recommendations for Cancer Prevention among Participants of the 2023 Korean National Cancer Prevention for Dietary Awareness and Practice Survey: Yoonjoo Choi, Hyein Jung, Byungmi Kim; Received July 12, 2024 Accepted June 17, 2025 Published online June 18, 2025; DOI: https://doi.org/10.4143/crt.2024.642 [Accepted]

Abstract PDF: Purpose
Most cancers are preventable by improving dietary habits, individuals with poor dietary behaviors should be encouraged to adopt more active steps to prevent cancer. We surveyed Korean adults to identify the awareness and practice of the recommended guidelines for dietary factors.
Materials and Methods
The 2023 Korean National Cancer Prevention for Dietary Awareness and Practice Survey was a cross-sectional online survey of 4,000 adults aged 20–69. The survey included questions on sociodemographics, lifestyle, and awareness and practice of five dietary recommendations (consuming fruits and vegetables, consuming a balanced diet, avoiding salt, charred foods, and alcohol intake).
Results
Despite more than 90.0% being aware that each dietary recommendation can be a risk determinant for cancer, the practice rate for recommendations showed lower rates than recognition. Especially, in both males and females, the younger (odds ratio [OR]: 1.971 in males and OR: 4.863 in females), with no nutritional education (OR: 2.715 in males and 2.093 in females), and the obese (OR: 1.451 in males, and OR: 1.579 in females) had higher odds of significant non-adherents (failed to comply with 3–5 recommendations) than participants who older, had nutritional education, and normal body mass index, respectively.
Conclusion
Although there is high awareness of dietary recommendations for cancer prevention, participants who were younger, had no nutritional education, or were obese showed poor adherence to cancer-preventive dietary practices. Our findings highlight the need for targeted interventions to improve the dietary habits of this at-risk population.

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Efficacy and Safety of Ifosfamide and Mesna in Metastatic Castration-Resistant Prostate Cancer after Taxane-Based Chemotherapy and Novel Hormonal Therapy Failure: Chang Gon Kim, Yeo Gyeong Ko, Jongjin Yoon, Chung Lee, Seung Hoon Beom, Young-Deuk Choi, Woong Kyu Han, Won Sik Ham, Hyunho Han, Jongsoo Lee, Ji Eun Heo, Daeseong Kim, Eun Sil Baek, Sangwoo Kim, Minsun Jung, Sang Joon Shin; Received February 10, 2025 Accepted June 8, 2025 Published online June 9, 2025; DOI: https://doi.org/10.4143/crt.2025.155 [Accepted]

Abstract PDF: Purpose
Limited treatment options exist for patients with metastatic castration-resistant prostate cancer (mCRPC) after the failure of taxane-based chemotherapy and novel hormonal therapy. Here, we report the safety and efficacy of ifosfamide and mesna in patients with mCRPC after the failure of taxane-based chemotherapy and novel hormonal therapy (NCT06236789).
Materials and Methods
Patients with histologically confirmed prostate cancer who had failed taxane-based chemotherapy and novel hormonal therapy received ifosfamide 2,500 mg/m² and mesna 1,500 mg/m² on days 1–3, repeated every 21 days. Safety, objective response rate, disease control rate, reduction in serum prostate-specific antigen (PSA) concentration by >50% (PSA₅₀) or >90% (PSA₉₀), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed.
Results
A total of 47 patients with mCRPC were included in the study. The median number of lines of treatment was 5 (range: 3–7). All patients were previously administered docetaxel and novel hormonal therapies including abiraterone (51.1%) and/or enzalutamide (61.7%). Thirty-eight patients (80.9%) were administered cabazitaxel. The objective response and disease control rates were 21.3% and 80.9%, respectively. PSA₅₀ and PSA₉₀ were achieved in 31.9% and 10.6%, respectively. During a median follow-up duration of 54.3 months, rPFS and OS were 5.0 and 9.0 months, respectively. All the patients experienced treatment-related adverse events of any grades; however, no new safety signs were detected. Genomic biomarker analysis revealed that alterations in the TP53 pathway were associated with inferior rPFS and OS.
Conclusion
Ifosfamide and mesna showed appreciable efficacy and manageable safety profiles in heavily treated patients with mCRPC.

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Comparison of Surveillance with Low-dose and Contrast-enhanced Chest Computed Tomography in Patients Disease-free for Two Years after Curative Resection for Lung Cancer: Bubse Na, Ji Hyeon Park, Kwon Joong Na, Samina Park, Chang Hyun Kang, Young Tae Kim, In Kyu Park; Received March 5, 2025 Accepted June 4, 2025 Published online June 5, 2025; DOI: https://doi.org/10.4143/crt.2025.256 [Accepted]

Abstract PDF: Purpose
Low-dose chest computed tomography (LDCT) is recommended for surveillance 2–3 years after curative resection of non-small cell lung cancer (NSCLC); however, supporting clinical evidence is limited. This study compared LDCT with contrast-enhanced chest computed tomography (CECT) in terms of recurrence detection and overall survival (OS) in patients two years after curative resection of NSCLC.
Materials and Methods
Among patients who underwent curative resection for NSCLC between January 2011 and December 2017 and survived for 2 years without recurrence, 2083 patients were included. Comparisons between the LDCT and CECT groups were performed in both the entire cohort and propensity score-matched cohort. The primary outcome was the difference in overall survival. Secondary outcomes included time-to-recurrence, recurrence-free survival, and post-recurrence survival in each group.
Results
In the propensity score-matched population, the 5-year OS (96.0% for LDCT, 98.0% for CECT, p=0.097) and recurrence-free survival (RFS) (95.4% for LDCT, 96.0% for CECT, p=0.76) did not differ. The OS and RFS did not differ in subgroup analyses stratified by pathologic stage and histologic type. In the competing risk analysis, the overall 5-year cumulative incidence of recurrence did not differ between the two groups. (4.56% for LDCT, 3.93% for CECT, p=0.765). When stratified by pathologic stage and histologic type, there was no significant difference in the cumulative incidence of recurrence. The distribution of recurrence sites did not differ between groups.
Conclusion
Similar OS and RFS were observed in LDCT and CECT surveillance in patients who achieved a 2-year disease-free status after curative resection for NSCLC.

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General

Presentation of Benefits and Harms in Cancer Screening Guidelines for Koreans: A Systematic Review: Mi Ah Han, Hunju Lee, Kwangmin Kim, Seong Jung Kim, Eu Chang Hwang, Jae Hung Jung; Cancer Res Treat. 2025;57(4):923-931. Published online March 27, 2025; DOI: https://doi.org/10.4143/crt.2024.1151

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study systematically reviewed cancer screening guidelines for the Korean population to evaluate the benefits and harms of the recommended cancer screening practices.
Materials and Methods
We searched international electronic databases from inception to July 2023. Two reviewers independently conducted reference screening and data extraction. Data were extracted based on recommendations from each guideline and presentation of benefits and harms. General characteristics of the cancer screening guidelines, including cancer type, recommended screening methods, certainty of evidence, were collected. Moreover, we obtained key information on the benefits and harms of screening interventions, including the quantification of their relative and absolute effects.
Results
Fifteen recommendations were identified for the use of interventions for the early detection of stomach, liver, colorectal, breast, cervical, and lung cancers in nine guidelines published between 2011 and 2015. Seven guidelines collected evidence through de novo systematic reviews. Eight guidelines presented the certainty of evidence and strength of recommendations. Benefits are presented as relative risks, and harms are presented as absolute risks. Six recommendations presented the absolute effects of both benefits and harms (comparable); eight presented them unevenly, including quantifying benefits relatively but presenting harms as absolute measures (asymmetric); and one presented neither benefits nor harms (incomplete).
Conclusion
More than half of guidelines fail to present the benefits and harms of screening in a balanced manner. To enable users and beneficiaries make informed decisions based on evidence, the benefits and harms supporting recommendations should be given in a transparent and balanced manner.

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Association of Physical Activity with Dementia Risk in Cancer Survivors: A Korean Nationwide Cohort Study: Su Kyoung Lee, Minji Han, Sangwoo Park, Sun Jae Park, Jihun Song, Hye Jun Kim, Jaewon Kim, Hyeokjong Lee, Hyun-Young Shin, Kyae Hyung Kim, Sang Min Park; Received September 16, 2024 Accepted March 25, 2025 Published online March 27, 2025; DOI: https://doi.org/10.4143/crt.2024.901 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to investigate the impact of physical activity on dementia risk among cancer survivors in South Korea.
Materials and Methods
This retrospective, population-based cohort study included 344,152 cancer survivors identified from the National Health Insurance Service database in South Korea. The mean follow-up time was 5.81 years. Different levels of physical activity post-cancer diagnosis, ranging from inactive to highly active, were assessed. The primary outcome was the incidence of overall dementia, Alzheimer’s disease, and vascular dementia. Secondary outcomes included dementia risk stratified by cancer type and treatment (chemotherapy and radiation).
Results
Of the total participants, 24,363 (7.08%) developed dementia. The risk of overall dementia decreased sequentially across the exercise groups compared to the inactive group: insufficiently active (adjusted hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.86 to 0.92), active (adjusted HR, 0.85; 95% CI, 0.83 to 0.88), and highly active (adjusted HR, 0.79; 95% CI, 0.76 to 0.82). This inverse relationship between exercise and dementia risk was statistically significant across various cancer types and was consistent regardless of age, comorbidities, and whether or not excluding the first 1, 2 years.
Conclusion
Among cancer survivors in South Korea, increased physical activity post-diagnosis was associated with a significantly lower risk of dementia. These findings underscore the importance of promoting physical activity in cancer survivors for cognitive health.

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The Role of Circulating Tumor Cell as a Promising Biomarker in the Evaluation of Pulmonary Nodules: A Prospective Study: Shijie Wang, Changdan Xu, Xiaohong Xu, Weipeng Shao, Guohui Wang, Xiongtao Yang, Liwei Gao, Feng Teng, Hongliang Sun, Yue Zhao, Hongxiang Feng, Guangying Zhu; Received August 29, 2024 Accepted March 26, 2025 Published online March 27, 2025; DOI: https://doi.org/10.4143/crt.2024.841 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Purpose
Our previous study showed that circulating tumor cell (CTC) count combined with gene mutation detection might help differentiate benign and malignant pulmonary nodules (PNs). Herein, we aimed to expand the study cohort and conduct further sequencing analysis.
Materials and Methods
Patients with PNs were included, and CTCs were identified before operation. Low-coverage whole-genome sequencing (LC-WGS) and lung cancer-related targeted gene sequencing were performed on CTCs. The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve. The differences in CTC counts among subgroups classified by demographic–clinical characteristics were analyzed. LC-WGS–based copy number variation (CNV) analysis and targeted gene mutation analysis were conducted.
Results
A total of 172 patients were included. CTC count of 2.5 was identified by the ROC curves as the optimal diagnostic cutoff. The sensitivity and specificity of CTC count for differentiating benign and malignant PNs were 54.2% and 78.6%, respectively. The diagnostic sensitivity and specificity of combined CTC count, radiological nodule type, and any malignant imaging features were 84.7% and 71.4%, respectively. The CTC counts were significantly greater in patients with aggressive tumors, later stage, and spread through air spaces. CTCs from malignant cases had more CNVs than those from benign cases.
Conclusion
CTC count can be used in identifying malignant PNs. The diagnostic efficacy can be improved if combined with computed tomography imaging characteristics. Further CNV analysis might help differential diagnosis. Greater CTC count might suggest more aggressive tumors. CTC detection can provide important information and guidance for subsequent management of PNs.

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Ten-Year Follow-up Clinical Outcomes and the Role of Adjuvant Chemotherapy in HER2-Positive Patients with Microinvasive Breast Cancer: Yeokyeong Shin, Soo-Young Lee, Hyehyun Jeong, Jin-Hee Ahn, Kyung Hae Jung, Sung-Bae Kim, Hee Jeong Kim, Jong Won Lee, Byung Ho Son, BeomSeok Ko, Ji Sun Kim, Il Yong Chung, Hee Jin Lee, Gyungyub Gong, Sae Byul Lee, Jae Ho Jeong; Received November 22, 2024 Accepted March 3, 2025 Published online March 5, 2025; DOI: https://doi.org/10.4143/crt.2024.1120 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Purpose
Although human epidermal growth factor receptor 2 (HER2) positivity is prevalent in microinvasive breast cancer (MIBC), data focused on HER2-positive MIBC are limited. We investigated the clinical course and long-term outcomes of HER2-positive MIBC and evaluated the role of adjuvant chemotherapy.
Materials and Methods
The study included patients with curatively resected pT1mi pN0 HER2-positive breast cancer between January 2000 and January 2020. Treatments and survival outcomes, including invasive breast cancer-free survival (IBCFS), distant recurrence-free survival (DRFS), and overall survival (OS) were analyzed.
Results
The analysis included 799 female patients. The median age was 51 years (range, 23 to 79 years), and 51.6% (n=412) were premenopausal. Multifocality was confirmed in 17.3% (n=138), and estrogen receptor (ER) positivity in 29.8% (n=238). Adjuvant chemotherapy was administered to 17.5% (n=140), with doxifluridine in 96.4% of cases. One patient (0.1%) received trastuzumab. With a median follow-up of 119.0 months (95% confidence interval [CI], 114.0 to 127.0), the 8-year IBCFS, DRFS, and OS were 91.2% (95% CI, 89.1 to 93.3), 97.5% (95% CI, 96.4 to 98.7), and 98.8% (95% CI, 98.0 to 99.6), respectively. No significant differences were observed between patients with and without adjuvant chemotherapy. The lack of differences in IBCFS by chemotherapy was consistent across subgroups, including pre-/postmenopausal patients, grade 1-2/3 tumors, and ER-negative disease.
Conclusion
A clinically meaningful proportion of HER2-positive MIBC patients experience IBCFS events with long-term follow-up. Adjuvant chemotherapy did not improve survival, potentially due to the use of an outdated, ineffective regimen. The role of modern adjuvant regimens, particularly those incorporating HER2-targeted therapy, warrants further exploration.

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Microinvasive carcinoma of the breast
Rachel Han, Edi Brogi
Human Pathology.2025; 162: 105856. CrossRef

1,635 View
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Association between Benign Thyroid Disorders and Breast Cancer Risk in Korean Women: Boyoung Park, Thi Xuan Mai Tran; Received August 16, 2024 Accepted February 25, 2025 Published online February 26, 2025; DOI: https://doi.org/10.4143/crt.2024.787 [Epub ahead of print]

Abstract PDF PubReader ePub: Purpose
This study aimed to investigate the potential association between thyroid disorders and breast cancer (BC) risk in a cohort of Korean women.
Materials and Methods
Data for this retrospective cohort study were obtained from the Korean National Health Insurance database, including all women aged ≥ 40 who underwent BC screening from 2009 to 2010 in Korea. Thyroid disorders were identified using medical records from 2009 to 2010 and extracted using the International Classification of Diseases, 10th revision (ICD-10) codes for thyroid nodules, hypothyroidism, and hyperthyroidism. BC cases were defined using the ICD-10 codes and tracked until December 2021. A Cox regression model was used to evaluate the association between thyroid disorders and the risk of BC. Additionally, we evaluated the association between well-known risk factors of BC and thyroid disorders using logistic regression analysis.
Results
Among 5,051,633 women, the mean±standard deviation age was 55.2±10.7 years, and the median follow-up was 11.6 years, with 87,784 BC cases recorded. The proportions of patients with thyroid nodules, hypothyroidism, and hyperthyroidism were 2.5%, 1.8%, and 0.9%, respectively. The hazard ratio for BC risk associated with thyroid nodules was 1.16 (95% confidence interval [CI], 1.11 to 1.20), for hypothyroidism was 0.98 (95% CI, 0.93 to 1.03), and for hyperthyroidism was 1.13 (95% CI, 1.06 to 1.21). In both premenopausal and postmenopausal women, an increased risk of BC was significantly associated with thyroid nodules (adjusted hazard ratio [aHR], 1.16 and 1.13) and hyperthyroidism (aHR, 1.11 and 1.16). History of benign breast disease, oral contraceptive use, breastfeeding, menopausal status, and hormone replacement therapy were associated with thyroid nodules and hyperthyroidism.
Conclusion
Our findings suggest an increased risk of BC in women with a history of thyroid nodules and hyperthyroidism, whereas no such association was found in women with hypothyroidism.

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A Multicenter Phase II Study of Modified FOLFIRINOX for First-Line Treatment for Advanced Urachal Cancer (ULTIMA; KCSG GU20-03): Inkeun Park, Jae Lyun Lee, Shinkyo Yoon, Sang Joon Shin, Seong-Hoon Shin, Jung Hoon Kim, Kwonoh Park, Hyo Jin Lee; Received December 21, 2024 Accepted February 12, 2025 Published online February 13, 2025; DOI: https://doi.org/10.4143/crt.2024.1231 [Epub ahead of print]

Abstract PDF PubReader ePub

Purpose
This study aimed to assess the efficacy and safety of first-line modified FOLFIRINOX in patients with advanced urachal cancer.
Materials and Methods
The ULTIMA trial (NCT04611724) is a single-arm, open-label, multicenter phase II study evaluating modified FOLFIRINOX (oxaliplatin 85 mg/m² over 2 hours, irinotecan 150 mg/m² over 1.5 hours, leucovorin 400 mg/m² over 2 hours, and 5-fluorouracil 2,400 mg/m² over 46 hours) plus prophylactic pegteograstim in patients with recurrent or metastatic urachal cancer every 2 weeks for up to 12 cycles, or until disease progression or unacceptable toxicity. The primary endpoint was the overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and the incidence of febrile neutropenia.
Results
Between April 2021 and November 2023, 21 patients with advanced urachal cancer were enrolled across five cancer centers. The median age was 50 years (range, 28 to 68 years), with 15 male patients. The most common metastatic site was the lung (47.6%), followed by lymph nodes (38.1%) and peritoneal seeding (33.3%). Two patients and 11 patients achieved a complete and partial response, respectively, yielding an ORR of 61.9%. The study met its primary endpoint in the first stage. With a median follow-up of 23.3 months, the median PFS was 9.3 months (95% confidence interval [CI], 6.7 to 11.9), and the median OS was 19.7 months (95% CI, 14.3 to 25.1). The treatment regimen was well tolerated, with no unexpected adverse events, and no instances of febrile neutropenia or grade 4 adverse events.
Conclusion
In this preliminary analysis of the ULTIMA trial, Modified FOLFIRINOX demonstrated a promising ORR and PFS in patients with advanced urachal cancer. Completing the full study is essential to confirm the potential role of this regimen in the management of advanced urachal cancer.

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Metastatic urachal carcinoma treated with trifluridine/tipiracil and bevacizumab: a case report
Takafumi Kitazono, Taichi Isobe, Satoshi Nishiyori, Wataru Kusano, Kenro Tanoue, Tomoyasu Yoshihiro, Hirofumi Ohmura, Kyoko Yamaguchi, Mamoru Ito, Kenji Tsuchihashi, Koichi Akashi, Eishi Baba
International Cancer Conference Journal.2025; 14(3): 280. CrossRef
Urachal cancer: a clinical, diagnostic, and therapeutic update
Henning Reis, Tibor Szarvas, Gladell P. Paner
Current Opinion in Urology.2025;[Epub] CrossRef

2,156 View
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2 Crossref

Palliative medicine

A Prospective, Single-Cohort, Open, Multi-center, Observational Study of Sublingual Fentanyl for Breakthrough Cancer Pain: Effectiveness, Safety, and Tolerability in Korean Cancer Patients: Youn Seon Choi, Su-Jin Koh, Woo Kyun Bae, Se Hyung Kim, Seong Hoon Shin, So Yeon Oh, Sang Byung Bae, Yaewon Yang, Eun-Kee Song, Yoon Young Cho, Pyung Bok Lee, Ho-Suk Oh, MinYoung Lee, Jin Seok Ahn; Cancer Res Treat. 2025;57(4):1231-1239. Published online December 26, 2024; DOI: https://doi.org/10.4143/crt.2024.557

Abstract PDF PubReader ePub: Purpose
Fentanyl, a highly lipophilic opioid, was developed as a sublingual fentanyl tablet (SFT) for the management of breakthrough cancer pain (BTcP), and its efficacy and safety were confirmed in a randomized, controlled study. We investigated the effectiveness and safety of SFT administered to alleviate BTcP in a real-world setting.
Materials and Methods
In this prospective, open, single-cohort study, conducted in 13 referral hospitals in South Korea, opioid-tolerant cancer patients receiving around-the-clock opioids for persistent cancer pain were enrolled if the individual had BTcP ≥ 1 episode/day during the preceding week. The primary outcome was the SFT titration success rate.
Results
Among 113 patients evaluated for effectiveness, 103 patients (91.2%) had a successful titration of SFT, with an effective dose range between 100 μg and 400 μg. The most frequent dose was 100 μg, administered to 65.0%, 72.1%, and 81.8% of the patients at week 1, 4, and 12, respectively. The proportion of patients achieving the personalized pain goal assessed in the first week was 75.2%. The mean change in pain intensity measured with a numeric rating scale at 30 and 60 minutes after taking SFT was –2.57 and –3.62, respectively (p < 0.001 for both). The incidence rate of adverse events related to SFT among 133 patients included for safety evaluation was 9.0% (12/133), which included vomiting (3.0%), nausea (2.3%), and headache (1.5%).
Conclusion
In a real-world setting, SFT provides rapid and effective analgesia in BTcP, even at the lowest dose (100 μg), and the safety profile was acceptable.

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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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General

Associations of Financial Toxicity with Employment Concerns and Cancer-Related Distress: A Cross-Sectional Survey among Korean Working-Age Cancer Survivors: Hyun-Ju Seo, Dal-Lae Jin, Young Ae Kim, Su Jung Lee, Seok-Jun Yoon; Cancer Res Treat. 2025;57(3):659-668. Published online December 3, 2024; DOI: https://doi.org/10.4143/crt.2024.090

Abstract PDF Supplementary Material PubReader ePub

Purpose
Although South Korea’s health insurance has a co-payment-decreasing policy for cancer survivors, information on the extent of financial toxicity and its related factors is limited. We assessed the level of financial toxicity and the association of high levels of financial toxicity with employment concerns after diagnosis and cancer-related distress in working-age cancer survivors.
Materials and Methods
A cross-sectional study was conducted. Study participants were recruited from the National Cancer Survivorship Center between November and December 2022. Financial burden was assessed using the Korean version of the Comprehensive Score for Financial Toxicity, and cancer-related distress was measured using the National Comprehensive Cancer Network Distress Thermometer. Multivariate logistic regression analyses were used to explore the associations between high financial toxicity, cancer-related distress, and changes in employment status after cancer diagnosis.
Results
Of 1,403 working-age cancer survivors, approximately 62% reported high levels of financial distress. Survivors reporting early retirement and taking time off work with the intent to return were more likely to report high financial toxicity (adjusted odds ratio [OR], 1.69; 95% confidence interval [CI], 1.14 to 2.5; and adjusted OR, 2.82; 95% CI, 1.24 to 6.43, respectively) than those with a full-time or part-time job. Moreover, cancer survivors with high distress levels were more likely to report high financial toxicity than those with low distress levels (adjusted OR, 4.36; 95% CI, 3.17 to 5.99).
Conclusion
High financial toxicity is associated with adverse employment concerns and cancer-related distress among working-age cancer survivors. Therefore, developing cancer survivorship interventions within the healthcare system is necessary to ensure improvements in financial well-being.

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Chronic Disease and Future Perceptions of Financial Control
Victoria H. Davis, Guanghao Zhang, Minal R. Patel
Medical Care.2025; 63(5): 353. 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
Cancer survivorship in the Western Pacific: from differences to shared-goals and from challenges to opportunities
Raymond Javan Chan, Reegan Knowles, Carolyn Taylor, Nirmala Bhoo Pathy, Ke Yu, Karolina Lisy, Julia Lai-Kwon, Miyako Tsuchiya, Yan Lou, Wendy Lam, Michael Jefford
The Lancet Regional Health - Western Pacific.2025; 65: 101749. CrossRef
Direct and Indirect Costs of Cancer in Adult Population of Poland in the Period 2021–2023
Izabela Gąska, Aleksandra Czerw, Monika Pajewska, Olga Partyka, Dorota Charkiewicz, Andrzej Deptała, Anna Badowska-Kozakiewicz, Katarzyna Sygit, Ireneusz Dziubek, Paulina Wojtyła-Buciora, Jarosław Drobnik, Piotr Pobrotyn, Dorota Waśko-Czopnik, Tomasz Sowi
Cancers.2025; 17(23): 3725. CrossRef

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Breast cancer

Machine Learning–Based Prognostic Gene Signature for Early Triple-Negative Breast Cancer: Ju Won Kim, Jonghyun Lee, Sung Hak Lee, Sangjeong Ahn, Kyong Hwa Park; Cancer Res Treat. 2025;57(3):731-740. Published online November 19, 2024; DOI: https://doi.org/10.4143/crt.2024.937

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to develop a machine learning–based approach to identify prognostic gene signatures for early-stage triple-negative breast cancer (TNBC) using next-generation sequencing data from Asian populations.
Materials and Methods
We utilized next-generation sequencing data to analyze gene expression profiles and identify potential biomarkers. Our methodology involved integrating various machine learning techniques, including feature selection and model optimization. We employed logistic regression, Kaplan-Meier survival analysis, and receiver operating characteristic (ROC) curves to validate the identified gene signatures.
Results
We identified a gene signature significantly associated with relapse in TNBC patients. The predictive model demonstrated robustness and accuracy, with an area under the ROC curve of 0.9087, sensitivity of 0.8750, and specificity of 0.9231. The Kaplan-Meier survival analysis revealed a strong association between the gene signature and patient relapse, further validated by logistic regression analysis.
Conclusion
This study presents a novel machine learning-based prognostic tool for TNBC, offering significant implications for early detection and personalized treatment. The identified gene signature provides a promising approach for improving the management of TNBC, contributing to the advancement of precision oncology.

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Gastrointestinal cancer

Effectiveness and Safety of Regorafenib and TAS-102 in Patients with Metastatic Colorectal Cancer: A Nationwide Population-Based Study in Taiwan: Ya-Wen Chang, Chun-Nan Kuo, Chia-Lun Chang, Jason C. Hsu, Yu Ko; Cancer Res Treat. 2025;57(3):830-839. Published online November 18, 2024; DOI: https://doi.org/10.4143/crt.2024.376

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to examine the real-world effectiveness and safety of regorafenib and trifluridine/tipiracil (TAS-102) in metastatic colorectal cancer (mCRC) patients in Taiwan.
Materials and Methods
Data were extracted from Taiwan’s National Health Insurance Research Database to evaluate the clinical outcomes of mCRC patients treated with either regorafenib or TAS-102 between 2016 and 2019. Overall survival (OS) was compared using Kaplan-Meier curves and Cox’s proportional hazard models, adjusting for age, sex, Quan-CCI score, liver metastases, number of metastatic sites, and the use of anti–epidermal growth factor receptor medications. Additionally, OS was compared between regorafenib monotherapy and TAS-102 monotherapy, excluding patients who had received both regorafenib and TAS-102.
Results
A total of 2,608 patients in the regorafenib group and 521 patients in the TAS-102 group were identified. The median OS was 6.5 months for regorafenib and 7.5 months for TAS-102, with a significant difference observed (p=0.001). The mean duration of treatment was similar for regorafenib and TAS-102 (108 days vs. 101 days) with no significant difference. The safety profiles of the two drugs were distinct; a higher proportion of patients in the regorafenib group had hypertension and hand-foot skin reaction while nausea and vomiting were more common in the TAS-102 group. In the subgroup analysis, patients receiving TAS-102 monotherapy showed significantly longer OS than those receiving regorafenib monotherapy.
Conclusion
The findings of this study indicated that TAS-102 had superior survival outcomes compared to regorafenib in mCRC patients. This study provides insights into the effectiveness and safety profiles of regorafenib and TAS-102 in Taiwan.

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Predictive Value of the nProfiler 1 Assay for the Efficacy of Adjuvant S-1–Based Doublet Chemotherapy in Stage III Gastric Cancer: A Post-Hoc Analysis of a Randomized Phase III Trial: Dong Ki Lee, Choong-kun Lee, Hyo Song Kim, Sun Jin Sym, Dae Young Zang, Ki Hyang Kim, Joo Han Lim, Hae Su Kim, Kyung Hee Lee, Heon Yung Gee, Sun Young Rha, Hyunki Kim, Minkyu Jung; Cancer Res Treat. 2025;57(3):770-780. Published online November 12, 2024; DOI: https://doi.org/10.4143/crt.2024.705

Abstract PDF Supplementary Material PubReader ePub: Purpose
The nProfiler 1 Stomach Cancer Assay (nProfiler1), designed to predict responses to fluorouracil-based adjuvant chemotherapy, measures the expression of four gastric cancer target genes (GZMB, WARS, SFRP4, and CDX1). The randomized phase III POST trial aimed to compare the efficacies of two adjuvant S-1-based doublet chemotherapies: S-1 plus cisplatin (SP) and S-1 plus docetaxel (DS). This study aimed to validate the nProfiler1 assay using a distinct cohort from the POST trial.
Materials and Methods
The nProfiler1 assay stratifies patients into three groups (low-risk, intermediate-risk, and high-risk) using the prognostic single-patient classifier and two groups (chemotherapy-benefit and no-benefit) using the predictive single-patient classifier. The nProfiler1 assay was applied to formalin-fixed paraffin-embedded slides obtained from the POST trial. Disease-free survival (DFS) and overall survival (OS), including 5-year survival rates, were calculated for the enrolled patients.
Results
Of the 153 patients in the POST trial, 118 were included in the post-hoc analysis. With a median follow-up of 57.9 months, no significant difference in DFS or OS was observed between the SP and DS groups. The prognostic single-patient classifier predicted the OS in the SP group (p=0.043) but not in the DS group (p=0.594). The chemotherapy-benefit group exhibited numerically longer DFS than the no-benefit group in the SP and DS groups.
Conclusion
The nProfiler1 assay offers valuable insights into the prognosis and efficacy of adjuvant chemotherapy based on fluorouracil plus platinum doublet regimens but not docetaxel-containing regimens. Further validation with larger patient cohorts and different regimens is warranted.

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General

Weight Change after Cancer Diagnosis and Risk of Diabetes Mellitus: A Population-Based Nationwide Study: Hye Yeon Koo, Kyungdo Han, Mi Hee Cho, Wonyoung Jung, Jinhyung Jung, In Young Cho, Dong Wook Shin; Cancer Res Treat. 2025;57(2):339-349. Published online August 29, 2024; DOI: https://doi.org/10.4143/crt.2024.586

Abstract PDF Supplementary Material PubReader ePub

Purpose
Cancer survivors are at increased risk of diabetes mellitus (DM). Additionally, the prevalence of obesity, which is also a risk factor for DM, is increasing in cancer survivors. We investigated the associations between weight change after cancer diagnosis and DM risk.
Materials and Methods
This retrospective cohort study used data from the Korean National Health Insurance Service. Participants who were newly diagnosed with cancer from 2010 to 2016 and received national health screening before and after diagnosis were included and followed until 2019. Weight change status after cancer diagnosis was categorized into four groups: sustained normal weight, obese to normal weight, normal weight to obese, or sustained obese. Cox proportional hazard analyses were performed to examine associations between weight change and DM.
Results
The study population comprised 264,250 cancer survivors. DM risk was highest in sustained obese (adjusted hazard ratios [aHR], 2.17; 95% confidence interval [CI], 2.08 to 2.26), followed by normal weight to obese (aHR, 1.66; 95% CI, 1.54 to 1.79), obese to normal weight (aHR, 1.29; 95% CI, 1.21 to 1.39), and then sustained normal weight group (reference). In subgroup analyses according to cancer type, most cancers showed the highest risks in sustained obese group.
Conclusion
Obesity at any time point was related to increased DM risk, presenting the highest risk in cancer survivors with sustained obesity. Survivors who changed from obese to normal weight had lower risk than survivors with sustained obesity. Survivors who changed from normal weight to obese showed increased risk compared to those who sustained normal weight. Our finding supports the significance of weight management among cancer survivors.

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Effects of smoking behavior change on diabetes incidence after cancer development: A nationwide cohort study
MI Hee Cho, Jinhyung Jung, Hye Yeon Koo, Wonyoung Jung, Kyungdo Han, In Young Cho, Dong Wook Shin
Diabetes & Metabolism.2025; 51(1): 101604. CrossRef
New‐onset prediabetes/diabetes worsens overall survival in patients with cancer: A real‐world retrospective cohort study
Maci Winn, Svenja Pauleck, Stephanie Richardson, Richard Viskochil, Prasoona Karra, Howard Colman, Jennifer A. Doherty, Yizhe Xu, Siwen Hu‐Lieskovan, Michelle Litchman, Mary C. Playdon, Sheetal Hardikar
Diabetes, Obesity and Metabolism.2025;[Epub] CrossRef

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2 Crossref

Breast cancer

Harnessing Institutionally Developed Clinical Targeted Sequencing to Improve Patient Survival in Breast Cancer: A Seven-Year Experience: Jiwon Koh, Jinyong Kim, Go-Un Woo, Hanbaek Yi, So Yean Kwon, Jeongmin Seo, Jeong Mo Bae, Jung Ho Kim, Jae Kyung Won, Han Suk Ryu, Yoon Kyung Jeon, Dae-Won Lee, Miso Kim, Tae-Yong Kim, Kyung-Hun Lee, Tae-You Kim, Jee-Soo Lee, Moon-Woo Seong, Sheehyun Kim, Sungyoung Lee, Hongseok Yun, Myung Geun Song, Jaeyong Choi, Jong-Il Kim, Seock-Ah Im; Cancer Res Treat. 2025;57(2):443-456. Published online August 21, 2024; DOI: https://doi.org/10.4143/crt.2024.296

Abstract PDF Supplementary Material PubReader ePub

Purpose
Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world.
Materials and Methods
We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis.
Results
NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs.
Conclusion
Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

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Genomic and transcriptomic analyses of residual invasive triple-negative breast cancer after neoadjuvant chemotherapy in the prospective MIRINAE trial (a randomized phase II trial of adjuvant atezolizumab plus capecitabine compared to capecitabine; KCSG-B
S.-A. Im, K. Park, J. Koh, C. Park, K.H. Jung, J. Lee, H.K. Ahn, A. Lee, S.H. Sim, M.H. Kim, J.H. Kim, J.H. Kim, K.E. Lee, K.H. Park, J. Bae, M.H. Lee, S. Lim, H.J. Kim, D.-W. Lee, J.H. Jeong, K.S. Lee, J. Sohn, K.J. Suh, J.-Y. Kim, Y.J. Cha, J. Moon, C.-
ESMO Open.2025; 10(10): 105804. CrossRef

3,240 View
210 Download
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Combination Therapy of Pyrotinib and Metronomic Vinorelbine in HER2+ Advanced Breast Cancer after Trastuzumab Failure (PROVE): A Prospective Phase 2 Study: Chunfang Hao, Xu Wang, Yehui Shi, Zhongsheng Tong, Shufen Li, Xiaodong Liu, Lan Zhang, Jie Zhang, Wenjing Meng, Li Zhang; Cancer Res Treat. 2025;57(2):434-442. Published online August 9, 2024; DOI: https://doi.org/10.4143/crt.2024.340

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Purpose
Approximately 50%-74% of patients with metastatic human epidermal growth factor receptor 2 (HER2)–positive breast cancer do not respond to trastuzumab, with 75% of treated patients experiencing disease progression within a year. The combination of pyrotinib and capecitabine has showed efficacy in these patients. This study evaluates the efficacy and safety of pyrotinib combined with metronomic vinorelbine for trastuzumab-pretreated HER2-positive advanced breast cancer patients.
Materials and Methods
In this phase 2 trial, patients aged 18-75 years with HER2-positive advanced breast cancer who had previously failed trastuzumab treatment were enrolled to receive pyrotinib 400 mg daily in combination with vinorelbine 40mg thrice weekly. The primary endpoint was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety.
Results
From October 21, 2019, to January 21, 2022, 36 patients were enrolled and received at least one dose of study treatment. At the cutoff date, 20 experienced disease progression or death. With a median follow-up duration of 35 months, the median PFS was 13.5 months (95% confidence interval [CI], 8.3 to 18.5). With all patients evaluated, an ORR of 38.9% (95% CI, 23.1 to 56.5) and a DCR of 83.3% (95% CI, 67.2 to 93.6) were achieved. The median OS was not reached. Grade 3 adverse events (AEs) were observed in 17 patients, with diarrhea being the most common (27.8%), followed by vomiting (8.3%) and stomachache (5.6%). There were no grade 4/5 AEs.
Conclusion
Pyrotinib combined with metronomic vinorelbine showed promising efficacy and an acceptable safety profile in HER2-positive advanced breast cancer patients after trastuzumab failure.

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Adjuvant Metronomic Chemotherapy After Surgery in pT1-T2 N0 M0 HER2-Positive and ER/PR-Positive Breast Cancer Plus Targeted Therapy, Anti-Hormonal Therapy, and Radiotherapy, with or Without Immunotherapy: A New Operational Proposal
Luca Roncati
Cancers.2025; 17(8): 1323. CrossRef

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Gastrointestinal cancer

Integrating Deep Learning–Based Dose Distribution Prediction with Bayesian Networks for Decision Support in Radiotherapy for Upper Gastrointestinal Cancer: Dong-Yun Kim, Bum-Sup Jang, Eunji Kim, Eui Kyu Chie; Cancer Res Treat. 2025;57(1):186-197. Published online August 2, 2024; DOI: https://doi.org/10.4143/crt.2024.333

Abstract PDF Supplementary Material PubReader ePub

Purpose
Selecting the better techniques to harbor optimal motion management, either a stereotactic linear accelerator delivery using TrueBeam (TBX) or magnetic resonance–guided gated delivery using MRIdian (MRG), is time-consuming and costly. To address this challenge, we aimed to develop a decision-supporting algorithm based on a combination of deep learning-generated dose distributions and clinical data.
Materials and Methods
We retrospectively analyzed 65 patients with liver or pancreatic cancer who underwent both TBX and MRG simulations and planning process. We trained three-dimensional U-Net deep learning models to predict dose distributions and generated dose volume histograms (DVHs) for each system. We integrated predicted DVH metrics into a Bayesian network (BN) model incorporating clinical data.
Results
The MRG prediction model outperformed the TBX model, demonstrating statistically significant superiorities in predicting normalized dose to the planning target volume (PTV) and liver. We developed a final BN prediction model integrating the predictive DVH metrics with patient factors like age, PTV size, and tumor location. This BN model an area under the receiver operating characteristic curve index of 83.56%. The decision tree derived from the BN model showed that the tumor location (abutting vs. apart of PTV to hollow viscus organs) was the most important factor to determine TBX or MRG. It provided a potential framework for selecting the optimal radiation therapy (RT) system based on individual patient characteristics.
Conclusion
We demonstrated a decision-supporting algorithm for selecting optimal RT plans in upper gastrointestinal cancers, incorporating both deep learning-based dose prediction and BN-based treatment selection. This approach might streamline the decision-making process, saving resources and improving treatment outcomes for patients undergoing RT.

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Comprehensive review of Bayesian network applications in gastrointestinal cancers
Min-Na Zhang, Meng-Ju Xue, Bao-Zhen Zhou, Jing Xu, Hong-Kai Sun, Ji-Han Wang, Yang-Yang Wang
World Journal of Clinical Oncology.2025;[Epub] CrossRef

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