Background: Hepatocellular carcinoma (HCC) is one of the deadliest cancer over the world. In this study, we aimed to determine the most critical molecular event in HCC patients with tumor protein p53 (TP53) or catenin beta 1 (CTNNB1) mutations, and to explore how these two mutations differ in their impact on HCC prognostication.

Methods: We performed an integrated comparative analysis of exome and transcriptome data from The Cancer Genome Atlas (TCGA) for HCC patients. Patient prognosis and correlation with the immune infiltration characteristics were performed. HCC cell line based in vitro experiments were also performed to validate the mechanistic insights.

Results: The 3-year progression-free survival (PFS) analysis of HCC patients with TP53 mutations indicated a significantly poorer clinical outcome compared to those with CTNNB1 mutations. Functional annotation of the TP53 mutant cohort revealed a substantial upregulation of genes associated with immune regulation, while the CTNNB1 mutant cohort displayed a prominent activation of metabolic pathways. Further comparative analysis and in vitro experiments showed that TP53 missense mutations activated the signal transducer and activator of transcription 3 (STAT3) signaling pathway, which fostered neutrophil infiltration and enhanced the enrichment of regulatory T (Treg) cells by secreting specific inflammatory molecules in the tumor microenvironment. Notably, treatment with a an STAT3 inhibitor suppressed the expression of these inflammatory molecules, underscoring how an immunosuppressive tumor microenvironment in the TP53 mutant cohort contributes to a poor prognosis.

Conclusion: Our study provides valuable insights, revealing that HCC patients with TP53 missense mutations exhibit a distinct immune profile associated with poorer clinical outcome compared to those with CTNNB1 mutations.

Objective: There is a paucity of real-world evidence in the Indian context to address the outcome of primary brain tumors (PBTs) in children. This study aimed to describe the demographic profile, clinical characteristics, and histological features of PBTs based on the 2016 World Health Organization classification, assess the efficacy of treatment methods, and identify the factors that influence the outcome.

Methodology: This is a single-institution, hospital-based study. Data were collected for pediatric patients aged 0-19 years, from September 2001 to May 2023 (22 years), who were diagnosed with malignant PBTs. Patients with radiologically or histologically proven tumors were included. Those with metastatic disease to the central nervous system were excluded. The overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method.

Results: A total of 251 patients with pediatric brain tumors were included in this analysis. The mean age was 9.10 ± 5.54 years. The male-to-female ratio was 1.20:1. In this cohort, the most common histologies were medulloblastoma and astrocytoma. The mean survival of all patients with PBTs was 141.00 ± 7.90 months with 1-, 3-, and 8-year OS rates of 79.00%, 67.00%, and 60.00%, respectively. Medulloblastoma had 1-, 3-, and 8-year OS rates of 81.00%, 72.00%, and 65.00%, respectively. The 1-year OS rates for glioblastoma and brainstem glioma were 46.00% and 45.00%, respectively. Complete tumoral resection showed longer survival than lesser degrees of resection (p = 0.001). Embryonal tumors (ETs) had a better RFS of 133.60 ± 12.70 months (p ≤ 0.001).

Conclusion: ETs have a better prognosis than glial tumors. With an improved OS, the surgical resection extent has a favorable outcome. As a chemosensitive tumor, medulloblastoma benefits most from systemic treatment and responds well to a multimodal approach.

Objective: This study aimed to evaluate the effects of Xiaoyao San combined with Bazhen Decoction on insomnia in patients following breast cancer surgery.

Methods: A total of 86 patients experiencing insomnia after breast cancer surgery were randomly assigned to either the treatment group or the control group. The treatment group received Xiaoyao San combined with Bazhen Decoction, while the control group was treated with estazolam tablets. The treatment duration was 4 weeks. Pittsburgh Sleep Quality Index (PSQI) scores were assessed before and after treatment. The overall efficacy and incidence of adverse reactions were compared between the two groups.

Results: PSQI scores in both groups significantly decreased after treatment (p < 0.05). Total effective rate in the treatment group (93.02%) was higher than that in the control group (86.05%), although the difference was not statistically significant (p > 0.05). The incidence of adverse reactions in the treatment group (4.65%) was significantly lower than that in the control group (20.93%) (p < 0.05).

Conclusion: Xiaoyao San combined with Bazhen Decoction can effectively improve sleep quality in patients with insomnia following breast cancer surgery, demonstrating good clinical efficacy and fewer adverse reactions. Further studies are needed to confirm these findings and explore broader clinical applications.

Background: Primary mediastinal synovial sarcoma (PMSS) is an uncommon and aggressive soft tissue tumor, particularly rare in infants. Its diagnosis is challenging due to overlapping features with other thoracic neoplasms and requires integration of histopathology, immunohistochemistry, and molecular genetics.

Case presentation: We present a case of a 4-month-old girl admitted with respiratory distress and found to have a large posterior mediastinal mass. Histopathology and immunohistochemistry were compatible with biphasic synovial sarcoma. However, molecular confirmation via detection of SS18-SSX fusion was not performed. Despite multimodal chemotherapy, the tumor progressed, and complete surgical resection was unachievable. The patient died during follow-up in the pediatric intensive care unit.

Conclusion: Accurate diagnosis is critically dependent on SS18-SSX molecular testing, particularly in infants. Incomplete resection and lack of genetic confirmation may contribute to poor prognosis. Literature supports that complete resection is the only consistent predictor of survival. This case illustrates the limitations and consequences of managing PMSS without molecular confirmation or complete resection. A multidisciplinary approach with current diagnostic standards is essential in these high-risk pediatric tumors.

Backgound: The combination of osimertinib and savolitinib as second-line treatment after epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance can significantly improve median progression-free survival (mPFS), objective response rate (ORR), and duration of remission (DOR). The combination therapy is safe and controllable, with no new safety signals or unexpected toxicity. However, the mechanism of drug resistance for tumor progression after dual-targeted therapy is currently unclear, and there is no clinical data reference for treatment after drug resistance. This case suggests some treatment options for lung adenocarcinoma patient after dual-targeted therapy with osimertinib and savolitinib.

Case presentation: A patient with EGFR-mutated lung adenocarcinoma developed mesenchymal-epithelial transition factor (MET) amplification-related resistance after first-line almonertinib. Subsequent sequential regimens—osimertinib plus savolitinib, chemo-immuno-antiangiogenesis therapy, and finally furmonertinib plus capmatini—each yielded transient benefit.

Results: The report shows that the combination of chemotherapy and immunotherapy, as well as the dual-targeted therapy of firmonertinib and capmatinib, prolonged the overall survival of the patient.

Conclusions: This case suggests some treatment options for lung adenocarcinoma patient after dual-targeted therapy with osimertinib and savolitinib. The results indicated that traditional treatment or the combination of MET-TKI with another targeted therapy may improve the prognosis of patients.

Objective: The purpose of this study was to assess clinical characteristics and survival of patients with advanced pancreatic cancer who were treated with gemcitabine, cisplatin, and 21-h infusional 5-fluorouracil (5-FU).

Methods: This study was a prospective, observational study at a medical center in Western Iran. The clinical and survival data from 25 patients treated with gemcitabine, cisplatin, and 21-h infusional 5-FU at our center were prospectively assessed. Patients received chemotherapy consisting of cycles of continuous infusion of 5-FU (650 mg/m²) for 21 h on Days 1, 2, 3, and 4. Gemcitabine was administered at a dose of 1 g/m² on Days 1 and 8, and cisplatin was administered at a dose of 60 mg/m² on Day 1, with granulocyte colony-stimulating factor (G-CSF) support. Each cycle was repeated every 21 days for 5-6 cycles.

Results: A total of 25 patients with an age range of 39-73 years were studied. One out of the two patients with stage Ⅱ cancer survived for more than 43 months. Four out of the 14 patients with stage Ⅱ cancer survived for more than 15 months. Seventeen patients died, and eight subjects were alive at the end of the study. The mean and median of overall survival (OS) rates for the 25 patients were 20 and 12 months, respectively. The median progression-free survival (PFS) was 6 months.

Conclusion: It seems that the triple therapy with gemcitabine, cisplatin, and infusional 5-FU afforded significant PFS and OS benefits in patients with advanced pancreatic cancer.

Background: Tumor cavitation and pneumothorax are uncommon yet serious complications of antiangiogenic therapies. These risks are particularly significant in patients with metastatic renal cell carcinoma (mRCC). Axitinib, a selective inhibitor of vascular endothelial growth factor receptors (VEGFRs), is generally used as a second-line treatment for mRCC. However, rare cases of lung metastases with cavitary lesions and pneumothorax have been reported after the use of axitinib. Therefore, we decided to report one of these rare cases.

Case presentation: A 46-year-old male with mRCC developed pleural cavitations and secondary pneumothorax after starting axitinib therapy. Despite intensive management, his condition worsened with recurrent pneumothorax, ultimately leading to sepsis and multiorgan failure.

Conclusion: This case underscores the potential risks of tumor cavitation-induced pneumothorax in patients receiving axitinib. Close radiological monitoring and timely intervention are essential for reducing morbidity and mortality in such cases. Clinicians should remain vigilant for this rare but serious complication during axitinib therapy.