最新刊期
卷 35 ， 期 3 ， 2025
- 摘要：Breast cancer is one of the common malignant tumors among women worldwide, and with advances in screening and diagnostic technology, more and more breast cancer patients are being diagnosed at an early stage. Adjuvant treatment options for different types of early-stage breast cancer vary. In recent years, the development of treatment strategies has focused on maximizing the efficacy of treatment while avoiding over-treatment based on the patient’s individual risk profile. For hormone receptor (HR)-positive breast cancer, the introduction of cell cyclin-dependent kinase (CDK)4/6 inhibitors has significantly improved the prognosis of intermediate- and high-risk patients. Meanwhile, chemotherapy de-escalation strategies based on genetic testing are also advancing. However, controversies remain regarding which patients can benefit from CDK4/6 inhibitor-enhanced therapy and whether premenopausal patients with intermediate-risk classification from multi-gene assays can gain benefits from chemotherapy. In human epidermal growth factor receptor 2 (HR)-positive breast cancer, anti-HER2 targeted therapies and novel antibody-drug conjugate provide more effective treatment options. However, how to screen the optimal population for dual-targeted therapy is still under exploration, and currently there is no consensus on how to select subsequent intensified regimens for patients who fail to achieve pathological complete response after neoadjuvant therapy. For triple-negative breast cancer, while traditional adjuvant therapy has been continuously optimized, the application of immunotherapy in the neoadjuvant and adjuvant phases has also made significant progress. Nevertheless, the definition of the optimal population to benefit from immunotherapy and the optimization strategy of immunotherapy are still key areas of ongoing research. This review summarized the advancements and controversies in adjuvant therapy for early breast cancer, aiming to provide references for current clinical practice and insights for future research directions.关键词：Early breast cancer;Adjuvant treatment;Clinical research;Research progress27|1992|0更新时间：2025-12-31
- 摘要：Breast cancer remains the most prevalent malignancy in women, with a 5-year survival rate less than 20% in advanced stages. The deepening understanding of breast cancer pathogenesis and the emergence of novel therapeutic agents/regimens have progressively extended survival outcomes for advanced breast cancer patients. While therapeutic advancements have driven the formation of treatment consensus, new controversies continue to emerge. This article systematically reviews current consensus and controversies in managing different molecular subtypes of breast cancer based on pivotal 2024 clinical evidence, aiming to provide evidence-based guidance for clinical practice. For first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer, the CLEOPATRA trial established the trastuzumab-pertuzumab-taxane regimen as standard care. However, the PHILA study proposed a new alternative combining trastuzumab, pyrotinib, and taxanes. Subgroup analyses from both trials provide valuable references for differentiated clinical decision-making. In triple-negative breast cancer (TNBC) management, KEYNOTE-355 and TORCHLIGHT trials established chemotherapy combined with programmed death-1 (PD-1) inhibitors as standard therapy for programmed death ligand-1 (PD-L1)-positive patients. Nevertheless, controversies persist regarding patient selection criteria, PD-L1 positivity thresholds, and optimal immunotherapy agents. Early-phase studies of antibody-drug conjugate (ADC)/PD-L1 inhibitor combinations demonstrated unprecedented progression-free survival (PFS) exceeding 12 months in the first-line TNBC treatment, independent of PD-L1 expression, potentially representing the future frontline regimen. For hormone receptor-positive/HER2-negative advanced breast cancer, cyclin-dependent kinase (CDK) 4/6 inhibitor-endocrine therapy combinations remain guideline-endorsed first-line treatment. The SONIA trial challenged conventional paradigms by demonstrating that not all patients required upfront CDK4/6 inhibitors. It also highlighted critical unresolved issues: no standard recommendations exist for post-CDK4/6 inhibitor therapy, though current evidence supports prioritizing targeted therapies for mutation-positive cases or ADC/endocrine therapies for mutation-negative scenarios. Brain metastasis management presents ongoing challenges. Emerging anti-HER2 agents, including tyrosine kinase inhibitor (TKI) and ADC with demonstrated intracranial efficacy, necessitate further investigation into optimal integration strategies with local therapies. ADC dominate therapeutic innovation, with current research prioritizing optimal sequencing strategies amidst expanding ADC options. Future directions should focus on novel drug development, multimodal treatment integration, and personalized precision therapies to prolong patient survival.关键词：Advanced breast cancer;Consensus;Controversies18|2967|0更新时间：2025-12-31
- 摘要：Cyclin-dependent kinase (CDK)4/6 inhibitors plus endocrine therapy represents the standard first-line treatment for patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer. The introduction of CDK4/6 inhibitors has significantly improved the prognosis of breast cancer patients. However, it has also brought new clinical challenges, such as disease progression and treatment resistance in many patients. Currently, there is a lack of standardized subsequent treatment options for patients whose disease progresses after CDK4/6 inhibitor combined with endocrine therapy. Endocrine therapy resistance can lead to tumor progression through estrogen receptor (ESR)-dependent or ESR-independent pathways. Novel endocrine agents have the potential to benefit breast cancer patients harboring ESR1 mutations. Patients with alterations in the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway may be particularly sensitive to targeted inhibitors of this pathway. Furthermore, newly approved or investigational antibody-drug conjugate (ADC), immunotherapy-based combinations, and novel cell cycle inhibitors have demonstrated promising anti-tumor activities. Precision medicine-based combination strategies not only expand clinical treatment options but also enable physicians to make personalized treatment decisions for patients. Biomarker-driven precision therapeutic strategies have emerged as a critical area of treatment development in the post-CDK4/6 inhibitor era.关键词：Hormone receptor-positive advanced breast cancer;Cyclin-dependent kinase 4 and 6 inhibitor;Precision medicine;Endocrine therapy;Targeted therapy;Antibody-drug conjugate12|2155|0更新时间：2025-12-31
- 摘要：The development of breast pathology technology provides basic support for precise typing and individualized treatment of breast cancer. Precision in breast cancer diagnosis and management is evolving as a fundamental trend, with the advent of novel therapeutic agents necessitating enhanced accuracy in pathological diagnostic evaluations. The application of trastuzumab deruxtecan (T-DXd) has offered new therapies for breast cancer patients with human epidermal growth factor receptor 2 (HER2)-low and HER2-ultra low status. With the refinement of the classification for HER2 expression status, as a traditional detection method, the efficacy of immunohistochemistry (IHC) has been challenged. In addition, HER2-low has poor interpretation consistency, with spatial and temporal heterogeneity, which is affected by the storage time of the blank slides. Nowadays, finding auxiliary methods that can effectively improve the testing efficiency and interpretation accuracy of IHC as well as new accessible HER2 detection methods are important exploration directions. Whether HER2-low can be considered an independent molecular type of breast cancer has become an important issue with the update of treatments and the progress of new drugs. However, the answer is no at this time due to the absence of distinct and stable biological and pathological features and the lack of specific therapeutic benefit and prognostic relevance. With the widespread adoption and advancement of genomic profiling technologies, multiple causative genetic mutations associated with breast cancer have been identified. The development and clinical application of targeted drugs have elevated genomic profiling to an increasingly pivotal role in clinical decision-making for breast cancer treatment. In recent years, multiple inhibitors targeting the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway (PAM pathway) have demonstrated promising therapeutic efficacy in hormone receptor (HR) positive/HER2-negative breast cancer. The clinical prioritization of PIK3CA/AKT1/PTEN molecular profiling has been intensified, and the trend is to move forward the time of the initial test. Tumor tissue samples are preferred for testing, and plasma samples can be used as a necessary supplement. Samples from primary or recurrent tumors are considered to have similar testing efficacy and can be selected as appropriate. BRCA mutation is one of the common types of genetic mutations in breast cancer. While current guidelines vary in specifics regarding target populations, they universally prioritize clinical parameters including diagnostic age, family history, and treatment response to identify patients who have elevated BRCA mutation risks and may benefit from poly (ADP-ribose) polymerase (PARP) inhibitor therapy. This article summarized the latest advances and controversies in breast pathology techniques, focusing on the diagnostic criteria and methodological limitations in detecting HER2-low and HER2-ultra low breast cancers, therapeutic progress in PAM pathway-aberrant breast cancer, and the target population for detecting BRCA gene mutations.关键词：Breast;Pathology;New techniques;Human epidermal growth factor receptor 2-low;Phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway;BRCA7|1669|0更新时间：2025-12-31
Specialist's Commentary
- 摘要：Background and purpose: The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer statistics in Shanghai. Breast cancer is one of the common malignant tumors among women. In recent years, the incidence of female breast cancer was increasing, while its trend of mortality showed declining. This study aimed to investigate the survival rates of new female breast cancer cases in Shanghai from 2002 to 2017. Methods: Data of new cases and deaths of female breast cancer patients with follow-up information from 2002 to 2017 were obtained from the Population-based Cancer Registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. Numbers, proportions, and survival rates were stratified by year of diagnosis, age, histological type and stage at diagnosis for analysis. The 5-year observed survival rates were calculated based on the life table method. The probabilities of surviving from 0 to 99 years were estimated with the Elandt-Johnson model, and then cumulative expected survival rates were calculated using the Ederer Ⅱ method. Finally, the 5-year relative survival rates were calculated. The annual percent change (APC) of survival rates was estimated by Joinpoint Regression Program. Results: A total of 73 600 new female breast cancer cases were diagnosed from 2002 to 2017 in Shanghai. Among them, 67 681 cases were morphological verification, accounting for 91.96%. By December 31, 2022, 23 745 (32.26%) cases had died, and 19 466 (26.45%) cases had died of cancer. A total of 68 332 (92.84%) cases, who were either dead or followed for over 5 years, were considered to have complete follow-up. The remaining 5 268 (7.16%) cases were lost to follow-up. 73 538 (99.92%) cases were included in the observed cohort for survival analysis. The number of observed cases nearly doubled from 3330 in 2002 to 6095 in 2017. The 5-year observed survival rate changed from 78.77% in 2002 to 84.55% in 2017 dynamically, showed a low increasing trend with an average rate of 0.50% per year (APC=0.50%, t=8.75, P<0.001). The 5-year relative survival rate also increased from 83.46% to 89.24% slowly, with an average rate of 0.47% (APC=0.47%, t=9.80, P<0.001). The overall 5-year observation survival rate of female cancer was 83.24% (82.96%-83.52%), and the 5-year relative survival rate was 87.58% (87.29%-87.87%) in Shanghai from 2002 to 2017. It was increasing over time, decreasing with aging and advanced stage at diagnosis continuously. There was no significant difference in the 5-year relative survival rates between the groups aged 15 to 64 (P>0.05). The group with an unknown stage had the highest number of cases, followed by the stage Ⅱ group, and then the stage Ⅰ group. The 5-year relative survival rate of cases with stage Ⅰ disease reached 99.10% (98.78%-99.42%), but these cases only accounted for 25.51% of the total. The 5-year relative survival rate of cases with stage Ⅳ disease was 52.54% (50.98%-54.11%), and these cases accounted for 6.13% of the total. The 5-year relative survival rate of cases with s unknown stage was 82.04% (81.42%-82.65%), and these cases accounted for 31.05% of the total. Conclusion: The diagnostic levels and survival rates of female breast cancer in Shanghai were relatively high and continue to improve. However, the proportions of cases with unknown histological type and unknown stage remain relatively high, and the proportion of stage Ⅰ cases is not very large. The survival rates of stage Ⅳ cases are relatively low. This study provides evidence for further research, prevention and control efforts for female breast cancer.关键词：Breast cancer;Survival;Epidemiology;Shanghai23|1248|0更新时间：2025-12-31
Specialist's Article
- 摘要：Background and purpose: Human papilloma virus (HPV) infection status is crucial for diagnosing cervical precancerous lesions and classifying cervical cancer. High-risk (HR) HPV is often linked to P16 protein overexpression, so P16 detection via immunohistochemistry (IHC) is commonly used to assess HPV infection. However, the differences between HPV status and P16 expression remains unclear. An in-depth study of the correlation between HPV and P16 is essential for clinical guidance. Methods: We retrospectively collected clinical and pathological data of cervical lesions from 618 patients diagnosed at the Department of Pathology, Fudan University Shanghai Cancer Center from January 2020 to December 2023 (Ethical number: 050432-4-2307E). Polymerase chain reaction (PCR) reverse dot hybridization was used to detect HPV including HR and low-risk (LR) subtypes, and immunohistochemistry was used to detect P16 for comparative analysis. Based on different clinical and pathological diagnoses, the sensitivity and specificity of P16 expression in evaluating HPV infection were evaluated. Among the 618 cases of cervical lesions, there were 92 cases of cervical squamous cell carcinoma, 257 cases of cervical adenocarcinoma, 79 cases of high-grade squamous intraepithelial lesions (HSIL), 105 cases of low-grade squamous intraepithelial lesions (LSIL), and 85 cases of chronic cervical inflammation. Results: According to clinical diagnosis, the HR-HPV positive rate in cervical squamous cell carcinoma was 88.0% (81/92), the P16 positive rate was 91.3% (84/92), and the overall consistency rate between P16 and HPV detection was 90.2% (88/92); for HR-HPV infection, the sensitivity and specificity of P16 were 96.3% and 45.5%. The positive rate of HR-HPV in adenocarcinoma was 54.5% (140/257), the positive rate of P16 was 58.8% (151/257), and the overall consistency rate between P16 and HPV detection was 82.5% (212/257); for HR-HPV infection, the sensitivity and specificity of P16 were 87.9% and 76.1%. In HSIL, the HR-HPV positive rate was 75.9% (60/79), the positive rate of P16 was 70.9% (56/79), and the overall consistency rate between P16 and HR-HPV detection was 82.2% (65/79); for HR-HPV infection, the sensitivity and specificity of P16 were 85.0% and 73.7%. In LSIL, the HR-HPV positive rate was 73.3% (77/105), the positive rate of P16 was 8.5% (9/105), and the overall consistency rate between P16 and HR-HPV detection was 33.3% (35/105); for HR-HPV infection, the sensitivity and specificity of P16 were 10.4% and 96.4%. In chronic cervical inflammation, the HR-HPV positive rate was 20% (17/85), the positive rate of P16 was 0.0% (0/85); for HR-HPV infection, the sensitivity and specificity of P16 were 0.0% and 100.0%. There was a significant positive correlation between P16 positivity and HPV16/18 in cervical squamous cell carcinoma, adenocarcinoma, and HSIL (P=0.000), while there was no significant correlation in LSIL and chronic cervical inflammation (P>0.05). Conclusion: In cervical squamous cell carcinoma and adenocarcinoma, the consistency of P16 expression and HPV DNA positivity are high, especially in HPV16/18 subtype. There is a good concordance between HR-HPV positivity and P16 protein overexpression. The positive expression of P16 in HSIL may initially reflect HPV infection status. However, in LSIL and chronic cervicitis, P16 expression may not accurately correlate with HPV infection. The inconsistency between P16 and HPV DNA testing could be influenced by multiple factors, including HPV subtypes, histopathological categories, specimen quality, and technical limitations. In clinical practice, it is recommended to conduct comprehensive analysis or employ multiple diagnostic methods to confirm HPV infection status for precise evaluation.关键词：Cervical lesions;Human papilloma virus;P16 immunohistochemistry;Cervical squamous cell carcinoma;Cervical adenocarcinoma;High-grade squamous intraepithelial lesions;Low-grade squamous intraepithelial lesions;Chronic cervical inflammation;Consistency11|1166|0更新时间：2025-12-31
- 摘要：Background and purpose: SEC14L1P1, a pseudogene of the SEC14 family, is closely associated with the development of various tumors, but its role in oral squamous cell carcinoma (OSCC) has not been clarified. This study aimed to gain insights into the expression characteristics and subcellular localization of SEC14L1P1 in OSCC cells, as well as its effects on OSCC cell proliferation and migration. Methods: The expression of SEC14L1P1 in head and neck squamous cell carcinoma (HNSCC) tissues was analyzed by the ENCORI database; The expression of SEC14L1P1 and its relationship with patient prognosis in HNSCC was further analyzed using the GDC and UCSC Xena databases. The expression of SEC14L1P1 in OSCC cell lines was detected by real-time fluorescence quantitative polymerase chain reaction (RTFQ-PCR); RNA nucleoplasmic separation assay was performed to determine the localization of SEC14L1P1 in OSCC cells. SEC14L1P1 knockdown (SS-SEC14L1P1) group and knockdown control (SS-NC) group were established for CAL-27 cells, and SEC14L1P1 overexpression (SEC14L1P1) group and overexpression control (Vector) group were established for HN30 cells. The effects of SEC14L1P1 expression on the proliferation and migration abilities of cells in each group were assessed by cell counting kit-8 (CCK-8) and transwell migration assays. RTFQ-PCR and Western blot experiments were used to detect the effects of altered SEC14L1P1 expression on the expression levels of epithelial-mesenchymal transition (EMT)-related genes. To investigate the effects of SEC14L1P1 on the proliferation of OSCC cells in vivo using a subcutaneous xenograft tumor model in nude mice, 12 four-week-old BALB/c nude mice were randomly divided into two groups: the antisense oligonucleotide (ASO)-NC group and the ASO-SEC14L1P1 group, with 6 mice in each group. All mice were individually labeled. Further mechanistic studies were performed by analyzing molecules interacting with SEC14L1P1 through the RNAInter database, and the ENCORI database was queried for expression correlation between SEC14L1P1 and DHX9. The effect of altered SEC14L1P1 expression on the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway was detected by Western blot assay. Results: Database analysis showed that the expression of SEC14L1P1 was higher in HNSCC tissues than in normal tissues, and was strongly associated with poor patient prognosis. The RTFQ-PCR results showed that SEC14L1P1 was highly expressed in all six OSCC cell lines; RNA nucleoplasmic separation showed that SEC14L1P1 was mainly localized in the nucleus in CAL-27 and HN30 cells. Compared with SS-NC, the relative expression of SEC14L1P1 in the SS-SEC14L1P1 group was significantly lower and significantly inhibited cell proliferation and migration, while the relative expression of SEC14L1P1 in the SEC14L1P1 group was significantly higher compared with the Vector group, which also significantly increased cell proliferation and migration. The down-regulation of SEC14L1P1 was accompanied by increased mRNA and protein levels of E-cadherin, and decreased mRNA and protein levels of N-cadherin and vimentin, with the opposite result after SEC14L1P1 overexpression. In vivo experiments showed that the xenograft tumor weight and volume of the ASO-SEC14L1P1 group were significantly reduced. Further mechanistic studies revealed a positive correlation between SEC14L1P1 and DHX9 expressions, and DHX9 has been shown to activate the PI3K/AKT signaling pathway. Knockdown of SEC14L1P1 resulted in decreased protein expressions of phosphorylated-PI3K (p-PI3K) and phosphorylated-AKT (p-AKT), and overexpression of SEC14L1P1 increased protein expressions of p-PI3K and p-AKT. Conclusion: SEC14L1P1 showed high expression levels in OSCC cells and tissues and promoted the proliferation and migration of OSCC cells, a phenomenon that may be related to the regulation of the PI3K/AKT signaling pathway by SEC14L1P1, which in turn promotes EMT.关键词：SEC14L1P1;Oral squamous cell carcinoma;Cell proliferation;Cell migration;Epithelial-mesenchymal transition34|1398|0更新时间：2025-12-31
- 摘要：Background and purpose: Tumor microangiogenesis is an important basis for tumor growth and metastasis, and its characteristics include angiogenesis, increased vascular permeability and abnormal capillary structure. Microangiogenesis not only affects the blood supply and metabolism of tumor, but also is directly related to the invasion, prognosis and treatment response of tumor. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a non-invasive imaging technique. By quantitatively analyzing the distribution and dynamic changes of contrast agents in tumor tissues, it can reflect the microvascular density (MVD), permeability and blood perfusion of tumors. The purpose of this study was to further clarify the application value of DCE-MRI in the diagnosis and treatment of rectal cancer by in-depth analysis of the relationship between quantitative analysis parameters of rectal cancer and microangiogenesis, and to promote the popularization and optimization of this technology in clinical practice. Methods: A total of 348 patients with rectal cancer who were scheduled for surgical treatment in Xinxiang Central Hospital from January 2021 to June 2024 were selected, and rectal cancer tissue specimens and adjacent tissues (> 5 cm away from tumor margin) were collected. This study was approved by the medical ethics committee of Xinxiang Central Hospital (approval number: 2021-144-01K). The quantitative analysis parameters of DCE-MRI [Rate constant (Kep), volume transport constant (Ktrans), volume fraction of contrast agent in extracellular space (VE)] and MVD in cancer tissues and adjacent tissues were compared. The quantitative analysis parameters and MVD of DCE-MRI in rectal cancer patients with different differentiation degrees and clinical stages were compared. Spearman correlation was used to analyze the correlation between DCE-MRI parameters and differentiation degree, clinical stage and MVD in patients with rectal cancer. Results: The values of Kep value, Ktrans value, Ve value and MVD were higher in rectal cancer tissues than in adjacent tissues (P<0.05). The Kep value, Ktrans value, Ve value and MVD of patients with low differentiated and middle differentiated rectal cancer were higher than those of patients with high differentiated rectal cancer (P<0.05). The values of Kep value, Ktrans value, Ve value and MVD of patients with low differentiated rectal cancer were higher than those of patients with middle differentiated rectal cancer (P<0.05). The Kep value, Ktrans value, Ve value and MVD of patients with stage Ⅱ, Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅰ rectal cancer (P<0.05). The Kep value, Ktrans value, Ve value and MVD of patients with stage Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅱ rectal cancer (P <0.05). The Kep value, Ktrans value, Ve value and MVD of patients with stage Ⅳ rectal cancer were higher than those of patients with stage Ⅲ rectal cancer (P<0.05). The Kep value, Ktrans value and Ve value of rectal cancer patients were negatively correlated with the differentiation degree (r=-0.683, -0.743, -0.721, P<0.05). The Kep value, Ktrans value and Ve value of rectal cancer patients were positively correlated with clinical stage (r=0.764, 0.703, 0.814, P<0.05). The Kep value, Ktrans value and Ve value of rectal cancer patients were positively correlated with MVD (r=0.812, 0.754, 0.835, P<0.05). Conclusion: DCE-MRI parameters are related to the differentiation degree, clinical stage and microangiogenesis of rectal cancer.关键词：Rectal cancer;Dynamic contrast-enhanced magnetic resonance imaging;Quantitative parameters;Degree of differentiation;Clinical staging;Microangiogenesis6|356|0更新时间：2025-12-31
Article
- 摘要：Malignant pleural mesothelioma (MPM) is strongly associated with a history of asbestos exposure and is characterized by high malignancy, high mortality, and poor prognosis. Current treatments for MPM are limited and generally suboptimal, resulting in a median overall survival (OS) of approximately one year for MPM patients. However, advancements in treatment options, including surgery, radiotherapy, chemotherapy, immunotherapy and targeted therapy, have brought new hope to patients with MPM. For early-stage MPM patients categorized under the TNM staging system, surgical treatment is feasible and can improve survival rates and quality of life. However, there is still debate regarding the optimal surgical approach for MPM. In addition to surgery, radiotherapy plays a vital role in MPM treatment. It is often used as prophylactic treatment or for alleviating local symptoms in advanced stages. Radiotherapy can also serve as neoadjuvant or adjuvant therapy in surgical contexts. For patients experiencing local progression or isolated distant metastases after systemic treatment, radiotherapy is a viable option. The advent of advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and volumetric intensity-modulated arc therapy (VMAT), has significantly improved the precision and efficacy of radiotherapy while minimizing damage to healthy tissues. Furthermore, brachytherapy can relieve pain or act as a localized supplemental therapy. Chemotherapy remains the standard treatment for MPM. The combination of pemetrexed and platinum-based drugs is widely applied as first-line therapy and has been shown to significantly extend survival. However, commonly used second-line regimens often yield suboptimal results. In recent years, immunotherapy has developed rapidly. Dual immunotherapy with nivolumab and ipilimumab has demonstrated impressive clinical efficacy and safety. The combination of immunotherapy and chemotherapy has also notably extended patients' median survival. Multiple clinical trials have confirmed that this combination therapy benefits patients. Currently available targeted therapies for MPM primarily focus on anti-angiogenesis. Bevacizumab combined with chemotherapy has established its position as a first-line treatment. Research on ramucirumab and apatinib suggests that these drugs have certain efficacy and safety profiles. Beyond conventional treatment options, the UV1 cancer vaccine combined with dual immunotherapy offers new hope for patients. Chimeric antigen receptor T (CAR-T) cell therapy is an emerging treatment method being investigated in MPM patients, with phase Ⅰ clinical trials demonstrating good antitumor effects. Additionally, some antibody-drug conjugates are becoming therapeutic options for MPM through precise targeting. Tumor treating fields combined with chemotherapy has also shown efficacy in extending survival. Despite the increasing variety of treatment options for MPM, its diagnosis and treatment still face numerous challenges, including difficulties in early detection, treatment resistance, and a lack of large-scale evidence-based clinical studies. Future research should focus on improving early diagnosis rates, developing new treatment strategies, overcoming resistance, and advancing personalized therapy. Strengthening the integration of basic research and clinical trials will also be essential. Through multidisciplinary collaboration and continuous innovation, it is hoped that more effective and safer treatment options will become available, ultimately improving the prognosis of MPM patients.关键词：Malignant pleural mesothelioma;Medical treatment;Immunotherapy;Targeted therapy;Cancer vaccine therapy;Chimeric antigen receptor T cell therapy13|821|0更新时间：2025-12-31
- 摘要：Immunotherapy for cancer, as an emerging treatment modality, has made significant strides in recent years and has become a crucial therapeutic approach following surgery, radiotherapy, chemotherapy, and targeted therapy. In particular, the clinical utilization of immune checkpoint inhibitors (ICIs) has not only enhanced the survival rates of patients with refractory or recurrent tumors but has also significantly optimized the overall strategy for cancer treatment. However, as the population undergoing cancer immunotherapy continues to grow, this expansion not only yields clinical benefits but also precipitates a range of specific adverse reactions known as immune-related adverse events (irAEs). Pleural effusion is a common and severe complication in cancer patients, significantly affecting both their quality of life and treatment outcomes. Typically, tumor-related pleural effusion is often due to pleural metastasis, with malignant pleural effusion (MPE) characterized by rapid growth, being difficult to control, and tendency for recurrence. With the approval of new drugs and the expansion of indications for existing medications, the number of cancer patients receiving ICIs treatment is increasing, bringing ICIs-related pleural effusion into focus. While ICIs treatment-related pleural effusion is relatively rare in clinical practice, it is closely linked to treatment choices of patients and prognosis. Unlike MPE, the pathogenesis of ICIs treatment-related pleural effusion is more complex, not only involving non-specific immune activation leading to autoimmune inflammatory reactions but also potentially related to nodular pleural granulomatous reactions, eosinophilic chronic pleurisy, and tumor-infiltrating lymphocytes. In terms of diagnosis, ICIs treatment-related pleural effusion is typically diagnosed through exclusion, requiring the exclusion of other causes such as tumor progression, radiotherapy, and chemotherapy-induced pleural effusion, adding complexity and difficulty to the diagnostic process. Treatment for ICIs treatment-related pleural effusion often involves glucocorticoids, tocilizumab, or infliximab, aiming to alleviate symptoms and improve prognosis by suppressing excessive immune reactions. Preventing the occurrence of ICIs treatment-related pleural effusion is equally crucial, necessitating comprehensive patient assessment before ICIs administration and continuous monitoring during treatment to promptly detect and manage potential adverse reactions. Through this comprehensive management approach, the impact of ICIs treatment-related pleural effusion on patient quality of life and treatment outcomes can be minimized, optimizing overall treatment results. This review aimed to explore the pathogenesis, histological features, clinical manifestations, diagnostic methods and treatment strategies of ICIs treatment-related pleural effusion, and delve into the characteristics of ICIs treatment-related pleural effusion, in order to enhance understanding of this complication and provide a reference for clinical practice.关键词：Malignant tumor;Immune checkpoint inhibitors;Pleural effusion;Adverse events;Treatment11|778|0更新时间：2025-12-31
Review
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