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Item Breast fine-needle aspiration cytology utilizing the International Academy of Cytology Yokohama System: One-year retrospective study in a tertiary care center in Himachal Pradesh(Wolters Kluwer – Medknow, 2024-12) Sarohi, Monica; Mardi, Kavita; Dingyon, Tenzin L.Background: In 2016, the International Academy of Cytology (IAC) established a reporting system for breast fine‑needle aspiration (FNA) cytology. This system proposed five categories in its classification: category for insufficient; category 2 for benign; category 3 for atypical, probably benign; category 4 indicating suspicious for malignancy; and category 6 for malignant. Aims and Objectives: The aim of the present study was to review and categorize the breast FNA samples according to the new system of reporting, to assess the risk of malignancy (ROM) for each category, and to assess the diagnostic yield of breast FNA biopsy (FNAB). Materials and Methods: The present retrospective study was conducted in the department of pathology, IGMC, Shimla from January 2019 to December 2019. All the samples during this period were included in the study. Results: A total of 405 breast cytology cases were included in the present study. The FNA findings were correlated with histopathology in 82 cases. The ROM for each category was 16.6% for insufficient, 3.7% for benign, 0% for atypical for malignancy, 100% for suspicious for malignancy, and 92.3% for malignant category. Conclusion: The IAC Yokohama system for reporting breast FNA cytology helps in standardizing reports and easier communication of the pathologists with treating surgeons. It offers a ROM for each category which helps during follow‑up of patients. Utilizing the system in day‑to‑day reporting will improve diagnostic clarity and management.Item Is there any diagnostic value of serum caveolin-1 levels on the determination of pancreatic adenocarcinoma?(Wolters Kluwer – Medknow, 2024-12) Karabulut, Senem; Afsar, Cigdem U.; Paksoy, Nail; Ferhatoglu, Ferhat; Dogan, Izzet; Tastekin, DidemBackground: Caveolin‑1 (CAV‑1) is a vital component in cancer pathogenesis, as its expression determines the survival of patients with cancer. This study investigates CAV‑1 serum levels in pancreatic adenocarcinoma (PA) patients and their role in tumor progression and prognostic factors. Method: The trial included 33 patients with pathologically confirmed pancreatic cancer (PC). The enzyme‑linked immunosorbent assay (ELISA) method was used to measure the concentrations of CAV‑1 in the blood. The study also included 20 healthy subjects. The statistical analysis was two‑sided, and a P value of ≤ 0.05 was determined as statistically significant. Results: The median age of the subjects was 59 years (32–84 years) at the time of diagnosis. There were 13 (39%) female participants. In 21 (63%) patients, the primary focus was the pancreatic head. In 23 stage IV patients, hepatic metastasis (n = 19, 83%) was observed. Only one patient (3%) was still alive at the end of the study period. Palliative chemotherapy (CTx) was provided, with 39% of the 23 patients responding to it. The overall survival (OS) rate in this cohort was 41.3 ± 8.3 weeks at a 95% confidence interval (CI), after 25–58 weeks. Serum baseline CAV‑1 values among patients with PA were significantly higher compared with controls (p = 0.009). Patients with poor performance status, a pancreatic head tumor, lower albumin levels, higher serum carcinoembryonic antigen (CEA) levels, and higher CA 19.9 levels had significantly higher serum CAV‑1 levels (p = 0.01, P = 0.05, P = 0.03, P = 0.02, and P = 0.04, respectively). However, CAV‑1 did not show any prognostic value (p = 0.75). Conclusion: Although serum CAV‑1 is a useful diagnostic marker in PC patients, it is not a prognostic or predictive marker.Item Polatuzumab vedotin plus bendamustine and rituximab in relapsed/refractory diffuse large B-cell lymphoma: A phase III bridging study in Chinese patients(Wolters Kluwer – Medknow, 2024-12) Song, Yuqin; Zhang, Qingyuan; Cai, Qingqing; Song, Yongping; Zhang, Liling; He, Pengcheng; Wang, Li; Hirata, Jamie; Musick, Lisa; Deng, Rong; Liu, Wenxin; Wang, Xin; Zhu, JunBackground: Patients with transplant‑ineligible relapsed/refractory diffuse large B‑cell lymphoma (R/R DLBCL) have limited treatment options and poor outcomes. Methods: This phase III study (NCT04236141) evaluated the efficacy and safety of polatuzumab vedotin plus bendamustine and rituximab (Pola+BR) versus BR in Chinese patients with transplant‑ineligible R/R DLBCL to support regulatory submission in China. Patients were randomized 2:1 to receive Pola+BR or placebo+BR. The primary endpoint was complete response (CR) at the end of treatment (EOT) by positron emission tomography–computed tomography. Results: Overall, 42 patients were analyzed (Pola+BR, n = 28; placebo+BR, n = 14). At data cutoff (July 12, 2021; median follow‑up: 7.5 months), CR at EOT was 25.0% (7/28) with Pola+BR and 14.3% (2/14) with placebo+BR, 10.7% difference [95% confidence interval (CI): –19.0, 40.4]. The median investigator‑assessed progression‑free survival was 4.6 (95% CI: 3.1–6.4) months with Pola+BR and 2.0 (95% CI: 1.9–4.6) months with placebo+BR, with a 50% reduction in risk of progression or death (unstratified hazard ratio: 0.50; 95% CI: 0.24–1.05). The median overall survival was 10.6 [95% CI: 5.5–not evaluable (NE)] and 6.5 (95% CI: 6.0–NE) months, with a 45% reduction in risk of death. The incidence of Grade 3–4 adverse events was similar between Pola+BR (20/27 patients, 74.1%) and placebo+BR arms (11/14 patients, 78.6%). Conclusions: Efficacy findings were consistent with results of the GO29365 study (NCT02257567); treatment with Pola+BR led to clinically meaningful improvements in response rates in Chinese patients with transplant‑ineligible R/R DLBCL with no new safety signals.Item Factors retarding enhanced recovery from thermal ablation of liver tumors: A single-center prospective study(Wolters Kluwer – Medknow, 2024-12) Zhang, Lanxia; Dai, Fei; Zeng, Qingjing; He, Xuqi; Guo, Na; Chen, Xiaorui; Li, KaiPurpose: To evaluate the risk factors that may delay enhanced recovery in the ablation of liver tumors. Methods: A total of 310 patients who underwent ultrasound‑guided ablation of liver tumors under general anesthesia were prospectively enrolled. Baseline data, intraoperative parameters, and postoperative events were evaluated. Postoperative pain was scored using the visual analog scale (VAS). Logistic regression analysis was conducted for univariate and multivariate analyses. Results: The study included 42 females (13.5%) and 268 males (86.5%). The mean age of the sample was 57 ± 11 years old. The average length of stay (LOS) was 4.3 ± 2.4 days. A total of 199 out of 310 patients (64.2%) experienced moderate to severe pain (VAS score > 3). Seventy out of 310 patients (22.6%) experienced other complications. In the multivariable analysis, the number of lesions [odds ratio (95% confidence interval): 3.23 (2.15–4.84); P < 0.001], maximum diameter of lesions [1.12 (1.07–1.17), P < 0.001], and smallest distance between the lesions and the liver capsule [0.91 (0.89–0.94), P < 0.001] were risk factors for postoperative pain (VAS > 3). A history of alcohol consumption [2.62 (1.33–5.19), P = 0.005] was a risk factor for other complications. Surgical history [0.40 (0.24–0.67), P = 0.001] was a protective factor against LOS. Total operation time [1.01, 1.00–1.01, P = 0.009] was a mild risk factor for LOS. Conclusion: The number of lesions, maximum diameter of the lesions, smallest distance between the lesions and the liver capsule, total operation time, and a history of alcohol use were risk factors that may delay enhanced recovery in patients undergoing ablation of liver tumors. These findings may provide evidence to promote the use of the enhanced recovery after surgery protocol.Item A retrospective analysis of unusual metastasis from carcinoma oesophagus to subcutaneous tissue(Wolters Kluwer – Medknow, 2024-12) Singhal, Saloni; Kesharwani, Pragati; Kumar, Amresh; Lodi, Ashar I.; Bhandari, VirendraIntroduction: Oesophageal carcinoma is the ninth most common cancer worldwide. Skin and subcutaneous soft tissue are rare sites of metastases, constituting only 1% of sites of distant metastases. The location of subcutaneous metastasis from oesophageal carcinoma is variable. Material and Method: This is a single‑institutional retrospective study done over 10 years. 798 patients with carcinoma oesophagus reported to our department over 10 years and distance metastasis was seen in 32% of the total treated patients. Results: The incidence of subcutaneous metastasis of all treated cases in our institution over a decade is one case per 1,000 people year. The site of subcutaneous metastasis varied widely from common sites like the chest wall, back, and abdomen to rare sites like the nose, axillary region, scalp, and great toe. None of the patients survived more than a year after development of subcutaneous metastasis and the median overall survival recorded was five months. Discussion: In a large cohort of 838 patients with oesophageal cancer done by LE Quint et al., approximately 20% of the patients showed distant metastasis, with a significantly lower rate of 1% for metastatic lesions involving the skin and the liver and lungs being the most common. Since the incidence of subcutaneous metastasis in carcinoma oesophagus is rarely seen, and we got the incidence of 1% as well. Conclusion: Subcutaneously are most likely missed if the patient is not being examined thoroughly. Only after the histopathological or cytological confirmation was the diagnosis of subcutaneous metastasis in our patients made.Item Comparison between lymph and non-lymph node resection in patients with stage IA non-small-cell lung cancer: A retrospective study(Wolters Kluwer – Medknow, 2024-12) Lei, Bao; Zhang, Zhiping; Li, Chunxia; Yang, Jiao; Peng, Jing; Zhao, Yanqiu; Liu, Guiming; Liang, Han; Feng, Jun; Xiang, XudongObjective: This retrospective study aimed to determine the need for lymph node resection during surgical treatment in patients with stage IA non‑small‑cell lung cancer (NSCLC). Materials and Methods: A total of 1428 patients diagnosed with cT1N0M0 1A stage NSCLC who underwent surgery were divided into two groups: lymphadenectomy (n = 1324) and nonlymphadenectomy (n = 104). The effects of lymph node resection on overall survival (OS) and recurrence‑free survival (RFS) and on clinicopathological factors that affected the prognosis of the patients were investigated. Results: The group that underwent lymph node resection had a better 5‑year OS (89.2% vs 81.1%) and 3‑year RFS (87.6% vs 79.2%) than the one that did not. Multivariate Cox regression analysis revealed that the risk of OS in the nonlymphadenectomy group increased by 72% compared to that in the lymphadenectomy group [hazard ratio (HR), 1.72; 95% confidence interval (CI), 1.08–2.74; P < 0.05]. The risk of RFS in the group without lymphadenectomy increased by 45% compared to that in the group with lymphadenectomy (HR, 1.45; 95% CI, 0.98–2.14;P = 0.06). Significant reductions in the OS (HR, 5.90; 95% CI, 1.80–20.00; P < 0.005) and RFS (HR, 4.00; 95% CI, 1.50–11.00;P < 0.005) can be seen in the absence of lymph node resection in NSCLC patients with emphysema. Conclusion: A thorough evaluation and removal of the hilar and mediastinal lymph nodes may prove useful in determining the cancer stage and assessing the need for further treatment, thus enhancing the prognosis of patients with stage IA NSCLC.Item Effect of cryoablation on the spatial transcriptomic landscape of the immune microenvironment in non-small cell lung cancer(Wolters Kluwer – Medknow, 2024-12) Zhou, Jun; Wang, Shengxi; Liu, Ming; Li, ZhaopeiBackground: Cryoablation induces antitumor immune responses. Spatial transcriptomic landscape technology has been used to determine the micron‑level panoramic transcriptomics of tissue slices in situ. Methods: The effects of cryoablation on the immune microenvironment in non‑small cell lung cancer (NSCLC) were explored by comparing the Whole Transcriptome Atlas (WTA) panel of immune cells before and after cryoablation using the spatial transcriptomic landscape. Results: The bioinformatics analysis showed that cryoablation significantly affected the WTA of immune cells, particularly genes related to cellular components, biological processes, molecular functions, proliferation and migration, and cytokine‑cytokine receptor interaction signaling pathways. Conclusions: The findings of this study suggest that cryoablation significantly impacts the biological functions of immune cells in the tumor microenvironment of NSCLC through multiple mechanisms.Item Successful treatment of epidermal growth factor receptor exon 19 deletion non-small cell lung cancer with almonertinib after osimertinib-induced interstitial lung disease: A case report(Wolters Kluwer – Medknow, 2024-12) Li, Zhichao; Wang, Gang; Xue, Guoliang; Wang, Nan; Hu, Yanting; Cao, Pikun; Cai, Hongchao; Wei, Zhigang; Ye, XinOsimertinib, a third‑generation epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI), has revolutionized one of the standard most efficient treatments for EGFR mutation‑positive non‑small cell lung cancer (NSCLC). Osimertinib, a third‑generation EGFR–TKI, is currently one of most efficient treatments in clinical practice. However, it has a potentially fatal side effect: interstitial lung disease (ILD). When severe ILD occurs, a drug substitution is often required, and there is a rising concern about which drug to choose to inhibit the progression of NSCLC and avoid aggravating while alleviating ILD. Herein, we report an NSCLC case with osimertinib‑induced ILD successfully rechallenged by almonertinib. In addition, we conducted a literature review on the clinical efficacy and adverse effects of almonertinib, hoping to provide insight into NSCLC treatment.Item Comparison of clinical outcomes in patients with advanced pulmonary sarcomatoid carcinoma treated with immunotherapy-based regimens or chemotherapy: A study based on the SEER database and multicentric real-world settings(Wolters Kluwer – Medknow, 2024-12) Peng, Duanyang; Xiong, Le; Luo, Yuxi; Chen, Junxing; Zheng, Yue’e; Zeng, Xiaoli; Liu, Shubin; Liu, Anwen; Wang, Xia; Zeng, ZhiminBackground: Pulmonary sarcomatoid carcinoma (PSC) is a rare lung cancer characterized by early metastasis and invasion. It is predominantly diagnosed at a locally advanced or metastatic stage, hindering the possibility of surgical intervention. However, a standard treatment for advanced PSC remains unestablished. This study evaluated the effects of chemotherapy and immunotherapy‑based strategies in patients with advanced PSC. Methods: The Surveillance, Epidemiology, and End Results (SEER) database and data from three cancer centers were used in this retrospective study. Progression‑free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Univariate and multivariate analyses were conducted to identify the prognostic factors. Results: In total, 202 patients with stage IV PSC were identified from the SEER database (median OS, 5 months). The median follow‑up time of patients from the three centers was 18.8 months. First‑line treatment with immunotherapy‑based regimens and chemotherapy was administered to 12 and 27 patients, respectively. The median PFS was 2.1 and 7.3 months [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.06–0.40; P < 0.001], while the median OS was 3.6 and 21.4 months (HR, 0.21; 95% CI, 0.09–0.50; P < 0.001) in the chemotherapy and immune‑based groups, respectively. The immunotherapy‑based regimen was an independent prognostic factor for PFS (HR, 0.21; 95% CI, 0.08–0.55; P = 0.001) and OS (HR, 0.20; 95% CI, 0.08–0.49; P < 0.001). Conclusions: Conventional chemotherapy offered limited benefits in patients with advanced PSC; however, those who received first‑line immunotherapy‑based regimens exhibited significantly improved responses.Item Factors influencing surgical site infections and health economic evaluation in patients undergoing robot-assisted radical resection for colorectal cancer(Wolters Kluwer – Medknow, 2024-12) Liu, Guangying; Ma, LimeiAims: To investigate the incidence and factors influencing surgical site infections (SSIs) in patients undergoing robot‑assisted radical resection for colorectal cancer and assess their health and economic impact on the patients and hospital. Materials and Methods: This retrospective case‑controlled study comprised patients who underwent robot‑assisted radical resection for colorectal cancer at a tertiary hospital in China. Information about baseline characteristics, perioperative details, postoperative SSI incidence, hospitalization costs, and follow‑up was collected. Univariate and multivariate analyses were performed to identify the independent risk factors for SSI. Propensity score matching was used to evaluate the health and economic impacts of SSI on the patients and the hospital. Results: The overall incidence of colorectal SSI in 546 patients undergoing robot‑assisted radical resection for colorectal cancer was 11.72% (64/546). Intraoperative blood loss, duration of operation, preoperative absolute lymphocyte count, preoperative and postoperative serum albumin levels, tumor location, gender, history of radiotherapy or chemotherapy, surgical wound classification, and preoperative hypoalbuminemia levels were associated with SSI. Rectal cancer, male gender, and class 3 or 4 surgical wounds were identified as independent risk factors for postoperative SSI. SSI prolonged the hospital stay by 6.60 days, increased the patient’s direct costs by 31,669.88 CNY, increased the economic burden by 3,262.38 CNY, and caused an indirect economic loss of 50,546.79 CNY for the hospital. Conclusions: Patients undergoing robot‑assisted radical resection for colorectal cancer are at a high risk for SSI. SSI can prolong postoperative hospital stays and increase the economic burden for patients and hospitals.Item Characteristics and prognosis of testicular mixed teratoma and seminoma(Wolters Kluwer – Medknow, 2024-12) Li, Kai; Sun, Fengdan; Fan, CaibinBackground: To evaluate the association of demographic and clinicopathological characteristics with the survival of patients with testicular mixed teratoma and seminoma (TMTS). Methods: The data of 3296 eligible patients with TMTS who underwent surgery between 2010 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cancer‑specific survival (CSS) were determined using the Kaplan–Meier survival curves. The association of demographic and clinicopathological characteristics with the OS and CSS of patients with TMTS was assessed using the Cox proportional hazard regression model. Results: The number of patients with TMTS increased annually. In Kaplan–Meier analyses, TMTS patients with advanced T stage (P < 0.001 for OS and P < 0.001 for CSS), lymph node metastasis (P < 0.001 for OS and P < 0.001 for CSS), distant metastasis (P < 0.001 for OS and P < 0.001 for CSS), no regional lymph node resection (P = 0.003 for OS and P = 0.002 for CSS), large tumor size (P = 0.001 for OS and P = 0.001 for CSS), and LVI (P < 0.001 for OS and P < 0.001 for CSS) exhibited inferior OS and CSS. Moreover, distant metastasis (HR 11.224, P < 0.001; HR 15.817, P < 0.001) and regional lymph node resection (HR 0.425, P = 0.003; HR 0.366, P = 0.004) were identified as independent prognostic factors for OS and CSS in patients with TMTS through multivariable analyses. Conclusions: Distant metastasis and lymph node metastasis were deemed important prognostic factors for OS and CSS in patients with TMTS. Therefore, a comprehensive understanding and clinical assessments of these prognostic factors are necessary before tailoring clinical management and treatment plan specified for patients with TMTS.Item Association of diabetes mellitus with long-term prognosis after ablation therapy for patients with hepatocellular carcinoma: A single-center cohort study(Wolters Kluwer – Medknow, 2024-12) Wang, Neng; Shen, Qiang; Zhou, Ping-Sheng; Wang, Ming-Da; Zhang, Jing-Lei; Sheng, Yue-Hong; Qian, Guo-JunBackground: This study investigated the clinical efficacy and prognostic factors of ablative treatment in hepatocellular carcinoma (HCC) patients with and without diabetes mellitus (DM). Methods: Retrospective data were collected from HCC patients who underwent ablation between January 2016 and December 2019. The baseline clinicopathological characteristics and long‑term outcomes, such as overall survival (OS) and recurrence‑free survival (RFS), were compared between those with and without DM. Predictive factors associated with survival and recurrence were identified through univariable and multivariable Cox regression analyses. Results: Of the 3528 patients enrolled in the study, 588 (16.7%) had concurrent DM. The 1‑, 3‑, and 5‑year RFS rates in patients with DM (73.8%, 33.7%, and 5.8%, respectively) were significantly (P < 0.001) lower than those in the non‑DM patients (70.4%, 37.6%, and 18.6%, respectively). Likewise, significant differences (P < 0.001) in the 1‑, 3‑, and 5‑year OS rates were observed between the DM (99.9%, 78.1%, and 29.1%, respectively) and non‑DM (99.9%, 85.9%, and 54.3%, respectively) patients. Multivariable Cox regression analysis identified DM as an independent risk factor for OS [hazard ratio (HR), 1.982; P < 0.001] and RFS (HR, 1.175; P = 0.002). Conclusion: Patients with DM exhibited a poorer oncological prognosis than those without DM following ablation for HCC. DM was identified as an independent factor influencing the prognosis of HCC patients after curative ablation. Thus, active therapies targeting DM might enhance oncological outcomes and facilitate individualized treatment decisions.Item Integrin α6 and integrin β4 in exosomes promote lung metastasis of colorectal cancer(Wolters Kluwer – Medknow, 2024-12) Cong, Fengyun; Huang, Jiahao; Wu, Changtao; Zhong, Huage; Qiu, Guanhua; Luo, Tao; Tang, WeizhongBackground: Colorectal cancer (CRC) is one of the most common cancers worldwide. The mechanisms underlying metastasis, which contributes to poor outcomes, remain elusive. Methods: We used the Cancer Genome Atlas dataset to compare mRNA expression patterns of integrin α6 (ITGA6) and integrin β4 (ITGB4) in patients with CRC. We measured ITGA6 and ITGB4 expression levels in highly metastatic (i.e., HCT116 and SW620) and lowly metastatic (i.e., SW480 and Caco2) CRC cell lines. Exosomes were isolated from cell culture media and characterized using western blotting and nanoparticle analyses. The role of exosomes in lung metastasis was investigated using xenograft experiments in mice models, which received CRC cell injection and were treated with exosomes. Results: ITGA6 and ITGB4 were significantly overexpressed in CRC tissues, and ITGA6 was associated with the American Joint Committee on Cancer (AJCC) stage and outcome. ITGA6 and ITGB4, as well as exosomal ITGA6 and ITGB4, were significantly more highly expressed in HCT116 and SW620 cells than in SW480 and Caco2 cells. The proliferation and tubulogenesis of vascular endothelial cells were markedly decreased by disruption of ITGA6 and ITGB4 but were markedly increased by ectopic expression of ITGA6 and ITGB4. Exosomal ITGA6 and ITGB4 promoted CRC metastasis to the lung in vivo. Conclusions: Taken together, our findings suggested that exosomal ITGA6 and ITGB4 displayed organotropism to the lung and upregulated proliferation and tubulogenic capacities, which might help reduce lung metastasis from CRC. These findings provided new insights into the mechanisms of CRC metastasis and provided novel potential therapeutic targets.Item Elevated CA19-9 within the normal range suggests poorer prognosis in stage II CRC: A retrospective analysis of a large sample in a single center(Wolters Kluwer – Medknow, 2024-12) Zhang, Ruoxin; Chen, Fan; Weng, Junyong; Ye, Zilan; Li, XinxiangObjective: Carbohydrate antigen 19‑9 (CA19‑9) and carcinoembryonic antigen (CEA) serve as pivotal tumor markers in colorectal cancer (CRC). However, uncertainty persists regarding the prognostic significance of the two tumor markers when falling within the normal range. We attempt to compare the prognostic differences of tumor markers at different levels within the reference range. Methods: This retrospective study scrutinized 2,167 cases of stage II CRC verified by pathology after surgery at the Fudan University Shanghai Cancer Center. Using R software to calculate the optimal critical value to compare the clinical and pathological characteristics and prognosis of different levels of tumor markers. The survival and regression modeling strategies packages of R software drew the nomograms. Results: Utilizing R software, the optimal critical value of CA19‑9 was determined as 12.12 U/mL and that of CEA as 1.89 U/mL. Kaplan‑Meier survival analysis unveiled that, within the normal range, higher levels of CEA were linked to poorer overall survival (OS) [HR = 1.829 (1.280, 2.989), P = 0.0033] and disease‑free survival (DFS) [HR = 1.472 (1.114, 1.944), P = 0.0444]. Similarly, heightened levels of CA19‑9 also indicated inferior OS [HR = 1.750 (1.203, 2.455), P = 0.0076] and DFS [HR = 1.361 (1.098, 1.686), P = 0.0049]. Furthermore, multivariate analysis identified CA19‑9 as an independent risk factor for OS (HR = 1.49,95% CI: 1.086–2.045, P = 0.014) and DFS (HR = 1.327,95% CI: 1.070–1.647, P = 0.01), while the impact of CEA on OS and DFS was not statistically significant. A nomogram constructed based on the Cox regression model can effectively evaluate the prognosis of CRC patients. Conclusion: Although within the normal range, elevated CA19‑9 was associated with an inferior prognosis, chemotherapy decisions of different intensities can be adjusted based on nomograms. This work will contribute to standardizing the diagnosis and treatment of stage II CRC and provide clinicians with essential insights for chemotherapy decisions.Item Microwave ablation after VATS in patients with multiple pulmonary nodules(Wolters Kluwer – Medknow, 2024-12) Cui, Xiangyu; Zhao, Jinglan; Lu, Ruizhen; Sui, Yingzhong; Shao, Changqing; Zhang, Zhixue; Chen, JunBackground: The management of residual nodules after video‑assisted thoracoscopic surgery (VATS) for multiple pulmonary nodules (MPNs) is challenging. Microwave ablation (MWA), which is highly repeatable and minimally invasive, has garnered widespread attention in the treatment of MPNs. Methods: Ninety‑one patients with MPNs who underwent VATS for resection of high‑risk nodules followed by MWA for residual nodules were examined. Clinical efficacy and complications were assessed. The primary end points were MWA success rate and complete ablation rate. Secondary end points were local progression‑free survival (LPFS), overall survival (OS), and complications. Results: MWA was successfully completed in all patients. Mean tumor diameter, ablation time, and ablation output power were 0.81 cm, 3.4 minutes, and 39 W, respectively. LPFS was 100% at 3, 6, 12, and 24 months, respectively. OS was 100% at 12 and 24 months, respectively. No intraoperative or postoperative deaths occurred. Complications with MWA were infrequent. Pneumothorax was most common, occurring in 31 patients (34.07%); among these, seven (7.69%) required closed thoracic drainage. Pleural effusion occurred in six patients (6.59%), hydropneumothorax in five (5.49%), and pneumonia in three (3.30%). The pain level after MWA was moderate‑to‑severe in 29 patients (31.87%). Conclusion: MWA is safe and feasible for treating residual nodules in patients with MPNs who have undergone VATS. The incidence of complications was low, and most complications were mild.Item Triptolide exhibits dual anti-tumor effects through inhibiting autophagy and extracellular matrix activation in pancreatic cancer(Wolters Kluwer – Medknow, 2024-12) Gu, Jianxiang; Shi, Zhao; Zhou, Siqi; Zhou, Quan; Nie, Shuang; Li, Hongzhen; Shen, Shanshan; Zou, XiaopingAim: The tumor microenvironment in pancreatic cancer, characterized by abundant desmoplastic stroma, has been implicated in the failure of chemotherapy. Therefore, developing therapeutic strategies targeting tumor and stromal cells is essential. Triptolide, a natural compound derived from the plant Tripterygium wilfordii, has shown antitumor activity in various cancers, including pancreatic cancer. However, its effects on pancreatic cancer cells and the microenvironment remain unclear. This study aimed to explore the effect of triptolide on tumor cells and the tumor microenvironment in pancreatic cancer. Methods: Cell Counting Kit‑8, colony formation, apoptosis, and cell cycle assays were performed to determine the effect of triptolide on tumor cells. Additionally, co‑culture assays were performed to explore the effects of the compound on cancer‑associated fibroblasts (CAFs) in vitro. Orthotopic xenograft and subcutaneous tumor models were used to explore the antitumor and antistromal activation effects of triptolide in vivo. RNA sequencing was performed to identify the pathways involved in these processes in pancreatic cancer cells. Results: Triptolide inhibited the proliferation of pancreatic cancer cells and attenuated stromal activation in vitro and in vivo. Furthermore, it suppressed autophagy and induced apoptosis in pancreatic cancer cells by inhibiting the secretion of CXCL1. Extracellular matrix formation in CAFs was disrupted by suppressing the paracrine secretion of TGF‑β from tumor cells. Conclusion: These findings indicate that triptolide plays a dual antitumor role against tumor cells and CAFs, thus providing new insights into treating pancreatic cancer in the future.Item The low cross-sectional muscle index at the third cervical vertebra is a marker for sarcopenia in patients with laryngopharyngeal cancer(Wolters Kluwer – Medknow, 2024-12) Gundog, Mete; Kiraz, Esin; Eroglu, CelalettinBackground: Muscle loss and sarcopenia play a significant role in head and neck cancer. In this study, the value of C3 cross‑sectional skeletal muscle index was investigated to evaluate sarcopenia. Methods: Seventy‑four patients were included in this retrospective study. Skeletal muscle index (SMI) was calculated using the paracervical muscles at the level of the third cervical vertebra. Survival rates and toxicities were compared. Results: The 3‑year overall survival rates were 33.3% in patients with low SMI (≤44.79) and 63.9% in patients with high SMI (>44.79) (P < 0.01). The 3‑year progression‑free survival rates were 25.9% in patients with low SMI and 63.2% in patients with high SMI (P < 0.01). Multivariate analyses found that advanced age (>65) was associated with a 2.9‑fold increased risk of death and low SMI was associated with a 3.9‑fold increased risk of death. Conclusion: Low SMI is associated with prolonged treatment time, increased toxicity, and decreased survival.Item Clinical features and prognosis analysis of stage III/IV patients with lung cancer after treatment with toripalimab: A real-world retrospective(Wolters Kluwer – Medknow, 2024-12) Wang, Chenlin; Liang, Ning; Qiao, Lili; Wu, Ya’nan; Zhang, Jiandong; Zhang, YanAim: Toripalimab is the first antitumor programmed cell death protein 1 (PD‑1) antibody approved in China. For better patient management, it is important to understand the real‑world outcomes of toripalimab in treating patients with lung cancer in the real world outside of clinical trials to improve patient care. Methods: We retrospectively examined the clinical data of 80 patients with lung cancer who received the PD‑1 inhibitor (toripalimab). The Chi‑square test was performed to identify clinical factors associated with the advancement of the disease. Multivariate Cox regression analysis was used to screen prognostic variables linked to real‑world progression‑free survival (PFS) and overall survival (OS). OS and PFS were calculated using the Kaplan‑Meier method, and the comparisons were determined using the log‑rank test, and continuous and categorical variables were explained using median and percentage, respectively. Result: The median OS of the estimated 80 patients was 15.85 months (95% confidence interval [CI]: 14.103–17.949 months), and the estimated PFS was 5.650 months (95% CI: 7.226–11.264 months). The longer OS and PFS correlate with the patient’s staging and number of treatment lines. The PD‑1 drug gave stage III patients a significantly longer PFS and OS compared to stage IV patients (PFS: 14.65 vs. 6.68, P = 0.004; OS: 21.1 vs. 13.7, P = 0.003). First‑ or second‑line immunotherapy patients have significantly longer PFS and OS than third‑ or fourth‑line (PFS: 6.4 vs. 3.6, P = 0.009; OS: 20.0 vs. 10.5, P = 0.003). In patients with stage IV (n = 60) with extensive metastasis, the site of metastasis is mostly 1–3 sites after receiving toripalimab. The duration of PD‑1 inhibitor OS in progressive patients (n = 56) was significantly prolonged (P = 0.038). Conclusion: For patients with lung cancer, toripalimab can considerably extend PFS and OS in the first or second line and in stage III. PD‑1 inhibitors are administered to patients with stage IV extensively metastatic lung cancer, which indicates an oligometastatic progression pattern, primarily in 1–3 locations, who are treated with PD‑1 inhibitors. Continuing toripalimab beyond disease progression significantly prolonged OS.Item Dermatofibrosarcoma protuberans: A clinical and pathological observational report of Asian samples from one center(Wolters Kluwer – Medknow, 2024-12) Peng, Qili; Lu, Yi; Su, Tingting; Tong, Pengpeng; Huang, Yixiong; Chen, RuiBackground: Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade fibrohistiocytic tumor with malignant potential. It is considered to have a high local recurrence rate due to the characteristic invasion of the finger-like lesion into the soft tissues. Method: This retrospective study presents details of 20 DFSP patients with a history of surgery and a long follow-up period. All patients were followed up for 10 years to assess the relationship between the surgical margin and the recurrence rate. Seventeen patients provided informed consent for detailed pathological examinations. Results: Twenty Asian patients with a mean age of 42.55 years were included in this study. The location of the DFSP varied among the individuals; seven were closed by sutures, four were full-thickness skin grafts, and nine were closed using a pedicled flap. The average follow-up period was 4.185 ± 3.09 years. Recurrence was observed in 8 out of the 20 patients 1–8 years after surgery (recurrence group). A significant (P = 0.04) difference in the average surgical margin was observed between the recurrence group (1.62 ± 0.74 cm) and the remaining patients (heal group; 2.83 ± 1.43 cm). The median Ki-67 value was 12%. Conclusion: Local control of DFSP after surgery is challenging. The first choice of DFSP treatment is surgery to clear the margins and reconstruct the area. Enhancing the diagnosis rate of DFSP during the initial visit is important for the proper management and operation opportunity.Item The ability of contrast-enhanced ultrasound with Sonazoid to differentiate endometrial carcinoma from benign endometrial lesions: A preliminary, prospective, and multicenter clinical study(Wolters Kluwer – Medknow, 2024-12) Li, Xin; Huang, Ying; Jiang, Tianan; Luo, Hong; Dong, Xuejuan; Zhuo, Tao; Cheng, Wen; Zhang, Xinling; Che, Ying; Zhang, Bingsong; Jiang, Xue; Liu, Rui; Zhang, Jing; Liang, PingObjective: To examine the diagnostic efficacy of contrast‑enhanced ultrasound (CEUS) with Sonazoid (Sonazoid‑CEUS) for endometrial lesions. Methods: In this prospective and multicenter study, data were collected from 84 patients with endometrial lesions from 11 hospitals in China. All the patients received a conventional US and Sonazoid‑CEUS examination. The lesion characteristics based on US and Sonazoid‑CEUS imaging were collected from the case report forms. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined using histopathologic diagnosis as the gold standard. Results: Of the 79 patients included, 29 were diagnosed with benign lesions and 50 with endometrial carcinoma (EC). The accuracy, sensitivity, specificity, PPV, and NPV for Sonazoid‑CEUS and US at differentiating EC from benign endometrial lesions were 82.2%, 94%, 62.1%, 81.0%, and 85.7%, and 79.7%, 96%, 51.7%, 92.3%, and 88.2%, respectively, with no significant differences observed for any of the values. For Sonazoid‑CEUS, the best delineators of EC versus benign lesions were early enhancement and hyperenhancement (74% vs 53.3%, P = 0.029, 68% vs 45%, P < 0.001), and lesion size enlargement (76% vs 48%, P = 0.001). Despite finding no significant difference in the enhancement patterns ( P = .367), a faster wash‑in pattern with the contrast agent entering before the surrounding myometrium was more common in the EC vs benign cases (92% vs 48.3%). Conclusions: Sonazoid‑CEUS has higher accuracy, specificity, and comparable sensitivity for differentiating EC from benign endometrial lesions compared with conventional US. It provides complementary hemodynamics information reflective of tissue vascularization, which may improve the overall diagnostic efficiency.