Patients with metastatic castration-resistant prostate cancer (mCRPC) face poor prognoses due to tumor heterogeneity and drug resistance. Antibody-drug conjugates (ADCs) have been under development for over two decades for mCRPC treatment. Several clinical trials have demonstrated promising antitumor activity and acceptable safety profiles for ADCs in this setting. Among prostate-specific membrane antigen (PSMA)-targeted ADCs, ARX517 demonstrates superior safety and more significant prostate-specific antigen (PSA) reductions compared to earlier agents such as MLN2704, PSMA-ADC, and MEDI3726. ADCs targeting B7-H3, such as MGC018 and DB-1311, have also shown antitumor activity. ADCs targeting other antigens, including six-transmembrane epithelial antigen of the prostate (STEAP)1 (DSTP3086S), trophoblast cell surface antigen (TROP)2 (sacituzumab govitecan), and solute carrier (SLC) 44A4 (ASG-5ME), have shown preliminary antitumor activity in early trials but face challenges with insufficient efficacy or toxicity. Tisotumab vedotin (targeting tissue factor) has shown no significant therapeutic response in mCRPC. Meanwhile, disitamab vedotin (HER2-targeted), ABBV-969 and DXC008 (both dual PSMA/STEAP1-targeted) are currently under evaluation. Notably, an international multicenter phase Ⅲ clinical trial (NCT06925737) for mCRPC has been initiated in May 2025 for evaluating B7-H3-targeted ADC ifinatamab deruxtecan. This review summarizes recent advances in ADCs targeting key antigens in mCRPC (including PSMA, B7-H3, STEAP1, TROP2, SLC44A4, and others) and explores combination strategies, offering insights to inform the clinical management of mCRPC.

Objective: To establish a niraparib-resistant ovarian cancer cell line and preliminarily explore its biological characteristics and metabolic signatures. Methods: (1) Using ovarian adenocarcinoma cell line A2780 as parental cells, the niraparib-resistant cell line A2780-NiraR was established by the method of concentration gradient increased induction, and its morphological characteristics were observed using inverted phase-contrast microscope. The half-inhibitory concentration (IC50) of niraparib was determined by cytotoxicity assay. (2) Cell proliferation was determined by cell count kit-8 (CCK-8) assay and direct cell counting assay, cell cycle distribution was analyzed by flow cytometry. (3) The differential metabolites between A2780 and A2780-NiraR cells were detected by non-target metabolomics based on ultra-high performance liquid chromatography-high resolution mass spectrometry (UPLC/HRMS). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was conducted on the above differential metabolites to explore related metabolic pathways. Results: (1) Compared with the parental A2780 cells, A2780-NiraR cells exhibited predominantly short-spindle or oval morphology with reduced cellular projections and indistinct cell borders. The IC50 values of niraparib were 3.17 and 26.19 μmol/L against A2780 cells and A2780-NiraR cells, respectively (F=98.50, P<0.001). (2) A2780-NiraR cells had a slower proliferation rate compared with A2780 cells (F=146.80, P<0.001). The doubling time of A2780-NiraR cells [(37.5±1.9) hours] was significantly longer than that of A2780 cells [(14.5±1.0) hours; t=10.50, P<0.001]. Compared with the parental A2780 cells, A2780-NiraR cells had a significantly lower S phase fraction [(44.5±0.7)% in A2780 cells, (30.2±2.9)% in A2780-NiraR cells; t=4.78, P<0.001] and higher G0/G1 phase fraction [(35.4±1.2)% in A2780 cells, (52.2±3.1)% in A2780-NiraR cells; t=5.10, P<0.001]. (3) The metabolites of A2780 and A2780-NiraR cells were analyzed by non-target metabolomics. Forty-four differential metabolites between A2780 and A2780-NiraR cells were screened using the orthogonal partial least squares-discriminant analysis (OPLS-DA) model, the majority of which were significantly increased, such as pyrrolidone carboxylic acid, L-lysine and 1-pyrroline-4-hydroxy-2-carboxylate. Pathway enrichment analysis indicated that the arginine metabolism, purine metabolism, and pyrimidine metabolism were the most significantly enriched pathways. Conclusion: A2780-NiraR cells have acquired a stable niraparib resistance phenotype, and metabolic pathways including arginine metabolism may serve as potential therapeutic targets for enhancing niraparib efficacy in ovarian cancer.

Objective: To investigate the effectiveness and safety of secondary cytoreductive surgery (SCS) in patients with platinum-sensitive recurrent epithelial ovarian cancer who progressed after first-line maintenance therapy with poly adenosine diphosphate ribose polymerase inhibitor (PARPi). Methods: Clinical pathological data and prognostic information were retrospectively collected from 30 ovarian cancer patients who underwent SCS between January 2018 and June 2024. The Kaplan-Meier method was used to analyze the second progression-free survival (PFS2) time and 3-year overall survival (OS) rate. Results: (1) Primary treatment: the median age at diagnosis was 51.3 years. A total of 40% (12/30) patients underwent primary debulking surgery with an expectation of achieving no gross residual disease (R0), while 60% (18/30) received neoadjuvant chemotherapy and interval debulking surgery. Optimal cytoreduction was achieved in 93% (28/30) of patients. BRCA1/2 gene testing was performed in 29 patients (testing rate 97%, 29/30), identifying 11 BRCA-mutated (37%, 11/30) and 18 BRCA wild-type (60%, 18/30) patients. The median duration of PARPi maintenance therapy among the 30 patients was 11.9 months; patients with BRCA gene mutations had a median duration of 19.2 months, while those with BRCA wild-type had a median duration of 10.1 months. (2) Secondary surgery: pathologically confirmed recurrence patterns, single lesion in 9 patients (30%, 9/30), oligo-lesion (2 lesions) in 3 patients (10%, 3/30), and multi-lesion (≥3 lesions) in 18 patients (60%, 18/30). Among the 30 patients, optimal cytoreduction was achieved in 97% (29/30) of SCS patients, with suboptimal cytoreduction in 1 patient (3%, 1/30). Adjuvant chemotherapy included platinum+paclitaxel in 24 (80%, 24/30) patients and platinum+liposomal doxorubicin in 6 (20%, 6/30) patients. PARPi re-treatment was administered to 17 patients (57%, 17/30) after chemotherapy. (3) Efficacy and safety: as of the follow-up cutoff in June 2024, the median follow-up time was 28.0 months. A total of 19 (63%, 19/30) patients experienced the next recurrence. The median PFS2 time after SCS was 18.5 months. Recurrence occurred in 7 BRCA-mutated and 12 BRCA gene wild-type patients. Median PFS2 time was significantly longer in BRCA-mutated patients compared to BRCA wild-type patients (25.7 vs 14.1 months; P=0.028). Three deaths occurred during follow-up, resulting in a 3-year OS rate of 90%. Among the 30 patients, postoperative complications occurred in 4 patients (13%, 4/30). One patient developed a ureteral fistula on 7 days post-SCS requiring ureteral stenting, and one patient was transferred to the intensive care unit on 1 day post-SCS due to hypovolemic shock. No deaths occurred within 30 days after SCS. Conclusion: For platinum-sensitive recurrent ovarian cancer patients progressed after first-line PARPi maintenance therapy who are anticipated to achieve R0 resection, SCS represents a safe and effective second-line treatment option.

Objective: To evaluate the safety and effectiveness of fuzuloparib for the treatment of ovarian epithelial cancer patients in the real world setting. Methods: A retrospective analysis was conducted on the baseline data of 4 620 ovarian cancer patients who had received fuzuloparib monotherapy or combination therapy. Another 224 ovarian cancer patients who were willing to receive fuzuloparib monotherapy or combination therapy were prospectively enrolled, and their baseline characteristics, drug effectiveness, and safety data were analyzed. Results: (1) Among the 4 620 patients in the retrospective cohort, the median age of patients was 60 years; tumor types: 89.8% (4 149/4 620) had ovarian cancer. Among patients with clearly documented information, the vast majority had a histological type of serous carcinoma (82.9%, 3 770/4 546) and International Federation of Gynecology and Obstetrics (FIGO) staging of Ⅲ-Ⅳ (90.9%, 1 537/1 691). (2) Among the 224 patients in the prospective cohort, the median age of patients was 57 years; tumor types: 83.9% (188/224) had ovarian cancer. Among patients with clearly documented records, the predominant pathologic type was serous carcinoma (91.9%, 193/210), and FIGO stage was Ⅲ-Ⅳ in 79.9% (139/174). (3) Among the 224 prospective patients: 84 patients received first-line fluzoparib maintenance therapy, 92 patients received fluzoparib maintenance therapy after platinum-sensitive recurrence, 23 patients received direct fluzoparib treatment after platinum-sensitive recurrence, 19 patients received direct fluzoparib treatment after platinum-resistant recurrence. The median follow-up durations were 8.5, 8.7, 7.9, and 6.7 months, respectively. The median durations of fluzoparib treatment were 6.7, 4.8, 3.1, and 1.9 months, respectively. The median progression-free survival (PFS) times were not reached during follow-up, 12.6 months, not reached during follow-up, and 4.8 months, respectively. The 1-year PFS rates were 84.1%, 55.0%, 69.8%, and 45.5%, respectively. The remaining 6 patients received other fluzoparib regimens. (4) Among the 224 patients in the prospective dataset, 205 had safety data recorded. Of these, 127 patients (62.0%, 127/205) experienced treatment-related adverse events, with common events including anemia (24.4%, 50/205), thrombocytopenia (21.0%, 43/205), and leukopenia (19.5%, 40/205). Among the 205 patients, 43 (21.0%, 43/205) experienced grade 3 or higher treatment-related adverse events, with common events including anemia (8.3%, 17/205) and thrombocytopenia (8.3%, 17/205). Conclusions: The effectiveness of fuzuloparib in clinical application is generally consistent with other drugs in the same class, with good safety. This study provids new clinical evidence for the treatment of ovarian cancer with fuzuloparib.

Objective: To explore the application value of right-opening single flap valvuloplasty based on tubular stomach in gastrointestinal reconstruction after laparoscopic proximal gastrectomy. Method: Use a linear cutting stapler to make a parallel curve from the angle of the stomach to the junction of the gastric fundus to remove the lesser curvature of the stomach, and detach the gastric body about 5 cm away from the tumor to create a tubular stomach. Use a marker pen to draw a C-shaped seromuscular flap area with a width of 2.5 cm and a height of 3.5 cm 1.5 cm below the residual stomach closure nail, and create a free muscle flap in the gap between the plasma muscle layer and the submucosal layer. Make a transverse incision of 3 cm at the lower edge of the mucosal bed, and intermittently suture the entire lower edge of the gastric wall with 3 stitches. Under laparoscopy, use 4-0 barbed wire to suture the 1 cm wide muscular layer at the top of the tubular stomach and the posterior wall of the esophagus about 5 cm away from the esophageal stump with 3 stitches. Push the upper end of the tubular stomach into the mediastinum, and then tighten the barbed wire to ensure a tight fit between the stomach and the posterior wall of the esophagus. Use an ultrasonic scalpel to remove the esophageal stump, suture the entire posterior wall of the esophagus with the gastric mucosa, and use barbed wire to suture the anterior wall from left to right. The anastomotic site is completely covered with a free muscle flap, and the barbed line is used to continuously suture the muscle flap along the C-shaped line to the gastric pulp muscle layer at the edge of the mucosal bed, embedding the anastomotic site and completing the reconstruction of the digestive tract. Results: Clinical data of 23 patients (18 from the First Affiliated Hospital of Wenzhou Medical University and 5 from the Quzhou Hospital affiliated with Wenzhou Medical University) who underwent laparoscopic proximal gastrectomy, tubular gastroesophageal anastomosis, and pure manual right flap reconstruction surgery for esophagogastric junction adenocarcinoma and proximal gastric cancer from October 2023 to August 2024. There were 15 males and 8 females, with an age of (65.3±7.7) years, the BMI was (22.9±2.8) kg/m2. All patients in the group successfully completed the surgery, with a surgery time of (218.5±38.1) minutes, including (73.5±19.2) minutes for anastomosis, intraoperative blood loss of (64.5±15.4) ml, postoperative passage of gas on (3.4±0.5) days, first consumption of liquid food after surgery of (3.9±1.1) days, and postoperative hospital stay of (9.1±0.8) days. One patient developed anastomotic stenosis (grade I) after surgery, presenting with mild swallowing obstruction, which returned to normal after dietary adjustment, and there were no cases of secondary surgery. The median follow-up time for the entire group was 4.0 (0.7-7.0) months, during which there were no deaths or tumor recurrence or metastasis, no complications such as anastomotic stenosis or gastric emptying disorders, and no complaints of acid reflux or heartburn. At one month of postoperative follow-up, the reflux symptom index (RSI) score was (3.1±2.9) points, and at three months, the RSI score was (2.4±1.4) points. Conclusions: The application of right-opening single flap valvuloplasty based on tubular stomach for gastrointestinal reconstruction after laparoscopic proximal gastrectomy is safe,feasible,and has satisfactory short-term efficacy.

The liver is the main target organ for hematogenous metastases from colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for seven times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised Guideline version 2025 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, comprehensive treatment. The revised Guideline emphasizes precision treatment based on genetic molecular typing, especially recommending immune checkpoint inhibitors for dMMR/MSI-H patients, and enriched local treatment methods, such as liver transplantation, yttrium-90 microsphere selective internal radiotherapy, etc. The revised Guideline includes state-of-the-art experience and findings, detailed content, and strong operability.

Objective: Through microscopic and ultrastructural observations,to explore the origin of the cartilage of the anteroposterior pseudocyst.Staging for the auricular pseudocyst according to the different pathological changes and exploring its clinical significance. Methods: 48 cases(51 ears)of the auricular pseudocyst were collected as the observation objects(46 males, 2 females, 15-76 years old) and 45 patients(45 ears)chronic suppurative otitis media hospitalized patients who underwent tympanic membrane repair as a normal control group(43 males, 2 females, 12-74 years old).The outer wall of the cyst was surgically resected and the residual auricular cartilage was retained in the control group for HE staining or transmission electron microscopy specimens, and the specimens were observed and analyzed under light microscope and transmission electron microscopy. Results: According to the data of this study, auricular pseudocyst was relatively common in people aged 21-60 years. The disease course of 4 ears was ≤ 10 days,the course of 16 ears was > 10 days yet ≤ 30 days, the course of 20 ears was > 1 month but ≤ 2 months,the course of 6 ears was > 2 months yet ≤ 1 year, the course of 3 ears was > one year but ≤ two years,and the course of 2 ears was > 2 years. The observation of microstructure and ultrastructure of the different course of outer walls of the auricle pseudocyst was shown:due to various causes of cartilage fluid that separated perichondrium and cartilage tissue, when the perichondrium was stimulated, the bone progenitor cells from the quiescence phase came to the activities period. With the extension of the course, the periosteum was thickening gradually, cartilage the bone progenitor cells idifferentiated into chondroblasts, which idifferentiated into chondrocytes last, from native to mature, from thin to thick. It was stable a period of time when the cartilage mature. The outer wall of the cyst was new cartilage, which reflected additional growth. The nucleus of the chondrocytes evolved into nucleolysis, and necrosis, when the lesions was stimulated.The control group had a thin layer of cartilage and periosteum, containing a small amount of osteoprogenitor cells; the cartilage layer was thick, the cartilage cells were small near the periosteum, and the deep cartilage cells were large, all of which were mature chondrocytes. Conclusions: The outer cartilage of auricle pseudocyst is newborn cartilage. The pathological staging is divided into early stage(cartilage formation), middle stage(cartilage maturity) and late stage(cartilage necrosis).This stage can provide a reference for exploring the pathogenesis of pseudocysts of the auricle and formulating surgical treatment principles.

Lung cancer is the malignancy with the highest incidence and mortality burden globally, ranking first in both morbidity and mortality among all types of malignant tumors. Pathologically, lung cancer is classified into non-small cell lung cancer (NSCLC) and small cell lung cancer, with NSCLC accounting for approximately 85% of cases. Due to the often subtle or nonspecific clinical manifestations in early-stage disease, many patients are diagnosed at a locally advanced or metastatic stage, where treatment options are limited and prognosis remains poor. Therefore, molecular targeted therapy focusing on driver genes has become a key strategy to improve the survival outcomes of patients with advanced NSCLC. The epidermal growth factor receptor (EGFR) is one of the most common driver genes in NSCLC. While EGFR mutations occur in approximately 12% of advanced NSCLC patients globally, the incidence rises to 55.9% in Chinese patients. Among EGFR mutations, P-loop and αC-helix compressing (PACC) mutations account for about 12.5%. Currently, EGFR tyrosine kinase inhibitors (TKIs) have become the first-line standard treatment for advanced NSCLC patients with classical EGFR mutations, with efficacy well-established through clinical studies and real-world evidence. However, with rapid advancements in NSCLC precision medicine and deeper exploration of the EGFR mutation spectrum, EGFR PACC mutations have emerged as a key clinical focus. The structural characteristics of these mutations lead to significant variability in responses to EGFR TKIs, leaving therapeutic options still limited, while detection challenges persist due to the sensitivity constraints of current testing technologies, driving increasing demand for improved diagnostic and treatment approaches. The current clinical evidence primarily stems from retrospective analyses and small-scale exploratory studies, while prospective, large-scale, high-level evidence-based medical research specifically targeting this mutation subtype remains notably insufficient. This evidence gap has consequently led to the absence of standardized guidelines or expert consensus regarding optimal treatment strategies for advanced NSCLC with EGFR PACC mutations. As a clinical consensus specifically addressing EGFR PACC-mutant NSCLC, this document provides a comprehensive framework encompassing the clinical rationale for EGFR PACC mutation testing, therapeutic strategies for advanced-stage disease, management of treatment-related adverse events, and follow-up protocols. The consensus underscores the pivotal role of EGFR PACC mutation detection in precision medicine implementation while offering evidence-based recommendations to guide personalized therapeutic decision-making. By establishing clear clinical pathways encompassing molecular testing, therapeutic intervention, and long-term monitoring for EGFR PACC-mutant NSCLC, this consensus aims to meaningfully improve patient survival outcomes while serving as a robust, evidence-based foundation for developing personalized clinical management approaches.

Objective: To explore differences in the clinical and pathological features and postoperative survival after radical resection of biliary tract cancer in different locations such as intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,distal cholangiocarcinoma,and gallbladder cancer. Methods: This is a retrospective case series study. The clinical and pathological data of 4 852 patients with biliary tract cancer admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi 'an Jiaotong University from January 2013 to December 2022 were retrospectively analyzed. Among them, 2 110(43.49%%) patients were male and 2 742(56.51%) patients were female,aged from 26 to 88 years with age of (61.3±10.8) years. Observation indicators: (1) The distribution,diagnosis and treatment of patients with biliary tract cancer; (2) Comparison of clinical and pathological features of patients with biliary tract cancer after curative-intent resection; (3) Survival analysis of patients with biliary tract cancer after curative-intent resection; (4) Analysis of effect on adjuvant therapy for patients with biliary tract cancer after curative-intent resection. One-way analysis of variance,Kruskal-Wallis H test and χ2 test were used for among-group comparisons,respectively. Survival univariate analysis was performed using the Kaplan-Meier method and Log-rank test. Results: Among the 4 852 patients with biliary tract cancer,there were 2 303 cases (47.46%) of gallbladder cancer,952 cases (19.62%) of intrahepatic cholangiocarcinoma,892 cases (18.38%) of perihilar cholangiocarcinoma,and 705 cases(14.53%) of distal cholangiocarcinoma. From the perspective of the year of diagnosis and treatment,the overall number of patients diagnosed and treated for biliary tract cancer has shown an upward trend. From the perspective of diagnosis and treatment,the curative-intent resection rate was 33.37%(1 619/4 852),and the curative-intent resection rate of distal cholangiocarcinoma was higher than that of other biliary tract cancer (χ2=23.897,P<0.01). Univariate analysis showed that there were statistical differences in gender,age,bile duct stones,total bilirubin at admission,carcinoembryonic antigen,CA19-9,CA125,the degree of pathological differentiation,vascular invasion,microvascular invasion,perineural invasion,surgical margins,pT staging,and pN staging among patients for biliary tract cancer in different locations (all P<0.05). Survival comparison analysis showed that recurrence-free survival and overall survival of patients with gallbladder cancer after curative-intent resection were significantly better than those of intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,and distal cholangiocarcinoma (χ2=87.780,83.717,both P<0.01). Comparing the postoperative prognosis of patients with biliary tract cancer between the two periods of 2013 to 2017 and 2018 to 2022, the results showed that recurrence-free survival and overall survival of patients with biliary tract cancer from 2018 to 2022 were significantly better than those from 2013 to 2017 (χ2=31.202,25.615, both P<0.01),and the proportion of early recurrence and short-term death after curative-intent resection was significantly reduced (χ2=21.588,9.623, both P<0.01),with gallbladder cancer being the most significant (P<0.01). Postoperative adjuvant therapy for patients with biliary tract cancer can effectively prolong recurrence-free survival and overall survival (χ2=5.033,11.273,both P<0.05). Conclusions: Gallbladder cancer remains the most common biliary tract cancer with a relatively favorable prognosis after radical resection. There are significant differences in the clinical and pathological features of biliary tract cancer in different locations,and patients with adjuvant therapy effectively improving prognosis.

Objective: To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus. Methods: This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age (M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results: Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy (P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively (P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively (P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions: HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients' survival.

Multinodular hepatocellular carcinoma (HCC) poses substantial clinical challenges due to its high tumor burden,pronounced heterogeneity,and poor prognosis. This review summarizes current definitions and staging systems for multinodular HCC and examines the evidence and controversies surrounding surgical management. Particular attention is given to the efficacy and safety of hepatic resection across varying tumor burdens and biological behaviors. The heterogeneity between intrahepatic metastasis and multicentric occurrence subtypes is explored in the context of treatment decision-making. Liver transplantation,while potentially curative and offering notable survival benefits-especially for patients meeting the Milan criteria or within expanded selection frameworks-is limited by donor scarcity and the risk of post-transplant recurrence. Salvage transplantation remains a debated strategy for patients who experience recurrence after resection. In the era of targeted and immune therapies,combining locoregional approaches with systemic treatment has broadened the therapeutic landscape for unresectable multinodular HCC,creating new opportunities for conversion and downstaging. This review also highlights recent advances and persistent challenges in the clinical integration of these strategies. Moving forward,the management of multinodular HCC should prioritize precision medicine,multidisciplinary collaboration,and individualized treatment planning,supported by high-quality clinical research and technological innovation,with the ultimate goal of improving both survival and quality of life for patients.

This study investigates the expression pattern and functional significance of EF-hand domain-containing protein 2 (EFHD2) in hepatocellular carcinoma (HCC), with particular focus on its regulatory effects on tumor proliferation, migration, and invasion. Cellular experimental study was completed from June 2024 to January 2025 in the Basic Laboratory of the General Hospital of Southern Theater Command. TCGA database to determine EFHD2 expression and its clinicopathological correlations. GSCA database to assess methylation patterns and immune infiltration. Model of transient overexpression and knockdown of EFHD2 was constructed in hepatocellular carcinoma cells Hep3B, then RT-qPCR and Western blot were applied to verify the transfection efficiency. CCK-8 and colony formation assays for proliferation assessment, Transwell chambers for migration/invasion quantification. Protein-protein interaction networks were constructed via STRING, followed by GO/KEGG enrichment analysis. Statistical analysis was performed using the two independent samples t-test. The results showed that EFHD2 demonstrated significant upregulation in HCC tissues versus normal controls (P<0.05). Elevated EFHD2 expression correlated with advanced clinical stage (P<0.05) and poor differentiation (P<0.05). In the CCK-8 assay, the EFHD2 overexpression group demonstrated significantly higher cell viability than the control group, as evidenced by 450 nm relative absorbance values on Day 1 (0.529±0.019 vs. 0.515±0.016, F=0.041, P=0.320), Day 2 (1.356±0.019 vs. 1.094±0.042, F=3.833, P<0.001), Day 3 (2.817±0.049 vs. 2.143±0.124, F=3.833, P<0.001), and Day 4 (3.848±0.015 vs. 3.430±0.021, F=0.469, P<0.001). The EFHD2 knockdown group showed reduced cell viability compared to controls: Day 1 (0.541±0.020 vs. 0.552±0.015, F=0.098, P=0.423), Day 2 (1.154±0.009 vs. 1.326±0.029, F=2.485, P<0.001), Day 3 (2.453±0.041 vs. 2.653±0.031, F=0.479, P<0.001), and Day 4 (3.685±0.038 vs. 3.836±0.021, F=6.804, P<0.001). In colony formation assays, the overexpression group displayed a significant increase in colony numbers (254.667±23.861 vs. 186.000±16.703, F=0.865, P=0.015), whereas the knockdown group exhibited decreased colony formation (229.000±24.637 vs. 306.667±36.501, F=0.988, P=0.038). In Transwell assays, the EFHD2 overexpression group revealed enhanced migratory capacity [ (605.000±72.670) cells vs. (472.667±28.095) cells, F=2.462, P=0.042] and invasive potential [(767.333±21.221) cells vs. (414.333±16.623) cells, F=0.331, P<0.001]. The knockdown group showed attenuated migration [(311.000±71.084) cells vs. (479.667±50.846) cells, F=0.718, P=0.029] and invasion [(247.667±48.263) cells vs. (345.667±32.130) cells, F=0.727, P=0.043] compared to controls. The network of EFHD2-interacting proteins was further constructed by the STRING database, and the GO and KEGG analysis were used to perform bioinformatics analysis reveal that EFHD2 is mainly involved in actin cytoskeleton regulation. In conclusion, EFHD2 is highly expressed in HCC and is involved in the process of proliferation, migration and invasion of HCC.

Lung cancer is one of the leading causes of cancer-related mortality worldwide. Low-dose CT screening can increase the detection rate of early-stage lung cancer and reduce lung cancer mortality. This article compares and analyzes the latest Japanese and Chinese guidelines for low-dose CT lung cancer screening, exploring the commonalities and differences between the two countries in the construction of lung cancer screening systems and the detailed management of lung nodules. Both guidelines emphasize the importance of age and smoking in selecting screening candidates, but the specific criteria differ. The Japanese guideline targets heavy smokers aged 50-74 years, while its Chinese counterpart targets a broader high-risk population, including individuals with different ages, smoking histories, occupational exposures, and family genetic factors. In terms of equipment and radiation dose requirements, both guidelines consider individualization, but there are differences in specific values and methods. Regarding imaging and post-processing analysis, the Chinese guideline provides more detailed technical specifications, emphasizing the use of various post-processing techniques. In lung nodule management strategies, both guidelines adopt nodule classification, but there are differences in nodule size assessment criteria and follow-up intervention procedures, with the Chinese guideline placing greater emphasis on multidisciplinary team consultations. The Japanese guideline highlights easily overlooked imaging features of lung cancer and non-nodule manifestations, while the Chinese guideline emphasizes the integration of smoking cessation and lung cancer screening. Overall, the guidelines of the two countries share commonalities in many aspects of lung cancer screening but also have their own characteristics, and learning from each other can help improve lung cancer screening systems.

Objective: To explore the long-term survival outcomes of patients with anaplastic thyroid cancer (ATC) and analyze key factors influencing the prognosis. Methods: A retrospective analysis was conducted on the clinical and follow-up data of 77 ATC patients treated at the Sun Yat-sen University Cancer Center from March 2000 to July 2022, with tumor-specific survival as the primary endpoint. The Kaplan-Meier method was used to plot the survival curves, and univariate and multivariate Cox regression analyses were performed to identify the prognostic factors. Results: Among the 77 patients, 64 underwent surgical treatment, with 33 receiving surgery alone, 8 undergoing surgery combined with chemotherapy, 13 undergoing surgery with radiotherapy, 1 undergoing surgery with chemotherapy and radiotherapy, 2 receiving surgery combined with chemotherapy and targeted therapy, 3 receiving surgery with targeted therapy, and 4 receiving surgery with immunotherapy and targeted therapy. Among the 13 patients who did not undergo surgery, 2 received chemotherapy alone, 3 received targeted therapy alone, 1 received immunotherapy alone, 1 received chemoradiotherapy, 5 received chemotherapy combined with immunotherapy, and 1 received immunotherapy combined with targeted therapy. The median follow-up time was 8.4 months, with 58 patients (75.3%) died, and the median survival time was 6.63 months. Univariate Cox regression analysis showed that C-reactive protein, monocyte count, lymphocyte count, abnormal albumin levels, the maximum diameter of the primary tumor, BMI, and whether immunotherapy was administered were significantly associated with survival in ATC patients (all P＜0.05). Multivariate Cox regression analysis indicated that immunotherapy was an independent factor for survival in ATC patients (HR=0.18, 95% CI: 0.05-0.62, P=0.007). Among the 40 patients admitted after 2015, the 11 patients who received immunotherapy had a median survival time of 17.2 months, which was superior to the 29 patients who did not receive this treatment (median survival time 6.2 months, P=0.03). Conclusions: ATC patients receiving immunotherapy had a better prognosis and longer survival. Additionally, elevated C-reactive protein, abnormal albumin, monocyte count, lymphocyte count, and BMI might be associated with poorer prognosis in ATC. Tailoring treatment based on the individual characteristics of ATC patients may be beneficial for their long-term survival.

Objective: To detect the association of tumor circumferential involvement range (CIR) with neoadjuvant chemoradiotherapy (NCRT) efficacy and long-term survival outcomes in locally advanced rectal cancer (LARC) patients. Methods: Clinical data of 451 patients admitted to our hospital from January, 2018 to January, 2022 were retrospectively collected. According to the CIRs as determined by rectal magnetic resonance imaging, patients were divided into the High group (≥2/3 cycle, 270 patients) and the Low group (＜2/3 cycle, 181 patients). The primary outcome was three-year disease-free survival. The baseline characteristics, pathological features, and survival outcomes were compared. Results: Compared to patients in the Low group, patients in the High group exhibited significantly larger tumor vertical diameters [(4.7±1.7) vs. (3.6±1.4)cm, P＜0.001], higher rates of mrT4 stage (37.8% vs. 13.2%, P＜0.001), and higher rates of positive mesorectal fascia (54.1% vs. 29.8%, P＜0.001) and extramural vascular invasion (55.6% vs. 38.1%, P＜0.001). Patients in the High group were mainly pT3-4 stages (46.7% vs. 30.9%, P=0.002), with significantly lower rates of pathological complete response (22.2% vs. 33.1%, P=0.010) , poorer tumor regression grades (48.9% vs. 60.8%, P=0.013), and higher rates of positive peripheral nerve invasion (11.5% vs. 5.5%, P=0.031), as compared to patients in the Low group. The median follow-up time was 40 months. About 11 (2.4%) and 48 patients (10.6%) experienced tumor local recurrence and distant metastasis, respectively. The recurrence rates were 2.2% and 2.6%, and the distant metastasis rates were 7.7% and 12.6%, respectively, in the Low group and the High group, with no statistical significance (P=0.957, P=0.096). The three-year disease-free survival in the High group was significantly lower than that in the Low group (84.4% vs. 92.4%, P=0.014). Conclusions: The CIR is closely related to tumor burden, which can judge tumor response to NCRT, and is negatively related to survival prognosis. For patients who have more than a 2/3 cycle of CIR, intensified or consolidated treatments may be required to improve survival outcomes.

Objective: To explore the safety and efficacy of computed tomography (CT) guided percutaneous interstitial brachytherapy in the treatment of recurrent cervical cancer with isolated lesions in the radiated field. Methods: A retrospective analysis was conducted on the clinical data of 30 patients with recurrent cervical cancer with isolated lesions in the radiated field who underwent CT guided percutaneous interstitial implantation for close range radiation treatment at Zhengzhou University Affiliated Cancer Hospital from March 2023 to August 2024. Under local anesthesia, a needle was implanted into the recurrent tumor in the pelvic or abdominal wall of the patients percutaneously guided by CT. The target area was delineated to ensure full dose coverage. The prescribed dose for high-risk clinical target areas was 600 cGy/time, once a week, followed by close range radiotherapy. The number of implanted needles were recorded, and the target area, radiation dose, and other parameters were evaluated through dose volume parameter maps. The degree of lesion shrinkage and the occurrence of complications during and after treatment were observed. Results: 30 patients underwent a total of 72 rounds of brachytherapy with implantation, with a technical success rate of 100% (72/72). 20 cases received 2 treatments, 8 cases received 3 treatments, and 2 cases received 4 treatments; 4 cases used 1needle, 20 cases used 2 needles, 4 cases used 3 needles, and 2 cases used 4 needles. The high-risk clinical target dose D90 was (718.17±222.61) cGy. The average dose D2cc of 2 cm3 surrounding the bladder, rectum, sigmoid colon, and small intestine was (168.29±53.80) cGy, (178.87±105.38) cGy, (136.05±78.06) cGy, and (288.91±117.49) cGy, respectively. The median follow-up time was 11 months. Among the 30 patients, there were 12 cases of complete remission,14 cases of partial remission, 3 cases of stable disease, and 1 case of disease progression, with an objective remission rate of 86.7%. None of the patients experienced significant bleeding or pain during treatment. After treatment, 3 patients with recurrent lymph nodes near the rectum developed grade 1 radiation proctitis, which was remitted after treatment. No significant complications were observed in the remaining patients. Conclusion: CT guided percutaneous brachytherapy is safe and feasible for the recurrence of single lesions in the radiated field of cervical cancer.