World Journal of Surgical Oncology最新文献

Background: Hemicorporectomy is an exceptionally rare and radical procedure reserved for highly selected patients with locally advanced pelvic malignancies without distant metastasis. Dedifferentiated sacral chordoma represents an aggressive histological subtype that may preclude conventional en bloc resection due to extensive local invasion. In such extraordinary circumstances, hemicorporectomy may be considered as a last-resort surgical strategy.

Case presentation: A 67-year-old male patient was diagnosed with a dedifferentiated sacral chordoma exhibiting extensive invasion of pelvic organs and retroperitoneal extension up to the L4 level, without distant metastasis. Following multidisciplinary evaluation, curative-intent hemicorporectomy was deemed the only feasible treatment option. The procedure was performed in a single-stage anterior-to-posterior approach, incorporating contemporary reconstructive techniques, including urinary diversion and an anterolateral thigh musculocutaneous flap. Pathological examination confirmed dedifferentiated chordoma with clear surgical margins. The postoperative period was complicated by wound-related issues requiring surgical debridement and an episode of pulmonary edema. Despite these complications, the patient achieved functional stabilization, including independent sitting and wheelchair mobilization. At six months, pulmonary metastases were detected, and palliative care was initiated. The patient died nine months after surgery due to pulmonary complications.

Conclusions: This case highlights that hemicorporectomy, though associated with significant morbidity, remains a viable curative or palliative option in carefully selected patients with locally advanced pelvic tumors. When performed with meticulous planning and multidisciplinary coordination, the procedure can provide meaningful short-term survival, symptom relief, and quality-of-life improvement in otherwise untreatable cases.

Background: Gallbladder cancer (GBC) is a highly aggressive malignancy of the digestive system with a poor prognosis. Therefore, the development of effective targeted therapeutic strategies is critical for improving survival outcomes in patients with GBC. Erb-B2 receptor tyrosine kinase 2 (ERBB2) is a proto-oncogene whose overexpression or mutation has been closely linked to the initiation and progression of various cancers.

Methods: Whole-exome sequencing (WES) was performed on tumor tissue from a patient with advanced GBC who underwent conversion surgery following combination therapy with the multi-targeted tyrosine kinase inhibitor anlotinib and the PD-1 immune checkpoint inhibitor camrelizumab, to identify potential genomic alterations associated with treatment response. Transcriptomic profiling was conducted in cell lines transfected with plasmids encoding either wild-type ERBB2 or the I655V mutant. Western blot analysis was used to assess activation of the downstream PI3K-AKT and MAPK-ERK signaling pathways and to measure PD-L1 expression levels. Bioinformatic analyses were employed to predict the structural and functional consequences of the ERBB2 I655V mutation.

Results: WES revealed that the ERBB2 I655V mutation may be associated with therapeutic response. Mechanistically, the I655V substitution resides within the GG4-like motif of the ERBB2 transmembrane domain and may alter the transmembrane dimerization interface, potentially promoting heterodimer formation with other ErbB family members and leading to enhanced downstream signaling. Transcriptome sequencing and in vitro experiments demonstrated that the ERBB2 I655V mutation constitutively activates ERBB2, resulting in sustained activation of the PI3K-AKT and MAPK-ERK pathways. This subsequently upregulates PD-L1 expression and contributes to an immunosuppressive tumor microenvironment, which may underline the observed clinical response to combined targeted and immunotherapy.

Conclusions: The ERBB2 I655V mutation may be associated with improved treatment response to immunotherapy in gallbladder cancer.

Background: Transarterial chemoembolization (TACE) remains a widely embraced therapeutic modality for primary liver cancer. The present study sought to explore the prevalence of psychological crisis in patients with primary liver cancer following TACE and pinpoint its associated factors, to provide actionable implications for enhancing clinical treatment and care protocols.

Methods: A cross-sectional study design was utilized. Eligible participants were patients diagnosed with primary liver cancer who had undergone TACE and admitted to our hospital during the period from January 2023 to March 2025. The Triage Assessment Form (TAF) was adopted to assess the psychological crisis status of all enrolled patients.

Results: A total of 276 primary liver cancer patients who had received TACE were included in the final analysis. The mean total score of psychological crisis among these patients was 18.25 ± 3.17. Spearman rank correlation analysis revealed significant associations between psychological crisis scores and age, gender, marital status, educational level, and average monthly household income (all p < 0.05). Multivariate linear regression analysis, adjusted for clinical covariates (Child-Pugh class, BCLC stage, TACE session frequency, post-procedural pain, and complications), confirmed the above five sociodemographic factors as independent correlates of psychological crisis scores (all p < 0.05). Collectively, these factors explained 56.2% of the variance in the outcome variable, with no statistically significant associations observed between psychological crisis scores and the included clinical variables (all p > 0.05).

Conclusion: Patients with primary liver cancer following TACE exhibit moderate acute post-procedural psychological crisis-like states, which are primarily associated with sociodemographic vulnerability factors rather than objective clinical indicators. Targeted psychological screening and brief interventions for high-risk groups (younger patients, females, unmarried/divorced individuals, those with lower educational attainment, and lower household income) are critical to mitigate the adverse impacts of acute psychological distress on perioperative TACE care.

Background: Recent advances in melanoma treatment, including targeted therapies and immunotherapies, have improved patient outcomes. The discovery of molecular targets is crucial, enabling more precise treatment strategies that address specific genetic mutations. Our study delves into the multifunctional role of coagulation factor Coagulation Factor V (F5) in melanoma.

Methods: The melanoma data about gene expression, clinical information, prognosis, and immune infiltration were obtained from TCGA database. The A2058 cell were used to examine the effects of F5 in the behavior of tumor cells in vitro.

Results: Our results revealed that F5 expression levels in melanoma patients are significantly correlated with prognosis, with lower expression levels associated with poorer outcomes. Single-cell transcriptomic analysis further revealed a strong association between F5 expression and diverse immune cell populations and chemokines. In addition, overexpression of F5 in the melanoma cell line A2058 significantly inhibited cell migration, proliferation, and colony formation capacity, while upregulating the expression of multiple immune chemokines.

Conclusions: These findings go beyond the traditional view of F5 as a coagulation factor and reveal its importance in immunomodulation and tumor biology.

Background: The comparative oncologic and perioperative benefits of three-field versus two-field lymphadenectomy in thoracic esophageal squamous cell carcinoma (ESCC) remain debated. This systematic review and meta-analysis evaluated outcomes across survival, nodal clearance, surgical metrics, and postoperative complications.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to June 15th, 2025. Comparative studies reporting outcomes of 3-field (3FL) versus 2-field (2FL) lymphadenectomy in thoracic ESCC were included. Primary outcomes were overall survival (OS), disease-free survival (DFS), recurrence, residual tumor status, and nodal/metastatic involvement. Secondary outcomes included lymph node yield, operative time, blood loss, hospital stay, complications, and mortality. Random-effects meta-analyses were performed using odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).

Results: Twenty-seven studies (28 reports) involving 10,039 patients (3FL: 3,389; 2-field: 6,504) were included. No significant differences were found in OS or DFS across all timepoints. R0 resection and recurrence rates were comparable. Three-field lymphadenectomy was associated with a higher number of dissected lymph nodes (MD = 15.01; 95% CI: 7.74-22.28), although heterogeneity was very high and small-study effects were detected. N + rates were only marginally higher with 3FL and did not reach significance (OR = 1.20; 95% CI: 0.99-1.47). Operative time, blood loss, and hospital stay were similar overall, but sensitivity analyses showed longer operative time and greater blood loss with the 3-field technique. Overall complication rates were not significantly different between groups; however, pulmonary complications (OR = 1.67; 95% CI: 1.06-2.63) and recurrent laryngeal nerve palsy (OR = 1.69; 95% CI: 1.06-2.69) were significantly higher with 3FL. Mortality rates were largely comparable, though in-hospital mortality was lower in the 3FL group (OR = 0.35; 95% CI: 0.13-0.93).

Conclusion: Three-field lymphadenectomy in thoracic ESCC provides superior nodal clearance but does not improve long-term survival compared to the two-field approach. It is associated with increased risk of certain complications. These findings highlight the trade-off between oncologic radicality and surgical risk, underscoring the need for individualized surgical decision-making.