中华肿瘤杂志最新文献

Objective: To analyze the distribution and temporal trends of the disease burden of prostate cancer, and to explore the relationship between the socioeconomic level and the disease burden. Methods: Data abstracted from GLOBOCAN 2022 were used to analyze the difference in the burden of prostate cancer at regional, national, and human development index (HDI) levels. Spearman test was used to explore the correlation between HDI and disease burden, and restricted cubic splines were used to fit the curve. Data in Cancer Incidence in Five Continents (CI5) was used to analyze the temporal trend of the prostate cancer incidence from 1988 to 2017, expressed by average annual percentage change (AAPC). Results: In 2022, the global estimated number of new cases of prostate cancer was 1 468 000, with an age-standardized incidence rate (ASIR) of 29.4/10⁵. The estimated number of deaths was 397 000, with the age-standardized mortality rate (ASMR) of 7.3/10⁵. Large disparities in disease burden exited across regions and countries. In 2022, the estimated number of new cases in China was 134 000, with 48 000 deaths. The ASIR was 9.7/10⁵, and the ASMR was 3.3/10⁵. According to different HDI levels, the highest ASIR (57.7/10⁵) was found in the very high HDI areas and the highest ASMR (14.0/10⁵) was found in the low HDI areas. Spearman correlation analysis showed that HDI was positively correlated with ASIR (r=0.49) and 1-mortality/incidence (r=0.84) and ASMR (r=-0.19) was negatively correlated with HDI. From 1988 to 2017, the country with the highest increase in the incidence rate of prostate cancer was found in China (AAPC=7.7%), and decreased most in the United States (AAPC=-1.4%), both P＜0.05. Conclusion: The burden of prostate cancer is still relatively heavy globally, with different countries and regions showing different burden patterns, which are closely related to the level of development.

Objective: To explore the pathogenesis, clinicopathological and molecular genetic features of H3/IDH wildtype, paediatric-type high-grade glioma (RTK1). Methods: A total of five cases diagnosed by the clinical features,imaging,histopathology,molecular genetics and prognosis from the Department of Pathology, the First Medical Center of PLA General Hospital were collected(2022-2025). Results: Among the five cases, three were female and two were male, aged 5-38 years,the median age is 8 years old.Tumors were located in the left/right frontal lobe, cerebellum brainstem, and right temporal lobe, respectively. The poor limb movement, unstable walking, headache accompanied by nausea, vomiting in five cases. Histopathology shows features of high-grade gliomas histological changes characterized by densely arranged cells with cell atypia, vascular proliferation,necrosis and mitotic activity. Molecular showed of PDGFRA amplification or mutation in five cases, accompanied by MGMT methylation, TERT, TP53 mutation. The total course of disease from onset to death in one case is about 10 years, indicating that the progression of the disease is slower than that of adult high-grade gliomas. Conclusions: Pediatric-type gliomas occur predominantly in children but can also be observed in adults. Their disease progression and prognosis are generally more favorable compared to adult-type high-grade gliomas. Molecular testing plays a crucial role in diagnosis and differential diagnosis, holding significant importance for treatment and prognosis evaluation.

Objective: To address postoperative complications of esophageal cancer, especially anastomotic leakage and the resulting fatal infections, we aimed to establish an optimized surgical system, secure approach for esophagectomy with retrosternal reconstruction (SAFER), centered on the retrosternal reconstruction route, with the goals of reducing surgical risk and enhancing surgical quality. Methods: The SAFER esophagectomy system was developed in collaboration with 9 medical centers in China. We retrospectively analyzed data from 131 consecutive esophageal cancer patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences and Nanjing Drum Tower Hospital between January and April 2025. All patients underwent thoracoscopic-laparoscopic-assisted three-incision esophagectomy or inflatable mediastinoscopic esophagectomy, with digestive tract reconstruction via the retrosternal route. Key components of the SAFER system included: (1) Standardized total mesoesophageal excision and lymphadenectomy with preservation of the azygos vein arch and right bronchial artery; (2) Gastric mobilization and abdominal lymphadenectomy; (3) Tubular stomach construction and retrosternal tunnel creation; (4) Cervical anastomosis; (5) Enhanced recovery after surgery (ERAS) protocols. Results: There were no perioperative deaths. The anastomotic leakage rate was 5.3% (7/131), significantly lower than the rates reported in most traditional literature (4.2%-22.2%). None of the leakage cases developed systemic infection or organ failure, with an average healing time of 17 days. Other complications included pneumonia (8.4%, 11/131), hoarseness (9.2%, 12/131), and atrial fibrillation (7.6%, 10/131). No chylothorax occurred. Median operative time was 268 minutes, with a median blood loss of 50 ml. The median number of lymph nodes dissected was 36 (19 thoracic + 17 abdominal). Physical status score at 1 week postoperatively was 0-1, and the average hospital stay was 7 days. Conclusions: The SAFER system, utilizing retrosternal reconstruction and other optimized procedures, maximally isolates the tubular stomach and anastomosis from the thoracic cavity, thereby preventing systemic infection caused by anastomotic leakage. Its standardized workflow significantly reduces surgical complexity, ensures oncological resection and standardized lymphadenectomy, and facilitates rapid recovery, providing a safe and high-quality solution for esophageal cancer surgery.

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Standardized pathological diagnosis of lung cancer is crucial for determining clinical strategy and evaluating prognosis. Currently, there are issues such as relatively lagging overall construction, uneven diagnostic levels and inaccessibility to advanced diagnostic techniques in the pathology departments of county-level and prefectural medical institutions within the close-knit medical alliance in China. To implement the national policy on the hierarchical diagnosis and treatment of lung cancer, standardize the pathological diagnosis of lung cancer in county-level and prefectural medical institutions to meet the basic needs of lung cancer diagnosis and treatment, and support the advancement of the Healthy China strategy and the construction of a close-knit medical alliance, experts were organized by the Lung Cancer Group of the Pathology Committee of the China Anti-Cancer Association, to develop comprehensive consensus recommendations and their levels to promote the standardization of the entire process of lung cancer pathological diagnosis. This was done by combining domestic and international guidelines and current domestic situation, focusing on three types of specimen: cytology, biopsy and surgical resection. The consensus framework is constructed and elaborated from five aspects: pre-processing of specimen standardization, morphological pathological assessment, immunohistochemistry, special staining, molecular pathological detection and standardized reporting. It also covers issues of concern in industry such as postoperative pathological assessment after neoadjuvant therapy and intraoperative frozen diagnosis. During the process of consensus formation, the Delphi questionnaire survey and consensus conference method were used, by combination of online and offline forms. The consensus focuses on the standardization and feasibility of application, aiming to promote the standardization of lung cancer pathological diagnosis and provide guiding suggestions for clinical diagnosis, treatment, and prognosis evaluation of lung cancer in county-level and prefectural medical institutions.

Objective: To analyse the incidence and mortality of leukemia in China and some regions around the world in 2022, and to provide data support and scientific basis for leukemia prevention and control. Methods: Based on GLOBOCAN 2022 database, the incidence and death data of leukemia in different regions in the world and China were collected, and the epidemiological characteristics of leukemia were analyzed according to the regions, genders, ages and human development index (HDI). The correlation between HDI index and age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) was analyzed by Spearman's rank correlation test. Results: In 2022, the global number of new and fatal leukemia cases were 487,294 and 305,405, respectively, with ASIR and ASMR at 5.3/10⁵ and 3.1/10⁵. The highest numbers of new and fatal cases were in Asia, totaling 227 206 and 158 144, respectively, accounting for 46.6% and 51.8% of the global totals. North America and Oceania had relatively high ASIR (11.2/10⁵ and 10.2/10⁵ respectively), while Oceania and Latin America and the Caribbean region had relatively high ASMR (both at 3.7/10⁵). Globally, the ASIR and ASMR of leukemia in males are both 1.4 times of those in females. The incidence and mortality of leukemia in the elderly were significantly higher compared to the working-age population and children and adolescents, in which the incidence ratio of the elderly and the working-age population is 6.3 and the mortality ratio is 8.3. HDI levels were positively correlated with both ASIR (r=0.78, P＜0.001) and ASMR (r=0.39, P＜0.001) across different regions. In 2022, the number of new and fatal leukemia cases in China were 81 946 and 50 074, respectively, with the ASIR and ASMR were 4.5/10⁵ and 2.4/10⁵ respectively. The ASIR and ASMR for males in China were 1.3 and 1.4 times of those for females, respectively. In terms of the incidence trend of leukemia, the incidence of male and female leukemia in China was relatively stable from 2002 to 2017. It is predicted that the number of leukemia cases and deaths in China in 2050 will be 111 189 and 78 995, respectively, with an increase of 35.7% and 57.8% compared with 2022. Conclusions: There are significant differences in the burden of leukemia by region, HDI, sex, and age. With the aging of the population and the acceleration of industrialization, the risk of leukemia incidence and death in China has further increased, and the prevention and treatment of leukemia should be further strengthened.

Objective: The optimal adjuvant treatment regimen for pancreatic cancer after surgery remains undetermined. This study aimed to compare the efficacy and safety of S-1 combined with gemcitabine (GS) versus S-1 monotherapy in adjuvant therapy for pancreatic cancer. Methods: A retrospective analysis was conducted on postoperative pancreatic ductal adenocarcinoma (PDAC) patients who received GS or S-1 adjuvant chemotherapy at Peking Union Medical College Hospital from March 2016 to September 2024. Clinicalopathological characteristics, molecular features, treatment details, efficacy outcomes, and toxicity data were collected via electronic medical records and telephone follow-up. Results: A total of 454 patients were included, with 313 receiving GS and 141 receiving S-1. GS-treated patients were generally younger (median age: 62 vs. 66 years, P＜0.001). The median disease-free survival (DFS, 15.4 vs. 12.5 months, P=0.150) and overall survival (OS, 33.5 vs. 24.7 months, P=0.150) showed trends toward prolongation in the GS group compared with the S-1 group. In CA19-9-positive patients prior to adjuvant chemotherapy, GS therapy significantly prolonged DFS (10.7 vs. 8.8 months, P=0.040) and OS (28.2 vs. 19.8 months, P=0.003) compared with S-1 monotherapy. However, the GS group had a higher incidence of grade ≥3 adverse events [59.3%(128/216) vs. 39.4%(26/66), P=0.007], particularly neutropenia [40.7%(88/216) vs. 19.7%(13/66), P=0.003] and fatigue [19.0%(41/216) vs. 7.6%(5/66), P=0.045]. Molecular analysis revealed that TP53 gene variants may predict poor survival outcomes, but no association was observed between homologous recombination repair-related gene variants and treatment efficacy of GS or S-1. Conclusions: GS adjuvant therapy demonstrates trends toward improved DFS and OS compared with S-1 monotherapy in postoperative pancreatic cancer patients, though without statistical significance. GS was superior to S-1 in CA19-9-positive patients. The correlation between genetic mutation profiles and adjuvant treatment outcomes in pancreatic cancer requires further exploration.

With the development of precision medicine and big data technology, a large amount of medical data continues to accumulate, providing solid support for the application of real world study (RWS) in the field of cancer. Real world data (RWD) originates from clinical practice and can compensate for the limitations of randomized controlled trials, providing key evidence in the development of tumor prevention and control strategies, drug research and development, and medical insurance decisions. This article systematically reviews the design strategies of tumor RWS, including data source selection, research directions and research design types. It also delves into data analysis techniques such as data processing, statistical analysis methods, and bias control. In addition, this article summarizes the challenges currently faced by tumor RWS, such as data quality, privacy protection, and heterogeneity processing, and future development directions, such as artificial intelligence driven analysis and global collaboration. This article aims to provide methodological references for researchers and promote the standardized development of real world evidence (RWE).

The development of artificial intelligence technologies, the promotion of precision medicine concepts, and the widespread application of electronic health data and multi-omics data have collectively advanced the use of clinical prediction models as essential tools for supporting medical decision-making in oncology research. However, despite the rapid growth in related research, much research remains difficult to implement in clinical practice due to methodological inconsistencies and limited evidence quality. Ensuring the scientific rigor, interpretability, and clinical utility of prediction models has become a key challenge for researchers. Taking the field of oncology as an example, this paper systematically reviews the common types and whole framework of prediction model research and explores relevant methodological principles, common challenges, and pitfalls across key stages, including research topic selection, study design, and study implementation, to provide methodological guidance for oncology prediction model research.