中华肿瘤杂志最新文献

Lung cancer is one of the malignant tumours with the highest morbidity and mortality rates worldwide today, posing a major threat to human health. Accurate diagnosis and standardised treatment play a crucial role in improving the survival rate of lung cancer patients. In recent years, the rapid rise of artificial intelligence (AI) has brought about significant changes in the medical field, providing a new diagnostic and treatment model for lung cancer, and making a series of breakthroughs in lung cancer diagnostic imaging, pathological diagnosis, surgical oncology, radiotherapy, and drug development and treatment. This article introduces the current status of AI application in the field of lung cancer diagnosis and treatment, and extensively discusses the current challenges and future prospects, hoping to provide references and suggestions for future clinical practice.

Objective: To explore the association of 21-gene recurrence score (RS) and clinicopathologic characteristics of hormone receptor (HR) positive T1-3N1M0 breast cancer and its value in prognosis evaluation. Methods: The clinicopathological data of 287 patients with T1-3N1M0 breast cancer were collected, the 21-gene assay was completed, and follow-up was conducted. According to the 21-gene RS, the patients were divided into the RS<26 and RS≥26 groups. The relationship between the 21-gene RS and clinicopathological characteristics, treatment, recurrence, and metastasis was analyzed. Univariate and multivariate statistical analyses were used to analyze the risk factors for disease free survival (DFS). Results: The median RS of the 287 patients was 16. There were 240 cases with RS <26 and 47 cases with RS≥26. Tumor size, grade, estrogen receptor (ER), progesterone receptor (PR), and Ki-67 index were significantly different between the two cohorts (P<0.05 for all). After a median follow-up of 74 months, the recurrence rate in the RS<26 group (8.3%) was significantly lower than that in the RS≥26 group (23.4%), the locoregional recurrence (LRR) rates in the RS<26 and RS≥26 groups were 2.1% and 0%,and the distant metastasis (DM) rates were 6.3% and 23.4%, respectively. The 5-year relapse free survival (RFS) rates of patients with RS<26 and RS≥26 were 93.8% (95% CI: 90.7%-96.9%) and 87.2% (95% CI: 78.2%-97.3%), and the 5-year DFS rates were 92.1% (95% CI: 88.7%-95.6%) and 85.1% (95% CI: 75.5%-95.9%), respectively, with significant differences between the two cohorts (P=0.007 and P=0.006, respectively). Univariate analysis showed age, tumor size, grade, PR status, Ki-67 index and RS were prognostic factors for DFS (P<0.05 for all). Multivariate analysis showed that age and tumor size were independent significant predictors for DFS (P<0.05). Conclusions: The 21-gene RS of T1-3N1M0 breast cancer is related to tumor size, grade, ER, PR, and Ki-67 index. RS is an important factor affecting DM and DFS.

Objective: To develop a tool package that meets the routine statistical analysis requirements of population-based cancer registries in China based on R language, with the aim of improving data quality and efficiency, and promoting the nationwide scientific utilization of cancer registry data. Methods: The functional demands for statistical analysis of population-based cancer registry staff were collected through questionnaires or face-to-face interviews. Based on the concept of generic functions in R software's S3 object system, functions were developed by defining specific S3 classes for different data types, allowing the same function to perform diverse tasks depending on the class of input data. A stepwise development strategy was adopted to ensure logical coherence among functional modules, and all functions were systematically tested and validated in accordance with standard R package development guidelines. Results: Six categories of functions, including data reading, data manipulation, data processing, statistical calculation, visualization, and statistical reporting, were developed to support routine statistical analysis of population-based cancer registry data. Data reading functions support reading data formats required by the National Cancer Registry. Data manipulation functions empower conditional filtering of registry data and support regrouping, merging, or transforming the data based on registry attributes (such as urban/rural location) to accommodate different analytical needs. Data processing functions includes age grouping, International Classification of Diseases 10^th Revision (ICD-10) classification, childhood cancer classification, and population estimation. Statistical calculation functions permit the calculation of age-standardized rates, truncated rates, cumulative rates, cumulative risks, life tables, and expansion from abridged to complete life tables. Visualization functions can generate commonly used statistical charts, including population pyramids, bar charts, and line graphs. Statistical reporting functions can integrate key indicators, charts, and narrative descriptions into comprehensive cancer registry reports. Conclusion: An R package named Canregtools was developed based on the concept of S3 generic functions. This package is free of charge, open-source, and highly efficient. It can meet the diversified needs in cancer registry data analysis, visualization, and reporting through standardized data processing workflows, thereby enhancing the quality and efficiency of routine statistical analysis in population-based cancer registries in China.

Objective: To explore the application of the suspension culture method in pancreatic cancer organoid construction. Methods: Cell suspensions obtained from 8 pancreatic cancer tissue samples at the Second Hospital of Lanzhou University between July 2023 and March 2024, were prepared by digested pancreatic cancer tumor tissues using mixed enzymes, inoculated into ultra-low adsorption culture plates for suspension culture, and when the organoids were cultured to a certain size, passaging and freezing were initiated, and their structural morphology was observed by inverted microscope. Hematoxylin-eosin (HE) staining showed that pancreatic cancer organoids were lumpy or irregularly tubular, with obvious nuclear atypia, and were remarkably similar in tissue structure to pancreatic cancer tissue. Results: Among the 8 pancreatic cancer tissue samples, pancreatic cancer organoids were successfully constructed in three patients, and HE staining showed that pancreatic cancer organoids had a high degree of structural similarity with tumor tissues. Immunohistochemistry suggested that CK7, CK19, P53, and Ki-67 were expressed in the pancreatic cancer organoids and tumor tissues of case origin in more or less the same way. Conclusion: The suspension culture method is able to construct pancreatic cancer-like organs that are approximately the same as the originating tumor tissues at the tissue level.

Objective: To investigate the clinical application of internal mammary perforator (IMP) as recipient vessels in immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flap. Methods: The clinical data of 10 patients with early breast cancer who underwent DIEP for immediate breast reconstruction using IMP as the recipient vessels from January 2022 to December 2023 were analyzed. The number, position, and diameter of IMP, diameter of DIEP, the size of the flap, the operation time, surgical complications, cosmetic effect of breast, and patients' satisfaction were summarized and analyzed. Results: The number of IMPs was 2-3, and they were distributed in the second to the fourth ribs. The diameter of the IMP artery was (1.15±0.22) mm, and the diameter of the vein was (1.35±0.19) mm. The diameter of the DIEP was (1.55±0.28) mm, and that of its accompanying vein was (1.50±0.23) mm. The sizes of the flaps ranged from 10.0 cm×8.0 cm×3.0 cm to 12.0 cm×22.0 cm×4.0 cm, with an average of 20.5 cm×11.2 cm×2.8 cm. The weight of the flap was (389.1±51.5) g. The operation time was (574.8±68.1) min. All 10 cases of flaps survived. The reconstructed breasts were natural, soft, and symmetrical to the healthy side breasts. There was no obvious operative complication. The average BREAST-Q score of the patients was 93.5. No recurrence or metastasis was found during follow-up. Conclusions: Although technically difficult, using IMP as recipient vessels in DIEP flats for immediate breast reconstruction results in a low complication rate of the injuries in the internal mammary region. Under the premise of strictly adhering to the surgical indications, satisfactory results can be achieved, and it is safe and reliable.

Objective: To explore the safety and efficacy of camrelizumab combined with tegafur gimeracil oteracil potassium (S-1) and albumin-bound paclitaxel in the treatment of initially unresectable cholangiocarcinoma. Methods: From October 2022 to August 2024, 17 patients with unresectable intrahepatic cholangiocarcinoma and 4 patients with hilar cholangiocarcinoma were admitted to Xiangyang Central Hospital. They received treatment with camrelizumab combined with S-1 and nab-paclitaxel. Their short-term efficacy and adverse reactions were evaluated, and their long-term survival was followed up. Results: Of the 21 patients, 2 were in complete remission, 6 were in partial remission, 12 had stable disease, and 1 had progressive disease. The objective remission rate was 38.10% (8/21), and the disease control rate was 95.23% (20/21). Five patients were converted to resectable cholangiocarcinoma, with a conversion success rate of 23.81%,2 patients had complete postoperative pathological remission, and 3 patients had major pathological remission. The median progression-free survival time was 11 months (95% CI: 8.37-13.62), and the 1-year progression-free and overall survival rates were 28.57% and 95.23%, respectively. The overall adverse event rate was 90.48% (19/21), and the grade 3 adverse event rate was 28.57% (6/21). Conclusion: The combination of camrelizumab with S-1 and nab-paclitaxel for initially unresectable cholangiocarcinoma has favorable short-term efficacy, tolerable adverse reactions, and improved long-term survival for patients.

Objective: To investigate the correlations between primary location and other clinical characteristics of papillary thyroid carcinoma (PTC) with cervical lymph node metastasis, providing evidence for optimizing surgical strategies. Methods: A total of 805 patients with unifocal PTC who underwent surgical treatment at the Sixth Medical Center of PLA General Hospital from January 1, 2015 to March 16, 2025, were included. Data on gender, age, tumor location and size, preoperative ultrasound findings, and postoperative pathological diagnosis were collected. The associations between clinical characteristics and lymph node metastasis in the central compartment (Level Ⅵ) and lateral neck (Levels Ⅱ-Ⅳ) were analyzed. Chi-square tests and multivariate logistic regression were used to identify independent risk factors for lymph node metastasis. Results: Among the 805 PTC patients, 363 (45.1%) had lymph node metastasis, including 44 (5.5%) in Level Ⅱ, 64 (8.0%) in Level Ⅲ, 79 (9.8%) in Level Ⅳ, and 345 (42.9%) in Level Ⅵ, with Level Ⅵ showing the highest metastasis rate. Multivariate logistic regression analysis revealed that male sex (OR=1.43, P=0.031), age <55 years (OR=2.02, P<0.001), tumor located in the lower pole (OR=1.88, P<0.001), and tumor size >1.0 cm (OR=3.15, P<0.001) were independent risk factors for Level Ⅵ metastasis. Male sex (OR=4.20, P=0.006) and tumor located in the upper pole (OR=6.78, P<0.001) were independent risk factors for Level Ⅱ metastasis. Tumor size >1.0 cm (OR=2.77, P=0.006) was an independent risk factor for Level Ⅳ metastasis. Age <55 years (OR=6.00, P=0.003), tumor located in the upper pole (OR=2.17, P=0.002), and tumor size >1.0 cm (OR=3.65, P<0.001) were independent risk factors for metastasis involving >5 lymph nodes. Patients with tumors in the isthmus had a significantly higher Level VI metastasis rate (85.7%, 12/14) compared to those with tumors in the thyroid lobes (42.2%, 334/791, P=0.001), and a higher rate of bilateral Level Ⅵ metastasis (35.7%, 5/14 vs. 5.1%, 40/791, P<0.001). Conclusions: Lymph node metastasis in PTC is closely associated with tumor location and size. Tumors in the lower pole primarily metastasize to Level Ⅵ, whereas those in the upper pole are more likely to metastasize to Level Ⅱ. For low-risk PTC confined to the thyroid lobe, lobectomy with isthmusectomy and central lymph node dissection is recommended. For isthmic tumors, total thyroidectomy with bilateral central lymph node dissection is advised. Male patients with upper pole tumors require careful preoperative evaluation of Level Ⅱ lymph node involvement. For patients aged <55 years with tumors >1.0 cm in the upper pole, individualized treatment strategies should be formulated based on additional high-risk factors.