World Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Fibroblast-associated CTHRC1 as a key indicator of recurrence risk in prostate cancer.
Ma Y, Lin G, Wang K … +9 more , Liu Z, Shao Y, Yu W, Zhao X, Yu D, Zhan F, Wang X, Duan S, Duan K
World J Surg Oncol · 2026 Mar · PMID 41832493 · Full text
BACKGROUND: Prostate adenocarcinoma (PRAD) has substantial recurrence after primary treatment, and reliable prediction is clinically needed. We integrated clinical, genomic, and transcriptomic data to identify recurrence...
BACKGROUND: Prostate adenocarcinoma (PRAD) has substantial recurrence after primary treatment, and reliable prediction is clinically needed. We integrated clinical, genomic, and transcriptomic data to identify recurrence-associated genes, characterize their tumor microenvironmental context, and develop a prognostic model. METHODS: Gene expression and clinical data were obtained from TCGA (training; n = 145) and the GEO dataset GSE54460 (validation; n = 106). Single-cell RNA-seq data were analyzed to resolve gene expression across cell types. Immune infiltration was estimated using ssGSEA and the ESTIMATE algorithm, and cell–cell communication was assessed with CellChat. Recurrence-associated genes were identified by univariate Cox regression, and a LASSO Cox model was used to construct and externally validate the risk score. RESULTS: Pathological T stage, N stage, Gleason score, and TP53 mutation were linked to higher recurrence risk. We identified six risk genes (AMH, CRYBA2, CTHRC1, EFNA2, BMP6, ARHGDIG) and two protective genes (CKMT2, IP6K3) and built a risk-score model that discriminated against PFS in the training and validation cohorts. Single-cell analysis localized CTHRC1 predominantly to a fibroblast subpopulation characterized by upregulated midkine (MDK) signaling and extensive intercellular communication. Drug–gene correlation screening nominated decitabine, tegafur, calusterone, EMD-1204831, and ARQ-680; expression of several risk genes positively correlated with CTLA4, suggesting testable sensitivity to checkpoint blockade. CONCLUSIONS: Clinical variables together with transcriptomic features—particularly a CTHRC1-high fibroblast program—associate with PRAD recurrence. The externally validated risk score and the stromal context of CTHRC1/MDK provide testable avenues for prognosis and therapeutic exploration.
Sentinel lymph node status and oncological outcomes of high-risk and low-risk cutaneous primary melanoma.
Mohamed HS, Fadel MG, Wilkinson MJ … +5 more , Hadjicosta O, Weir J, Power K, Hayes AJ, Smith MJ
World J Surg Oncol · 2026 Mar · PMID 41826996 · Full text
INTRODUCTION: The role of sentinel lymph node biopsy (SLNB) in clinically node-negative melanoma has been questioned in the era of effective adjuvant immunotherapy. We evaluated the staging and prognostic value of SLNB i...
INTRODUCTION: The role of sentinel lymph node biopsy (SLNB) in clinically node-negative melanoma has been questioned in the era of effective adjuvant immunotherapy. We evaluated the staging and prognostic value of SLNB in a single-centre cohort, with emphasis on patients with “high-risk” primary tumours. METHODS: We retrospectively analysed 300 consecutive patients with cutaneous melanoma who underwent wide local excision with SLNB at a tertiary melanoma centre (April 2018–April 2023). Patients were stratified by AJCC 8th edition T stage into low-risk (T1–T3a) and high-risk (T3b–T4b) groups. Outcomes included SLN positivity, recurrence, and disease-free survival (DFS). DFS was assessed using Kaplan–Meier methods with log-rank testing; restricted mean survival time (RMST) was calculated to 3 years. In high-risk patients with available data, the Melanoma Institute of Australia sentinel node risk tool was evaluated for discrimination and calibration. RESULTS: Median age was 60.7 years and 51.3% were male. Overall SLN positivity was 22.0% (66/300) and was higher in high-risk than low-risk melanoma (31.5% [28/89] vs. 18.0% [38/211], P = 0.009). Recurrence occurred in 16.0% (48/300), more frequently in high-risk patients (31.5% vs. 9.5%). Estimated DFS at 1 and 3 years was 96.6% and 81.8% for low-risk melanoma versus 87.9% and 68.6% for high-risk melanoma (log-rank P < 0.001); RMST to 3 years favoured the low-risk group by 115.9 days (95% CI 20.8–213.3). SLNB resulted in substantial stage migration in high-risk clinically node-negative patients, identifying pathological stage IIIC disease in 31.5% (28/89) who would otherwise be classified as stage IIB/IIC. CONCLUSION: SLNB continues to provide clinically important staging and prognostic information, particularly in high-risk clinically node-negative melanoma where occult nodal disease is common. Omitting SLNB risks systematic understaging and loss of prognostic resolution.
Neoadjuvant afatinib in a patient with locally advanced lung adenocarcinoma harboring an NPTN-NRG1 fusion: a case report.
Zhou CY, Xu ZY, Qiu ZB … +5 more , Wang F, Li HJ, Liao RQ, Wu YL, Zhong WZ
World J Surg Oncol · 2026 Mar · PMID 41826994 · Full text
BACKGROUND: Stage III non-small cell lung cancer (NSCLC) is heterogeneous and poses significant treatment challenges. In recent years, neoadjuvant therapy has emerged as a promising treatment strategy for patients with s...
BACKGROUND: Stage III non-small cell lung cancer (NSCLC) is heterogeneous and poses significant treatment challenges. In recent years, neoadjuvant therapy has emerged as a promising treatment strategy for patients with stage III NSCLC. CASE PRESENTATION: We report the case of a 39-year-old woman with stage IIIB lung adenocarcinoma harboring a neuroplastin-neuregulin 1 (NPTN-NRG1) fusion who achieved a dramatic response to neoadjuvant afatinib. After three months of therapy, imaging showed a partial response; the patient subsequently underwent complete surgical resection with an uneventful recovery and has remained disease-free to date. To explore the mechanism underlying this response, we performed single-cell RNA sequencing (scRNA-seq) and T-cell receptor (TCR) sequencing of tumor tissues and lymph nodes. The analysis revealed a mutual interaction between CD8+ effector T cells, CD8+ memory T cells, and natural killer-like (NK-like) T cells via C-C chemokine ligand (CCL)5-C-C chemokine receptor (CCR)5, CCL5-CCR3, and CCL5-CCR1 ligand-receptor pairs. These findings indicate that the post-treatment microenvironment is characterized by active chemokine signaling and immune cell crosstalk, which may contribute to the anti-tumor response. CONCLUSIONS: This case highlights the efficacy of afatinib in the perioperative treatment of NSCLC with NRG1 fusion, and supports its potential as a personalized therapeutic strategy.
Development and validation of a phospholipid metabolism-associated lncRNA model for prognostic stratification and therapeutic guidance in HNSCC.
Zhang Y, Liu S, Song G … +4 more , Wang K, Zhou Z, Xiao Y, Wu D
World J Surg Oncol · 2026 Mar · PMID 41814378 · Full text
Alterations in phospholipid metabolism are increasingly recognized as critical in cancer progression, yet their specific contributions to head and neck squamous cell carcinoma (HNSCC) remain unclear. This study aimed to...
Alterations in phospholipid metabolism are increasingly recognized as critical in cancer progression, yet their specific contributions to head and neck squamous cell carcinoma (HNSCC) remain unclear. This study aimed to establish a prognostic model based on phospholipid metabolism-related long non-coding RNAs (lncRNAs) to predict clinical outcomes in HNSCC patients. Transcriptomic data from The Cancer Genome Atlas (TCGA) were analyzed to identify differentially expressed lncRNAs linked to phospholipid metabolism. Using univariate and multivariate Cox regression analyses, a 10-lncRNA signature (AC104041.1, AC106820.3, AL355488.1, LINC01305, AC133644.1, AC091185.1, AL158166.1, AL512274.1, DBH-AS1, AC025176.1) was developed. The model’s predictive accuracy was confirmed through Kaplan–Meier survival analysis, time-dependent receiver operating characteristic (ROC) curves, and decision curve analysis (DCA), surpassing traditional clinical indicators for overall survival (OS). Gene set enrichment analysis, immune profiling, and drug sensitivity testing revealed distinct biological differences between clusters. Low-risk patients and those in cluster 2 exhibited better prognoses, enhanced immune infiltration, and heightened immune activity, while high-risk patients in cluster 1 showed increased sensitivity to chemotherapeutic agents. Functional assays demonstrated that AL158166.1 knockdown inhibited HNSCC cell proliferation, migration, invasion, and phospholipid metabolism, likely through suppression of the PI3K/AKT/mTOR pathway. These findings suggest that AL158166.1 plays a pivotal role in HNSCC progression. In conclusion, the proposed lncRNA-based prognostic model provides a reliable tool for survival prediction and personalized treatment guidance in HNSCC, highlighting promising therapeutic targets and advancing precision immunotherapy and chemotherapy strategies.
Synchronous breast carcinoma and diffuse large B-cell lymphoma: a case report and literature review on diagnostic challenges and management implications.
Zhu C, Huang L
World J Surg Oncol · 2026 Mar · PMID 41814374 · Full text
BACKGROUND: Synchronous breast carcinoma and diffuse large B-cell lymphoma occurring as independent primary malignancies is exceptionally rare. Because these tumors differ markedly in histological origin, biological beha...
BACKGROUND: Synchronous breast carcinoma and diffuse large B-cell lymphoma occurring as independent primary malignancies is exceptionally rare. Because these tumors differ markedly in histological origin, biological behavior, and treatment strategies, their coexistence can easily lead to diagnostic pitfalls and therapeutic dilemmas. Reporting such a case provides new insights into the clinical recognition and management of rare dual primaries. CASE PRESENTATION: A 54-year-old woman presented with a painless left cervical (neck) mass. Imaging revealed a left breast lesion with multi-station lymphadenopathy (including cervical nodes), initially interpreted as metastatic breast carcinoma. Breast core biopsy confirmed HER2-overexpressing invasive ductal carcinoma with strong ER/PR positivity. Cervical (neck) lymph-node biopsy established diffuse large B-cell lymphoma (non-GCB/MCD) with TP53, MYD88, and CD79B mutations. The patient received rituximab-based therapy plus a Bruton tyrosine kinase inhibitor and underwent simple mastectomy. The breast carcinoma has remained controlled without evidence of recurrence, whereas the relapsing lymphoma ultimately determined the disease course. CONCLUSIONS: This case emphasizes the need for independent biopsies of suspicious lesions to avoid misclassification as metastatic disease. Management should follow a “lymphoma-first” approach with careful sequencing to balance treatments for both malignancies and to minimize overlapping toxicities. Prognosis is largely driven by the biological features of the lymphoma, particularly in high-risk molecular subtypes. A dual-track follow-up strategy, recording outcomes for each tumor separately, may improve clarity in assessing prognosis and guiding individualized care. This report underscores the importance of multidisciplinary collaboration and highlights potential directions for future research on the mechanisms and management of synchronous dual primaries.
Prognostic significance of isolated clinically detected regional melanoma metastasis in minor nodal basins.
Rautalin M, Saks D, Lo SN … +1 more , Pennington TE
World J Surg Oncol · 2026 Mar · PMID 41814335 · Full text
BACKGROUND: The first sites of lymphatic drainage from primary melanoma tumour, sentinel nodes, are primarily found at major nodal basins in the axilla, groin or neck. However, there are minor nodal fields at triangular...
BACKGROUND: The first sites of lymphatic drainage from primary melanoma tumour, sentinel nodes, are primarily found at major nodal basins in the axilla, groin or neck. However, there are minor nodal fields at triangular intermuscular space (TIS) in the back, epitrochlear in the arm and popliteal in the lower leg. In case of finding isolated metastasis of melanoma at these minor nodal fields, the treatment approach is yet little documented. This study assesses this subgroup of melanoma patients, their overall survival (OS) and recurrence free survival (RFS). METHODS: Retrospective database review of patients treated at Melanoma Institute Australia from 1980-2020 was performed. 18 years or older patients with isolated minor nodal field metastasis were included. Comparison of major and minor nodal fields metastasis RFS and OS was performed with matched cohort group using Kaplan-Meier method and log-rank test. RESULTS: Of the 36 included patients 20 were male, 16 female, mean age 53 years at time of diagnosis. Median Breslow thickness was 2.1 (0 to 8.2). Sites of the metastases were epitrochlear (21/36, 58%), TIS (11/36, 31%) and popliteal (4/36, 11%). Treatments consisted of resection of the minor nodal field metastasis for 23/36 (63.9%) patients. Two (5.6%) patients received adjuvant radiation therapy and one (2.8%) adjuvant anti-PD1 immunotherapy. Radical lymphadenectomy of the onwards major nodal basin was performed for 1 (2.8%) patient in the ilioinguinal field and for 9 (25%) patients in the axilla. 15 out of 36 (41.7%) patients developed a further recurrence during follow-up (range 2 to 15 years). There is a clear separation of the Kaplan-Meier curves indicating a more favourable prognosis in patients with isolated metastasis to a minor node field compared with a matched cohort of patients with metastasis to a major node field (p=0.0071). CONCLUSIONS: Patients with minor nodal field metastasis might have better prognosis in terms of RFS compared to those with metastasis in major fields. Their treatment may be best managed with a personalised approach combining neoadjuvant immunotherapy where indicated, and limited surgery. For those achieving a lesser response, close observation rather than further dissection, would seem a reasonable approach.
A comparative study of the '3 + 2' model 'seven-step method' programmed robotic distal gastric cancer radical resection versus conventional robotic surgical techniques.
Ma Y, Su A, Bi X … +7 more , Wu Z, Sun J, Yin J, Zhang W, Hu M, Cai H, Ma Y
World J Surg Oncol · 2026 Mar · PMID 41814332 · Full text
BACKGROUND: This study aimed to compare perioperative outcomes, costs, and learning-curve characteristics between a “3 + 2” model combined (The operation is performed by three robotic arms, with two assistants providing...
BACKGROUND: This study aimed to compare perioperative outcomes, costs, and learning-curve characteristics between a “3 + 2” model combined (The operation is performed by three robotic arms, with two assistants providing assistance). with a “seven-step” standardized robotic surgical procedure and conventional robotic surgery for radical distal gastrectomy in distal gastric cancer, and to evaluate its clinical applicability. METHOD: A retrospective cohort study was conducted. A total of 215 patients who underwent robot-assisted radical distal gastrectomy at Gansu Provincial People’s Hospital between May 2018 and October 2023 were included. According to the actual surgical approach used, patients were assigned to either the “3 + 2” model “seven-step” group (n = 107) or the conventional robotic group (n = 108). Perioperative indices, postoperative complications, and surgical costs were compared between the two groups. The learning curve was analyzed using cumulative sum (CUSUM) analysis based on operative time. RESULTS: Robot-assisted surgery was successfully completed in both groups, with no conversion to open surgery and no perioperative mortality. Compared with the conventional group, the “3 + 2” model “seven-step” group had a shorter operative time (P < 0.05). CUSUM analysis showed that the inflection point occurred at case 16 in the “3 + 2” group and at case 19 in the conventional group, indicating that the “3 + 2” group reached a relatively stable operative-time phase earlier. There were no statistically significant differences between the groups in intraoperative blood loss, postoperative complication rate, or postoperative length of stay (P > 0.05). No statistically significant difference in total surgical costs was observed between the two groups. CONCLUSION: The “3 + 2” model “seven-step” standardized robotic radical distal gastrectomy for distal gastric cancer demonstrated perioperative safety comparable to that of conventional robotic surgery, while reducing operative time and achieving an earlier transition to a relatively stable phase on the learning curve. Cost differences should be further evaluated in larger samples and with more detailed cost-item analyses.
Novel LUC7L::NUTM1 fusion in PDGFRA-rearranged myeloproliferative neoplasm with eosinophilia: a case report.
Zhou J, Yao H, Ren J … +4 more , Sun K, Chen D, Zhang R, Wang G
World J Surg Oncol · 2026 Mar · PMID 41814313 · Full text
Myeloid/lymphoid neoplasm with PDGFRA rearrangement are a group of haematologic tumors, in which the clonal proliferation of precursor eosinophils leads to persistent eosinophilic hyperplasia, and varying degrees of invo...
Myeloid/lymphoid neoplasm with PDGFRA rearrangement are a group of haematologic tumors, in which the clonal proliferation of precursor eosinophils leads to persistent eosinophilic hyperplasia, and varying degrees of involvement of the liver, spleen and lymph nodes. While PDGFRA rearrangements are frequently observed in mpn-eo, the co-occurrence of t(15;16)(q14;p13) translocations leading to LUC7L::NUTM1 fusion genes has not been previously documented. Here we present a 30-year-old male patient with leukocytosis and generalized lymphadenopathy. Bone marrow cytology revealed eosinophilia with abnormal and atypical granulocytes showing dysplastic cytoplasmic granules. Cytogenetic analysis identified t(15;16)(q14;p13), while RNA sequencing confirmed the novel LUC7L::NUTM1 fusion gene and co-detected FIP1L1::PDGFRA fusion gene. The patient achieved stable disease imatinib (100 mg/day) treatment. This first report of dual PDGFRA/NUTM1 fusions expands the molecular spectrum of MPN-Eo and highlights the therapeutic implications of novel fusion detection.
A novel machine learning-based model for precise prediction of postoperative recurrence in gallbladder cancer: development and multicenter validation across four centers.
He J, Xiong W, Chen H … +2 more , Pan Q, Ji W
World J Surg Oncol · 2026 Mar · PMID 41814305 · Full text
BACKGROUND: Gallbladder cancer (GBC) is a highly aggressive malignancy with an extremely poor prognosis, and its high postoperative recurrence rate is a major challenge affecting long-term patient survival. Accurately pr...
BACKGROUND: Gallbladder cancer (GBC) is a highly aggressive malignancy with an extremely poor prognosis, and its high postoperative recurrence rate is a major challenge affecting long-term patient survival. Accurately predicting individualized recurrence risk is crucial for formulating adjuvant treatment and follow-up strategies. This study aimed to develop and validate a high-accuracy predictive model by integrating multi-center clinicopathological data and systematically comparing multiple machine learning algorithms. The SHAP (SHapley Additive exPlanations) framework was employed to enhance model interpretability, quantifying the contribution of key predictive factors, thereby providing an accurate and transparent tool for individualized postoperative recurrence risk assessment in GBC. METHODS: This study retrospectively included GBC patients who underwent radical resection from four centers. Clinicopathological characteristics (e.g., TNM stage, tumor differentiation, vascular invasion, perineural invasion), serum tumor markers, and preoperative imaging data were collected. Data from one entire center served as the training set, while data from the remaining three centers were combined as the validation set, achieving a case number ratio of approximately 7:3. Four machine learning algorithms—Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), and Cox Proportional Hazards Regression model—were employed to construct prediction models. Model performance was evaluated by the Area Under the Receiver Operating Characteristic Curve (AUC) for discrimination, calibration curves for accuracy, and Decision Curve Analysis (DCA) for clinical utility. SHAP analysis was applied to the best-performing model for interpretability, quantifying the contribution of each feature to the predictions. RESULTS: On the training set, the XGBoost model demonstrated the best predictive performance, with an AUC of 0.969, significantly superior to RF (AUC = 0.941), SVM (AUC = 0.711), and the Cox model (AUC = 0.676). The calibration curve indicated high consistency between predicted probabilities and actual recurrence probabilities for the XGBoost model. DCA further confirmed its highest clinical net benefit across a wide range of threshold probabilities. SHAP analysis revealed that the T-stage was the most important risk factor affecting model predictions, followed by tumor differentiation grade, N-stage, CEA, and indirect bilirubin levels. The analysis also provided individualized risk explanations, demonstrating complex interactions among features. CONCLUSION: This study successfully constructed a postoperative recurrence prediction model for GBC based on the XGBoost algorithm, which demonstrated excellent performance in discrimination, calibration, and clinical utility. The model’s interpretability analysis not only validated known clinical risk factors but also provided a powerful tool for individualized risk assessment. This model holds promise for assisting clinicians in early postoperative identification of high-risk patients, thereby offering decision support for formulating individualized adjuvant treatment strategies (e.g., more active recommendation of adjuvant chemotherapy for high-risk patients) and differentiated follow-up plans.
Habitat model based on transvaginal ultrasound images for non-invasive prediction of lymphatic vessel interstitial infiltration in endometrial cancer.
Jiao C, Yuanyuan G, Jianghua H … +1 more , Maochun Z
World J Surg Oncol · 2026 Mar · PMID 41814280 · Full text
BACKGROUND: This study aims to develop a habitat model based on vaginal ultrasound images for the non-invasive prediction of LVSI in endometrial cancer (EC) patients. METHODS: We retrospectively collected data from 871 E...
BACKGROUND: This study aims to develop a habitat model based on vaginal ultrasound images for the non-invasive prediction of LVSI in endometrial cancer (EC) patients. METHODS: We retrospectively collected data from 871 EC patients who underwent surgical resection from September 2017 to January 2025, dividing them into LVSI and non-LVSI groups. Patients’ age and gender were matched using Propensity Score Matching (PSM) in a 1:1 ratio to control for potential confounding factors. Selected patients were randomly divided into training and testing groups in a 7:3 ratio. We extracted habitat features and radiomic features from transvaginal ultrasound images, established a combined machine learning (ML) model after dimensionality reduction, and evaluated the proposed model’s utility using receiver operating characteristic and decision curve analysis. RESULTS: A total of 250 EC patients were included in the study. In the training group, the AUC for the radiomic model was 0.809 (0.745–0.873),the AUC for the habitat model was 0.862 (0.809–0.916),and the AUC for the combined model was 0.874 (0.824–0.924).In the testing group, the AUC for the radiomic model was 0.779(0.667–0.892), the AUC for the habitat model was 0.794(0.692–0.895),and the AUC for the combined model was 0.849(0.758–0.939).The combined model outperformed the single radiomic and habitat models. Decision curve analysis confirmed the clinical utility of the combined model. CONCLUSION: The habitat model based on ultrasound images can accurately and non-invasively distinguish LVSI in EC patients, aiding doctors in developing more favorable treatment plans for patients.
Outcomes of patients with cervical spine metastasis treated with different surgical approaches-decision based on location.
Chen J, Wang B, Liu L … +9 more , Luo Y, Liu F, Tang Y, Hu P, Zhou H, Li Z, Liu X, Liu Z, Wei F
World J Surg Oncol · 2026 Mar · PMID 41808187 · Full text
BACKGROUND: The low incidence of cervical metastases and complex anatomical structure of cervical spine complicate surgical strategy formulation and make it controversial. By summarizing and analyzing clinical data of pa...
BACKGROUND: The low incidence of cervical metastases and complex anatomical structure of cervical spine complicate surgical strategy formulation and make it controversial. By summarizing and analyzing clinical data of patients with metastatic cervical spine tumors, this study aims to investigate treatment decisions of separation surgery and outcomes of different approaches to provide clinical evidence and references. METHODS: For atlantoaxial metastases, occipitocervical fixation with decompression (OPFD) was performed. In cases involving lower cervical spine, anterior cervical corpectomy (ACCP) or posterior cervical fixation with decompression (PCFD) was performed. When both vertebral body and appendices were affected, the choice of approach was based on surgeons’ personal preference and patient’s specific condition. Baseline characteristics, clinical manifestations, surgical approach, perioperative complications, and postoperative outcomes, including neurological function, pain level, and survival were compared between the surgical approaches. RESULTS: The most common symptom was neck pain (116/124). Twenty-three patients underwent posterior OPFD, 47 patients underwent ACCP, and 42 patients underwent PCFD. There were no significant differences in perioperative complications, and postoperative therapy among patients with lower cervical metastases. For cases with simultaneous involvement of vertebral body and appendices, patients who underwent PCFD had significantly longer survival than those who underwent ACCP (29.4 ± 14.9 vs. 19.7 ± 12.5, p = 0.028). The same phenomenon was observed in other two comparisons. All patients experienced varying degrees of pain relief with those undergoing posterior approach demonstrating significantly greater pain relief (p < 0.05). No neurological deterioration was observed postoperatively. Perioperative complication rate was 26.6%. Multivariate Cox analysis showed that surgical approach was independent risk factors for survival. CONCLUSION: For patients with cervical metastases, we made treatment decisions based on the specific location of tumor and requirements of separation surgery to ensure that patients receive subsequent comprehensive therapy. The discernible differences between surgical approaches were that patients who underwent posterior approach tended to have more significant pain relief and longer survival.
Percutaneous thermal ablation-based locoregional treatment for hepatocellular carcinoma larger than 3 cm: a 10-year single-center retrospective study.
Luo W, Pang LN, Han L … +10 more , Li XB, Li XY, Liu HJ, Yang X, Ding L, Zhang PD, Liu J, He GB, Zhou XD, Yu M
World J Surg Oncol · 2026 Mar · PMID 41808181 · Full text
OBJECTIVES: To investigate the long-term efficacy of percutaneous thermal ablation (PTA)-based locoregional treatment of patients with hepatocellular carcinoma (HCC) bearing tumors > 3 cm. METHODS: In this single-center,...
OBJECTIVES: To investigate the long-term efficacy of percutaneous thermal ablation (PTA)-based locoregional treatment of patients with hepatocellular carcinoma (HCC) bearing tumors > 3 cm. METHODS: In this single-center, retrospective study of 359 HCC patients with 587 tumors (5.1 ± 0.021 cm) treated with PTA-based locoregional treatment between 2011 and 2021 was performed. Radiological response was evaluated per lesion on enhanced computed tomography imaging one month after ablation. Local tumor progression (LTP), regional recurrence (RR), disease-free survival (DFS) and overall survival (OS) rates were assessed per patient in follow-up, while a Cox hazards regression analysis was used to determine significant factors associated with OS and DFS. Therapeutic outcomes were assessed in a subgroup analysis of tumor size, number, and the patients’ age after propensity score matching. RESULTS: The mean ± SD follow up duration was 30.0 ± 22.1 months. Complete Response was achieved in 87.7% of lesions after treatment. LTP and RR were detected in 52.5% and 66.9% of patients, respectively. The 1-, 3-, and 5-year DFS rates were 43.8%, 23.8%, and 14.6%, respectively. The 1-, 3-, 5-, 7-, and 10-year OS rates were 81.3%, 47.0%, 20.7%, 16.7%, and 14.4%, respectively. According to the multivariate analysis, tumor number, cirrhosis and platelet were significant factors for OS (P < 0.05); while tumor number and size were associated with DFS. In the subgroup analysis, the cumulative OS rates at 1, 3, and 5 years were 80.1%, 39.5%, and 27.1% in the medium tumor group(3 cm ≤ diameter < 5 cm) and 66.7%, 37.1%, and 7.3%, respectively, in the large tumor group (diameter ≥ 5 cm, HR = 1.44, 95% CI: 1.0–2.1, P < 0.05). The cumulative RR rates at 1, 3, and 5 years were 62.8%, 84%, and 89.3%, respectively, in the multiple-lesion group and 45.0%, 66.9%, and 76.6%, respectively, in the single-lesion group (HR = 0.63, 95% CI: 0.46–0.86, P < 0.05). The 1-, 3-, and 5-year OS rates were 71.5%, 34.9%, and 16.6% in patients aged ≤ 50 years and 83%, 50.4%, and 30.2%, respectively, in patients aged > 50 years (P < 0.05). CONCLUSIONS: PTA-based locoregional therapy represents an alternative method for the treatment of HCC patients with medium/large tumors.
Systemic therapy outcomes following separation surgery versus maximal feasible resection for spinal metastases from non-small cell lung cancer: a real-world retrospective cohort study.
Shen Z, Wang P, Yuan H … +3 more , Li B, Xiao J, Xu W
World J Surg Oncol · 2026 Mar · PMID 41808173 · Full text
STUDY DESIGN: Retrospective cohort study OBJECTIVE: To compare systemic therapy outcomes between separation surgery and maximal feasible resection for patients with spinal metastases from non-small cell lung cancer (NSCL...
STUDY DESIGN: Retrospective cohort study OBJECTIVE: To compare systemic therapy outcomes between separation surgery and maximal feasible resection for patients with spinal metastases from non-small cell lung cancer (NSCLC). The presence of bone metastases has been associated with diminished response of primary tumors to systemic therapy, especially immunotherapy. However, in patients with spinal metastases, the impact of varying degrees of bone metastatic burden reduction on the efficacy of subsequent systemic therapy remains unknown. MATERIALS AND METHODS: Adult patients (≥18 years) with spinal metastases from NSCLC who underwent surgical intervention at our institution between between January 2019 and June 2024 were retrospectively identified. Patients were categorized into two groups based on surgical strategy: separation surgery (SS) or maximal feasible resection (MFR). Systemic therapy response (objective response rate, disease control rate and best overall response) was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Surgical outcomes included blood loss, operating time, intraoperative blood transfusion, and complications. Overall survival (OS) was analyzed using the Kaplan–Meier method, and differences between groups were compared using the log-rank test. RESULTS: A total of 36 patients with spinal metastases from NSCLC were included. Patients in the MFR group exhibited a significantly higher disease control rate compared to those in the SS group (71.4% vs. 27.3%, P = 0.024). However, MFR was associated with increased surgical morbidity, including greater intraoperative blood loss [median 800 mL (IQR: 650–1425) vs. 500 mL (IQR: 100–1000), P = 0.041], a higher rate of intraoperative blood transfusion (71.4% vs. 31.8%, P = 0.048), and more intraoperative complications (28.6% vs. 0%, P = 0.017). There was no statistically significant difference in overall survival between the two surgical strategies [median 23.7 months (95% CI: 18.8–29.4) vs. 20.6 months (95% CI: 17.5–22.5); HR = 0.42 (95% CI: 0.16–1.08); P = 0.065]. However, Exploratory subgroup analyses indicated that MFR combined with denosumab was associated with a significantly lower hazard of death compared with SS plus bisphosphonates (HR = 0.14, 95% CI: 0.03–0.61, P = 0.009) and MFR plus bisphosphonates (HR = 0.15, 95% CI: 0.02–0.95, P = 0.044). A non-significant trend was also observed versus SS combined with denosumab (HR = 0.34, 95% CI: 0.10–1.18, P = 0.088). CONCLUSION: Compared to SS, MFR was associated with improved outcomes of subsequent systemic therapy in patients with spinal metastases from NSCLC, albeit at the cost of increased surgical trauma and a higher risk of intraoperative complications. In addition, MFR was associated primarily with disease stabilization rather than objective tumor regression. Notably, the combination of MFR with denosumab was associated with longer overall survival. These findings support the consideration of MFR in carefully selected patients, particularly when optimizing the response to systemic therapy is a key clinical objective. Importantly, given the small sample size, the observed differences in disease control rate and subgroup survival should be interpreted as hypothesis-generating. LEVEL OF EVIDENCE: Level IV
Evolving challenges in the management of early esophageal adenocarcinoma: from clinical staging to molecular insights.
Giorgi L, Garbarino GM, De Martino R … +5 more , Pansa A, Casiraghi M, Basato S, Alfieri R, Castoro C
World J Surg Oncol · 2026 Mar · PMID 41808114 · Full text
This report explores the evolving management of early esophageal adenocarcinoma (EAC), focusing on the therapeutic balance between endoscopic resection and esophagectomy. It synthesizes recent evidence from international...
This report explores the evolving management of early esophageal adenocarcinoma (EAC), focusing on the therapeutic balance between endoscopic resection and esophagectomy. It synthesizes recent evidence from international guidelines, surgical and endoscopic series, and predictive modeling studies to clarify lymph-node metastasis (LNM) risk, evaluate current staging limitations, and discuss future directions in treatment stratification and personalized care.
Impact of neoadjuvant imatinib duration and tumor response on recurrence-free survival in locally advanced gastrointestinal stromal tumors: a retrospective multicenter cohort study.
Zong H, Kou Y, Song H … +11 more , Lan Z, Mu Y, Xiao Q, Jin X, Li Y, Xiang S, Huo Y, Zhou M, Zhang X, Wu X, Zhang J
World J Surg Oncol · 2026 Mar · PMID 41808093 · Full text
BACKGROUND: Neoadjuvant imatinib (IM) is widely used in locally advanced gastrointestinal stromal tumors (GISTs) to improve resectability and reduce recurrence, but optimal duration and the prognostic role of tumor respo...
BACKGROUND: Neoadjuvant imatinib (IM) is widely used in locally advanced gastrointestinal stromal tumors (GISTs) to improve resectability and reduce recurrence, but optimal duration and the prognostic role of tumor response remain unclear. METHODS: We performed a multicenter retrospective cohort study of patients with locally advanced GISTs who received preoperative imatinib and surgery between 2014 and 2024 at four tertiary centers in China. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, and a novel parameter, the Percent Tumor Response Index (PTRI), was proposed to integrate baseline size with shrinkage rate. Recurrence-free survival (RFS) and overall survival (OS) were analyzed by Kaplan–Meier and Cox regression. RESULTS: Among 168 patients (median treatment 7.5 months), all achieved disease control: partial response (PR) in 52.4% and stable disease (SD) in 47.6%. Median tumor size decreased from 10.0 to 7.0 cm (p < 0.001). After a median follow-up of 53 months, 3- and 5-year RFS rates were 88.6% and 83.2%, and OS rates were 97.6% and 92.0%. Using maximally selected rank statistics (MSRS), 8 months was identified as a potentially meaningful threshold. Patients treated ≤ 8 months had superior RFS compared with > 8 months. In multivariable Cox regression analysis, a preoperative imatinib duration exceeding 8 months (HR 2.40, p = 0.034) and a postoperative mitotic count > 5/5 HPF (HR 2.31, p = 0.042) were independently associated with worse RFS, whereas a higher Percent Tumor Response Index (PTRI), a newly proposed exploratory metric, was associated with a reduced risk of recurrence, corresponding to a 32% risk reduction per unit increase (p = 0.002). CONCLUSIONS: In our cohort, a preoperative imatinib duration exceeding 8 months for locally advanced GISTs was associated with inferior RFS. Elevated PTRI predicted favorable recurrence outcomes, whereas higher postoperative mitotic count indicated poorer prognosis.
Analysis of ovarian cancer burden among reproductive-aged women and its association with the socio-demographic index from 1990 to 2021.
Zhong W, Xu Y, Yuan H … +1 more , Zhang T
World J Surg Oncol · 2026 Mar · PMID 41808088 · Full text
OBJECTIVE: This study analyzed the global burden of ovarian cancer in reproductive-aged women (1990–2021) to identify trends, drivers, and project future trends for guiding prevention strategies. METHODS: Using Global Bu...
OBJECTIVE: This study analyzed the global burden of ovarian cancer in reproductive-aged women (1990–2021) to identify trends, drivers, and project future trends for guiding prevention strategies. METHODS: Using Global Burden of Disease 2021 data, we analyzed ovarian cancer burden and its association with the Socio-demographic Index (SDI). Trends were evaluated using average annual percentage change and Age-Period-Cohort modeling, with projections to 2036 via ARIMA models. RESULTS: In 2021, there were 85,749 new cases and 25,258 deaths globally among reproductive-aged women. The age-standardized rates declined from 1990 to 2021. Projections indicate stable age-standardized incidence and prevalence rates through 2036, but further declines in mortality and DALY rates. Significant regional disparities persist, with the burden decreasing in high-SDI regions but increasing in low- and middle-SDI regions. Disease risk increased after age 35. Successive birth cohorts from the 1990s onward showed a higher baseline risk. Population growth was the primary driver of increasing case numbers. High body mass index (BMI) was the leading risk factor. CONCLUSIONS: While the global burden of ovarian cancer is declining, substantial regional heterogeneity exists. Tailored strategies focusing on high-risk populations and modifiable factors like high BMI are crucial to mitigate the disease's impact and reduce disparities.
CT radiomics of adenocarcinoma of the esophagogastric junction: machine learning-based prediction of perineural invasion status.
Zheng H, Chen Z, Zhang Z … +5 more , Huang Q, Ke X, Xu J, Ye K, Lin J
World J Surg Oncol · 2026 Mar · PMID 41803925 · Full text
BACKGROUND: Preoperative diagnosis of perineural invasion (PNI), a critical prognostic factor in adenocarcinoma of the esophagogastric junction (AEG), remains challenging. This study aimed to develop and validate a compu...
BACKGROUND: Preoperative diagnosis of perineural invasion (PNI), a critical prognostic factor in adenocarcinoma of the esophagogastric junction (AEG), remains challenging. This study aimed to develop and validate a computed tomography (CT)-based radiomics model for the noninvasive prediction of PNI and to evaluate the incremental value of integrating radiomics with clinical risk factors. METHODS: A retrospective cohort of 306 patients with pathologically confirmed AEG was randomized into training (n = 214) and testing (n = 92) cohorts. Radiomics features were extracted from venous-phase CT images using PyRadiomics. Following feature selection with the least absolute shrinkage and selection operator (LASSO) algorithm, five machine learning classifiers—logistic regression (LR), random forest (RF), extra trees (ET), adaptive boosting (AdaBoost), and support vector machine (SVM)—were trained to build the radiomics model. A clinical model was constructed using independent risk factors identified by multivariate logistic regression, which were then integrated with the radiomics signature to build a combined clinical-radiomics model. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and standard classification metrics. RESULTS: Among the patients, 224 (73.2%) were PNI-positive. The radiomics model based on RF demonstrated the best performance, with an area under the curve (AUC) of 0.878 in the training cohort and 0.808 in the testing cohort. The clinical model achieved lower AUCs (0.747 and 0.636, respectively). The combined model significantly outperformed both, achieving AUCs of 0.932 and 0.861 in the training and testing cohorts (all P < 0.05, DeLong test), with good calibration and the highest net clinical benefit on DCA. CONCLUSION: A CT-based clinical-radiomics model can effectively predict PNI status in AEG preoperatively. The integration of radiomic features with clinical parameters further enhances predictive performance and clinical utility, offering a valuable noninvasive tool to guide individualized treatment planning.
Fusion surgery in robot-assisted esophagectomy: stepwise learning curves across the da Vinci™ and hinotori™ platforms.
Sato Y, Hatanaka Y, Tanaka Y … +10 more , Fujibayashi S, Mitsui N, Yokoi R, Horaguchi T, Matsumoto K, Fukada M, Yasufuku I, Asai R, Tajima JY, Matsuhashi N
World J Surg Oncol · 2026 Mar · PMID 41803916 · Full text
BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) provides superior precision, three-dimensional visualization, and enhanced instrument dexterity compared to conventional approaches. The “Fusion Surgery...
BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) provides superior precision, three-dimensional visualization, and enhanced instrument dexterity compared to conventional approaches. The “Fusion Surgery” concept, which emphasizes dynamic cooperation between console and bedside surgeons, has the potential to improve operative efficiency and facilitate technical skill acquisition. This study used stepwise learning curves in RAMIE to explore the feasibility and initial experience with the da Vinci™ and hinotori™ robotic platforms. METHODS: We retrospectively analyzed 30 patients with esophageal cancer who underwent RAMIE using the Fusion Surgery approach between June 2024 and November 2025. The first 25 consecutive procedures were performed with the da Vinci system, followed by five with the hinotori system, all by the same surgical team. Thoracic lymphadenectomy was standardized into lower, middle, and upper mediastinal segments. Learning curves were assessed using cumulative sum (CUSUM) analysis of console operation time. Intraoperative blood loss and postoperative hospital stay were evaluated as secondary outcomes. RESULTS: The median total console operation time was 210 min. Middle mediastinal dissection time was significantly shorter with the hinotori system than with the da Vinci system (46 vs. 76 min, p = 0.010), whereas upper and lower mediastinal dissections showed favorable trends. CUSUM analysis demonstrated progressive improvement across all mediastinal levels. Upper mediastinal console time continued to decrease after transition to the hinotori system, middle mediastinal dissection showed marked improvement following the transition, and lower mediastinal dissection exhibited a steady downward trend from the initial cases. These findings indicate cumulative learning and effective transfer of technical skills across robotic platforms. CONCLUSIONS: The Fusion Surgery approach may support gradual improvement in RAMIE performance across all mediastinal levels. Transitioning from the da Vinci to the hinotori robotic system did not interrupt the learning curve, supporting smooth continuation of surgical proficiency on a new platform. Fusion Surgery may provide a robust and adaptable framework for sustained technical advancement in RAMIE.
Development and validation of a predictive and prognostic model of perineural invasion in colorectal cancer.
Wu X, Zhang J, Cheng F
World J Surg Oncol · 2026 Mar · PMID 41803864 · Full text
BACKGROUND: Growing evidence indicates that perineural invasion (PNI) is associated with local recurrence, distant metastasis, and unfavorable prognosis in patients with colorectal cancer (CRC). However, reliable tools f...
BACKGROUND: Growing evidence indicates that perineural invasion (PNI) is associated with local recurrence, distant metastasis, and unfavorable prognosis in patients with colorectal cancer (CRC). However, reliable tools for the diagnosis and outcome assessment of PNI-positive colorectal cancer remain insufficiently studied. In this study, diagnostic and prognostic models were constructed and validated for patients with PNI-positive colorectal cancer. METHODS: Patients included in this study were selected from two independent datasets within the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for perineural invasion in colorectal cancer. Univariate and multivariate Cox proportional hazards regression analyses were also conducted to identify independent prognostic factors associated with outcomes in patients with PNI positive colorectal cancer. Two nomogram models were then developed to estimate the risk and prognosis of PNI positive colorectal cancer. The area under the curve(AUC) and calibration curves were applied to evaluate the predictive performance of the nomograms. Decision curve analysis(DCA) and Kaplan Meier survival curves were further used to assess their potential clinical usefulness. RESULTS: Multivariate logistic regression analysis was performed to determine independent risk factors of colorectal cancer with perineural invasion (CRCPNI), including N stage, T stage, tumor deposits, grade, primary site, and carcinoembryonic antigen(CEA) level. Multivariate Cox regression analysis further identified age, T stage, CEA level, N stage, chemotherapy, and tumor deposits as factors independently associated with prognosis in CRCPNI patients. The results of these analyses were presented using nomogram models. Receiver operating characteristic(ROC) analysis, calibration plots, and DCA were applied to evaluate the performance of the risk and prognostic models. CONCLUSION: After validation, the predictive model was shown to be reliable and can provide supportive information for individualized clinical decision making in future practice.
Effect of immune-related lncRNA BZRAP1-AS1/miR-541-3p and its molecular mechanism in cervical cancer.
Zou Z, Huang L, Yin K … +3 more , Li Y, Tang M, He C
World J Surg Oncol · 2026 Mar · PMID 41803862 · Full text
BACKGROUND: Cervical cancer (CC) remains a significant health concern for women worldwide, with poor prognosis often linked to late diagnosis. This study aimed to explore the clinical significance and molecular mechanism...
BACKGROUND: Cervical cancer (CC) remains a significant health concern for women worldwide, with poor prognosis often linked to late diagnosis. This study aimed to explore the clinical significance and molecular mechanisms of long non-coding RNA BZRAP1-AS1. METHODS: A total of 105 CC patients were enrolled, and paired tumor and normal tissues were collected. The expression levels of BZRAP1-AS1 and miR-541-3p were quantified by qRT-PCR. The direct binding between BZRAP1-AS1 and miR-541-3p was validated using a dual-luciferase reporter assay. Functional assays, including CCK-8, Transwell, and flow cytometry analysis, were performed in CC cell lines. RESULTS: BZRAP1-AS1 was upregulated in CC tissues and correlated with advanced FIGO stage and lymph node metastasis (P < 0.05). Kaplan–Meier analysis revealed that patients with high BZRAP1‑AS1 expression had significantly shorter overall survival (log‑rank P = 0.007). Multivariate Cox regression confirmed high BZRAP1‑AS1 expression as an independent predictor of poor prognosis (HR = 3.031, 95% CI = 1.136–8.090). Silencing of BZRAP1-AS1 inhibited cell proliferation and invasion, while promoting apoptosis. Mechanistically, BZRAP1-AS1 acted as a competing endogenous RNA (ceRNA) to sponge miR-541-3p. Rescue experiments indicated that inhibition of miR-541-3p reversed the tumor-suppressive effects resulting from BZRAP1-AS1 knockdown. CONCLUSION: Our findings suggest that BZRAP1-AS1 may serve as an independent prognostic marker in cervical cancer. Mechanistically, it appears to promote tumor progression by downregulating miR‑541‑3p. The BZRAP1‑AS1/miR‑541‑3p axis thus warrants further investigation, though its translational potential requires validation through larger multi‑center studies.
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