World Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Clinical outcomes of a 3-day modified BEP regimen in malignant ovarian germ cell tumors in a single-center real-world study.
Zhang X, Ren Y, Liang Y … +4 more , Wang L, Wang Y, Chen Y, Xu J
World J Surg Oncol · 2026 Jun · PMID 42271363 · Full text
BACKGROUND: Malignant ovarian germ cell tumors (MOGCTs) mainly affect adolescents and young women and are highly curable with bleomycin, etoposide, and cisplatin (BEP). To reduce toxicity associated with the standard 5-d...
BACKGROUND: Malignant ovarian germ cell tumors (MOGCTs) mainly affect adolescents and young women and are highly curable with bleomycin, etoposide, and cisplatin (BEP). To reduce toxicity associated with the standard 5-day regimen, we evaluated the efficacy, safety, and fertility outcomes of a 3-day modified BEP regimen in patients with MOGCTs. METHODS: We conducted a retrospective analysis of 81 MOGCT patients with 3-day modified BEP at the Women's Hospital, Zhejiang University School of Medicine from 2004 to 2024. The 3-day modified BEP regimen comprised bleomycin (15 U) and etoposide (100 mg/m) on days 1-3, and cisplatin (75 mg/m) on day 1, repeated every 4 weeks for 3-6 cycles. RESULTS: All 81 MOGCT patients included in our study underwent primary surgery before chemotherapy; 86.4% had early-stage disease, and fertility-sparing surgery was performed in 73 cases. After a median follow-up of over 9 years, the 5-year progression-free survival rate was 97.5% (95% CI: 94.2-100), with no treatment-related deaths. Bleomycin-induced pneumonitis occurred in 4.9% and resolved with supportive care. Among 30 patients attempting conception, 90% achieved pregnancy, resulting in 25 term live births. CONCLUSIONS: The 3-day modified BEP regimen provides excellent survival with reduced toxicity, offering greater convenience and preserved fertility, supporting its use as a safer and more practical treatment alternative for initial chemotherapy in MOGCTs.
The evolving landscape of colorectal liver metastasis management: from resection to transplantation - a narrative review.
Papadia FS, di Domenico S, Santoliquido M … +1 more , De Cian F
World J Surg Oncol · 2026 Jun · PMID 42271358 · Full text
Colorectal cancer remains a leading cause of cancer-related mortality worldwide, with the liver representing the most common site of metastatic spread. The management of colorectal liver metastases (CRLM) has undergone a...
Colorectal cancer remains a leading cause of cancer-related mortality worldwide, with the liver representing the most common site of metastatic spread. The management of colorectal liver metastases (CRLM) has undergone a profound transformation over the past three decades, evolving from a surgical discipline focused solely on resectability to a complex, multimodal enterprise integrating advanced systemic therapies, refined surgical techniques, regional chemotherapy, local ablative procedures, and most recently, liver transplantation for highly selected patients. This narrative review synthesizes contemporary evidence from recent landmark trials and large cohort studies to provide a comprehensive overview of the current treatment landscape. We examine the evolution of surgical resection as the cornerstone of curative-intent therapy, the ongoing debate surrounding perioperative chemotherapy timing and regimens, and the emerging role of thermal ablation as a non-inferior alternative for small metastases. The revival of hepatic arterial infusion pump chemotherapy and the place of targeted therapies are contextualized within modern treatment algorithms. A central focus is the notable introduction of liver transplantation for non-resectable CRLM, with critical appraisal of selection criteria including metabolic tumor volume, the Oslo score, and tumor biology. We conclude by proposing a framework for personalized, biology-driven treatment selection that balances oncologic efficacy with patient quality of life and ethical considerations surrounding organ allocation.
Predictors of postoperative morbidity and delayed initiation of adjuvant chemotherapy after cytoreductive surgery in advanced-stage epithelial ovarian cancer.
Çaltek NÇ, Yassa M, Şahin G … +2 more , Öner YÖ, Yüksel İT
World J Surg Oncol · 2026 Jun · PMID 42271354 · Full text
OBJECTIVE: This study aimed to identify the factors predicting postoperative morbidity after cytoreductive surgery in patients with advanced-stage epithelial ovarian cancer, to evaluate the effect of this morbidity on th...
OBJECTIVE: This study aimed to identify the factors predicting postoperative morbidity after cytoreductive surgery in patients with advanced-stage epithelial ovarian cancer, to evaluate the effect of this morbidity on the time to initiation of adjuvant chemotherapy, and to examine the association between delayed chemotherapy and survival outcomes. METHODS: Patients with FIGO stage III-IV epithelial ovarian cancer who underwent surgery at a tertiary university hospital between May 2020 and December 2024 were retrospectively evaluated. Severe postoperative complications were defined as Clavien-Dindo grade IIIa or higher. Initiation of adjuvant chemotherapy later than 42 days after surgery was considered delayed. Clinical, laboratory, and perioperative variables associated with postoperative complications were analyzed using univariable and multivariable logistic regression analyses. Survival analyses were performed separately in the primary debulking surgery (PDS) and interval debulking surgery (IDS) groups. RESULTS: A total of 180 patients were included in the study, and 20 (11.1%) developed postoperative complications. In comparative analyses, bowel surgery (OR 3.55, 95% CI 1.32-9.34, p = .010), perioperative transfusion (OR 5.28, 95% CI 1.84-19.05, p = .004), and postoperative transfusion (OR 3.17, 95% CI 1.20-9.34, p = .025), were found to be significantly more frequent in the group that developed complications. In multivariable analysis, only perioperative transfusion was identified as an independent risk factor for postoperative complications (OR: 3.72; 95% CI: 1.17-14.25; p = .035). No significant association was found between the time to initiation of adjuvant chemotherapy and most patient- and surgery-related variables; however, chemotherapy was initiated earlier in patients who underwent IDS. In survival analyses, no significant association was observed between the timing of chemotherapy initiation and progression-free survival or overall survival in the PDS group, whereas in patients undergoing IDS, early initiation of chemotherapy was associated with significantly improved overall survival (p = .0013). CONCLUSION: In advanced-stage epithelial ovarian cancer, morbidity after cytoreductive surgery appears to be more closely related to surgery-related factors. Timely initiation of adjuvant chemotherapy may be particularly important for overall survival, especially in patients undergoing IDS.
LY86-AS1 predicts poor prognosis and inhibits progression in non-small cell lung cancer by targeting the miR-132-3p/RB1CC1 axis.
Liu Y, Pan J, Dai Y … +3 more , Man S, Li J, Hong Y
World J Surg Oncol · 2026 Jun · PMID 42260571 · Full text
BACKGROUND: Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases. Despite significant advances in surgery, radiotherapy, chemotherapy, and targeted and immunotherapy, the overall five-year surviva...
BACKGROUND: Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases. Despite significant advances in surgery, radiotherapy, chemotherapy, and targeted and immunotherapy, the overall five-year survival of NSCLC patients is still dismally low. The objective of this investigation was to evaluate the potential of LY86-AS1 as a prognostic biomarker in NSCLC and to elucidate its associated molecular regulatory network. METHODS: Expression levels of LY86-AS1, miR-132-3p, and RB1CC1 were detected in NSCLC tissues and cell lines using RT-qPCR. The correlation of LY86-AS1 expression with clinical pathological characteristics was evaluated using the Kaplan-Meier curve and multivariate Cox regression analysis. CCK-8 and Transwell assays were then performed to test the effects of LY86-AS1, miR-132-3p, and RB1CC1 on the proliferation, migration, and invasion of NCI-H1299 and A549 cells. RESULTS: LY86-AS1 was significantly underexpressed in NSCLC. Low levels of LY86-AS1 were strongly associated with a poor prognosis and were independent prognostic factors. Overexpression of LY86-AS1 significantly inhibited the proliferation, migration, and invasion of NSCLC cells. Mechanistically, overexpression of miR-132-3p reversed the inhibitory effect of LY86-AS1 on NSCLC cells, while the overexpression of RB1CC1 abolished the oncogenic effect of miR-132-3p. CONCLUSIONS: LY86-AS1 upregulates RB1CC1 expression by sponging miR-132-3p, thereby inhibiting the malignant progression of NSCLC and is a potential prognostic biomarker and therapeutic target for NSCLC.
Preoperative monocyte-to-albumin ratio predicts overall survival after hepatectomy for hepatocellular carcinoma: a single-center retrospective study.
Jiang X, Zhang LY, Liao JP … +3 more , Tang X, Liu GM, Xu JW
World J Surg Oncol · 2026 Jun · PMID 42251315 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Hepatectomy is a potentially curative option for selected patients, but postoperative recurrence and death remain frequent. T...
BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Hepatectomy is a potentially curative option for selected patients, but postoperative recurrence and death remain frequent. There is a need for simple, low-cost indices that can be measured before surgery to improve risk stratification. The monocyte-to-albumin ratio (MAR) reflects systemic inflammation and nutritional status. This study evaluated whether preoperative monocyte-to-albumin ratio predicts overall survival (OS) in patients with hepatocellular carcinoma undergoing hepatectomy and aimed to construct a prognostic nomogram incorporating this ratio for individualized survival estimation. METHODS: We retrospectively analyzed 539 consecutive patients with pathologically confirmed hepatocellular carcinoma who underwent curative-intent hepatectomy at Meizhou People's Hospital between May 2011 and July 2023. Clinical characteristics, laboratory tests, tumor features, and survival data were obtained from medical records. Monocyte-to-albumin ratio was calculated as monocyte count × 1000 / albumin (g/dL). The optimal cut-off value was determined using R software. Overall survival was estimated by the Kaplan-Meier method and compared between groups using log-rank tests. Cox proportional hazards regression was used to identify independent prognostic factors. A prognostic nomogram was developed based on multivariable Cox analysis and internally assessed using the concordance index(C-index), time-dependent receiver operating characteristic curves(ROC), and calibration plots. RESULTS: Patients were classified into high and low monocyte-to-albumin ratio groups according to the optimal cut-off. Those with a high ratio had significantly shorter overall survival than those with a low ratio (log-rank p < 0.001). In multivariable Cox analysis, a lower monocyte-to-albumin ratio was independently associated with better overall survival after adjustment for standard clinicopathological variables (hazard ratio 0.58, 95% confidence interval 0.42-0.82, p < 0.001). The nomogram that combined monocyte-to-albumin ratio with other independent factors showed good discrimination and calibration, and provided higher prognostic accuracy than single predictors. CONCLUSIONS: Preoperative MAR is an independent prognostic marker of OS in patients with HCC undergoing hepatectomy. A nomogram integrating this ratio with routine clinicopathological factors may offer a practical tool for individualized risk assessment and postoperative management.
The HALP-CONUT integrated score predicts survival and postoperative complications in locally advanced esophageal squamous cell carcinoma following neoadjuvant therapy: evidence from a multicenter retrospective cohort study.
Chen H, Huang X, Lin Z … +8 more , Wei Y, Chen C, Zheng B, Lin Y, Huang R, Cheng L, Xu C, Yang Z
World J Surg Oncol · 2026 Jun · PMID 42249442 · Full text
BACKGROUND: The prognostic role of nutrition-inflammation indices in esophageal squamous cell carcinoma (ESCC) requires further investigation. We developed the HALP-CONUT Integrated Score (HCIS) and evaluated its ability...
BACKGROUND: The prognostic role of nutrition-inflammation indices in esophageal squamous cell carcinoma (ESCC) requires further investigation. We developed the HALP-CONUT Integrated Score (HCIS) and evaluated its ability to predict survival and postoperative complications in locally advanced ESCC patients undergoing neoadjuvant therapy. METHODS: This multicenter retrospective study analyzed 410 patients. HCIS was calculated by integrating the HALP index and CONUT score. Patients were stratified into risk groups. Survival was analyzed using Kaplan-Meier and Cox regression. Logistic regression assessed associations with complications and pathologic complete response (pCR). Predictive performance was evaluated using ROC curves, C-index, and decision curve analysis. RESULTS: Patients with high HCIS scores had significantly worse overall survival (OS) compared with those in lower-risk groups (p < 0.001). Multivariate Cox analysis confirmed HCIS as an independent prognostic factor for OS (HR 4.59, 95% CI 2.64-7.97, p < 0.001). Higher HCIS scores were also independently associated with increased risk of major postoperative complications (OR 7.144, 95% CI 3.698-13.813, p < 0.001) and a lower likelihood of achieving pCR (OR 6.470, 95% CI 3.577-12.40, p = 0.005). Predictive models incorporating HCIS demonstrated superior discrimination compared with models based on HALP or CONUT alone (AUC for OS: 0.789 vs 0.711 and 0.703, respectively). CONCLUSION: HCIS is a robust biomarker that integrates hematologic, nutritional, and inflammatory parameters. It independently predicts survival, postoperative complications, and pCR, providing a valuable tool for risk stratification and individualized treatment planning in locally advanced ESCC.
Prolonged S-adenosylmethionine exposure is associated with poorer treatment response and adverse outcomes in breast cancer: a retrospective cohort study.
Gao J, Lu Y, Zhang Z … +10 more , Zhai M, Kong S, Jia L, Liang G, Liu J, Ma Z, Li W, Zhu C, Zhang T, Li W
World J Surg Oncol · 2026 Jun · PMID 42243831 · Full text
BACKGROUND: Hepatoprotective regimens are frequently used during chemotherapy for breast cancer, but their effects on oncologic outcomes remain unclear. S-adenosylmethionine (SAMe), a universal methyl donor, may influenc...
BACKGROUND: Hepatoprotective regimens are frequently used during chemotherapy for breast cancer, but their effects on oncologic outcomes remain unclear. S-adenosylmethionine (SAMe), a universal methyl donor, may influence treatment response through epigenetic and epitranscriptomic regulations. METHODS: We retrospectively analyzed data from 1013 consecutive women with primary breast cancer treated at Zhengzhou University People's Hospital between January 1, 2018 and January 1, 2020, and who underwent surgery followed by standard adjuvant chemotherapy. Overall survival (OS) and disease-free survival (DFS) were compared across hepatoprotective regimens. Propensity score matching (1:2) was performed to balance baseline characteristics between SAMe-treated and untreated patients. Receiver operating characteristic (ROC) analysis identified the optimal exposure threshold for recurrence discrimination, and survival was further assessed according to SAMe exposure duration using Cox proportional hazards models. Transcriptomic data from the Cancer Transcriptome Relationships Database (CTR-DB) were analyzed for SAMe-related pathways. In an exploratory neoadjuvant cohort (n = 62), intratumoral SAMe levels, m6A/m5C/m7G signals and METTL3/METTL14 expression were quantified in post-treatment tumor tissues. RESULTS: SAMe exposure during adjuvant chemotherapy was associated with shorter OS and DFS than other or no hepatoprotectants (both P < 0.05). After matching, prolonged SAMe exposure (≥ 14days) remained associated with worse OS and DFS than non-SAMe exposure (both P < 0.05), and this association persisted after multivariable adjustment. CTR-DB analyses revealed enrichment of methionine metabolism and RNA methylation-related pathways in non-responsive tumours. In the neoadjuvant cohort, tumours from patients with poor radiologic response showed higher intratumoral SAMe levels, stronger m6A signals, and higher METTL3 and METTL14 expression. Higher m6A levels were also associated with poorer MRI-based response. CONCLUSIONS: Prolonged SAMe exposure during chemotherapy was associated with poorer treatment response and worse survival. Transcriptomic and tissue-level findings further support a possible link with altered m6A methylation. These results indicate that a cautious and standardized approach to SAMe use during chemotherapy may help limit treatment resistance and improve long-term outcomes.
Bridging the evidence gap: three-year BCG maintenance therapy shows enhanced protection over one-year regimen in Chinese NMIBC.
Du X, Deng Z, Shi Y … +3 more , Ding J, Guo H, Yang R
World J Surg Oncol · 2026 Jun · PMID 42237315 · Full text
BACKGROUND AND OBJECTIVE: The current recommendation of BCG therapy in China is a 1-year regimen, based on local strain variations and the absence of evidence for a 3-year instillation protocol. Our aim was to compare th...
BACKGROUND AND OBJECTIVE: The current recommendation of BCG therapy in China is a 1-year regimen, based on local strain variations and the absence of evidence for a 3-year instillation protocol. Our aim was to compare the protective efficacy of the 3-year BCG regimen versus a 1-year regimen in Chinese NMIBC patients. METHODS: We collected 140 patients followed by BCG monotherapy at our center from 2017 to 2024. All patients had ≥ 1 year of follow-up. Participants were allocated based on clinical practice into a standard three-year instillation group (n = 72) and a modified one-year group (n = 68). Kaplan-Meier survival analysis evaluated the impact of both regimens, while Cox regression identified factors for recurrence. Subgroup analyses and interaction tests were performed for all categorical variables. The prognostic role of instillation regimens across different risk stratifications was assessed via interaction and subgroup analyses. KEY FINDINGS AND LIMITATIONS: Kaplan-Meier analysis demonstrated superior RFS in the three-year group (HR 0.31; 95% CI 0.14-0.67). Multivariate Cox regression confirmed the three-year regimen as an independent protective factor against recurrence (p = 0.006, HR 0.282; 95% CI 0.114-0.697). The protective effect remained significant in high-risk subgroups. Adverse events were numerically fewer in the three-year group, though this comparison should be interpreted cautiously. This study is limited by its retrospective design, the marked imbalance in treatment completion between groups (25% vs. 51.5%), and the small number of recurrence events (n = 27), all of which preclude causal interpretation and require cautious reading of the hazard ratio estimates. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our findings suggest that the standard 3-year regimen may offer superior recurrence risk reduction compared to the 1-year regimen in Chinese high-risk NMIBC patients. Given the retrospective design and limited sample size, these results should be considered hypothesis-generating and warrant confirmation in prospective studies. A 3-year BCG regimen may offer better protection than a 1-year regimen for Chinese high-risk NMIBC patients.
Immune-inflammatory-fibrinogen score as a novel prognostic biomarker in patients with gastric cancer undergoing radical gastrectomy: a multicenter study.
Zhao W, Zhong Q, Li BL … +11 more , Weng CM, Zhang HX, Wang G, Zhang ZQ, Wu YX, Wu D, Chen JY, Chen QY, Zheng CH, Huang CM, Xie JW
World J Surg Oncol · 2026 Jun · PMID 42226295 · Full text
BACKGROUND: Gastric cancer (GC) progression involves changes in immune responses, inflammation, and coagulation. The prognostic value of related biomarkers remains unclear. This study aimed to develop a novel immune-infl...
BACKGROUND: Gastric cancer (GC) progression involves changes in immune responses, inflammation, and coagulation. The prognostic value of related biomarkers remains unclear. This study aimed to develop a novel immune-inflammation-fibrinogen score (FSL score) to predict outcomes in GC patients after radical gastrectomy. METHODS: Clinicopathological data from 401 GC patients enrolled in a randomized controlled trial (2015-2016; ClinicalTrials.gov: NCT02327481) were retrospectively analyzed as the training cohort, with 173 patients included for external validation. Cox regression was used to construct the FSL score based on preoperative hematological markers and to evaluate its association with overall survival (OS) and recurrence-free survival (RFS). A nomogram incorporating the FSL score and clinicopathological factors was developed and evaluated using the C-index, time-dependent AUC, calibration curves, AIC, BIC, and decision curve analysis (DCA), and compared with the AJCC 8th TNM staging system. RESULTS: Patients with high FSL scores had significantly better 3-year OS (training cohort: 87.4% vs. 71.3%, p = 0.001; validation cohort: 68.4% vs. 42.6%, p = 0.009) and RFS (training cohort: 81.0% vs. 67.6%, p = 0.001; validation cohort: 72.4% vs. 54.9%, p = 0.025). The FSL score independently predicted OS and RFS (all p < 0.05). A nomogram integrating the FSL score, preoperative CEA level, pT stage, pN stage, and postoperative chemotherapy outperformed the TNM system for OS (C-index: 0.806 vs. 0.757; AIC: 1378.25 vs. 1395.73; BIC: 1390.49 vs. 1394.10) and RFS (C-index: 0.803 vs. 0.763; AIC: 1310.10 vs. 1319.08; BIC: 1320.11 vs. 1322.26), with good discrimination, calibration, and clinical utility confirmed by DCA and external validation. CONCLUSIONS: The FSL score is a promising prognostic biomarker for GC patients undergoing radical gastrectomy. The proposed nomogram enables accurate and individualized survival prediction.
Development and validation of a machine learning model for predicting distant metastasis in patients with renal cell carcinoma: a population-based study.
Cheng C, Peng X, Qiu R … +3 more , Ma H, Gui M, Shi R
World J Surg Oncol · 2026 Jun · PMID 42226290 · Full text
BACKGROUND: Distant metastasis is the leading cause of death in renal cell carcinoma (RCC), yet accurate prediction tools remain lacking. We aimed to develop and validate a machine learning model to predict synchronous d...
BACKGROUND: Distant metastasis is the leading cause of death in renal cell carcinoma (RCC), yet accurate prediction tools remain lacking. We aimed to develop and validate a machine learning model to predict synchronous distant metastasis-defined as metastasis present at the time of initial diagnosis-in RCC. METHODS: We identified 106,448 RCC patients from the SEER database (2010-2020), divided into training (n = 52,368), internal validation (n = 22,444), and external validation (n = 31,636) cohorts. Nine machine learning algorithms were compared using area under the curve (AUC), calibration, and decision curve analysis. Model interpretability was assessed using SHAP analysis. RESULTS: Distant metastasis was present in 10.7% of patients. N1 stage (OR 8.28-9.46), tumor size > 7 cm (OR 6.30-7.72), T4 stage (OR 6.29-8.51), and sarcomatoid histology (OR 1.89-3.28) were independent risk factors, while chromophobe histology (OR 0.04-0.11) and multifocal tumors (OR 0.40-0.53) were protective. Gradient Boosting achieved AUCs of 0.906, 0.906, and 0.926 in training, internal, and external validation cohorts, respectively. The model demonstrated good calibration and clinical utility across threshold probabilities of 5%-80%. Performance remained stable across subgroups and sensitivity analyses. A web calculator was developed (https://952307952pxw.shinyapps.io/RCC-Calculator/). CONCLUSIONS: We developed a machine learning model that accurately predicts synchronous distant metastasis at the time of initial RCC diagnosis, with good generalizability. The online calculator may assist clinicians in risk stratification and individualized decision-making.
In silico analysis of driver genes in squamous cell carcinoma of the cervix: insights into their biological functions, prognosis, immune infiltration, and therapy.
Bhat S, Devi V, Kabekkodu SP
World J Surg Oncol · 2026 Jun · PMID 42226181 · Full text
BACKGROUND: Cervical cancer is the fourth most common cancer affecting the female reproductive system worldwide. Although several studies have reported recurrent mutations in cervical squamous cell carcinoma (SCC), a com...
BACKGROUND: Cervical cancer is the fourth most common cancer affecting the female reproductive system worldwide. Although several studies have reported recurrent mutations in cervical squamous cell carcinoma (SCC), a comprehensive understanding of the clinically relevant driver genes remains limited. Unlike previous single-cohort or frequency-based reports, this study integrates four independent cervical squamous cell carcinoma (SCC) cohorts with network-based analysis, multiendpoint survival assessment, and drug-gene interaction to prioritize functionally and clinically relevant driver hub genes. MATERIALS AND METHODS: In this study, we performed a genomic analysis of a cohort of 4 squamous cell carcinomas of the cervix (SCCs), consisting of 467 samples, to identify driver genes and their clinical significance. Key pathways and biological functions affected were tested by functional enrichment analysis. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and CytoHubba tools were used to construct a protein‒protein interaction network (PPIN) and identify the hub genes. Additional analyses included enrichment assessment of cancer hallmarks, survival evaluation, immune cell infiltration profiling, and drug‒gene interaction studies. RESULTS: Our analysis revealed 9,749,109 mutations across 44 driver genes. PIK3CA, KMT2C, KMT2D, FBXW7, FAT1, EP300, TP53, NOTCH1, STK11, and CASP8 were the top 10 mutated genes. PIK3CA, NOTCH1, PTEN, KRAS, ERBB2, TP53, ARID1A, EP300, STK11, and FBXW7 emerged as the top 10 hub genes according to the results of the PPIN and Cytohubba analyses. In addition, we observed significant differences in T helper cell type 2, natural killer cell, dendritic cell, and gamma delta T-cell composition in samples with hub gene mutations. Prioritization analysis of drug and hub gene interactions revealed 112 clinically relevant compounds, especially HER2-directed therapies (trastuzumab), PI3K inhibitors (alpelisib), and mTOR inhibitors (everolimus). CONCLUSION: Collectively, our analysis describes the driver genes and mutation characteristics in SCC. The multi-cohort and network-based framework employed in this study identifies candidate hub genes that warrant further clinical investigation in cervical cancer.
Robotic segmental ureterectomy for upper tract urothelial carcinoma: comparable short-term oncological outcomes and improved postoperative recovery compared to open approach.
Lasmanovich R, Chepeliuk O, Fihman M … +8 more , Shvero A, Kleinmann N, Fridman E, Portnoy O, Laufer M, Zilberman DE, Rosenzweig B, Dotan ZA
World J Surg Oncol · 2026 Jun · PMID 42226062 · Full text
BACKGROUND: Segmental ureterectomy (SU) is an established kidney-sparing strategy for upper tract urothelial carcinoma (UTUC), yet few studies have compared the standard open approach to the emerging robotic modality. ME...
BACKGROUND: Segmental ureterectomy (SU) is an established kidney-sparing strategy for upper tract urothelial carcinoma (UTUC), yet few studies have compared the standard open approach to the emerging robotic modality. METHODS: We performed a clinical outcome and safety evaluation of robotic-assisted SU compared to the traditional open approach. In this retrospective study of 53 patients (40 open, 13 robotic) treated between 2008 and 2025, we assessed perioperative, functional, and oncological parameters. RESULTS: Regarding safety endpoints, robotic SU demonstrated a favorable profile with no significant difference in postoperative complication rates compared to open surgery (15.4% vs. 26.5%, p = 0.7). While the robotic approach involved longer operative times (351 vs. 285 min, p = 0.01), it resulted in a significantly shorter median hospital stay (4 vs. 12 days, p < 0.001). Utilizing Firth's penalized Cox regression to account for sparse events, no significant differences were observed in overall survival (HR 1.25, 95% CI 0.13-6.17, p = 0.815) or disease-free survival (HR 1.22, 95% CI 0.31-3.63, p = 0.75). Similarly, secondary endpoints including intraluminal recurrence-free (p = 0.188), intravesical recurrence-free (p = 0.581), and metastasis-free survival (p = 0.997) did not differ significantly. Postoperatively, functional evaluation revealed a trend toward improved renal function in the robotic cohort (+ 22.94 vs. +7.46 mL/min/1.73 m², p = 0.08). CONCLUSIONS: Robotic SU appears feasible and was not associated with an apparent compromise in short-term oncological outcomes during the available follow-up period, while offering the benefits of minimally invasive recovery. Given the limited follow-up and small sample size of the robotic cohort, these results provide preliminary evidence of safety. Further multi-institutional, large-scale studies with extended follow-up are required to establish definitive long-term non-inferiority.
Trapezoidal tunnel intracorporeal esophagogastric anastomosis technique in laparoscopic-assisted proximal gastrectomy: technical notes and preliminary experience.
Sakurazawa N, Kakinuma D, Hagiwara N … +5 more , Kogo H, Suzuki M, Komori H, Nakamura Y, Yoshida H
World J Surg Oncol · 2026 Jun · PMID 42219492 · Full text
BACKGROUND: Proximal gastrectomy (PG) is a curative surgical option that can also improve quality of life. Although esophagogastric anastomosis is a simple one-site procedure, reflux esophagitis remains a concern. This s...
BACKGROUND: Proximal gastrectomy (PG) is a curative surgical option that can also improve quality of life. Although esophagogastric anastomosis is a simple one-site procedure, reflux esophagitis remains a concern. This study presents an esophagogastric anastomosis technique that simplifies intra-abdominal manipulation by forming a trapezoidal tunnel in the residual stomach through extra-abdominal manipulation. We then evaluated the feasibility and functional outcomes of this technique. METHODS: We retrospectively analyzed clinical data from 12 consecutive patients who underwent laparoscopic PG using the trapezoidal tunnel technique between November 2017 and September 2020 at Nippon Medical School Chiba Hokuso Hospital and between October 2020 and May 2022 at Nippon Medical School Hospital. Demographic and clinical pathological characteristics, preoperative details, and postoperative outcomes were analyzed. Reflux and stenosis status was assessed via endoscopy during follow-up conducted at least 1 year after surgery. RESULTS: Laparoscopic PG using the trapezoidal tunnel technique was successfully performed in all 12 cases. The mean operative time was 262 (195-362) minutes (including 57 [40-89] minutes for reconstruction). No postoperative complications of Clavien-Dindo grade II or higher were observed. The mean hospital stay was 12 (10-21) days. Endoscopic findings during postoperative follow-up (61 [14-89 months]) were normal, except for one patient who developed Los Angeles classification grade A esophagitis. Notably, no anastomotic strictures were identified. CONCLUSION: The trapezoidal tunnel technique is a feasible approach for anti-reflux reconstruction following laparoscopic PG that simplifies intra-abdominal surgical techniques while maintaining favorable postoperative clinical outcomes. Given the retrospective nature of the cases analyzed, further large-scale clinical trials are essential to verify the safety and efficacy of this technique.
Modeling distress in cancer patients using a fuzzy logic approach based on expert consensus.
Pandey A, Thomas BC, Pandey M
World J Surg Oncol · 2026 May · PMID 42218534 · Full text
OBJECTIVE: To develop and validate a fuzzy logic model based on expert consensus to elucidate distress dynamics in cancer patients, examining the non-linear interactions between psychological, social, and medical factors...
OBJECTIVE: To develop and validate a fuzzy logic model based on expert consensus to elucidate distress dynamics in cancer patients, examining the non-linear interactions between psychological, social, and medical factors. METHODS: A two-round Delphi process with 23 psychosocial oncology experts was conducted to generate an interaction matrix of 18 distress-related variables. Using the skfuzzy Python library, a Mamdani fuzzy inference system was constructed, focusing on Negative Psychological Factors, Symptoms, and Positive Psychological Factors as primary drivers. Model validation included network analysis, time-series simulations, and sensitivity analyses, compared against a traditional crisp system dynamics model. RESULTS: The fuzzy model confirmed a self-reinforcing "vicious cycle" of distress driven by Negative Psychological Factors (weight = 2.00) and Symptoms (weight = 1.50). Simulations demonstrated that positive psychological interventions could reduce overall distress levels by up to 25%. Network analysis identified distress as a central system hub, while the fuzzy model produced smoother, more clinically realistic trajectories than the crisp model. CONCLUSION: This study provides a robust mathematical explanation for the success of the validated DIC-2 clinical tool. The results underscore the necessity of early, multidisciplinary interventions to disrupt distress cycles, supporting the clinical shift toward treating distress as the "sixth vital sign".
A logNII-based model for predicting pathological complete response following neoadjuvant therapy in esophageal squamous cell carcinoma: a retrospective single-center study.
Zhang M, Huang J, Wang C … +2 more , Yang B, Lu T
World J Surg Oncol · 2026 May · PMID 42218485 · Full text
OBJECTIVE: This study aimed to develop and validate a predictive model for pathological complete response (pCR) following neoadjuvant therapy in esophageal squamous cell carcinoma (ESCC), focusing on Nutrition-Inflammati...
OBJECTIVE: This study aimed to develop and validate a predictive model for pathological complete response (pCR) following neoadjuvant therapy in esophageal squamous cell carcinoma (ESCC), focusing on Nutrition-Inflammation Index (NII) and its potential nonlinear relationship with pCR. METHODS: A single-center retrospective cohort of 363 ESCC patients receiving neoadjuvant therapy followed by esophagectomy was analyzed. We employed restricted cubic splines within multivariable logistic regression to characterize the relationship between log-transformed Nutrition-Inflammation Index (logNII) and pCR. The model's performance was rigorously assessed by its discriminative ability (Area Under the Curve, AUC), calibration, and clinical utility using bootstrap validation and decision curve analysis (DCA). RESULTS: The logNII demonstrated a significant, independent, and nonlinear association with pCR after adjusting for key clinical covariates. The final predictive model, which incorporated logNII and clinical variables, achieved an AUC of 0.816 (95% CI: 0.770-0.863). DCA confirmed the model provided significant net clinical benefit across a wide range of threshold probabilities, highlighting its potential for clinical decision-making. CONCLUSION: We established logNII as a robust, independent, and nonlinear predictor of pCR in ESCC. The developed model demonstrates excellent predictive performance and clinical utility, offering a valuable tool for personalizing treatment strategies in the neoadjuvant setting.
Advances in the molecular subtyping of gastric cancer.
Chen J, Zhang X, Zhao Y
World J Surg Oncol · 2026 May · PMID 42216188 · Full text
Despite decades of significant progress in gastric cancer research, the prognosis remains poor because of the disease's high aggressiveness. Historically, gastric cancers were classified based on histopathology and anato...
Despite decades of significant progress in gastric cancer research, the prognosis remains poor because of the disease's high aggressiveness. Historically, gastric cancers were classified based on histopathology and anatomical site-criteria that inadequately support precision therapy. Advances in molecular technologies have produced multiple molecular classification schemes, among which the Cancer Genome Atlas (TCGA) and the Asian Cancer Research Group (ACRG) classifications are the most mature and widely applied. In this review, we systematically summarize molecular subtypes of gastric cancer and explore their underlying molecular mechanisms, therapeutic implications, and prognostic associations. The evidence indicates that molecular subtyping is a key basis for improving precision therapy and enhancing patient outcomes: TCGA and ACRG provide clear clinical guidance, while emerging classifications offer new directions for individualized treatment and support the clinical translation of precision oncology in gastric cancer.
Distal ureterectomy versus radical nephroureterectomy for nonmetastatic distal ureteral urothelial carcinoma: a GRADE-assessed systematic review and meta-analysis of comparative studies.
Mirza W, Hussain K, Khalid M … +3 more , Ali RN, Moeen-Ud-Din MB, Hadhoud AM
World J Surg Oncol · 2026 May · PMID 42216175 · Full text
BACKGROUND: The oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal prese...
BACKGROUND: The oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal preservation is clinically desirable. METHODS: A systematic review and meta-analysis of comparative studies was performed. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 27, 2026. A total of 229 records were identified, 14 full-text articles were assessed, and 6 studies were included. The primary outcome was a positive surgical margin. Secondary outcomes included intravesical recurrence, cancer-specific survival, lymph node metastasis, muscle-invasive disease (≥ pT2), and high-grade pathologic disease burden as a marker of baseline oncologic risk and treatment-selection balance. Random-effects models were used. Risk of bias was assessed with ROBINS-I, and certainty of evidence was evaluated using GRADE. RESULTS: A total of 6 comparative studies comprising 1,247 patients were included, of whom 588 underwent distal ureterectomy, and 659 underwent radical nephroureterectomy. DU was not associated with a significant difference in positive surgical margin compared with RNU (RR 1.24, 95% CI 0.64-2.43). Cancer-specific survival was also comparable (HR 0.97, 95% CI 0.72-1.29). No significant differences were observed for lymph node metastasis (RR 0.85, 95% CI 0.40-1.80), muscle-invasive disease (RR 0.96, 95% CI 0.86-1.08), or high-grade disease (RR 0.97, 95% CI 0.86-1.09). Intravesical recurrence was not significantly different in the primary pooled analysis (HR 1.36, 95% CI 0.89-2.07), although sensitivity analysis suggested a higher recurrence hazard after DU. Most outcomes were supported by very low to low certainty evidence. CONCLUSIONS: In selected patients with nonmetastatic distal ureteral urothelial carcinoma, DU appears to preserve oncologic adequacy relative to RNU while offering a kidney-sparing surgical alternative. The main trade-off may be a higher risk of intravesical recurrence, underscoring the need for careful surveillance and individualized surgical decision-making.
LncRNA GAS6-AS1 enhances the progression of pediatric neuroblastoma by modulating miR-3200-3p.
Chen J, Huang H, Lin J … +2 more , Xu Y, Wu Q
World J Surg Oncol · 2026 May · PMID 42215989 · Full text
BACKGROUND: Neuroblastoma, a highly malignant and heterogeneous tumor, is the most frequent extracranial solid malignancy in children. PURPOSE: This study explores the prognostic significance and biological role of GAS6-...
BACKGROUND: Neuroblastoma, a highly malignant and heterogeneous tumor, is the most frequent extracranial solid malignancy in children. PURPOSE: This study explores the prognostic significance and biological role of GAS6-AS1 in neuroblastoma, aiming to identify novel biomarkers that could enhance the understanding of disease progression. METHODS: RT-qPCR was used to measure GAS6-AS1 expression levels in neuroblastoma tissues. The association between GAS6-AS1 expression and clinical features was assessed using the chi-square test, while its prognostic impact was examined via Cox regression and Kaplan-Meier survival analysis. Functional experiments, including CCK-8, colony formation, and flow cytometry, were conducted to assess how GAS6-AS1 knockdown influences neuroblastoma cell proliferation and apoptosis. Additionally, Transwell assays evaluated its role in cell migration and invasion. Bioinformatics analysis and dual-luciferase reporter assays were employed to investigate downstream regulatory mechanisms. RESULTS: Elevated GAS6-AS1 expression was observed in neuroblastoma tissues and associated with adverse clinicopathological characteristics. Survival analysis revealed that high GAS6-AS1 levels independently predicted poorer outcomes. Functional assays revealed that GAS6-AS1 depletion attenuated oncogenic behaviors, including proliferation and metastatic potential. Further investigation identified miR-3200-3p as a downstream target of GAS6-AS1, where its suppression counteracted the inhibitory effects of GAS6-AS1 knockdown on malignant phenotypes. Moreover, the results of GO and KEGG analyses indicated that the involvement of the GAS6-AS1/miR-3200-3p axis in neuroblastoma progression may be related to protein polyubiquitination, MAP kinase activity, and autophagy. CONCLUSIONS: This study establishes GAS6-AS1 as a promising prognostic biomarker in neuroblastoma. GAS6-AS1 exerts oncogenic effects by modulating miR-3200-3p, thereby promoting neuroblastoma progression through enhanced malignant phenotypes.
Postoperative loss of skeletal muscle mass and visceral fat predicts survival and morbidity after surgically treated non-metastatic chondrosarcoma: a longitudinal CT morphometric study.
Kylies J, Ballhause TM, Striefler JK … +4 more , Duprée A, Well L, Frosch KH, Priemel M
World J Surg Oncol · 2026 May · PMID 42210225 · Full text
BACKGROUND: Chondrosarcoma is the second most common malignant primary bone tumor in adults. Surgical resection is the mainstay of treatment. However, outcomes remain heterogeneous even after complete (R0) resection with...
BACKGROUND: Chondrosarcoma is the second most common malignant primary bone tumor in adults. Surgical resection is the mainstay of treatment. However, outcomes remain heterogeneous even after complete (R0) resection within its oncologic margins. The prognostic relevance of CT-based body composition, both preoperatively and over the disease course, has not been defined in chondrosarcoma. METHODS: A retrospective cohort study including 79 adults with histologically confirmed, non-metastatic (N0M0) chondrosarcoma treated by complete (R0) resection between 2010 and 2024 was conducted. Each patient had two evaluable CT examinations acquired on the same scanner, a preoperative baseline (tCT1) and a follow-up scan approximately one year postoperatively (tCT2; mean interval 13.3 ± 2.2 months). At the L3 level, skeletal muscle and visceral fat indices (Skeletal muscle index (SMI), Paraspinal Muscle Index (PSMI), Psoas Muscle Index (PMI), Skeletal Muscle Density (SMD), Visceral adipose Tissue (VAT)) were derived and compared over time. Changes were analyzed in relation to tumor localization and grade. Survival was assessed using Kaplan-Meier and Cox regression models. ROC analysis/Youden J Index identified prognostic thresholds (SMI loss ≥ 30%; VAT loss ≥ 25%). Preoperative sarcopenia was defined using established sex-specific SMI cutoffs. RESULTS: A marked postoperative deterioration in SMI, PSMI, PMI, and VAT was observed, whereas muscle density (SMD) largely remained unchanged. Losses were most pronounced in trunk-localized tumors (e.g., SMI - 41.3 ± 20.4%) and in high-grade disease (SMI: G1 - 22.5 ± 13.2%, G2 - 36.3 ± 20.6%, G3 - 52.1 ± 15.6%). Patients with SMI loss ≥ 30% showed reduced median overall survival (64 vs. 116 months; p = 0.02), and VAT loss ≥ 25% was associated with similarly poor survival (42 vs. 88 months; p < 0.01). In multivariable analysis, both SMI loss ≥ 30% (HR 1.44, 95% CI 1.10-2.33; p = 0.02) and VAT loss ≥ 25% (HR 1.40, 95% CI 1.20-2.41; p = 0.01) independently predicted worse survival. Preoperative sarcopenia was associated with shorter median survival (42 vs. 116 months; p < 0.0001), higher surgical site infection rates (27% vs. 2%; p < 0.001), and prolonged hospitalization across anatomical sites (all p < 0.001), and remained an independent prognostic factor on adjusted analysis (HR 1.31, 95% CI 1.19-2.45; p < 0.01). CONCLUSIONS: In R0-resected, non-metastatic chondrosarcoma, both preoperative sarcopenia and postoperative declines in muscle and adipose tissue, particularly SMI loss ≥ 30% and VAT loss ≥ 25%, are independent predictors of reduced survival and worse postoperative outcomes. Leveraging routinely acquired staging CTs for morphometric analysis may enable early risk identification and guide personalized perioperative management.
Bilateral risk reducing mastectomy uptake trends in healthy BRCA1/2 mutation carriers of an European City, the brachoice study.
Bernini M, Innocenti S, Turchetti D … +11 more , Miccoli S, Innella G, Pellegrini A, Melina M, Zanotti S, Cucchi MC, Galluzzo V, Lozano Miralles ME, Ventimiglia F, Cocchi D, Serra M
World J Surg Oncol · 2026 May · PMID 42210211 · Full text
This study evaluates the uptake of bilateral risk-reducing mastectomy (BRRM) among unaffected BRCA1/2 mutation carriers in the metropolitan area of Bologna, Italy, between 2012 and 2024. Pathogenic BRCA variants, which c...
This study evaluates the uptake of bilateral risk-reducing mastectomy (BRRM) among unaffected BRCA1/2 mutation carriers in the metropolitan area of Bologna, Italy, between 2012 and 2024. Pathogenic BRCA variants, which confer a markedly increased lifetime risk of breast cancer, are managed through preventive strategies such as BRRM, which can reduce risk by more than 90%.Among 178 women (89 BRCA1 and 89 BRCA2 carriers), 22.5% elected to undergo BRRM, with a significantly higher uptake among BRCA1 carriers (33.7%) compared with BRCA2 carriers (11.2%). Most procedures were performed more than two years after genetic testing, and the most common age at surgery was 41-45 years.Furthermore, the results demonstrate a progressive increase over time in both genetic testing and BRRM uptake, in line with international trends. However, the observed rates remain lower than those reported in Northern Europe. Despite limitations related to cohort size and data completeness, this study provides updated evidence on decision-making regarding BRRM among Italian women at hereditary risk of breast cancer.
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