World Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Machine learning-based prognostic model integrating preoperative HALP score and lactate dehydrogenase for predicting postoperative recurrence of prostate cancer.
Wang H, Qiu X, Li Z … +6 more , Wu J, Gan L, Xie D, Wei Y, Wang J, Wang W
World J Surg Oncol · 2026 May · PMID 42204546 · Full text
OBJECTIVE: Postoperative biochemical recurrence (BCR) of prostate cancer (PCa) remains a major clinical challenge, and traditional risk assessment systems show suboptimal predictive performance for PCa recurrence. This s...
OBJECTIVE: Postoperative biochemical recurrence (BCR) of prostate cancer (PCa) remains a major clinical challenge, and traditional risk assessment systems show suboptimal predictive performance for PCa recurrence. This study aimed to develop and validate interpretable machine learning (ML) models for predicting PCa postoperative recurrence by integrating multi-dimensional clinical features, and to construct a simplified and practical prognostic model for individualized risk stratification. METHODS: A total of 320 PCa patients (125 recurrences vs. 195 non-recurrences) who underwent laparoscopic radical prostatectomy (LRP) at the primary center were retrospectively enrolled as the internal cohort, and 144 patients (50 recurrences vs. 94 non-recurrences) from another campus were included as the external validation cohort. Ten ML algorithms were used to construct prediction models with clinicopathological, preoperative hematological and nutrition-inflammation features. Stratified sampling and ten-fold cross-validation were used for model training and validation, and SHAP analysis was adopted for feature importance evaluation and model interpretability. Recursive feature inclusion was performed to optimize the model, and clinical cutoffs of key indicators were determined. RESULTS: The gradient boosting machine (GBM) model achieved the best predictive performance in the internal cohort with an AUC of 0.891, which was significantly superior to the UCSF-CAPRA score (AUC = 0.703) and the D'Amico classification (AUC = 0.610). A simplified 5-feature GBM model [positive surgical margin, preoperative hemoglobin-albumin-lymphocyte-platelet (HALP) score, postoperative Gleason score, preoperative maximum prostate specific antigen, preoperative lactate dehydrogenase (LDH)] achieved an AUC of 0.912 in the internal cohort and 0.895 in the external cohort, with excellent calibration and higher net clinical benefit. The optimal cutoffs were 41.31 for preoperative HALP score and 182.61 U/L for preoperative LDH. Low HALP was associated with shorter recurrence-free survival (HR = 0.30, P < 0.0001), and high LDH indicated increased recurrence risk (HR = 1.37, P = 0.083). A three-tier risk stratification system was established based on the cutoff values to predict postoperative recurrence risk. CONCLUSION: The ML model integrating preoperative HALP score, LDH and core clinicopathological features has high accuracy and good clinical applicability for predicting PCa postoperative recurrence. Validated successfully in both internal and external cohorts, the 5-feature simplified model can serve as a practical tool for individualized recurrence risk assessment, facilitating optimized clinical management of PCa patients.
A machine learning-based risk prediction framework for atypical hyperplasia and endometrial cancer in postmenopausal women.
Li C, Wang J, Zhang Y … +2 more , Hu L, Wang Y
World J Surg Oncol · 2026 May · PMID 42192437 · Full text
BACKGROUND: This study aimed to develop and internally validate a machine learning-based model for predicting endometrial malignancy, defined as atypical hyperplasia or endometrial cancer (AH/EC), in postmenopausal women...
BACKGROUND: This study aimed to develop and internally validate a machine learning-based model for predicting endometrial malignancy, defined as atypical hyperplasia or endometrial cancer (AH/EC), in postmenopausal women, integrating routinely available clinical, ultrasound, and laboratory features to support individualized diagnostic triage and potentially reduce unnecessary invasive diagnostic procedures in low-risk patients. METHODS: This retrospective, single-center study included 858 postmenopausal women who underwent endometrial histopathological evaluation at Henan Provincial People's Hospital between February 2022 and September 2025. The cohort was randomly divided into a training set (70%, n = 602) and a validation set (30%, n = 256). Feature selection was performed in the training cohort using univariate analysis (P < 0.001), LASSO regression with the λ₁se criterion, and the Boruta algorithm. Nine supervised machine learning models were developed in the training cohort and evaluated in the validation cohort. Model performance was assessed based on discrimination (area under the receiver operating characteristic curve [AUC], sensitivity, specificity, F1 score), calibration (Brier score, calibration curves), and clinical utility (decision curve analysis). SHAP was applied to interpret the optimal model, and a nomogram was constructed based on the Logistic Regression model. RESULTS: A total of 155 patients (18.1%) were diagnosed with AH/EC. Six predictors were retained for model development: Endometrial thickness, Postmenopausal bleeding, Presence of blood flow signal, CA19-9, CA125, and Lesion outline regularity. In the validation cohort, the Neural Network model showed the highest AUC (0.840, 95% CI: 0.770-0.909), comparable to Logistic Regression (AUC 0.838, 95% CI: 0.768-0.908), with higher sensitivity (0.739 vs. 0.674) and similar calibration (Brier score 0.099 for both models). Both models showed acceptable validation performance. CONCLUSION: A prediction framework based on routinely obtainable clinical, ultrasound, and laboratory variables may support personalized risk assessment in postmenopausal women undergoing diagnostic evaluation for suspected endometrial lesions. Further multicenter external validation and prospective studies are needed to confirm its generalizability and clinical applicability.
Exploring the impacts of docetaxel and paclitaxel based neoadjuvant therapies on early postoperative complications in HER2-positive breast cancer patients.
Sagdic MF, Tunc E, Kaya S … +3 more , Kulturoglu MO, Yıldırım ÖA, Dogan L
World J Surg Oncol · 2026 May · PMID 42192428 · Full text
BACKGROUND: HER2-positive breast cancer accounts for 15-20% of all breast cancer cases. Anti-HER2-based neoadjuvant therapy combined with taxanes, particularly docetaxel and paclitaxel, constitutes the standard treatment...
BACKGROUND: HER2-positive breast cancer accounts for 15-20% of all breast cancer cases. Anti-HER2-based neoadjuvant therapy combined with taxanes, particularly docetaxel and paclitaxel, constitutes the standard treatment approach. Although these regimens are widely used, most studies have focused on systemic adverse effects, with limited data addressing their impact on postoperative surgical complications. This study aimed to evaluate the association between docetaxel- and paclitaxel-based neoadjuvant regimens and early wound complications in HER2-positive breast cancer patients. METHOD: We retrospectively analyzed 139 patients with HER2-positive breast cancer who underwent breast-conserving surgery following neoadjuvant therapy at Ankara Etlik City Hospital between October 2022 and January 2025. Patients were grouped according to the taxane received (docetaxel, n = 95; paclitaxel, n = 44). Demographic, clinicopathologic characteristics, and early postoperative wound complications were compared. Major complications were defined as major wound dehiscence and skin necrosis. Associations between variables and major complications were evaluated using univariate analysis. RESULTS: Major complications were significantly more frequent in the docetaxel group compared to the paclitaxel group (9.5% vs. 0%, p = 0.022), while no significant difference was observed in minor complications (p = 0.704). In subgroup analysis excluding patients who underwent axillary lymph node dissection, this association remained significant (11.1% vs. 0%, p = 0.034). CONCLUSIONS: Docetaxel-based neoadjuvant therapy was associated with a higher rate of major postoperative wound complications compared with paclitaxel-based regimens in patients with HER2-positive breast cancer. This association persisted after excluding patients who underwent axillary lymph node dissection. These findings should be interpreted with caution due to the retrospective design and limited number of events.
Global burden of breast cancer and its association with red meat consumption: spatiotemporal trends, projections, and triangulation of evidence.
Wang Z, Gao J, Liu Z … +5 more , Gong Y, Xu X, Zhao H, Zhang Y, Zhang L
World J Surg Oncol · 2026 May · PMID 42192421 · Full text
BACKGROUND: Despite being the leading cause of cancer-related deaths among women globally, a comprehensive understanding of breast cancer (BC) remains limited due to gaps in data quality, geographic coverage, burden metr...
BACKGROUND: Despite being the leading cause of cancer-related deaths among women globally, a comprehensive understanding of breast cancer (BC) remains limited due to gaps in data quality, geographic coverage, burden metrics, and risk factor attribution. This study utilized a multi-model approach to assess the global burden of BC and its projected trends, complemented by Mendelian randomization (MR) analysis to explore the potential causal relationship between red meat consumption and BC risk. METHODS: This study utilized GBD data from 1990 to 2021 to assess the epidemiology of BC. Temporal trends and risk factor dynamics were examined using joinpoint regression and age-period-cohort (APC) analyses. Bayesian APC modeling was employed to project the disease burden through 2030. The analysis was stratified by socio-demographic index (SDI) and conducted by continent. Disease attribution factors were validated through MR. RESULTS: The study identified significant geographical and gender disparities in global BC epidemiological patterns in 2021. Analysis of data from 1990 to 2021 revealed age-dependent variations in disease burden, particularly affecting populations aged 50 years and older. Although global disability-adjusted life years (DALYs) and mortality rates exhibited an overall decline, incidence rates continued to rise. Female DALYs consistently exceeded those of males, with male metrics showing post-peak declines and projected further reductions by 2030. Both genders demonstrated increasing trends in incidence and prevalence, with females exhibiting notably higher rates in high-income regions, including North America, Western Europe, Australia, and New Zealand. In contrast, males showed a relative predominance in certain African countries, parts of Western Europe, and China. The disease burden was inversely associated with the socio-demographic index (SDI), indicating limited improvements in regions with low SDI. By 2021, high red meat intake and elevated BMI were identified as the leading contributors to BC mortality in the GBD comparative risk assessment framework. Exploratory Mendelian randomization analysis provided suggestive evidence that genetically predicted beef consumption may be associated with increased BC risk, though these findings should be interpreted cautiously due to methodological limitations. CONCLUSION: The global burden of BC is increasing, particularly in low- and middle-SDI regions, highlighting the urgent need for coordinated international efforts to strengthen prevention and control strategies. Priority interventions should combine evidence-based screening practices from high-SDI settings with affordable, targeted therapies, while simultaneously expanding access to treatment, increasing healthcare capacity, and enhancing health education in resource-limited areas. Furthermore, addressing modifiable risk factors requires comprehensive dietary interventions, including promoting plant-based nutrition, launching community-based obesity prevention programs, and implementing public health strategies to reduce red meat consumption at the population level.
Exploring the advantages of mixed reality technology in Robot-assisted laparoscopic partial adrenalectomy.
Zou XC, Wu ZH, Xu XD … +3 more , Chao HC, Huang JB, Zeng T
World J Surg Oncol · 2026 May · PMID 42192419 · Full text
BACKGROUND AND PURPOSE: As an emerging interactive display technology, mixed reality(MR) allows for the integration of multi-dimensional virtual objects with the real world, enhancing the precision of surgical operations...
BACKGROUND AND PURPOSE: As an emerging interactive display technology, mixed reality(MR) allows for the integration of multi-dimensional virtual objects with the real world, enhancing the precision of surgical operations. This technology has demonstrated significant value in renal tumor surgeries, but its application in adrenal tumor surgeries remains unclear. This study aims to investigate the clinical efficacy and potential benefits of mixed reality technology in robot-assisted laparoscopic partial adrenalectomy (RALPA) for treating adrenal tumors. PATIENTS AND METHODS: A total of 82 eligible patients who underwent RALPA for adrenal tumors at the Second Affiliated Hospital of Nanchang University from September 2020 to October 2024 were included in this retrospective study. The patients were divided into two groups based on their preoperative diagnosis and treatment: 32 patients in the mixed reality (MR)group and 50 patients in the traditional CT imaging (control) group. All patients received bilateral adrenal gland CT scans, both plain and enhanced. The MR group utilized CT data to create a virtual model, which was then used for surgical planning and intraoperative guidance through a 3D tablet computer and Hololens glasses. Preoperative variables and perioperative indicators were collected to evaluate surgical outcomes in both groups. RESULTS: Postoperative statistics indicated that the operation time for the MR group was significantly shorter than that of the control group (102.00(98.00 103.00) minutes vs. 103.50(101.00 106.75) minutes, p = 0.017). The estimated intraoperative blood loss was also lower in the MR group compared to the control group (58.50(53.00 63.00) ml vs. 77.00(72.00 86.00) ml, p < 0.001). Additionally, the recovery time for gastrointestinal function in the MR group was significantly shorter than that in the control group (28.00(26.00 30.00) hours vs. 32.00(30.00 35.00) hours, p < 0.001). While there was no significant difference in the incidence of postoperative complications between the two groups, the postoperative hospitalization duration for patients in the MR group was significantly shorter (4.00(4.00 5.00) days vs. 5.00(5.00 5.00), p = 0.004). No statistically significant difference was observed in the spectrum of potential adrenal diseases between the MR and control groups (p > 0.05). CONCLUSION: Compared to traditional CT imaging, RALPA guided by mixed reality technology may be associated with a modest reduction in surgical time, a decrease in intraoperative blood loss, and faster recovery of gastrointestinal function. However, the clinical significance of these observed differences remains limited, and the findings should be interpreted cautiously due to the retrospective study design. Prospective controlled studies are needed to confirm whether MR technology provides a true clinical advantage over conventional imaging in adrenal surgery.
Finding a predictive index for evaluating the efficacy of neoadjuvant therapy in locally advanced gastric cancer patients.
Wang P, Huang G, Zhang J … +1 more , Fu Q
World J Surg Oncol · 2026 May · PMID 42185909 · Full text
BACKGROUND: Emerging evidence suggests that the addition of immunotherapy may improve tumor regression grade (TRG) in locally advanced gastric cancer (LAGC) patients. However, the clinical benefit of immunotherapy in pat...
BACKGROUND: Emerging evidence suggests that the addition of immunotherapy may improve tumor regression grade (TRG) in locally advanced gastric cancer (LAGC) patients. However, the clinical benefit of immunotherapy in patients with low PD-1 expression remains a subject of debate and requires further exploration. Importantly, a proportion of Neoadjuvant immuno-chemotherapy group (NICT) patients did not present significant benefits from neoadjuvant therapy. The aim and objectives of our study is to stratify LAGC patients who can benefit from neoadjuvant therapy based on TRG results. METHODS: We conducted a retrospective study (2020-2023) included 94 LAGC patients (cT3N + M0, 4a-bNanyM0) with gastric adenocarcinoma who receiving neoadjuvant therapy (57 patients in the neoadjuvant chemotherapy (NCT) group, and 37 in NICT group). All patients received ulterior radical surgery, and clinicopathological data were retrospectively reviewed and analyzed. We introduced multivariate analysis demonstrated significant associations between TRG and Tumor differentiation (OR, 7.985; 95% CI, 0.998-34.370; p = 0.007), N stage (OR, 13.286; 95% CI, 1.861-50.324; p = 0.013), tumor size (OR, 5.397; 95% CI, 1.174-24.818; p = 0.030), and immunotherapy (OR, 16.872; 95% CI, 2.889-75.563; p < 0.001). We developed the Clinical Predictive Pathological Remission Score (CPPRS) according to the four indicators mentioned above, assigning 0 points for immunotherapy, well-differentiated tumors, absence of lymph node metastasis, and tumor size < 3.55 cm, while 1 point was assigned for NCT, moderate/poor differentiation, tumor size > 3.55 cm, and lymph node metastasis. RESULTS: NICT group exhibited a significantly higher TRG0 rate compared to the NCT group, independent of PD-1 expression (9/37 vs. 2/57, p = 0.004). Tumor differentiation (OR, 7.985; 95% CI, 0.998-34.370; p = 0.007), N stage (OR, 13.286; 95% CI, 1.861-50.324; p = 0.013), tumor size (OR, 5.397; 95% CI, 1.174-24.818; p = 0.030), and immunotherapy (OR, 16.872; 95% CI, 2.889-75.563; p < 0.001) were significantly associated with TRG. CPPRS demonstrated a strong correlation with TRG (p < 0.001). CONCLUSIONS: The addition of immunotherapy improves TRG in LAGC patients without the need for PD-1 expression assessment. CPPRS serves as a valuable predictive tool for evaluating the efficacy of neoadjuvant therapy in LAGC patients.
MiR-4725-3p acts as an oncogene and prognostic biomarker in hepatocellular carcinoma.
Zhao X, Chang Z, Su J … +3 more , Gu J, Lu Z, Dai P
World J Surg Oncol · 2026 May · PMID 42177572 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm with high incidence and dismal prognostic outcomes. PURPOSE: This study sought to validate the prognostic significance of miR-4725-3p in HCC...
BACKGROUND: Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm with high incidence and dismal prognostic outcomes. PURPOSE: This study sought to validate the prognostic significance of miR-4725-3p in HCC and the possible molecular mechanism. METHODS: A total of 117 HCC patients were stratified into two groups according to the median expression level of miR-4725-3p. Following a 5-year follow-up with death as the end event, a Kaplan-Meier curve was drawn. The potential risk factors for poor prognosis were evaluated using Cox regression analysis. Cell Counting Kit-8 (CCK-8) and Transwell assay were employed to assess the role of miR-4725-3p silencing on Huh-7 and Hep3B cells viability and migration. Downstream target genes of miR-4725-3p were predicted, and a dual-luciferase assay was conducted to verify the interaction. RESULTS: MiR-4725-3p was significantly upregulated in HCC tissue and cell line. Survival analysis showed that high miR-4725-3p expression was associated with poor prognosis in HCC patients (log-rank P = 0.006). At the cellular level, silencing miR-4725-3p significantly suppressed the viability and migration of Huh-7 and Hep3B cells. Mechanistically, activating transcription factor 5 (ATF5) was identified as a direct target of miR-4725-3p. ATF5 was downregulated in HCC tissue and cells. CONCLUSION: The results of this study revealed that miR-4725-3p serves as a promising prognostic biomarker for HCC, and its oncogenic role in promoting HCC cell viability and migration may be mediated, at least in part, via the negative regulation of ATF5.
A novel cartilage-based reference point for the recurrent laryngeal nerve: implication for preoperative risk stratification in posterior subcapsular thyroid tumors.
Lu Q, Wang F, Zhu X … +6 more , Li J, Li W, Wang D, Li Y, Zhao Y, Miao G
World J Surg Oncol · 2026 May · PMID 42177527 · Full text
BACKGROUND: Protecting the recurrent laryngeal nerve (RLN) is central in thyroidectomy, yet little is known about preoperative localization of the RLN and its role in assessing injury risk. We evaluated whether a novel c...
BACKGROUND: Protecting the recurrent laryngeal nerve (RLN) is central in thyroidectomy, yet little is known about preoperative localization of the RLN and its role in assessing injury risk. We evaluated whether a novel cartilage-based landmark, the inferior cricoid-tracheal (ICT) point, located at the intersection of the lateral tracheal border and the inferior margin of the cricoid cartilage, approximates the laryngeal entry point (LEP) of the RLN and enables ultrasound-based measurement of tumor-nerve distance. METHODS: The study consisted of two independent cohorts. In the first cohort, the distance between the ICT point and the LEP was evaluated intraoperatively in 34 patients. In the second cohort, 78 patients with posterior subcapsular tumors underwent preoperative ultrasound measurement of the tumor-to-ICT point distance and intraoperative neuromonitoring (IONM) of RLN signals. An adverse RLN event was assessed using a decrease in signal amplitude of ≥ 50% as the threshold. Postoperative voice status was assessed clinically. RESULTS: The mean ICT point-to-LEP distance was 2.27 ± 0.82 mm. Among the 78 patients with posterior subcapsular tumors, no IONM-defined adverse RLN events were observed in the 49 patients with a tumor-to-ICT point distance ≥ 2.5 mm. Among the 29 patients with a distance < 2.5 mm, 5 had adverse RLN events, whereas the remaining 24 had preserved RLN signals after careful dissection. CONCLUSIONS: Preoperative ultrasound measurement of the tumor-to-ICT point distance may provide an exploratory reference for assessing tumor-RLN proximity in posterior subcapsular thyroid tumors. In this study, a tumor-to-ICT point distance ≥ 2.5 mm was associated with no observed IONM-defined adverse RLN events. This cutoff may serve as a practical reference for preoperative risk assessment, although further validation in larger independent cohorts is still needed.
Upregulation of CYP1B1-AS1 correlates with aggressive phenotypes and poor prognosis in thyroid cancer.
Li X, Qin H, Duan X … +2 more , Wang J, Zhang J
World J Surg Oncol · 2026 May · PMID 42177486 · Full text
BACKGROUND: Aberrant expression of lncRNA CYP1B1-AS1 drives the pathogenesis of diverse cancers, with thyroid carcinoma (TC) being no exception. AIM: This study was designed to clarify how CYP1B1-AS1 expression impacts p...
BACKGROUND: Aberrant expression of lncRNA CYP1B1-AS1 drives the pathogenesis of diverse cancers, with thyroid carcinoma (TC) being no exception. AIM: This study was designed to clarify how CYP1B1-AS1 expression impacts prognostic outcomes in TC patients. METHODS: qRT-PCR was employed to measure CYP1B1-AS1 and miR-3127-5p expression signatures in TC tissues and cell lines. Prognostic value was analyzed by Kaplan-Meier survival and multivariate Cox regression assays. Binding affinities between CYP1B1-AS1/miR-3127-5p and miR-3127-5p/ERBB2 were validated by dual-luciferase reporter assays; RNA pull-down assays were used to confirm the CYP1B1-AS1/miR-3127-5p interaction. Flow cytometry, CCK-8, Wound Healing and Transwell assays were employed to evaluate TC cell apoptosis, growth, motility and invasiveness, respectively. Western blot was performed to detect ERBB2 protein expression. RESULTS: CYP1B1-AS1 was significantly upregulated in TC tissues and cell lines, with concomitant downregulation of miR-3127-5p. TC patients with elevated CYP1B1-AS1 expression exhibited markedly decreased survival rates. CYP1B1-AS1, TNM stage, local invasion, and LNM were defined as prognostic correlates for TC. Knockdown of CYP1B1-AS1 inhibited the malignant phenotypic behaviors of TC cells. CYP1B1-AS1 bound to miR-3127-5p, and the miR-3127-5p inhibitor could counteract the inhibitory effects induced by CYP1B1-AS1 knockdown. ERBB2 was identified as a downstream target gene of miR-3127-5p. CONCLUSION: Increased CYP1B1-AS1 expression correlates strongly with reduced overall survival in TC patients, establishing it as a clinically applicable prognostic indicator and promising therapeutic target.
Carbon (charcoal) tattoo localization of biopsy-proven metastatic axillary lymph nodes for targeted axillary dissection after neoadjuvant therapy in breast cancer: a systematic review and single -arm meta-analysis.
Mirza W, Khan A, Iqbal H … +3 more , Khan ME, Khan HM, Moeen-Ud-Din MB
World J Surg Oncol · 2026 May · PMID 42177471 · Full text
BACKGROUND: Targeted axillary dissection (TAD) using carbon tattooing aims to localize and excise biopsy-proven metastatic axillary nodes after neoadjuvant systemic therapy (NAST), potentially improving post-NAST axillar...
BACKGROUND: Targeted axillary dissection (TAD) using carbon tattooing aims to localize and excise biopsy-proven metastatic axillary nodes after neoadjuvant systemic therapy (NAST), potentially improving post-NAST axillary staging while enabling the de-escalation of axillary surgery. METHODS: We systematically searched Scopus, Embase, PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov, supplemented by screening reference lists. Prospective and retrospective clinical studies evaluating carbon tattooing-guided targeted tattooed lymph node (TLN) excision in initially node-positive breast cancer patients treated with NAST were included. Random-effects generalized linear mixed models (GLMM) were used to pool the proportions of dichotomous outcomes. Continuous outcomes were pooled using a random-effects inverse variance model. The risk of bias was assessed using the ROBINS-I tool. Leave-one-out sensitivity analyses and a pre-specified clinical subgroup analysis (completion-ALND verification cohort vs. feasibility/no-mandatory-ALND cohort) were also performed. RESULTS: Nine studies were included in this review. The pooled TLN identification rate was 0.94 (95% CI: 0.88-0.97). The pooled sentinel lymph node (SLN) identification rate was 0.754 (95% CI 0.541-0.888), with substantial heterogeneity between studies. TLN-SLN concordance was 0.554 (95% CI 0.333-0.755), indicating a moderate overlap between the tattooed node and SLN. In the completion-ALND verification cohorts, the pooled false-negative rate (FNR) of the targeted procedure versus ALND for residual nodal disease was 0.068 (95% CI 0.042-0.108). The pooled mean number of retrieved nodes was 3.25 (95% CI 2.54-3.96), and the pooled tattoo-to-surgery interval was 153.0 days (95% CI 131.9-174.2). Sensitivity analyses showed that no single study unduly influenced pooled estimates. CONCLUSION: Carbon tattooing-guided targeted axillary procedures after NAST demonstrated high TLN retrieval and low verification-cohort FNR, supporting procedural feasibility for post-NAST axillary staging in initially node-positive breast cancer patients. However, variable SLN identification, moderate TLN-SLN concordance, and heterogeneity in technique and reporting support implementation within standardized multidisciplinary workflows with local audits. Further prospective comparative studies are required.
Prognostic value of lymphovascular invasion and CEA for cancer-specific survival in octogenarian colorectal cancer patients.
Weng X, Zhou Y, Zhang Y … +5 more , Fang X, Xu R, Wang Y, Qiu Q, Chen X
World J Surg Oncol · 2026 May · PMID 42174669 · Full text
OBJECTIVE: To investigate the prognostic value of lymphovascular invasion (LVI) and preoperative carcinoembryonic antigen (CEA) level for cancer-specific survival (CSS) in octogenarian (≥ 80 years) colorectal cancer (CRC...
OBJECTIVE: To investigate the prognostic value of lymphovascular invasion (LVI) and preoperative carcinoembryonic antigen (CEA) level for cancer-specific survival (CSS) in octogenarian (≥ 80 years) colorectal cancer (CRC) patients, and to explore the modifying effects of tumor laterality and histological subtype on this prognostic value. METHODS: This retrospective cohort study enrolled 214 octogenarian CRC patients and 214 age-matched younger patients (50-79 years) as controls. The associations between LVI/CEA status and clinicopathological characteristics were analyzed. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate prognostic impacts, with subgroup analyses by tumor laterality and histological subtype. RESULTS: Octogenarian patients had higher rates of LVI positivity (38.3% vs. 29.9%, P = 0.042) and elevated CEA (41.1% vs. 32.7%, P = 0.038) than younger patients, with a lower 5-year CSS rate (52.3% vs. 68.7%, P < 0.001). LVI positivity (HR = 2.14, 95% CI = 1.57-2.91, P < 0.001) and elevated CEA (HR = 1.87, 95% CI = 1.35-2.59, P < 0.001) were independent prognostic factors for worse CSS in octogenarians, with more pronounced adverse effects in right-sided colon cancer and adenocarcinoma subtypes. CONCLUSION: LVI positivity and elevated preoperative CEA levels are independent prognostic factors for poor CSS in octogenarian CRC patients. Their prognostic impact varies by tumor laterality and histological subtype, highlighting the need for personalized risk stratification in this population.
Association of TREM1 expression with mTOR and DRP1 in gallbladder cancer: a study of 105 cases.
Liu Z, Wei S, Wang C … +4 more , Chen X, Yin M, Chen T, Zhu J
World J Surg Oncol · 2026 May · PMID 42174658 · Full text
BACKGROUND: Gallbladder cancer is highly aggressive and characterized by poor prognosis and limited treatment options. TREM1 (Triggering Receptor Expressed on Myeloid cells 1) may be involved in cancer inflammation and p...
BACKGROUND: Gallbladder cancer is highly aggressive and characterized by poor prognosis and limited treatment options. TREM1 (Triggering Receptor Expressed on Myeloid cells 1) may be involved in cancer inflammation and progression, but its relevance to gallbladder cancer is poorly understood. Expression of TREM1 in gallbladder cancer and correlation with mTOR activation, DRP1 upregulation, and clinical outcomes were investigated in the present study. METHODS: Immunohistochemical staining of 105 gallbladder cancer specimens from patients receiving cholecystectomy, radical resection or palliative resection between 2015 and 2020 was conducted to show expression of TREM1, mTOR and DRP1. Data was analyzed by Chi-square test, Kaplan-Meier survival curve, Cox regression model and correlation analyses. RESULTS: High TREM1 expression was observed in 63% gallbladder cancer cases and was linked to a more advanced T stage (p = 0.015), the presence of lymph node metastasis (p = 0.041) and an elevated TNM stage (p = 0.006). Positive correlations were shown between TREM1 and mTOR (p < 0.001) and between TREM1 and DRP1 (p < 0.001). Patients with high TREM1 expression had shorter overall survival than those with low expression (median 18 months vs. 50 months, p < 0.001). TREM1 was identified by multivariate analysis as an independent prognostic factor (HR = 1.838, 95% CI: 1.038-3.252, p = 0.037). CONCLUSIONS: Immunohistochemical analysis demonstrated that TREM1 is overexpressed in gallbladder cancer and positively correlated with mTOR and DRP1 expression. TREM1 may be a suitable prognostic biomarker and therapeutic target in gallbladder cancer.
Efficacy of endocrine therapy alone versus endocrine therapy combined with radiotherapy after breast-conserving surgery in older patients with early-stage estrogen receptor-positive breast cancer: a meta-analysis.
Wu X, Wang Y, Luo B … +3 more , Huang X, Huang S, Liu J
World J Surg Oncol · 2026 May · PMID 42174618 · Full text
BACKGROUND: In the general adult female population, the benefit of adjuvant radiotherapy following breast-conserving surgery (BCS) is well established. Nevertheless, whether radiotherapy should be routinely added after B...
BACKGROUND: In the general adult female population, the benefit of adjuvant radiotherapy following breast-conserving surgery (BCS) is well established. Nevertheless, whether radiotherapy should be routinely added after BCS for older women with estrogen receptor-positive (ER+) breast cancer remains controversial. The present meta-analysis aimed to evaluate the efficacy and clinical value of endocrine therapy (ET) plus radiotherapy relative to ET alone in this population. METHODS: A systematic search was conducted across the Cochrane Library, PubMed, Embase, and Web of Science. Studies comparing ET plus radiotherapy versus ET alone in older (≥ 60 years) women with ER+ breast cancer after BCS were eligible. The primary conclusions were drawn exclusively on randomized controlled trials (RCTs), with findings from cohort studies serving as supporting evidence. Methodological quality was evaluated utilizing the National Institutes of Health Quality Assessment Tools. The meta-analysis was conducted in STATA (v15.0). Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were computed. Appropriate models were chosen for pooling results depending on between-study heterogeneity. Leave-one-out sensitivity analyses were performed to evaluate the robustness of findings. Outcomes comprised breast cancer-specific survival (BCSS), overall survival (OS), distant metastasis rate (DMR), local recurrence rate (LRR), and 5-year disease-free survival (DFS). Subgroup analyses were conducted by age, geographic region, ET regimen, radiotherapy regimen, and nodal status. For LRR, the absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. RESULTS: Twenty studies (9 RCTs, 11 cohort studies) met the eligibility criteria. The primary analysis based on RCTs revealed that radiotherapy plus ET reduced the risk of local recurrence (HR = 0.33, 95% CI: 0.18-0.60); the corresponding ARR was 3.2%, and NNT was 31. No statistically significant differences were observed between the two groups in OS (HR = 1.00, 95% CI: 0.89-1.13), BCSS (HR = 0.96, 95% CI: 0.48-1.93), DMR (HR = 1.12, 95% CI: 0.67-1.87), or 5-year DFS (HR = 0.64, 95% CI: 0.35-1.16). The results from cohort studies were reported separately as supporting evidence. CONCLUSION: For older women with early-stage ER+ breast cancer after BCS, adjuvant radiotherapy combined with ET reduces the risk of local recurrence, yet this combination demonstrates no statistically significant improvement in OS, BCSS, DMR, or 5-year DFS. The absolute benefit of radiotherapy is modest. Treatment decisions should involve individualized trade-offs incorporating the risk of recurrence, burden of comorbidities, life expectancy, and patient preferences.
Prognostic impact of epidermal growth factor receptor mutation in grade 3 stage IA lung adenocarcinomas.
Jiang H, Lin H, Pan W … +6 more , Lu C, Gu J, Xu F, Chen Z, Ma T, Ge D
World J Surg Oncol · 2026 May · PMID 42169150 · Full text
OBJECTIVES: Stage IA adenocarcinomas (LUAD) with high-risk features exhibited an increased recurrence rate, and the role of adjuvant therapy in this population remains controversial. Our study aimed to evaluate the progn...
OBJECTIVES: Stage IA adenocarcinomas (LUAD) with high-risk features exhibited an increased recurrence rate, and the role of adjuvant therapy in this population remains controversial. Our study aimed to evaluate the prognostic impact of epidermal growth factor receptor (EGFR) mutation in grade 3 stage IA LUAD. METHODS: Between 2016 and 2020, 483 consecutive patients undergoing operation, with grade 3 pathologic stage IA LUAD were evaluated. The Kaplan-Meier analysis was performed to assess recurrence-free survival (RFS) and overall survival (OS). Prognostic factors were evaluated using the Cox proportional hazards model. RESULTS: An EGFR mutation was identified in 238 patients (49.3%), including 122 (51.3%) with an exon 19 deletion (Ex 19), 100 (42.0%) with an exon 21 L858R (Ex 21), and 16 (6.7%) with other EGFR mutations. The adjuvant chemotherapy was performed in 23 (4.8%) cases. EGFR mutant showed worse RFS than EGFR wild type (5-year RFS, 88.8% vs. 94.4%, p = 0.016). Subgroup analysis stratified by tumor size indicated that, among patients with pT1c tumors, EGFR mutant had a statistically lower 5-year RFS compared with EGFR wild type (n = 117; 83.1% vs. 96.2%; p = 0.036). Multivariable Cox regression analysis revealed that perineural invasion and EGFR mutation (HR = 2.095, 95%CI, 1.118 to 3.924) were independent predictors of worse RFS. CONCLUSIONS: In grade 3 stage IA3 LUAD, the presence of an EGFR mutation was associated with a poorer prognosis compared with EGFR wild type. These findings underscore the potential need to explore tailored adjuvant treatment strategies in this subgroup.
MicroRNA-563 as a potential biomarker in triple-negative breast cancer: impeding tumor progression by targeting ITGAV and epithelial-mesenchymal transition.
Li X, Qin H, Zhai J … +2 more , Hu X, Liu L
World J Surg Oncol · 2026 May · PMID 42169120 · Full text
BACKGROUND: Triple-negative breast cancer (TNBC) is characterized by its aggressive nature and limited treatment options, which contribute to a poor prognosis. However, the potential role of microRNA-563 (miR-563) in thi...
BACKGROUND: Triple-negative breast cancer (TNBC) is characterized by its aggressive nature and limited treatment options, which contribute to a poor prognosis. However, the potential role of microRNA-563 (miR-563) in this malignancy remains unclear. This study investigates the tumor-suppressive role of miR-563 and its underlying mechanisms, proposing its potential as a novel biomarker in TNBC. METHODS: The expression of miR-563 was analyzed in clinical samples of TNBC in comparison to healthy controls and non-TNBC cases. Functional assays were conducted using TNBC cell lines. Bioinformatics prediction and luciferase reporter assays identified integrin subunit alpha-V (ITGAV) as a direct target, which was further validated through rescue experiments. Additionally, epithelial-mesenchymal transition (EMT) markers were assessed to elucidate the mechanistic pathway. RESULTS: MiR-563 was significantly downregulated in TNBC patients, demonstrating an area under the curve (AUC) of 0.895 for diagnosis. This downregulation correlated with advanced disease stage, lymph node metastasis, and poorer progression-free survival. Overexpression of miR-563 resulted in the suppression of TNBC cell proliferation, migration, and invasion. ITGAV was identified as a direct target of miR-563, and rescue experiments indicated a partial reversal of the tumor-suppressive effects of miR-563. Furthermore, miR-563 inhibited EMT, as evidenced by the upregulation of E-cadherin and downregulation of Vimentin. CONCLUSIONS: These findings identify miR-563 as a crucial tumor suppressor and a potential diagnostic predictor in TNBC, operating in part through the ITGAV-mediated pathway.
Tumor capsule status modifies the survival impact of anatomical versus non-anatomical hepatectomy in early-stage hepatocellular carcinoma: a multicenter retrospective study.
Zhu P, Tang Y, Cheng C … +1 more , Zeng Y
World J Surg Oncol · 2026 May · PMID 42169110 · Full text
BACKGROUND: The oncologic superiority of anatomical resection (AR) over non-anatomical resection (NAR) for hepatocellular carcinoma (HCC) remains controversial, and the extent to which tumor capsule integrity modifies th...
BACKGROUND: The oncologic superiority of anatomical resection (AR) over non-anatomical resection (NAR) for hepatocellular carcinoma (HCC) remains controversial, and the extent to which tumor capsule integrity modifies the survival benefit of AR has not been well defined. METHODS: This multicenter retrospective study included 1,958 patients with early-stage HCC who underwent curative-intent hepatectomy across seven institutions. Patients were classified according to hepatectomy type (AR vs. NAR) and tumor capsule status (complete, incomplete, or absent). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Cox proportional hazards models. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Ordered interaction analyses were conducted to assess effect modification between hepatectomy method and tumor capsule status. RESULTS: In IPTW-weighted analyses, NAR was independently associated with worse OS (HR 1.46, 95% CI 1.27-1.67; P < 0.001) and RFS (HR 1.24, 95% CI 1.12-1.38; P < 0.001) compared with AR. Tumor capsule status showed a graded association with survival outcomes, with incomplete and absent capsules associated with progressively poorer OS and RFS. Importantly, a significant ordered interaction between hepatectomy method and tumor capsule status was observed for both OS (HR 1.65, 95% CI 1.35-2.01; P < 0.001) and RFS (HR 1.45, 95% CI 1.24-1.70; P < 0.001). Stratified analyses demonstrated no significant survival difference between AR and NAR in patients with complete capsule, whereas AR conferred a pronounced survival advantage in patients with absent capsule. CONCLUSIONS: Anatomical resection is associated with improved oncologic outcomes in early-stage HCC overall; however, this survival benefit is strongly modified by tumor capsule status. These findings suggest that tumor capsule status may serve as an important stratification factor when evaluating the extent of liver resection.
Comparing intraoperative ultrasound and wire-guided localisation for skin cancer metastases: impacts on patient safety, outcomes, costs, and implementation.
Hawwash N, Royle G, Mullan D … +2 more , Kosutic D, Gajanan K
World J Surg Oncol · 2026 May · PMID 42169104 · Full text
AIMS: Localisation of non-palpable isolated or oligometastatic disease can be an intraoperative challenge. This quality improvement study aims to demonstrate the novel use of intraoperative ultrasound (IOUS) in localisin...
AIMS: Localisation of non-palpable isolated or oligometastatic disease can be an intraoperative challenge. This quality improvement study aims to demonstrate the novel use of intraoperative ultrasound (IOUS) in localising oligometastatic disease. We evaluated its clinical effectiveness in comparison with the gold-standard wire-guided localisation technique in localising oligometastatic disease. METHODS: We assembled a database of patients at a specialist tertiary referral centre in the United Kingdom who had IOUS-guided or wire-guided tumour localisation and conducted informal interviews with two Plastic Surgery Consultants, a Consultant Radiologist and a Radiographer. We retrospectively analysed the effectiveness of IOUS guidance in localising cancer metastasis, focusing on physician-reported patient safety, clinical outcomes, costs and implementation and compared this to the wire-guided technique. RESULTS: Over the last 8 years, 19 patients had IOUS-guided tumour localisation, and 8 patients had wire-guided localisation since its on-site implementation 3 years ago. A retrospective cohort analysis was performed comparing 8 patients who underwent wire-guided tumour localisation between 2022 and 2024 with 8 patients who received IOUS-guided tumour localisation over the same period. Although IOUS extended the duration of surgery, it was less invasive, associated with lower complication rates (12.5% vs. 25.0%) and offered real-time reassurance. IOUS use was £12.65 (18%) cheaper and easier to implement compared with wire-guided localisation. Since 2017, IOUS-guided localisation has been associated with a low positive margin rate of 5.26% and a re-excision rate of 11.1%. CONCLUSION: The advantages of using IOUS for patient safety, cost-effectiveness and overall outcomes highlight its role in clinical practice and the need for a standardised protocol for its implementation. Conducting a large-scale multi-centre study is necessary to improve the generalisability of findings.
Rescue transsplenic thrombectomy for portal remnant thrombosis after ALPPS stage 1.
Fernández CF, Segurola CL, Esnal RV … +7 more , De Prado JG, Noël SF, Bonilla KXF, Romero AP, Maestro ÓC, Quinto AAM, Justo I
World J Surg Oncol · 2026 May · PMID 42169020 · Full text
BACKGROUND: This report describes a critical complication following the first stage of an unplanned ALPPS procedure (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy). While ALPPS is designed t...
BACKGROUND: This report describes a critical complication following the first stage of an unplanned ALPPS procedure (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy). While ALPPS is designed to induce rapid hypertrophy of the future liver remnant (FLR), the development of portal vein thrombosis (PVT) in the remnant liver can be catastrophic, jeopardizing the success of the second stage. This report highlights the novelty of using a rescue transsplenic mechanical thrombectomy and balloon dilation to restore flow, demonstrating a successful interventional radiology approach to salvage a complex surgical plan. CASE PRESENTATION: A 68-year-old male with a history of rectal adenocarcinoma was diagnosed with a 6 cm hepatic lesion (pancreatobiliary origin) infiltrating the right portal vein. During an intended right hepatectomy, intraoperative tumor progression prompted conversion to the first stage of a tourniquet ALPPS procedure. Ten days post-surgery, CT imaging revealed a partially occlusive thrombosis of the main portal vein and insufficient FLR growth. A transsplenic portography was performed, confirming stenosis at the left portal branch. The medical team intervened using Alteplase instillation followed by mechanical thrombectomy and balloon dilation of the stenotic area and embolization of the splenic tract. This approach restored portal flow and allowed completion of hepatectomy after adequate hypertrophy. CONCLUSIONS: Transsplenic mechanical thrombectomy performed by interventional radiology represents an effective option for the treatment of portal vein thrombosis following the first stage of an ALPPS procedure. In our case, it enabled portal recanalization and promoted the growth of the future liver remnant.
Factors influencing the incidence of postoperative lymphedema in patients with locally advanced triple-negative breast cancer.
Liu ZY, Chen R
World J Surg Oncol · 2026 May · PMID 42169013 · Full text
OBJECTIVE: To analyze the risk factors for postoperative secondary upper limb lymphedema in patients with locally advanced triple-negative breast cancer (TNBC). METHODS: In this retrospective cohort study, a total of 176...
OBJECTIVE: To analyze the risk factors for postoperative secondary upper limb lymphedema in patients with locally advanced triple-negative breast cancer (TNBC). METHODS: In this retrospective cohort study, a total of 176 patients with stage IIIB-IIIC TNBC treated at our hospital from January 2021 to December 2023 were included consecutively. The modified technique was introduced in 2022, and all procedures were performed by the same surgical team. They were divided into an experimental group (modified surgical technique, n = 90) and a control group (standard technique, n = 86) based on the surgical approach. The modified technique involved concurrent resection of the clavicular portion of the pectoralis major muscle fibers and the clavipectoral fascia in addition to standard axillary lymph node dissection (ALND). The incidence of postoperative upper limb lymphedema was compared between groups, and its association with obesity, cardiovascular disease, and metabolic syndrome was analyzed. RESULTS: The postoperative lymphedema incidence was 23.3% (21/90) in the experimental group, significantly lower than the 41.9% (36/86) in the control group (P = 0.009). Lymphedema incidence in obese patients was 47.8% (43/90), markedly higher than the 16.3% (14/86) in non-obese patients (P < 0.001). Multivariate logistic regression identified obesity (OR = 4.80, 95% CI 2.38-9.68, P < 0.001) and standard surgical technique (OR = 2.45, 95% CI 1.23-4.88, P = 0.011) as independent risk factors for lymphedema. CONCLUSION: Obesity and surgical technique are independent risk factors for postoperative upper limb lymphedema in locally advanced TNBC patients. The modified ALND technique may help reduce lymphedema incidence, with a particularly pronounced benefit observed in obese patients. However, the proposed mechanism remains speculative, and the findings require prospective validation. Prospective randomized studies are needed before routine adoption.
Knocking down FAM110A suppresses colon adenocarcinoma progression by inhibiting the Nrf2/HO-1 axis to induce ferroptosis.
Li Q, Li Z, Lin Y … +6 more , Xu Q, Lu X, Zhou J, Yi J, Chen J, Yang C
World J Surg Oncol · 2026 May · PMID 42168991 · Full text
BACKGROUND: The family with sequence similarity 110 member A (FAM110A) is implicated in cell cycle regulation, but its role in colon adenocarcinoma (COAD) remains unknown. Through integrative bioinformatics analysis, cli...
BACKGROUND: The family with sequence similarity 110 member A (FAM110A) is implicated in cell cycle regulation, but its role in colon adenocarcinoma (COAD) remains unknown. Through integrative bioinformatics analysis, clinical tissue sample validation, and experimental validation, we investigated the role of FAM110A in COAD. METHODS: We employed a comprehensive bioinformatics approach, utilizing The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets, alongside various R packages for data acquisition and analysis. The clinical COAD tissue samples and their corresponding paracancerous normal colonic mucosa samples were collected for immunohistochemical (IHC) staining to verify the expression of FAM110A in clinical specimens. After knocking down FAM110A, the cell viability, migration, invasion, cell cycle, apoptosis, reactive oxygen species (ROS), malondialdehyde (MDA), 4-hydroxynonenoic acid (4-HNE), Fe, and glutathione (GSH) levels, and FAM110A, glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), nuclear transcription factor erythroid 2-related factor 2 (Nrf2), and heme oxygenase 1 (HO-1) protein expression levels of HCT-116 and SW620 cells were determined. Furthermore, rescue experiments were performed by overexpressing Nrf2 in FAM110A-knockdown HCT-116 cells to verify the regulatory relationship between Nrf2 and FAM110A in cell growth and ferroptosis. RESULTS: Multiple differentially expressed genes in COAD in the TCGA-COAD and GSE20916 datasets were identified. The elevated expression of FAM110A in tumor samples compared to normal tissues suggested its potential diagnostic role in COAD. Multivariate Cox regression models incorporating clinical variables indicated that FAM110A was one of the independent prognostic factors for COAD. The drug sensitivity analysis revealed correlations between FAM110A and the efficacy of several anticancer drugs. Clinical tissue IHC analysis further confirmed the significantly higher expression of FAM110A in COAD tumor tissues compared with paired paracancerous normal colonic mucosa tissues. The immune infiltration analysis revealed that FAM110A could serve as a biomarker for predicting response to immunotherapies for COAD. FAM110A was enriched in multiple pathways. Knocking down FAM110A reduced cell viability, migration, invasion, and GSH levels, as well as GPX4, SLC7A11, Nrf2, and HO-1 protein expression levels, arrested the cell cycle, and elevated apoptosis, ROS, MDA, 4-HNE, and Fe levels in HCT-116 and SW620 cells. Overexpression of Nrf2 reversed the effects of FAM110A knockdown on HCT-116 cell growth and ferroptosis. CONCLUSIONS: Our findings underscore the diagnostic and prognostic significance of FAM110A in COAD. Knocking down FAM110A alleviated COAD via Nrf2/HO-1 axis inhibition to promote ferroptosis, and Nrf2 overexpression could rescue the ferroptosis and growth inhibition induced by FAM110A deficiency, providing a theoretical basis for developing drugs targeting FAM110A for treating COAD.
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