World Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Omission of completion axillary dissection in clinically node-negative breast cancer with 1-2 metastatic sentinel lymph nodes.
Qiao W, Guo X, Li P … +2 more , Liu Q, Deng M
World J Surg Oncol · 2026 May · PMID 42104353 · Full text
BACKGROUND: The SENOMAC trial demonstrated that omitting completion axillary lymph node dissection (ALND) is safe in patients with clinically node-negative (cN0) T1, T2, or T3 breast cancer with 1-2 sentinel-node macrome...
BACKGROUND: The SENOMAC trial demonstrated that omitting completion axillary lymph node dissection (ALND) is safe in patients with clinically node-negative (cN0) T1, T2, or T3 breast cancer with 1-2 sentinel-node macrometastases. However, its applicability to populations with higher mastectomy rates, such as in China, remains unclear. This study evaluated the safety and efficacy of omitting completion ALND in cN0 T1-T2 breast cancer patients who underwent sentinel lymph node biopsy (SLNB) with 1-2 SLN macrometastases in a Chinese cohort. METHODS: This single-center retrospective study included 202 patients diagnosed between January 1, 2017, and December 31, 2023, who underwent SLNB at our institute. Patients were divided into SLNB-only (n = 93) and completion ALND (n = 109) groups. Baseline characteristics were compared using chi-square or t-tests; survival outcomes and complications via Kaplan-Meier analysis, log-rank tests, and Cox proportional-hazards regression. RESULTS: Median follow-up was 58 months (range = 3-103). No significant differences were found in 5-year recurrence-free survival (95.7%, vs. 94.5%, P = 0.96) and overall survival (OS) (97.8%, vs. 97.2%, P = 0.84) between the SLNB-only and completion ALND groups. The incidence of lymphedema, assessed by combined subjective and objective criteria, was significantly lower in the SLNB-only group than in the completion ALND group (4.3%, vs. 12.8%, P = 0.03). Hormone-receptor-positive status was an independent prognostic factor for OS (hazard ratio = 0.04, 95% confidence interval 0.004-0.46, P = 0.01]. CONCLUSION: In this retrospective cohort, omission of completion ALND was not associated with a statistically significant difference in 5-year RFS or OS compared with completion ALND, while lymphedema incidence was significantly lower. These findings suggest that omitting ALND may be feasible in selected patients with cN0 T1-T2 breast cancer and 1-2 SLN macrometastases. However, given the study's limitations, future larger, prospective, randomized, and multicenter studies are needed to confirm these findings.
Germline HLA-I genotypes predict pathologic response and survival outcomes in esophageal cancer patients undergoing neoadjuvant immunochemotherapy: a retrospective cohort study.
Omindo WW, Wang Q, Deng S … +4 more , Zhang R, Sun W, Zhang L, Zhang N
World J Surg Oncol · 2026 May · PMID 42093013 · Full text
BACKGROUND: Neoadjuvant immunochemotherapy (nICT) has reshaped the treatment paradigm for locally advanced esophageal cancer (EC), but patient responses remain highly heterogeneous. Reliable biomarkers to predict therape...
BACKGROUND: Neoadjuvant immunochemotherapy (nICT) has reshaped the treatment paradigm for locally advanced esophageal cancer (EC), but patient responses remain highly heterogeneous. Reliable biomarkers to predict therapeutic benefit are urgently needed. Class I human leukocyte antigen (HLA-I) molecules are essential for anti-tumor immunity, presenting neoantigens to cytotoxic T lymphocytes.This study investigated the relationship between germline HLA-I genotypes and treatment response in patients with esophageal cancer receiving nICT. METHODS: We retrospectively analyzed 30 Chinese EC patients who underwent surgery following nICT. High-resolution sequencing was used to determine germline HLA-I genotypes. Associations between specific HLA alleles and both short-term pathologic response and long-term survival outcomes, including pathologic complete response (pCR) and event-free survival (EFS) were evaluated. RESULTS: HLA-A*11:01 carriers exhibited significantly prolonged EFS compared with non-carriers (P = 0.015). In contrast, the HLA-A*24:02 allele was more frequent in non-pCR patients (50.0% vs. 12.5%, P = 0.064), and shorter EFS was observed among carriers (median 16.0 vs. 38.8 months, P = 0.063), although these differences did not reach statistical significance. HLA-I homozygosity was more common among patients who achieved pCR (75.0% vs. 27.3%, P = 0.034). CONCLUSION: In this small retrospective cohort, germline HLA-I genotypes were associated with differences in pathologic response and event-free survival following nICT. These findings should be interpreted as exploratory and hypothesis-generating, requiring validation in larger prospective studies before clinical translation.
Postoperative outcomes in patients with gastric cancer undergoing prehabilitation in a high-complexity referral centre.
Suescun Fajardo OJ, Torres Gaviria S, Chona MC … +3 more , López Basto L, Medina Parra J, Merchán Chaverra R
World J Surg Oncol · 2026 May · PMID 42083030 · Full text
BACKGROUND: Gastric cancer remains one of the most frequent oncological diseases, often associated with a high rate of postoperative complications. Prehabilitation has shown benefits in other surgical settings, although...
BACKGROUND: Gastric cancer remains one of the most frequent oncological diseases, often associated with a high rate of postoperative complications. Prehabilitation has shown benefits in other surgical settings, although its role in gastric cancer patients remains under investigation. OBJECTIVE: To describe the postoperative outcomes of patients with gastric cancer who underwent a prehabilitation programme in a high-complexity referral centre in Bogotá, Colombia. METHODS: A descriptive observational retrospective cohort study was conducted at Clínica Universitaria Colombia between January 2021 and December 2023. Patients aged 18-80 years with a confirmed diagnosis of gastric cancer who underwent surgical treatment were included. RESULTS: A total of 140 patients with gastric cancer received prehabilitation. The mean age was 60.9 years, and 60% were male. Postoperative complications occurred in 23.6% of patients, with surgical site infection being the most frequent (17.1%). Admission to the intensive care unit was required in 7.1%, and overall mortality was 4.3%. In bivariate analysis, malnourished patients presented higher rates of total complications, surgical site infection, and ICU admission. CONCLUSIONS: Malnutrition is consistently associated with worse postoperative outcomes. Therefore, prehabilitation plays a crucial role in improving nutritional and functional parameters that directly influence the recovery and prognosis of patients with gastric cancer.
Management and prognostic outcomes of gastrointestinal stromal tumors in Sub-Saharan Africa: the central role of surgery in resource-limited settings: a systematic review and meta-analysis (2014-2024).
Gnangnon FHR, Godjo C, Fotso P … +3 more , Gayito Adagba RA, Gbessi DG, Dossou FM
World J Surg Oncol · 2026 May · PMID 42071220 · Full text
BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. However, data from Sub-Saharan Africa (SSA) remain fragmented, and no prior systematic review has synthes...
BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. However, data from Sub-Saharan Africa (SSA) remain fragmented, and no prior systematic review has synthesized regional diagnostic and treatment practices. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42024575650). PubMed, Embase, Scopus, Google Scholar, and African Journals Online were searched for studies published between January 2014 and June 2024. Eligible population-, community-, and hospital-based studies reporting on GIST management or prognosis in SSA were included. Study quality was assessed using Joanna Briggs Institute tools. Random-effects models (REML with Hartung-Knapp adjustment) were used to estimate pooled outcomes. RESULTS: Twenty-one studies comprising 410 patients met inclusion criteria. The median age ranged from 52 to 56 years, and the male-to-female ratio was approximately 1.3:1. The stomach was the most frequent tumor site (64.1%), followed by the small intestine (14.6%). Most patients were symptomatic at diagnosis, with abdominal pain (50.4%) and abdominal mass (47.3%) being the predominant complaints. Computed tomography was the primary imaging modality (99.5%). Surgery was performed in 70% of patients, with R0 resection achieved in 68.2%. Imatinib was used as neoadjuvant (n = 58), adjuvant (n = 64), or palliative therapy (n = 75). Among 199 evaluable patients, the pooled disease-control rate was 77.3% (CR: 32.5%; PR: 27.9%; SD: 7.9%), while progressive disease occurred in 18.9%. The pooled median overall survival was 44.0 months. Postoperative mortality was 0.7%, and overall mortality during follow-up was 9.8%. CONCLUSION: This review provides the first comprehensive synthesis of GIST management in Sub-Saharan Africa. Despite limited diagnostic infrastructure and late presentations, therapeutic outcomes particularly disease control with imatinib and low postoperative mortality appear numerically comparable in selected settings where treatment is accessible, although structural and methodological disparities preclude direct equivalence. Strengthening early detection, expanding immunohistochemistry and molecular testing, and improving access to tyrosine kinase inhibitors remain critical for improving survival in the region.
Is surgery necessary for mismatch repair-deficient/microsatellite instability-high colorectal cancer patients with a clinical complete response after neoadjuvant immunotherapy? A retrospective cohort study with literature context.
Zuo H, Huang J, Peng S … +8 more , Wei J, Luo Y, Qin S, Zou X, Rong J, Lin Y, Lai H, Mo X
World J Surg Oncol · 2026 May · PMID 42069618 · Full text
BACKGROUND: The purpose of this study was to retrospectively compare the prognostic outcomes of patients with colorectal cancer (CRC) who achieved a clinical complete response (CCR) after neoadjuvant immunotherapy (NI) a...
BACKGROUND: The purpose of this study was to retrospectively compare the prognostic outcomes of patients with colorectal cancer (CRC) who achieved a clinical complete response (CCR) after neoadjuvant immunotherapy (NI) and those who achieved a CCR after surgery. A literature review of publications was conducted in the PubMed database. MATERIALS AND METHODS: This study included 70 patients who were diagnosed with mismatch repair deficiency/microsatellite instability high (dMMR/MSI-H) colorectal cancer and who were treated with NI between 2018 and 2024. CCR patients were grouped into the "watch and wait" (W&W) method group or the radical surgery group. Afterwards, the oncological and clinical outcomes of patients who achieved a clinical complete response (CCR) were compared to those of patients who were classified as tumour free. We also conducted a literature review of publications in the PubMed database of clinical studies that compared clinical outcomes between W&W and surgery for CCR dMMR/MSI-H patients. RESULTS: Among the 70 NI-treated dMMR/MSI-H CRC patients, 44 (62.86%) achieved a CCR. Of these, 25 patients were managed with a watch-and-wait (W&W) strategy, while 19 underwent curative-intent surgery. In the surgery group, 16 patients (84.21%) achieved a pathological complete response (pCR). During follow-up, 2 patients (10.53%) in the surgery group developed recurrence, and both subsequently died, while the remaining 17 patients were alive at the last follow-up. No statistically significant differences were observed between the W&W and surgery groups in terms of recurrence or survival outcomes. A literature review including nine studies further demonstrated comparable oncological outcomes between W&W and surgical management in patients who achieved a CCR. CONCLUSION: Patients in the W&W group presented similar oncological outcomes to those who underwent surgery. Surgery may not be necessary for patients with dMMR/MSI-H colorectal cancer who achieve a clinical complete response after neoadjuvant immunotherapy. However, large sample sizes and multicentre investigations are needed to validate these findings.
The predictive value of multidimensional frailty instruments for postoperative adverse outcomes in cancer patients: a systematic review and meta-analysis.
Chen Y, Song S, Wang Z … +7 more , Guo Y, Fu Z, Xu T, Chen Y, Jiang Z, Ding L, Xu Q
World J Surg Oncol · 2026 May · PMID 42067894 · Full text
PURPOSE: To systematically review the predictive performance of Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), and Edmonton Frailty Scale (EFS) for adverse outcomes including postoperative complicati...
PURPOSE: To systematically review the predictive performance of Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), and Edmonton Frailty Scale (EFS) for adverse outcomes including postoperative complications, unplanned readmission, 30-day mortality, prolonged length of stay among cancer patients. MATERIALS AND METHODS: A comprehensive search was conducted across English and Chinese databases until October 2, 2025. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 tool. Predictive performance was evaluated by pooling sensitivity, specificity, and summary receiver operating characteristic curves. RESULTS: There were 21 studies (4,435 individuals) that were included for the meta-analysis. TFI demonstrated pooled sensitivities of 0.64 (for postoperative complications), 0.77 (for unplanned readmission), and 0.50 (for prolonged hospital stay), with corresponding specificities of 0.67, 0.54, and 0.64 respectively. The areas under the curve (AUC) were 0.70, 0.71, and 0.60. GFI demonstrated sensitivities of 0.59, 0.65, and 0.55 for complications, 30-day mortality, and functional decline, with specificity of 0.73, 0.63, and 0.77, and the AUC of 0.71, 0.68, and 0.74. EFS had sensitivity 0.39, specificity 0.87, and AUC 0.57 for complications. Subgroup analysis revealed that TFI had reasonable predictive value for adverse outcomes with sensitivity 0.61-0.81 and specificity 0.60-0.68 among most gynecological and gastrointestinal cancer subgroups. In most subgroups, GFI showed higher specificity (0.64-0.84) relative to sensitivity (0.43-0.68). CONCLUSION: TFI and GFI demonstrated moderate predictive validity for adverse outcomes, whereas EFS exhibited poor predictive performance. These findings highlight the necessity for caution interpretation of frailty assessments in clinical practice and underscore the importance of further validating these tools within diverse oncological contexts.
Nomogram predicting outcomes in HCC patients treated with TACE-HAIC, TKIs, and PD-1 inhibitors.
Chen J, Li Y, Wang Y … +5 more , Li Y, Li J, Yuan Y, Wang C, Xu W
World J Surg Oncol · 2026 May · PMID 42063151 · Full text
BACKGROUND: This study aimed to develop and validate a prognostic nomogram to predict overall survival (OS) in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) undergoing multimod...
BACKGROUND: This study aimed to develop and validate a prognostic nomogram to predict overall survival (OS) in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) undergoing multimodal therapy, combining transarterial chemoembolization, hepatic arterial infusion chemotherapy, tyrosine kinase inhibitors, and programmed death-1 inhibitors. METHODS: A retrospective analysis included 193 patients with BCLC stage C HCC treated at Xuzhou Medical University Affiliated Hospital between February 2021 and February 2024. Patients were randomly divided into a training cohort (n = 135) and a validation cohort (n = 58). Independent prognostic factors were identified via Cox regression analysis. A nomogram was developed and evaluated using the concordance index (C-index), time-dependent receiver operating characteristic curves, calibration plots, and decision curve analysis. Risk stratification was performed using X-tile software. RESULTS: The median OS was 402 days. Multivariate analysis identified ALBI grade (HR [Hazard Ratio] = 10.09-19.63), maximum tumor diameter ≥ 5 cm (HR = 2.69), multiple tumors (HR = 2.59), and vascular invasion (HR = 2.74) as independent predictors of OS. The nomogram demonstrated strong discriminatory performance, with C-indices of 0.788 in the training cohort and 0.805 in the validation cohort. The time-dependent AUCs for 1-year and 1.5-year OS were 0.879 and 0.887 in the training cohort, and 0.923 and 0.832 in the validation cohort, respectively. Calibration curves showed excellent agreement between predicted and observed outcomes. Decision curve analysis supported the clinical utility of the model. Risk stratification based on the nomogram revealed significant survival differences between the low- and high-risk groups (median OS: 566 vs. 454 days; P < 0.001). CONCLUSIONS: This novel nomogram, integrating locoregional and systemic therapies, offers an individualized tool for prognostication in patients with BCLC stage C HCC, potentially guiding therapeutic decision-making and patient counseling.
Comparison of survival outcomes between local excision and radical resection in patients with rectal mucosal melanoma.
Zou J, Zhu H, Tang Y … +3 more , Huang Y, Chi P, Wang X
World J Surg Oncol · 2026 Apr · PMID 42063130 · Full text
BACKGROUND: Rectal Mucosal Melanoma (RMM) is a rare but highly aggressive malignancy with poor prognosis. Due to its rarity, the optimal surgical approach (local excision [LE] vs. radical resection [RR]) remains controve...
BACKGROUND: Rectal Mucosal Melanoma (RMM) is a rare but highly aggressive malignancy with poor prognosis. Due to its rarity, the optimal surgical approach (local excision [LE] vs. radical resection [RR]) remains controversial. While RR aims to achieve wider margins and lymph node dissection, LE offers advantages in reduced morbidity and better functional preservation. This SEER-based study comparatively evaluated long-term survival outcomes between LE and RR in RMM patients. METHODS: Clinicopathological data of patients with RMM were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A 1:1 propensity score matching (PSM) approach was employed to balance baseline covariates between the surgical groups (P < 0.05). Cox proportional hazards models were used to identify risk factors for cancer-specific survival (CSS) and overall survival (OS). RESULTS: Among 196 eligible patients, those in the RR group were older and more likely to present with advanced N-stage disease. Both pre- and post-PSM analyses showed no survival advantage of RR over LE. Multivariate analysis identified diagnosis during 2000–2008, N2 stage, and M1 stage as independent predictors of poorer CSS. For OS, N2 stage and omission of postoperative radiotherapy were independently associated with worse outcomes. CONCLUSION: Radical resection does not confer a survival benefit over local excision in the treatment of RMM. LE may be the preferred surgical approach, offering an optimal balance between oncological efficacy and functional preservation.
Revolutionizing lung cancer screening: the rise of artificial intelligence integrating circulating tumor markers.
Li H, Nan H, Sun Y … +4 more , Zhao M, Qiu Y, Chen S, Wang Y
World J Surg Oncol · 2026 Apr · PMID 42063042 · Full text
Lung cancer persists as the predominant oncological cause of mortality globally, underscoring an imperative public health issue that demands effective screening methodologies to mitigate its impact. The National Lung Scr...
Lung cancer persists as the predominant oncological cause of mortality globally, underscoring an imperative public health issue that demands effective screening methodologies to mitigate its impact. The National Lung Screening Trial (NLST) from the National Cancer Institute has established that low-dose computed tomography (LDCT) can detect lung cancer at an early stage and decrease mortality. Nonetheless, concerns such as radiation-induced risks, false positives, overdiagnosis, and medical costs demand attention. The importance of Artificial Intelligence (AI) in lung cancer screening is growing due to its superior capabilities for extracting image data and managing complex models. Circulating tumor markers (CTMs), encompassing circulating tumor DNA (ctDNA), circulating tumor RNA (ctRNA), circulating tumor cells (CTCs), and exosomes, present a non-invasive diagnostic and surveillance strategy for lung cancer. Despite their established utility in treatment and prognostic monitoring, the application of CTMs in early lung cancer screening is less documented. However, recent innovations highlight the potential of AI in conjunction with CTMs to enhance early diagnostic capabilities. This review synthesizes current research on the convergence of AI with CTMs, offering innovative avenues to augment and refine lung cancer screening methodologies.
The FGD5-AS1/miR-142-5p/CDK5 axis promotes ESCC progression by regulating mitochondrial fission and mitophagy: insights from integrative bioinformatics and experimental analyses.
Hou M, Chen S, Yang H … +3 more , Huang Q, Zhan H, Gui Y
World J Surg Oncol · 2026 Apr · PMID 42063038 · Full text
Esophageal squamous cell carcinoma (ESCC) continues to pose a significant health challenge worldwide because of its poor prognosis and limited therapeutic options. To identify key regulators, we performed integrative bio...
Esophageal squamous cell carcinoma (ESCC) continues to pose a significant health challenge worldwide because of its poor prognosis and limited therapeutic options. To identify key regulators, we performed integrative bioinformatic approaches, such as differential expression analysis, weighted gene co-expression network analysis (WGCNA), LASSO regression, support vector machine (SVM) modeling, and ceRNA network construction, followed by experimental validation. These analyses across three GEO cohorts consistently highlighted FGD5-AS1 and CDK5 as upregulated, while miR-142-5p was downregulated and emerged as a central regulator within the ceRNA network. Clinical samples and functional assays confirmed these findings, showing that FGD5-AS1 overexpression enhanced proliferation, invasion, and migration while suppressing apoptosis in ESCC cells. Moreover, FGD5-AS1 promoted mitochondrial fission and mitophagy through miR-142-5p sequestration, leading to increased CDK5 levels, thereby driving tumor progression. Animal experiments further demonstrated that modulation of FGD5-AS1 expression significantly altered tumor growth. Collectively, these integrative results reveal that the FGD5-AS1/miR-142-5p/CDK5 axis promotes ESCC malignancy by regulating mitochondrial dynamics, suggesting that the FGD5-AS1/miR-142-5p/CDK5 axis may represent a candidate molecular target and warrants further investigation for its potential clinical relevance in ESCC.
Optimized sentinel nodes detection in endometrial cancer: intraoperative indocyanine green mapping with postoperative bread-loaf slicing ultrastaging.
Huang YS, Lin H, Ou YC … +6 more , Huang CC, Fu HC, Huang SW, Wang YW, Chen YY, Wu CH
World J Surg Oncol · 2026 Apr · PMID 42057129 · Full text
BACKGROUND: Accurate lymph node assessment is crucial in early-stage endometrial cancer staging, but traditional lymphadenectomy carries significant morbidity risks. This study evaluates whether indocyanine green (ICG)-b...
BACKGROUND: Accurate lymph node assessment is crucial in early-stage endometrial cancer staging, but traditional lymphadenectomy carries significant morbidity risks. This study evaluates whether indocyanine green (ICG)-based sentinel lymph node (SLN) mapping combined with bread-loaf slicing ultrastaging optimizes lymph node metastasis detection in uterine-confined endometrial cancer. METHODS: We retrospectively analyzed patients with early-stage endometrial cancer who underwent surgery with SLN mapping at Kaohsiung Chang Gung Memorial Hospital from November 2021 to December 2024. SLN mapping was performed using either ICG fluorescence imaging or patent blue dye during minimally invasive and open surgical approaches. All retrieved lymph nodes underwent ultrastaging examination using the bread-loaf slicing method. RESULTS: Among 131 patients, the overall SLN mapping success rate was 93.9%, and the overall detection rate was 95.9%. In exploratory subgroup analyses, bilateral mapping success was higher in the ICG group than in the patent blue group (79.2% vs. 27.3%, p < 0.001). Bilateral mapping success was also higher in minimally invasive surgery than in open surgery in the overall cohort (79.1% vs. 43.8%, p = 0.002). Bread-loaf slicing ultrastaging identified lymph node metastases in 4.0% of patients. No recurrence were observed among patients with pathological stage I diseases during follow-up. CONCLUSIONS: The combination of intraoperative ICG-based SLN mapping with bread-loaf slicing ultrastaging demonstrated high mapping success rate and detection rate, and supports a feasible, standardized surgical-pathologic workflow for lymph node assessment in uterine-confined endometrial cancer.
Radiomics for predicting microsatellite instability-high status in colorectal cancer: a systematic review and meta-analysis.
Gou Q, He X, Zhang X
World J Surg Oncol · 2026 Apr · PMID 42057077 · Full text
OBJECTIVE: Microsatellite instability (MSI) has emerged as a key predictive biomarker for chemotherapy and immunotherapy response, and as a prognostic indicator in colorectal cancer (CRC). The current clinical standard f...
OBJECTIVE: Microsatellite instability (MSI) has emerged as a key predictive biomarker for chemotherapy and immunotherapy response, and as a prognostic indicator in colorectal cancer (CRC). The current clinical standard for MSI detection relies on polymerase chain reaction (PCR) or immunohistochemical analysis of tumor biopsy specimens. CT, PET-CT, and MRI-based radiomics models present a promising non-invasive alternative for this purpose. MATERIALS AND METHODS: To identify studies assessing the diagnostic efficacy of CT, MRI and PET-CT-based radiomics in detecting MSI status in CRC, a systematic search was performed across PubMed, Embase, the Cochrane Library, and Web of Science. The pooled area under the curve (AUC), sensitivity, and specificity were estimated using a random-effects model in Meta-DiSc 1.4, RevMan 5.4, and Stata 15. Data were visualized through forest plots and a summary receiver operating characteristic (SROC) curve. A comprehensive heterogeneity assessment was conducted via I² statistics, sensitivity analyses, threshold effect evaluation, subgroup analyses, and meta-regression. RESULTS: This meta-analysis included 34 studies with a total of 7,959 patients. The overall model demonstrated a pooled area under the curve (AUC) of 0.90 (95% CI: 0.87-0.93). The pooled sensitivity and specificity were 0.85 (95% CI: 0.79-0.89) and 0.82 (95% CI: 0.78-0.86), respectively, both marked by substantial heterogeneity (I² = 87% and 92%, respectively; P < 0.01). CONCLUSION: Radiomics holds significant promise as a non-invasive tool for MSI status prediction in CRC. In particular, machine learning and deep learning offer enhanced potential for model performance. These results pave the way for future research to develop and validate more accurate predictive models, thereby improving diagnostic precision, therapeutic decision-making, and prognosis in colorectal cancer.
Surgical management of spinal metastases originating from thyroid cancer.
Esmaeilzadeh M, Hounchonou HF, Müller JA … +2 more , Bengel F, Krauss JK
World J Surg Oncol · 2026 Apr · PMID 42057062 · Full text
BACKGROUND: The spine is an uncommon metastatic location from thyroid cancer. Here, we describe our experience with spinal cord compression as presentation of metastatic thyroid carcinoma, including surgical management a...
BACKGROUND: The spine is an uncommon metastatic location from thyroid cancer. Here, we describe our experience with spinal cord compression as presentation of metastatic thyroid carcinoma, including surgical management and outcome. METHODS: Five patients with spinal metastases from thyroid cancer were identified over a 20-year period. RESULTS: This descriptive case series comprised 5 women with a median age of 61 years. Three patients presented to the emergency room without a previous diagnosis of thyroid carcinoma. Clinical symptoms at presentation included pain, ataxia, and bladder and bowel incontinence. Imaging (MRI in four patients and CT in one) revealed thoracic spinal metastases in four cases and a sacral lesion in one case. Surgical treatment consisted of en-bloc resection in one patient and subtotal resection in the remaining four. The median Karnofsky Performance Score improved from 70% to 90%, postoperatively. Histopathological analysis confirmed follicular thyroid carcinoma in all cases. Postoperatively, all patients received radioactive iodine therapy, and three patients additionally underwent radiotherapy. One patient had a recurrence. The median survival time was 69 months (range 19–188 months). CONCLUSION: The main goals of surgical management in patients with spinal metastases from thyroid cancer are preservation of neurological function and restoration of spinal stability. This is followed by comprehensive evaluation and treatment of the primary malignancy. Multidisciplinary management is essential, with subsequent therapy directed toward control of systemic disease.
Exploration of between-hospital variation and the basis for decision making in management of malignant colorectal polyps- a Danish population-based study.
Würtz HJ, Lund L, Lindebjerg J … +3 more , Steffensen KD, Edwards A, Rahr HB
World J Surg Oncol · 2026 Apr · PMID 42057017 · Full text
BACKGROUND: Finding an unexpected carcinoma in an endoscopically resected colorectal polyp poses a dilemma regarding the subsequent management strategy. Proceeding to surgery with formal segmental bowel resection is asso...
BACKGROUND: Finding an unexpected carcinoma in an endoscopically resected colorectal polyp poses a dilemma regarding the subsequent management strategy. Proceeding to surgery with formal segmental bowel resection is associated with a low recurrence risk but substantial morbidity and mortality, whereas surveillance without surgery entails low morbidity but a higher risk of recurrence. Clinical guidelines are based on histopathological risk factors (HRF), but pathology data are often incomplete, and national databases have revealed marked practice variation between hospitals. We aimed to explore between-hospital variation and the basis for treatment decisions after endoscopic resection of malignant colorectal polyps in Denmark. METHODS: A national cohort of colorectal cancer patients from 2016-2020 was extracted from national clinical and pathology registers. Patients undergoing local resection only (surveillance group) and local resection followed by subsequent bowel resection (surgery group) were compared in uni- and multivariable analyses stratified by reported HRF. Patient- and hospital-related factors were included as covariates with particular focus on between-hospital variation. RESULTS: Overall, 2,188 patients were analyzed, 1,277 in the surveillance group and 911 in the surgery group. Multivariable analyses showed that male sex, older age, comorbidity, lower performance status and left colon or rectum tumor location were significantly associated with surveillance, most even in the presence of HRF. Long higher education and certain hospitals were significantly associated with bowel resection. Predictors of bowel resection despite absence of HRF were certain hospitals and active smoking. In the surgery group without HRF conclusive information was missing in up to 70% of the pathology reports regarding certain HRF. Preoperative image-based overstaging may have resulted in a higher rate of cancer-free specimens. Overall, 63% of bowel resection specimens were cancer-free. CONCLUSION: We found marked between-hospital practice variation in management strategy for malignant colorectal polyps, even in adjusted analyses. Among the probable explanations were missing or incomplete pathology data and suspicion of more advanced disease based on clinical staging. Consistency in hospital practice, completeness of the pathology reports and overall better collaboration of the multidisciplinary team are needed to improve the decision-making process in patients with endoscopically removed malignant colorectal polyps.
Nodal stage is the key prognostic factor in synchronous and metachronous multiple primary colorectal adenocarcinoma after curative-intent resection: a retrospective study.
Xing Y, Wu Z, Mei S … +3 more , Wang Z, Wang Q, Liu Q
World J Surg Oncol · 2026 Apr · PMID 42050660 · Full text
BACKGROUND: Multiple primary colorectal cancer (MPCRC) is uncommon but clinically challenging, and differences between synchronous MPCRC (SMPCRC) and metachronous MPCRC (MMPCRC) remain incompletely defined. We compared c...
BACKGROUND: Multiple primary colorectal cancer (MPCRC) is uncommon but clinically challenging, and differences between synchronous MPCRC (SMPCRC) and metachronous MPCRC (MMPCRC) remain incompletely defined. We compared clinicopathological and surgical features between SMPCRC and MMPCRC and explored prognostic factors for overall survival (OS) in MPCRC. METHODS: This retrospective cohort study consecutively included patients with pathologically confirmed multiple primary colorectal adenocarcinoma who underwent curative-intent resection at our hospital. SMPCRC was defined as tumors identified within 6 months and MMPCRC as a subsequent primary diagnosed after 6 months. Clinicopathological and perioperative variables were extracted from medical records and pathology reports. Mismatch repair protein expression was assessed as an exploratory pathological variable. OS was analyzed using Kaplan–Meier methods and Cox proportional hazards regression. RESULTS: A total of 165 patients were included (120 SMPCRC and 45 MMPCRC) with follow-up until December 2024. Baseline characteristics were broadly comparable between groups. SMPCRC more frequently underwent laparoscopic surgery (97.5% vs 88.9%, p = 0.035) and had a higher lymph node yield (27.86 ± 13.32 vs 20.87 ± 14.07, p = 0.004). Vascular invasion was more common in SMPCRC (45.8% vs 26.7%, p = 0.026), and N-stage distribution differed between subtypes (p < 0.001). OS did not differ significantly between SMPCRC and MMPCRC. In multivariable analysis, N stage remained the only independent predictor of OS (HR 2.979, 95% CI 1.404–6.320, p = 0.004). CONCLUSION: Although SMPCRC and MMPCRC differed in several perioperative and pathological features, OS was primarily determined by N stage. N stage should be considered the key variable for prognostic stratification in resected MPCRC.
Integrating single-cell transcriptomics and machine learning to predict breast cancer prognosis and immunotherapy sensitivity: a study based on proliferating T cells.
Kan Y, Xu Y, Yao S … +3 more , Wu Z, Zheng D, Chen J
World J Surg Oncol · 2026 Apr · PMID 42050659 · Full text
BACKGROUND: Breast cancer, a highly prevalent and heterogeneous malignancy, poses challenges in prognosis and treatment. Emerging evidence links proliferative T cells (Tprolif) to tumor development and progression. This...
BACKGROUND: Breast cancer, a highly prevalent and heterogeneous malignancy, poses challenges in prognosis and treatment. Emerging evidence links proliferative T cells (Tprolif) to tumor development and progression. This study aims to enhance prognostic accuracy in breast cancer by identifying Tprolif-associated risk genes for molecular subtyping and developing a prognostic model grounded in these subtypes. METHODS: Single-cell RNA sequencing (scRNA-seq) data from breast cancer samples were integrated with bulk RNA-seq data from the TCGA-BRCA and GSE20685 cohorts to define Tprolif-based molecular subtypes. A prognostic risk signature was constructed using 10 classical machine learning algorithms, with the optimal algorithm selected through performance testing and validated across multiple datasets. The expression of key model genes was analyzed, and their impact on breast cancer cell proliferation and migration was examined through in vitro experiments. RESULTS: Three distinct molecular subtypes were identified, each characterized by unique immune cell infiltration profiles and survival outcomes. Using Tprolif-based subtyping and machine learning, the random survival forest (RSF) algorithm exhibited superior predictive performance, as measured by the C index. Patients with lower risk scores demonstrated a more active immune microenvironment with greater immune cell infiltration. Functional assays revealed that knockdown of MTFR1 and SLC52A2 markedly inhibited breast cancer cell proliferation and migration. CONCLUSION: This study underscores the pivotal role of Tprolif cells in breast cancer immune heterogeneity and introduces a robust prognostic model for patient stratification. The identification of molecular subtypes and validation of MTFR1 and SLC52A2 as potential therapeutic targets provide crucial insights for personalized cancer treatment strategies.
Transarterial radioembolization versus transarterial chemoembolization for tumor control and survival outcomes in early to intermediate stage hepatocellular carcinoma: systematic review and meta-analysis.
Mirza W, Khan ZA, Bhatti ABH
World J Surg Oncol · 2026 Apr · PMID 42050547 · Full text
BACKGROUND: Transarterial radioembolization (TARE) is increasingly used as an alternate and potentially superior treatment option to Transarterial chemoembolization (TACE) for early- to intermediate-stage unresectable he...
BACKGROUND: Transarterial radioembolization (TARE) is increasingly used as an alternate and potentially superior treatment option to Transarterial chemoembolization (TACE) for early- to intermediate-stage unresectable hepatocellular carcinoma (HCC). However, randomized controlled trials (RCTs) comparing the two modalities have reported mixed findings, and the comparative efficacy and safety remain uncertain. METHODS: A comprehensive literature search was conducted across five databases until August 2025, following PRISMA guidelines. Only RCTs comparing Yttrium-90 TARE (Y90-TARE) with TACE in adults with early- to intermediate-stage unresectable HCC were included. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Secondary outcomes were adverse events, quality of life, and downstaging for liver transplantation. The quality of the evidence was assessed using the GRADE framework. RESULTS: Four RCTs comprising 169 patients (TARE = 87, TACE = 82) were included. No significant differences were observed in PFS (HR: 0.72, 95% CI: 0.43–1.20; P = 0.21), OS (HR: 0.82, 95% CI: 0.49–1.35; P = 0.43), ORR (OR: 1.32, 95% CI: 0.60–2.93; P = 0.49), and downstaging to liver transplantation (OR, 2.19; 95% CI, 0.85–5.66; P = 0.11). However, TARE was associated with significantly fewer treatment-related adverse events (OR, 0.38; 95% CI, 0.19–0.75; P = 0.005). The quality-of-life outcomes were comparable. CONCLUSION: Patients with early to intermediate stage HCC, treated with TARE and TACE, had similar survival outcomes. TARE appears to have a better safety profile with fewer treatment-related adverse events. The limitations of the current data suggest that prospective comparative studies including larger number of patients are needed.
Dose to the axillary-lateral thoracic vessel junction predicts breast cancer-related lymphedema after postmastectomy radiotherapy: development and temporal validation of NTCP and nomogram models.
Xiang N, Wu F, Zhang C … +3 more , Gu H, Jin Z, Yu C
World J Surg Oncol · 2026 Apr · PMID 42045921 · Full text
BACKGROUND: Breast cancer-related lymphedema (BCRL) is a disabling late complication after postmastectomy radiotherapy (PMRT), particularly in patients who undergo axillary lymph node dissection (ALND). The axillary–late...
BACKGROUND: Breast cancer-related lymphedema (BCRL) is a disabling late complication after postmastectomy radiotherapy (PMRT), particularly in patients who undergo axillary lymph node dissection (ALND). The axillary–lateral thoracic vessel junction (ALTJ), an anatomically defined lymphatic–functional substructure, may represent a relevant residual lymphatic drainage site after surgery. We aimed to evaluate whether the radiation dose to the ALTJ can predict BCRL and to develop predictive models for individualized risk estimation. METHODS: A total of 271 patients treated with PMRT from 2019 to 2022 comprised the development cohort, and 45 independent patients treated in 2023 formed the temporal validation cohort. All patients underwent modified radical mastectomy. The ALTJ was contoured on planning CT according to Gross et al. Candidate clinical factors and ALTJ dose–volume histogram (DVH) parameters were analyzed. A normal tissue complication probability (NTCP) model was developed using LASSO-based feature selections followed by multivariable logistic regression, and a Cox regression–based nomogram was constructed using multimethod consensus feature selection. Both models were evaluated and validated without refitting in the temporal cohort. RESULTS: The 2-year cumulative BCRL incidence was 25.1% in the development cohort and 22.2% in the validation cohort. Multivariate analysis revealed that the number of dissected lymph nodes (LNDno) and ALTJ V30 were the strongest predictors. The final NTCP model achieved an AUC of 0.816 in the development cohort and 0.860 in the validation cohort, with Brier scores of 0.135 and 0.111, respectively. A preliminary risk stratification system was developed using thresholds of LNDno > 13 and ALTJ V30 > 51.75%, categorizing patients into high-, moderate-, and low-risk groups with 2-year BCRL rates of 58.8%/54.5%, 26.4%/18.2%, and 5.3%/0% in the development and validation cohorts, respectively. A nomogram, integrating LNDno with the ALTJ V25, V30, V35, and Dmean, achieved C-indices of 0.948 and 0.894 in the development and validation cohorts, respectively. CONCLUSIONS: This study reveals that the ALTJ V30 and surgical extent are important predictors of BCRL in postmastectomy patients receiving radiotherapy. These findings support the consideration of the ALTJ as a quantifiable lymphatic-functional substructure relevant to BCRL risk and suggest that an ALTJ V30 < 51.75% is an exploratory planning threshold that requires external validation. The NTCP model and nomogram may assist individualized risk estimation and risk-adapted surveillance.
Pulmonary metastasectomy and survival in osteosarcoma: a systematic review and meta-analysis of surgery-related prognostic factors.
Ning B, Luo X, Wei G … +12 more , Feng W, Zou Z, Li S, Xiong L, Miao J, Tang H, Li F, Hu J, Deng J, Liu S, Liu Y, Wei Q
World J Surg Oncol · 2026 Apr · PMID 42036655 · Full text
BACKGROUND: Pulmonary metastasis is a major cause of disease progression and mortality in patients with osteosarcoma. The survival impact of pulmonary metastasectomy and the prognostic relevance of surgery-related factor...
BACKGROUND: Pulmonary metastasis is a major cause of disease progression and mortality in patients with osteosarcoma. The survival impact of pulmonary metastasectomy and the prognostic relevance of surgery-related factors remain incompletely defined. This systematic review and meta-analysis aimed to evaluate the association between pulmonary metastasectomy and survival outcomes and to identify key prognostic determinants. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to December 2025. Studies enrolling patients with histologically confirmed osteosarcoma and lung metastases that examined associations between surgery-related factors and survival outcomes were eligible. Outcomes included post-relapse survival (PRS) and post-metastasectomy overall survival (PMOS). Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models according to between-study heterogeneity. RESULTS: Twenty-one retrospective studies were included. Pulmonary metastasectomy was associated with improved post-relapse survival compared with no metastasectomy (HR = 0.29, 95% CI: 0.18–0.46). Complete resection consistently demonstrated a favorable association with survival across endpoints (PRS: HR = 0.21, 95% CI: 0.12–0.38; PMOS: HR = 0.31, 95% CI: 0.23–0.42). Bilateral pulmonary metastases were associated with inferior PMOS (HR = 1.56, 95% CI: 1.27–1.93), whereas the association with PRS did not reach statistical significance (HR = 1.37, 95% CI: 0.92–2.04). Video-assisted thoracoscopic surgery was associated with a modestly increased risk of mortality (HR = 1.69, 95% CI: 1.01–2.82). Across studies, a higher number of metastatic nodules was consistently linked to worse survival, although quantitative synthesis was limited by heterogeneous cutoff definitions. CONCLUSION: In observational studies, pulmonary metastasectomy is associated with improved survival in selected patients with osteosarcoma lung metastases, particularly when complete resection is achieved. Metastatic distribution, nodule burden, and surgical approach may influence prognosis. These findings support careful patient selection and individualized surgical decision-making while underscoring the need for prospective validation.
Investigation of angiogenesis and epithelial-mesenchymal transition markers (CD31, VEGF, and E-Cadherin) in prostatic cancer patients: a multi-omics study.
Shahshenas S, Jalali Nadoushan M, Yarmohammadi H … +1 more , Soltanipur M
World J Surg Oncol · 2026 Apr · PMID 42035163 · Full text
BACKGROUND: Prostate cancer (PCa) progression is critically driven by angiogenesis and epithelial–mesenchymal transition (EMT), processes that facilitate tumor growth, invasion, and metastasis. However, the coordinated r...
BACKGROUND: Prostate cancer (PCa) progression is critically driven by angiogenesis and epithelial–mesenchymal transition (EMT), processes that facilitate tumor growth, invasion, and metastasis. However, the coordinated roles of the endothelial marker CD31 (PECAM1), VEGF, and E-cadherin in PCa aggressiveness remain to be fully elucidated. Here, we investigated the relationships among these biomarkers, Gleason score, and tumor grade, and integrated immunohistochemical (IHC) findings with transcriptomic analyses. METHODS: Seventy-eight prostate adenocarcinoma specimens obtained via radical prostatectomy or transurethral resection (2020–2025) underwent IHC staining for CD31, VEGF, and E-cadherin. Marker expression was quantified by labeling indices, Final Staining Score (FSS), and semi-quantitative scoring, then correlated with Gleason score and grade using appropriate statistical tests (ANOVA, Mann–Whitney U, Kruskal–Wallis, correlation, logistic regression, and ROC analysis). Bioinformatic analyses of 500 TCGA-PRAD RNA-seq samples included Weighted Gene Co-expression Network Analysis (WGCNA) to identify gene modules and hub genes, Differential gene expression (DEG), and Gene Set Enrichment Analysis (GSEA) to assess pathway enrichment. RESULTS: CD31 positivity was observed in 30.8% of cases and was associated with significantly higher Gleason scores and grades (p < 0.01). VEGF FSS increased stepwise with grade (p < 0.001), while E-cadherin expression inversely correlated with tumor aggressiveness (p < 0.001). Individually, CD31 and VEGF yielded AUCs of 0.767 and 0.680, respectively, for discriminating Gleason > 7, whereas E-cadherin loss provided the strongest inverse predictive value. The logistic regression model, integrating age with immunohistochemical expression of E-cadherin, VEGF and CD31, demonstrated strong discriminatory performance for distinguishing high-grade from low-grade tumors (AP 0.90, AUC 0.95). WGCNA identified PECAM1 as a hub in an angiogenesis-enriched module, and GSEA confirmed upregulation of angiogenic and EMT programs in high-grade tumors. CONCLUSION: High-grade PCa is characterized by enhanced angiogenesis (CD31, VEGF) and loss of epithelial adhesion (E-cadherin), underscoring the interplay of vascularization and EMT in tumor progression. These markers, individually and in combination, may inform prognostic stratification and represent potential therapeutic targets.
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