Objective: To investigate the pattern of lymph node metastasis (LNM) in multiple primary lung cancers (MPLC) and related influencing factors. Methods: We retrospectively analyzed the lymph node status of 215 patients with MPLC diagnosed by pathological and imaging examinations at Guangdong Jiangmen Central Hospital between January 2015 and December 2021, evaluating the relationship between age, smoking history, tumor markers, primary lesion diameter (PLD), pathological type, lesion location and LNM. Results: There were no statistically significant differences in age, smoking history, Cyfra 21- 1, tumor location, or the number of lesions between groups regarding LNM. Binary logistic regression analysis demonstrated that CEA (OR=0.129, 95% CI=0.039- 0.426), PLD (OR=0.377, 95% CI=0.207- 0.689), and pathological type (OR=1.303, 95% CI=1.019- 1.665) were independent risk factors. ROC analysis demonstrated that CEA and PLD could serve as potential predictive indicators for LNM, but a comprehensive model integrating multiple risk factors provided higher clinical predictive value. The LNM rate was significantly higher in patients with CEA > 5ng/mL than those with CEA <= 5ng/mL (P < 0.05) and was associated with a poorer prognosis. LNM rates and prognosis varied across pathological subtypes (P < 0.05), with higher incidences observed in Solid Predominant Adenocarcinoma (SPA), Micropapillary Predominant Adenocarcinoma (MPA), and Acinar Predominant Adenocarcinoma (ACI), while no LNM occurred in Papillary Predominant Adenocarcinoma (PAP), Lepidic Predominant Adenocarcinoma (LPA), or Minimally Invasive Adenocarcinoma (MIA). The incidence of LNM is positively correlated with prognosis. The LNM rate was positively correlated with PLD. Conclusion: LNM in MPLC is associated with CEA, PLD and pathological type. Systematic lymph node dissection may be considered appropriate when PLD > 20mm, CEA > 5ng/mL, or when the tumor is SPA or MPA, whereas systematic lymph node sampling may be considered for ACI and other pathological types. These findings provide a preliminary framework that requires prospective validation.
Background: Paraneoplastic rheumatic manifestations may precede the diagnosis of an occult malignancy and closely mimic primary autoimmune connective-tissue diseases. Scleroderma-like manifestations have rarely been reported in association with lymphoid malignancies, including diffuse large B-cell lymphoma (DLBCL). Case Presentation: A 47-year-old woman presented with progressive skin thickening, difficulty walking, reduced appetite, and weight loss. She had been diagnosed with scleroderma by an outside physician in early 2024 and had been treated with methotrexate 15 mg once weekly. Physical examination revealed facial skin tightening, sclerodactyly, skin induration extending to the wrists and elbows, and asymmetric thickening of the right neck, forearm, and thigh muscles. Pruritic migratory annular plaques were observed on the trunk and resolved spontaneously within two weeks, clinically suggesting an erythema annulare centrifugum-like eruption. Raynaud phenomenon was absent, antinuclear antibody testing was negative, and cervical and axillary lymphadenopathy was present. Computed tomography demonstrated multiple destructive osteolytic lesions in the lumbar vertebrae. Neck magnetic resonance imaging showed edema-like T2 hyperintensity involving the sternocleidomastoid muscle and adjacent tissues without contrast enhancement. Biopsy of a vertebral lesion revealed DLBCL, with tumor cells positive for leukocyte common antigen and CD20 and a Ki-67 proliferation index of approximately 80%. The patient was started on standard first-line R-CHOP immunochemotherapy but died in the intensive care unit after the first treatment administration, precluding assessment of treatment response and longer-term follow-up. Conclusion: This case illustrates an unusual presentation of DLBCL accompanied by scleroderma-like cutaneous changes, multifocal muscle thickening, and an annular eruption. The simultaneous absence of Raynaud phenomenon and antinuclear antibodies, together with constitutional symptoms, lymphadenopathy, asymmetric soft-tissue abnormalities, and destructive bone lesions, should prompt reconsideration of presumed systemic sclerosis and evaluation for an underlying malignancy. Although a paraneoplastic association was strongly suspected, it could not be confirmed because the patient died after the first treatment administration, precluding assessment of the rheumatic manifestations after lymphoma-directed therapy.
Yong Chen,1 Ming Hu,1 Wenming Wang,1 Zhongtao Li,1 Lijia Fan,1 Chengxia Wang,1 Jianxue Wang,1 Yuansheng Tao1,2 1Jiuting Branch of Songjiang District Central Hospital, Jiuting Hospital of Songjiang District of Shanghai, Shanghai, People’s Republic of China; 2Department of General Surgery, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Songjiang District Central Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Yuansheng Tao, Department of General Surgery, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Songjiang District Central Hospital, Songjiang District, Shanghai, 201615, People’s Republic of China, Email taoys1999@163.comObjective: This retrospective, single-center study evaluated the predictive value of the preoperative Aggregate Index of Systemic Inflammation (AISI) and serum hsa_circ_0076251 for 2-year recurrence in stage II/III colorectal cancer (CRC) patients after radical resection.Methods: In this single-center, retrospective cohort study, we retrospectively analyzed 156 patients. Of these, 148 patients had at least 24 months of recurrence-free follow-up or experienced recurrence/death within 2 years and were included in the 2-year RFS analysis. AISI was calculated from preoperative blood counts, and hsa_circ_0076251 levels were quantified via qRT- PCR. Multivariate Cox regression and ROC curve analyses were used to identify independent predictors and assess diagnostic performance. Adjuvant chemotherapy was included as a covariate in the multivariable analysis. Internal validation was performed using bootstrap resampling and 10-fold cross-validation.Results: Fifty- one patients (32.7%) experienced recurrence. High AISI (≥ 520; 93 HR=2.71, 95% CI: 1.58– 4.66, P< 0.001) and low hsa_circ_0076251 (< 0.65; HR=2.29, 95% CI: 1.32– 3.95, P=0.003) were 94 independent predictors of poor recurrence- free survival after adjustment for T stage, 95 N stage, CEA, and adjuvant chemotherapy. The combined model achieved an apparent AUC of 0.82 (95% CI: 0.75– 0.88) and an optimism-corrected AUC of 0.78 (95% CI: 0.70– 0.85) by bootstrap resampling; these results require external validation before clinical use. High-risk patients, identified by the combination of high AISI and low serum hsa_circ_0076251, had significantly lower 2-year recurrence-free survival rates compared to low-risk patients (45.2% vs 88.9%; P < 0.001). These findings require external validation before any clinical use can be considered.Conclusion: Preoperative AISI and serum hsa circ 0076251 are synergistic, independent biomarkers that may improve early CRC recurrence risk stratification. However, the current model is investigational and should not yet be used to guide adjuvant therapy or surveillance decisions until validated in independent, prospective, multi- center cohorts. These findings are preliminary and hypothesis-generating; they require prospective, multicenter, externally validated studies before routine clinical application. Preoperative AISI and serum hsa_circ_0076251 are synergistic, independent biomarkers that were associated with early CRC recurrence in this retrospective cohort. These findings are preliminary and hypothesis-generating and do not yet support clinical risk stratification or adjuvant therapy planning. However, this conclusion should be interpreted with caution because the present study was retrospective and single-center, and the model has not yet been externally validated.Plain Language Summary: Plain Language Summary This study examined whether two preoperative markers- the Aggregate Index of Systemic Inflammation (AISI) and serum hsa_circ_0076251- can predict the recurrence of stage II/III colorectal cancer within two years after surgery. We found that patients with higher AISI and lower hsa_circ_0076251 levels had a significantly greater risk of recurrence. Combining both markers improved prediction accuracy in this retrospective cohort and helped identify patients who might be considered for future research studies on closer follow- up or more intensive treatment. However, because this was a single-center retrospective study and the model has not been externally validated, these findings should not be used to guide treatment intensification, de-escalation, or surveillance in routine clinical practice. These findings suggest that a simple blood- based test might, after external validation, help inform postoperative risk assessment in colorectal cancer patients; however, clinical utility has not yet been established.Keywords: colorectal cancer, recurrence, systemic inflammation, circular RNA, biomarker
Danfeng Wu,1,* Zhongli Liu,1,* Chenxi He,2,* Binwei Lin,1,3,4 Wen Zhou,5,6 Qiuling Shi,2,5 Xiaoyan Wang11Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People’s Republic of China; 2School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China; 3Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People’s Republic of China; 4Sichuan Clinical Research Center for Radiation and Therapy,Mianyang Central Hospital, Mianyang, People’s Republic of China; 5State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People’s Republic of China; 6Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qiuling Shi, State Key Laboratory of Ultrasound in Medicine and Engineering, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China, Email qshi@cqmu.edu.cn Xiaoyan Wang, Department of Oncology, Sichuan Clinical Research Center for Radiation and Therapy, NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People’s Republic of China, Email 273890354@qq.comBackground & Aims: Nutritional status significantly affects the treatment efficacy and survival outcomes of esophageal cancer patients receiving radiotherapy. Although body mass index (BMI) and Nutritional Risk Screening 2002 (NRS-2002) are well-established independent assessment tools, there is a lack of strong evidence validating their combinedprognostic value. This study aims to compare theprognostic value of the combined BMI and NRS-2002 model with that of single-indexmodels (BMI or NRS-2002) for survival in esophageal cancer patients undergoing radiotherapy.Methods: A retrospective analysis was conducted on data from 676 esophageal cancer patients, with a median follow-up of 24 months. Cox regression analysis was used to evaluate the prognostic value of the combined model and single models, andthe Akaike Information Criterion (AIC) and C-index were used to compare model fit and discrimination. Meanwhile, the prognostic consistency of nutritional indicators was evaluated across key clinical subgroupssuch as TNM stage.Results: Multivariate Cox regression analysis identified pre-radiotherapy BMI and NRS-2002 as independent prognostic factors for overall survival (OS). Compared to underweight patients, those with normal BMI (HR=0.599, 95% CI: 0.457– 0.785, P< 0.001) and overweight status (HR=0.689, 95% CI: 0.493– 0.963, P=0.029) had significantly better survival. Conversely, nutritional risk (NRS-2002 ≥ 3) was associated with poorer survival (HR=1.279, 95% CI: 1.029– 1.591, P=0.027). The combined model demonstrated superior model fit (lowest AIC: 5068.882) and discrimination (optimism-corrected C-index: 0.6597) compared to single-indicator models, although the incremental gain in discriminatory power was modest.Conclusion: Combining pre-radiotherapy BMI with the NRS-2002 provides a slight improvement in risk stratification for overall survival among esophageal cancer patients undergoing radiation therapy compared to a model based on a single indicator. Although this combined model offers complementary prognostic information, its incremental value in distinguishing patient risk is limited. In clinical practice, this combined assessment can serve as a practical adjunct to risk stratification, helping to identify high-risk patients who require comprehensive nutritional intervention. Further external validation in prospective cohorts is still needed.Keywords: esophageal cancer, radiotherapy, BMI, NRS-2002, survival prognosis
Chadrack Kabeya Diyoka,1,2 Pascal Pambi Mukanga,1,2 Jacques Tshibuabua Mutamba,3 Dominique Ilunga Masumbuku,1,3 Diane Muantama Balimo,4,5 Hendrick Mbutshu Lukuke61Management of Health Systems and Services, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo; 2Department of Management of Health Policies and Service, School of Public Health, University of Kananga, Kananga, Democratic Republic of the Congo; 3Department of Epidemiology, Disease Prevention and Control, School of Public Health, University of Kananga, Kananga, Democratic Republic of the Congo; 4Technical Sector of Public Health, Higher Institute of Medical Techniques of Uvira, Uvira, Democratic Republic of Congo; 5Public Health, Lancaster University, Lancaster, UK; 6Health Promotion and Communication Unit, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the CongoCorrespondence: Chadrack Kabeya Diyoka, Department of Management of Health Policies and Service, School of Public Health, University of Kananga, Kananga, Democratic Republic of the Congo, Email ckdgroupe02@gmail.comBackground: The objective of this study was to describe the healthcare-seeking behaviours of families of children with cancer in southeastern DRC by: (i) identifying initial care-seeking options; (ii) characterising the sequence and patterns of pathways leading to paediatric oncology; and (iii) quantifying the interval from symptom onset to the first paediatric oncology consultation and describing its variation by cancer type.Methods: This retrospective cross-sectional study reviewed medical records of children with cancer managed at the Lubumbashi University Clinics, DRC, between January 2020 and June 2025. The analysis of referral times and treatment pathways was conducted in accordance with the Aarhus conceptual framework. Descriptive analyses and explorations of variation were performed using SPSS Statistics and Epi Info 7.2.6.0 software, in addition to R 4.5.3.Results: A total of 44 children with cancer were included; 54.5% were female, and the median age was 156 months (IQR: 108– 156). Retinoblastoma was the most frequent cancer (38.6%), followed by lymphomas (13.6%) and carcinomas (11.4%). The median interval from symptom onset to the first paediatric oncology consultation was 5.5 months (IQR: 2– 12), reaching 9 months (IQR: 5– 12) among children with retinoblastoma. Initial care-seeking options comprised primary care (54.5%), paediatric oncology (18.2%), tertiary care (15.9%), traditional medicine (6.8%), and secondary care (4.5%). The care pathways highlighted a complex navigation within the formal sector-oriented health system, characterized by multiple transitions between levels of care. Paediatric oncology was reached at the first, second, third, and fourth recorded care-seeking contacts by 8, 15, 16, and 5 children, respectively.Conclusion: Primary care was the most common first point of contact, and earlier access to paediatric oncology is a priority, particularly for children with retinoblastoma. The causes of the observed intervals were not established. Prospective mixed-methods studies should identify where time accumulates and explore the experiences of families and healthcare providers.Keywords: healthcare-seeking behaviour, families, children, cancer, Southeast region
