OBJECTIVE:The aim of this study was to develop and validate a novel surgical T (sT) staging system for recurrent nasopharyngeal carcinoma (rNPC) that better reflects anatomical barriers to resection and improves prognostic accuracy compared with the American Joint Committee on Cancer (AJCC) staging system. METHODS:Cadaveric dissections and a retrospective analysis of 211 patients with rNPC undergoing endoscopic nasopharyngectomy were conducted. RESULTS:The proposed sT staging system incorporates 3 key anatomical barriers-the pharyngobasilar fascia (PBF), interpterygoid fascia (IPF), and dura mater-to stratify rNPC into 4 stages (sT1-sT4). In a retrospective cohort of 211 patients who underwent endoscopic nasopharyngectomy, the 5-year overall survival (OS) rates based on AJCC rT staging were 92.9% (rT1), 72.9% (rT2), 69.3% (rT3), and 37.1% (rT4). In contrast, the 5-year OS rates under the sT staging system were 93.4% (sT1), 80.3% (sT2), 60.0% (sT3), and 34.0% (sT4), demonstrating improved separation of survival outcomes across stages (p < 0.001). In the held-out validation cohort under a hash-locked 80/20 split, the sT model achieved superior discrimination compared with AJCC rT (C-index, 0.624 vs 0.546; 2-year time area under the curve [AUC] 0.709 [simple/IPCW 0.709/0.740] vs 0.632 [0.632/0.667]) with acceptable calibration at 2-4 years. The 5-year AUC was not estimable because no patients remained event free beyond 5 years. CONCLUSIONS:By encoding barrier-guided spread aligned with endoscopic resectability (PBF, IPF, and dura), the sT system improves external discrimination and stage separation, thereby enhancing preoperative risk stratification and surgical planning. External, multi-institutional validation with longer follow-up is warranted.

BACKGROUND:Chronic rhinosinusitis with nasal polyps (CRSwNP) in Chinese patients often exhibits a mixed Type 1/2/3 inflammatory phenotype (63%), potentially impacting the efficacy of biologics targeting Type 2 inflammation. This prespecified subgroup analysis of WAYPOINT (NCT04851964) evaluated the efficacy and safety of tezepelumab in Chinese patients with CRSwNP. METHODS:Adult patients with severe CRSwNP were randomized 1:1 to tezepelumab (210 mg) or placebo for 52 weeks. Co-primary endpoints were changes from baseline at Week 52 (W52) in total nasal-polyp score and bi-weekly mean nasal-congestion score. Key secondary endpoints included changes from baseline in Nasal Polyposis Symptom Diary (NPSD) loss-of-smell score, 22-item Sinonasal Outcome Test (SNOT-22) total score, Lund-Mackay score, NPSD total symptom score, and time to first nasal-polyp surgery decision and/or systemic glucocorticoid use. RESULTS:Twenty-nine patients received tezepelumab, and 34 received placebo. At W52, tezepelumab achieved numerically greater improvements in total nasal-polyp score (least-squares mean difference vs. placebo [95% CI]: -2.03 [-2.88, -1.19]) and bi-weekly mean nasal-congestion score (-0.72 [-1.23, -0.21]). Compared with placebo, tezepelumab also improved NPSD loss-of-smell score (-0.44 [-0.82, -0.06]), SNOT-22 total score (-16.34 [-29.80, -2.88]), Lund-Mackay score (-5.30 [-7.23, -3.38]), and NPSD total symptom score (-3.76 [-6.89, -0.63]). No tezepelumab-treated patients required nasal-polyp surgery or systemic glucocorticoids. CONCLUSION:Consistent with the overall population, tezepelumab reduced nasal-polyp size and improved loss-of-smell and other sinonasal symptoms in Chinese patients with CRSwNP, with a favorable safety profile. No surgery or systemic glucocorticoids were required. These benefits were observed despite relatively lower baseline eosinophil counts in these patients. Further investigation is warranted to assess the generalizability to the broader Chinese population with CRSwNP.

Introduction:Previous studies have demonstrated that chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by excessive fibrin deposition which is related to impaired production of tissue plasminogen activator(t-PA) by epithelial cells. This study aims to evaluate whether t-PA expression in endothelial cells is also decreased under the inflammatory milieu of CRSwNP. Methods:Vascularity and proangiogenic genes expression in polyp tissues from eosinophilic CRSwNP (eCRSwNP) and non-eosinophilic CRSwNP (neCRSwNP) were assessed by immunohistochemistry and real-time PCR. Single-cell RNA sequencing data set of CRS, Immunohistochemistry were used. Human primary nasal endothelial cells were stimulated by IL-13 and IFN-γ with or without retinoic acid. Results:We observed the increased expression of proangiogenic genes and vascularity in both eCRSwNP and neCRSwNP. Single-cell RNA sequencing and immunostaining revealed that t-PA expression was decreased in endothelial cells of polyp tissues. In vitro study, IL-13 and IFN-γ could significantly attenuate t-PA expression in endothelial cells, which can be rescued by retinoic acid. Conclusions:Our findings showed a significant contribution of endothelial cells in the production of t-PA in sinonasal tissues. Furthermore, the levels of t-PA in endothelial cells could also be impaired in the inflammatory environment of CRSwNP. Retinoic acid could restore t-PA expression in endothelial cells impaired by inflammatory cytokines (including IL-13 and IFN- γ), thus degrading the deposited fibrin in polyp tissue.

BACKGROUND:For skull base chordomas, two key aspects remain controversial: (1) the necessity of adjuvant RT following gross total resection (GTR) and (2) the comparative long-term efficacy of different RT modalities. OBJECTIVE:This study aimed to evaluate the effects of endonasal endoscopic surgery, RT, and other variables on progression-free survival (PFS) and overall survival (OS) in patients with skull base chordomas. METHOD:A retrospective analysis was conducted on 83 patients (2006-2025) treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University, to assess the prognosis of skull base chordoma between 2006 and 2025. RESULTS:Between 2006 and 2014, GTR was achieved in 25.8% of patients. Between 2015 and 2022, GTR was achieved in 50.0% of patients. Multivariate Cox regression analysis revealed several independent prognostic factors. For PFS, GTR, the presence of complications, and a tumor volume <25 cm3 were significantly associated with outcome. For OS, the independent predictors included STR, GTR and complications. CONCLUSIONS:Surgery remains the primary treatment for skull base chordoma. We therefore recommend pursuing maximal safe resection to achieve GTR whenever feasible. The efficacy of resection is also influenced by the endoscopic endonasal surgery learning curve. Our analysis also revealed tumor volume, and a complicated surgical course as independent prognostic factors. Furthermore, our data may not support the routine use of adjuvant RT following GTR.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common upper airway inflammatory disorder, characterized by persistent inflammation of the sinonasal mucosa and nasal polyp formation. The pivotal roles of interleukin (IL)-4/IL-13 signaling in CRSwNP pathogenesis is increasingly recognized, evidenced by the remarkable clinical success of biologics targeting this pathway. This review provides a concise overview of the IL-4/IL-13 pathway in CRSwNP, encompassing its molecular architecture, pathogenic mechanisms, current targeted therapies, and emerging therapeutic strategies.

BACKGROUND:Chronic rhinosinusitis (CRS) leads to a burden in life and economy. Better therapies need to be explored. OBJECTIVE:This stage I study aims to explore the efficacy and safety of intranasal corticosteroids combined with mucoactive drugs for CRS. METHODS:This randomized-controlled, double-blind study was conducted at 13 hospitals from 2021.01.31 to 2023.01.17. CRS patients were randomly assigned into the eucalyptol-limonene-pinene enteric capsules (ELP) group or placebo group, both using budesonide nasal spray (two doses of 64 μg into each nostril twice a day), and followed up at baseline, week 4, and week 8. The difference of Major Symptom Score (MSS) sum score from baseline to week 8 was defined as the primary endpoint. RESULTS:The data of 291 patients (ELP group: 146 VS. placebo group: 145) were analyzed. The improved mean (SD) of MSS of the budesonide-ELP patients was 4.24 (2.59) at week 4 and 4.37(2.64) at week 8, higher than 3.51(2.27) (Pweek 4 = 0.012) and 3.85 (2.47) (Pweek 8 = 0.093) of budesonide-treated patients, respectively. While, the budesonide-ELP patients had a higher improvement percentage in nasal congestion, postnasal drip, rhinorrhea, and anosmia at week 8 (all P < 0.05). The current clinical control questionnaire in the ELP group significantly differed with placebo group patients at week 4 (P = 0.012), but not at week 8 (P = 0.681). Moreover, the change of Lund-Mackay (LM) and VAS between the two groups was not different at week 8, respectively. However, the CT score of budesonide-ELP-treated patients has significantly improved among smokers at week 8 (P = 0.022). CONCLUSION:Intranasal corticosteroid combined with mucoactive drugs therapy (budesonide-256 μg/day combined with ELP enteric capsules-0.8 g/day) has the potential to improve subjective symptoms and promote physiological recovery for adult patients with CRS, especially for smokers.

KEY POINTS:Mucosal flap reconstruction can improve the long-term survival rate of patients with recurrent nasopharyngeal carcinoma. Mucosal flap reconstruction also increases the treatment-related risks of ear fullness and dysphagia. This matching study provides preliminary evidence for the use of mucosal flap reconstruction in salvage endoscopic nasopharyngectomy.

BACKGROUND:Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impairs the quality of life, and disease control is now considered the primary treatment goal. Although patient-reported outcome measures (PROMs) such as the 22-item Sinonasal Outcome Test (SNOT-22) and CRS-PRO are widely used, their utility in predicting long-term postoperative disease control remains limited. METHODS:This prospective follow-up study aimed to evaluate postoperative recovery and identify the predictors of suboptimal disease control in patients with CRSwNP by integrating preoperative PROMs with objective clinical features. A total of 102 patients with CRSwNP undergoing functional endoscopic sinus surgery (FESS) were enrolled, of whom 89 completed at least 12 months of follow-up. Preoperative and postoperative PROMs were compared across disease control groups classified based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 criteria. Least absolute shrinkage and selection operator regression was applied to select objective clinical predictors, which were then combined with either CRS-PRO or SNOT-22 item scores to develop and compare the nine machine learning models. Model performance was assessed using area under the curve (AUC), decision curve analysis, sensitivity, specificity, and other metrics. RESULTS:Eosinophil and neutrophil counts were identified as key objective predictors of suboptimal disease control after FESS. Among all models, logistic regression incorporating CRS-PRO scores and selected clinical features achieved the best performance, yielding an AUC of 0.866, accuracy of 83.3%, sensitivity of 72.7%, specificity of 89.5%, and F1-score of 76.2%. This model demonstrated a strong discriminatory ability and potential utility in individualized clinical decision-making. CONCLUSION:Integrating preoperative CRS-PRO item scores with selected objective clinical parameters enables the accurate prediction of suboptimal disease control in patients with CRSwNP following FESS. This approach supports personalized risk stratification and postoperative management strategies.

To characterize research on inflammation in CRS over the past 23 years, and analyze trends in hotspots, and collaboration networks. We conducted a methodological, objective, and extensive analysis of inflammation in CRS to track research trends and hotspots. Original research literature published between 2000 and 2023 was obtained from The Web of Science Core Collection (WoSCC) database. Data on country/region, institution, author, journal, keywords, and references were extracted using VOSviewer and CiteSpace for analysis. The number of publications on inflammation in CRS has significantly increased over the past 23 years. The United States has been the most prolific contributor in terms of publications and collaborations. The top 10 high-frequency keywords were “chronic rhinosinusitis,” “nasal polyps,” “asthma,” “inflammation,” “sinusitis,” “rhinosinusitis,” “eosinophils,” “nasal polyposis,” “chronic rhinosinusitis with nasal polyps,” and “allergic rhinitis.” The timeline view revealed changes in keywords over time, with endotype and biologics emerging as recent hotspots. Substantial improvement has been made in the study of inflammation in CRS. The United States leads with the most published articles, productive institutions, and influential journals. Strengthening collaborations between institutions and countries is recommended. The current focus is primarily on immunotherapy, and inflammation in CRS is likely to continue being a prominent topic.

BACKGROUND:Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease with varying patterns across regions. OBJECTIVE:This study aims to investigate the clinical and histopathological features of CRSwNP in Xizang, a high-altitude region in China. MATERIALS AND METHODS:We retrospectively analyzed the histopathological features of CRSwNP patients from Shanghai and Xizang who underwent functional endoscopic sinus surgery (FESS) between 2017 and 2024. Polyp tissue samples were assessed, and statistical analyses compared features between the two regions in CRSwNP, eosinophilic CRSwNP (eCRSwNP), and noneosinophilic CRSwNP (neCRSwNP) patients. RESULTS:Twenty-eight patients from Xizang and 35 from Shanghai were analyzed. All Shanghai patients were Han Chinese, and all Xizang patients were Tibetan. Compared to Shanghai, Tibetan patients had significantly lower rates of smoking and asthma. Overall inflammation levels in Xizang were lower, while eosinophil counts were lower in eCRSwNP patients. Neutrophil infiltration, mucosal ulceration, and squamous metaplasia were higher in Xizang patients, while neCRSwNP patients exhibited more neutrophil infiltration and less subepithelial edema. CONCLUSIONS:The study revealed that Tibetan patients with CRSwNP have lower eosinophilic inflammation but higher neutrophil infiltration and squamous metaplasia compared to Shanghai patients, indicating the impact of high-altitude environments on inflammatory patterns.

PURPOSE:This study aimed to explore survival outcomes of and prognostic factors in nasopharyngeal mucoepidermoid carcinoma (NPMEC). PATIENTS AND METHODS:We reviewed a total of 57 patients diagnosed with NPMEC, including 19 patients in our center and 38 patients with detailed individual survival data in the literature. The Kaplan-Meier method and the log-rank test were used to assess overall survival (OS) and progression-free survival (PFS). Furthermore, the multivariate survival analysis was evaluated using the Cox regression model. RESULTS:The average age of the patients was 45.8 years (range 13-71 years), with a male-to-female ratio of 0.84. During the mean follow-up time of 49 months (range, 3-149 months), the OS rates at 1, 3 and 5 years were 96.1%, 78.7%, and 62.8%, respectively, and the PFS rates at 1, 3 and 5 years were 91.4%, 71.6%, and 51.3%, respectively. The log-rank test showed that lymphatic metastasis affected OS and PFS, while stage T affected PFS. Multivariate regression analysis showed that lymphatic metastasis was associated with worse OS and PFS, that stage T was associated with unfavorable PFS, and that combined therapy improved PFS independently. CONCLUSIONS:Patients with NPMEC have favorable 5 year OS and PFS. Lymphatic metastasis was the independent factor for OS, while lymphatic metastasis, stage T, and treatment modality were the independent factors for PFS.

This study explored the feasibility and security of the clinical application of preoperative embolization and tumor resection for advanced juvenile nasopharyngeal angiofibroma (JNA) without a time interval, performed on the same date, and under the same general anesthesia (GA). Between December 2020 and December 2023, patients with JNA underwent embolization and resection at our hospital. All patients underwent preoperative embolization using liquid embolic material under GA with partial coil assistance; the tumor was removed immediately under the same GA. Both embolization and resection were performed on the same date in the same hybrid operating room without a time interval. Outcome measures included adverse events, blood loss, residual disease, and recurrence. Complete tumor embolization and complete tumor resection (R0) were achieved in 27 patients under a single GA. 1/27 patient (3.7

Background Endoscopic surgery has become the first-line treatment for surgically resectable recurrent nasopharyngeal carcinoma (rNPC), but it is associated with a high risk of postoperative tumor progression. Currently, there is a lack of effective and well-tolerated adjuvant treatment regimens. Thus, the primary objective was to investigate the efficacy and safety of tislelizumab as adjuvant therapy with endoscopic surgery for the treatment of patients with rNPC.Methods This was a single-center, open-label, randomized, controlled, phase 2 trial between November 23, 2021, and May 8, 2024. Eligible patients included those with complete tumor disappearance as indicated by postoperative imaging, histopathologically diagnosed with undifferentiated or differentiated non-keratinizing rNPC. Patients with rNPC were randomized to receive endoscopic surgery alone or adjuvant tislelizumab treatment 2–6 weeks after endoscopic surgery. Tislelizumab was administered as a 200 mg intravenous infusion every 3 weeks until disease progression, death, unacceptable toxicity, withdrawal of consent, investigator’s decision, or 1 year. The primary endpoint was progression-free survival (PFS) at 1 year, and secondary endpoints included 1-year progression-free interval (PFI), 1-year overall survival (OS), and safety.Results The trial is ongoing. 42 patients were enrolled at a median follow-up of 18 months (IQR 10–27), the 1-year PFS was significantly higher in the tislelizumab group (94%, 95% CI: 83% to 100%) than in the endoscopic surgery alone group (57%, 95% CI: 38% to 85%). The 1-year PFI was also higher in the tislelizumab group (100%, 95% CI: 100% to 100%) than in the endoscopic surgery alone group (60%, 95% CI: 40% to 89%). No significant difference in the 1-year OS was observed at the data cut-off. Grade ≥3 immune-related adverse events (irAEs) occurred in 9% of tislelizumab recipients, and all of these events were elevated blood creatine phosphokinase levels. Additionally, the most common irAEs in this group were hypothyroidism, affecting 27%, and pruritus, observed in 9%.Conclusions Tislelizumab as adjuvant therapy significantly enhanced PFS and PFI, with a favorable safety profile. Longer follow-up is necessary to determine whether this regimen can be considered as the standard of care for patients with resectable rNPC following endoscopic surgery.Trial registration number NCT05092217.

Objective:To investigate the anatomic origin of juvenile nasopharyngeal angiofibroma（JNA） through radiologic analysis of tumor invasion patterns, providing insights into tumor etiology and surgical recurrence prevention. Methods:This retrospective cohort study included primary JNA cases at the Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University from March 2015 to September 2024. All patients underwent preoperative high-resolution CT（HRCT） scans, and some underwent enhanced magnetic resonance imaging. The study retrospectively analyzed the patients' imaging data to examine tumor invasion into the pterygopalatine fossa and the vidian canal. These sites were categorized into non-invaded, partially invaded, and completely invaded for the pterygopalatine fossa and the vidian canal. The study analyzed the proportions of invasion at these sites to further speculate on the origin of JNA. Results:A total of 105 JNA patients were included in the study. Among them, 100% of the patients had complete tumor invasion in the pterygopalatine fossa. For the vidian canal, the proportions of complete invasion, partial invasion, and non-invasion were 54.3%, 27.6%, and 18.1%, respectively. As the staging of JNA tumors increased, the proportion of vidian canal invasion also increased. Conclusion:Our evidence suggests that the pterygopalatine fossa, rather than the vidian canal, might be the likely origin of JNA, which is enlightening for the study of the etiological mechanisms of JNA.

Following the initial treatment of nasopharyngeal carcinoma (NPC), tumor progression often portends an adverse prognosis for these patients. MicroRNAs (miRNAs) have emerged as critical regulators of tumor immunity, yet their intricate mechanisms in NPC remain elusive. Through comprehensive miRNA sequencing, tumor tissue microarrays and tissue samples analysis, we identified miR-142-3p as a significantly upregulated miRNA that is strongly associated with poor prognosis in recurrent NPC patients. To elucidate the underlying molecular mechanism, we employed RNA sequencing, coupled with cellular and tissue assays, to identify the downstream targets and associated signaling pathways of miR-142-3p. Our findings revealed two potential targets, CFL2 and WASL, which are directly targeted by miR-142-3p. Functionally, overexpressing CFL2 or WASL significantly reversed the malignant phenotypes induced by miR-142-3p both in vitro and in vivo. Furthermore, signaling pathway analysis revealed that miR-142-3p repressed the RIG-I-mediated immune defense response in NPC by inhibiting the nuclear translocation of IRF3, IRF7 and p65. Moreover, we discovered that ADAR1 physically interacted with Dicer and promoted the formation of mature miR-142-3p in a dose-dependent manner. Collectively, ADAR1-mediated miR-142-3p processing promotes tumor progression and suppresses antitumor immunity, indicating that miR-142-3p may serve as a promising prognostic biomarker and therapeutic target for NPC patients.

e18078 Background: In recent years, endoscopic surgery has become the first-line treatment for surgically resectable recurrent nasopharyngeal carcinoma (rNPC); however, the role of programmed death 1 (PD-1) blockade in patients after endoscopic surgery for rNPC remains unknown. This study aimed to evaluate the efficacy and safety of tislelizumab as adjuvant consolidation therapy. Methods: This was a single-center, open-label, randomized, controlled, phase 2 trial. Eligible patients aged 18–70 years were histopathologically diagnosed with undifferentiated or differentiated nonkeratinizing rNPC. Patients with rNPC were randomized to receive endoscopic surgery alone or endoscopic surgery followed by tislelizumab treatment. Tislelizumab was administered as a 200 mg intravenous infusion every 3 weeks until disease progression or unacceptable toxicity was confirmed. The primary endpoint was progression-free survival (PFS) at 1 year, and secondary endpoints included 1-year progression-free interval (PFI), 1-year overall survival (OS), and safety. Results: The trial is ongoing. Forty-two patients had been enrolled between November 23, 2021 and May 8, 2024. At a median follow-up of 18 months (IQR 10–27), the 1-year PFS was significantly higher in the tislelizumab group (94%, 95% confidence interval (CI) 83–100%) than in the endoscopic surgery alone group (57%, 95% CI 38–85%). The 1-year PFI was also higher in the tislelizumab group (100%, 95% CI: 100%–100%) than in the endoscopic surgery alone group (60%, 95% CI: 40%–89%). No significant difference in the 1-year OS was observed at the data cutoff. Common surgery-related adverse events in the endoscopic surgery group included skull base osteonecrosis (30%), with three cases of grade 2 and three cases of grade 3 or higher AEs. In the tislelizumab group, 18% of patients with osteonecrosis only experienced grade 1 AEs. Grade ≥3 immune-related adverse events (irAEs) occurred in 9% of tislelizumab recipients, and the most common irAEs in this group were hypothyroidism, affecting 27%, and pruritus, observed in 9%. Conclusions: Tislelizumab as adjuvant therapy significantly enhanced PFS and PFI, with a favorable safety profile. Longer follow-up is necessary to determine whether this regimen can be considered as the standard of care for patients with resectable rNPC following endoscopic surgery. Clinical trial information: NCT05092217 .

OBJECTIVES:To explore the prognostic factors in patients with advanced olfactory neuroblastoma (ONB) underwent endoscopic surgery. MATERIALS AND METHODS:Retrospective medical records were reviewed of patients with pathologically proven ONB who underwent endoscopic surgical resection. Clinicopathological characteristics including patient demographics, treatment, complications, follow-up, and outcomes were analyzed. Kaplan-Meier overall survival (OS) and disease-free survival (DFS) curves were plotted. Univariate and multivariate Cox regression models were used to determine prognostic factors. RESULTS:Eighty-five patients with Kadish stage C ONB were examined. According to the various staging systems used, most patients harbored modified Kadish stage C (78.8%). Twenty-six patients (30.6%) underwent bony skull base resection, 11 (12.9%) underwent dura resection, and 24 (28.2%) underwent additional intracranial resection that included the olfactory bulb and duct. Median follow-up was 39 months. Five-year OS and DFS rates were 83.7% and 74.9%, respectively. Five-year OS was 100% in patients treated with bony skull base resection and 77.5% in those who were not (P = .052). Dura resection did not improve OS. Multivariate Cox regression analysis identified perioperative complications (P = .009), gross total resection (P = .004), orbital invasion (P = .014), postoperative radiotherapy (P = .030), and bony skull base resection (P = .019) as independent prognostic predictors. CONCLUSION:For patients with advanced ONB, endoscopic surgery in conjunction with radiotherapy and chemotherapy is effective and safe. Dura resection should be performed with caution in selected patients to balance survival and complications. Postoperative radiotherapy is important to improve OS and DFS.

Olfactory neuroblastoma (ONB) is a rare malignancy known to originate from the olfactory epithelium. The complex tumor ecosystem of this pathology remains unclear. Here we explored the cellular components within 10 ONB tumors and 1 olfactory mucosa sample based on single cell RNA profiles. We showed the intra-tumoral heterogeneity by identifying five unique expression programs among malignant epithelial cells. A novel three-classification system (Neural/Basal/Mesenchymal) of ONB was established according to the distinguished gene expression patterns. Biomarkers for categorizing bulk tumors into the new subtypes were elucidated. Different responses towards certain chemotherapy regimens could be cautiously inferred according to the molecular features representing three tumor types,thus helping with precision chemotherapy. Herein, we also analyzed subclusters of tumor microenvironment (TME) and the interactions among different cell types in the TME. Relative abundance of immunosuppressive tumor associated macrophages indicated the benefits of immunotherapies targeting macrophages.

Endoscopic skull base surgery presents significant technical challenges and high surgical risks, requiring collaboration among multiple disciplines such as otolaryngology, neurosurgery, ophthalmology, and oral maxillofacial surgery. In recent years, there has been rapid development in endoscopic skull base surgery, characterized by flourishing anatomical research and an expanding range of surgical indications. The future brings both opportunities and challenges, and endoscopic skull base surgery must grasp new directions in medical development, actively providing patients with safer and more effective treatment options.