Systemic Epstein-Barr virus-positive (EBV-positive) T/NK cell lymphoproliferative diseases of childhood (sEBV+T/NK-LPD) are a spectrum of rare diseases that have highly variable biological behavior, from indolent conditions to highly aggressive malignancies. Clinicians currently face substantial challenges in promptly assessing disease severity and predicting patient outcomes, leading to limitations in treatment planning. To address this challenge, we constructed a comprehensive triage system to aid in rapid clinical interventions. The study included 156 patients with newly diagnosed sEBV+T/NK-LPD from 42 institutions. An independent prospective cohort of 35 newly enrolled patients was further included to evaluate the model's performance. An additional 45 patients from the literature and 18 patients who underwent hematopoietic stem cell transplantation were included to test the score's generalizability. An integrative machine learning strategy was applied to identify robust and optimal factors and to integrate multiple algorithms to enhance the system's performance and stability. This system, termed COLLAPSED, identifies critical factors and provides a stable, high-performing ensemble. This model was validated externally and simplified into a risk score to improve interpretability and accessibility. The COLLAPSED system substantially enhances clinicians' ability to rapidly and precisely identify high-risk patients, thus enabling timely clinical decision-making and expedited initiation of potentially lifesaving treatments.

Objective: We previously developed the percutaneous suspension technique to improve the anterior mediastinal exposure in minimally invasive thymectomy. In this study, we aimed to integrate this technique with tubeless video-assisted thoracoscopic surgery (VATS) for uniportal subxiphoid thoracoscopic thymectomy and to evaluate perioperative outcomes of this combined approach. Methods: This retrospective, multicenter study included patients with anterior mediastinal masses who underwent uniportal subxiphoid thoracoscopic thymectomy using the percutaneous suspension technique combined with tubeless VATS at 4 centers between March and September 2025. Comprehensive early outcome data, including intraoperative and postoperative variables, were collected and analyzed. Results: In total, 15 patients were included, with a median age of 53 years (range, 25-75 years). Median operative and anesthesia times were 83 minutes (range, 35-192 minutes) and 140 minutes (range, 108-264 minutes), respectively. The median pain score was 2 (range, 1-3) on postoperative day 1 and was 0 in all patients on postoperative day 7. The median postoperative length of stay was 2 days (range, 1-4 days). No conversions and no major intraoperative or postoperative complications occurred. 5 patients (33.3%) developed mild pneumothorax and 3 (20.0%) developed mild atelectasis, all managed conservatively without chest drain insertion. No patient required reinsertion of a chest drain or urinary catheter during hospitalization or after discharge. Conclusions: Tubeless uniportal subxiphoid thoracoscopic thymectomy with the percutaneous suspension technique is safe and feasible for anterior mediastinal masses, although tubeless VATS potentially associated with a slightly higher incidence of minor complications.

OBJECTIVES:The role of adjuvant therapy in ypT0-2N0M0 oesophageal squamous cell carcinoma (OSCC) remains controversial. This study aimed to assess the impact of adjuvant therapy on overall survival (OS) and disease-free survival (DFS) and to develop prognostic nomogram models. METHODS:Patients with ypT0-2N0M0 followed by radical oesophagectomy between 2011 and 2024 were reviewed. Propensity score matching (PSM) was applied to adjust for baseline imbalances between treatment groups. OS and DFS were estimated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model, and nomogram models were developed. RESULTS:A total of 363 patients were enrolled in the study, of whom 67 received adjuvant therapy. Patients who received adjuvant therapy had significantly poorer OS and DFS compared with those who did not, both before and after PSM (P < .05). Multivariate analyses identified adjuvant therapy as an independent adverse prognostic factor for OS and DFS (P < .05). The nomogram demonstrated good discrimination for OS, with time-dependent areas under the receiver operating characteristic curve (AUCs) of 0.729 (95% CI, 0.623-0.835) and 0.716 (95% CI, 0.642-0.790) at 1 and 3 years, respectively, and acceptable discrimination for DFS, with corresponding AUCs of 0.673 (95% CI, 0.596-0.751) and 0.659 (95% CI, 0.589-0.728). CONCLUSIONS:In patients with ypT0-2N0M0 OSCC, adjuvant therapy may not be associated with improved OS or DFS. The developed nomogram models demonstrated good performance in predicting individualized OS and DFS.

Background cT4 esophageal cancer represents a major therapeutic challenge, with definitive chemoradiotherapy (dCRT) currently considered the standard treatment. However, survival outcomes remain unsatisfactory. CS following induction therapy has emerged as a potential alternative strategy, though its clinical effectiveness remains under debate. This systematic review and meta-analysis aimed to compare survival outcomes between conversion surgery (CS) and definitive therapy in patients with cT4 esophageal cancer. Methods Relevant literature was retrieved from PubMed, the Cochrane Library, and Embase. Patients were categorized into the CS group or the definitive therapy group. A systematic review and meta-analysis were performed to evaluate 1-, 3-, and 5-year overall survival (OS) outcomes in patients with esophageal cancer. Odds ratios, mean differences, and 95% confidence intervals were calculated using fixed-effects or random-effects models. Results Seventeen studies involving a total of 3721 patients with cT4 esophageal cancer were included. After excluding studies with high heterogeneity, CS was associated with significantly better survival compared to definitive therapy at 1-year (73.6% vs. 49.6%), 3-year (37.0% vs. 18.4%), and 5-year (26.5% vs. 11.6%) OS. A subgroup analysis of three studies including 341 patients with cT4b disease revealed a significant survival advantage for the CS group in both 1-year OS (86.4% vs. 37.6%) and 3-year OS (48.6% vs. 11.4%). Conclusions CS following induction therapy significantly improves survival in patients with cT4 esophageal cancer. However, the survival benefit of CS for cT4b disease requires further validation in larger prospective studies.

The wider application of posttransplant cyclophosphamide (PTCY) and granulocyte colony-stimulating factor (G-CSF)/antithymocyte globulin (ATG)-based protocols has revolutionized haploidentical hematopoietic stem cell transplantation (haplo-HSCT) by decreasing graft-versus-host disease and facilitating engraftment. In this study, we compared the clinical outcomes and the immune reconstitution of propensity score-matched (1:1:1) patients receiving PTCY (n = 45), ATG (n = 45), or PTCY plus ATG (n = 45). Patients in the ATG group had significantly higher overall survival (OS) (p = 0.029) and leukemia-free survival (LFS) (p = 0.034). CD3+ (p < 0.01) and CD8+ T-cell counts (p = 0.02) were greater at 3 months after transplantation in the ATG group. After adjustment for relevant covariables, Cox models revealed a significant association between CD8+ T-cell reconstitution and OS in all patients (p = 0.008); CD8+ T-cell recovery and LFS showed a similar trend (p = 0.034). Sensitivity analysis revealed stable results. Restricted cubic spline curve analysis to visualize the relationship between immune reconstitution and outcomes revealed that the CD8+ T-cell count at 3 months post-HSCT strongly correlated with survival prognosis. These findings demonstrate that conditioning regimens profoundly impact immune reconstitution, which may contribute to differences in survival prognosis. Moreover, increasing the probability of CD8+ T-cell reconstitution after HSCT may become an important strategy for improving outcomes.

BACKGROUND:Lymph node metastasis is a crucial factor in predicting the prognosis of patients with pathologic T1-2 esophageal squamous cell carcinoma, but the optimal extent of lymphadenectomy remains unclear. This study aims to determine the prognostic significance of high-risk lymph node stations and identify risk factors for high-risk lymph node station involvement. METHODS:Patients with pathologic T1-2 esophageal squamous cell carcinoma who underwent esophagectomy with lymph node dissection were enrolled between January 2014 and December 2019. The incidence of metastasis at each regional lymph node station was assessed, and the efficacy index was calculated to evaluate the therapeutic value of dissection. RESULTS:In total, 695 patients with T1-2 esophageal squamous cell carcinoma were included. Lymph node stations 2, 7, 8, 16, and 17 were defined as high-risk stations, with metastasis rates of 6.47%, 4.17%, 11.37%, 5.90%, and 7.34%, respectively, which were greater than those of the other stations. Patients with high-risk lymph node station metastasis exhibited elevated efficacy index values (1.67-5.44) and significantly worse overall survival (P < .001). High-risk lymph node station metastasis was an independent prognostic factor (hazard ratio, 1.986; 95% confidence interval, 1.452-2.716, P < .001). Logistic regression identified body mass index, tumor differentiation, tumor size, and tumor location as independent risk factors for high-risk lymph node station involvement. CONCLUSION:Lymph node stations 2, 7, 8, 16, and 17 were high-risk stations associated with poor prognosis and high therapeutic value. Identification of these high-risk lymph node stations may guide a more tailored lymphadenectomy strategy in patients with T1-2 esophageal squamous cell carcinoma.

ObjectiveIn recent years, fecal microbiota transplantation (FMT) has been increasingly investigated for the prevention and treatment of acute graft-versus-host disease (aGVHD). Nevertheless, its clinical efficacy remains uncertain. Therefore, this study aims to systematically evaluate the clinical efficacy of FMT in preventing and treating aGVHD.MethodsWe systematically searched Cochrane Library, PubMed, Embase, and Web of Science from inception to October 2025 for studies comparing FMT with conventional regimens (corticosteroids and/or immunosuppressants) for aGVHD prevention and treatment. All statistical analyses were performed using RevMan 5.4.1 and Stata 16.ResultsSix studies involving 262 patients were included. Among them, 85 patients received FMT for aGVHD prevention, 65 received conventional prophylaxis, 68 received FMT for Gastrointestinal aGVHD (GI-aGVHD) treatment, and 44 received conventional treatment for GI-aGVHD. Meta-analysis showed no significant difference in the incidence of aGVHD between the FMT and conventional groups [odds ratio (OR) = 1.30, 95% confidence interval (CI) = 0.10-16.72, p = 0.84]. However, the FMT group demonstrated significantly higher 14-day and 30-day complete response (CR) rates, as well as 14-day clinical response rates, in patients with GI-aGVHD compared to the conventional group (OR = 8.54, 95% CI = 2.49–29.29, p = 0.0007; OR = 8.44, 95% CI = 2.98–23.96, p < 0.0001; OR = 4.66, 95% CI = 1.73–12.55, p = 0.002). No significant differences were observed in the incidence of bacteremia or sepsis between the two groups (OR = 0.37, 95% CI = 0.13–1.01, p = 0.05; OR = 0.38, 95% CI = 0.11–1.33, p = 0.13). Additionally, the abundances of Bacteroides and Bifidobacterium were significantly higher in the FMT group than in the conventional group [standardized mean difference (SMD) = 1.59, 95% CI = 0.15–3.03, p = 0.03; SMD = 1.01, 95% CI = 0.41–1.60, p = 0.0009].ConclusionFMT showed favorable effects in improving clinical symptoms of GI-aGVHD and increasing the abundance of beneficial gut bacteria, and no increased risk of bloodstream infection was observed. These findings suggest that, for patients with established GI-aGVHD who may respond poorly to conventional regimens, FMT can serve as an effective adjunctive or salvage treatment. However, no significant advantage was observed for FMT in preventing aGVHD.

Resection of giant anterior mediastinal masses (AMMs) has traditionally required median sternotomy as the limited operative space and visibility of conventional video-assisted thoracoscopic surgery (VATS) pose significant technical challenges. In this study, we describe a percutaneous suspension technique using a Tian-Ping sternal lifter, to facilitate uniportal VATS for the complete resection of a giant teratoma. A 28-year-old Chinese female presented with a three-month history of intermittent chest pain and cough. Computed tomography (CT) revealed a 17.0 × 9.0 cm AMM with heterogeneous density, and positron emission tomography/computed tomography (PET/CT) demonstrated increased metabolic activity. Complete tumor resection was achieved via a uniportal subxiphoid VATS approach, with operative exposure enhanced by a Tian-Ping sternal lifter that expanded the retrosternal working space. The patient had an uneventful recovery and was discharged nine days after surgery. Histopathology confirmed a mature cystic teratoma. At 18-month follow-up, the patient remained asymptomatic with no recurrence or procedure-related complications. This single-case report illustrates the feasibility of a percutaneous suspension technique using a Tian-Ping sternal lifter to assist uniportal subxiphoid VATS resection of large AMMs, offering a minimally invasive, sternum-sparing option for selected patients.

Background and Objective:Lung transplantation (LTx) remains the only definitive treatment for end-stage lung disease. Throughout 2025, the global transplant community has made notable progress in addressing persistent challenges in the field, ranging from policy-level improvements in graft allocation to deeper biological insights into post-transplant complications. This review aims to synthesize the pivotal literature published in 2025 across four core areas: optimizing allocation, advancing perioperative care, defining the mechanisms of graft injury, and exploring translational frontiers. Methods:We conducted a structured literature search focused primarily on studies published in 2025 that highlight major advancements in LTx. In addition, the search was supplemented with key society guidelines, consensus statements, and relevant early 2026 publications. Selected articles were critically analyzed and categorized into clinical advancements, and basic/translational findings. Key Content and Findings:In clinical research, the refinement of allocation strategies and the expansion of donor criteria, have effectively broadened access. Perioperative management has evolved with the integration of artificial intelligence to predict complications such as primary graft dysfunction (PGD) and chronic lung allograft dysfunction (CLAD). In basic and translational research, studies have dissected the molecular basis of complications. Additionally, new insights into the evolution of drug-resistant pathogens and macrophage plasticity have deepened our understanding of infection and rejection. Conclusions:In 2025, significant progress has been achieved in the field of LTx research. Strategies for clinical donor allocation and perioperative management, along with the understanding of molecular mechanisms underlying complications, have also been greatly improved. These advancements are essential to further optimize outcomes and address the complex challenges in LTx.

Background Delayed platelet engraftment is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Objectives This retrospective study evaluates the efficacy and safety of hetrombopag, an oral thrombopoietin receptor agonist, in promoting platelet engraftment post-allo-HSCT. Design Retrospective observational cohort study. Methods A cohort of 133 patients was analyzed, including 68 treated with hetrombopag post-transplant and 65 controls. Cumulative incidence function evaluated platelet engraftment, with propensity score matching and competing risk analysis to strengthen robustness. Factors associated with platelet engraftment were examined using multivariate Cox models with time-dependent coding of hetrombopag exposure. Results Hetrombopag significantly reduced the time to overall response (OR: 15.0 days vs. 20.0 days; p = 0.009) and complete response (CR: 17.5 days vs. 34.0 days; p < 0.001). The cumulative incidence of CR was higher in the hetrombopag group (92.78% vs. 86.58%; p = 0.001), with a significantly shorter median time to CR (19 days vs. 38 days) defined by the cumulative incidence function. Multivariate Cox regression identified hetrombopag as a protective factor for platelet recovery (HR: 2.04; p = 0.004). Competing risk and PSM analyses confirmed hetrombopag’s role in faster platelet engraftment. The treatment was well-tolerated, with manageable mild liver enzyme elevations and hypomagnesemia but no grade 3/4 adverse events. Conclusion Hetrombopag significantly accelerates platelet engraftment and has a favorable safety profile, suggesting its potential as a therapeutic adjunct in managing thrombocytopenia post-allo-HSCT. This study complements and validates findings from prior prospective studies, providing external confirmation in a real-world cohort.

Esophagectomy is the standard treatment for pathological T1–2 (pT1–2) esophageal squamous cell carcinoma (ESCC). However, the optimal extent of lymphadenectomy remains controversial. The number of examined lymph node stations (ELNS) may define dissection extent. This study aims to determine optimal ELNS for accurate nodal staging and overall survival (OS) benefit in patients with pT1–2 ESCC. Multicenter data of patients with pT1–2 ESCC undergoing esophagectomy with lymphadenectomy were included. The association of ELNS count with accurate nodal staging and OS was evaluated using multivariate models. Chow test was performed to identify structural breakpoints of ELNS count. Subgroup analyses and integrated time-dependent area under the curve (iAUC) were used to validate the effectiveness of the models. Among 1423 patients, the model identified five and seven as breakpoints for accurate nodal staging and OS, respectively (all P < 0.05). In multivariate analysis, ≥ 5 ELNS (P = 0.008) was an independent predictive factor of lymph node involvement detection, while = 7 ELNS (P = 0.015) was an independent prognostic factor for OS. Patients with 7 ELNS removed demonstrated superior OS compared with others (P = 0.026). The predictive accuracy for lymph node involvement detection was improved in ≥ 5 ELNS group (AUC, 0.68 versus 0.64). Furthermore, a higher prognostic value was found in patients with 7 ELNS (iAUC, 0.76 versus 0.65). ELNS = 5 is established as the optimal threshold for ensuring nodal staging adequacy and ELNS = 7 as the optimal threshold for maximizing OS benefits in patients with pT1–2 ESCC.

OBJECTIVES:This study aimed to develop and validate machine learning (ML) models to predict survival following oesophagectomy in oesophageal squamous cell carcinoma (ESCC) patients using intratumoural and peritumoural radiomic features. METHODS:A retrospective analysis was conducted on ESCC patients with preoperative contrast-enhanced computed tomography who underwent oesophagectomy from June 2016 to January 2020. Patients were randomly assigned to training and test sets (8:2 ratio). Radiomic features were independently extracted from intratumoural and peritumoural regions. Cox regression, random survival forests (RSF), and gradient boosting decision tree (GBDT) were used for modelling. The performance of models was evaluated by discrimination and calibration. RESULTS:The study included 443 patients, 354 in the training set and 89 in the test set. Peritumoural radiomic features predominated in the final selection, with 14 of 17 selected features originating from peritumoural region. The optimal GBDT model (the integrated area under the curve [iAUC]: 0.854; the integrated Brier score [iBS]: 0.160) using dual-region radiomic and clinical features outperformed other models, with a 1-year time-dependent area under the curve (tAUC) of 0.712 (95% CI, 0.655-0.738) and 3-year tAUC of 0.733 (95% CI, 0.655-0.805). It effectively stratified patients into high- and low-risk groups (P < .001). CONCLUSIONS:ML models using intratumoural and peritumoural radiomic features showed potential for predicting postoperative survival in ESCC patients, with the optimal GBDT model demonstrating effective risk stratification.

Although post-transplant cyclophosphamide (PTCy) is widely used to prevent graft-versus-host disease (GVHD), its protective effect remains inadequate in patients undergoing myeloablative haploidentical peripheral blood stem cell transplantation (haplo-PBSCT). We retrospectively evaluated the efficacy of PTCy combined with either pre-transplant or post-transplant antithymocyte globulin (ATG) for GVHD prevention in 114 haplo-PBSCT recipients. The PTCy+FTATG group (n = 74) received ATG at a total dose of 5 mg/kg on days -3 to -1, together with PTCy at 25 mg/kg on days +3 and +4. The PTCy+PTATG group (n = 40) received PTCy at 50 mg/kg on days +3 and +4, followed by ATG at 2.5 mg/kg on day +8. Both univariate and multivariate analyses showed that PTCy+FTATG prophylaxis significantly lowered the risk of grade II-IV acute GVHD (9.5% vs 27.5% [HR 0.24; 95% CI: 0.10-0.59; P = 0.002]) and grade III-IV acute GVHD (5.4% vs 17.5% [HR 0.19; 95% CI: 0.07-0.54; P = 0.002]). The 2-year cumulative incidence of chronic GVHD was 16.7% in the PTCy+FTATG group and 27.5% in the PTCy+PTATG group (P = 0.15). At 2 years, overall survival (OS), progression-free survival (PFS), and graft-versus-host disease-free relapse-free survival (GRFS) were 87.8% vs 72.5% (P = 0.04), 82.2% vs 65.0% (P = 0.03), and 78.1% vs 55.0% (P = 0.005), respectively. These results suggest that half-dose PTCy combined with low-dose pre-transplant ATG may be a promising strategy for GVHD prophylaxis.

Driven by the evolving clinical demands of minimally invasive thoracic surgery, innovation in anatomical surgical approaches that promote enhanced perioperative recovery, incision concealment, and pain reduction has become an important direction for future development. As a concealed-incision strategy, the periareolar approach has been applied to a range of thoracic diseases and has shown potential advantages in cosmetic outcomes and postoperative pain control. However, broader clinical adoption remains limited by the lack of unified patient-selection criteria, insufficient standardization of surgical techniques, the risk of areolar injury, the technical learning curve, and unresolved perioperative management issues. Moreover, thoracic surgeons’ understanding of this approach remains incomplete. This review summarizes the surgical techniques, clinical applications, practical challenges, and future prospects of the periareolar approach, aiming to provide a reference for clinical practice and standardized implementation.