Objectives With the growing demand from elderly cancer patients under palliative care at the end of life, family caregivers often face great pressure and burdens. This study aims to develop a burden and needs assessment tool for family caregivers of elderly cancer patients who receive palliative care at the end of life, and identify caregiver needs in the context of eastern culture. Methods After the literature review and two rounds of Delphi consultations from 15 palliative care, geriatric, and oncology experts, a survey questionnaire was developed to assess the care burden and needs of family caregivers of elderly cancer patients who received palliative care at the end of life. Using the convenience sampling method, a multicenter survey was conducted for family caregivers from 30 medical institutions across China, from January to November 2025. Results The final questionnaire included four dimensions and 13 items, with a Kendall coefficient of 0.319, indicating a high degree of consensus on Delphi consultations. The Kaiser-Meyer Olkin value and Bartlett test of sphericity was 0.831 and < 0.001, respectively, with a Cronbach’s α coefficient of 0.723–0.860, indicating the satisfactory reliability and validity of the questionnaire. The questionnaire included four main caregiver needs dimensions: medical decision-making needs, social support needs, spiritual and psychological needs, and life support needs. Medical decision-making needs had the highest average score among the survey participants. Conclusion The constructed care burden and needs assessment tool for family caregivers has satisfactory reliability and validity, and can be used as an evaluation tool for care needs.

Background:Predicting response to immunotherapy is crucial for advanced non-small cell lung cancer (NSCLC) treatment planning, but effective predictive markers for immunotherapy efficacy are still lacking. This study aimed to develop an explainable machine learning model for predicting immunotherapy responses in advanced NSCLC patients. Methods:A total of 245 advanced NSCLC patients from two centers who received immunotherapy were retrospectively enrolled. For each primary tumor, three regions of interest were analyzed, namely, the intratumoral region (ITR), peritumoral region (PTR), and combined intratumoral and PTR (IPTR). Pre-radiomics features and delta-radiomics features reflecting the rate of change between radiomics features before and after treatment were extracted. Models for predicting immunotherapy responses were established via the extreme gradient boosting (XGBoost) classifier and assessed in terms of discrimination, calibration, and clinical utility. The SHapley Additive exPlanations (SHAP) tool was employed to explore the interpretability of the model. Kaplan-Meier (KM) analysis of progression-free survival (PFS) was conducted to evaluate the prognostic value of the prediction models. Results:The delta-radiomics models of ITR and IPTR demonstrated optimal performance in predicting immunotherapy response, significantly improving the area under the curve (AUC) to 0.85 and 0.83 in the internal validation cohort and 0.84 and 0.86 in the external validation cohort. SHAP revealed a strong relationship between the delta-radiomics feature values and the model-predicted probabilities. KM curves indicated that the high-risk groups identified by the delta-radiomics models had significantly worse PFS than did the low-risk groups across all cohorts. Conclusions:The results demonstrated that a model based on multiple time points outperformed one based on a single time point. The delta-radiomics model has been proved a noninvasive approach for assessing the response of advanced NSCLC patients to immunotherapy and facilitates individualized treatment decision making.

BackgroundRetrospective evidence indicated potential survival benefit of consolidative stereotactic radiotherapy (SRT) in patients with metastatic driver mutation-negative non-small cell lung cancer (NSCLC) harboring oligo-residual disease (ORD) after effective immune checkpoint inhibitor treatment. However, prospective data about consolidative SRT in this disease population after first-line chemoimmunotherapy remains scarce.Methods and findingsFrom March 2021 to March 2023, 59 patients (94.92% males) with metastatic driver mutation-negative NSCLC harboring ORD after effective first-line chemoimmunotherapy were enrolled in this single-arm, phase 2 trial (NCT04767009), which was conducted at Fudan University Shanghai Cancer Center, Shanghai, China. The median (interquartile range) age was 64 (57,71) years. All of the patients received extracranial and/or cranial SRT covering all of the oligo-residual lesions, without holding the maintenance systemic therapy during SRT. The most common sites targeted by consolidative SRT included the lung (n = 30), lymph nodes (n = 26), bone (n = 22), and brain (n = 22). All efficacy and safety analyses followed the intention-to-treat principle with all 59 enrolled patients included. No patient was lost to follow-up. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS) and treatment-related adverse events (TRAEs). With a median follow-up of 14.8 months, the median PFS was 29.0 (90% CI [13.97, Not Reach]) months, meeting the primary endpoint. The 2-year OS rate was 88.9% (95% CI [75.9%,100%]). TRAEs of any grade and grade ≥3 occurred in 58 (98.31%) and 13 (22.03%) patients, respectively. Moreover, a prespecified propensity score-matched comparison was conducted with a contemporary cohort of patients who developed ORD but received systematic therapy alone, which found that incorporating consolidative SRT was associated with prolonged PFS (adjusted HR 0.286, P < 0.001) and OS (adjusted HR 0.229, P = 0.023). The main methodological limitation of this single-arm trial is its inability to establish causal relationships and the findings require validation in randomized controlled trials.ConclusionsConsolidative SRT was associated with prolonged PFS and generally acceptable toxicities in first-line chemoimmunotherapy-treated patients with metastatic NSCLC harboring ORD, supported by propensity-matched comparisons with a contemporary cohort.

PURPOSE:A preclinical model found that elective nodal irradiation attenuated the efficacy of radiotherapy (RT) and radio-immunotherapy. However, limited clinical studies have explored the correlation between radiation dose-volume parameters of negative tumor-draining lymph nodes (TDLN) and T-cell activation/prognosis for patients with cancer treated with definitive radiochemotherapy. EXPERIMENTAL DESIGN:Patients with locally advanced esophageal cancer undergoing definitive chemoradiotherapy (CRT) were selected from two prospective trials. Dose-volume parameters of TDLN as well as other lymphocyte-related organs at risk and lymphocyte subsets such as CD3-CD19+ B cells, CD8+CD28+ T cells, and activated T cells (CD3+CD8+HLA-DR+) before and at the end of RT were collected. Logistic analysis was utilized to correlate dose-volume parameters with reductions in lymphocyte subsets. Prognosis of TDLN irradiation was investigated through Kaplan-Meier analysis and Cox hazards models. RESULTS:Among 512 patients, the median mean dose of TDLN and negative non-TDLN was 25.6 and 15.1 Gy, respectively. Multivariable analyses indicated that TDLN V15 >50% was an independent predictor of poorer local recurrence-free survival (HR, 1.31; P = 0.029) and distant metastasis-free survival (HR, 1.39; P < 0.001), as well as greater reductions in CD3-CD19+ B cells (OR, 1.98; P = 0.002), CD8+CD28+ T cells (OR, 3.42; P < 0.001), and CD3+CD8+HLA-DR+ T cells (OR, 4.67; P = 0.002) after RT. CONCLUSIONS:A higher radiation dose-volume parameter of TDLNs in patients with esophageal cancer undergoing CRT was significantly associated with suppression of T-cell activation and a worse prognosis. Limiting the percentage of TDLN V15 may be beneficial for improving the prognosis of CRT with or without PD-1 inhibitors.

Breast cancer Mammography (MAM) screening was proven to improve survival worldwide. However, younger patients with higher breast density made MAM less effective in China. It is necessary to establish Chinese-specific effective screening strategies. This study aims to explore the efficacy of artificial intelligence (AI)-assisted ultrasound breast cancer screening in China. Eligible participants were those aged 35–69 years and were attending the Chinese "Two Cancer (breast and cervical cancer) Screening" program. Two districts were selected as cluster to receive either AI-assisted ultrasound screening or routine ultrasound screening. We obtained data on cancer diagnosis through active follow-up and linkage with municipal cancer registry. The primary outcome was improved screening sensitivity enabling the detection of more true-positive cases. This study is registered at ClinicalTrials.gov under the number NCT06521788 (Initial Release Date: 07/22/2024). A total of 21,790 individuals in two districts were included in this study, with 8,736 participants in Hongkou district receiving AI-assisted ultrasound screening and 13,054 in Pudong district undergoing routine ultrasound screening. Of the 21,790 screened participants, 232 (10.7‰) tested positive, with AI detecting similar positivity rates compared to routine screening (12.2‰ vs. 9.6‰, P = 0.07). After one year of follow-up, 49 participants were diagnosed with breast cancer: 30 were screen-detected cancers, and 19 were interval cancers. The AI group demonstrated a significantly higher screening sensitivity (75

Background MRI has helped to identify mesorectal fascia (MRF) positivity as a poor prognostic factor in patients with locally advanced rectal cancer. However, outcomes in patients with MRF positivity may vary. Purpose To investigate the prognosis of the four types of MRF-positive classifications and their genetic and protein-level interpretations. Materials and Methods In this multicenter retrospective study (January 2009 to May 2023), patients with locally advanced rectal cancer who underwent rectal MRI were analyzed and categorized as follows: MRF caused by tumor invasion (tumor invasion vs no tumor invasion), extramural vascular invasion (EMVI; EMVI vs no EMVI), lymph node metastasis (LNM; LNM vs no LNM), and tumor deposits (TD; TD vs no TD). Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors were evaluated using multivariable Cox proportional hazard models. Tumor-associated genes were sequenced, tumor mutational burden (TMB) was calculated, and immunohistochemistry was performed to quantify the expression of Ki-67, as well as the infiltration densities of CD3+ and CD8+ T cells. Results A total of 959 patients from three centers were included (median age, 56 years [IQR, 48-63 years]; 622 men). Kaplan-Meier analysis showed MRF with TD and MRF with EMVI were associated with worse DFS compared with MRF without TD (median DFS, 18 vs 99 months, respectively; P < .001) and MRF without EMVI (median DFS, 39 vs 99 months, respectively; P = .01). At multivariable Cox regression analysis, MRF with TD and MRF with EMVI were independent risk factors for poorer DFS (hazard ratio, EMVI vs TD: 1.95 [P = .006] vs 2.55 [P < .001], respectively). TMB and T cell infiltration (CD3+ and CD8+) were lower in patients with MRF and EMVI compared with MRF without EMVI (log-transformed TMB: -0.49 vs -0.44, respectively [P = .04]; mean counts, CD3+: 103.4 vs 251.4, respectively; mean counts, CD8+: 72.3 vs 183.0, respectively [P < .001 for all]). Ki-67 expression was higher in patients with MRF with TD versus MRF without TD (median, 70% vs 60%, respectively; P = .01). Conclusion MRF caused by TD or EMVI at pretreatment rectal MRI predicted poor prognosis in patients with locally advanced rectal cancer. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Horvat and Kim in this issue.

Background: The radiologic and pathologic correlations of subsolid lung cancers are unclear. No study has used the whole-mount sections to analyze the correlations. This study aims to clarify the radiologic and pathologic correlations through the use of the whole-mount sections analysis. Methods: Patients with subsolid lung adenocarcinomas receiving segmentectomy or lobectomy were included. The whole-mount sections were made. The same radiologic and pathologic sections were identified. Radiologic and pathologic tumor and solid/invasive sizes were compared. Histologic features in the solid component and ground-glass opacity (GGO) regions were evaluated. Results: There were 102 patients with 20 pure GGO and 82 part-solid tumors analyzed. There was one adenocarcinoma in situ, 32 minimal invasive adenocarcinomas, and 69 invasive adenocarcinomas. For all patients or patients with the matched sections, radiologic tumor diameter was larger than pathologic one (P<0.001; P=0.009), while radiologic solid component diameter was smaller than that of pathologic invasive diameter (P=0.01; P<0.001). The clinical T stage was pathologically upstaged in nearly 50% of patients. For pure GGO tumors, prevalence of lepidic, acinar, and papillary subtypes was 100.0%, 84.2%, and 47.4%, with no micropapillary or solid subtype. For part-solid tumors, in the GGO region, prevalence of lepidic, acinar, papillary, and micropapillary subtypes was 100.0%, 83.3%, 57.1%, and 11.9%, no solid subtype existed. In the solid region, prevalence of lepidic, acinar, papillary, micropapillary, and solid subtypes was 19.0%, 95.2%, 59.5%, 26.2%, and 2.3%. Conclusions: For subsolid lung cancers, the pathologic invasive size was radiologically underestimated. There were acinar/papillary, but no micropapillary subtype in pure GGO tumors. In part-solid tumors, there were micropapillary subtypes in GGO region and micropapillary/solid subtypes in solid region.

BackgroundFor esophageal squamous cell carcinoma (ESCC), universally accepted pathological criteria for classification by differentiation degree are lacking. Tumor budding, single-cell invasion, and nuclear grade, recognized as prognostic factors in other carcinomas, have rarely been investigated for their correlation with differentiation and prognosis in ESCC. This study aims to determine if pathological findings can predict differentiation degree and prognosis in ESCC.Patients and methodsThis study reviewed tumor slides from 326 patients who underwent surgery for ESCC between 2007 and 2012. Tumors were evaluated for subtypes, tumor nest size, tumor stroma, and nuclear grade (nuclear diameter and mitosis) across different differentiation groups. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, with group differences assessed using the stratified log-rank test and Cox proportional hazards model.ResultsThe mean values of tumor budding invasion margins in well, moderately, and poorly differentiated groups were 25.3%, 30.7%, and 36.3%, respectively. Mean tumor budding/10HPFs were 8.0, 10.3, and 13.0, respectively. Well-differentiated tumors showed more keratinizing subtypes, smaller tumor budding invasion margins, more Grade 1 tumor budding (0-4 cells), absence of single-cell invasion, larger nuclear diameter (≥5 lymphocytes), higher mitotic counts, more submucosal invasion, and less lymphovascular invasion. Conversely, poorly differentiated tumors exhibited opposite characteristics. Multivariate analyses identified the nuclear diameter as independent prognostic factors for OS and DFS.ConclusionsPathological features can stratify the differentiation landscape in ESCC patients. The nuclear diameter (4 lymphocytes) can help predict prognosis in ESCC than other pathological features.Implications for practiceWe first time report the mean values of tumor budding invasion margins and tumor budding/10HPF in well, moderately, and poorly differentiated groups for esophageal squamous cell carcinoma. The landscape of well differentiation was depicted with more keratinizing subtypes, smaller tumor budding invasion margins, more Grade 1 tumor budding (0-4 cells), absence of single-cell invasion, larger nuclear diameter (≥5 lymphocytes), higher mitotic counts, and less lymphovascular invasion. The nuclear diameter as independent prognostic factors for prognosis. The findings indicate that pathological features can stratify the differentiation landscape in ESCC patients and offer novel insight into definition of well or moderately differentiation.

Background Prospective data is limited on the efficacy fi cacy and safety of consolidative stereotactic radiotherapy (SRT) in metastatic epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients harboring oligo-residual disease (ORD) after fi rst-line third-generation EGFR-tyrosine kinase inhibitors (TKIs). Methods In this single-arm, phase II trial, 61 patients from two academic centers were enrolled from March 2021 to March 2023. All these patients had metastatic EGFR-mutant NSCLC and harbored ORD after first-line third- generation EGFR-TKIs. Consolidative SRT was performed and EGFR-TKIs were not held during SRT. The primary endpoint was progression-free survival (PFS) and the secondary endpoints included overall survival and treatment-related adverse events (TRAEs). A prespecified fi ed propensity score matched (PSM) comparison was conducted with a contemporary cohort of patients who developed ORD but received EGFR-TKIs alone. This trial was registered with ClinicalTrails.gov, NCT04764214. Findings All patients received consolidative SRT. With a median follow-up of 21.1 months, the median PFS was 29.9 (80% CI 22.4-32.4) - 32.4) months and the lower boundary exceeded the predefined fi ned threshold, meeting the primary endpoint. TRAEs occurred in 43 (70%) patients, with pneumonitis (27.9%) and esophagitis (26.2%) being the most common toxicities. Four patients (6.6%) reported grade >= 3 TRAEs, each for pneumonitis, esophagitis, leukopenia, and cranial radiation necrosis. PSM analysis showed significantly fi cantly prolonged PFS in EGFR-TKI + SRT group compared to EGFR-TKI group (HR 0.46, 80% CI 0.20-0.61; - 0.61; p = 0.002). Interpretation Consolidative SRT is associated with an encouraging PFS in fi rst-line third-generation EGFR-TKItreated metastatic NSCLC patients harboring ORD, with generally acceptable toxicities. Further confirmatory fi rmatory studies are warranted. Funding Hui Lan Public Welfare and the Chinese Society of Clinical Oncology Foundation. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Background Triple-negative breast cancer (TNBC) is highly heterogeneous, resulting in different responses to neoadjuvant chemotherapy (NAC) and prognoses among patients. This study sought to characterize the heterogeneity of TNBC on MRI and develop a radiogenomic model for predicting both pathological complete response (pCR) and prognosis. Materials and methods In this retrospective study, TNBC patients who underwent neoadjuvant chemotherapy at Fudan University Shanghai Cancer Center were enrolled as the radiomic development cohort (n = 315); among these patients, those whose genetic data were available were enrolled as the radiogenomic development cohort (n = 98). The study population of the two cohorts was randomly divided into a training set and a validation set at a ratio of 7:3. The external validation cohort (n = 77) included patients from the DUKE and I-SPY 1 databases. Spatial heterogeneity was characterized using features from the intratumoral subregions and peritumoral region. Hemodynamic heterogeneity was characterized by kinetic features from the tumor body. Three radiomics models were developed by logistic regression after selecting features. Model 1 included subregional and peritumoral features, Model 2 included kinetic features, and Model 3 integrated the features of Model 1 and Model 2. Two fusion models were developed by further integrating pathological and genomic features (PRM: pathology-radiomics model; GPRM: genomics-pathology-radiomics model). Model performance was assessed with the AUC and decision curve analysis. Prognostic implications were assessed with Kaplan‒Meier curves and multivariate Cox regression. Results Among the radiomic models, the multiregional model representing multiscale heterogeneity (Model 3) exhibited better pCR prediction, with AUCs of 0.87, 0.79, and 0.78 in the training, internal validation, and external validation sets, respectively. The GPRM showed the best performance for predicting pCR in the training (AUC = 0.97, P = 0.015) and validation sets (AUC = 0.93, P = 0.019). Model 3, PRM and GPRM could stratify patients by disease-free survival, and a predicted nonpCR was associated with poor prognosis (P = 0.034, 0.001 and 0.019, respectively). Conclusion Multiscale heterogeneity characterized by DCE-MRI could effectively predict the pCR and prognosis of TNBC patients. The radiogenomic model could serve as a valuable biomarker to improve the prediction performance.

Background and purpose: Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration, and the 1-, 3- and 5-years observed overall survival (OS) rates and disease-free survival (DFS) rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China. Methods: A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study. Clinical information and the follow-up endpoint data were collected through medical records review, telephone visits and death registry data linkage. The last follow-up date was November 30, 2023. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year OS rate and DFS rate, and survival data were described by different subgroups including age group, gender, treatment period, tumor staging, and pathological characteristics. Results: With a median follow-up time of 50.99 months, the 5-year OS rate of surgically resected gastric cancer patients was 70.37%, and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%. The 5-year OS rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 94.32%, 82.56%, 51.01% and 23.97%, respectively. The differences in survival among patients with different age, tumor location, gross classification, Borrmann classification and Lauren classification were significant. Conclusion: Staging is an important factor directly affecting the survival of gastric cancer patients. Screening and early diagnosis and treatment in large population, especially high-risk group, should be strengthened to further improve the patients’ survival.

Background: An increasing number of patients with synchronous esophageal cancer (EC) and gastric cancer (GC) have been diagnosed in recent years. Colon or jejunal interposition for esophageal reconstruction has been frequently performed. This study aimed to evaluate the technical feasibility of a new surgical procedure for patients with synchronous thoracic middle -lower segment EC and distal GC. Methods: Between July 2012 and December 2021, 18 patients underwent simultaneous esophagectomy and distal gastrectomy, in which the tubular stomach was formed by greater curvature of proximal stomach, with the right gastroepiploic vessels used as the blood supply. Patient demographics and perioperative data were analyzed. Results: All 18 patients were male, with a mean age of 64.9 years (range, 51-72 years). The mean +/- standard deviation (SD) operative duration was 249.6 +/- 17.4 min (range, 195-275 min) and mean estimated blood loss was 200.0 +/- 86.6 mL (range, 100-400 mL). Ten (55.6%) patients recovered well without any complications, with a mean postoperative length of hospitalization of 9.2 +/- 2.6 days (range, 6-13 days). Overall, postoperative complications, defined as Clavien-Dindo grades I-V, occurred in eight (44.4%) patients, with anastomotic leakage in four (22.2%), and hydrothorax (11.1%), gastric retention (5.6%), pneumonia (5.6%), and jaundice (5.6%) occurring in two, one, one, and one patient(s), respectively. All patients who experienced complications recovered after treatment, except for one who died of anastomotic leakage. Conclusions: The surgical procedure might be a new treatment option for selected patients with synchronous thoracic middle -lower segment EC and distal GC.

Background and purpose: Effective treatment for cervical cancer patients is one of the global strategies to eliminate cervical cancer. By analyzing the metastasis characteristics and survival status of patients with distant metastasis of cervical cancer from a hospital-based cancer registry data, our study provided real-world evidence for better survival of cervical cancer and finally eliminating cervical cancer. Methods: A total of 572 cervical cancer patients who had metastasis cancer at the initial diagnosis or developed distant metastasis during follow-up in Fudan University Shanghai Cancer Center from 2008 to 2017 were included in this study. Medical records review, telephone visits and death registry data linkage were applied in collecting endpoint data. The first follow-up date was the diagnose date of metastasis, and the last follow-up date was November 1, 2020. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year overall survival (OS) rates for overall and site-specific patients. Results: The median follow-up time was 38.93 months, and 348 cases died during the follow-up. 72.55% were single site metastasis, and 27.45% were multiple metastases. Among all metastatic sites, the proportion of lung metastasis was the highest, 41.26%, 15.21% to bone, and 11.54% to liver. After metastasis, the 1-year, 3-year and 5-year OS rates were 62.29% (95% CI: 62.25-62.33), 33.13% (95% CI: 33.08-33.18) and 23.42% (95% CI: 23.37-23.47), respectively. In single site metastasis, 1-year OS was the highest after metastasis to the lung (72.52%). Besides, there was no significant difference among different metastatic sites, both in 3-year and 5-year OS. Conclusion: The most frequent distant metastatic sites of cervical cancer are lung, bone and liver. The survival rate after metastasis is poor. Further research with systematic treatment strategy is required for better survival.

BACKGROUND:Esophagectomy can be performed using various surgical techniques. The aim of this study was to understand the impact of surgery on long-term survival for esophageal cancer. METHODS:Between May 2010 and July 2012, 300 patients with esophageal cancer were randomly assigned to undergo esophagectomy with either a left or right thoracic approach. Disease-free survival (DFS) and overall survival (OS) were compared based on the per-protocol principle among 286 patients with esophageal squamous cell carcinoma determined by postoperative pathologic results (146 in the right and 140 in the left thoracic arms). RESULTS:The median DFS was 92 months in the right thoracic arm and 41 months in the left thoracic arm (hazard ratio, 0.73; 95% CI, 0.54-0.99; P = .045), with a cumulative 10-year DFS of 47.6% and 37.5%, respectively. The median OS was 136 months in the right thoracic arm and 99 months in the left thoracic arm (hazard ratio, 0.75; 95% CI, 0.54-1.04; P = .081), with cumulative 10-year OS of 52.4% and 43.7%, respectively. DFS and OS were comparable between the 2 arms for patients without lymph node metastasis. Conversely, for patients with lymph node metastasis, 10-year DFS was 32.7% and 21.4%, respectively (P = .018), and 10-year OS of the right and left thoracic arms was 37.9% and 25.9%, respectively (P = .012). CONCLUSIONS:Compared with the left thoracic approach, patients who underwent esophagectomy through the right thoracic approach had better 10-year survival rates, and the survival benefit was significant for those with lymph node metastasis.

Background Brain metastasis (BM) is most common in non-small cell lung cancer (NSCLC) patients. This study aims to enhance BM risk prediction within three years for advanced NSCLC patients by using a deep learning-based segmentation and computed tomography (CT) radiomics-based ensemble learning model. Methods This retrospective study included 602 stage IIIA-IVB NSCLC patients, 309 BM patients and 293 non-BM patients, from two centers. Patients were divided into a training cohort (N = 376), an internal validation cohort (N = 161) and an external validation cohort (N = 65). Lung tumors were first segmented by using a three-dimensional (3D) deep residual U-Net network. Then, a total of 1106 radiomics features were computed by using pretreatment lung CT images to decode the imaging phenotypes of primary lung cancer. To reduce the dimensionality of the radiomics features, recursive feature elimination configured with the least absolute shrinkage and selection operator (LASSO) regularization method was applied to select the optimal image features after removing the low-variance features. An ensemble learning algorithm of the extreme gradient boosting (XGBoost) classifier was used to train and build a prediction model by fusing radiomics features and clinical features. Finally, Kaplan‒Meier (KM) survival analysis was used to evaluate the prognostic value of the prediction score generated by the radiomics–clinical model. Results The fused model achieved area under the receiver operating characteristic curve values of 0.91 ± 0.01, 0.89 ± 0.02 and 0.85 ± 0.05 on the training and two validation cohorts, respectively. Through KM survival analysis, the risk score generated by our model achieved a significant prognostic value for BM-free survival (BMFS) and overall survival (OS) in the two cohorts (P < 0.05). Conclusions Our results demonstrated that (1) the fusion of radiomics and clinical features can improve the prediction performance in predicting BM risk, (2) the radiomics model generates higher performance than the clinical model, and (3) the radiomics-clinical fusion model has prognostic value in predicting the BMFS and OS of NSCLC patients.

Introduction Previous studies demonstrated that wedge resection is sufficient for ground glass-dominant lung adenocarcinoma (LUAD) with tumour diameter ≤2 cm, however, the optimal surgical type for ground glass-dominant LUAD with tumour diameter of 2–3 cm remains unclear. The purpose of this trial is to investigate the safety and efficacy of segmentectomy for ground glass-dominant invasive LUAD with tumour size of 2–3 cm.Methods and analysis We initiated a phase III trial to investigate whether segmentectomy is suitable for ground glass-dominant invasive LUAD with tumour size of 2–3 cm. This trial plans to enrol 307 patients from multiple institutions including four general hospitals and two specialty cancer hospitals over a period of 5 years. The primary endpoint is 5 year disease-free survival. Secondary endpoints are lung function, 5 year overall survival, the site of tumour recurrence and metastasis, segmentectomy completion rate, radical segmentectomy (R0 resection) completion rate and surgery-related complications.Ethics and dissemination This trial has been approved by the Ethics Committee of Fudan University Shanghai Cancer Centre (reference 2212267-18) and by the institutional review boards of each participating centre. Written informed consent is required from all participants. The study results will be published in a peer-reviewed international journal.Trial registration number NCT05717803.

Background: Previous studies found that the long-term survival of male breast cancer patients differed from those of female patients, however, the conclusions were contradictory. We conducted the study to examine the sex disparity in breast cancer survival by carefully controlling demographic and clinical factors using data from the Shanghai Cancer Registry (SCR). Methods: Every male breast cancer patient was matched with four female patients by the diagnosis year, age, stage, and histology. We used Kaplan-Meier survival estimates to calculate the cumulative observed overall survival (OS) and cancer-specific survival (CSS) rates and log-rank tests to compare the survival rates by sex. We used Cox proportional-hazards regression models to assess the association between sex and risk of death. Results: A total of 50,958 patients with breast cancer (0.85% male) were registered in the SCR between 2002 and 2013. After matching, 434 male and 1,736 female patients were included in the study. With a median follow-up of 10 years, men with breast cancer showed worse OS (P<0.001) and CSS (P<0.001) than did women. The 5- and 10-year OS rates for male and female patients were 67.27% and 77.75%, and 45.95% and 62.60%, respectively; the 5- and 10-year CSS rates for male and female patients were 70.19% and 79.79%, and 50.57% and 67.20%, respectively. Compared with women, men had 65% increased risk of overall death [95% confidence interval (CI): 1.42-1.92] and 70% increased risk of cancer-specific death (95% CI: 1.44-2.00). Conclusions: This study found male patients with breast cancer had poorer long-term survival than women in China.

BackgroundThe objective of this study was to explore the abilities of atezolizumab plus chemotherapy in preventing brain metastases (BMs) among metastatic non-small cell lung cancer (NSCLC) without initial BMs, as well as the risk factors of BMs.MethodsIndividual patient data from three trials involving first-line atezolizumab for metastatic NSCLC (IMpower130, IMpower131, and IMpower150) were pooled. Among patients without baseline BMs and without epidermal growth factor receptor (EGFR) and/or anaplastic lymphoma kinase (ALK) mutations, those receiving atezolizumab + chemotherapy +/- bevacizumab were classified as the atezolizumab plus chemotherapy group and those receiving placebo + chemotherapy +/- bevacizumab were classified as the chemotherapy group. The cumulative incidences of BM (CI-BMs) between the two groups were compared. Other factors associated with the CI-BM were analyzed by Cox regression analyses.ResultsWith a median follow-up of 17.6 months (range, 0.03-33.64 months), 74 (3.1%) of the 2380 enrolled patients developed BMs, including 50 (3.1%) and 24 (3.0%) in the atezolizumab plus chemotherapy group (n = 1589) and the chemotherapy group (n = 791), respectively. The CI-BMs at 6, 12, and 24 months were 1.7%, 2.8%, and 3.3%, respectively. After taking competing risk events into account, there was no significant difference in the CI-BMs between the two groups (p = .888). Nevertheless, the use of bevacizumab and the histology of nonsquamous NSCLC were found to be independently associated with the risk of BMs.ConclusionsIn patients with metastatic EGFR/ALK wild-type NSCLC without baseline BMs, adding atezolizumab in the first-line treatment might not reduce the CI-BM. However, the administration of bevacizumab may reduce the risk of BMs. In patients with metastatic EGFR/ALK wild-type non-small cell lung cancer without baseline brain metastases (BMs), adding atezolizumab in the first-line treatment could not reduce the cumulative incidence of BM. However, administration of bevacizumab may reduce the risk of BMs.

Radiomics offers a noninvasive avenue for predicting clinicopathological factors. However, thorough investigations into a robust breast cancer outcome-predicting model and its biological significance remain limited. This study develops a robust radiomic model for prognosis prediction, and further excavates its biological foundation and transferring prediction performance. We retrospectively collected preoperative dynamic contrast-enhanced MRI data from three distinct breast cancer patient cohorts. In FUSCC cohort (n = 466), Lasso was used to select features correlated with patient prognosis and multivariate Cox regression was utilized to integrate these features and build the radiomic risk model, while multiomic analysis was conducted to investigate the model’s biological implications. DUKE cohort (n = 619) and I-SPY1 cohort (n = 128) were used to test the performance of the radiomic signature in outcome prediction. A thirteen-feature radiomic signature was identified in the FUSCC cohort training set and validated in the FUSCC cohort testing set, DUKE cohort and I-SPY1 cohort for predicting relapse-free survival (RFS) and overall survival (OS) (RFS: p = 0.013, p = 0.024 and p = 0.035; OS: p = 0.036, p = 0.005 and p = 0.027 in the three cohorts). Multiomic analysis uncovered metabolic dysregulation underlying the radiomic signature (ATP metabolic process: NES = 1.84, p-adjust = 0.02; cholesterol biosynthesis: NES = 1.79, p-adjust = 0.01). Regarding the therapeutic implications, the radiomic signature exhibited value when combining clinical factors for predicting the pathological complete response to neoadjuvant chemotherapy (DUKE cohort, AUC = 0.72; I-SPY1 cohort, AUC = 0.73). In conclusion, our study identified a breast cancer outcome-predicting radiomic signature in a multicenter radio-multiomic study, along with its correlations with multiomic features in prognostic risk assessment, laying the groundwork for future prospective clinical trials in personalized risk stratification and precision therapy.