Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor with variable clinical behavior. The International Medullary Thyroid Carcinoma Grading System (IMTCGS) was developed to refine prognostic stratification, but its validation in Chinese populations remains limited. This study aimed to validate the IMTCGS and evaluate the prognostic significance of Ki-67, preoperative calcitonin levels, and molecular alterations in a Chinese MTC cohort. We conducted a retrospective analysis of 140 MTC patients who underwent initial surgery at a single center between May 2017 and June 2025. Tumors were graded using the IMTCGS criteria. Associations among clinicopathological variables, Ki-67 index, preoperative calcitonin levels, molecular characteristics (assessed by next-generation sequencing), and progression-free survival (PFS) were analyzed using Kaplan-Meier analysis, Cox proportional hazards models, and receiver operating characteristic (ROC) curves. High-grade MTC (47.9

Tumor-draining lymph nodes are central to anti-tumor immunity and influence the response to immunotherapy. Colorectal cancers with microsatellite instability and microsatellite stability differ substantially in tumor biology, prognosis and sensitivity to immune checkpoint blockade. However, the differences in tumor-draining lymph nodes between these two subtypes and their contribution to distinct anti-tumor immune responses remain poorly understood. Here, we performed an integrative multi-omics analysis to systematically compare tumor-draining lymph nodes and tumor microenvironments in these two colorectal cancer subtypes. We identified a distinct population of CD8+ T cells that displayed terminal exhaustion while retaining strong anti-tumor activity. These cells were highly tumor reactive, associated with tertiary lymphoid structure formation and enriched in microsatellite instability colorectal cancers. Lineage tracing indicated that they originated in tumor-draining lymph nodes. In microsatellite instability colorectal cancers, tumor-draining lymph nodes contained more pre-exhausted T cells, dendritic cells with enhanced antigen-presenting capacity and fewer regulatory T cells, thereby providing both precursors and a supportive niche for the development of these effector-exhausted T cells. Meanwhile, within tumors, IL21+CD4+ T cells and CXCL10+ myeloid cells promoted the differentiation and recruitment of these cells through cytokine signaling and increased major histocompatibility complex expression. Colorectal cancer cells with microsatellite instability further reinforced this immune ecosystem by activating the cyclic GMP-AMP synthase-stimulator of interferon genes pathway. Collectively, our findings identify effector-exhausted CD8+ T cells as key mediators of favorable immunity in microsatellite instability colorectal cancers and highlight the pivotal role of tumor-draining lymph nodes in shaping the tumor immune landscape.

Our previous study demonstrated that pathological grades of adenoid cystic carcinoma (ACC) correlate with distinct prognoses and treatment strategies. To explore the molecular alterations underlying these grades, we performed whole-exome sequencing (WES) on 20 head and neck ACC samples from 12 patients, categorized into grade I-II, grade III, and high-grade transformation (HGT). Comprehensive analyses, including somatic mutations, chromosomal structural variations, and phylogenetic tree construction, were conducted. Spatial transcriptome (ST) technology was further employed to analyze gene expression, pseudo-time trajectories, and copy number variations in a grade III sample. WES revealed that high-grade (grade III and HGT) ACC tissues frequently harbor mutations in TP53, PI3K pathway genes, and chromatin remodelers. Phylogenetic analysis showed that higher-grade regions exhibit more subclonal mutations or a larger proportion of intergenerational mutations. Copy number analysis identified recurrent deletions of 1p36.33 and amplifications of 8q24.21/9p24.1 in high-grade samples, along with significant deletions on chr12 in both WES and ST. ST pathway enrichment and cell trajectory analyses indicated that high-grade clusters are more primitive and proliferative, while low-grade clusters display greater microenvironmental stability and interstitial specialization. These findings highlight the complex spatial heterogeneity associated with ACC pathological grades, providing critical insights into disease progression and guiding therapeutic strategies.

Background:Numerous studies have documented a reduction in the number of lymph nodes (LNs) examined and the number of metastatic LNs in rectal cancer patients as a consequence of neoadjuvant chemoradiotherapy (NCRT). It is plausible that the current guidelines advocating a specific number of LNs to be examined in rectal cancer surgery may be inappropriate for patients undergoing neoadjuvant therapy. This study aimed to determine the optimal number of LNs to be examined in rectal cancer patients treated with NCRT. Methods:We conducted a retrospective analysis of clinicopathologic data from rectal cancer patients who underwent NCRT and radical resection at the Cancer Hospital, Chinese Academy of Medical Sciences/National Cancer Center (NCC) from January 2004 to December 2015, as well as patients diagnosed with rectal cancer who received neoadjuvant therapy followed by surgery in the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. The optimal cutoff value for the number of examined LNs (ELNs) was determined using the X-tile software. Prognosis was assessed using the Kaplan-Meier method and log-rank test, while Cox regression analysis was employed to identify prognostic risk factors. Results:A total of 6,634 patients were included, comprising 391 patients in the NCC cohort and 6,243 patients in the SEER cohort. In the NCC cohort, there was no significant survival difference between patients with <12 ELNs and those with ≥12 ELNs, with the 5-year disease-free survival (DFS) rates of 72.0% and 76.5%, respectively (P=0.10). Furthermore, the X-tile software identified 7 as the optimal cutoff value for ELNs. In this cohort, patients with <7 ELNs had a 5-year DFS rate of 65.1%, compared to 76.3% for those with ≥7 ELNs (P=0.03). Multivariate Cox analysis revealed that the number of ELNs (cutoff value at 7) was the independent prognostic factor for DFS [hazard ratio (HR) =3.255, 95% confidence interval (CI): 1.796-5.897, P<0.001]. In the SEER cohort, the 5-year cancer-specific survival (CSS) rate was 81.2% for patients with <12 ELNs compared with 83.1% for those with ≥12 ELNs (P=0.10). Among these patients, those with <7 ELNs had a 5-year CSS rate of 79.1%, compared to 83.0% for those with ≥7 ELNs (P=0.04). Multivariate Cox analysis demonstrated that the number of ELNs (cutoff at 7) was an independent prognostic factor associated with CSS (HR =1.606, 95% CI: 1.308-1.970, P<0.001). Conclusions:The optimal minimum number of LNs to be examined in rectal cancer patients treated with NCRT appears to be 7. The current standard of examining ≥12 LNs may be inappropriate. This finding provides valuable insights for determining the appropriate number of ELNs during surgery for rectal cancer patients who have undergone neoadjuvant therapy.

Objective: This study aimed to assess the impact of the number of metastatic lymph nodes (LNs) on survival and propose a subdivision of the N2b category in colorectal cancer (CRC) patients. Methods: We retrospectively analyzed from two sources: clinicopathologic data of CRC patients with stage pTxN2bM0 who initially underwent radical surgery at Cancer Hospital, Chinese Academy of Medical Sciences/National Cancer center (NCC), and patients with stage pTxN0-2bM0-1 in the Surveillance, Epidemiology and End Results (SEER) database from January 2010 to December 2015. The optimal cutoff value of the number of positive lymph nodes (PLNs) was determined based on the principle of maximum chi-square value. We constructed survival curves using the Kaplan–Meier method, assessed survival differences with the log-rank test, and conducted univariate and multivariate analyses using the Cox proportional hazard regression model. Results: A total of 68,335 CRC patients were included: 240 from the NCC cohort, and 68,095 from the SEER cohort. Within the SEER cohort, 65,189 patients had M0 stage disease and 2,906 had M1 stage disease. The optimal PLN cutoff value determined by X-tile software (Version 3.6.1) was 13. According to PLN, stage N2b patients were divided into two groups: stage N2b# (7 ≤ PLN < 13) and stage N3 (PLN ≥ 13). In the NCC cohort, the 5-year overall survival (OS) rates of stage N2b# and N3 patients were 66.0% and 45.7%, respectively (p < 0.001). In the SEER cohort, the 5-year cancer-specific survival (CSS) rate was 57.1% for stage N2b# patients compared with 40.2% for stage N3 patients (p < 0.001). The results of multivariate Cox analysis demonstrated that modified stage pN was the independent prognosis factor of OS in the NCC cohort (HR = 1.869, 95%CI:1.253–2.787, p = 0.002); modified stage pN was also the independent prognosis indicator of CSS in the SEER cohort (N3:N0, HR = 8.170, 95%CI: 7.298–9.146, p < 0.001). There was no survival difference between TxN3M0 and TxN0-2b#M0 (5-year CSS rate: 40.2% vs. 30.1%, p = 0.050; 5-year OS rate: 35.3% vs. 27.8%, p = 0.358). Conclusions: The N category served as a strong independent prognostic indicator in CRC patients. Furthermore, PLN emerged as an independent prognostic factor specifically in stage N2b CRC patients. These findings suggest that clinicians may utilize PLN for prognostic stratification and tailor adjuvant therapeutic strategies accordingly for patients diagnosed with stage N2b CRC.

The prognosis of thyroid cancer in patients varies significantly based on different pathological types or distinct clinical situations. Investigating the expression of immune checkpoint molecules PD-L1 and B7-H3 in high-risk thyroid cancer and their correlation with clinicopathological features and prognosis will contribute to the development of novel therapeutic strategies. A retrospective sample of 202 patients with thyroid cancer who underwent surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences was collected, including 33 cases of anaplastic thyroid cancer (ATC), 21 cases of differentiated thyroid cancer (DTC) with distant metastasis (DM), 7 cases of differentiated high-grade thyroid carcinoma (DHGTC), and 109 cases of aggressive subtypes of papillary thyroid carcinoma (PTC) (including 28 cases of tall cell PTC, 31 cases of diffuse sclerosing PTC, 20 cases of solid PTC, 15 cases of columnar cell PTC, and 15 cases of hobnail PTC). In the control group, there were 32 cases of classic PTC. The differences in protein expression between PD-L1 and B7-H3 in several high-risk thyroid cancers and normal tissues and controls were compared by immunohistochemical staining, and the clinicopathological features and prognostic relevance were statistically analyzed. The expression of PD-L1 in ATC (P < 0.001), tall cell PTC (P = 0.031), and DHGTC (P = 0.003) was significantly higher than that in classic PTC. The expression of B7-H3 in ATC (P < 0.001), DTC with DM (P = 0.001), diffuse sclerosing PTC (P = 0.013), columnar cell PTC (P = 0.007), solid PTC (P < 0.001), hobnail PTC (P < 0.001), and DHGTC (P < 0.001) was significantly higher than that in classic PTC. In ATC, PD-L1 expression correlated significantly with extrathyroidal extension (ETE) (P = 0.027) and B7-H3 expression correlated significantly with male patients (P = 0.031) and lymph node metastasis (LNM) (P = 0.026). The positive expression of B7-H3 (P = 0.041) was an independent risk factor for disease progression in ATC. B7-H3 positive expression (P = 0.049), PD-L1 positive expression (P = 0.015), and tumor diameter ≥ 2 cm (P = 0.038) were independent risk factors for disease progression in patients with DTC with DM. PD-L1 positive expression (P = 0.019) and tumor diameter ≥ 2 cm (P = 0.018) were independent risk factors for disease progression in patients with aggressive subtypes of PTC. B7-H3 and PD-L1 are expected to be effective prognostic indicators for patients with aggressive thyroid cancer, which can help in optimization of individualized treatment strategies. Immunotherapy targeting these two molecules may provide new and complementary ideas for the treatment of high-risk/refractory thyroid cancer.

Background It remains unclear whether addition of docetaxel to the combination of a platinum and fluoropyrimidine could provide more clinical benefits than doublet chemotherapies in the perioperative treatment for locally advanced gastric/gastro-esophageal junction (LAG/GEJ) cancer in Asia. In this randomized, phase 2 study, we assessed the efficacy and safety of perioperative docetaxel plus oxaliplatin and S-1 (DOS) versus oxaliplatin plus S-1 (SOX) in LAG/GEJ adenocarcinoma patients. Methods Patients with cT3–4 N any M0 G/GEJ adenocarcinoma were randomized (1:1) to receive 4 cycles of preoperative DOS or SOX followed by D2 gastrectomy and another 4 cycles of postoperative chemotherapy. The primary endpoint was major pathological response (MPR). Results From Aug, 2015 to Dec, 2019,154 patients were enrolled and 147 patients included in final analysis, with a median age of 60 (26–73) years. DOS resulted in significantly higher MPR (25.4 vs. 11.8%, P = 0.04). R0 resection rate, the 3-year PFS and 3-year OS rates were 78.9 vs. 61.8% ( P = 0.02), 52.3 vs. 35% (HR 0.667, 95% CI: 0.432–1.029, Log rank P = 0.07) and 57.5 vs. 49.2% (HR 0.685, 95% CI: 0.429–1.095, Log rank P = 0.11) in the DOS and SOX groups, respectively. Patients who acquired MPR experienced significantly better survival. DOS had similar tolerance to SOX. Conclusions Perioperative DOS improved MPR significantly and tended to produce longer PFS compared to SOX in LAG/GEJ cancer in Asia, and might be considered as a preferred option for perioperative chemotherapy and worth further investigation.

Purpose Chemoradiotherapy (CRT) remains the standard treatment for locally advanced rectal cancer (LARC). This phase 2 clinical trial was designed to evaluate the efficacy and safety of neoadjuvant triplet chemotherapy with mFOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin, and irinotecan) in LARC. Patients and methods The patients with LARC (the lower edge more than 5 cm from the anal verge) received up to 5 cycles of mFOLFOXIRI. MRI was performed to assess the baseline and postchemotherapy TN stage. Radical resection was performed within 4–6 weeks from the last dose of chemotherapy if the tumor shrank or remained stable. Adjuvant chemotherapy with mFOLFOX6 or XELOX was recommended. Postoperative radiation was planned for R1 resection, ypT4b, ypN2 and a positive CRM. The primary endpoint was the pathological complete response (pCR) rate. Results From February 2016 to March 2019, 50 patients were enrolled. Forty-eight (96%) were clinically node-positive, 28 (56.5%) with MRF invasion and 39 (78.4%) were EMVI positive. The median cycle of neoadjuvant mFOLFOXIRI chemotherapy was 5 (range,1–5). A total of 46/50 (92%) patients underwent total mesorectal excision (TME) surgery, all with R0 resection. The pCR rate was 4.3% (2/46). Twenty-three of 46 (50%) patients with cN + achieved a pathological node-negative status. The proportions of pathologically positive CRM and EMVI were 2.2% and 34.7%, respectively. Adjuvant radiotherapy was given to 14/46 (30.4%) patients. The most common Grade 3 or > toxicities included neutrocytopenia (50%), leukopenia (14%) and diarrhea (12%) during the neoadjuvant chemotherapy period. Clinically meaningful postoperative complications included pneumonia ( n = 1), pelvic infection ( n = 1) and anastomotic fistula ( n = 1). With a median follow-up time of 51.2 months, local recurrences and distant metastases were confirmed in 3 (6.5%) and 9 (19.6%) of cases, respectively. The 3-year disease free survival (DFS) and overall survival (OS)rates were 75.8% and 86.8%. Conclusion Neoadjuvant chemotherapy with mFOLFOXIRI yielded a significant down-staging effect and seemed to be effective in eliminating EMVI and transforming the positive MRF to negative in LARC. The survival results are promising. The long-term follow-up showed promising DFS and OS rates accompanied by a favorable safety profile. Trial registration ClinicalTrials.gov identifier: NCT03443661, 23/02/2018.

Objective:To analyze the recurrence pattern of rectal cancer patients with radical surgery after neoadjuvant chemoradiotherapy.Methods:The clinicopathological characteristics and follow-up information of rectal cancer patients with radical surgery after neoadjuvant chemoradiotherapy in the Cancer Hospital of the Chinese Academy of Medical Sciences from June 2004 to December 2017 were retrospectively collected. The recurrence pattern including the time and site was investigated.Results:The age of 537 patients was (55.5±11.7) years, of whom 361 were male (67.2%). The median follow-up time [ M( Q1, Q3)] was 77.9 (64.5, 95.6) months. Moreover, 30.7% (165/537) of patients had distant metastasis or local recurrence; 26.8% (144/537) of patients had distant metastasis; 5.6% (30/537) of patients had local recurrence; 1.7% (9/537) of patients had both distant metastasis and local recurrence. In all the recurrent patients, 23.6% (39/165) were in the first year after surgery, followed by 27.3% (45/165) in the second year, 17.0% (28/165) in the third year, and 15.8% (26/165) after five years. According to the risk curve drawn by the life table, the highest metastasis risk of patients occurred in the second year after surgery, and the metastasis risk peak occurred again after more than five years. The lung was the most common metastatic organ, accounting for 47.9% (69/144), followed by the liver (18.8%, 27/144). The ratios of the recurrent patients in each ypTNM stage were 9.5% (8/84), 12.0% (12/100), 26.5% (41/155), 52.5% (104/198), respectively. The proportion of recurrent patients in tumor regression grade (TRG) 1-2 and TRG 3-5 patients were 19.2% (38/198) and 37.5% (127/339), respectively. Conclusions:The recurrence pattern of patients undergoing radical surgery after neoadjuvant chemoradiotherapy is mainly distant metastasis. The lung is the primary metastatic organ. The risk of distant metastasis and local recurrence is high in the first three years after surgery, and there is still high risk of recurrence after five years. For patients with ypTNM stage 2, 3 and TRG3-5, the postoperative adjuvant chemotherapy and long-term follow-up should be strengthened.

Objective:To analyze the clinicopathological factors affecting long-term disease-free survival and the characteristics of local recurrence or distance metastasis of rectal cancer patients with complete pathological response after neoadjuvant chemoradiotherapy.Methods:The clinicopathological data and follow-up information of patients with a complete pathological response of rectal cancer after neoadjuvant chemoradiotherapy in the Cancer Hospital of Chinese Academy of Medical Sciences from June 2004 to December 2019 were retrospectively collected. The clinicopathological factors affecting the long-term disease-free survival of patients were analyzed to build a prediction model of local recurrence and distant metastasis and to evaluate the benefits of postoperative chemotherapy.Results:The age of 108 patients was(56.3±11.6) years, of which 68 were males (63.0%); The median follow-up time was 79.9 (61.8, 112.6) months. There were 12 patients (11.1%) who had a local recurrence or distant metastasis. The 5-year disease-free survival rate was 91.1% with 9 patients who experienced recurrence. Multivariate Cox proportional hazards regression analysis showed that the maximum diameter of the residual tumor or scar ( HR=8.41, 95% CI: 1.08-65.22, P=0.042) and the distance from the lower edge of the tumor to the anal margin before treatment ( HR=4.54, 95% CI: 1.23-16.81, P=0.023) were independent risk factors affecting the prognosis. The prognosis of patients was stratified based on relevant factors. The 5-year cumulative disease-free survival rate of those patients receiving postoperative standardized chemotherapy was 92.0%, while for patients who did not receive or complete standardized chemotherapy, the 5-year cumulative disease-free survival rate was 82.3%. Conclusions:The maximum diameter of the residual tumor or scar and the distance from the lower edge of the tumor to the anal margin before treatment were independent risk factors affecting the prognosis of patients with a complete pathological response. Patients with independent risk factors could benefit from the standardized postoperative chemotherapy.

Abstract Background The differential diagnosis of mucoepidermoid carcinoma (MEC) from neoplasm undergoing mucinous features brings more pitfalls to pathologists. Combining specific MAML2 gene rearrangement and histological characteristics may be the solution. Methods Twenty‐five tumors with mucinous components were selected for differential diagnosis of MEC. All the cases were detected for MAML2 gene rearrangement. The cases diagnosed as MEC were classified into four variants: classic, oncocytic, Warthin‐like, and nonclassified, and they were graded using the Brandwein system. The histological characteristics of non‐MECs were summarized for differential diagnosis. Univariate survival analysis was performed on MECs. Results There were 16 MECs; 62.5% were MAML2 rearranged. For the low‐, intermediate‐, and high‐grade MECs, the rate of rearrangement was 83.3%, 100%, and 28.6%, respectively. Both the oncocytic and Warthin‐like MECs were MAML2 rearranged. For the classic and nonclassified MECs without MAML2 rearrangement, non‐keratinized squamoid cells and distinctive mucinous cells were essential diagnostic criteria. On survival analysis, all the disease progression occurred in high‐grade MECs (p = 0.038). Nine cases were diagnosed as non‐MECs: pleomorphic adenoma with mucinous metaplasia showed no ex‐capsular involvement; metaplastic Warthin tumor appeared with overt keratinization and residual oncocytic bilayered epithelium; mix squamous cell and glandular papilloma showed an endobronchial papillary growing pattern; adenosquamous carcinoma was accompanied by squamous carcinoma in situ of the overlying mucosa. All the non‐MECs were negative for MAML2 rearrangement. Conclusion The application of combining MAML2 rearrangement and histological characteristics is helpful in the differential diagnosis between MEC and other tumors with mucinous components.

4031 Background: The optimal perioperative chemotherapy of locally advanced gastric or gastro-esophageal junction (G/GEJ) cancer has not been established in Asia, though FLOT was considered as standard therapy in Europe. Therefore, we aimed to assess efficacy and safety of DOS versus SOX as perioperative treatment in patients with locally advanced G/GEJ cancer in this study. Methods: This was a single center, open-label, randomized, phase 2 study. Eligible pts were aged ≥18 years with histologically diagnosed HER2 negative cT3-4 Nany M0 G/GEJ (Siewert II/III type) adenocarcinoma. Pts were randomized (1:1) to receive either 4 preoperative and 4 postoperative cycles of DOS (docetaxel 60mg/m2 D1, oxaliplatin 100mg/m2 D1, S-1 40-60mg bid D1-14 depending on body surface area (BSA), Q3W) or SOX (oxaliplatin 130mg/m2 D1, S-1 40-60mg bid D1-14 depending on BSA, Q3W). Pts underwent D2 gastrectomy after preoperative treatment. The primary endpoint was major pathological response (MPR) analyzed in the modified intention to treat (mITT) population according to Becker TRG criteria. Secondary endpoints included the 3-year progression free survival (PFS), the 3-year overall survival (OS), pathological complete response, R0 resection rate and safety. Results: From Aug, 2015, to Dec, 2019, 154 pts were enrolled, 7 pts withdrew consent, 147 pts were included as mITT population (DOS 71; SOX 76). 80.3% and 67.1% of the pts in the DOS and SOX groups accepted surgery respectively. More pts achieved MPR (25.4% vs. 11.8%, p = 0.035) and R0 resection (78.9% vs. 61.8%, p = 0.024) in the DOS group than the SOX group. With a median follow-up of 42.4 months, the 3-year PFS and the 3-year OS were 52.3% vs. 35% (p = 0.065, HR 0.667, 95%CI 0.432-1.029) and 57.5% vs. 49.2% (p = 0.114, HR 0.685, 95%CI 0.429-1.095) in the DOS and SOX groups, respectively. Pts who acquired MPR had a significant longer survival than non-MPR pts. The 3-year PFS were 89.4% vs. 38.6% (p < 0.001, HR 0.076, 95%CI 0.018-0.314). The 3-year OS were 100% vs. 50.1% (p = 0.008, HR 0.024, 95%CI 0.002-0.371). 56.1% and 60.8% of the pts completed at least 6 cycles of the perioperative chemotherapy in the DOS and SOX groups, respectively (p = 0.625). The most common grade ≥3 TRAEs included neutropenia (8.5% vs.10.5%), leucopenia (1.4% vs. 5.3%), thrombocytopenia (1.4% vs 15.8%, p = 0.002), anemia (1.4% vs. 3.9%) and diarrhea (1.4% vs. 2.6%). The incidence of grade 1-2 thrombocytopenia was also significant lower in the DOS group (15.5% vs. 31.6%, p = 0.022). No treatment-related deaths occurred. Conclusions: Perioperative DOS improved MPR significantly and tended to have better PFS compared with SOX in locally advanced G/GEJ cancer, might be regarded as a prefered option of perioperative chemotherapy. Clinical trial information: NCT02725424.

Objective:To investigate the clinicopathological characteristics and prognosis of rectal cancer patients with pathological complete response and near complete response after neoadjuvant therapy.Methods:The clinicopathological data of patients who underwent neoadjuvant chemoradiotherapy plus radical surgery of rectal cancer in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2004 to December 2016 were retrospectively collected. The clinicopathological characteristics and prognostic factor of patients with pathological complete response and near complete response were analyzed.Results:The clinical data of 142 patients were collected. There were 93 males and 49 females, aged from 24 to 81 years. The median disease-free survival was 53.9 months and the median overall survival was 55.0 months. Univariate analysis showed that the maximum diameter of scar or lesion, the status of lymph node metastasis and the distance between the lower edge of tumor and anal edge were associated with disease-free survival time; the maximum diameter of scar or lesion and the status of lymph node metastasis were associated with overall survival time. Multivariate Cox proportional hazards regression analysis showed that patients with scar or lesion diameter>3 cm ( HR=4.406,95% CI:1.619-12.006), positive lymph node metastasis status ( HR=4.102,95% CI:1.461-11.513) and tumor lower margin to anal margin distance ≤4 cm ( HR=18.171,95% CI:2.357-140.073) had shorter disease-free survival time.The patients with scar or lesion diameter>3 cm ( HR=8.573,95% CI:1.630-45.099) and lymph node metastasis status ( HR=4.721, 95% CI:1.068-20.860) had shorter overall survival time. Conclusions:The overall prognosis of patients with pathological complete response or near complete response after neoadjuvant therapy for rectal cancer is better. The distance between the lower margin of the tumor and the anal edge, the status of lymph node metastasis and the maximum diameter of scars or lesion were the related factors affecting the prognosis of patients with rectal cancer.

Objective: To investigate the clinical, cardiac imaging characteristics and prognosis of patients with primary cardiac angiosarcoma. Methods: The clinical data of 14 patients hospitalized with primary cardiac angiosarcoma from January 2001 to December 2017 in Peking Union Medical College Hospital were collected and analyzed. Metastatic cardiac angiosarcoma was not included in this study. Patients were followed up post discharge per telephone call or clinical visit. Results: Of the 14 patients, 8 were males and 6 were females, average age was 48 years. The main clinical symptoms were shortness of breath (8/14), hemoptysis (6/14), fever (5/14), chest pain (4/14) and cough (3/14). Imaging examinations showed that the tumors of 8 patients were located in the right heart and 6 in the pericardial cavity. Tumors in the right heart often infiltrate the atrial wall and cause pericardial effusion (7/8). Tumors in the pericardium were characterized by recurrent bloody pericardial effusion (6/6), prone to progressive constrictive pericarditis (3/6), pericardial fluid cytology was often negative (6/6). MRI showed heterogeneous high signal intensity (cauliflower aspect) on T2-weighted image and heterogeneous enhancement with asunray aspect at the perfusion study. At the time of diagnosis, 8 patients developed lung or adrenal metastasis (8/14). The median survival was only 305 days. Conclusions: Primary cardiac angiosarcoma is a rare disease with non-specific clinical manifestation and poor prognosis. Imaging examinations may help diagnosis. The high invasiveness and the easy-to-metastasis feature of the tumor contribute to the poor prognosis of cardiac angiosarcoma.

Background: Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis. Methods: In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed. Results: After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = -2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = -1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group. Conclusions: The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.

69Background: Chemoradiotherapy (CRT) remains the standard treatment choice for locally advanced rectal cancer (LARC). Neoadjuvant chemotherapy alone with doublet mFOLFOX6 (folinic acid, 5-fluorour...

Objective: To explore the risk factors for regional lymph node (RLN) metastasis in colorectal cancer patients with mismatch repair deficiency (dMMR). Methods: The data of 357 dMMR colorectal cancer patients who underwent surgery in National Cancer Center from January 2012 to December 2016 was retrospectively analyzed. Univariate and multivariate analysis were used to identify the risk factors for RLN metastasis. Results: Among the 357 patients, 204 were male and 153 were female, 61.6% (220/357) lesion located in right half colon, while the other 16.2% (58/357) located in rectum. Univariate analysis showed that tumor size, differentiation, lymphovascular invasion, tumor deposit, postoperative pathologic T stage (pT), the number of negative lymph nodes and the expression of the MSH6 protein were significantly associated with RLN metastasis (P<0.05). All of the patients with well differentiation tumors (15 patients) or staged pT1 (13 patients) had no RLN metastasis. Multivariate analysis showed that tumor differentiation (OR=2.582, 95%CI=1.567-4.274, P<0.001), pT (OR=3.778, 95%CI=1.448-12.960, P=0.015) and the expression of MSH6 protein (OR=2.188, 95%CI=1.159-4.401, P=0.021) were independent risk factors for RLN metastasis. Conclusions: The postoperative pT stage, tumor differentiation and the expression of MSH6 protein are independent risk factors for RLN metastasis of dMMR colorectal cancer. Preoperative assessment of these factors may further improve the accuracy of predicting the risk of RLN metastasis.

Objective: To explore the application value of the conditional disease-free survival (cDFS) analysis in predicting prognosis of stage-specific rectal cancer patients underwent neoadjuvant chemoradiotherapy (nCRT). Methods: Clinicopathologic data of 436 patients with rectal cancer received nCRT and radical operation in Cancer Hospital, Chinese Academy of Medical Sciences between January 2004 and December 2016 were retrospectively reviewed. With reference to conditional probability, the 3-year cDFS of patients at different ypTNM stage after completion of nCRT was estimated using the Kaplan-Meier method. Results: There were 66 patients of ypTNM stage 0 (pathological complete response), 87 patients of ypTNM stage Ⅰ, 135 patients of ypTNM stage Ⅱ and 148 patients of ypTNM stage Ⅲ. The 3-year accumulated DFS of patients with ypTNM stage 0, ypTNM stage Ⅰ, ypTNM stage Ⅱ, and ypTNM stage Ⅲ were 97.0%, 93.1%, 85.2%, and 64.2%, respectively. On the condition of postoperactive disease-free survival for 1 year, 2 years, 3 years, 4 years, and 5 years, the corresponding 3-year cDFS of patients at ypTNM stage 0 were 97.0%, 95.5%, 96.9%, 98.4%, 100.0%, respectively. The corresponding 3-year cDFS of patients at ypTNM Ⅲ were 68.2%, 79.3%, 86.3%, 92.1%, 96.4%, respectively. The more advanced ypTNM staging resulted in the more improvement of 3-year cDFS being acquired. Conclusion: cDFS is a better method to reflect the dynamic changes of the prognosis of rectal cancer patients with nCRT in different ypTNM stage, and it is useful to guide the clinicians to assess the prognosis and propose appropriate surveillance.

COVID-19给全球卫生健康事业和各国经济发展带来了重大挑战,为了有效遏制新冠肺炎疫情的蔓延,各地各学校纷纷停课,传统的学习模式受到了前所未有的挑战,各种线上教学模式的探索及应用确保了学生能够在特殊时期继续接受教育.同时,科室内以正处于住院医师规范化培训阶段的医学生等为代表的青年医师,纷纷展现出对疫情期间医疗工作的责任感及线上继续学习的迫切需求.

Background Neoadjuvant chemoradiotherapy (NCRT) results in fewer lymph nodes harvested and causes staging migration. Therefore, we compared the prognostic value of the logarithmic odds of positive lymph nodes (LODDS) with the lymph node ratio (LNR) and the American Joint Committee on Cancer (AJCC) ypN stage in patients with locally advanced rectal cancer (LARC) after NCRT. Methods A total of 445 patients with LARC who received NCRT and underwent radical surgery between January 2004 and December 2015 were recruited, and data from 4881 patients included in the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2013 were analyzed to verify our results. The time-dependent area under the receiver operating characteristic curve (TimeROC) was used to evaluate the discriminative ability of the different lymph node staging systems. Results ypN staging failed to satisfactorily stratify the patients treated with NCRT [the 3-year disease-free survival (DFS) rates were 65.7% and 55.4% for the ypN1 and ypN2 groups, respectively, P=0.252]. The LODDS classification was significantly associated with DFS, and the 3-year DFS rates for the LODDS0, LODDS1, and LODDS2 groups were 89.9%, 72.4%, and 53.9%, respectively (P<0.05 across all groups). Furthermore, the LODDS classification system was able to subclassify patients with ypN0 stage tumors regardless of whether ≥12 or <12 total lymph nodes (TLNs) were harvested. TimeROC analysis showed that the LODDS classification (AUC, median: 0.722, range: 0.692–0.754) had a higher accuracy for determining the prognosis than the ypN stage (AUC, median: 0.691, range: 0.684–0.712) or the LNR (AUC, median: 0.703, range: 0.685–0.730) classification, regardless of lymph node status. These results were verified using the SEER database. Conclusions The LODDS was a better prognostic factor for DFS than ypN staging or the LNR-based approach in patients with LARC after NCRT, particularly those with <12 TLNs harvested or ypN0 stage disease.