Hepatocellular carcinoma (HCC) was characterized by a highly complex genome, with structural variations (SVs) playing a significant role in its development. In this study, we employed Oxford Nanopore Technology long-read sequencing in paired tumor and adjacent normal liver tissues from 74 Chinese HCC patients to thoroughly characterize the landscape of somatic SVs. Our analysis revealed that somatic SVs were more prevalent in hepatitis B virus (HBV)-related HCC, with chromosome 1 emerging as a major hotspot, and several members of the chromosome 1 open reading frame (C1orf) family genes expression level exhibited significant age-related difference. Notably, HBV-related HCC cases exhibited a higher frequency of deletions, particularly among younger ones (≤ 35 years old). In addition, we observed an increased burden of HBV integration events in younger ones. Remarkably, the divergent-paired related homeobox ( DPRX ) loci was identified as a novel gene for HBV integration in younger patients. Together, these findings delineated the somatic SV landscape in HCC and underscored age-associated HBV-related genomic alterations as key pathological features of hepatocarcinogenesis.

539 Background: Transarterial chemoembolization (TACE) and systemic therapy are widely used treatments for advanced hepatocellular carcinoma (HCC). Although clinical studies have shown benefit from combining TACE with systemic therapy, the optimal sequencing and timing remain uncertain. Methods: This real-world retrospective cohort study used the National Cancer Database (2004–2022) to identify advanced HCC (AJCC stage III-IV) patients who received both TACE and systemic therapy. A pre-specified protocol was developed and reviewed before implementation; IRB approval was not required as data were de-identified. Based on treatment sequence, patients were categorized as TACE-first, systemic-first, or simultaneous (TACE and systemic therapy initiated within 3 days). The primary endpoint was overall survival (OS). Missing data were handled by case-wise deletion. Inverse probability of treatment weighting (IPTW) was applied using baseline covariates, and weighted Kaplan-Meier and Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analyses by AJCC stage and inter-treatment spacing were performed. Among patients who received systemic therapy first, three subgroups were defined according to the interval between systemic initiation and TACE (0-3 days, 4-14 days, and 15-90 days), reflecting the immune response window after systemic therapy. Results: A total of 1,403 patients were included (916 [65.3%] TACE-first, 202 [14.4%] systemic-first, 285 [20.3%] simultaneous). In the overall cohort, systemic-first sequencing significantly improved OS compared with both TACE-first (HR=1.21, 95% CI 1.01-1.46) and simultaneous (HR=1.27, 95% CI 1.03-1.58), while TACE-first and simultaneous group showed no significant difference. Subgroup analyses by stage showed that among stage III patients, systemic-first was superior to TACE-first (HR=0.79, 95% CI 0.69-0.91) but not significantly different from simultaneous (HR=0.88, 95% CI 0.70-1.11). Among stage IV patients, systemic-first was associated with significantly longer OS than both TACE-first (HR=0.78, 95% CI 0.68-0.90) and simultaneous treatment (HR=0.69, 95% CI 0.56-0.85). Among systemic-first patients, those receiving TACE within 4–14 days achieved the best outcomes, with significantly longer survival compared with both the 0–3 day group (HR=0.62, 95% CI 0.50–0.77) and the 15–90 day group (HR=0.63, 95% CI 0.46–0.87). Conclusions: This study suggests that for patients with advanced HCC, initiating systemic therapy first followed by TACE represents the most favorable sequencing strategy, with the greatest benefit observed when TACE is administered within 4-14 days. Further validation of these findings in larger or prospective studies is warranted.

Objective To investigate the efficacy and safety of Sintilimab combined with SOX regimen in the treatment of patients with advanced gastric cancer.Methods The clinical data of patients with advanced gastric cancer in Wuxi Branch,Ruijin Hospital,Shanghai Jiaotong University School of Medicine from January 2020 to January 2024 were retrospectively collected.According to the treatment methods,the patients were divided into two groups.The treatment group was treated with Sintilimab combined with SOX regimen,while the control group was treated with SOX regimen alone.The objective response rate(ORR),median progressionfree survival(PFS),median overall survival(OS),incidence of adverse reactions and quality of life were compared between the two groups.Results A total of 115 patients with advanced gastric cancer were included,52 in the treatment group and 63 in the control group.The ORR of the treatment group was significantly higher than that of the control group(59.62％vs.38.10％,P<0.05).Stratified analysis showed that in patients with PD-L1 CPS≥5,the ORR of treatment group was significantly higher than that of control group(73.91％vs.37.50％,P<0.05).The median follow-up time was 37.0 months.Survival analysis showed that the median PFS(9.3 months vs.8.1 months)and the median OS(16.0 months vs.12.8 months)in the treatment group were significantly better than those in the control group(P<0.05).In patients with PD-L1 CPS≥5,the median PFS(10.2 months vs.7.0 months)and median OS(17.2 months vs.11.0 months)in the treatment group were more obvious than those in the control group(P<0.05).The improvement rate of quality of life in the treatment group was significantly higher than that in the control group(51.92％,vs.23.81％,P<0.05).There was no statistical difference in the incidence of grade Ⅲ～Ⅳ side effects between the two groups(P>0.05).Conclusion In patients with advanced gastric cancer,the Sintilimab combined with the SOX regimen has higher clinical efficacy,significantly prolonging the PFS and OS of patients,improving prognosis,and enhancing quality of life.However,adverse effects have not increased significantly.

BACKGROUND:Accurate diagnosis and staging are crucial for the management of patients with hepatobiliary malignancies. Here, we investigated the efficacy of Al 18 F-NOTA-FAPI-74 PET/CT in detecting hepatobiliary malignancies and compared the results with 18 F-FDG PET/CT. PATIENTS AND METHODS:Participants with hepatobiliary malignancies were prospectively enrolled and underwent paired Al 18 F-NOTA-FAPI-74 and 18 F-FDG PET/CT from April 2023 to March 2024. Histopathology and/or follow-up imaging served as the reference standard. The SUVmax of the primary and metastatic lesions between Al 18 F-NOTA-FAPI-74 and 18 F-FDG PET/CT were compared using the Wilcoxon signed-rank test. The association between Al 18 F-NOTA-FAPI-74 uptake intensity and immunohistochemical FAP expression was analyzed with Spearman r correlation. RESULTS:Our cohort comprised of 28 patients with hepatobiliary malignancies, including 12 with hepatocellular carcinoma, 13 with intrahepatic cholangiocarcinoma (ICC), 2 with perihilar cholangiocarcinoma, and 1 with gallbladder carcinoma. Of these 28 patients, 13 underwent PET/CT for initial staging and 15 for restaging. Al 18 F-NOTA-FAPI-74 PET/CT showed higher sensitivity than 18 F-FDG PET/CT for detecting primary tumors [100% (13/13) vs 92.3% (12/13)], lymph node metastases [79.2% (42/53) vs 54.7% (29/53)], and bone and visceral metastases [97.6% (164/168) vs 69.0% (116/168)]. Al 18 F-NOTA-FAPI-74 PET/CT findings led to upstaging or restaging in 6 of 28 patients compared with the 18 F-FDG PET/CT-based stage. In addition, Al 18 F-NOTA-FAPI-74 PET/CT detected tumor-related obstructive inflammation in 7 patients, while 18 F-FDG PET/CT detected it in only 1 patient (25% vs 3.6%). All these 7 patients suffered from cholangiocarcinomas, including 5 with ICC and 2 with perihilar cholangiocarcinomas. The SUVmax of obstructive inflammation on Al 18 F-NOTA-FAPI-74 PET/CT was significantly lower than that of tumor (median SUVmax, 4.0 vs 8.8; P = 0.008). A positive correlation was found between FAPI uptake and FAP expression ( r = 0.730, P = 0.04). CONCLUSIONS:In patients with hepatobiliary malignancies, Al 18 F-NOTA-FAPI-74 PET/CT outperformed 18 F-FDG PET/CT in detecting primary tumors and metastatic lesions, resulting in more accurate staging or restaging. In addition, Al 18 F-NOTA-FAPI-74 PET/CT showed good detection efficacy for tumor-related obstructive inflammation, which was only found in cholangiocarcinoma, thus rendering Al 18 F-NOTA-FAPI-74 the potential to differentiate ICC from hepatocellular carcinoma.

To predict tertiary lymphoid structures (TLSs) in gallbladder cancer (GBC) using preoperative magnetic resonance imaging (MRI)-based radiomics. Patients with GBC from two centres served as training (n = 129) and external validation (n = 44) cohorts. Radiomics features were extracted from six imaging sequences for inclusion in a radiomics model (Rad-score). Univariate and multivariate logistic regression were used to identify independent clinico-radiological predictors of TLS status. The clinical and radiomics models were integrated into a combined model. Areas under receiver operating characteristic curves (AUC) were used to assess model performance. The combined model was divided into low- and high-risk according to the cut-off value determined by the maximum Youden index of the ROC. Intratumoural TLSs independently predicted RFS (p = 0.046). Eight features were included in the Rad-score. The clinical model included three independent predictors of TLS status (tumour height, liver invasion, and arterial-phase hypo-enhancement). In the training cohort, the combined model outperformed the separate clinical and radiomics models (AUC, 0.891 vs 0.870 and 0.775, respectively) and was externally valid. In both training and external cohorts, RFS in the low-risk group was substantially higher compared to the high-risk group. The low-risk group in the immunotherapy cohort had a significantly higher median overall survival than the high-risk group. The MRI-based combined model developed in this study can preoperatively predict intratumoural TLS status. It accurately stratified the RFS of patients after surgery and the OS of patients with immunotherapy. This combined model is useful for predicting response and prognosis, not only for the recurrence-free survival of patients with GBC who have undergone surgery, but also for the overall survival of patients who have received immunotherapy

Radiolabeled somatostatin receptor (SSTR) analogues are widely utilized for both imaging (PET or scintigraphy) and peptide receptor radionuclide therapy (PRRT) in the management of neuroendocrine neoplasms (NENs). These approaches have been extensively validated in low- to intermediate-grade gastroenteropancreatic neuroendocrine tumors (NET G1 - G2). However, data on the use of SSTR imaging - particularly SSTR PET imaging - in patients with high-grade NETs (G3) and neuroendocrine carcinomas (NECs) remain limited. This study aimed to evaluate the diagnostic performance of ¹⁸F-AlF-NOTA-octreotide (¹⁸F-AlF-OC) PET/CT in patients with high-grade NENs and assess its complementarity with ¹⁸F-FDG PET/CT. Out of 426 patients who underwent ¹⁸F-AlF-OC PET/CT between January 2023 and October 2024, 42 patients with histologically confirmed high-grade NENs (28 with G3 NETs and 14 with NECs) were retrospectively analyzed. 36 patients also underwent 18F-FDG PET/CT. Lesions were classified as positive on PET/CT if their uptake exceeded organ background activity and could not be explained by physiologic biodistribution. Tumor uptake higher than normal liver was considered high uptake. On a per-patient basis, ¹⁸F-AlF-OC PET/CT was positive in 39 of 42 patients, yielding a detection rate of 92.9

Background: Accurate diagnosis and staging are crucial for the management of patients with hepatobiliary malignancies. Here, we investigated the efficacy of Al 18 F-NOTA-FAPI-74 PET/CT in detecting hepatobiliary malignancies and compared the results with 18 F-FDG PET/CT. Patients and Methods: Participants with hepatobiliary malignancies were prospectively enrolled and underwent paired Al 18 F-NOTA-FAPI-74 and 18 F-FDG PET/CT from April 2023 to March 2024. Histopathology and/or follow-up imaging served as the reference standard. The SUVmax of the primary and metastatic lesions between Al 18 F-NOTA-FAPI-74 and 18 F-FDG PET/CT were compared using the Wilcoxon signed-rank test. The association between Al 18 F-NOTA-FAPI-74 uptake intensity and immunohistochemical FAP expression was analyzed with Spearman r correlation. Results: Our cohort comprised of 28 patients with hepatobiliary malignancies, including 12 with hepatocellular carcinoma, 13 with intrahepatic cholangiocarcinoma (ICC), 2 with perihilar cholangiocarcinoma, and 1 with gallbladder carcinoma. Of these 28 patients, 13 underwent PET/CT for initial staging and 15 for restaging. Al 18 F-NOTA-FAPI-74 PET/CT showed higher sensitivity than 18 F-FDG PET/CT for detecting primary tumors [100% (13/13) vs 92.3% (12/13)], lymph node metastases [79.2% (42/53) vs 54.7% (29/53)], and bone and visceral metastases [97.6% (164/168) vs 69.0% (116/168)]. Al 18 F-NOTA-FAPI-74 PET/CT findings led to upstaging or restaging in 6 of 28 patients compared with the 18 F-FDG PET/CT-based stage. In addition, Al 18 F-NOTA-FAPI-74 PET/CT detected tumor-related obstructive inflammation in 7 patients, while 18 F-FDG PET/CT detected it in only 1 patient (25% vs 3.6%). All these 7 patients suffered from cholangiocarcinomas, including 5 with ICC and 2 with perihilar cholangiocarcinomas. The SUVmax of obstructive inflammation on Al 18 F-NOTA-FAPI-74 PET/CT was significantly lower than that of tumor (median SUVmax, 4.0 vs 8.8; P = 0.008). A positive correlation was found between FAPI uptake and FAP expression ( r = 0.730, P = 0.04). Conclusions: In patients with hepatobiliary malignancies, Al 18 F-NOTA-FAPI-74 PET/CT outperformed 18 F-FDG PET/CT in detecting primary tumors and metastatic lesions, resulting in more accurate staging or restaging. In addition, Al 18 F-NOTA-FAPI-74 PET/CT showed good detection efficacy for tumor-related obstructive inflammation, which was only found in cholangiocarcinoma, thus rendering Al 18 F-NOTA-FAPI-74 the potential to differentiate ICC from hepatocellular carcinoma.

Microvascular invasion (MVI) critically portends early recurrence and poor survival in intra-hepatic cholangiocarcinoma (ICC) but is ascertainable only after resection. An accurate pre-operative predictor of MVI would aid surgical planning in everyday practice. To develop and internally validate a blood-based model that integrates serum tumor markers with inflammatory and liver-function indices for pre-operative estimation of MVI in ICC. This single-center, retrospective, non-interventional cohort included consecutive adults who underwent curative-intent hepatectomy for pathologically proven ICC and completed 3-year follow-up between January 2019 and December 2024. Of 602 patients screened, 450 met eligibility criteria after excluding cases with mixed histology, neoadjuvant therapy, macro-vascular invasion, or missing key data. Pre-operative variables (drawn ≤ 14 days before surgery) comprised CA19-9, CEA, AFP, CA-125, neutrophil-to-lymphocyte ratio (NLR), γ-glutamyl-transferase (γ-GT), albumin, maximum tumor diameter, and lesion multiplicity. Predictors were selected by LASSO, and a shrinkage-adjusted logistic model was internally validated with 1,000-bootstrap resamples. Performance was benchmarked against a tumor-marker-only model and evaluated for clinical utility using decision-curve analysis (DCA). Associations between model-predicted risk, early recurrence (≤ 12 months), and overall survival were explored with Cox regression. Among 450 eligible patients (median age 58 y; 64.2

To address the critical challenge of bidirectional dependency modeling in air traffic control (ATC) communications – a gap identified in state-of-the-art joint extraction models like CII – this study proposes CII-BERT, an enhanced framework integrating BERT’s contextual representation with task-specific DNN layers. Motivated by the need to reduce aviation risks caused by instruction misinterpretation, we define “flight safety” through two quantifiable metrics: conflict probability reduction and instruction error rate. Our approach uniquely employs continuous pre-training with domain-adapted augmentation strategies (synonym substitution and random block exchange), enabling robust learning of ATC-specific syntax and terminologies. Evaluated on a diverse control directive dataset (6,000 + samples across 7 operational scenarios), CII-BERT achieves 99.44

Rationale and Objectives The purpose of this study was to demonstrate the impact of postoperative adjuvant transarterial chemoembolization (TACE) on the prognosis of patients with macrotrabecular-massive hepatocellular carcinoma (MTM-HCC). Materials and Methods This retrospective study used the clinical records of patients with resected MTM-HCC with/without adjuvant TACE at three centers between January 2015 and December 2022. The primary end point was recurrence free survival (RFS). The secondary end points were overall survival (OS) and safety. Results A total of 559 eligible patients were classified into the adjuvant TACE group and the observation group. After propensity score matching analysis, both RFS (HR 0.62 [95% CI, 0.48 to 0.80]; P < 0.001) and OS (HR 0.59 [95% CI, 0.42 to 0.84]; P = 0.013) in the adjuvant TACE group were significantly better than the observation group. By Cox regression models, mALBI grade, types of hepatectomy, number, satellite lesion, without adjuvant TACE were identified as independent risk factors for RFS, and mALBI grade, number, maximum tumor size, satellite lesion, microvascular invasion, high AFP level, without adjuvant TACE were identified as independent risk factors for OS. The incidence of surgery-related adverse events (AEs) had no significant difference between the two groups (P = 0.609). The majority of AEs associated with adjuvant TACE were grade I (84.4%), and no treatment-related deaths occurred in either group. Conclusions Adjuvant TACE significantly improved the RFS and OS of patients with resected MTM-HCC with acceptable toxicity.

The liver is the most common metastatic organ of neuroendocrine tumors (NETs). NET liver metastases (NETLMs) are categorized into simple liver metastasis (type I), complex liver metastasis (type II) and diffuse liver metastasis (type III), of which diffuse liver metastasis accounts for the highest percentage, up to 60-70%. Radical resection is recommended for all patients with type I and partial type II liver metastases without extrahepatic metastases in G1 and G2 grades, with a 5-year survival rate of 65%-70%. But for patients with G3 or type III liver metastases, treatment is controversial. Ablation and TAE/TACE are commonly used localized treatments. Somatostatin analogue (octreotide and lanreotide) are efficacious in the treatment of better-differentiated NETs and can prolong the progression-free survival (PFS) of patients. Targeted drugs such as sunitinib, everolimus, sofantinib and cabozantinib are used to control tumor growth and improve symptoms. In addition, peptide receptor radionuclide therapy (PRRT), has been approved by the FDA for the treatment of progressive somatostatin receptor-positive gastroenteropancreatic NETs and has shown potential for prolonging PFS and improving survival. Multidisciplinary treatment is crucial for patients with NETLMs with high tumor load, and neoadjuvant therapy combined with surgery may lead to a better prognosis. However, the choice of treatment, indications for combination therapy, and disease prognosis still require further research and exploration. This review summarizes and evaluates the current treatment strategies and development trend of NETLM treatment through a literature review and provides new ideas as well as insights.

Background and aims: there is limited information on combination of hepatic arterial infusion chemotherapy (HAIC) and systemic therapy for advanced hepatocellular carcinoma (Ad-HCC). We aim to compare the efficacy and safety of HAIC plus camrelizumab (a PD-1 inhibitor) and apatinib (an VEGFR-2 inhibitor) versus camrelizumab and apatinib for Ad-HCC. Methods From April 2019 to October 2022, 416 patients with Ad-HCC received either HAIC plus camrelizumab and apatinib (TRIPLET protocol, n = 207) or camrelizumab and apatinib (C-A protocol, n = 209) were reviewed retrospectively. The propensity score matching (PSM) was used to reduce selective bias. Overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan–Meier method with the log-rank test. Cox regression analyses of independent prognostic factors were evaluated. Results After PSM 1:1, 109 patients were assigned to two groups. The median OS of not reached in the TRIPLET group was significantly longer than that of 19.9 months in the C–A group (P < 0.001), while in the TRIPLET group, the median PFS of 11.5 months was significantly longer than that of 9.6 months in the C–A group (P < 0.001). Multivariate analyses showed that the factors ‎significantly affected the OS were‎ CTP grade, tumor number > 3, and TRIPLET treatment (P < 0.001). Grade 3/4 adverse events occurred at a rate of 82.1% vs. 71.3% in TRIPLET and C-A groups, respectively. Conclusion The TRIPLET protocol has promising survival benefits in the management of patients with Ad-HCC, with acceptable safety.

Objective: This study aimed to compare the clinical efficacy of laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) in treating solitary hepatocellular carcinoma (HCC) of the hepatic caudate lobe. Methods: Patients with hepatic caudate lobe HCC who underwent LLR or RFA at three hospitals in China between February 2015 and February 2021 were included. In total, 112 patients met the inclusion criteria, of whom 52 underwent RFA and 60 underwent LLR. The outcomes of the two groups were compared and analyzed using propensity score matching (PSM) method. Results: There were no significant differences between the two groups in terms of sex, HBV/HCV positivity, AFP positivity (>100 ng/mL), tumor position, Child-Pugh score, or preoperative liver function tests (ALT, AST, TBIL, ALB, and PT) (p > 0.05). Compared to the LLR group, the RFA group had a shorter operation time, less intraoperative bleeding, and shorter postoperative hospital stay (p < 0.05). There was no statistically significant difference in overall postoperative complications between the two groups (p > 0.05). Despite the larger tumor size, the LLR group had better postoperative recurrence-free survival (RFS) (p = 0.00027) and overall survival (OS) (p = 0.0023) than the RFA group. After one-to-one PSM, 31 LLR patients and 31 RFA patients were selected for further analyses. The advantages of LLR over RFA were observed in terms of RFS (p < 0.0001) and OS (p = 0.00029). Conclusion: LLR should probably be recommended as the preferred method for solitary caudate lobe HCC.

Purpose To evaluate the efficacy and safety of mFOLFOX-based hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT)Methods This retrospective study included patients who received mFOLFOX-based HAIC combined with TKIs and ICIs from January 2021 to January 2023. The primary outcome was the objective response rate of PVTT response, and the secondary outcomes were 6-month, 1-year survival rate, overall survival (OS), and corresponding adverse events and complications were also evaluated. PVTT responses were assessed using ITK-SNAP software.Results A total of 37 patients were included in the analysis, 18.92% achieved a complete response and 56.76% achieved a partial response in PVTT response. The objective response rate (ORR) of PVTT was 75.68%. The 6-month survival rate was 89%, the 1-year survival rate was 66%, and the median OS was 15.8 months. In univariate analysis, Child-Pugh score (P=0.010) was important factor for predicting OS; in multivariate analysis, Child-Pugh score (P=0.015, HR= 3.089, 95%CI: 1.250-7.633) was the important factor for predicting OS. In terms of adverse reactions, the most common adverse reactions associated with HAIC are pain and thrombocytopenia associated with oxaliplatin.Conclusion FOLFOX-based HAIC combined with TKIs and ICIs induced an objective response rate of 75.68% in PVTT.Clinical signicance FOLFOX-based HAIC combined with TKIs and ICIs provides more treatment options for PVTT.

Background: Rectal neuroendocrine neoplasms are relatively rare. Patients with rectal neuroendocrine neoplasms undergoing radical surgery have a higher rate of lymph node metastases. Robust evidence on the status of lateral pelvic lymph node metastases and the role of lateral pelvic lymph node dissection in those patients is lacking. This case-series study aimed to explore and address these issues. Methods: This single-center, prospective case series consecutively enrolled patients with biopsy-proven rectal neuroendocrine neoplasms in a tertiary referral hospital between June 2022 and January 2024. All eligible patients underwent laparoscopic total mesorectal excision surgery and bilateral lateral pelvic lymph node dissection under general anesthesia. The clinicopathologic features, surgical outcomes, and postoperative complications were presented. The last follow-up was conducted in March 2024. Results: A total of 11 patients with rectal neuroendocrine neoplasms- 3 female and 8 male- were enrolled. The average age was 60.0 years (range, 53.5-65.5- 65.5 years), and the median tumor size was 2.0 cm (range, 1.6-2.5- 2.5 cm). Tumors invaded the muscularis propria in 7 patients. There were 3 cases of neuroendocrine tumor G1, 6 cases of neuroendocrine tumor G2, and 2 cases of neuroendocrine carcinoma. Among these patients, 11 (10 0.0%) had lymph node metastases, and 6 (54.5%) had lateral pelvic lymph node metastases. In addition, in 2 patients, only lateral pelvic lymph node metastases were observed, without involvement of the mesenteric lymph nodes. Five patients had tumors located on the left wall of the rectum, and only left-sided lateral pelvic lymph node metastases were observed. The other patient had both sides of lateral pelvic lymph node metastases due to circumferential growth of the tumor around the rectum. Anal preservation was achieved in all patients. The median operating time was 235.0 minutes (range, 210.5-335.5- 335.5 minutes), and the median estimated blood loss was 50.0 mL (range, 45.0-75.0- 75.0 mL). Two patients experienced postoperative dysuria and recovered spontaneously within 2-4- 4 months after surgery. Conclusion: On the basis of a prospective case series, we demonstrate, for the first time, the lateral pelvic lymph node metastasis status in patients with rectal neuroendocrine neoplasms requiring radical total mesorectal excision surgery. Simultaneous bilateral lateral pelvic lymph node dissection may be a feasible and beneficial procedure for preventing local recurrence in these patients due to the lack of definitive neoadjuvant or adjuvant therapy options. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

To investigate MR features associated with prognosis of unresectable HCC receiving immunotherapy and establish a MR feature-based scoring system to predict efficacy of immunotherapy. This retrospective study included patients with unresectable HCC who received immunotherapy at 2 hospitals between August 2018 and February 2022. The last follow-up was October 2022. Clinical variables and MR features were assessed using univariate and multivariate Cox regression analyses. A new scoring system was constructed based on independent risk factors and the CRAFITY score consisting of AFP (≥ 100 ng/ml) and CRP (≥ 1 mg/dl). And the predictive performance of CRAFITY core and new score were compared by receiver-operating-characteristics curves (ROCs), area under ROCs (AUCs), and calibration curves. A total of 166 patients (55.6 ± 10.4 years) were included in training cohort and 77 patients (55.4 ± 10.7 years) were included in validation cohort. There were significant differences in BCLC stage, max size, macrovascular invasion, intratumoral artery, and enhancing capsule between the 2 groups. Based on independent risk factors (gross GRowtH type, intratumoral fAt, enhancing tumor caPsule, Sex and CRAFITY score), a novel efficacy predictive tool named the GRAPHS-CRAFITY score was developed to predict OS. The OS was significantly different among the 3 groups according to GRAPHS-CRAFITY score (p value < 0.001). The GRAPHS-CRAFITY score could predict tumor response and disease control (p value < 0.001, p value < 0.001). The GRAPHS-CRAFITY score is a reliable and easily applicable tool to predict the efficacy of unresectable HCC receiving immunotherapy.

Purpose:The impact of visceral adiposity on overall survival (OS) in hepatocellular carcinoma (HCC) receiving immunotherapy was unclear. We aimed to determine how visceral adiposity affected OS and explore the interrelationships between visceral adiposity, body mass index (BMI), and other body compositions. Patients and Methods:Data from three centers were retrospectively analyzed. Skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI), and subcutaneous adipose tissue index (SATI) were used to define each body composition. The BMI subgroups included the underweight, the normal weight, and the obesity. The Log rank test compared survival curves calculated by the Kaplan-Meier method. The relationships between body compositions and BMI with OS were examined using Cox proportional risk regression models. Results:A total of 305 patients who met the criteria were included. Patients with low VATI had significantly worse OS (P = 0.001). The protections of VATI (P = 0.011) on OS were independent of covariates. However, after additional adjustment of SMI, the effect of VATI on OS disappeared (P = 0.146), but the effect of SMD on OS did not (P = 0.021). BMI has a significant U-shaped relationship with OS, and the effect of BMI on OS equally disappeared after additional adjustment by SMI. Conclusion:This study first demonstrated that high VATI and mid-level BMI were protective for the survival of patients with HCC receiving immunotherapy. Skeletal muscle status (including SMI and SMD) may be the better predictor for outcomes of patients with HCC receiving immunotherapy.

Under the background of green development theory and high-quality development, it is of great significance to promote enterprises to practice ESG development concept. By combing the relevant literature, this paper finds that foreign scholars have studied ESG earlier than domestic scholars, and the research results are also more. Current studies on ESG performance and enterprise value mainly focus on the impact of environment, social responsibility and corporate governance on enterprise value. Few studies focus on the overall impact of ESG performance on enterprise value, and scholars have not reached a consensus on the impact of ESG performance on enterprise value. Some scholars put forward that ESG is positively correlated with enterprise value, some scholars believe that there is no significant relationship between ESG components and enterprise value, and some scholars believe that ESG is not correlated with enterprise value. The differences in the results may be due to differences in how ESG performance is measured, or it may be due to the different countries and stages of development of the companies studied. Most foreign studies are based on enterprises in developed markets, and there is relatively little research on enterprises in emerging markets like China. In addition, few studies have addressed the transmission mechanism of the role of ESG performance and firm value, let alone considered the mediating role of executive background. Therefore, this paper studies the relationship between ESG performance and firm value of listed companies under the background of China's market economy. Secondly, it introduces the background of senior executives to explore whether the background of senior executives plays a certain role in the relationship between the two.