Pathological Stage Research Articles

Survival Outcomes of Neoadjuvant Therapy Followed by Sleeve Lobectomy in Non-Small Cell Lung Cancer

This study was carried out to evaluate the impact of neoadjuvant therapy on long-term survival in non-small cell lung cancer (NSCLC) patients undergoing sleeve lobectomy. A total of 613 patients were retrospectively analyzed, including 124 who received neoadjuvant therapy. A 1:2 Propensity score matching (PSM) method was adopted to create a balanced cohort including 110 with neoadjuvant therapy and 169 without neoadjuvant therapy. Survival was estimated using the Kaplan-Meier method and compared using the Log-rank test and Cox proportional hazards models. Neoadjuvant therapy was associated with improved 3-year DFS (73.6% vs. 54.4%, P<0.001) and OS (80.9% vs. 63.9%, P=0.002) compared to patients without neoadjuvant therapy. Moreover, neoadjuvant chemoimmunotherapy significantly improved 3-year DFS (85.3% vs. 54.4%, P=0.001) and OS (88.2% vs. 63.9%, P=0.006), whereas chemotherapy alone did not show a significant effect. Multivariable Cox regression analysis revealed that neoadjuvant therapy was an independent predictor of improved DFS and OS while pathological N2 stage was independently associated with poorer DFS and OS. Furthermore, subgroup analysis in the neoadjuvant arm revealed that pathological N2 stage was an independent risk factor for DFS (HR, 3.830; 95% CI, 1.687-8.694; P=0.001), and achieving major pathologic response (MPR) was an independent predictor for better OS (HR, 0.120; 95% CI, 0.015-0.933; P=0.043). Neoadjuvant therapy prior to sleeve lobectomy significantly increased DFS and OS in locally advanced NSCLC. Sleeve lobectomy is advisable followed by neoadjuvant therapy, especially with chemoimmunotherapy.

Ketogenic β-hydroxybutyrate regulates β-hydroxybutyrylation of TCA cycle-associated enzymes and attenuates disease-associated pathologies in Alzheimer's mice.

Lysine β-hydroxybutyrylation (Kbhb) is a post-translational modification that has recently been found to regulate protein functions. However, whether and how protein Kbhb modification participates in Alzheimer's disease (AD) remains unknown. Herein, we carried out 4D label-free β-hydroxybutylation quantitative proteomics using brain samples of 8-month-old and 2-month-old APP/PS1 AD model mice and wild-type (WT) controls. We identified a series of tricarboxylic acid (TCA) cycle-associated enzymes including citrate synthase (CS) and succinate-CoA ligase subunit alpha (SUCLG1), whose Kbhb modifications were decreased in APP/PS1 mice at pathological stages. Sodium β-hydroxybutyrate (Na-β-OHB) treatment markedly increased Kbhb modifications of CS and SUCLG1 and their enzymatic activities, leading to elevated ATP production. We further found that Kbhb modifications at lysine 393 site in CS and at lysine 81 site in SUCLG1 were crucial for their enzymatic activities. Finally, we found that β-OHB levels were decreased in the brain of APP/PS1 mice at pathological stages. While ketogenic diet not only significantly increased β-OHB levels, Kbhb modifications and enzymatic activities of CS and SUCLG1, and ATP production, but also dramatically attenuated β-amyloid plaque pathologies and microgliosis in APP/PS1 mice. Together, our findings indicate the importance of protein Kbhb modification for maintaining normal TCA cycle and ATP production and provide a novel molecular mechanism underlying the beneficial effects of ketogenic diet on energy metabolism and AD intervention.

Association between preoperative advanced lung cancer inflammation index and recurrence of hepatocellular carcinoma after curative resection.

The association between the advanced lung cancer inflammation index (ALI) and the recurrence of hepatocellular carcinoma (HCC) in patients treated with curative resection and its predictive value remains unclear. To assess the association between preoperative ALI and the recurrence of HCC in patients treated with surgical resection. This retrospective study analyzed patients with HCC treated with surgical resection at The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University (Huai'an, China) from 2019 to 2021. The advanced lung cancer inflammation index was calculated as (BMI × ALB/NLR), where BMI = body mass index, ALB = serum albumin and NLR = neutrophil-lymphocyte ratio. Univariate and multivariable Cox proportional risk models were performed to evaluate the association between the ALI and recurrence of HCC patients treated with surgical resection. Subgroup analyses were conducted based on age, sex, performance status (PS), cirrhosis, pathological staging, tumor grading, tumor size, and number of tumors. Among the 295 HCC patients treated with surgical resection, 180 patients (61.02%) had recurrences, with the mean follow-up being 462 (187, 730) days. Patients with higher ALI scores were significantly less likely to have a recurrence of HCC after surgical resection (hazard ratio (HR): 0.59, 95% confidence interval (95% CI): 0.42-0.83, p = 0.003). Based on subgroup analyses, HCC patients undergoing surgical resection with higher ALI scores were associated with recurrence in those ≥60 years of age, with tumors ≥5 cm, and in patients with single tumors and ≥2 tumors. This study confirms the association between ALI and the reduced risk of recurrence in HCC patients treated with surgical resection.

P2.05C.01 Pathologic Nodal Staging Reporting Quality: A Multi-Center Assessment of NSCLC Trends Over Time & Key Reporting Parameters

P2.05C.01 Pathologic Nodal Staging Reporting Quality: A Multi-Center Assessment of NSCLC Trends Over Time & Key Reporting Parameters

CT Imaging as a Single Modality for Clinical Staging of Gastric Cancer in Limited Resource Centers: A Retrospective Pilot Study.

Gastric cancer disproportionately impacts populations in resource-limited settings. Within a safety-net network, we assessed the utility of computed tomography (CT) as a single staging modality. We utilized a clinical database of gastric cancer patients treated within the Los Angeles County safety-net hospital system from 2016 to 2023 in conjunction with retrospective imaging review by certified radiologists. We assessed agreement between clinical and pathological staging for patients who underwent curative gastrectomy using the Kappa coefficient. Of 107 patients with available CT imaging, 43.9% (n = 47) were staged with CT as a single modality. Most tumors displayed infiltrating (75%) or diffuse (28%) morphology, 41% displayed adequate gastric distention and regional lymphadenopathy was common (68%). Twenty-nine patients underwent curative gastrectomy. Overall agreement was minimal (κ = 0.29, 95% CI [0.071-0.51], p = 0.022), weak for T3/T4 tumors (κ = 0.50, 95% CI [0.17-0.82], p < 0.01), and weak for Hispanic/Latino patients (κ = 0.47, 95% CI [0.19-0.76], p < 0.01). There was minimal agreement between clinical and pathologic staging when assessing clinical stage by CT imaging alone, suggesting that CT is not adequate as a single modality staging tool. While every effort should be made to obtain multimodal staging, larger studies are warranted to improve CT imaging protocols for staging in resource-limited settings.

CLASSIFICATION OF COLORECTAL CANCER PATIENTS BASED ON SERUM MICRONUTRIENTS: AN EXPLORATORY INVESTIGATION

Abstract Introduction/Objective Colorectal cancer (CRC) is a growing global health challenge with a multifactorial etiology encompassing genetic susceptibility, nutrition, and inflammation in the bowel. To examine micronutrient status in CRC patients undergoing CRC resection. Methods/Case Report We performed a pilot case-control study including 13 consecutive CRC patients and 10 healthy controls (CTRL) comparing the serum levels of 29 micronutrients, namely Copper, Zinc, Selenium, Chromium, Manganese, Carnitine, Choline, Inositol, Methylmalonic acid (MMA), Vitamin (Vit) B1, Vit B2, Vit B3, Vit B5, Vit B6, Vit C, Vit A, Vit D3, Vit E, Vit K1, Vit K2 and the amino acids Serine, Valine, Leucine, Isoleucine, Asparagine, Glutamine, Arginine, Citrulline and Cysteine. The analysis of trace metals (copper, zinc, selenium, chromium, manganese) in serum was done using the Inductively coupled plasma mass spectrometry (ICP-MS) methodology using the Agilent 8900 QQQ instrument. The analysis of serum water-soluble and fat-soluble vitamins and amino acids was conducted using the LC/MS (Xevo-TQ-XS) mass spectrometer (WBA0127). Elution of the fat-soluble vitamins was performed using a solid-phase extraction system with an OASIS Prime HLB plate containing 10 mg of sorbent per well, in a Waters vacuum manifold equipped with a waste collection plate. Comparison among continuous biological variables was carried out by multivariate ANOVA model (MANOVA), accounting for the effect of sex and age Results (if a Case Study enter NA) After considering the effect of age and sex, copper, arginine, and cysteine were increased, while zinc, selenium, chromium, Vit B1, Vit K1, and Vit A were decreased in CRC patients in comparison with CTRL. Zinc levels perfectly predicted the diagnosis of CRC, and was associated with lymph nodes (pN), of the pTNM staging. Copper levels in serum was strongly associated with the pathological pTNM staging of CRC. Conclusion Though this is a preliminary study which needs confirmation with a larger longitudinal cohort, our results show that serum micronutrients are linked to tumor growth, likely caused by increased demand from tumor tissue associated with an aberrant cell proliferation and changes in the antioxidant function.

Clinicopathological Characteristics of Small Cell Carcinoma of the Ovary, Hypercalcemic Type – a case Series

Abstract Introduction/Objective Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is a rare (&amp;lt;0.01%) and aggressive ovarian tumor primarily affecting young women (median of approximately 24 years), characterized by rapid growth, early metastasis, and association with hypercalcemia in two-thirds of cases. The diagnosis of SCCOHT is challenging due to its rarity and lack of specific clinical symptoms or biomarkers. Our study aims to delineate the clinicopathologic characteristics of SCCOHT based on our case series and add to the existing knowledge. Methods/Case Report A retrospective review of University of Pennsylvania Health system pathology database was conducted from 2012 to 2024. Our study identified four patients diagnosed with SCCOHT. Clinical information and histopathologic characteristics were reviewed. Results (if a Case Study enter NA) Among the four patients identified, the median age was 24 years, with a median tumor size of 14.5 cm, and all patients presented with weight loss, abdomen bloating, and elevated CA125 levels. Notably, two patients exhibited hypercalcemia, while one initially presented with normal calcium levels but developed hypercalcemia during disease recurrence. One patient maintained normal calcium levels throughout. Surgical intervention involved bilateral salpingo-oophorectomy in all cases, with pathological staging revealing two patients at pT1a, one at pT1c, and one at pT3c. Histopathological analysis consistently revealed similar morphology, including solid and cystic necrotic neoplasms with diffuse growth or nests/cords of undifferentiated small cells, which displaying vesicular chromatin and prominent nucleoli. Immunohistochemical staining demonstrated loss of BRG1 (SMARCA4) expression in two patients and diffuse positivity for WT1 in all patietns, while negative for cytokeratin, germ cell markers, and melanocytic markers. Genetic test revealed SMARCA4 mutation (p.E 717*, c.3169-1G&amp;gt;A) in one patient. Conclusion Small cell carcinoma of the ovary, hypercalcemic type, presents a diagnostic and therapeutic challenge due to its rarity and aggressive nature. Adequate treatment options are currently limited, highlighting the critical need for further research and development of targeted therapies in SCCOHT. Testing for mutations in the SMARCA4 gene is essential for accurate diagnosis of SCCOHT and may uncover new avenues for treatment and management strategies.

Appendiceal Mucosal Schwann Cell Proliferation Associated with Incidentally Detected Goblet Cell Adenocarcinoma of Appendix in a Case of Invasive Adenocarcinoma of Sigmoid Colon- A Case Report

Abstract Introduction/Objective Appendiceal mucosal Schwann cell proliferation has been suggested to be a putative histologic marker of appendiceal diverticular disease. Appendiceal Goblet cell adenocarcinoma, (GCA) is amongst the most rare appendiceal tumors with a reported incidence of 0.05 cases per 100,000 population per year in United States. They have features of both neuroendocrine tumors and adenocarcinomas, but behave more similarly to adenocarcinomas. Methods/Case Report Herein, we report a case of appendiceal mucosal schwann cell proliferation associated with incidentally detected Goblet cell adenocarcinoma of appendix in a known case of invasive adenocarcinoma of sigmoid colon. A 75-year-old female presented with sigmoid colon obstruction. Intraoperatively, she was found to have gangrenous and perforated colon, as well as a large obstructing sigmoid mass, and underwent total abdominal colectomy with end-ileostomy. On gross examination, a tan bosselated tumor (up to 3.5 cm) was seen in proximal sigmoid colon. Microscopic examination showed Invasive adenocarcinoma, moderately-differentiated. Appendix was unremarkable on gross examination. Incidentally, the appendix microscopically demonstrated “Goblet cell adenocarcinoma”, histologic grade 1 out of 3 (pathologic stage pTis pN0), present in multiple foci within lamina propria of the distal third of appendix over an area measuring 1.5 cm. Additionally, there were foci of SOX10-positive bland- looking spindle cell proliferation in lamina propria of the appendix. This proliferation is rendered as “Schwann cell proliferation”. Results (if a Case Study enter NA) NA Conclusion One study found that “Schwann cell proliferation” is seen in 42% of appendiceal diverticula cases. It has never been reported in association with “Appendiceal GCA” before. Here we report an intriguing case of Schwann cell proliferation associated with this rare entity of GCA for the first time in literature. Therefore, awareness of such coexistence of these pathologic entities in the same appendix is essential to alert the pathologist to look for GCA, whenever Schwann cell proliferation is encountered in random section of an appendix. This case also emphasizes the importance of being vigilant of the possible presence of other tumors in a specimen with a known tumor.

Neuropathological spectrum of anti-IgLON5 disease and stages of brainstem tau pathology: updated neuropathological research criteria of the disease-related tauopathy

Anti-IgLON5 disease is a unique condition that bridges autoimmunity and neurodegeneration. Since its initial description 10 years ago, an increasing number of autopsies has led to the observation of a broader spectrum of neuropathologies underlying a particular constellation of clinical symptoms. In this study, we describe the neuropathological findings in 22 patients with anti-IgLON5 disease from 9 different European centers. In 15 patients (68%), we observed a hypothalamic and brainstem-predominant tauopathy of varying severity in which the original research neuropathological criteria were readily applicable. This pathology was observed in younger patients (median age at onset 61 years) with a long disease duration (median 9 years). In contrast, in 7 (32%) patients, the originally described brainstem tauopathy was nearly absent or only minimal in the form of delicate threads, despite mild-to-moderate neurodegenerative features, consistent clinical symptoms and the presence of anti-IgLON5 antibodies in CSF and serum. These patients were older at onset (median 79 years) and had shorter disease duration (median < 1 year). Overall, about one-third of the patients showed concomitant TDP-43 pathology within the regions affected by tau pathology and/or neurodegeneration. Based on these observations and in view of the spectrum of the tau burden in the core regions involved in the disease, we propose a simple staging system: stage 1 mild neurodegeneration without overt or only minimal tau pathology, stage 2 moderate neurodegeneration and mild/ moderate tauopathy and stage 3 prominent neurodegeneration and tau pathology. This staging intends to reflect a potential (age- and time-dependent) progression of tau pathology, supporting the current notion that tau accumulation is a secondary phenomenon related to the presence of anti-IgLON5 antibodies in the CNS. Finally, we adapt the original research criteria of the anti-IgLON5 disease-related tauopathy to include the spectrum of pathologies observed in this larger postmortem series.

Machine learning and explainable artificial intelligence to predict pathologic stage in men with localized prostate cancer.

Though several nomograms exist, machine learning (ML) approaches might improve prediction of pathologic stage in patients with prostate cancer. To develop ML models to predict pathologic stage that outperform existing nomograms that use readily available clinicopathologic variables. Patients with prostate adenocarcinoma who underwent surgery were identified in the National Cancer Database. Seven ML models were trained to predict organ-confined (OC) disease, extracapsular extension, seminal vesicle invasion (SVI), and lymph node involvement (LNI). Model performance was measured using area under the curve (AUC) on a holdout testing data set. Clinical utility was evaluated using decision curve analysis (DCA). Performance metrics were confirmed on an external validation data set. The ML-based extreme gradient boosted trees model achieved the best performance with an AUC of 0.744, 0.749, 0.816, 0.811 for the OC, ECE, SVI, and LNI models, respectively. The MSK nomograms achieved an AUC of 0.708, 0.742, 0.806, 0.802 for the OC, ECE, SVI, and LNI models, respectively. These models also performed the best on DCA. Findings were consistent on both a holdout internal validation data set as well as an external validation data set. Our ML models better predicted pathologic stage relative to existing nomograms at predicting pathologic stage. Accurate prediction of pathologic stage can help oncologists and patients determine optimal definitive treatment options for patients with prostate cancer.

PET Imaging with [18F]ROStrace Detects Oxidative Stress and Predicts Parkinson's Disease Progression in Mice.

Although the precise molecular mechanisms responsible for neuronal death and motor dysfunction in late-onset Parkinson's disease (PD) are unknown, evidence suggests that mitochondrial dysfunction and neuroinflammation occur early, leading to a collective increase in reactive oxygen species (ROS) production and oxidative stress. However, the lack of methods for tracking oxidative stress in the living brain has precluded its use as a potential biomarker. The goal of the current study is to address this need through the evaluation of the first superoxide (O2•-)-sensitive radioactive tracer, [18F]ROStrace, in a model of late-onset PD. To achieve this goal, MitoPark mice with a dopaminergic (DA) neuron-specific deletion of transcription factor A mitochondrial (Tfam) were imaged with [18F]ROStrace from the prodromal phase to the end-stage of PD-like disease. Our data demonstrate [18F]ROStrace was sensitive to increased oxidative stress during the early stages of PD-like pathology in MitoPark mice, which persisted throughout the disease course. Similarly to PD patients, MitoPark males had the most severe parkinsonian symptoms and metabolic impairment. [18F]ROStrace retention was also highest in MitoPark males, suggesting oxidative stress as a potential mechanism underlying the male sex bias of PD. Furthermore, [18F]ROStrace may provide a method to identify patients at risk of Parkinson's before irreparable neurodegeneration occurs and enhance clinical trial design by identifying patients most likely to benefit from antioxidant therapies.

Early disruption of entorhinal dopamine in a knock-in model of Alzheimer's disease.

The entorhinal cortex (EC) is a critical brain area for memory formation, while also the region exhibiting the earliest histological and functional alterations in Alzheimer's disease (AD). The EC thus has been long hypothesized as one of the originating brain areas of AD pathophysiology, although circuit mechanisms causing its selective vulnerability remain poorly understood. We found that dopamine neurons projecting their axons to the lateral EC (LEC), critical for memory formation in healthy brains, become dysfunctional and cause memory impairments in early AD brains. In amyloid precursor protein knock-in mice with associative memory impairment, LEC dopamine activity and associative memory encoding of LEC layer 2/3 neurons were disrupted in parallel from the early pathological stage. Optogenetic reactivation of LEC dopamine fibers, as well as L- DOPA treatment, rescued associative learning behavior. These results suggest that dysfunction of LEC-projecting dopamine neurons underlies memory impairment in AD from early stages, pointing to a need for clinical investigation of LEC dopamine in AD patients.

Deciphering a hydrogen sulfide-related signature to supervise prognosis and therapeutic response in colon adenocarcinoma.

Hydrogen sulfide (H2S) is a critical molecule that participates in various molecular, physiological, and pathophysiological processes in biological systems. Emerging evidence has revealed that H2S is implicated in the progression of colon cancer and immune escape. Against this backdrop, the present study aimed to construct a prognostic risk feature for colon adenocarcinoma (COAD) by leveraging hydrogen sulfide-related genes (HSRG). Transcriptomic data and corresponding clinical-pathological information of colon cancer were obtained from The Cancer Genome Atlas and gene expression omnibus databases. Univariate Cox regression analysis was employed to assess the prognostic relevance of HSRG. Consensus clustering was utilized to perform molecular subtyping of COAD, followed by comparison of immune cell infiltration, drug sensitivity, and immune therapy response between subtypes. Differential expression gene and gene set enrichment analyses were conducted between subtypes. Univariate, lasso, and multivariate Cox regression analyses were applied to construct a prognostic model derived from HSRG. A nomogram model for predicting COAD prognosis was constructed and evaluated. In this study, we identified 12 HSRGs that were associated with COAD prognosis. Consensus clustering analysis revealed 3 COAD molecular subtypes that exhibited significant differences in terms of prognosis, tumor immune cell infiltration, drug sensitivity, and immune therapy response. Gene set enrichment analysis demonstrated that immunoregulatory processes were significantly suppressed in the poor-prognosis subtype while Wnt-related pathways and processes were significantly upregulated. Based on the differentially expressed genes between subtypes, we constructed a risk model comprising 11 genes that effectively distinguished high-risk patients from low-risk patients with significant associations with patient survival outcomes, drug treatment, pathological staging, and T staging. The HSRG-derived risk feature was an independent prognostic factor for COAD in drug treatment and pathological staging and could be integrated into a nomogram for prognosis prediction. Calibration curve, receiver operating characteristic curve, and decision curve analysis demonstrated excellent performance of the nomogram in evaluating COAD prognosis. Our study systematically assessed the prognostic significance of HSRG in COAD, identified HSRG-based molecular subtypes and risk features, and highlighted their potential utility in predicting prognosis and treatment response.

Application of artificial intelligence model in pathological staging and prognosis of clear cell renal cell carcinoma

This study aims to develop a deep learning (DL) model based on whole-slide images (WSIs) to predict the pathological stage of clear cell renal cell carcinoma (ccRCC). The histopathological images of 513 ccRCC patients were downloaded from The Cancer Genome Atlas (TCGA) database and randomly divided into training set and validation set according to the ratio of 8∶2. The CLAM algorithm was used to establish the DL model, and the stability of the model was evaluated in the external validation set. DL features were extracted from the model to construct a prognostic risk model, which was validated in an external dataset. The results showed that the DL model showed excellent prediction ability with an area under the curve (AUC) of 0.875 and an average accuracy score of 0.809, indicating that the model could reliably distinguish ccRCC patients at different stages from histopathological images. In addition, the prognostic risk model constructed by DL characteristics showed that the overall survival rate of patients in the high-risk group was significantly lower than that in the low-risk group (P = 0.003), and AUC values for predicting 1-, 3- and 5-year overall survival rates were 0.68, 0.69 and 0.69, respectively, indicating that the prediction model had high sensitivity and specificity. The results of the validation set are consistent with the above results. Therefore, DL model can accurately predict the pathological stage and prognosis of ccRCC patients, and provide certain reference value for clinical diagnosis.

Prognostic Prediction and Immune Microenvironment Characterization in Uveal Melanoma: A Novel Mitochondrial Metabolism-Related Gene Signature.

Uveal Melanoma (UM), a highly aggressive and metastatic intraocular cancer with a strong propensity for liver metastasis, presents limited therapeutic alternatives and unfavorable survival outcomes. Despite its low incidence, the underlying mechanisms of UM pathogenesis and the precise role of mitochondrial metabolism in UM remain inadequately understood. Utilizing Cox proportional hazards regression analysis was used to assess prognostic relevance, and consensus clustering was employed for molecular subtyping. A risk signature was constructed using Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression. We further conducted comparative analyses on clinicopathological characteristics, somatic mutation profiles, drug sensitivity, gene expression patterns, and tumor microenvironment features across different molecular subtypes. Moreover, a nomogram was developed and evaluated. Among 1234 mitochondria metabolism-related genes (MMRGs), 343 were identified as significantly associated with the prognosis of UM. These prognosis-associated MMRGs facilitated the classification of UM into two distinct molecular subtypes, which displayed notable differences in prognosis and pathological staging. Furthermore, an index termed the MMRGs-derived index (MMI) was derived from eight MMRGs, serving as a quantitative measure for poor prognosis risk in UM. MMI demonstrated significant associations with clinicopathological characteristics, somatic mutations, drug responsiveness, and the tumor microenvironment, where higher MMI levels corresponded to worse prognosis, advanced pathological stages, and increased immune cell infiltration. The nomogram built upon MMI provided a potential tool for clinical prognosis assessment in UM patients. This study demonstrated the potential value of MMRGs in predicting prognosis and molecular stratification within UM; however, additional clinical and basic research is warranted to validate their applicability and elucidate the related mechanisms.

COVID-19 Pandemic Impact on Uro-Oncological Disease Outcomes at a German Referral Center

Introduction: To assess differences in referral and pathologic outcomes for uro-oncology cases prior to, during, and after the COVID-19 pandemic, comparing clinical and pathological data from cancer surgeries performed at a university medical center between 2018 and 2023. Methods: We collected data of 212 patients with radical prostatectomy (RP) for prostate cancer, 157 patients with radical cystectomies (RCs) for bladder cancer, 36 patients with radical nephroureterectomies (RNUs) for upper tract urothelial carcinoma, 133 patients with partial nephrectomies (PNs), and 160 patients with radical nephrectomies (RNs) for renal cancer, 93 patients with orchifunicolectomy for testicular cancer, 39 patients with newly diagnosed penile cancer. Data from patients treated between 2018 and February 2020 (before the COVID-19 pandemic) were compared with data from patients treated between March 2020 and March 2022 (during the COVID-19 pandemic) and between April 2022 and February 2023 (after the COVID-19 pandemic). Results: No differences in terms of main pathologic features were observed in patients undergoing RP, RNU, orchifunicolectomy, or circumcision and/or penectomy. Further, a lower pathological tumor stage was diagnosed for RN after the COVID-19 pandemic (p < 0.05). A higher age at diagnosis for penile cancer was observed during the pandemic cohort in comparison to the pre-COVID-19 pandemic cohort (p < 0.05), but this did not translate into a worse pathological stage or lymph node involvement. Another notable change was the shortening of the length of stay (LOS) for orchifunicolectomy over the pandemic (p < 0.05). Conclusion: Neither decline in uro-oncologic activity nor pathological features were observed at our institution before, during, and after the COVID-19 pandemic. A significantly lower pathological tumor stage for RN after the COVID-19 pandemic was seen. Penile cancer was diagnosed at a significantly higher age during the COVID-19 pandemic, and a decrease in LOS for orchifunicolectomy was observed.

Insights of Expression Profile of Chemokine Family in Inflammatory Bowel Diseases and Carcinogenesis

Chemokines are integral components of the immune system and deeply involved in the pathogenesis and progression of inflammatory bowel disease (IBD) and colorectal cancer (CRC). Although a considerable amount of transcriptome data has been accumulated on these diseases, most of them are limited to a specific stage of the disease. The purpose of this study is to visually demonstrate the dynamic changes in chemokines across various stages of bowel diseases by integrating relevant datasets. Integrating the existing datasets for IBD and CRC, we compare the expression changes of chemokines across different pathological stages. This study collected 11 clinical databases from various medical centers around the world. Patients: Data of patient tissue types were classified into IBD, colorectal adenoma, primary carcinoma, metastasis, and healthy control according to the publisher’s annotation. The expression changes in chemokines in various pathological stages are statistically analyzed. The chemokines were clustered by different expression patterns. The chemokine family was clustered into four distinct expression patterns, which correspond to varying expression changes in different stages of colitis and tumor development. Certain chemokines and receptors associated with inflammation and tumorigenesis have been identified. Furthermore, it was confirmed that the 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis model and the azoxymethane (AOM)/ dextran sulfate sodium (DSS)-induced colon cancer model shows stronger correlations with the clinical data in terms of chemokine expression levels. This study paints a panoramic picture of the expression profiles of chemokine families at multiple stages from IBD to advanced colon cancer, facilitating a comprehensive understanding of the regulation patterns of chemokines and guiding the direction of drug development. This study provides researchers with a clear atlas of chemokine expression in the pathological processes of inflammatory bowel disease and colon cancer.

Body image and quality of life undergoing totally robotic versus robotic-assisted distal gastrectomy: a retrospective propensity score matched cohort study

BackgroundWith the improvement of anastomotic techniques and the iteration of anastomotic instruments, robotic intracorporeal suturing has become increasingly proficient. The era of fully intracorporeal anastomosis in robotic gastric cancer resection is emerging. This study aims to explore the impact of totally robotic distal gastrectomy (TRDG) and robotic-assisted distal gastrectomy (RADG) on patients’ quality of life.Patients and methodsThis study is a comparative retrospective study of propensity score matching. This study included 306 patients who underwent robotic distal gastrectomy for gastric cancer between June 2016 and December 2023 at our center. Covariates used in the propensity score included sex, age, BMI, ASA score, maximum tumour diameter, degree of histological differentiation, Pathological TNM stage, Pathological T stage, Pathological N stage, and Lauren classification. Outcome measures included operative time, intraoperative bleeding, time to first venting, time to first fluid intake, postoperative hospital stay, total hospitalization cost, total length of abdominal incision, postoperative complications, inflammatory response, body image, and quality of life.ResultsAccording to the results of the study, compared with the RADG group, the TRDG group had a faster recovery time for gastrointestinal function (P = 0.025), shorter length of abdominal incision (P < 0.001), fewer days in the hospital (P = 0.006) less pain (P < 0.001), less need for additional analgesia (P = 0.013), and a postoperative white blood cell count (P < 0.001) and C-reactive protein content indexes were lower (P<0.001). In addition, the TRDG group had significantly better body imagery and cosmetic scores (P = 0.015), physical function (P = 0.039), role function (P = 0.046), and global function (P = 0.021) than the RARS group. Meanwhile, the TRDG group had milder symptoms of fatigue (P = 0.037) and pain (P < 0.001). The PASQ Total Subscale Score (P < 0.001) and Global Subscale Score (P < 0.001) were significantly lower in the TRDG group than in the RADG group at postoperative 3 months.ConclusionTotally robotic distal gastrectomy has a smaller incision, faster gastrointestinal recovery time, fewer days of postoperative hospitalization, and lower inflammatory markers than robotic-assisted distal gastrectomy. At the same time, postoperative cosmetic and quality of life outcomes were satisfactory. Clinically, these benefits translate to enhanced patient recovery, reduced surgical trauma, and better postoperative outcomes. These findings could guide surgeons in selecting more effective surgical approaches for patients undergoing gastrectomy, leading to better overall patient satisfaction and outcomes.

Development and Validation of a Computed Tomography-Based Model for Noninvasive Prediction of the T Stage in Gastric Cancer: Multicenter Retrospective Study.

As part of the TNM (tumor-node-metastasis) staging system, T staging based on tumor depth is crucial for developing treatment plans. Previous studies have constructed a deep learning model based on computed tomographic (CT) radiomic signatures to predict the numberoflymphnodemetastases and survival in patients with resected gastric cancer (GC). However, few studies have reported the combination of deep learning and radiomics in predicting T staging in GC. This study aimed to develop a CT-based model for automatic prediction of the T stage of GC via radiomics and deep learning. A total of 771 GC patients from 3 centers were retrospectively enrolled and divided into training, validation, and testing cohorts. Patients with GC were classified into mild (stage T1 and T2), moderate (stage T3), and severe (stage T4) groups. Three predictive models based on the labeled CT images were constructed using the radiomics features (radiomics model), deep features (deep learning model), and a combination of both (hybrid model). The overall classification accuracy of the radiomics model was 64.3% in the internal testing data set. The deep learning model and hybrid model showed better performance than the radiomics model, with overall classification accuracies of 75.7% (P=.04) and 81.4% (P=.001), respectively. On the subtasks of binary classification of tumor severity, the areas under the curve of the radiomics, deep learning, and hybrid models were 0.875, 0.866, and 0.886 in the internal testing data set and 0.820, 0.818, and 0.972 in the external testing data set, respectively, for differentiating mild (stage T1~T2) from nonmild (stage T3~T4) patients, and were 0.815, 0.892, and 0.894 in the internal testing data set and 0.685, 0.808, and 0.897 in the external testing data set, respectively, for differentiating nonsevere (stage T1~T3) from severe (stage T4) patients. The hybrid model integrating radiomics features and deep features showed favorable performance in diagnosing the pathological stage of GC.

CapeOX as neoadjuvant chemotherapy for locally advanced rectal cancer: might less be more?

BackgroundLocally advanced rectal cancer (LARC) poses unique challenges in treatment, with current neoadjuvant chemoradiotherapy (NA-CRT) showing limitations. The CapeOX regimen emerges as a potential less aggressive neoadjuvant chemotherapy (NAC) for LARC.MethodsWe conducted a retrospective study involving treatment-naïve patients with LARC from March 2014 to March 2021 who received 2–4 cycles of CapeOX NAC followed by radical surgery. Treatment response was evaluated using tumor regression grade (TRG), MRI-based TRG (MRI-TRG), and Neoadjuvant Rectal (NAR) score.Results94.7% of patients experienced symptom improvement and 96.4% achieved sphincter-preserving surgery. Post-NAC showed significant tumor regression and MRI confirmed a tumor length reduction (P < 0.001). Clinical and pathological staging discrepancies post-NAC suggest broader therapeutic advantages. 5-year overall and disease-free survival rates were 78.4% and 73.4%. NAR scores provided better prognostic accuracy than MRI-TRG.ConclusionCapeOX NAC presents notable benefits for LARC patients and its clinical significance may be underestimated. The NAR score demonstrates superior prognostic value over MRI-TRG.