Objective: To investigate the clinical efficacy, toxicity and prognosis of SOX regimen (Oxaliplatin plus S-1) combined with Pabolizumab in the treatment of patients with metastatic gastric cancer. Methods: The clinical data of 107 patients with advanced metastatic gastric cancer admitted to Wuxi Branch of Ruijin Hospital Shanghai Jiao Tong University School of Medicine from May 2020 to May 2024 were retrospectively collected. According to the treatment methods, the patients in the chemotherapy group (n=56) only received SOX chemotherapy, and the patients in the combined group (n=51) were given SOX chemotherapy combined with Pembrolizumab. The differences of objective response rate (ORR), median progression-free survival (PFS), median overall survival (OS), grade Ⅲ-Ⅳ toxicity and quality of life improvement rate between the two groups were analyzed and compared. Results: According to the efficacy evaluation criteria of RECIST1.1, among all subjects, there were 1 case of complete response (CR) and 21 cases of partial response (PR) in chemotherapy group, 2 cases of CR and 31 cases of PR in combination group. The objective response rate (CR+PR%) in combination group was significantly higher than that in chemotherapy group (64.7% vs 39.3%, P=0.015). Stratified analysis showed that in patients with PD-L1 combined positive score (CPS) ≥1, the ORR of the combination group further increased to 75.9% (22/29), with a more significant advantage than the ORR of 38.9% (14/36) in the chemotherapy group (P=0.004). Survival analysis showed that among all enrolled patients, median PFS and median OS in combination group were 9.3 months and 17.4 months respectively, which were significantly longer than 8.4 and 13.1 months in chemotherapy group (PFS: P=0.020; OS: P=0.011). In addition, among patients with PD-L1 CPS ≥1, the median PFS and OS of the combination group showed a more significant advantage in prolonging compared to the chemotherapy group (median PFS: 10.7 months vs 8.2 months, P=0.003; median OS: 19.0 months vs 12.8 months, P=0.005). Among all enrolled patients, 14 cases showed improvement in quality of life in the chemotherapy group and 23 cases in the combination group, and the improvement rate of quality of life in combination group was significantly higher than that in chemotherapy group (45.1% vs 25.0%, P=0.029). There was no statistical difference in the incidence [67.9% (38/56) in chemotherapy group vs 78.4% (40/51) in combination group] of grade Ⅲ-Ⅳ toxicity between the two groups (P=0.219). Conclusion: In patients with PD-L1 CPS ≥1 or all enrolled patients, compared with chemotherapy alone, SOX regimen combined with pembrolizumab in the treatment of metastatic gastric cancer can significantly improve ORR, prolong PFS and OS, improve prognosis and quality of life, while the toxicity has not increased significantly.

Objective: To construct a non-invasive detection platform based on surface enhanced Raman spectroscopy (SERS) combined with machine learning, achieving high-precision recognition of precancerous lesions of gastric cancer. Method: Serum samples were collected from 213 subjects at Jiangdu People's Hospital Affiliated to Yangzhou University from July 6, 2023 to January 1, 2025, including 51 healthy controls and 162 gastric lesion patients (48 cases of high-grade intraepithelial neoplasia [HGIN], 60 cases of early gastric cancer, and 54 cases of advanced gastric cancer). Au Octahedral Nanoparticles (Au OCNPs) substrates was synthesized by seed mediated method, and its morphology was characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Serum samples were dropped onto the Au OCNPs array, and SERS spectra were acquired using a confocal micro-Raman spectrometer (excitation wavelength 785 nm, laser power 5 mW, exposure time 10 s). All original spectral data were preprocessed using Origin 2019 software, including spectral band selection, Savitzky-Golay smoothing, airPLS baseline correction, and Min-Max normalization. A principal component analysis-diagonal quadratic discriminant analysis (PCA-DQDA) model was constructed in MATLAB R2023a to evaluate the classification performance for healthy subjects and gastric lesion patients at different stages, and the model's accuracy and area under the curve (AUC) were validated by five-fold cross-validation. Results: The Au OCNPs arrays showed uniform morphology, sharp edges, a lattice spacing of 0.226 nm, and a characteristic absorption peak at 534 nm, with significant SERS enhancement and good reproducibility. The characteristic peak differences in SERS spectra between healthy subjects and gastric lesion patients were mainly concentrated at 625, 728, 1 006, 1 326, 1 446, and 1 584 cm^-1, indicating significant differences in the vibrational modes of biomolecules such as proteins and nucleic acids in serum during the progression of gastric precancerous lesions. For the binary classification of healthy subjects and all gastric lesion patients, the PCA-DQDA model achieved an overall accuracy of 97.2% (207/213). For the multi-class classification of healthy subjects and gastric lesion patients at different stages, the model achieved an overall accuracy of 93.4% (199/213), and an AUC of 0.872. Misclassifications occurred between adjacent subgroups with similar biological characteristics: among 51 healthy subjects, 4 were misclassified as HGIN, with a classification accuracy of 92.2% (47/51); among 48 HGIN samples, 1 was misclassified as healthy and 2 as early gastric cancer, with a classification accuracy of 93.6% (45/48). Conclusion: The serum SERS detection platform based on Au OCNPs arrays and the PCA-DQDA model exhibits advantages of non-invasiveness, high sensitivity, and molecular specificity in identifying gastric precancerous lesions, providing a new strategy for their recognition.

Objective: To analyze the mortality trends of liver cancer in the general population of Qidong City, Jiangsu Province from 1972 to 2024, and to predict the mortality burden from 2025 to 2034, providing a basis for liver cancer prevention and control strategies. Methods: Liver cancer mortality data (1972-2024) were extracted from the Qidong Cancer Registry database. Using corresponding population data, we calculated: crude mortality rate (CR), Chinese age-standardized rate (ASRC, standardized using the 1964 Chinese population), world age-standardized rate (ASRW, standardized using Segi's world population), and median age at death. Joinpoint regression (Joinpoint 4.9.1.0) was employed to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality, The ARIMA model in SAS 9.2 was applied to predict mortality trends over the next decade. Results: A total of 34 773 liver cancer deaths were recorded in Qidong from 1972 to 2024. Compared with 1972-1976, the proportion of liver cancer deaths among all cancer deaths in 2022-2024 decreased from 40.02% to 12.83%. The CR, ASRC, and ASRW declined from 49.33/10⁵, 45.62/10⁵, and 57.23/10⁵ in 1972-1976 to 44.09/10⁵, 8.54/10⁵, and 13.91/10⁵ in 2022-2024, respectively. The male-to-female ratio of ASRW was 3.33:1 from 1972 to 2024. For 2022-2024, the ASRW was 21.16/10⁵ for males and 7.22/10⁵ for females. Age-specific mortality rates showed declining trends in all age groups under 65 years from 1972 to 2024, with greater declines in younger age groups (all P＜0.05). In contrast, the mortality rate in the 75+ years age group showed an increasing trend (AAPC=2.15%, P=0.001). The median age at death from liver cancer in Qidong rose from 49 years in 1972 to 72 years in 2024, and the peak mortality age group shifted gradually from 45-54 years to 75+ years across periods. The time trend analysis revealed that from 1972 to 2024, the AAPCs for ASRW were -2.11%, -2.23%, and -1.89% (all P＜0.001) for both sexes combined, males, and females, respectively, all showing statistically significant downward trends. The CR showed a slow but significant increasing trend for females (AAPC=0.88%, P＜0.001), while the trends for both sexes combined and males were not statistically significant (all P＞0.05). Segmented fitting results showed the most pronounced decline occurred from 2008 to 2024, with an APC of -3.76% for CR and -7.15% for ASRW (both P＜0.001). The overall CR is projected to decline to 40.30/10⁵ in 2034, and the ASRW is projected to decline to 4.40/10⁵. Conclusions: The comprehensive prevention and control efforts implemented over 53 years in the high-incidence area of Qidong have influenced the overall standardized mortality rate and the liver cancer mortality rate among those under 65 years of age, with the most significant decline observed after 2008. Future efforts should focus on strengthening comprehensive prevention and control of liver cancer in the elderly population.

Objective: To analyze the incidence of malignant tumors in children and adolescents (aged 0-19 years) in China in 2022. Methods: Data were sourced from GLOBOCAN 2022 and Cancer Incidence in Five Continents (CI5) Volume Ⅻ. Incidence data by sex and age group for childhood and adolescent cancers from Chinese registries in CI5 Volume XII were extracted to calculate the proportion of each subtype. These proportions were then applied to the overall cancer incidence in children and adolescents in China from GLOBOCAN 2022 to estimate the number of incident cases for different tumor types. World standardized incidence rates (WSR) were calculated using Segi's world standard population. Results: In 2022, there were 32 792 new cases of malignant tumors in children and adolescents (aged 0-19 years) in China, with a WSR of 105.93 per million. Among them, 23 121 new cases occurred in children aged 0-14 years, accounting for 70.51% of all cases in children and adolescents, with a WSR of 100.30 per million. The most common diagnostic types of malignant tumors in Chinese children and adolescents in 2022 were leukemia (11 983 cases, 36.54%), followed by central nervous system tumors (4 485 cases, 13.68%) and lymphoma (2 764 cases, 8.43%), with WSR of 39.78 per million, 14.15 per million and 8.35 per million, respectively. Among different age groups, the highest WSR was observed in the 15-19 years (125.28 per million), followed by the 0-4 years (120.67 per million). Except for the 15-19 years group, the age-specific incidence rate was higher in males than in females. The top three cancer types by incidence in both sexes in 0-14 years group were consistent with those in the 0-19 years group, namely leukemia, central nervous system tumors, and lymphoma. In the 15-19 years group, the top three cancers in males were leukemia, bone tumors, and lymphoma, while in females they were malignant melanomas and other malignant epithelial tumors, leukemia, and malignant gonadal germ cell tumors. Conclusions: The incidence rates and cancer type distribution in children and adolescents vary considerably by sex and age group in China. Targeted prevention and control strategies for childhood and adolescent cancer malignant tumors should be developed accordingly.

Respiratory-correlated four-dimensional (4D) magnetic resonance imaging (4D-MRI) is useful to estimate breathing induced motion for MRI-guided radiotherapy. Based on 4D-MR image sets, a three-dimensional mid-position (MidP) MRI can be generated using deformable image registration (DIR) for radiotherapy planning. However, the desired spatial resolution and image contrast of the MidP MRI may differ from the original 4D-MRI.

This retrospective study validates a high-definition (HD)-MidP MRI approach that combines 4D-MRI motion information with a high-resolution MRI to enhance the spatial resolution of the MidP image.

Computed tomography (CT) and MR image sets of 25 lung cancer patients were eligible, of whom 17 were complete and suitable for analysis. Standard-definition (SD)-MidP images were derived by applying DIR to warp the ten respiratory phases of a 4D-CT or 4D-MRI, whereas the HD-MidP MRI was derived by warping a high-resolution respiratory-triggered MRI to the MidP. The MidP image quality was assessed with a 4-point Likert scale on tumor and organ at risk (OAR) distinctiveness by three readers. Additionally, the gross tumor volume (GTV) was delineated by the readers, from which a consensus contour was derived for each MidP image. Reader contours were evaluated using the Dice similarity coefficient (DSC) and mean distance to agreement (DTA). Anatomical accuracy was evaluated by comparing MidP tumor locations to manually determined tumor displacements, while DIR precision was analyzed using the distance to discordance metric (DDM). Moreover, deformation vector fields (DVFs) from the DIR were used to automatically calculate MidP-based treatment margins.

Eighteen targets were identified in seventeen patients. All HD-MidP MR image sets were delineated, while 98% (53/54) of the SD-MidP CT and 87% (47/54) of the SD-MidP MR image sets were of adequate quality for delineation. The SD-MidP MRI was positively scored in 13 out of 47 assessments for tumor distinctiveness and in 6 out of 47 assessments for OAR distinctiveness. In contrast, the HD-MidP MRI showed a substantial improvement, with positive scores in 45 out of 54 assessments for tumor distinctiveness and 51 out of 54 assessments for OAR distinctiveness. Contour analyses revealed that the HD-MidP MRI achieved the highest average DSC value (0.83) and, simultaneously, the lowest mean DTA value (0.96 mm). Compared to the manually determined tumor displacements, subvoxel differences in MidP tumor location were observed in 96% (52/54) of the registrations. The distribution of DDM values (median: 1.1 mm) for the HD-MidP MRI was found to be significantly higher than the distributions for the SD-MidP CT (median: 0.2 mm) and SD-MidP MRI (median: 0.7 mm), indicating a lower, but still subvoxel, precision for the HD-MidP MRI approach. The DVF variability was higher for the HD-MidP MRI (median: 2.7 mm) than for the SD-MidP MRI (median: 2.3 mm). However, when used to derive treatment margins, these margins were identical.

The presented HD-MidP MRI methodology scored highest on both tumor and OAR distinctiveness, with GTV contours demonstrating the best alignment. Combined with its high anatomical accuracy, these findings support its potential for lung radiotherapy planning.

Esophageal cancer presents significant treatment challenges due to its proximity to critical structures such as the heart, lungs, and spinal cord. While intensity-modulated proton therapy (IMPT) improves dose conformity, it is limited by factors such as the number of beam angles and lateral penumbra. Proton arc therapy (PAT) may overcome these issues by utilizing continuous gantry rotation to enhance conformity and spare organs-at-risk (OARs). This study compared PAT and IMPT in esophageal cancer, focusing on dosimetric outcomes, and dose-averaged linear energy transfer (LET_d) distributions.

A retrospective analysis was conducted on ten esophageal cancer patients with variable tumor characteristics. Treatment plans were created using Monaco v6.1 treatment planning system for both PAT and IMPT, maintaining identical robustness parameters (± 5 mm setup and ± 3.5% range uncertainties). Both modalities were prescribed a total dose of 50.4 Gy(RBE) in 28 fractions, ensuring ≥95% clinical target volume (CTV) coverage in the worst-case scenarios. Key metrics, including conformity index (CI), heterogeneity index (HI), and LET_d, were compared. Robustness evaluations were performed across 21 worst-case scenarios to assess plan quality and OAR sparing.

PAT demonstrated superior dose conformity (CI: 0.67 ± 0.17 vs. 0.54 ± 0.13; p < 0.01) and reduced lung V20 (6.88% vs. 13.44%; p < 0.01) compared to IMPT. Critical structure sparing, including reduced spinal cord doses (max dose of (30.93 ± 10.85) Gy(RBE) vs (23.22 ± 9.55) Gy(RBE), p = 0.02), was achieved without compromising CTV coverage. PAT showed higher LET_d within the CTV and lower LET_d in adjacent organs-at-risk relative to IMPT, without statistically significant differences. While the clinical significance remains uncertain, this pattern may support more refined biological dose shaping.

PAT emerged as a promising modality for esophageal cancer treatment, delivering improved dose conformity and reduced OAR exposure. These advantages suggest PAT's potential to decrease radiation-associated complications and improve therapeutic outcomes, warranting further clinical validation.

Robot-assisted partial nephrectomy (RAPN) is standard for cT1 renal masses, but its feasibility in patients on temporary mechanical circulatory support is poorly documented. We report RAPN performed while a patient was simultaneously supported with venous-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella®, as part of a staged plan for left ventricular assist device (LVAD) implantation and eventual heart transplantation.

A 51-year-old man presented with ST-elevation myocardial infarction complicated by cardiogenic shock requiring percutaneous coronary intervention with stenting, dual antiplatelet therapy, and combined VA ECMO-Impella® support. During workup for cardiac transplant, computed tomography (CT) staging revealed a 16-mm left renal mass suspicious for renal cell carcinoma. A multidisciplinary team prioritized definitive treatment to preserve transplant eligibility and elected RAPN under systemic heparinization alongside aspirin continuation (cangrelor briefly withheld). Therefore, RAPN was performed with 9 min of warm ischemia. The intraoperative course was hemodynamically stable. On postoperative day (POD) 4, late arterial bleeding from the resection bed was controlled by selective angioembolization. On POD 7, a durable LVAD was implanted as a bridge to heart transplantation. Final pathology showed pT1a, G2, R0 clear cell renal cell carcinoma. At 6 months, contrast-enhanced CT showed no recurrence and no major cardiovascular complications.

RAPN during simultaneous ECMO and Impella® support is technically feasible with meticulous anticoagulation management, interventional radiology standby, and coordinated planning. This approach enables oncologic control while preserving a trajectory to transplant candidacy.

Observational studies have suggested potential associations between myocardial infarction (MI) and cancer risk, but the causal nature of these relationships remains unclear due to confounding factors and reverse causation. We aimed to investigate the bidirectional causal relationships between MI and urinary system cancers using genetic instruments.

We conducted a two-sample Mendelian randomization (MR) analysis using summary statistics from large-scale genome-wide association studies. Genetic variants associated with MI were used as instrumental variables (n = 19 SNPs for prostate cancer [PCa] and malignant neoplasm of kidney [MRN], n = 6 SNPs for bladder cancer, n = 21 SNPs for bladder cancer [BCa] validation). We examined the causal effects of MI on PCa, BCa, and MRN risk, as well as reverse causation. Multiple MR methods were employed, including inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode approaches. Both discovery and validation datasets were analyzed to ensure robustness.

Forward MR analysis revealed no significant causal effect of MI on urinary system cancer risk across all examined malignancies. For PCa, the odds ratios (ORs) ranged from 0.964 to 1.007 across different methods and datasets (all p > 0.05). Similarly, MI showed no causal association with BCa risk (OR = 1.000, 95% CI: 0.999-1.002 in discovery cohort; OR = 1.000, 95% CI: 1.000-1.001 in validation cohort) or MRN risk (OR = 0.989-1.060 across methods in discovery cohort). Reverse MR analysis demonstrated no significant causal effects of PCa or kidney malignancy on MI risk, with ORs ranging from 0.250 to 1.200 (all p > 0.05). Sensitivity analyses confirmed the absence of pleiotropy and heterogeneity.

Our genetic evidence does not support causal relationships between MI and urinary system cancers in either direction. The observed associations in epidemiological studies may be attributed to shared risk factors, treatment effects, or residual confounding rather than direct causal mechanisms. These findings have important implications for cancer surveillance strategies in MI patients and understanding cardio-oncology interactions.

Patients with a multi-parameter magnetic resonance imaging (mpMRI) prostate imaging report and data system (PI-RADS) score ≤ 3, but with clinically significant prostate cancer (CSPCa) detected by biopsy, are termed MRI-Invisible prostate cancer (MRI(-)PCa). This study aims to explore risk factors for MRI(-)PCa and identify immunohistochemical indicators with predictive significance.

A retrospective analysis was conducted on 376 patients with PI-RADS score ≤ 3 who underwent 24-needle systematic prostate biopsy at Beijing Friendship Hospital, Capital Medical University (January 2015 to October 2025). Clinical data, imaging data, and Angiogenic factor with G and FHA domain 1 (AGGF1) immunohistochemical results were collected. Patients were grouped into CSPCa (n = 102) and non-CSPCa (n = 274). t-tests, rank sum tests, and χ2 tests were used for univariate analysis, followed by multivariate Logistic regression to determine independent risk factors. Receiver Operating Characteristic (ROC) curves were drawn. Subgroup analyses were conducted based on prostate-specific antigen (PSA) status and PI-RADS score using the same statistical methods. Moreover, we also used the Kruskal-Wallis test to compare the differences in AGGF1 expression percentages across different Gleason score groups according to ISUP in CSPCa patients.

Multivariate Logistic regression analysis showed that prostate-specific antigen density (PSAD) [OR: 0.971, 95%CI: 0.952, 0.991] and high expression of AGGF1 [OR: 1.065, 95%CI: 1.022, 1.109] were independent risk factors for MRI(-)PCa (p < 0.05). Meanwhile, when the PSAD of the patient is more than 0.25 ng/mL/cm3, it is necessary to be more suspicious that the patient may have prostate cancer (p < 0.05), and an AGGF1 immunohistochemical analysis should be conducted after the biopsy. In the PSA-negative subgroup, only high AGGF1 expression was an independent risk factor (p < 0.05). In the PSA-positive subgroup, PSAD [OR: 0.500, 95%CI: 0.279, 0.895] and AGGF1 [OR: 1.064, 95%CI: 1.037, 1.092] results were independent risk factors (p < 0.05). In subgroup analyses for PI-RADS 1-2 and PI-RADS 3, both PSAD and AGGF1 were accurate predictors of CSPCa (p < 0.05). Among all CSPCa patients, in the Gleason score 3 + 3 group, the average AGGF1 expression percentage of the patients was 48.60% ± 11.03%, which was significantly lower than that of the Gleason score 4 + 3 group (61.00% ± 6.12%) and the Gleason score 4 + 4 group (71.01% ± 4.46%), and the differences were statistically significant (p < 0.001).

For patients with a PI-RADS score ≤ 3, attention should be paid to PSAD before biopsy, especially for those patients with PSAD > 0.25 ng/mL/cm3, not just PSA levels. After biopsy, AGGF1 immunohistochemical staining can be supplemented to help determine the risk and the malignancy of CSPCa.

Bladder cancer (BC) is a prevalent malignancy with evolving treatment strategies and an increasingly aging patient population, resulting in a growing and complex burden of hospitalizations that extends beyond urological care and remains insufficiently characterized in real-world Internal Medicine settings. This study aimed to analyze the clinical data and outcomes for patients with BC admitted to the medicine ward. Additionally, this research presents three cases of fever of unknown origin, which all exhibited identical clinical and laboratory findings but ultimately resulted in different disease diagnoses.

This retrospective case-series study included all adult patients with BC admitted to the Internal Medicine ward of a tertiary referral hospital between 1 January 2020, and 31 December 2024. Data acquisition was performed through a systematic search of electronic discharge records using the ICD-10 code C67. Data recording involved detailed review of electronic medical records to collect demographic characteristics, clinical history, cancer-related treatments, causes of hospitalization, and outcomes. Three patients previously treated with intravesical Bacillus Calmette-Guérin (iBCG) who presented with fever of unknown origin were analyzed in detail. Data analysis comprised descriptive statistics and comparative testing using Fisher's exact test and unpaired two-tailed Student's t-test, with p < 0.05 considered statistically significant.

We identified 77 hospitalizations among 67 BC patients who were predominantly male, with a mean age of 75.2. A high prevalence of metabolic syndrome comorbidities and chronic obstructive pulmonary disease was documented. In addition, 31.1% of patients had metastatic BC, 22.9% had a second malignancy, 49.2% had undergone urological surgeries, and 38% had received chemotherapy or immunotherapy other than iBCG. The most common causes of hospitalization were infections, anemia/transfusions, a newly diagnosed metastatic disease, and acute renal failure. The mortality in this cohort was high (17%), with the leading cause of death again being an infection. Among patients who had previously received BCG immunotherapy, three cases of fever of unknown origin were noticed, and despite identical clinical settings, they were identified with different diseases [metastatic disease, infection caused by Bacillus Calmette-Guérin (BCGitis), and Hodgkin's lymphoma], necessitating individualized therapeutic medications.

BC patients in the Internal Medicine unit are generally older adults, often dealing with several chronic conditions and a considerable cancer burden. They are predominantly admitted due to infections, which points to the urgent need for effective infection prevention strategies for this vulnerable population. When BC patients have a fever lasting more than seven days following BCG instillation, which is the maximum duration for self-limited adverse events to occur, regardless of whether an antibiotic regimen has been prescribed, they should consult an internal medicine department for further evaluation.