Hemodynamic instability during pheochromocytoma resection remains a critical challenge. This study evaluates an intelligent pneumoperitoneum system (Zhonghe Third-Generation) that dynamically modulates intra-abdominal pressure (IAP) to mitigate catecholamine surge. The study was retrospective analysis of 93 patients who under robotic adrenalectomies since 2020 to 2025 years. Which including 43 with synergy group and 50 conventional controls. Thestudy was reveals that synergy group reduced AUC by 43.1% (18.3 ± 5.2 vs 24.7 ± 9.2 mmHg, P < 0.001).Lower peak SBP (178.9 ± 20.7 vs. 195.4 ± 23.8 mmHg, p < 0.001) and vasopressor requirements (1.2 ± 0.8 vs. 3.1 ± 1.5 doses, p < 0.001).Shorter operative time (58.4 ± 16.2 vs. 66.8 ± 12.4 min, p = 0.018). Intelligent pneumoperitoneum significantly enhances hemodynamic stability without compromising safety, advancing precision in robotic endocrine surgery.

Oral microbiome interacts with other organ systems and significantly impacts human health. However, analysis of its role in cancer remains scarce. This study aims to explore the relationship between oral microbiome diversity and prevalent cancer. We analyzed 7727 adults from the 2009-2012 National Health and Nutrition Examination Survey. The linear and non-linear associations between α-diversity and cancer were evaluated using multivariable logistic regression analysis and restricted cubic spline functions. Principal coordinates analysis (PCoA) and permutational multivariate analysis of variance (PERMANOVA) were also used to evaluate differences in β-diversity by cancer status. We found a negative association between oral microbiome α-diversity and the odds of cancer. After adjusting for all confounding covariates, participants in the highest tertile of diversity had 42-46% lower odds of cancer compared to those in the lowest tertile (OTU richness OR = 0.54, 95% CI 0.33-0.87, Ptrend = 0.007; Faith's phylogenetic diversity OR = 0.58, 95% CI 0.35-0.94, Ptrend = 0.012). Exploratory β-diversity analyses showed statistically significant but limited differences in overall microbial community composition according to cancer status. Subgroup analyses suggested a potential effect modification by age, with participants younger than 65 years showing sensitivity to modest elevation in microbiome diversity. Additionally, certain characteristics were associated with lower oral microbiome α-diversity, including age 40 onwards, female sex, lower income, and antibiotics use. Our findings reveal that higher oral microbiome diversity is associated with lower odds of having cancer, which suggests that microbiota profiles may have potential utility in cancer-related risk stratification.

Common robotic nephrectomy approaches access the kidney via transperitoneal (TP) or retroperitoneal (RP) routes, each with distinct trade-offs. We developed the transabdominal lumbar approach (TALA), combining advantages of both accesses with improved visualisation and strategic trocar placement, and compared it with conventional RP in a prospective randomised controlled trial using technique-oriented intraoperative endpoints.

In this single-centre, prospective, open-label RCT, 40 patients were randomised to TALA (n = 18) or conventional RP (n = 22). Eligible patients were ≥ 18 years with a renal tumour or non-functional kidney requiring robot-assisted total or partial nephrectomy. Exclusions included prior surgery on the affected kidney, renal vein tumour thrombus, and pregnancy. Both groups were followed for 30 days. The primary endpoint was time from first skin incision to renal artery identification.

TALA achieved a median time saving of 16 min compared to conventional RP (38 vs. 54 min, p = 0.001). Perioperative safety was comparable between groups, with three patients (7.5%) experiencing Clavien-Dindo grade III-IV complications.

TALA met its primary endpoint with a significantly shorter time to renal artery identification than conventional RP access, and improving perceived surgical exposure and instrument handling.

The prognostic value of primary tumor resection in high-risk neuroblastoma (HrNB) remains controversial. While several Western studies have suggested a survival benefit of complete resection, our institution has not observed a clear association. We therefore evaluated the long-term impact of surgical resection, particularly the extent of resection, in HrNB over four decades.

We retrospectively reviewed 64 consecutive patients with HrNB treated at our center between 1985 and 2023. Patients were classified into complete resection and incomplete/no resection groups. In the more recent cohort (2007-2023), outcomes were also compared between patients who underwent resection and those who did not. Overall survival (OS) and causes of death were analyzed.

Among 64 patients, 11 underwent no resection, 28 incomplete resection, and 25 complete resection. Five-year OS did not differ significantly between the complete and incomplete/no resection groups (57.4% vs. 53.0%). PBSCT-stratified analyses showed similar results. In the more recent cohort (n = 34), five-year OS was comparable between non-resection and resection groups (72.0% vs. 71.5%). A > 20% reduction in primary tumor diameter after induction chemotherapy was strongly associated with better survival.

Some HrNB patients can achieve favorable survival without surgical resection, supporting individualized surgical strategies and prospective multi-institutional validation.

Radiation Therapy Oncology Group (RTOG) and NRG Oncology have played a key role in shaping evidence-based management of central nervous system (CNS) tumors. These have defined standards for radiotherapy delivery, integrated systemic therapies for multimodal approaches, and advanced trial methodology across a range of CNS malignancies through large, multi-institutional studies. This is a comprehensive narrative review of trials involving adult CNS tumors, focused on gliomas, metastases, meningioma, and primary CNS lymphoma (PCNSL).

Trials were identified through protocol archives, published literature, and curated trial inventories, and were analyzed with respect to treatment strategies, trial evolution, and impact on practice.

Early trials established foundational radiotherapy paradigms, including dose, volume, and fractionation standards. Subsequent studies demonstrated limitations of dose escalation and led to development of prognostic tools such as recursive partitioning analysis (RPA). In gliomas, these trials defined the role of chemoradiation, setting new standards of care (SOC), and clarified the limited benefit of treatment intensification, while recent studies explored molecularly selected therapies. In BM, randomized trials transformed management through stereotactic radiosurgery (SRS)-based approaches and hippocampal-avoidance whole brain radiotherapy (HA-WBRT), with incorporation of neurocognitive function (NCF) and quality-of-life (QOL) endpoints. Trials in meningioma provided some of the first prospective data supporting role of radiotherapy, and PCNSL trials established the superiority of chemoradiotherapy, and response-adapted deployment of WBRT.

RTOG and NRG Oncology trials have driven iterative, evidence-based advances in transitioning to precision. These efforts continue to inform contemporary guidelines and provide a framework for future trials integrating molecular stratification, advanced imaging, and novel therapeutic strategies.

DNA methylation-based tumor classification has become an essential tool in neuropathological diagnostics, yet a subset of central nervous system (CNS) tumors remains unclassifiable using current approaches. The performance of machine learning-based classifiers across varying case complexity is not fully defined. We evaluated the Bethesda Classifier v3 (Bv3) in both straightforward and diagnostically challenging CNS tumor specimens. We first applied Bv3 to 195 CNS tumor samples that were successfully classified using the Heidelberg Classifier v12.8 (Hv12.8; n = 195). We then compared Bv3 classifications in a retrospective cohort of diagnostically challenging, unclassifiable cases by Hv12.8 (n = 321). Both cohorts have been re-evaluated to identify the integrated histomolecular diagnoses according to the WHO CNS5 (2021) classification, hereafter referred to as the final WHO2021 diagnosis. Misclassification was defined as cases with Bv3 scores ≥ 0.9 that did not match the final WHO2021 diagnosis. In the straightforward cohort, Bv3 correctly classified 189/195 cases (97%). In the challenging cohort, Bv3 classified 180/321 previously unclassifiable cases (56%). 13/321 (4%) cases were misclassified by Bv3, of which 7/13 (54%) were labeled as ganglioglioma. Among glioblastomas, 79% were correctly identified, including tumors with lower DNA concentration and lower tumor purity. Bv3 assigned HGAP (High-Grade Astrocytoma with Piloid features) with a score ≥ 0.9 in three cases, which were not concordant with the final WHO2021 diagnosis. The Bethesda Classifier v3 demonstrates robust performance across both straightforward and diagnostically challenging CNS tumor specimens and represents a valuable complementary machine learning tool in routine neuropathological diagnostics.

To evaluate the diagnostic value of probe-based confocal laser endomicroscopy (CLE) in upper tract urothelial carcinoma (UTUC) during ureteroscopy and to determine its potential role in intraoperative risk stratification and selection of patients for kidney-sparing treatment.

From December 2019 to February 2023, CLE was performed in 17 patients with suspected UTUC. A Cellvizio system with a 0.85-mm (2.7 Ch) probe was used after intravenous administration of 10% sodium fluorescein. The obtained images were compared with the results of standard histopathological examination.

CLE was technically feasible in all 17 patients. A total of 85 video sequences were obtained, with a mean of 5 per case. The mean examination time was 5 minutes, and the mean imaging time for a single area was 68 seconds. No complications were observed. UTUC was diagnosed in 15 patients, whereas inflammatory mucosal changes were found in 2. In all 15 patients with tumors, the CLE-based assessment was concordant with the final histopathological diagnosis: 7 tumors were high-grade and 8 were low-grade.

CLE is a safe and technically feasible method that allows real-time differentiation between low-grade and high-grade UTUC and may facilitate intraoperative decision-making between radical treatment and kidney-sparing treatment strategies.

MRI-targeted biopsy is the standard method for prostate cancer diagnosis; however, it is typically supplemented with perilesional or systematic biopsy to minimize the risk of false-negative results. Nevertheless, several studies have demonstrated the feasibility of performing MRI-targeted biopsy alone in carefully selected patients.

To identify factors allowing MRI-targeted biopsy to be performed alone without compromising the detection of clinically significant prostate cancer (csPCa).

A retrospective analysis was conducted in patients who underwent transperineal software mpMR/US fusion and saturation biopsy. Inclusion criteria were PSA more or equal 2 ng/ml and/or the presence of a suspicious lesion on digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), as well as a PI-RADS v2.1 score more or equal 3. Factors included in the stratified analysis were: type of biopsy, PI-RADS score, suspicious lesion on TRUS or DRE, PSA level, PSA density, and lesion size. To formulate clinical rules, a CHAID decision tree algorithm was developed with the following variables: detection of csPCa on software mpMR/US fusion biopsy, PI-RADS score, PSA density, lesion size, age, and type of biopsy. CsPCa was defined as ISUP grade more or equal 2.

A total of 322 patients were included (median age 63 years, PSA 6.7 ng/ml, prostate volume 48 cm). Primary biopsy was performed in 241 patients (74.8%) and repeat biopsy in 81 patients (25.2%). The detection rate of csPCa did not differ significantly between software mpMR/US fusion and combined biopsy (23.6% vs 30.4%; p=0.051). The additional diagnostic value of saturation biopsy for csPCa was 6.8% (range 0-28.6%). Stratified analysis showed no added value of saturation biopsy in primary biopsy patients with PI-RADS 5 lesions, PI-RADS 3-4 lesions with adverse factors, and in repeat biopsy patients with PI-RADS 5 lesions and adverse factors. The developed CHAID model demonstrated an accuracy of 80.2%, sensitivity of 100%, and specificity of 60.7%. According to the model, saturation biopsy was considered unnecessary in patients with PI-RADS 5 lesions with adverse factors, as well as in patients with PI-RADS less or equal 4 lesions combined with PSA density less or equal 0.20 ng/ml/cm and lesion size less or equal 10-12 mm. Application of the CHAID algorithm could reduce the number of saturation biopsies by 60.5% with a missed csPCa risk of less or equal 3.3%.

The presented results indicate that combined biopsy can be safely replaced by only MRI-targeted approaches in carefully selected patients without a substantial risk of missing csPCa, thereby creating a basis for the implementation of personalized prostate biopsy strategies.

Postoperative urinary retention (POUR) is a well-known complication in patients with extramedullary spinal cord tumors and leads to additional complications which are associated with increase in treatment duration and costs. The goal of current study is to define statistically significant risk factors of POUR in patients with extramedullary spinal cord tumors.

The data of 221 patients (155 women and 66 men, aged 19 to 84 years) undergoing surgery for extramedullary spinal cord tumors at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation from January 2019 to December 2022 were evaluated. Of these, 178 patients were included in the prospective analysis, and 43 patients - in the retrospective analysis (based on data obtained from electronic health records). Urological symptoms in patients in the prospective group were assessed by the Centers urologist before and after neurosurgical intervention. Neurological status and urinary function were assessed by neurologist and urologist using the modified JOA score.

A statistically significant association was established between multiple clinical and topographic-anatomical features of extramedullary tumors and postoperative urinary retention (POUR). Based on the results of multiparametric analysis, an algorithm for stratifying patients according to the risk of developing POUR was proposed.

The conducted study demonstrates the association of POUR with a number of clinical and topographic-anatomical features of extramedullary tumors, which should be taken into account when planning surgical intervention and managing patients in the early postoperative period.

Clinical trial design in oncology relies heavily on evidence synthesized from prior studies. However, relevant information, including Kaplan-Meier curves, baseline characteristics, and eligibility criteria, is typically embedded in figures, tables, and free text, making systematic extraction and quantitative synthesis challenging. We developed LEAD-ONC (Literature to Evidence for Analytics and Design in Oncology), a platform designed to transform published clinical trial reports into structured, analyzable data to support evidence-informed trial design.

LEAD-ONC integrates large language models and computer vision techniques to extract multimodal information from published oncology trials, including survival curves, risk tables, and baseline characteristics. Individual patient data are reconstructed from digitized Kaplan-Meier curves, whereas baseline covariates are extracted and harmonized at the trial level across studies. The platform incorporates cross-trial similarity assessment to identify clinically comparable studies and applies Bayesian hierarchical survival modeling to generate predictive survival distributions for future trials.

We demonstrate the utility of LEAD-ONC using a case study in metastatic non-small cell lung cancer. The platform successfully extracted and harmonized data from multiple phase III trials and generated predictive survival distributions for a target population defined by mixed histology. Model-based projections of median overall survival and treatment effect illustrate how the platform can support quantitative assumptions for trial design.

LEAD-ONC provides a scalable framework for systematic evidence synthesis from published literature. By enabling target population-specific survival projections, the platform supports more transparent and data-driven clinical trial design.

LEAD-ONC is available at: https://lead-onc.org/step1.