Background and purpose:Malnutrition and deterioration of nutritional status are common in patients after surgery for gastric cancer,especially in the elderly,and severely affect patient prognosis.Studies have shown that oral nutritional supplements(ONS)can improve the nutritional status and clinical outcomes of patients after surgery for gastric cancer with nutritional risk.This study analyzed elderly patients who underwent radical surgery for gastric cancer in a previous randomized controlled trial to explore the impact of ONS on elderly patients after surgery for gastric cancer with nutritional risk.Methods:Patients discharged after gastric cancer radical surgery with nutritional risk who received treatment at Zhongshan Hospital affiliated with Fudan University from January 2017 to December 2018 were selected.The control group received dietary advice three months after discharge,while the ONS group received dietary advice combined with ONS three months after discharge.The weight,body mass index(BMI),hemoglobin,plasma albumin,and chemotherapy tolerance of the two groups were compared three months after discharge.The data for this study was based on a previous randomized controlled trial(ChiCTR2000029708)which had received ethical approval.This study was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University(B2019-257R2).Results:A total of 125 patients who met the inclusion criteria were finally selected,including 69 in the ONS group and 56 in the control group.After 3 months of intervention,there were no significant differences in weight,BMI,hemoglobin,and plasma albumin levels between the two groups.However,the ONS group showed a significantly smaller decrease in weight change during the intervention period compared to the control group[(2.50±1.60)kg vs(4.24±1.80)kg,P＜0.05].The chemotherapy tolerance of the ONS group was significantly improved compared to the control group,with a decrease in the overall chemotherapy change rate(15.9%vs 41.1%,P=0.002),and fewer patients in the ONS group experienced chemotherapy delays,reduced drug dosages,and discontinuation of chemotherapy than those in the control group.Multivariate analysis showed that body weight,plasma albumin,hemoglobin,NRS2002,and BMI had no significant effect on the normal course of chemotherapy(P＞0.05);only ONS was a significant protective factor,significantly reducing the risk of chemotherapy modification(OR=0.227,P=0.001).Conclusion:ONS helps improve the chemotherapy tolerance of elderly postoperative gastric cancer patients and to some extent enhances their nutritional outcomes.For elderly postoperative gastric cancer patients with nutritional risk,nutritional intervention after discharge has a positive impact on improving clinical outcomes.

Immune checkpoint inhibitors(ICIs)have revolutionized cancer therapy,but their use is frequently complicated by immune-related adverse events(irAEs),which often require management with corticosteroids or additional immunosuppressive agents.The prognostic impact of these therapeutic strategies in the setting of irAEs has not been systematically elucidated.This systematic review and meta-analysis aimed to evaluate the impact of corticosteroid(CS)and second-line immunosuppressant(IM)use on survival outcomes among patients who developed irAEs during ICI therapy.Following a preregistered protocol(PROSPERO CRD1144835),we systematically searched PubMed,Embase,Web of Science,Cochrane Library,SinoMed,CNKI and Wanfang to identify studies published in the past 10 years(up to May 2025)reporting on the association between CS and IM use and survival outcomes in ICI-treated patients with irAEs.Two reviewers independently performed study selection,data extraction,and quality assessment.Meta-analyses were performed using R software.A total of 11 studies comprising 7 255 patients were included.Meta-analysis showed that CS use versus no use was not significantly associated with overall survival(OS)(HR=0.73,95%CI:0.45-1.18)or progression-free survival(PFS)(HR=0.68,95%CI:0.00-98.01).For post-irAE survival outcomes,higher cumulative CS dose(per 1 000 mg increment)was associated with a mild protective effect on post-irAE OS(HR=0.95,95%CI:0.92-0.98)and post-irAE PFS(HR=0.96,95%CI:0.94-0.99).In contrast to CS alone,IM use in combination with CS was associated with significantly increased risk of disease progression or death for post-irAE OS(HR=1.40,95%CI:1.11-1.76)and post-irAE PFS(HR=1.32,95%CI:1.08-1.62).Sensitivity analyses demonstrated good robustness of the main significant results.Current evidence suggests that CS and IM management strategies may differentially affect survival outcomes in patients with irAEs following ICI therapy.Increased cumulative CS dose is not associated with worse outcomes,whereas the addition of second-line IMs may increase the risk of adverse survival outcomes.Further prospective studies are warranted to optimize irAE management strategies and to balance the risks of immunosuppressive therapy with anticancer efficacy.

Colorectal cancer(CRC)is the most common malignant tumor of the digestive tract,with its incidence rate increasing annually and showing a younger-age trend,imposing heavy health and economic burdens on society and families.Regular moderate-to-vigorous physical exercise has been demonstrated to significantly reduce the risk of developing CRC,alleviate complications and adverse reactions related to anti-tumor treatment,improve patients'quality of life,and prolong survival.As a simple and economical non-pharmacological intervention,exercise plays a crucial role throughout CRC development and treatment by regulating inflammatory signals and promoting anabolic metabolism through multi-omics regulatory networks.This article reviewed the latest evidence from clinical and experimental studies,emphasizing the indispensability of exercise in the comprehensive management of CRC patients,and provided a summary analysis of relevant mechanisms.Future research should further investigate the specific impacts of various exercise types,intensities,and frequencies on CRC,combine them with clinical treatment methods such as radiotherapy and chemotherapy,and explore precision approaches under multimodal interventions to maximize clinical benefits.

Regarding the surgical treatment of differentiated thyroid cancer(DTC)in the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer(abbreviation ATA guideline),the overall trend is that for patients in the low-risk group,the surgical scope tends to be more conservative,while for cases in the intermediate-risk group,more individualized treatment is adopted.It emphasizes that the treatment plan should be selected based on the extent of disease,clinical stage,tumor characteristics,and patient preferences.When determining initial treatment goals,shared decision-making with the patient is crucial.When recommending treatment plans,patient preferences must be taken into account as appropriate.For patients who choose surgical treatment,the primary goal is to resect the primary tumor and metastatic lymph nodes.The completeness of surgical resection is an important factor determining prognosis.The main goals should be:reducing the risk of persistent/recurrent disease and metastatic spread,and minimizing treatment-related complications.It is essential to weigh the benefits and risks of surgery;for instance,the burden and harm to the patient caused by permanent hypoparathyroidism may outweigh the thyroid cancer itself.This article summarizes the important progress of the 2025 ATA guidelines in the field of surgery,in order to provide reference for thyroid cancer physicians.

Differentiated thyroid carcinoma(DTC)generally has a favorable prognosis.Most patients with DTC achieve good outcomes with surgery combined with radioactive iodine(RAI)therapy,with a 10-year survival rate exceeding 90%.However,about 5%-10%of patients develop unresectable local disease or distant metastases during the course of treatment,and may even gradually progress to a radioiodine-refractory(RAIR)state.For these advanced and inoperable patients,traditional treatments are difficult to control disease progression,making systemic drug therapy the mainstay of treatment.Over the past decade,significant advances in molecular targeted therapy and immunotherapy have transformed the landscape of advanced DTC.The2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer(abbreviation ATA guideline)propose a precision treatment model centered on molecular subtyping.This article compares the main differences in systemic therapy for advanced DTC between the 2015 and 2025 ATA guidelines,and,by integrating key clinical trials and real-world data,analyzes the evolution of treatment strategies over the past ten years and future directions.

External beam radiotherapy(EBRT)is one of the important treatment methods for head and neck malignant tumors.However,EBRT in differentiated thyroid cancer(DTC)has remained controversial for decades.In 2025,the American Thyroid Association(ATA)updated its clinical practice guidelines for the management of DTC in adults,which is known as the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer(abbreviation ATA guideline).In recent years,various emerging radiotherapy techniques,such as intensity modulated radiotherapy(IMRT)and stereotactic body radiotherapy(SBRT),have been applied in DTC and have achieved positive results.Compared with the 2015 ATA guideline,the revised guidelines adopt a more permissive perspective on EBRT,underscoring the importance of modern radiotherapy techniques and individualized indications.Notably,the recommendations now include the use of EBRT in the management of oligometastatic disease or SBRT.This article compared the2025 ATA guideline with 2015 ATA guideline,then provides a systematic interpretation of the section on EBRT,aiming to provide evidence-based foundation for clinical practice.

Background and purpose:Owing to the reliance on computed tomography(CT)for evaluating skull-base bone invasion in nasopharyngeal carcinoma and the potential harm of ionizing radiation from CT,zero echo time magnetic resonance imaging(ZTE-MRI)offers high-resolution bone delineation without radiation exposure.Therefore,this study aimed to systematically assess the diagnostic performance of ZTE-MRI for detecting skull-base bone invasion and to explore its clinical feasibility as an alternative to CT.Methods:This prospective study collected 95 nasopharyngeal carcinoma patients treated in Fujian Provincial Cancer Hospital from April 2020 to December 2022 as the research subjects.The patients who do not meet the inclusion standards would be excluded.Using the GE Discovery 750W 3.0T MR scanner to obtain unenhanced scan and enhanced scan,using ZTE-MRI technology to obtain ZTE-MRI and CT image.The results of the imaging scans were used to independently assess skull base bone invasion by two radiologists.This study was approved by the Ethics Committee of Fujian Cancer Hospital(K2025-314-01),and informed consent from the patients were obtained.Results:A total of 80 nasopharyngeal carcinoma patients were included in the final analysis.There was a high degree of consistency between CT diagnosis of nasopharyngeal carcinoma skull base bone invasion and of gold standards,and the difference was statistically significant(κ=0.645,P＜0.001).There was a high degree of consistency between ZTE-MRI diagnosis of nasopharyngeal carcinoma skull base bone invasion and of gold standards,and the difference was statistically significant(κ=0.774,P＜0.001).There was a high degree of consistency between ZTE-MRI combined with conventional MRI diagnosis of nasopharyngeal carcinoma skull base bone invasion and gold standards,and the difference was statistically significant(κ=0.912,P＜0.001).Conclusion:ZTE-MRI technology provides"like CT"images for the skull base bone invasion in nasopharyngeal carcinoma,and ZTE-MRI technology can replace CT examination in clinical practice.

Background and purpose:Melanoma is a highly invasive malignant tumor originating from melanocytes,which poses a great threat to human life and health around the world,and its morbidity and mortality have been rising continuously in recent years.Telomerase and autophagy play crucial roles in cell proliferation,survival and stress response.Telomerase maintains the replication ability of cells by prolonging telomeres at the ends of chromosomes,and autophagy,as a self-degradation mechanism of cells,can not only help cells remove damaged components to promote survival,but also induce cell death under certain conditions.In the tumor environment,they are often abnormally activated or out of balance,and participate in the occurrence and development of many cancers,including melanoma.This study investigated the roles of telomerase and autophagy in melanoma progression and evaluated the potential synergistic therapeutic effects of combined application of telomerase inhibitor BIBR1532 and autophagy inhibitor chloroquine(CQ)in melanoma treatment.Methods:Malignant melanoma cells A375 were treated with telomerase inhibitor BIBR1532.The cell viability was assessed using the cell counting kit-8(CCK-8)assay,and the cell apoptosis was detected using the Annexin Ⅴ/propidium iodide(PI)double staining method.Additionally,the expressions of autophagy-related proteins LC3-Ⅱand p62 were detected by Western blot,and the changes in autophagy flux were observed using dual-tagged adenovirus transfection technology.Based on these studies,BIBR1532 and the autophagy inhibitor CQ were further applied in combination to analyze cell proliferation,apoptotic rate,changes in mitochondrial membrane potential,and cell cycle distribution,and the cloning formation experiment was used to verify the cell's proliferative capacity,thereby comprehensively evaluating the efficacy of this combined treatment strategy.Results:Telomerase inhibitor BIBR1532 at a concentration of 50 μmol/L significantly inhibited the growth of malignant melanoma cells A375 and induced apoptosis.At the same concentration,BIBR1532 upregulated the expression of the autophagy-related protein LC3-Ⅱ in A375 cells,while downregulating the expression of p62 protein.By transducing A375 cells with a dual-tagged adenovirus,it was observed that autophagy flux was significantly enhanced after treatment with BIBR1532.Furthermore,the combined application of BIBR1532(50 μmol/L)and the autophagy inhibitor CQ(20 μmol/L)significantly promoted the death of A375 cells,induced apoptosis and destruction of mitochondrial membrane potential,caused cell cycle arrest at the G2/M phase,and significantly inhibited the cell's clonogenic ability.Conclusion:Telomerase inhibitor BIBR1532 not only inhibits the proliferation of malignant melanoma cells but also activates the autophagy process in these cells,and inhibition of the autophagy response by autophagy inhibitor CQ can enhance the sensitivity of malignant melanoma cells to telomerase inhibitor BIBR1532.

Background and purpose:The ripple filter(RiFi)is a passive energy modulator used in particle beam therapy to broaden the Bragg peak.The 1D-RiFi features a wavy structure that can broaden a monoenergetic carbon ion beam to 3 mm,while the 2D-RiFi employs a two-dimensional groove structure to achieve a 6 mm beam broadening.This study aimed to evaluate the potential advantages of the 2D-RiFi over the 1D-RiFi in terms of dose distribution optimization,treatment efficiency,and organ at risk(OAR)dose control by comparing water phantom and clinical patient plans.Methods:Carbon ion treatment plans were designed for water phantoms and 20 patients using both 1D-RiFi and 2D-RiFi.The water phantom plans targeted a cubic region of interest(80 mm×80 mm×80 mm)at ranges of 95,105,190 and 290 mm.From patients who underwent carbon ion therapy at Shanghai Proton and Heavy Ion Center,20 cases were selected via simple random sampling with computer-generated random numbers,stratified by the proportion of different tumor sites(6 head and neck tumors,4 prostate tumors,4 lung tumors,2 pancreatic tumors,2 liver tumors and 2 shoulder tumors).Key dosimetric metrics,including homogeneity index(HI),conformity index(CI)and clinical target volume(CTV)coverage by 95%prescription dose(V95),were analyzed along with OAR doses.Energy layers,beam time,and irradiation time were compared between the two RiFi types.Statistical analysis was performed using the Wilcoxon rank-sum test,with a significance level of P＜0.05.This study was approved by the ethics committee of Shanghai Proton and Heavy Ion Center(approval number:240311EXP-01).Results:For water phantom plans,the 1D-RiFi plans achieved HI of 0.04±0.01,CI of 1.10±0.03,V95 of 99.92%±0.06%and flatness of 6.52%±0.61%,while the 2D-RiFi plans achieved HI of 0.04±0.01,CI of 1.11±0.04,V95 of 99.92%±0.06%,and flatness of 7.52%±0.81%.The mean doses to the distal and lateral block in 1D-RiFi plans were(1.34 Gy±0.43)Gy[relative biological effectiveness(RBE)]and(0.98±0.05)Gy(RBE),respectively,compared to(1.47±0.33)Gy(RBE)and(0.94±0.03)Gy(RBE)for 2D-RiFi plans.The use of 2D-RiFi reduced the average beam-on time by 43%and the number of energy layers by 48%.For clinical plans,the 1D-RiFi plans had HI of 0.07±0.04,CI of 1.94±0.67,and V95 of 98.81%±1.61%,compared to HI of 0.07±0.05,CI of 1.95±0.70,and V95 of 98.79%±1.69%for the 2D-RiFi plans,with no statistically significant differences(P=0.77,0.65 and 0.66,respectively).OAR mean doses increased slightly with the 2D-RiFi plans(average increase of 0.8%,P=0.62)but remained within clinically acceptable limits.The 2D-RiFi plans reduced energy layers by 45%-50%(average 48%),beam time by 32%-49%(average 44%),and irradiation time by 28%-41%(average 36%).Conclusion:Treatment plans using the 2D-RiFi achieved comparable target coverage to those using the 1D-RiFi,with a slight but clinically acceptable increase in OAR doses.The application of the 2D-RiFi significantly reduced the number of energy layers,beam time and irradiation time in carbon ion therapy,enhancing treatment efficiency.

Background and purpose:Limited-stage(LS)-small cell esophageal carcinoma(SCEC),characterized by high aggressiveness and an extremely poor prognosis,lacks standardized staging systems due to its rarity.Consequently,no randomized controlled clinical trials exist to guide therapeutic strategies,necessitating reliance on extrapolated protocols from small cell lung cancer(SCLC)paradigms,though clinical outcomes remain dismal.This study aimed to analyse survival outcomes,prognostic factors,failure patterns and therapeutic strategies in patients with LS-SCEC.Methods:We conducted a retrospective single-center study of LS-SCEC patients diagnosed and treated at Fudan University Shanghai Cancer Center from January 2006 to June 2023.Clinicopathological data for diagnosis,staging and follow-up were rigorously collected.Patients with mixed esophageal tumors in whom small cell carcinoma was not the predominant histological component(＜50%)were excluded.Continuous variables were presented as x±s.Categorical variables were summarized as counts and percentages,with intergroup comparisons performed using χ2 test or Fisher's exact tests.Survival analysis was performed using the Kaplan-Meier method,and Cox regression was used to analyse factors related to prognosis.A two-sided P＜0.050 was considered statistically significant.A 1∶1 nearest-neighbour propensity score matching was applied to compare survival outcomes between patients undergoing radical chemoradiotherapy and those receiving radical surgery followed by adjuvant chemotherapy.Results:Of 261 eligible LS-SCEC patients included,the median follow-up duration was 72.7 months(95%CI:52.0-92.4),with a median cancer-specific survival(CSS)of 24.5 months(95%CI:19.7-29.3)and a 5-year CSS rate of 32.8%.The median progression-free survival(PFS)was 12.0 months(95%CI:10.7-13.3).Among these,67 patients remained recurrence-free,and 169 patients exhibited disease progression after first-line treatment.Distant metastasis was the predominant recurrence pattern(131 patients,77.5%),whereas locoregional recurrence occurred in only 38 patients(22.5%).The most frequent metastatic sites were liver(54 patients),followed by bone(25 patients),brain(24 patients),and lung(23 patients).The number of chemotherapy cycle and TNM stage(8th edition)were independent prognostic factors for CSS and PFS in LS-SCEC patients.Comparative analysis of radical surgery with adjuvant chemotherapy versus radical chemoradiotherapy revealed no statistically significant differences in CSS and PFS(P＞0.05),even after propensity score matching.Patients with cervical/upper thoracic tumors,longer tumor lengths,and advanced stages were more likely to receive chemoradiotherapy;additionally,the chemoradiotherapy group had a higher proportion of patients completing≥4 chemotherapy cycle.Conclusion:This large-sample retrospective study with comprehensive datasets and long-term follow-up demonstrated comparable survival outcomes between radical chemoradiotherapy and radical surgery plus adjuvant chemotherapy for LS-SCEC.A minimum of 4 chemotherapy cycle was associated with improved prognosis.SCEC is associated with a high risk of distant metastasis and marked heterogeneity.Therefore,the treatment of LS-SCEC should prioritize an individualized approach.