Background and Aims:Breast-conserving surgery,which balances tumor excision with preservation of breast tissue,has become a widely adopted surgical approach for breast cancer.However,postoperative tumor recurrence remains a major factor affecting patient prognosis.Accurate risk prediction tools are urgently needed to guide personalized treatment strategies.This study aimed to develop a risk prediction model for tumor recurrence after BCS based on admission clinical data and to evaluate its predictive performance to provide a scientific and practical tool for clinical decision-making.Methods:A total of 224 breast cancer patients who underwent breast-conserving surgery between May 2017 and May 2019 were enrolled.Postoperative recurrence was recorded during follow-up.Multivariate Logistic regression analysis was used to identify independent risk factors for recurrence and to construct a risk prediction model.The model's discriminative ability was assessed using the receiver operating characteristic(ROC)curve,and its calibration was evaluated using a calibration curve.Results:208 patients completed follow-up,ranging from 32 to 84 months,with a mean duration of(58.41±7.33)months.The recurrence rate was 17.79%.Multivariate Logistic regression analysis revealed that TNM stage Ⅲ(OR=2.029),tumor diameter≥4 cm(OR=1.782),≥4 lymph node metastases(OR=1.958),lymphovascular invasion(OR=1.984),and HER2 positivity(OR=1.774)were independent risk factors for recurrence(all P<0.05).The Logistic regression model was established as follows:Y=-12.788+0.707X?+0.578X?+0.672X?+0.685X?+0.573X?.The model yielded an area under the ROC curve(AUC)of 0.934(95%CI=0.891-0.963),with a sensitivity of 86.49%and specificity of 96.49%.The calibration curve demonstrated good agreement between predicted and observed outcomes(χ2=0.501,P=0.392).Conclusion:TNM stage Ⅲ,tumor diameter≥4 cm,≥4 lymph node metastases,lymphovascular invasion,and HER2 positivity are independent risk factors for tumor recurrence after breast-conserving surgery.The risk prediction model based on these factors demonstrates favorable discrimination and calibration,offering valuable guidance for postoperative risk assessment and clinical intervention.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Perioperative rehabilitation aims to alleviate symptoms,restore function,and improve quality of life.These goals largely involve subjective patient experiences,which are not fully captured by traditional outcome measures.In recent years,patient-reported outcomes(PROs)have emerged as essential tools to quantify patients'perceptions of health and have been widely used in drug and device clinical trials.This review summarizes the current applications of PROs in general surgery,including symptom description,comparison of surgical methods,complication warning,and patient management.Practical cases and evidence from domestic and international studies are discussed.With the integration of electronic PROs(ePROs),artificial intelligence,and natural language processing,future efforts should focus on developing localized,specialty-specific tools and establishing stronger correlations between PROs and clinical outcomes to support the transition from disease-centered to patient-centered surgical care.

With the continuous advancement of precision medicine,robotic surgical techniques have been rapidly promoted,and robotic thyroidectomy has been increasingly applied in China,demonstrating advantages such as refined manipulation,minimal invasiveness,and improved cosmetic outcomes.Since the initiation of this procedure,our center has completed over 4 000 cases of robotic thyroidectomy,accumulating extensive practical experience and establishing a comprehensive system for surgical coordination and assistant training.An excellent surgical assistant plays a pivotal role in ensuring procedural efficiency and patient safety.Based on our center's experience,this article systematically summarizes key training elements and intraoperative coordination techniques for assistants in robotic thyroidectomy.Key areas include preoperative preparation(such as patient selection,imaging review,and assessment of non-recurrent laryngeal nerve risk)and intraoperative cooperation(including Trocar placement,instrument exchange,gauze management,and hemostasis).This paper aims to provide practical reference for surgical teams engaged in robotic thyroidectomy,promote the standardization of related techniques,enhance team coordination and surgical quality,and ultimately deliver safer and more efficient medical services to patients.

Thyroid cancer has become one of the fastest-growing malignancies in recent years,with a significant improvement in the 5-year relative survival rate among Chinese patients.Accurate diagnosis,standardized treatment,and effective follow-up are essential to improve clinical outcomes,while the promotion and implementation of clinical guidelines are critical for achieving standardized and homogeneous management.In 2022,the China Anti-Cancer Association(CACA)released the 2022 Chinese Guidelines for Integrated Diagnosis and Treatment of Tumors(CACA)—Thyroid Cancer,which systematically applied the concept of multidisciplinary integrated management to the entire care continuum of thyroid cancer,reflecting both Chinese characteristics and local experience.Building upon this,the 2025 edition of the guidelines was updated and revised based on the latest evidence and clinical practices.This article provides a systematic interpretation of the 2025 CACA guidelines,focusing on the diagnosis,treatment,and follow-up of thyroid cancer,with the aim of offering practical guidance for clinicians and promoting standardized,integrated management of thyroid cancer in clinical practice.

Background and Aims:The BRAFV600E mutation is the most common genetic alteration in papillary thyroid carcinoma(PTC)and is widely used to guide surgical extent and risk stratification.However,other genetic variants are increasingly identified in clinical practice,and their association with lymph node metastasis(LNM)remains unclear.Most existing studies have compared BRAFV600E-mutated cases with BRAF wild-type cases without stratifying specific mutation types,potentially affecting the accuracy of risk assessment.This study aimed to compare the lymph node metastatic features between PTC patients with different common genetic alterations and those with the BRAFV600E mutation.Methods:A retrospective analysis was conducted on 4 795 PTC patients who underwent surgery and genetic testing at Fudan University Shanghai Cancer Center from January 2019 to January 2025.Patients with a single genetic alteration were included and grouped accordingly.Propensity score matching(PSM)was used to control for confounding factors including age,sex,and T stage.The number of metastatic lymph nodes and N stage were compared between each mutation group and the BRAFV600E group.Results:After PSM,patients in the CCDC6-RET and NCOA4-RET fusion groups had significantly higher numbers of metastatic lymph nodes and N1b stage rates compared to the BRAFV600E group(all P<0.05).No significant differences were observed between the ETV6-NTRK3 fusion or RAS mutation groups and the BRAFV600E group in terms of lymph node metastasis or N stage(all P>0.05).Conclusion:PTC patients harboring CCDC6-RET or NCOA4-RET fusions exhibit a significantly higher lymph node metastatic burden than those with the BRAFV600E mutation,suggesting more aggressive behavior.In contrast,ETV6-NTRK3 and RAS-mutated PTCs show similar metastatic profiles to BRAFV600E-mutated cases.Preoperative genetic profiling may help identify patients at high risk of metastasis and guide individualized lymph node dissection strategies.

Background and Aims:Medullary thyroid carcinoma(MTC)is an aggressive malignancy that is frequently associated with cervical lymph node metastasis,significantly affecting patient prognosis.However,the risk factors for lateral cervical lymph node metastasis(LLNM)in MTC remain inconclusive.This study aims to identify the risk factors associated with LLNM in MTC patients,in order to inform individualized surgical decision-making.Methods:The clinicopathologic data of 242 patients with MTC who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital from 2011 to 2019 were retrospectively collected.The relationships between preoperative tumor markers,including calcitonin and carcinoembryonic antigen(CEA),and LLNM were evaluated.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM.Results:Preoperative calcitonin level was significantly associated with tumor diameter,the number of lymph node metastases,and the extent of lymph node involvement,while preoperative CEA level was significantly associated with tumor diameter(all P<0.05).The area under the ROC curve for preoperative calcitonin in diagnosing LLNM was 0.750(P=0.000),with an optimal cutoff value of 266.00 ng/L(sensitivity 0.854,specificity 0.577).The diagnostic value of preoperative CEA for LLNM was limited.Univariate analysis showed that sex,extracapsular extension,T stage,central lymph node metastasis(CLNM),bilateral lesions,preoperative calcitonin,tumor diameter,and multifocality were significantly associated with LLNM in MTC patients(all P<0.05).Multivariate analysis revealed that CLNM(OR=17.645,95%CI=7.728-40.290)and preoperative calcitonin≥266.00 ng/L(OR=7.832,95%CI=3.132-19.582)were independent risk factors for LLNM.Conclusion:CLNM and elevated preoperative calcitonin level are closely associated with LLNM in patients with MTC.The combination of these two indicators may help identify high-risk patients for LLNM,thereby and promoting individualized and precise treatment strategies for MTC.

Background and Aims:Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer.However,the incidence of postoperative complications remains significant,and the associated risk factors have not been fully elucidated.This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods:A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022.Patients were grouped according to the presence or absence of postoperative surgical complications,and multivariate Logistic regression was used to identify independent risk factors.Results:A total of 545 patients with 602 reconstructed breasts were included.Surgical complications occurred in 13.6%(82/602)of the cases,including infection,wound dehiscence/poor healing,flap or nipple-areola necrosis,and implant leakage/rupture.Multivariate analysis revealed that nipple-areola complex resection(OR=1.934,95%CI=1.056-3.542,P=0.033),postoperative radiotherapy(OR=2.483,95%CI=1.527-4.036,P<0.001),implant volume≥300 mL(OR=1.663,95%CI=1.025-2.696,P=0.039),and surgeon experience with fewer than 10 cases(OR=1.804,95%CI=1.092-2.979,P=0.021)were all independent risk factors for complications.Conclusion:NAC resection,radiotherapy,large implant volume,and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction.Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.

Background and Aims:Triple-negative breast cancer(TNBC)is a clinically aggressive subtype of breast cancer with limited treatment options.Immune checkpoint blockade(ICB)combined with chemotherapy has emerged as a key neoadjuvant therapeutic strategy for TNBC.However,significant variability in ICB efficacy exists among patients,and the underlying mechanisms related to the tumor immune microenvironment(TME)remain unclear.Cancer-associated fibroblasts(CAFs),as major stromal components,regulate TME and influence immunotherapy responses.Fibroblast activation protein(FAP),a key marker of CAFs,has been associated with poor prognosis in multiple solid tumors,yet its immunological role in TNBC has not been systematically investigated.This study aims to elucidate the expression pattern of FAP in TNBC,its impact on the immune microenvironment and ICB efficacy,and to explore its potential immunosuppressive mechanisms and clinical implications.Methods:The data from TCGA and the I-SPY2 clinical trial were integrated to assess the association of FAP expression with prognosis,immune cell infiltration,and immune checkpoint molecule expression in TNBC.Immune landscape profiling was conducted using CIBERSORT,GSEA enrichment analysis,and differential gene expression analysis(DESeq2)to characterize the immune features associated with FAP expression and to identify downstream genes at the transcriptomic level.CAF models with FAP overexpression or knockdown were constructed and co-cultured with CD8? T cells to evaluate FAP's regulatory effects on CD8? T cell activity and apoptosis.The expression of COL1A1,a potential FAP-regulated gene identified from transcriptomic analysis,was validated using qPCR and Western blot.Finally,clinical data and multiplex immunofluorescence pathology samples from TNBC patients at Xiangya Hospital were analyzed alongside I-SPY2 data to determine the predictive value of FAP expression for pathological complete response(pCR)following neoadjuvant immunotherapy.Results:FAP was significantly upregulated in TNBC tumor tissues compared to normal tissues and associated with shorter overall survival.Multivariate Cox regression analysis identified FAP as an independent adverse prognostic factor.High FAP expression was correlated with reduced infiltration of CD8? T cells,NK cells,and Tfh cells,as well as upregulation of immune checkpoints including CD276,TIM-3,and PD-L2.In CAF models,FAP overexpression suppressed CD8? T cell activity and promoted apoptosis,while FAP knockdown had the opposite effect.Transcriptomic analysis showed that COL1A1 and other collagen-related genes were significantly upregulated in the FAP-high group and positively correlated with FAP expression;qPCR and Western blot confirmed that FAP positively regulates COL1A1 expression.Analysis of I-SPY2 data revealed that FAP-low patients receiving pembrolizumab plus chemotherapy had significantly higher pCR rates compared to FAP-high patients.Consistently,clinical data from the Xiangya cohort showed reduced CD8? T cell infiltration and lower pCR rates in FAP-high patients,with a ROC AUC of 0.857 for predicting treatment response.Conclusion:FAP-high CAFs contribute to the formation of an immunosuppressive TME in TNBC by promoting COL1A1 secretion,inhibiting CD8? T cell function,and upregulating immune checkpoint molecules.High FAP expression is associated with poor prognosis and reduced response to immunotherapy,highlighting FAP as both a prognostic biomarker and a potential therapeutic target for stratified and combination treatment strategies in TNBC.

Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.