Prostate cancer represents a prevalent malignancy within the male genitourinary system. In recent years, its incidence in China has gradually increased, becoming a significant public health issue. While early detection correlates strongly with improved prognosis, the majority of newly diagnosed prostate cancer patients in China are already in intermediate or advanced stages, precluding curative-intent interventions and contributing to marked survival disparities. The progression of prostate cancer is lengthy, typically encompassing diagnosis, treatment, progression, metastasis, and death, accompanied by a decline in quality of life. Personalized treatment plans should be developed based on the disease stage and patient preferences. In non-metastatic prostate cancer, where the tumor is confined to the prostate, surgery and radiotherapy are the primary treatments, supplemented by neoadjuvant and adjuvant therapies to delay metastasis. For metastatic prostate cancer, systemic therapy is prioritized to prolong survival. In metastatic hormone-sensitive prostate cancer, controlling androgen levels is crucial, while treatment options for metastatic castration resistant prostate cancer are relatively limited, necessitating individualized and precise treatment. During prostate cancer management, prostate-specific antigen levels are closely linked to prognosis and require monitoring. Bone metastasis, the most common site in prostate cancer patients, often triggers skeletal-related events, demanding effective prevention and management. Treatment-related adverse reactions are also a clinical challenge, requiring balanced risk-benefit assessments and judicious drug selection to preserve quality of life. Rapid advancements in screening technologies, surgical innovations, drug development, and China-specific epidemiological factors further complicate decision-making in holistic prostate cancer management. To optimize the standardization of prostate cancer diagnosis and treatment in China, the Genitourinary Oncology Committee of Chinese Anti-cancer Association synthesized global guidelines, clinical evidence and clinical expertise, and addressed critical challenges in the whole-course management of prostate cancer to formulate a multidisciplinary consensus. The expert consensus on whole-course management of prostate cancer (2025 edition) establishes standardized protocols to guide clinical practice, improve treatment outcomes, and enhance patient quality of life.
Humans ; Male ; Prostatic Neoplasms/diagnosis* ; Consensus ; Prostate-Specific Antigen/blood* ; Quality of Life ; Prostatic Neoplasms, Castration-Resistant/pathology* ; China ; Bone Neoplasms/secondary* ; Androgen Antagonists/therapeutic use*

Lung cancer is the malignancy with the highest incidence and mortality burden globally, ranking first in both morbidity and mortality among all types of malignant tumors. Pathologically, lung cancer is classified into non-small cell lung cancer (NSCLC) and small cell lung cancer, with NSCLC accounting for approximately 85% of cases. Due to the often subtle or nonspecific clinical manifestations in early-stage disease, many patients are diagnosed at a locally advanced or metastatic stage, where treatment options are limited and prognosis remains poor. Therefore, molecular targeted therapy focusing on driver genes has become a key strategy to improve the survival outcomes of patients with advanced NSCLC. The epidermal growth factor receptor (EGFR) is one of the most common driver genes in NSCLC. While EGFR mutations occur in approximately 12% of advanced NSCLC patients globally, the incidence rises to 55.9% in Chinese patients. Among EGFR mutations, P-loop and αC-helix compressing (PACC) mutations account for about 12.5%. Currently, EGFR tyrosine kinase inhibitors (TKIs) have become the first-line standard treatment for advanced NSCLC patients with classical EGFR mutations, with efficacy well-established through clinical studies and real-world evidence. However, with rapid advancements in NSCLC precision medicine and deeper exploration of the EGFR mutation spectrum, EGFR PACC mutations have emerged as a key clinical focus. The structural characteristics of these mutations lead to significant variability in responses to EGFR TKIs, leaving therapeutic options still limited, while detection challenges persist due to the sensitivity constraints of current testing technologies, driving increasing demand for improved diagnostic and treatment approaches. The current clinical evidence primarily stems from retrospective analyses and small-scale exploratory studies, while prospective, large-scale, high-level evidence-based medical research specifically targeting this mutation subtype remains notably insufficient. This evidence gap has consequently led to the absence of standardized guidelines or expert consensus regarding optimal treatment strategies for advanced NSCLC with EGFR PACC mutations. As a clinical consensus specifically addressing EGFR PACC-mutant NSCLC, this document provides a comprehensive framework encompassing the clinical rationale for EGFR PACC mutation testing, therapeutic strategies for advanced-stage disease, management of treatment-related adverse events, and follow-up protocols. The consensus underscores the pivotal role of EGFR PACC mutation detection in precision medicine implementation while offering evidence-based recommendations to guide personalized therapeutic decision-making. By establishing clear clinical pathways encompassing molecular testing, therapeutic intervention, and long-term monitoring for EGFR PACC-mutant NSCLC, this consensus aims to meaningfully improve patient survival outcomes while serving as a robust, evidence-based foundation for developing personalized clinical management approaches.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; ErbB Receptors/antagonists & inhibitors* ; Mutation ; Lung Neoplasms/pathology* ; Protein Kinase Inhibitors/therapeutic use* ; Molecular Targeted Therapy ; Consensus

Mutations in the human epidermal growth factor receptor 2 (HER-2) gene are recognized as significant but relatively rare driver alterations in non-small cell lung cancer (NSCLC). These mutations predominantly manifest as gene mutation, amplification, and protein overexpression, with an estimated prevalence from 2.8% to 15.4% among NSCLC patients in China. Research indicates that HER-2 mutations, particularly exon 20 insertions (ex20ins), are strongly correlated with aggressive tumor biology, poor prognosis, and limited responsiveness to immunotherapy, thereby exhibiting characteristics of "cold tumors". Overexpression and amplification of HER-2 are also indicative of a heightened risk of chemotherapy resistance and unfavorable survival outcomes, suggesting a distinct molecular subtype with unique biological behaviors. In recent years, novel antibody-drug conjugates (ADCs), particularly trastuzumab deruxtecan (T-DXd), have demonstrated groundbreaking efficacy in HER-2-mutant advanced NSCLC patients. These ADCs have shown significant clinical benefits, including high objective response rates and progression-free survival advantages, making T-DXd the first targeted therapy approved for this patient population globally. Additionally, ADCs have exhibited therapeutic potential in patients with HER-2 overexpression, thus broadening the scope of their indications. To standardize the clinical diagnosis and treatment of HER-2 variant NSCLC, the Chinese Anti-cancer Association convened multidisciplinary experts from oncology, pulmonology, thoracic surgery, pathology, and molecular diagnostics to develop this consensus based on the latest evidences from both domestic and international studies, coupled with China's clinical practice experience. This consensus focuses on the molecular characteristics, clinical significance, diagnostic strategies, treatment options, and safety management of HER-2 alterations, addressing ten critical clinical questions in a systematic manner. It is recommended that HER-2 status be routinely tested at initial diagnosis, disease progression, or recurrence in NSCLC. Mutation detection should prioritize next-generation sequencing (NGS), while protein overexpression may be assessed using immunohistochemistry (IHC) standards for gastric cancer. Fluorescence in situ hybridization (FISH) is recommended for detecting HER-2 amplification. Regarding treatment, for HER-2-mutant patients, first-line therapy may involve chemotherapy with or without immune checkpoint inhibitors (ICIs), similar to treatment approaches for driver-gene negative populations. Upon failure of first-line treatment, trastuzumab deruxtecan, may be considered as alternative therapeutic options. For patients with HER-2 overexpression, ADCs should be considered after failure of standard systemic therapy. However, the management of HER-2 amplification remains insufficiently supported by evidence, necessitating a cautious, individualized approach. The consensus also includes detailed recommendations for screening and managing adverse effects associated with ADCs, such as interstitial lung disease (ILD), emphasizing the crucial role of safety management in ensuring treatment efficacy. The publication of this consensus aims to drive the standardization of molecular diagnosis and treatment pathways for HER-2 variant NSCLC, improve clinical outcomes and quality of life for patients, and facilitate the implementation of personalized precision treatment strategies.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Lung Neoplasms/pathology* ; Receptor, ErbB-2/metabolism* ; Mutation ; Immunoconjugates/therapeutic use* ; Consensus ; Trastuzumab/therapeutic use* ; Camptothecin/analogs & derivatives*

Objective:We summarize the clinical characteristics of surgeries in which the thyroid lobe is used as a transfer flap to treat early pharyngeal fistula following total laryngectomy.We also provide useful data for improving the diagnosis and management of this condition.Methods:Retrospective analysis was conducted on data from 8 patients with pharyngocutaneous fistulas after total laryngectomy for laryn-geal and pharyngeal cancer patients admitted to Hunan Provincial People's Hospital(The First Hospital Affiliated to Hunan Normal University)between October 2016 and October 2023.The surgeons performed a double-layer repair technique that included local inversion and a purse-string suture of the fistula using the thyroid lobe as a transfer flap.Clinical data were collected to analyze postoperative outcomes.Results:All eight patients experienced successful pharyngeal fistula repair.Postoperatively,these patients were managed with nasogastric tube feed-ing,liquid diet,and prophylactic antibiotics to prevent infection.After 10 days,their diet was changed to oral liquids,and their nasogastric tubes were removed.All patients were discharged after complete recovery.Conclusions:Use of the thyroid lobe as a transfer flap in a double-layer repair technique involving local inversion of the fistula is an effective method for repairing early pharyngeal fistula after total laryngectomy.This approach offers several advantages,including ease of flap harvesting,shortened operation time,reduced patient discom-fort,high transfer flap survival rate,and rapid postoperative recovery.The clinical efficacy of this technique is well-supported,making it a re-liable option for the management of early pharyngeal leaks.

The incidence of breast cancer(BC)is on the rise.The effective and precise management of BC continues to be topical.Tumor in-filtrating lymphocytes(TILs),significant biomarkers indicative of the biological behavior of BC,have not been well recognized in clinical prac-tice.There are some impediments,including the lack of a standard protocol for the quantification of TILs,an optimized threshold for TILs,and a repeatable noninvasive method for the assessment of TILs.These issues are the major controversies preventing the use of TILs as bio-markers in the clinical management of BC.Nevertheless,the value of TILs as biomarkers in the assessment of the prognosis and prediction of the response to treatment cannot be neglected,as they show promise in promoting precise and individualized management of BC.We aimed to offer a comprehensive outline of the current controversies and consensus regarding TILs as biomarkers in the management of BC,with the aim of providing a basis for the rational application of TILs as biomarkers.

Objective:To investigate gut microbiota differences between individuals with and without colorectal adenoma(CRA)and to identify gut microbes associated with CRA.Methods:This cross-sectional study analyzed the gut microbiota of 100 patients with CRA and 68 individuals without CRA(aged 40-75 years)who underwent colonoscopies between March 2021 and March 2022 at Tianjin Nankai Hospital.Fecal samples were sequenced for the V3-V4 region of the bacterial 16S rRNA gene using the Illumina NovaSeq platform.Results:Compared to the non-CRA group,the CRA group exhibited reduced relative abundances of identified and unidentified Lachnospiraceae,with increased Faecalibacterium and Streptococcus.In the non-CRA group,the relative abundances of Coprococcus,unidentified Clostridiaceae,and Clostridium were higher.LEfSe analysis revealed significant enrichment of Gammaproteobacteria,Proteobacteria,Enterobacteriales,and Faecalibacterium in the CRA group,while the non-CRA group was enriched for Moraxellaceae,Acinetobacter,and Anaerostipes.Conclusions:These findings suggest a discernible disparity in the gut microbiota structure between CRA patients and individuals without adenoma.The enrichment of potential pathogenic taxa,such as Faecalibacterium and Streptococcus,in the CRA group suggests a possible association with adenoma development.

Gastric cancer(GC)is one of the most prevalent malignant tumors worldwide.Although the incidence of GC has significantly de-creased over the past decade owing to advancements in early stage diagnostic techniques,its mortality rate remains high.Immune check-point inhibitors(ICIs),such as programmed cell death protein-1(PD-1)inhibitors,have become a promising treatment option for patients with GC.However,only a minority of patients with GC exhibit durable responses to PD-1 inhibitor therapy.Moreover,the overall efficacy of these treatments is limited.Existing studies have indicated that immunotherapeutic failure is closely associated with the development of res-istance to PD-1 inhibitors;however,the mechanisms underlying this resistance are not fully understood.Therefore,this review aimed to ex-plore the potential molecular mechanisms contributing to the resistance to PD-1 inhibitors in the treatment of GC and provide a new re-search perspective on the clinical responses to this resistance.

Proteasome inhibitors(PIs)have become the backbone of combinatorial treatment regimens for patients with multiple myeloma(MM).The PIs-bortezomib,carfifilzomib,and ixazomib are all approved for treatment of MM.However,these drugs have shown a variety signs of cardiovascular toxicity,including heart failure,hypertension,arrhythmias,ischaemic heart disease,and thromboembolism,which in-crease patient risk associated with treatment,and negatively impact patient outcomes.Effective detection,monitoring,and management of PI-related cardiovascular toxicity are thus essential for improving clinical outcomes for patients with MM.This consensus proposes recom-mendations for the monitoring and management of cardiovascular toxicity related to PIs with the aim of standardizing their clinical applica-tion.

Objective:This study aimed to investigate the safety and efficacy of cadonilimab plus chemotherapy with or without bevacizu-mab in the treatment of recurrent or metastatic cervical cancer(R/M CC).Methods:A retrospective analysis was conducted on 25 patients with R/M CC who were admitted to Tianjin Medical University Cancer Institute&Hospital between August 2022 and June 2024.All patients received cadonilimab plus chemotherapy with or without bevacizumab,followed by cadonilimab as maintenance therapy.Treatment effic-acy and adverse events were comprehensively evaluated,and patients were followed up until October 2024.Results:The median follow-up duration was 18 months(range:4-26 months).The median progression-free survival(PFS)and overall survival were not reached,and the 1-year PFS rate was 77.9%.The objective response rate was 68%,while the disease control rate was 80%.Common adverse reactions in-cluded decreased white blood cell count(40%),nausea(32%),rash(24%),and anemia(24%).No treatment-related deaths occurred during the study period.Conclusions:Cadonilimab plus chemotherapy with or without bevacizumab demonstrated a high objective response rate and a favorable safety profile in patients with R/M CC.However,further studies with larger sample sizes and extended follow-up periods are needed to further validate these findings.

Objective:To investigate the diagnostic efficacy of transrectal conventional ultrasound-guided systematic biopsy and transrectal contrast-enhanced ultrasonography(CEUS)-guided targeted biopsy for suspected prostate cancer(PCa).Methods:A total of 239 patients with suspected PCa who were admitted to Shanghai Fengxian District Central Hospital between February 2021 and February 2024 were se-lected.Among them,139 patients who underwent transrectal CEUS-guided targeted biopsy were included in the CEUS group.The conven-tional group included 100 patients who underwent transrectal conventional ultrasound-guided biopsy(12-core biopsy).The detection rates of PCa and clinically significant prostate cancer(CsPCa)in the two groups were compared.The detection rates of PCa in different subgroups were also analyzed.Core number,positive single-core count,and biopsy-related complications were compared between the two groups.Results:Biopsy confirmed PCa in 75(53.96%)patients and benign lesions in 64(46.04%)patients in the CEUS group.In the conventional group,38(38.00%)patients had PCa,and 62(62.00%)had benign lesions.The detection rate of PCa in the CEUS group was significantly higher than that in the conventional group(P<0.05).There were statistically significant differences in the detection rate of PCa between the different age groups and patients with different prostate specific antigen(PSA)levels in the CEUS group(P<0.05).Moreover,there were stat-istically significant differences in the detection rate of PCa between patients with different PSA levels in the conventional group(P<0.05).For patients aged>70 years,the PCa detection rate in the CEUS group was significantly higher than that in the conventional group(P<0.05).When the PSA level was>20 ng/mL,the PCa detection rate in the CEUS group was significantly higher than that in the conventional group(P<0.05).When the prostate volume was 31-60 cm3,the detection rate of PCa in the CEUS group was significantly higher than that in the conventional group(P<0.05).The CEUS group received a total of 283 targeted punctures,whereas the conventional group received 1,200 systematic punctures.The positivity rate for a single core was significantly higher in the CEUS group than that in the conventional group(P<0.001).Biopsy-related complications were comparable between the two groups(P>0.05).Conclusions:Transrectal CEUS-guided targeted biopsy can achieve a high detection and single-core positive rate in the diagnosis of PCa,particularly in older patients with high PSA levels.Moreover,it is safe.