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*

Gastrointestinal tumors are a serious and threatening public health concern.Endoscopic minimally invasive treatment is an im-portant way to achieve early diagnosis and treatment of gastrointestinal tumors.Here,we summarize the history and current status of en-doscopic minimally invasive resection of early-stage gastrointestinal tumors,and explain the application of the new ERBEC concepts of endo-scopic minimally invasive surgery for the treatment of gastrointestinal tumors,which include elements,reservation-resection,bilateral-bene-fit,expansion,and collaboration.We also discuss the future direction of endoscopic minimally invasive resection for gastrointestinal tumors.

Objective:To explore the relationship between adipocytokine levels in bone marrow and the onset,progression,and prognosis of myelodysplastic syndromes(MDS).Methods:Retrospective analysis of adipocytokine levels in the bone marrow of 72 patients with MDS and 16 patients with MDS-related secondary acute myeloid leukemia(sAML),including adiponectin(ADP),leptin(LEP),visfatin/nicotinamide phosphoribosyltransferase(NAMPT),adipsin/complement factor D(CFD),and C1q/TNF-related protein 1(CTRP1),detected by enzyme-linked immunosorbent assay(ELISA)at The Affiliated Cancer Hospital of Zhengzhou University from February 2020 to February 2022.High-throughput sequencing was used to detect MDS-related genes in 70 patients and the relationship between adipocytokines and the clinical characteristics,disease subtypes,mutant genes,and prognosis of patients were analyzed.Seventy-eight MDS-related genes were identified.Results:Clinical characteristics showed that ADP(P=0.027)and LEP(P=0.019)levels were significantly lower in men than inwomen;ADP(P=0.020),CFD(P<0.001),and NAMPT(P=0.021)levels were significantly lower in patients aged<65 years than in patients aged≥65,where-as LEP levels were significantly higher(P=0.043).Adiponectin levels were significantly higher in patients with BMI<24 than in patients with BMI≥24(P=0.025),whereas LEP levels were significantly lower(P=0.020);NAMPT levels were significantly higher in the group with in-creased blasts than in the group with no blasts(P=0.037).The CTRP1 levels were significantly higher in the MDS group than in the sAML group(P=0.010).Abnormal gene correlation analysis showed that elevated CTRP1 levels were positively correlated with the occurrence of epigenetically related abnormal genes(P=0.001)and were positively correlated with the occurrence of TET2 and U2AF1(P<0.001 and P=0.036,respectively);ADP and CFD levels were positively correlated with the occurrence of NPM1(P=0.048 and P=0.026,respectively).Multifactorial Cox proportional hazards regression model analysis showed that LEP<0.2 ng/mL was an independent risk factor for progres-sion-free survival(PFS)and overall survival in patients with MDS(P=0.002 and P<0.001,respectively),whereas NAMPT<2.1 ng/mL was a protective factor for PFS in patients with MDS(P=0.043).Conclusions:Adipocytokines in the bone marrow microenvironment are closely as-sociated with the clinical characteristics,gene mutations,and prognosis of patients with MDS,with LEP<0.2 ng/mL being an independent prognostic risk factor and NAMPT<2.1 ng/mL being a prognostic protective factor.

Objective:To evaluate the effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia in patients un-dergoing laparoscopic radical gastrectomy.Methods:Sixty patients who underwent elective laparoscopic radical gastrectomy were enrolled between May 2022 and October 2023 at Tianjin Medical University Cancer Institute&Hospital.Patients were assigned into two groups us-ing a random number table method:the control(group C)and the ultrasound-guided serratus anterior plane block(SAPB)(group S).Patient-controlled intravenous analgesia(PCIA)was administered at the end of the surgery.After surgery,visual analogue scale(VAS)of static pain scores was evaluated at 1,6,12,24,and 48 hours.PCIA pump was started at the VAS pain score≥4 after surgery,and sufentanil 0.1μg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA use,time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and the duration of hospitalization stay were recorded for the two groups.Results:VAS scores were significantly lower at postoperative 1,6,and 12 h in group S than in group C(P<0.05).Additionally,the number of effective uses of PCIA,and rescue analgesia were significantly lower in group S[(6.1±0.4)(2)]than in group C[(18.6±1.4)(17)](P<0.001).The time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and duration of hospital stay were shortened in group S than in group C(P<0.05).There were no significant differences in other parameters between these two groups.Conclusion:Ultrasound-guided SAPB can reduce postoperative pain and facilitate fast recovery in laparoscopic radical gastrectomy patients.

Objective:To analyze the clinical characteristics,diagnosis,and treatment of renal cell carcinoma in kidney transplant recipients.Methods:The clinical data of 27 kidney transplant recipients(2 female and 25 male patients)with renal cell carcinoma admitted to Tianjin First Center Hospital between March 2011 and March 2023 were retrospectively analyzed.Twenty-four of the 27 patients underwent radic-al nephrectomy,including one who underwent bilateral surgery and one who underwent nephroureterectomy.Three patients were conser-vatively treated.The surgical approaches included open,laparoscopic,and robot-assisted laparoscopic procedures,and analyses were per-formed on the diagnosis and treatment process,pathological features,and surgical prognoses of patients.Results:The surgical duration was 148 min(range,100-210 min),and the postoperative hospital stay was 7 d(range,4-10 d).Twenty-four cases of renal cell carcinoma were detected in native kidneys,with an average diameter of(4.03±2.49)cm,including 6 cases of papillary renal cell carcinomas,1 case of chro-mophobe cell carcinoma,and 17 cases of clear cell carcinomas.One of the conservatively treated patients with graft clear renal cell car-cinoma was pathologically confirmed via biopsy puncture.The clinical stages of the 27 patients were divided based on the extent of the tu-mor(T),extent of spread to the lymph nodes(N),and presence of metastasis(M),referred to as the TNM staging criteria as follows:T1aN0M0 in 18 cases,T1bN0M0 in 4 cases,T2aN0M0 in 2 cases,and T4N1M1 in 3 cases.The average age at the first tumor diagnosis after transplantation was(51.21±7.60)years.Median dialysis time before transplantation was 19 months(range,1.2-72 months).The median time from tumor diagnosis to transplantation surgery was 95 months(range,12-180 months).The median follow-up time of the 27 patients was 47 months(range,3-147 months),and two patients died after 129 and 95 months of follow-up because of pneumonia and sepsis,re-spectively.Conclusions:Early diagnosis of renal cancer after renal transplantation is difficult because of multiple cystic changes and necrotic tendencies.In addition,it is especially important to have a standardized follow-up plan and determine the timing of prophylactic surgery.

Objective:To enhance comprehension of undifferentiated embryonal sarcoma of the liver(UESL)in children by analyzing ultra-sound,CT,and MRI imaging features.Methods:A retrospective analysis was conducted on 11 cases of UESL in children,confirmed through surgery and pathology,at the Children's Hospital,Affiliated Capital Institute of Pediatrics from December 2009 to December 2021.We ana-lyzed the ultrasound,CT,and MRI imaging features of all patients and summarized their characteristics.Results:All 11 cases presented with solitary hepatic masses ranging from 11.5 to 19.8 cm in diameter.Imaging manifestations of UESL correlated with component proportion and distribution within the masses.Lesions displayed clear boundaries in all cases.CT scans revealed mixed low density in 11 cases,with ir-regular floc soft tissue density shadows observed at the edge of cystic density areas or around partitions in a few cases.Ultrasound images of all six cases showed solid space-occupying masses,with varying sizes of anechoic regions within the solid mass.MRI T1WI showed mixed low intensity signal in three cases and strip/large high intensity signal areas in the lesion.T2WI revealed mixed high intensity signal and strip low intensity signal areas in 3 lesions.In the arterial phase,lesions displayed slightly to moderately heterogeneous strip/patch enhancement,primarily marginal enhancement in nine cases and thickened,tortuous arterial shadows in eight cases.In the delayed phase,lesions showed continuous uneven enhancement,with enhancement at the edge and peripheral-to-central filling observed in eight cases.Additionally,the enhancement range continuously increased in eight cases,with the false capsule sign identified in eight cases in the delayed stage.Conclu-sions:Imaging features of UESL in children exhibit distinct characteristics.Understanding these features,in conjunction with clinical findings,may aid in early diagnosis.

Radiomics-based early prediction and treatment efficacy evaluation is critical for personalized treatment strategies in patients with colorectal cancer liver metastases(CCLM).Owing to the high artificial intelligence(AI)participation,repeatability,and reliable perform-ance,deep learning(DL)based on convolutional neural networks enhances the predictive efficacy of the models,enabling its potential clinic-al application more promising.Subsequent to the gradual construction of a multimodal fusion model and multicenter large sample database,radiomics and DL will become increasingly essential in the management of CCLM.This review focuses on the main steps of radiomics and DL,and summarizes the value of its application in early state prediction and treatment efficacy evaluation of different treatment modalities in CCLM,we also look forward to the potential of its in-depth application in the clinical management of CCLM.

Organoids are novel in vitro models that can effectively simulate the complexities of tumor microenvironments.Compared to tra-ditional preclinical models,organoids retain most of the histological and molecular properties of the primary tumor;therefore,they are more useful for studying tumor heterogeneity,underlying functional pathways,and immune microenvironments as well as for research on biomarker discovery,drug screening,and individual chemotherapy.Furthermore,current limitations,challenges such as low modeling suc-cess rates,high costs,and lack of standardization are expected to be overcome by continued innovations in bioengineering technologies and interdisciplinary integration.This article reviews the advantages,establishment processes,and prospects and challenges associated with the clinical application of organoids in bladder cancer.