Pancreatic cancer is a highly malignant digestive tract tumor with hidden symptoms,limited treatment options and rapid progression.With an increasing incidence rate year by year,pancreatic cancer has increasingly become a prominent issue endangering public health,causing a huge social burden.Although there was no significant improvement in survival rates for pancreatic cancer patients in the past two decades,recent progress in epidemiology,basic research and clinical research of pancreatic cancer has accelerated significantly compared to the past.Some findings have already enabled a small proportion of pancreatic cancer patients to achieve better survival.This article provided a review of the significant progress made in research,diagnosis and treatment of pancreatic cancer in 2023.

Background and Purpose:Accurate differentiation of pancreatic ductal adenocarcinoma(PDAC)from mass-forming chronic pancreatitis(MFCP)is clinically significant.The application of dual-layer spectral detector CT(DLCT)in pancreas has been explored.This study aimed to investigate the value of DLCT in distinguishing resectable PDAC from MFCP.Methods:We retrospectively collected data of 33 patients with resectable PDAC and 19 patients with MFCP admitted to Fudan University Shanghai Cancer Center from September 1,2021 to May 31,2023.Prior to surgery,patients underwent enhanced DLCT scans,including arterial phase(AP),parenchymal phase(PP)and venous phase(VP).DLCT quantitative parameters,including attenuation enhancement fraction(AEF),lesion-to-parenchyma ratio(LPR)and iodine enhancement fraction(IEF)were calculated.Difference analysis was conducted using independent sample t-test or chi-square test.Univariate and multivariate analyses were performed using binary logistic regression.Receiver operating characteristic(ROC)curves were used for performance evaluation.P＜0.05 was considered statistically significant.Results:Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP,LPR40_VP,IEF_PP/VP,carbohydrate antigen 19-9(CA19-9)and double-duct sign(all P＜0.05).The spectral combined model composed of LPR40_VP and IEF_PP/VP exhibited the best discriminatory efficacy,surpassing CA19-9,double-duct sign and AEF_AP/PP(all P＜0.05).The combined model demonstrated an area under curve(AUC)of 0.841,sensitivity of 90%,specificity of 73%,and accuracy of 79%.Conclusion:DLCT has certain potential in differentiating resectable PDAC from MFCP.Spectral quantitative parameters can complement CA19-9 and outcome shortcomings of conventional CT in distinguishing resectable PDAC from MFCP.

Background and purpose:In recent years,domestic radiotherapy equipment and related software have made great progress,and testing the functionality and stability of the equipment and software is an essential step.This paper focused on comparing the differences in intensity-modulated radiation therapy(IMRT)plans dosimetry and organ at risk(OAR)volume calculations for common cancers between uRT-treatment planning system(TPS)and Monaco-TPS,and to evaluate the feasibility of dose calculation for Infinity linac(linear accelerator,Elekta,Sweden)using uRT-TPS.Methods:Twenty cases of rectal cancer,lung cancer,breast cancer and nasopharyngeal carcinoma were selected.The IMRT plans were completed in uRT-TPS and Monaco-TPS.The dose uniformity and conformity,mean dose,maximum dose of planning target volume(PTV)and OAR between two plans under the same prescribed dose of PTV were compared.And the pass rates of two TPS plans validated at the same linear accelerator were compared.Meanwhile,monitor units(MU),source skin distance(SSD)and the volume of OAR in uRT-TPS and Monaco-TPS were compared.Results:Wonderful plans that met the clinical requirements were obtained in uRT-TPS and Monaco-TPS.Comparable uniformity and conformability was received in PTV,and the maximum dose of PTV was reduced by 1.1 Gy for uRT-TPS(P = 0.006).For breast cancer and lung cancer,the dose in lung was lower for Monaco-TPS(P＜0.05).For nasopharyngeal carcinoma,the dose indicators that oral cavity and throat in the uRT-TPS was reduced by 9.2%and 5.1%,respectively.The verification results of absolute point dose(＜3%)and three-dimensional surface dose(＞95%)for both plans met the clinical requirements.The region of interest in uRT-TPS was smaller compared with Monaco-TPS(P＜0.05).Conclusion:A comparable IMRT plan was obtained for common tumors in uRT-TPS and Monaco-TPS.It is feasible to calculate the dose of Infinity linac using uRT-TPS.

Mucinous ovarian cancer(MOC)is a rare pathological type different from epithelial ovarian cancer,and the clinical treatment should refer to serous ovarian cancer(SOC)guidelines.However,since the clinicopathological features of MOC are significantly different from SOC,careful differentiation is needed in diagnosis and treatment.Surgery combined with adjuvant chemotherapy is the standard treatment for MOC.However,due to the low prevalence rate,it is difficult to carry out clinical trials,hence lacking evidence-based medicine and consensus on the indications of intraoperative appendectomy and the choice of postoperative adjuvant chemotherapy.In addition,further translational preclinical studies of targeted therapy and immunotherapy are needed to facilitate the diagnosis and individualized treatment of MOC.

Breast cancer is the most prevalent malignant tumor among women globally,posing a serious threat to women's health.With the establishment of staging and typing principles for breast cancer diagnosis and treatment,and the development and application of novel antitumor drugs,the survival and quality of life of breast cancer patients have been continuously improving.In China,the large base of breast cancer patients possesses unique incidence characteristics,necessitating ongoing exploration of more appropriate treatment strategies;the volume and level of clinical research are also continuously advancing.In 2023,significant clinical research results were reported for different subtypes of breast cancer.In surgical treatment,clinical trials on targeted axillary lymph node dissection and the establishment of a predictive model BRCA-CRisk for contralateral breast cancer risk provide more evidence for de-escalation in surgical treatment.In the area of human epidermal growth factor receptor 2(HER2)-positive breast cancer,pyrotinib has shown significant efficacy in advanced breast cancer treatment.In triple-negative breast cancer,precision subtype treatment and immunotherapy continue to improve patient survival.For hormone receptor-positive breast cancer,significant research results were obtained in exempting low-risk patients from chemotherapy and exploring alternative options after resistance to endocrine therapy.In the aspect of BRCA mutations,BGB-290-201 further confirmed the therapeutic efficacy and safety of poly(ADP-ribose)polymerase(PARP)inhibitors for the Chinese population.For advanced HER2-negative patients carrying germline BRCA(gBRCA)1/2 mutations,pamiparib will be an ideal treatment choice.This article reviews the important clinical research in the field of breast cancer in China in 2023,summarizes key results,and aims to provide reference ideas for future clinical research.

Background and purpose:BRCA1/2 plays an important role in maintaining the genome stability.Whether BRCA1/2 germline mutation could increase the tumor sensitivity to radiotherapy,thereby inducing secondary primary cancer after radiotherapy is unclear.This study aimed to investigate whether postoperative radiotherapy is a risk factor for the development of second primary cancer in triple-negative breast cancer(TNBC)patients with BRCA1/2 germline mutation.Methods:This research was based on a previously reported retrospective cohort,i.e.,the Fudan University Shanghai Cancer Center TNBC cohort.Between January 1,2007 and December 31,2014,a total of 292 female TNBC patients with BRCA1/2 mutation were enrolled.We performed logistic regression analysis in patients without BRCA1/2 germline mutation(n=261)and BRCA1/2 germline mutation patients(n=31),respectively,to assess the risk factors affecting the incidence of second primary cancer.We then performed interactive analysis on the above two analyses to evaluate the interactive effect between BRCA1/2 germline mutation and postoperative radiotherapy.P<0.05 indicates a statistically significant difference.The research was approved by Fudan University Shanghai Cancer Center TNBC Ethics Committee(050432-4-2108),and each patient provided written informed consent.Results:Logistic regression analysis in patients with BRCA1/2 germline mutations showed that postoperative radiotherapy significantly increased the risk of secondary primary disease compared to non-radiotherapy[odds ratio(OR)=2.475,95%confidence interval(CI):1.933-3.167,P<0.001].In patients without BRCA1/2 germline mutation,the effect of radiotherapy on the incidence of second primary tumor was not significant.There was a significant interaction between BRCA1/2 germline mutation and postoperative radiotherapy for the incidence of secondary primary cancer(OR=9.710,95%CI:0.320-295.250,P=0.193).Conclusion:Although statistical analysis results show that patients with BRCA1/2 germline mutations have an increased risk of developing a second primary tumor after postoperative radiotherapy compared to patients who have not received radiotherapy,there is no significant correlation between BRCA1/2 germline mutations and radiotherapy for the development of a second primary tumor.Therefore,patients with BRCA1/2 germline mutations who receive radiotherapy after surgery may not increase the risk of developing a second primary tumor.

Ductal carcinoma in situ(DCIS),a pathological type of breast cancer that is limited to the terminal ducts of the breast without breaking through the basement membrane,is considered as the precursor of invasive ductal carcinoma(IDC).When DCIS breaks through the basement membrane and invades surrounding tissues,it can form infiltrating lesions.If the maximum diameter of a single infiltrating lesion is less than 1mm or the maximum diameter of multiple infiltrating lesions is less than 1mm,it is defined as ductal carcinoma in situ with microinvasion(DCIS-Mi).About 12%-40%of untreated and intervened DCIS will progress to IDC,and DCIS and IDC can also coexist.However,there is a considerable portion of DCIS that never progresses with good prognosis.Recently,overdiagnosis and overtreatment of DCIS have become the research hotspots.The histological grade of DCIS is mainly based on the morphology of the nucleus,which is divided into three nuclear levels:low,medium,and high.There are also significant differences in receptor expression and molecular type distribution between DCIS,DCIS-Mi,and IDC.For DCIS with or without microinvasion as well as different histological grades,there are many controversies about the treatment regimen,clinical prognosis and risk.The development of modern imaging technology has achieved preliminary evaluation of histological grading,infiltration status,and prognosis prediction of DCIS.The most commonly used breast imaging techniques in clinical practice currently include mammography(MG),ultrasound(US),and magnetic resonance imaging(MRI).The imaging principles of these three techniques are different,and each has its own advantages and disadvantages in breast disease imaging diagnosis.However,they can complement each other and play an important role in disease diagnosis,treatment,and prognosis evaluation.Mammography has the advantages of safety,reliability and good repeatability.It is the preferred screening method for breast cancer recommended by international guidelines.The main manifestations of DCIS on MG can be divided into non calcified lesions and calcified lesions.On US,the main manifestations are lesions and non-lesion type,which can be further divided into hypoechoic changes,calcification,ductal changes,and structural disorders and distortions.MRI has higher sensitivity in detecting DCIS without calcification and multifocal DCIS compared with MG,and has higher accuracy in evaluating the lesion range.However,there are also shortcomings such as low diagnostic specificity and insensitivity to microcalcification display.In addition,radiomics has great potential in the histopathological evaluation,prediction,and guidance of individualized precision treatment of DCIS.In the current era of precision medicine,image features,histopathology,molecular genes,etc.are increasingly significant in predicting the prognosis of breast cancer.The early accurate diagnosis and molecular type of DCIS are also extremely important in clinical work.It has become a consensus in clinical treatment to predict the potential benefits of different treatments through molecular typing,histological grade,and imaging findings,in order to develop the most suitable personalized treatment plan.This article reviewed the correlation between imaging features and the molecular subtype,histopathology and prognosis of DCIS.

Gastric cancer,a malignant tumor with high morbidity and mortality in China,has characteristics such as high heterogeneity and poor prognosis.With the advent of the 21st century,significant progress has been made in gastric cancer diagnosis and treatment due to the rapid development of genomics,laparoscopic minimally invasive techniques,targeted therapy and immunotherapy.This article summarized the important research progress in the field of gastric cancer prevention and treatment since the 21st century,and looked forward to the future.We hope to make greater progress and breakthroughs in early screening,diagnosis and precise treatment of gastric cancer,further improve the overall survival rate of patients,and transform gastric cancer into a controllable"chronic disease".

Background and purpose:Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration,and the 1-,3-and 5-years observed overall survival(OS)rates and disease-free survival(DFS)rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China.Methods:A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study.Clinical information and the follow-up endpoint data were collected through medical records review,telephone visits and death registry data linkage.The last follow-up date was November 30,2023.Kaplan-Meier method was applied in evaluating the 1-,3-and 5-year OS rate and DFS rate,and survival data were described by different subgroups including age group,gender,treatment period,tumor staging,and pathological characteristics.Results:With a median follow-up time of 50.99 months,the 5-year OS rate of surgically resected gastric cancer patients was 70.37%,and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%.The 5-year OS rates of stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 94.32%,82.56%,51.01%and 23.97%,respectively.The differences in survival among patients with different age,tumor location,gross classification,Borrmann classification and Laurence classification were significant.Conclusion:Staging is an important factor directly affecting the survival of gastric cancer patients.Screening and early diagnosis and treatment in large population,especially high-risk group,should be strengthened to further improve the patients'survival.

Background and purpose:The plasma used for routine coagulation test(CCT)can only reflect a single component at a certain coagulation time point/segment,while thromboelastography(TEG)can depict the overall dynamic process curve of coagulation and fibrinolysis,which can more independently and completely reflect the true state of the blood and can serve as a supplement to coagulation function testing.This study aimed to evaluate the application value of combined coagulation function indexes in monitoring the hypercoagulable state of patients with colorectal cancer after chemotherapy,and to explore the risk factors of thrombosis in patients with colorectal cancer after chemotherapy,so as to provide reference for clinical monitoring of hypercoagulable state.Methods:A total of 160 patients with colorectal cancer from Fudan University Shanghai Cancer Center from June 2021 to June 2023 were selected as the experimental group,and 80 healthy subjects were selected as the control group.Then the experimental group was divided into a group without thrombosis(82 cases)and a group with thrombosis(78 cases)according to whether they had thrombosis or not.The determinations of thromboelastography(TEG)[coagulation reaction time(R),coagulation formation time(K),blood clot formation rate(α-Angle),maximum amplitude(MA)and coagulation index(CI)],conventional coagulation tests(CCT)[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(Fib),D-dimer(DD),fibrinogen degradation products(FDP)]and platelet count(PLT)were studied among three groups.With or without thrombosis as the criterion of hypercoagulable state,statistically significant indicators were selected to be included in the binary logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of single and combined detection of the coagulation function indicators for hypercoagulable state in patients with colorectal cancer after chemotherapy.Basic information,tumor stage and Autar score of deep vein thrombosis were collected in 160 patients with colorectal cancer.Logistic regression analysis was performed to explore the risk factors of thrombosis.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(number:050432-4-2108*).Results:Compared with the control group,the R,TT and PLT of the group with thrombosis were decreased(P＜0.05),while APTT,PT,DD and FDP were increased(P＜0.05).The differences in various indicators between the group with thrombosis and the control group were statistically significant(P＜0.05).Compared with the group without thrombosis,the K in the group with thrombosis decreased(P＜0.05),while Angle,MA,CI,FIB,DD and FDP all increased(P＜0.05).ROC curve analysis showed that in the assessment of hypercoagulable state in patients with colorectal cancer after chemotherapy,the area under curve(AUC)of TEG was 0.756,sensitivity was 67.5%,and specificity was 73.8%.The AUC of CCT was 0.691,sensitivity was 78.8%,and specificity was 56.2%.The combined detection AUC was 0.840,sensitivity was 80.0%,and specificity was 77.5%.In the analysis of risk factors,tumor stage,distant metastasis and Autar score were correlated with thrombus formation in patients with colorectal cancer after chemotherapy(P＜0.05),and the differences of the three risk factors in K,Angle,MA,CI,Fib,DD and FDP were statistically significant(P＜0.05).Conclusion:K,Angle,MA,CI,Fib,DD and FDP are the main indicators to reflect the hypercoagulable state,and the combined detection of TEG and CCT can better reflect the coagulation state of patients with colorectal cancer after chemotherapy.Tumor stage Ⅲ to Ⅳ,distant metastasis and high Autar score are risk factors for thrombosis.The incidence of thrombosis can be reduced by monitoring the relevant coagulation indicators in the high-risk population.