Objective To analyze the epidemic status of breast cancer globally and in China based on gender(female),age,and human development index(HDI)according to the Global cancer statistics 2022 published by the International Agency for Research on Cancer.Methods The epidemiological data of breast cancer from 185 countries and territories were sourced from the GLOBOCAN 2022 database.The HDI data were compiled based on the Human development report 2022 published by the United Nations Development Programme.The epidemiological data were stratified by age,gender,and HDI to describe the prevalence of breast cancer globally and in China.Pearson correlation analysis was used to evaluate the correlation of standardized incidence rate(SIR),standardized mortality rate(SMR)and mortality-to-incidence ratio(M/I)with HDI.Results The data of 175 countries and territories were included.The number of breast cancer incident cases worldwide was 2 297 000 in 2022,ranking the 2nd only to lung cancer,with an SIR of 46.8 per 100 000(ranking the 1st in the world).The number of breast cancer deaths globally was 666 000,ranking the 4th among all cancer deaths,with an SMR of 12.7 per 100 000(ranking the 2nd worldwide).In China,the number of breast cancer incident cases was 357 000,ranking the 6th among all cancers,accounting for 15.5％of the global breast cancers,with an SIR of 33.0 per 100 000(ranking the 2nd among all cancers in China).The number of breast cancer deaths in China was 75 000,ranking the 7th among all cancer deaths,accounting for 11.3％of the global breast cancer deaths,with an SMR of 6.1 per 100 000(ranking the 6th among all cancer deaths in China).For females around the world,the number of breast cancer incidents and deaths,SIR,and SMR ranked the 1st among all cancers.For Chinese females,both the incident number of breast cancer and SIR ranked the 2nd,while the deaths and SMR ranked the 5th and the 4th,respectively.SIR was positively correlated with HDI(r=0.76,P＜0.01),M/I was negatively correlated with HDI(r=-0.89,P＜0.01),while SMR was not correlated with HDI(r=-0.09,P=0.23).The incidence of breast cancer worldwide and in China increased with age from 25 to 29 years old.The number of breast cancer deaths in the world increased with age from 30 years old,peaked at 50-59 years old,and declined after 70 years old.The breast cancer deaths in China showed 2 small peaks at the age of 50-54 and 65-69 years old,and gradually decreased after 70 years old.The age-dependent trend of SIR varied in different countries and territories with different HDI levels,as well as globally and in China,whereas SMR continued to increase with age.Conclusion The disease burden of breast cancer is serious globally and in China.Especially in females,both SIR and SMR rank the 1st in the world;although they rank the 2nd and the 4th,respectively,in China,the number of incidents and deaths cannot be ignored.HDI is positively correlated with SIR and negatively correlated with M/I,however,with no correlation with SMR.The SIR in countries and territories with different HDI levels changes differently with age,while SMR increases with age in all.

Minimally invasive enucleation of pancreatic tumors has become a focal topic in the field of pancreatic surgery. This technique, which allows for complete tumor removal while preserving maximal pancreatic function, has seen widespread application in clinical practice in recent years. Preoperative evaluation is essential, requiring a thorough assessment of the necessity, feasibility, and appropriateness of surgery, and a careful choice between follow-up observation, parenchyma-sparing resection, or radical resection. If the lesion carries a potential risk of malignancy, radical resection, such as pancreaticoduodenectomy, should be performed. During minimally invasive local resection, selecting an appropriate surgical approach, accurately localizing the tumor, protecting the main pancreatic duct (MPD), and effectively repairing and reconstructing the MPD in case of injury are key to ensuring both surgical safety and efficacy. In addition, pancreatic wound management and the long-term prognosis of patients who undergo MPD repair and reconstruction are also areas of significant concern.

Surgical resection is the mainstay of curative treatment for long-term survival of patients with liver cancer. However, many patients are excluded for surgical resection due to insufficient future liver remnant(FLR). The two-stage hepatectomy (induction of FLR hypertrophy followed by tumor resection) is one of the main treatment strategies for insufficient FLR. The new associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important innovative procedure for inducing FLR hypertrophy, which has the advantages of rapid and significant induction of FLR hypertrophy as well as high tumor resection rate, but it was controversial in the early years due to high postoperative morbidity and mortality. After more than 10 years of development, ALPPS has made tremendous advance. Surgical safety of ALPPS has been significantly improved, and oncological benefits and other issues have been largely clarified. This article aims to introduce the current status and progress of ALPPS.

The emergence of neoadjuvant immunotherapy and neoadjuvant immunotherapy combined with chemotherapy has further elevated the status of neoadjuvant therapy in the treatment of gastric cancer. These new approaches have shown potential in improving the pathologic complete response rate and patient survival rate,providing more treatment options for patients with locally advanced gastric cancer. However,the application of neoadjuvant immunotherapy in gastric cancer still faces some challenges. On the one hand,only a portion of patients can benefit from immunotherapy,and how to accurately screen this group of patients is currently the focus of research. On the other hand,adverse reactions related to immunotherapy also require attention and proper management,such as the occurrence of immune related adverse reactions that may affect patients' quality of life and treatment compliance. Meanwhile,the new adjuvant immunotherapy has brought new challenges to the traditional concept of radical surgery. Such as changes in surgical methods, scope of lymph node dissection, etc. Therefore, in the future, it is necessary to further explore biomarkers that can predict the efficacy of immunotherapy, screen potential beneficiaries, and optimize treatment plans to improve the effectiveness and safety of immunotherapy, in order to achieve the maximum value of neoadjuvant immunotherapy in the treatment of locally advanced gastric cancer.

Objective To evaluate the clinical value of 3D reconstruction in preoperative assessment of laparoscopic partial nephrectomy(LPN),and to help improve the safety of surgical treatment and promote individualized treatment in clinical practice.Methods A retrospective study was conducted on 120 patients with T1 renal cell carcinoma who underwent LPN at Fudan University Shanghai Cancer Center during Dec.2019 and Dec.2023.The patients were divided into a 3D group(n=60)and a 2D group(.n=60).Surgical parameters and vascular variation data were compared between the two groups.Results Baseline characteristics were comparable between the two groups(P＞0.05).The 3D group had significantly shorter operation time[129.5(110.3,154.0)min vs.145.0(125.0,173.8)min,P=0.016],less blood loss[50.0(10.0,50.0)mL vs.200(100.0,200.0)mL,P＜0.001],and shorter warm ischemia time[22.0(18.0,27.0)min vs.29.0(26.0,32.0)min,P＜0.001].The operation time,intraoperative blood loss and warm ischemia time were significantly longer or more in patients with vascular variations than in those without(P＜0.05).Conclusion 3D reconstruction can enhance the accuracy of preoperative assessment of tumors and the surrounding anatomical structures as well as vascular variations in LPN,optimize surgical planning,reduce intraoperative trauma,and demonstrate greater advantages in cases with complex vascular anatomy.

Objective To investigate the heterogeneous lineage of cancer-associated fibroblast(CAF)in clear cell renal cell carcinoma(ccRCC),and explore the relationship between antigen-presentation carcinoma-associated fibroblast(apCAF)and the spatial distribution and formation potential of tertiary lymphoid structure(TLS).Methods Seven single-cell transcriptomic cohorts(n=88)were integrated,and batch effects were corrected using the Harmony algorithm to identify consistent CAF subpopulations across samples.The spatial transcriptomics(GSE175540,n=24)were combined to analyze the spatial interactions between CAF and TLS.Functional annotation was performed using AUCell,and Wilcoxon test was employed to compare the differences in CAF abundance between the immune-sensitive group and the resistant group.The co-localization of TLS with different chemokines was assessed.Results Nine conserved CAF clusters were defined,which were reproducible across different cohorts.Among them,Fibro 4 served as an antigen-presenting type of apCAF,characterized by high expression of HLA-DRA/CD74,and abundance in the immune-sensitive group;its functions were enriched in T cell activation pathways;it was strongly correlated with TLS,and positioned at the periphery of TLS.Cell co-localization analysis revealed that apCAF could recruit lymphocytes to aggregate and form TLS structures via the CXCL13-CXCR5 and CCL19-CCR7 axes.Conclusion This study first reveals that apCAF drives the formation of TLS in ccRCC through a chemokine network,thereby correlating with the response to immunotherapy.The apCAF-TLS axis provides a new strategy for targeting stromal remodeling in the immune microenvironment,and its combined scoring is expected to serve as a biomarker for predicting the efficacy of immune checkpoint blockade therapy.

In recent years,the combined application of targeted-immunotherapy has become a recommended treatment option for advanced renal cell carcinoma in various guidelines.However,although this strategy has significant therapeutic effects and survival advantages,it is associated with a variety of adverse reactions that cannot be ignored.Therefore,how to effectively manage adverse reactions and ensure the treatment safety has become one of the core issues.This article systematically reviews the adverse effects and management strategies,discusses the early identification of adverse reactions,monitoring methods,the design of individualized treatment plans and future development,aiming to provide practical safety management guidance and explore the direction of future development.

Under the policy-driven context of the new healthcare reform and the high-quality development of public hospitals,the operational-financial synergy in medical equipment management has become a critical factor in enhancing hospital governance efficiency.From the perspective of business-finance integration,it systematically analyzes core challenges in medical equipment management within public hospitals:barriers to data interaction between operational and financial domains hindering management efficiency,the absence of management accounting functions weakening decision-making rationality,and resource waste caused by inefficient management of existing equipment.The following optimized operational management pathways are proposed:building an integrated business-finance information platform to establish collaborative workflows;strengthening the decision-support role of management accounting by fostering talent development and institutional restructuring to transform financial functions toward value creation;and innovating the management model for existing equipment through a shared allocation mechanism and a closed-loop maintenance system.

Colorectal cancer (CRC) ranks among the most prevalent malignant tumors globally and poses a severe threat to human health. Surgical resection remains the cornerstone of CRC treatment. With the rapid advancement of minimally invasive techniques, the Da Vinci surgical robot has been increasingly adopted in CRC management. This article will systematically review the current application of the Da Vinci robotic system in minimally invasive CRC treatment, analyzes its advantages and limitations, and discusses future prospects, aiming to provide references for clinical practice and further research.

Objective To explore the change trajectory of self-acceptance of patients with permanent urostomy,in order to provide basis for self-acceptance intervention practice of patients.Methods 168 patients with abdominal wall stoma with urinary diversion from June 2021 to June 2023 in Fudan University Cancer Hospital were selected as the survey subjects by convenience sampling.We used a general information questionnaire,SAQ,PTGI,SSRS,and COST-PROM.Baseline surveys were conducted a week after surgery(T0),and follow-up surveys were conducted at 1 month(T1),3 months(T2),and 6 months(T3)after discharge.The mixed model of latent variable growth was used to analyze the change trajectory of self-acceptance of patients with permanent urinary stoma,and the core predictors of each subtype were explored through the decision tree model.Results The number of patients who participated in the 4 surveys was 168,168,165 and 163,respectively,and the final questionnaire recovery rate was 97.02％(163/168).The self-acceptance scores of patients with permanent urostomy were(35.72±8.63)(36.81±9.23)(39.88±8.95)and(43.17±9.56)points,respectively.The 3 subgroups of self-acceptance changes were identified,including low self-acceptance slow rising group(49.08％),medium self-acceptance first falling then rising group(30.06％),and medium self-acceptance fast rising group(20.86％)(P＜0.001).The decision tree model showed that education level,age,post-traumatic growth,social support,and economic burden could all predict the change track subtype of self-acceptance of patients with permanent urostomy,and the importance of post-traumatic growth was 100％.Conclusion The self-acceptance of patients with permanent urostomy is generally on the rise,and there is a population heterogeneity development track.Posttraumatic growth is the core predictor.It is important to identify the slow increase group of low self-acceptance according to the predictive indicators,and construct an intervention program focusing on improving the post-traumatic growth of patients with permanent urinary stoma to improve their self-acceptance level.