Histotripsy is a non-invasive ultrasound tissue fractionation technique that utilizes focused ultrasound waves to induce cavitation within tissues, thus generating microbubbles. Subsequently, these microbubbles rapidly expand and collapse, generating mechanical forces that disrupt targeted tissues without the use of heat, with the characteristics of non-thermal and non-ionizing modality. Preclinical studies in animal models have demonstrated the potential of histotripsy in treating both benign and malignant tumors, cardiovascular lesions, thrombi, and hematomas. Preliminary evaluations from randomized controlled clinical trials have also been conducted for liver tumors and benign prostatic hyperplasia. This review summarizes the principles and development of histotripsy, and its clinical applications, particularly in the treatment of liver cancer, and compares them with current clinical ablation technologies.

[Purpose]To evaluate the progress and challenges of grade-A tertiary cancer hospitals in China with the implementation of high-quality development.[Methods]The convenience sam-pling method was employed to select 13 grade-A tertiary cancer hospitals in China as the study sites.Data were collected over 4 consecutive years(2020-2023),including 8 indicators across 4 dimensions:number of outpatient visits,inpatient admissions and surgical procedures;average length of hospital stay;open bed capacity;and staff number,physician-to-nurse ratio,and per-centage of senior clinical staff.The changes in annual data before and after the implementation of policies to promote the high-quality development of public hospitals were analyzed using the gene-ralized estimating equations(GEE)statistical method.[Results]Compared with 2020,in 2023,the numbers of outpatient visits(55.47％),inpatient admissions(50.25％)and surgical procedures(46.17％),open bed capacity(10.02％),staff number(13.03％)were significantly increased in 13 hospitals,with a reduction of length of hospital stay(18.98％)(all P＜0.05).However,no significant change was observed in physician-to-nurse ratios or percentages of senior clinical staff during this period(both P＞0.05).[Conclusion]The analysis reveals that from 2020 to 2023,grade-A tertiary cancer hospitals in China have achieved marked improvements in overall service capacity and ser-vice efficiency,with resource allocation progressively shifting from material inputs to talent-focused investments,yielding higher outputs with minimal incremental inputs—a clear indicator of preliminary success in high-quality development.Future initiatives should prioritize workforce structure optimization,increasing nurse staffing levels,and enhancing cultivation of high-quality clinical professionals.

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.

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 investigate the application effect of traditional Chinese medicine(TCM)in treating bone marrow suppression induced by chemotherapy for pancreatic cancer.Methods A retrospective analysis was conducted on the clinical data of 53 pancreatic cancer patients who under-went chemotherapy induced bone marrow suppression at Fudan University Shanghai Cancer Center be-tween January and August 2024.All patients developed varying degrees of bone marrow suppression during the first to third cycles of conventional chemotherapy.In the fourth cycle of chemotherapy,TCM was added,and the improvement in bone marrow suppression after TCM treatment was ob-served.Results After thefirst cycle of chemotherapy,all patients exhibited different degrees of bone marrow suppression,including leukopenia,thrombocytopenia,neutropenia,and anemia.Compared with combined TCM treatment before,among patients with bone marrow suppression of grade Ⅱ and above,the proportion of those with leukopenia decreased significantly after one month of TCM treat-ment(P=0.019),and the proportion of those with thrombocytopenia also decreased,but the differ-ence was not statistically significant(P=0.066).There was no statistically significant difference in the proportion of patients with neutropenia before and after TCM treatment(P=0.231).One month after TCM treatment,the white blood cell count,hemoglobin level,and platelet count of the patien-tsincreased comparedto before combined treatment(P=0.006,P=0.011,P＜0.001).One month after TCM treatment,the average number of use of recombinant human granulocyte colony-stim-ulating factor and recombinant human thrombopoietin were(2.8±1.9)times/cycle and(3.1±1.2)times/cycle,respectively,which were less than those before combined TCM treatment[(4.5±1.7)times/cycle and(4.5±1.3)times/cycle](P=0.002,0.038).Conclusion Combined TCM treatment can improve adverse reactions of bone marrow suppression after chemotherapy for pancreatic cancer and increase white blood cell count and hemoglobin level.

Background and purpose:Approximately 30%of patients with metastatic colorectal cancer(CRC)develops pulmonary metastasis,yet less than 10%are eligible for surgical resection.Radiofrequency ablation(RFA)serves as an alternative therapy for non-surgical candidates,but the relationship between its efficacy and tumor diameter remains controversial.This study aimed to investigate the impact of tumor size on survival outcomes and local progression risk in CRC patients with pulmonary metastasis after RFA,and to validate the clinical utility of a 3 cm threshold for prognosis.Methods:This retrospective study included CRC patients with pulmonary metastasis who underwent RFA at Fudan University Shanghai Cancer Center between January 2016 and December 2024.Patients were stratified into two groups based on maximum lesion diameter:≤3 cm(Small group)and 3-5 cm(Large group).Patient inclusion criteria:⑴ pathologically confirmed lung metastases originating from CRC,with metastases limited to the lungs or extra-pulmonary metastatic lesions having been radically treated;⑵ maximum lesion diameter<5 cm;⑶complete clinical data available;⑷ complete imaging data available,including computed tomography(CT)images during ablation and contrast-enhanced CT images during postoperative follow-up;⑸ follow-up time of at least＞6 months after RFA;⑹ technical complete ablation;⑺ fewer than 3 pulmonary metastatic lesions.Exclusion criteria:⑴ target lesions previously treated with local therapies such as RFA or radiotherapy;⑵ patients unable to tolerate RFA;⑶ patients with follow-up time＜6 months after RFA.Three senior interventional physicians performed percutaneous RFA under guidance of a 64-slice spiral CT scanner.Chest contrast-enhanced CT scans obtained 1 month after RFA were used as the baseline,followed by contrast-enhanced CT scans every 3 months for 1 year,then every 6 months for subsequent follow-up.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical approval number:2108241-11).Primary endpoints included overall survival(OS),progression-free survival(PFS),and local tumor progression(LTP).Kaplan-Meier analysis and multivariate COX regression were employed to evaluate the independent prognostic value of tumor size.Results:A total of 134 patients who met the inclusion criteria were ultimately enrolled,including 77 in the Small group and 57 in the Large group.With a median follow-up of 35 months,the≤3 cm group demonstrated superior 1-,3-,and 5-year OS rates(100.0%,95.1%,74.2%)compared to the 3-5 cm group(94.7%,36.8%,27.0%,P＜0.0001),and the≤3 cm group demonstrated superior 1-,3-,and 5-year PFS rates(90.9%,34.4%,23.3%)compared to the 3-5 cm group(13.8%,0.0%,0.0%,P＜0.000 1).The≤3 cm group also exhibited significantly lower 1-,3-,and 5-year LTP rates(0.0%,19.7%,33.6%)compared to the 3-5 cm group(46.0%,75.5%,75.5%,P＜0.000 1).Multivariable analysis identified tumor diameter＞3 cm as an independent predictor of worse OS[hazard ratio(HR)=6.49,95%CI:3.18-13.24,P＜0.001],while elevated preoperative carcinoembryonic antigen(CEA)(≥5 ng/mL)correlated with shorter OS(HR=1.82,P=0.033).Conclusion:CRC patients with pulmonary metastasis and tumor diameters of 3-5 cm exhibited significantly inferior survival outcomes after RFA compared to the≤3 cm group.A tumor diameter of 3 cm can serve as a critical threshold for selecting RFA indications,and combining preoperative CEA levels can optimize patient stratification.

Hepatocellular carcinoma(HCC)is a severely detrimental global public health issue,and its incidence and mortality rates remain at a high level.According to the data from the World Health Organization,there were 866 000 new cases of HCC and 759 000 deaths worldwide in 2022,and it is predicted that by 2040,there will be significant increases in the numbers of new cases and deaths due to HCC.In the face of these great challenges,significant advances have been made in the diagnosis and treatment of HCC in recent years,and from the improvements in traditional surgeries and local treatment to groundbreaking innovations in targeted therapy and immunotherapy and the application of the concept of precision medicine,various treatment methods have provided more treatment options and survival opportunities for patients with different stages.This article reviews the advances in the treatment of HCC and analyzes current therapeutic difficulties and future development directions,in order to provide a reference for clinical practice and academic research.

Most patients with hepatocellular carcinoma(HCC)are diagnosed at an intermediate or advanced stage,losing the opportunity for surgical resection.Conversion therapy,which uses non-surgical approaches to render initially unresectable tumors resectable,has gradually become part of routine clinical practice and a research focus.However,multiple challenges remain,including the lack of clear criteria for identifying"potentially resectable"cases,difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy,controversy over the necessity of surgery in patients achieving radiological complete response,the need for optimization of perioperative assessment and management,uncertainty in determining the optimal timing of surgery,and the absence of consensus on postoperative sequential systemic therapy regimens and duration.Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials.With the accumulation of clinical experience,growing evidence,and advances in treatment,more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a groundbreaking and innovative technique in the field of liver surgery,and it has significantly increased the resection rate of large or multifocal liver cancer that cannot be resected in stage Ⅰ surgery.Continuous improvements in the ALPPS surgical procedure have further enhanced surgical safety.Compared with systemic therapy and local treatment for oncological conversion,ALPPS has notable advantages in the success rate of surgical resection and the time interval required for the procedure.Future research will focus on the long-term oncological outcomes and quality of life of patients after ALPPS.

In recent years,the surgical treatment model for rectal cancer has undergone profound changes.The therapeutic goal has gradually shifted from single tumor radical resection to balancing functional preservation,and the therapeutic concept has transformed from merely emphasizing surgical techniques to attaching importance to comprehensive treatment.Especially in the treatment of low rectal cancer,the neoadjuvant therapy model has been continuously optimized.For patients with good tumor regression after neoadjuvant therapy,"watch and wait"and transanal local excision have become important optional strategies.This not only avoids some severe surgery-related complications but also maximizes the preservation of patients'organ functions,bringing a qualitative leap in their quality of life.This treatment strategy is gradually expanding from locally advanced low rectal cancer to relatively early-stage low rectal cancer.In terms of surgical techniques,based on the traditional intermediate approach of"first plane,then vessels",the concept of a"vessel-centered"approach is proposed.By managing vessels first and then expanding the plane,it enables thorough dissection of lymph nodes at the root of the inferior mesenteric artery while preserving the left colic artery.With the aid of dual-fluorescence intraoperative navigation technology[indocyanine green(ICG)fluorescence and intraoperative real-time imaging system(IRIS)ureter fluorescence imaging],real-time visualization of lymph nodes and ureters is achieved,ensuring the completeness of lymph node dissection and helping to reduce the risk of ureteral injury.The angulation-free double anastomosis technique used during surgery effectively reduces the incidence of anastomotic leakage and improves surgical safety.For patients with high-risk factors for anastomotic leakage,intestinal stent bypass is expected to replace the traditional prophylactic end ileostomy,thus avoiding complications associated with prophylactic end ileostomy and the trauma caused by secondary stoma closure.In general,the development trend of surgical treatment for rectal cancer is to minimize patient trauma,preserve organ functions,and improve quality of life under the premise of ensuring oncological efficacy,promoting the development of surgical techniques towards standardization and precision to maximize patients'perioperative safety.