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.

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.