Objective:To investigate the predictive value of nutritional risk related indicators in the prognosis of elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radical radiotherapy.Methods:A retrospective case series study was conducted. The clinical data of ESCC patients aged ≥ 70 years who received radical radiotherapy in Shanxi Province Cancer Hospital from January 2015 to December 2019 were retrospectively analyzed. According to the radiotherapy planning system, the maximum transverse diameter of gross tumor volume of primary tumors (GTVt) and GTVt volume in the esophagus were calculated. The nutritional risk related indicators of ESCC patients before and after radiotherapy were calculated and recorded, including body mass index (BMI), geriatric nutritional risk index (GNRI), and neutrophil-to-lymphocyte ratio (NLR); Kaplan-Meier method was used for survival analysis, and log- rank test was performed; Cox proportional risk model was used to analyze the factors influencing the prognosis of patients. The overall survival (OS), progression-free survival (PFS), short-term efficacy, and adverse reactions of patients with different clinicopathological characteristics were compared.Results:The last follow-up time was 30 December, 2023. The 1-year, 3-year, and 5-year OS rates of 161 elderly patients with ESCC were 79.5%, 33.9%, and 16.1% respectively, with a median OS time of 25.8 months (95% CI: 20.11-31.49 months); the 1-year, 3-year, and 5-year PFS rates were 65.8%, 28.9%, and 14.8%, respectively, with a median PFS time of 20.0 months (95% CI: 16.31-23.69 months). There were statistically significant differences in the median OS time of patients with different age, lesion contrast length, maximum transverse diameter of GTVt, GTVt volume, short-term efficacy, BMI before radiotherapy, BMI after radiotherapy, GNRI after radiotherapy, NLR before radiotherapy, and NLR after radiotherapy (all P < 0.05); there were statistically significant differences in the median PFS time of ESCC patients with different age, maximum transverse diameter of GTVt, GTVt volume, short-term efficacy, BMI before radiotherapy, BMI after radiotherapy, GNRI after radiotherapy, and NLR before radiotherapy (all P <0.05). The results of multivariate Cox regression analysis showed that the maximum transverse diameter of GTVt was an independent influencing factor of the patients' OS ( P < 0.05); GTVt volume, short-term efficacy, GNRI after radiotherapy, and NLR before radiotherapy were independent influencing factors for OS and PFS of the patients (all P < 0.05). Among 161 elderly patients with ESCC, 45 achieved complete remission (CR), 111 achieved partial remission (PR), and 5 achieved stable disease (SD). There were statistically significant differences in the proportions of patients with different maximum transverse diameter of GTVt, GTVt volume, BMI after radiotherapy, GNRI after radiotherapy, and NLR before radiotherapy reaching CR and PR+SD (all P < 0.05). Among the 161 patients, grade 0, 1, 2, and 3 radiation-induced esophagitis (RE) occurred in 59, 54, 42, and 6 cases, respectively during treatment and within 3 months after treatment; among them, ≥ grade 2 RE occurred in 48 cases (29.8%); grade 0, 1, 2, and 3 radiation pneumonitis (RP) occurred in 95, 38, 25, and 3 cases, respectively; among them, ≥ grade 2 RP occurred in 28 cases (17.4%). Conclusions:Nutritional risk related indexes GNRI and NLR may be predictive indicators for the prognosis of elderly ESCC patients undergoing radical radiotherapy.

Objective:To explore the efficacy and safety of camrelizumab combined with chemotherapy in treatment of advanced esophageal carcinoma.Methods:A retrospective cohort study was conducted. A total of 84 patients with advanced esophageal carcinoma admitted to the First Affiliated Hospital of Xi'an Medical University from June 2020 to May 2022 were selected, and all patients were divided into the observation group and the control group according to the different treatment methods, 42 cases in each group. The control group was given albumin-bound paclitaxel combined with cisplatin chemotherapy, and the observation group was given camrelizumab based on the control group. The clinical efficacy, survival, tumor markers levels, T lymphocyte subsets levels, quality of life and adverse reactions were compared in both groups.Results:There were no statistically significant differences in age, gender, body mass index, clinical stage and tumor site between the 2 groups (all P > 0.05). There were 9 cases of partial remission (PR), 15 cases of stable disease (SD) and 18 cases of progression of the disease (PD) in the control group; and 15 cases of PR, 18 cases of SD, 9 cases of PD in the observation group. There was no statistically significant difference in objective remission rate between the control group and observation group [21.4% (9/42) vs. 35.7% (15/42), χ2 = 2.10, P = 0.147]. The disease control rate in the observation group was higher than that in the control group [78.6% (33/42) vs. 57.1% (24/42)], and the difference was statistically significant ( χ2 = 4.42, P = 0.035). The median overall survival time was 12 months (95% CI: 10.7-13.3 months) and 9 months (95% CI: 7.6-10.4 months), respectively in the observation group and the control group, and the difference in overall survival was statistically significant ( χ2 = 9.45, P = 0.002). The levels of carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) in both groups after treatment were lower than those before treatment, and the levels of these tumor markers in the observation group [CA125: (54±6) IU/ml, CEA: (9.2±1.1) μg/L, SCC: (0.72±0.19) μg/L] were lower than those in the control group [CA125: (61±7) IU/ml, CEA: (11.3±1.5) μg/L, SCC: (1.26±0.30) μg/L] (all P < 0.001). After treatment, the T lymphocyte proportions of CD3 +, CD4 + and the level of CD4 +/CD8 + in the observation group were higher than those before treatment; and T lymphocyte proportions of CD3 +, CD4 + and the level of CD4 +/CD8 + in the observation group were higher than those in the control group (all P < 0.05). The scores of quality of life scale in both groups after treatment were higher than those before treatment (all P < 0.001), and the score in the observation group was higher than that in the control group [(64±5) points vs. (60±4) points], and the difference was statistically significant ( t = 4.05, P < 0.001). There were no statistically significant differences in the incidence of gastrointestinal reactions, liver dysfunction and rash between the 2 groups (all P > 0.05). The incidence of cutaneouscapillary endothelial proliferation in the observation group was higher than that in the control group [14.29% (6/42) vs. 0 (0/42) ], and the difference was statistically significant ( P = 0.026). Conclusions:Camrelizumab combined with chemotherapy can improve the disease condition, prolong the survival time, improve the quality of life and regulate the disorder of T lymphocytes in patients with advanced esophageal carcinoma, and its safety is controllable.

Objective:To investigate the value of machine learning models based on CT radiomics for predicting the outcome of neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC).Methods:A retrospective case series study was conducted. A total of 279 LAGC patients receiving NAC before surgery in Shanxi Province Cancer Hospital from January 2018 to November 2020 were included. According to a ratio of 7∶3, all patients were randomly divided into the training set (196 cases) and the validation set (83 cases). According to the tumor regression grade (TRG), the pathological grade was divided into the good response of NAC (GR) group (TRG 0-1, 55 cases) and the poor response of NAC (PR) group (TRG 2-3, 224 cases). The clinicopathological data of patients were collected, such as age, gender, differentiation degree, clinical T and N staging, carcinoembryonic antigen (CEA), and carbohydrate antigen 199 (CA199) level. Radiomics features were extracted from the enhanced CT images in the vein phase, and the features were screened by 3-step dimensionality reduction. And then 5 machine learning algorithms including logistic regression (LR), naive bayes (NB), random forest (RF), support vector machine (SVM) and extreme gradient boosting (XGB) were applied to build prediction models based on the CT radiomics. The receiver operating characteristic (ROC) curve and the decision analysis (DCA) curve were drawn to evaluate the predictive performance and clinical benefit of each model on the outcome of NAC in patients with LAGC.Results:Among 196 patients in the training set, there were 39 cases in GR group and 157 cases in PR group; among 83 patients in the validation set, there were 16 cases in GR group and 67 cases in PR group. There were no statistically significant differences in clinicopathological data of patients between the training and validation sets, or between GR and PR groups in the training and validation sets (all P > 0.05). A total of 102 radiomics features were extracted from region of interest of CT images in the vein phase, and 6 key features were finally selected including original_firstorder_10Percentile, original_firstorder_RoubustMeanAbsoluteDeviation, original_glcm_Idmn, original_glcm_MCC, original_ngtdm_Busyness, original_ngtdm_Contrast; and there were statistically significant differences in 6 features between the GR and PR groups (all P < 0.05). LR, NB, RF, SVM and XGB machine learning algorithms were used to construct 5 prediction models based on the CT radiomics. The area under ROC curve for NAC prediction in the training set was 0.553, 0.709, 0.668, 0.772 and 0.790, respectively; in the validation set was 0.662, 0.622, 0.683, 0.752 and 0.784, respectively. The model constructed by XGB showed the best comprehensive performance, and its accuracy, sensitivity and specificity was 0.771, 0.562 and 0.821, respectively. In the DCA of 5 machine learning models in the training set, XGB-based model provided a higher net benefit. Conclusions:Machine learning models based on enhanced CT radiomics in the vein phase have a high predictive efficacy in the outcome of NAC in LAGC patients before surgery and it helps make clinical personalized treatment decisions.

Objective:To investigate the therapeutic efficacy of different modes of neoadjuvant therapy for locally advanced rectal cancer (LARC) with proficient in mismatch repair intact (pMMR) or microsatellite stability (MSS).Methods:A retrospective case series study was conducted. A total of 210 LARC patients with pMMR or MSS admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were selected. Patients were divided into the chemotherapy alone group (98 cases) and the total neoadjuvant therapy (TNT) group (112 cases) based on different neoadjuvant treatment modes. The pathological complete remission (pCR) rate of both groups was compared. In the TNT group, 24 patients received short-course radiotherapy (SCRT) plus chemotherapy (group A), 62 patients received SCRT plus chemotherapy combined with immunotherapy (group B), 23 patients received long-course radiotherapy (LCRT) plus chemotherapy (group C), and 3 patients received LCRT plus chemotherapy combined with immunotherapy (group D). The pCR rate, tumor down-staging and the incidence of adverse reactions were compared between the 4 groups. A subgroup analysis was performed in 87 patients with the distance from the tumor site to anal verge >5 cm and T 2-3N 0-2M 0 TNM staging. And then 87 patients were divided into the chemotherapy alone group (47 cases) and the TNT group (40 cases), and the overall survival (OS) and disease-free survival (DFS) of patients were compared between the 2 groups. Results:Among the 210 LARC patients, 126 cases were male and 84 cases were female, with the age of (51±11) years. There were 3 cases in clinical stage Ⅱ and 207 cases in clinical stage Ⅲ; 68 cases with the distance from the tumor site to the anal verge <5 cm and 142 cases with the distance from the tumor site to the anal verge ≥ 5 cm. The pCR rate of the TNT group was higher than that of the chemotherapy alone group [40.2% (45/112) vs. 7.2% (7/98)], and the difference was statistically significant ( χ2 = 30.62, P < 0.001). In group D, 1 patient achieved pCR, but no statistical comparison was made due to the small sample size. There was no statistically significant difference in pCR rate between group A and group C [25.0% (6/24) vs. 21.7% (5/23), χ2 = 0.07, P = 0.792]. The pCR rate of group B was higher than that of group A and group C [53.2% (33/62) vs. 25.0% (6/24), 53.2% (33/62) vs. 21.7% (5/23)], and the differences were statistically significant ( χ2 = 5.56, P = 0.029; χ2 = 6.73, P = 0.013). However, there were no statistically significant differences in T and N down-staging among group A, group B and group C (all P > 0.05). During neoadjuvant treatment, the incidence of grade 3-4 myelosuppression was 10.7% (12/112) in the TNT group, and no grade 3-4 radiation proctitis was observed. The incidence of granulocytopenia in group B was lower than that in group A, and the incidence of thrombocytopenia in group was lower than that in group C; and the differences were statistically significant (all P < 0.05). In the subgroup analysis, there were no statistically significant differences in OS and DFS between the chemotherapy alone group and the TNT group ( χ2 = 2.17, P = 0.141; χ2 = 0.24, P = 0.624). Conclusions:The neoadjuvant treatment of SCRT combined with immunotherapy has a high pCR rate and a good safety in LARC patients with pMMR or MSS. TNT is not effective in improving the survival of low-risk LARC patients with tumors located in the mid to high segment of the rectum and may have the risk of overtreatment.

Objective:To construct and validate a prognostic model of colon cancer based on differentially expressed anoikis-related genes, and to preliminarily investigate the relationship between anoikis-related genes and the tumor immune microenvironment of colon cancer.Methods:A total of 472 cancer tissues samples of patients with colon cancer, RNA sequencing data and clinical data of 41 normal tissues samples were downloaded from the Cancer Genome Atlas (TCGA) database between the establishment time and July in 2024. A total of 919 genes related to anoikis were screened out from GeneCards database, and the common genes were selected from the RNA sequencing gene datasets of colon cancer and normal colon tissues in the TCGA database, among which the differentially expressed anoikis-related genes of colon cancer and normal colon tissues were screened out based on P < 0.05. Furthermore, genes related to the prognosis of 446 colon cancer patients with prognostic data in the TCGA database were screened by using univariate Cox proportional risk model; the genes with P < 0.05 were further screened out and a colon cancer prognosis model was constructed by using LASSO-Cox proportional risk model. The risk score of the above 446 colon cancer patients in the TCGA database was calculated according to the prognostic model, and the patients were divided into high-risk (≥ median value) group and low-risk (< median value) group according to the median risk score, and the overall survival of the 2 groups was analyzed by using the Kaplan-Meier method. The risk score based on R software-based time ROC program package was used to predict 1-year, 2-year, 3-year overall survival therapeutic efficacy of colon cancer patients in the TCGA database. According to the median risk score of colon cancer patients in the TCGA database, the patients in the International Cancer Genome Consortium (ICGC) database were divided into high-risk group and low-risk group. Kaplan-Meier method and receiver operating characteristic (ROC) curve were used to verify the predictive effect of the prognostic model. The differentially expressed genes between low-risk group and high-risk group stratified by prognostic model risk score in the TCGA database were used to perform single sample gene set enrichment analysis (ssGESA) of immune cells and immune function by using R software related programs. The differences in risk scores of patients with different immunophenotypes (including inflammator response type, wound healing type, interferon gamma dominant type and lymphocyte depletion type) were compared; and correlation analysis of infiltration and risk scores between immune cells and stromal cells in tumor microenvironment was made. Based on the tumor immune function and rejection (TIDE) database, the relationship between the prognostic model risk score and programmed death receptor ligand 1 (PD-L1) gene expression level was analyzed. Results:Based on anoikis-related genes in the GeneCards database, 236 differentially expressed anoikis-related genes between colon cancer tissues and normal tissues were obtained from the TCGA database. LASSO Cox regression was applied to establish a prognostic model constructed by 7 differentially expressed anoikis-related genes in cancer tissues and normal colon tissues related to the prognosis of colon cancer. Risk score = 0.366×TIMP1-0.404×NAT1+0.207×LTB4R2+0.075×INHBB+0.140×CD36-0.109×MMP3+2.994×OFCC1. The median risk score of 446 colon cancer patients in the TCGA database was 1.754 719 545. Survival analysis showed that the overall survival of colon cancer patients in high-risk group of the TCGA database was worse than that in low-risk group ( P < 0.001); ROC curve analysis showed that the area under the curve for predicting 1-year, 2-year and 3-year overall survival of patients in the TCGA database based on the prognostic model risk score was 0.705, 0.731 and 0.723, respectively. Kaplan-Meier method analysis showed that in the ICGC database, the overall survival of colon cancer patients in high-risk group was worse than that in low-risk group ( P = 0.041); ROC curve analysis showed that the area under the curve of prognostic model risk score for predicting 1-year and 2-year overall survival of colon cancer patients in the ICGC database was 0.663 and 0.966, respectively. ssGESA analysis showed that macrophage level in high-risk group was higher than that in low-risk group, helper T (Th) 1 cell and Th2 cell levels in high-risk group were lower than those in low-risk group (all P < 0.01). In terms of immune function, the cell killing activity and histocompatibility complex Ⅰ level in high-risk group were lower than those in low-risk group, and type Ⅱ interferon response score in high-risk group was higher than that in low-risk group (all P < 0.05). The analysis of immunophenotype showed that the risk score of inflammatory response type was higher than that of wound healing type ( P < 0.05), and there was no statistically significant difference in risk score between the other 2 types (all P > 0.05). Risk score was positively correlated with stromal cell infiltration score ( R = 0.340, P < 0.001) and immune cell infiltration score ( R = 0.148, P < 0.05); the expression level of PD-L1 in high-risk group was higher than that in low-risk group in the TCGA database ( P = 0.048), and the expression level of PD-L1 was positively correlated with risk score ( R = 0.130, P = 0.009). Conclusions:A prognostic model of colon cancer constructed by anoikis-related genes can better predict the prognosis of colon cancer patients, and anoikis-related genes may play an important role in tumor immunity of colon cancer.

Objective:To explore the level of triglyceride-glucose (TyG) index and its effect and clinical value in predicting breast cancer.Methods:A retrospective case-control study was conducted. A total of 700 patients with breast tumors who underwent surgical treatment in the Inner Mongolia Autonomous Region People's Hospital from July 2021 to June 2024 were selected, and finally 625 patients were included, including 388 patients with benign breast tumors and 237 patients with breast cancer, and all lesions were determined to be benign or malignant by pathology after surgery. Triglyceride and blood glucose data were collected to calculate the TyG index. The correlation between TyG index and occurrence of breast cancer was analyzed by univariate and multivariate binary logistic regression models. With postoperative pathological diagnosis as the gold standard, the receiver operating characteristic (ROC) curve was used to evaluate the efficacy of TyG index in distinguishing breast cancer from benign breast tumors.Results:The age of patients in the breast cancer group and the benign breast tumor group was (57±12) years old and (42±12) years old, respectively. There were statistically significant differences in the distributions of patients between the two groups in terms of nationality, marital status, height, body mass, body mass index (BMI), cholesterol, low-density lipoprotein cholesterol, triglyceride, blood glucose levels, and color ultrasound Breast Imaging Report and Data System (BI-RADS) classification (all P < 0.05), and there was no statistically significant difference in the level of high-density lipoprotein cholesterol between the two groups ( P > 0.05); the TyG index in the breast cancer group was higher than that in the benign breast tumor group (8.6±0.6 vs. 8.4±0.6), and the difference was statistically significant ( P <0.001). Logistic regression analysis showed that in the model with only the TyG index as a variable, the risk of breast cancer increased with the increase of TyG index [ OR = 1.97, 95% CI: 1.48-2.63, P < 0.001, Hosmer-Lemeshow (HL) test P = 0.077]; in the model with 6 variables including TyG index, nationality, marriage, height, body mass and BMI, the risk of breast cancer increased with the increase of TyG index ( OR = 1.47, 95% CI: 1.08-2.00, P = 0.015, HL test P = 0.832); however, after adding age and BI-RADS classification variables, although the TyG index was still an independent influencing factor for the occurrence of breast cancer ( OR = 0.58, 95% CI: 0.35-0.96, P = 0.033, HL test P = 0.165), the rise of TyG index was an independent protective factor for the occurrence of breast cancer; in the two variable models including TyG index and BI-RADS classification, the TyG index was not an independent influencing factor for the occurrence of breast cancer ( OR = 1.10, 95% CI: 0.72-1.70, P = 0.659), suggesting that the TyG index may not be able to assist in the diagnosis of breast cancer by ultrasound. ROC curve analysis showed that the area under the curve to distinguish breast cancer and benign breast tumor according to the TyG index was 0.623, the optimal critical value of the TyG index was 8.51, the corresponding sensitivity was 59.5%, and the specificity was 62.4%. Conclusions:The TyG index of breast cancer patients is higher than that of benign breast tumor patients. Breast tumor patients with elevated TyG index have an increased risk of breast cancer, which may be a potential non-invasive biomarker of breast cancer.

Objective:To explore the correlation between clinical and CT imaging features and epidermal growth factor receptor (EGFR) gene mutation in patients with non-small cell lung cancer (NSCLC) and screening of mutation prediction indicators.Methods:A retrospective case-control study was conducted. The clinical data of 178 NSCLC patients who were confirmed by pathology and underwent pre-treatment chest-enhanced CT scan and EGFR gene mutation testing in General Hospital of Ningxia Medical University from January 2015 to December 2019 were retrospectively analyzed. Patients were classified into EGFR mutation-positive and mutation-negative groups based on genetic testing results, and the clinical and CT imaging features were compared between the two groups; the multivariate logistic regression model was used to identify the independent influencing factors for EGFR gene mutation in NSCLC patients.Results:Among 178 NSCLC patients, 115 cases (64.6%) were EGFR gene mutation-positive and 63 cases (35.4%) were mutation-negative. Among the 115 EGFR gene mutation-positive patients, there were 61 cases (53.0%) of exon 19 deletion (19del) mutation, 45 cases (39.1%) of exon 21 L858R mutation, 8 cases (7.0%) of exon 20 mutation, and 1 case (0.9%) of exon 18 mutation. The proportions of female patients [60.0% (69/115) vs. 30.2% (19/63)] and patients with out smoking history [74.8% (86/115) vs. 36.5% (23/63)] in EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.001), while the proportions of patients with different pathological types and clinical stages in the two groups showed no statistically significant differences (both P > 0.05). The median maximum diameter of tumor [ M ( Q1, Q3)] detected by CT in the EGFR gene mutation-positive group was 3.70 (2.90, 4.70) cm, while in the mutation-negative group it was 5.30 (3.40, 6.80) cm, and the difference was statistically significant ( Z = -3.66, P < 0.001). The proportions of patients with air bronchogram [27.8% (32/115) vs. 7.9% (5/63)] and without emphysema [83.5% (96/115) vs. 55.6% (35/63)] in the EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.01). The results of multivariate logistic regression analysis showed that no smoking history (yes vs. no, OR = 0.218, 95% CI: 0.073-0.647), short maximum diameter of tumor detected by CT ( OR = 0.814, 95% CI: 0.676-0.981), air bronchogram (yes vs. no, OR = 5.354, 95% CI: 1.782-16.090), and no emphysema (yes vs. no, OR = 0.289, 95% CI: 0.128-0.653) were independent risk factors for EGFR gene mutation in NSCLC patients (all P < 0.05). Conclusions:Clinical and CT imaging features may relate to EGFR gene mutation status in NSCLC patients, and no smoking history, short maximum diameter of tumor detected by CT, air bronchogram and no emphysema may predict EGFR gene mutation.

Objective:To investigate the relationship between retinoblastoma binding protein 1 (RB1) gene deletion and the prognosis of multiple myeloma (MM) patients, and the possible effect of renal insufficiency on it.Methods:A retrospective cohort study was conducted. The clinical data and follow-up information of MM patients who were treated in the Second Affiliated Hospital of Xuzhou Medical University and the Affiliated Hospital of Xuzhou Medical University from December 2020 to November 2023 were collected. According to the presence of RB1 gene deletion in bone marrow samples detected by fluorescence in situ hybridization (FISH), the patients were divided into the RB1 gene deletion group and the RB1 gene non-deletion group, and the clinicopathological characteristics and hematological index levels were compared between the two groups. Renal insufficiency was determined by renal function assessment indicator serum creatinine (Scr) >177 μmol/L. The Spearman test was used to analyze the relationship between the number of RB1 gene deletion positive cells and levels of Scr, hemoglobin and serum calcium in MM patients. The Kaplan-Meier method was used to analyze progression-free survival (PFS), and the Cox proportional hazards model was used to determine the influencing factors of PFS in all MM patients and RB1 gene deletion and non-deletion MM patients.Results:A total of 75 MM patients were enrolled, of whom 24 (32.0%) had RB1 gene deletion. There were no significant differences in gender, age ≥65 years old, bone destruction and lactate dehydrogenase level between the RB1 gene deletion and non-deletion groups (all P > 0.05). There were significant differences in the distributions of patients in each stage of MM International Staging System (ISS) and revised International Staging System (R-ISS) between the two groups, as well as in hemoglobin, serum calcium, Scr, β 2-microglobulin, serum albumin levels, and the proportion of bone marrow plasma cells (all P < 0.05). The number of RB1 gene deletion positive cells was positively correlated with Scr level ( r = 0.863, P = 0.016), but not with hemoglobin and serum calcium levels (both P > 0.05). The PFS of the RB1 gene non-deletion group was better than that of the RB1 gene deletion group (1-year PFS rate: 83.5% vs. 71.7%, 2-year PFS rate: 56.3% vs. 26.3%), and the difference was statistically significant ( P = 0.012). PFS in the non-renal insufficiency group was better than that in the renal insufficiency group (1-year PFS rate: 85.6% vs. 61.9%, 2-year PFS rate: 58.0% vs. 13.5%), and the difference was statistically significant ( P = 0.001). The PFS of patients without renal insufficiency in both the RB1 gene deletion and non-deletion groups was better than that in patients with renal insufficiency, and the differences were statistically significant (both P < 0.05). Multivariate Cox regression analysis showed that ISS stage Ⅲ was an independent risk factor for poor PFS in MM patients (stage Ⅲ vs. stage Ⅰ, HR = 11.317, 95% CI: 1.220-104.979, P = 0.033). Multivariate Cox regression analysis in RB1 gene deletion and non-deletion groups showed that ISS stage Ⅲ (stage Ⅲ vs. stageⅠ, HR = 4.166, 95% CI: 1.419-12.225, P = 0.009), R-ISS stage Ⅲ (stage Ⅲ vs. stage Ⅰ, HR = 3.800, 95% CI: 1.005-14.367, P = 0.049), serum calcium > 2.52 mmol/L (> 2.52 mmol/L vs. ≤2.52 mmol/L, HR = 2.398, 95% CI: 1.037-5.546, P = 0.041) and renal insufficiency (yes vs. no, HR = 2.363, 95% CI: 1.021-5.472, P = 0.045) were independent risk factors for poor PFS in RB1 gene non-deletion MM patients, and serum calcium >2.52 mmol/L (>2.52 mmol/L vs. ≤ 2.52 mmol/L, HR = 3.673, 95% CI: 1.160-11.627, P = 0.027) and renal insufficiency (yes vs. no, HR = 3.985, 95% CI: 1.220-13.016, P = 0.022) were independent risk factors for poor PFS in RB1 gene deletion MM patients. Conclusions:The PFS of MM patients with RB1 gene deletion is worse than that of patients without RB1 gene deletion, RB1 gene deletion may be related to renal insufficiency in MM patients, and the prognosis of MM patients with RB1 gene deletion and renal insufficiency may be worse.

Objective:To investigate the value of coarse calcification ultrasound feature for the differential diagnosis of benign and malignant thyroid nodules and the China Thyroid Imaging Reporting and Data System (C-TIRADS) classification.Methods:A retrospective case series study was conducted. Two hundred and twenty solid thyroid nodules with coarse calcification confirmed by surgical pathology in 210 patients from January 2023 to February 2024 in Shanxi Province Cancer Hospital were selected. Using the postoperative pathological results as the gold standard, the nodules were divided into benign and malignant groups, and the ultrasound characteristics and specific features of coarse calcification of the nodules were compared between the two groups. Binary logistic regression analysis was used to screen for independent predictors of nodal malignancy in the coarse calcification features, and the independent predictors were assigned scores based on the C-TIRADS classification. The efficacy of C-TIRADS classification combined with independent predictors of nodal malignancy in the coarse calcification features for diagnosing malignant nodules was analyzed using receiver operating characteristic (ROC) curve.Results:The postoperative pathological findings of 220 thyroid nodules showed 70 (31.82%) were benign and 150 (68.18%) were malignant. The echogenicity, maximum diameter, orientation, margins of nodules and the location, number, promiscuity, peripheral soft tissue shadow of coarse calcification were compared between the benign and malignant groups, and the differences were statistically significant (all P < 0.05). Logistic regression analysis showed that the presence of coarse and irregular calcification ( OR = 7.20, 95% CI: 3.16-16.37, P < 0.001) and coarse calcification with peripheral soft tissue shadow ( OR = 7.87, 95% CI: 3.74-16.57, P < 0.001) were independent predictors for nodule malignancy. The area under the curve (AUC), sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification were 0.75, 66.67%, 81.43%, and 71.36%, respectively; the AUC, sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification combined with coarse and irregular calcification and peripheral soft tissue shadow were 0.88, 84.00%, 80.00%, and 82.73%, respectively; the difference in AUC for diagnosing malignant nodules with C-TIRADS classification alone and in combination with coarse calcification features was statistically significant ( Z = 4.69, P < 0.001). Conclusions:Coarse and irregular calcification and peripheral soft tissue shadow are risk factors for malignancy of thyroid nodules, and the diagnostic accuracy of the two in combination with C-TIRADS classification is high.

With the introduction of new drugs, the treatment model for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has changed from systemic chemotherapy to immunotherapy, targeted therapy and multidrug combination. In addition, re-irradiation and salvage surgery have shown good clinical efficacy in patients with local recurrence of light tumor load or organ metastases with local treatment conditions. This article reviews the treatment progress of R/M HNSCC, and emphasizes the individualized and precise treatment based on the patient's past treatment experience, current disease characteristics and immune and genetic status to provide rational recommendations for treatment selection of R/M HNSCC.