Objective: To investigate the expression of insulin-like growth factor 1 receptor (IGF-1R) in desmoplastic small round cell tumor (DSRCT) and evaluate the inhibitory efficacy of OSI-906, an IGF-1R selective inhibitor, on the growth of DSRCT cells.

Methods: The clinical and pathological data of 8 cases of DSRCT diagnosed at Renji Hospital, Shanghai Jiao Tong University School of Medicine from 2012 to 2024 were collected and analyzed. The expression of IGF-1R in DSRCT tissues was detected using immunohistochemistry (IHC), and its distribution features were analyzed. Alamar-Blue and CCK8 assays were performed to detect the half maximal inhibitory concentration (IC₅₀) of OSI-906 in three DSRCT cell lines, and Western blotting was used to detect the expression of key proteins in the IGF-1R kinase receptor-related signaling pathway.

Results: IGF-1R protein expression was localized at the cell membrane or cytoplasm, a moderate-to-strong positive expression rate of 75% was found in all 8 DSRCT tissue samples. Alamar-Blue and CCK8 assays revealed that the IC₅₀ of OSI-906 for JN-DSRCT-1, DSRCT-B1Z and DSRCT-B3OD cell lines were 6.942, 60.440 and 3.487 µmol/L, respectively, and OSI-906 inhibited the viability of DSRCT-B3OD cell line in a dose-dependent manner. Western blotting analysis demonstrated that the expression level of phosphorylated AMPK was significantly upregulated, while the expression level of phosphorylated mTOR was significantly downregulated.

Conclusion: IGF-1R is highly expressed in DSRCT cells. In vitro, the OSI-906 shows a certain inhibitory effect on the growth of DSRCT cells, possibly by regulating the AMPK/mTOR pathway. These findings highlight the significance of IGF-1R as a potential therapeutic target in DSRCT.

Bispecific antibody (BsAb) refers to a large class of novel immunotherapeutic drugs that can recognize two different epitopes or antigens, combining the ability to activate the patient’s immune system and target tumor target cells. Several clinical trial studies on oncology have shown that BsAb has become an important strategy for the treatment of advanced solid tumors such as advanced lung and gastric cancers. Compared to the combination of two kinds of monoclonal antibodies, BsAb has shown specific biological activity and lower resistance when applied to the treatment of advanced solid tumors. This paper provides an overview of the development history, mechanism of action, classification, and clinical applications of BsAb in advanced solid tumors, and discusses the possible biomarkers for the clinical efficacy.

Objective: This study aims to evaluate the correction effect of adaptive radiotherapy (ART) based on fan beam CT (FBCT) and image-guided radiotherapy (IGRT) using the uLinac HalosTx medical linear accelerator on the setup errors of tumor patients. It also analyzes the impact of the planning duration of ART on body position stability, with the intention of providing a reference for clinical optimization of ART procedures.

Methods: Using a retrospective cohort analysis, 27 patients with malignant tumors (5 patients with esophageal cancer, 13 patients with cervical cancer, and 9 patients with prostate cancer) admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from September 2024 to March 2025 were included. Through FBCT three-dimensional registration technology, the setup errors in the X (Lat), Y (Lng), and Z (Vrt) directions were measured before and after the ART plan was formulated, and the impact of different durations of ART planning (0-20 min, >20-25 min, >25 min) on the setup errors was analyzed.

Results: The setup errors in the X (Lat), Y (Lng), and Z (Vrt) directions in patients with esophageal cancer decreased from 0.190±0.131 cm, 0.197±0.152 cm and 0.267±0.208 cm, respectively, to 0.098±0.062 cm, 0.094±0.092 cm and 0.074±0.057 cm (P<0.001); the setup errors in patients with cervical cancer decreased from 0.185±0.131 cm, 0.331±0.270 cm and 0.244±0.209 cm, respectively, to 0.066±0.085 cm, 0.133±0.096 cm and 0.087±0.073 cm (P<0.001); the setup errors in the patients with prostate cancer decreased from 0.169±0.137 cm, 0.294±0.221 cm and 0.279±0.177 cm, respectively, to 0.052±0.067 cm, 0.132±0.125 cm and 0.084±0.079 cm (P<0.001). The relationship between the duration of ART planning and setup errors showed that there were no significant differences in the setup errors in the X (Lat), Y (Lng) and Z (Vrt) directions in patients with esophageal cancer among different duration groups (P>0.05); however, there were significant differences in the setup errors in patients with pelvic malignancies among different duration groups (P<0.05), with increase in the setup errors in the three-dimensional directions as the duration of planning increased.

Conclusion: ART can effectively improve setup accuracy and significantly reduce the setup errors in patients with esophageal, cervical or prostate cancer. However, for patients with pelvic malignancies, it is recommended to strictly control the duration of ART planning to avoid the accumulation of setup errors caused by prolonged time.

Objective: To describe an effective chemotherapy regimen for metastatic sclerosing epithelioid fibrosarcoma (SEF).

Methods: The diagnosis and treatment of one SEF case were reported.

Results: The patient with primary left-sided colon SEF underwent radical left hemicolectomy. Two months later, multiple metastases in the abdominal and pelvic cavity were found. The patient received first-line chemotherapy with FOLFIRI. Disease progression was observed after 17 months, while no relevant treatment was performed due to the epidemic. After the next 19 months, the abdominal and pelvic tumor progressed significantly, then a secondary cytoreductive surgery was underwent. A CT scan conducted three weeks after surgery revealed multiple metastases within the abdominal and pelvic cavities. Second-line chemotherapy with single-agent Epirubicin was administered, the tumor increased significantly after two cycles. Subsequently, the patient received third-line GT chemotherapy, achieved partial response (PR) after 2 cycles, and completed 7 cycles in total. With regular follow-up, treatment efficacy was assessed as a sustained PR. The patient has achieved a progression-free survival (PFS) exceeding 19 months to date.

Conclusion: SEF is an exceptionally aggressive malignancy characterized by high invasiveness and poor prognosis. Here, we report a case, the GT regimen chemotherapy demonstrated remarkable efficacy in treating SEF, providing valuable insights for future therapeutic approaches.

Objective: To establish normal or specific gene-deficient gallbladder epithelial organoids and gallbladder cancer organoids for investigating the molecular mechanisms driving gallbladder cancer progression.

Methods: Gallbladder and gallbladder cancer tissues were enzymatically digested with collagenase Ⅳ, followed by neutralization, filtration, and centrifugation to isolate epithelial cell pellets. The isolated epithelial cells were embedded in Matrigel and cultured in a three-dimensional system. Gene editing technologies, including the Cre-loxP transgenic mouse and CRISPR-Cas9 system, were employed to generate gallbladder epithelial organoids with specific gene knock-outs or mutations. The gene editing efficiency was verified using flow cytometry, puromycin selection, and Sanger sequencing. The growth behavior and functional features of the organoids under different culture conditions were observed, and the effects of small pharmaceutical molecules (such as Wnt agonists and inhibitors) on the growth of the organoids were further assessed.

Results: Murine gallbladder epithelial organoids and human gallbladder cancer organoids were successfully generated and stably propagated in the long term under optimized organoid culture conditions. A gallbladder epithelial organoid model with specific gene knock-outs was successfully established, providing a robust platform for molecular mechanism research in gallbladder cancer. Further research demonstrated that the Wnt signaling pathway was highly activated in gallbladder cancer organoids, with growth dynamics significantly modulated by Wnt agonists or inhibitors.

Conclusion: Normal murine gallbladder epithelial organoids and human gallbladder cancer organoids, combined with advanced gene-editing technologies, serve as powerful tools for deciphering the molecular mechanism and developing targeted therapeutic strategies through building disease models with high efficiency and accuracy. Wnt signaling is one of the critical regulatory signaling pathways in gallbladder progression, highlighting its potential as a therapeutic target.

Objective: To investigate the impact of different radiotherapy doses on the concurrent chemoradiotherapy efficacy and prognosis in patients with stage Ⅱ-Ⅳa esophageal squamous cell carcinoma (ESCC) receiving S-1 (Tegafur-gimeracil-oteracil potassium) chemotherapy.

Methods: Based on inclusion and exclusion criteria, 154 eligible patients with ESCC were selected from those treated at the Department of Radiation Oncology of the First Affiliated Hospital of Bengbu Medical University between January 2019 and January 2023. According to prescribed radiation dose, these patients were divided into a standard-dose radiotherapy (SD-RT) group (n = 75, total radiation dose: 50-54 Gy) and a high-dose radiotherapy (HD-RT) group (n = 79, total radiation dose: 60 Gy). Since a relatively high proportion of the enrolled patients were elderly (age > 75 years, accounting for > 70%) with poor physical condition, and some patients declined standard intravenous chemotherapy due to personal reasons, all enrolled patients received oral S-1 concurrent chemotherapy during radiotherapy. Follow-up evaluations were conducted 1 - 3 months after concurrent chemoradiotherapy. The short-term clinical efficacy and the incidence of acute radiotherapy-related adverse reactions were evaluated for both the SD-RT and HD-RT groups according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Long-term survival was analyzed using Kaplan-Meier curves. Log-rank test and multivariate COX regression analysis were used to identify independent prognostic factors affecting progression-free survival (PFS) and overall survival (OS) of ESCC patients.

Results: Among the 154 ESCC patients, the objective response rate (ORR) and disease control rate (DCR) were 88.0% and 97.3% in the SD-RT group, respectively, while those of the HD-RT group were 93.7% and 100%. There was no statistically significant difference in the short-term clinical efficacy between the two groups (P=0.516, χ²=2.369), but significant differences were observed in both PFS and OS (PFS^{SD-RT vs HD-RT}: 20.0 months vs 26.0 months, P=0.009; OS^{SD-RT vs HD-RT}: 26.0 months vs 34.0 months, P=0.047). Subgroup analysis based on clinical stage demonstrated that HD-RT can improve the long-term survival in patients with stage Ⅲ-Ⅳa ESCC (PFS^{SD-RT vs HD-RT}: 15.0 months vs 20.0 months, P=0.002; OS^{SD-RT vs HD-RT}: 17.0 months vs 22.0 months, P=0.006), but did not significantly benefit patients with stage Ⅱ ESCC. Additionally, the subgroup analysis according to median gross tumor volume (GTV) showed that ESCC patients with smaller tumor volumes (≤43.39 cm^⊃3;) exhibited greater sensitivity to HD-RT compared to those with larger tumors (>43.39 cm³) (PFS^{SD-RT vs HD-RT}: 18.0 months vs 26.0 months, P = 0.028; OS^{SD-RT vs HD-RT}: 22.0 months vs 32.0 months, P = 0.025). In terms of radiation-related toxicity, there were no significant statistical differences between the SD-RT and HD-RT groups in the incidence of myelosuppression (P = 0.539), radiation esophagitis (P = 0.882), or radiation pneumonitis (P=0.636). Log-rank test and multivariate COX regression analysis identified radiation dose, T stage, and clinical stage as independent prognostic factors for PFS of ESCC patients (all P < 0.05), while radiation dose and clinical stage were independent prognostic factors for OS of ESCC patients (both P < 0.05).

Conclusion: For ESCC patients treated with S-1-based concurrent chemoradiotherapy, increasing the total radiation dose to 60 Gy can improve their long-term survival outcomes without increasing the risk of radiation-related adverse events. This survival benefit was particularly pronounced in ESCC patients with advanced-stage disease (Ⅲ-Ⅳa) and smaller tumor volumes (≤43.39 cm³).

Primary bone lymphoma (PBL) is a rare malignancy characterized by lymphoma cells primarily invading bone tissue. Unlike other lymphoma subtypes, PBL usually remains confined to bone at diagnosis without involving lymph nodes or other organs. It affects individuals of all ages, generally showing a better prognosis than secondary bone lymphoma. However, the low incidence of PBL has led to limited large-scale studies, with most researches relying on case reports or small retrospective analyses, causing challenges in diagnosis and delays in treatment. This review summarizes the clinical manifestations, diagnostic methods, treatment strategies, and prognostic outcomes of PBL to enhance understanding of its management and improve patients’ outcomes and quality of life.

Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor originating from the epithelial cells of the intrahepatic bile ducts, with adenocarcinoma being its predominant pathological type. Due to its insidious onset and the difficulty of early diagnosis, ICC has a high mortality rate. Currently, complete resection of the tumor through surgery remains the only potential curative treatment for ICC, but only a small proportion of patients are eligible for surgery. In this context, a multidisciplinary comprehensive treatment model, centered around surgery and combined with systemic chemotherapy, targeted therapy, immunotherapy, supplemented by local interventional therapies and radiotherapy, has emerged as an effective strategy for improving the prognosis of ICC patients. This paper systematically reviews the latest research advances in chemotherapy, targeted therapy, immunotherapy, and local treatment for ICC, and summarizes the current clinical treatment strategies, aiming to provide a robust reference for the precise treatment of patients with advanced ICC.

Objective: To explore the relationship between anxiety status and progestogen level in perimenopausal women and their effects on the pathogenesis of uterine fibroid.

Methods: A total of 376 perimenopausal women who visited the Department of Gynecology and Neurology of Nanjing Tongren Hospital affiliated School of Medicine of Southeast University from August 2019 to July 2023 were selected as the study subjects. Based on the and divided into two groups according to the Self-Rating Anxiety Scale (SAS), they were divided into a non-anxiety group (n=202, SAS score< 50) and an anxiety group (n=174, SAS score≥50). Additionally, according to the presence or absence of uterine fibroids, they were categorized into a non-uterine fibroid group (n=225) and a uterine fibroid group (n=151). The t test or χ² test was used to compare general demographic and clinical data between the non-uterine fibroid group and the uterine fibroid group. Multivariate logistic regression analysis was used to analyze the correlation between anxiety status, progesterone level, and uterine fibroid risk in perimenopausal women. The bootstrap method was used to analyze whether progesterone level mediate the relationship between anxiety status and uterine fibroid risk.

Results: Comparison of baseline data between the non-uterine fibroid group and the uterine fibroid group showed that previous caesarean section, number of abortions, hemoglobin level, neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR) were not associated with the incidence of uterine fibroid (all P > 0.05). In contrast, menstrual period, menstrual cycle, progesterone level, and SAS score were significantly associated with the incidence of uterine fibroid (all P < 0.05). Analysis of the effects of different clinical features on the risk of uterine fibroid showed that age, chronic diseases history, and dysmenorrhea history were all significantly associated with the incidence of uterine fibroid in perimenopausal women (all P < 0.05). Further, univariate logistic regression analysis showed that age≥55 years, chronic diseases, and dysmenorrhea were significant risk factors for uterine fibroid in perimenopausal women (all P < 0.05). These seven significant risk factors (menstrual period, menstrual cycle, progesterone level, SAS score, age, chronic disease history, and dysmenorrhea history) were included in a multivariate logistic regression analysis , which identified SAS score and progesterone level as independent risk factors for uterine fibroid in perimenopausal women. Specifically, SAS score was positively correlated with uterine fibroid risk, while progesterone level was negatively correlated with the risk. Restriction cubic spline analysis showed a nonlinear quantitative response relationship between continuously changing progesterone level and the risk of uterine fibroid (χ² = 12.315, P < 0.001), when progesterone level was ≤2.00 ng/mL, the risk of uterine fibroid decreased with the increase of progesterone level (HR=1.014, 95% CI: 1.006-1.012, P < 0.001), and when progesterone level was > 2.00 ng/mL, the risk of uterine fibroid stabilized with further increases in progesterone level (HR=1.003, 95% CI: 0.998-1.002, P = 0.001). After further adjusting for a variety of related confounding factors affecting the incidence of uterine fibroid in perimenopausal women, it was found that SAS score was an independent risk factor for predicting the incidence of uterine fibroid in perimenopausal women. Mediation effect analysis revealed that SAS score had a direct effect on the incidence of uterine fibroid (β₁=0.202, 95% CI: 0.124-0.216), and progesterone level partially mediated the effect of SAS score on uterine fibroid risk (β₂ = 0.196, 95% CI: 0.152-0.207). The total effect value was β_total=0.398, and the mediating effect accounted for 49.25% of the total effect.

Conclusion: There was an independent correlation between anxiety status and progestogen level in perimenopausal women, anxiety status was a risk factor for the development of uterine fibroids, while progestogen levelwas a protective factor.

In recent years, the incidence of breast cancer among Chinese women has been increasing annually, with its poor prognosis and high mortality rates presenting major challenges in current breast cancer treatment. Breast cancer stem cells (BCSCs) are the key factors which leading to the occurrence, development, treatment resistance, and recurrence of breast cancer. A high proportion of BCSCs are also closely related to adverse outcome of breast cancer patients. However, traditional drugs are difficult to effectively eliminate BCSCs and may even increase their enrichment level. Therefore, developing therapeutic strategies specifically targeting BCSCs represents a critical breakthrough for improving treatment efficacy in breast cancer patients. Significant progresses have been made in this field, including the development of various inhibitors targeting BCSCs surface markers, key signaling pathways, and immune checkpoints, as well as advances in nano-drug delivery systems (NDDS) and the discovery of numerous novel targets, offering new directions for breast cancer treatment. This paper systematically reviews recent advances and existing challenges in BCSCs-targeted therapies, and outlines future directions, aiming to provide new insights for both clinical practice and scientific research in breast cancer treatment.

Objective: To report an acute myeloid leukemia(AML) with insertion translocations of ins(21;8)(q22.1;q22q24), and to investigate its clincal and laborator characteristics.

Methods: Bone marrow cells were cultured by 24 hours, following which chromosomes were harvested and analyzed by R-banding karyotype. Reverse transcription polymerase chain reaction (RT-PCR) was used to screen for 53 leukemia-realted fusion genes. The illumina high-throughput sequence was employed to detect AML-related gene mutations. Fianlly, the patient's clinical manifestations, laboratory findings, and treatment response were comprehensively analyzed.

Results: The karyotype of this patient was 46,XX,ins(21;8)(q22.1;q22q24)[20]. RT-PCR detected the presence of the RUNX1/RUNX1T1 (AML1/ETO) fusion gene. The AML-associated gene mutation screening identified Class Ⅰ mutation in CALR, Class Ⅱ mutations in EZH2, ASXL2, and RAD21, and Class Ⅲ mutation in CREBBP.

Conclusion: The ins(21;8)(q22.1;q22q24) is a rare insertion variant translocation of t(8;21)(q22;q22), requires expanded case studies to clarify its clinical features and prognostic implications in AML patients with this mutation.

Objective: This study aims to explore the clinical characteristics of patients with multiple myeloma concurrently presenting with a second primary malignancy. By analyzing the causes based on literature reports, this study aims to deepen the understanding of multiple primary cancers in multiple myeloma patients, and provide some assistance for auxiliary examinations and risk assessments of multiple myeloma patients.

Methods: A retrospective analysis was conducted on the clinical data of four patients with multiple myeloma who also had a second primary malignancy admitted to The Second Affiliated Hospital, Chongqing Medical University. Each patient was diagnosed with multiple myeloma through bone marrow aspiration and had a second primary malignancy confirmed through pathological biopsy.

Results: The onset age of the 4 patients ranged from 42 to 81 years old; three were males and one was female. One patient had smoldering myeloma with a second primary hematological malignancy (follicular lymphoma), while the other 3 patients had concurrent solid malignancies, including bladder cancer, esophageal cancer, and breast cancer, respectively.

Conclusion: Multiple myeloma accompanied by a second primary malignancy is rare, and early pathological biopsy is necessary for diagnosis to avoid missed diagnosis.

Objective: To explore the associations between red blood cell distribution width and cysteine-rich 61 (Cyr61) with efficacy and prognosis of luspatercept in the treatment of myelodysplastic syndrome.

Methods: From August 2020 to August 2023, 140 patients with myelodysplastic syndrome who received luspatercept treatment were selected. They were divided into effective group (104 cases) and ineffective group (36 cases) based on clinical efficacy, and into survival group (118 cases) and death group (22 cases) based on prognosis. Logistic regression analysis was used to investigate the correlation between red blood cell distribution width and Cyr61 with prognosis. Kaplan-Meier method was employed to plot survival curves, and receiver operating characteristic (ROC) curves were used to analyze the value of red blood cell distribution width and Cyr61 in evaluating the efficacy and prognosis of luspatercept treatment for myelodysplastic syndrome.

Results: Compared with the ineffective group, the platelet count, neutrophil count, and hemoglobin level were significantly lower (P<0.05) in the effective group, while the platelet distribution width, red blood cell distribution width, and Cyr61 level were significantly higher (P<0.05). Compared with the ineffective group, the red blood cell distribution width and Cyr61 level were significantly lower (P<0.05) in the effective group as the efficacy improved. The red blood cell distribution width and Cyr61 level were positively correlated with ineffectiveness. Especially when the red blood cell distribution width was >20.86% and Cyr61 was >61.65 pg/mL, the risk of treatment non-response in patients with myelodysplastic syndrome increased significantly with the increase in red blood cell distribution width and Cyr61 level. Compared with the survivors, the platelet count, neutrophil count, and hemoglobin level were significantly lower (P<0.05), while the platelet distribution width, red blood cell distribution width, and Cyr61 level were significantly higher (P<0.05). The logistic regression analysis results showed that the red blood cell distribution width [odds ratio: 0.694 (95% confidence interval: 0.504-0.812); P<0.05] and Cyr61 [odds ratio: 0.543 (95% confidence interval: 0.405-0.653); P<0.05] were independent risk factors for prognosis. The Kaplan-Meier analysis results showed that the survival rate significantly decreased with the increase in red blood cell distribution width and Cyr61 level (P<0.05). The receiver operating characteristic curve analysis results showed that both red blood cell distribution width and Cyr61 had certain significance for predicting the efficacy and prognosis of luspatercept treatment for myelodysplastic syndrome (P<0.05, area under the curve>0.75), and the combination of the two had the highest accuracy in predicting efficacy and prognosis (P<0.05, area under the curve>0.90).

Conclusion: With the increase in red blood cell distribution width and Cyr61 levels, the risk of treatment ineffectiveness and death in patients with myelodysplastic syndrome receiving luspatercept therapy significantly increases. Clinically, the combination of red blood cell distribution width and Cyr61 can effectively evaluate the efficacy and prognosis of luspatercept in the treatment of myelodysplastic syndrome.

Objective: Exploring the predictive value of sarcopenia based on preoperative CT diagnosis for the prognosis of patients with pancreatic cancer.

Methods: A retrospective analysis was conducted on the clinical, pathological, and imaging data of 488 patients who underwent radical resection for pancreatic cancer, to analyze the correlation between sarcopenia and the prognosis of patients with pancreatic cancer.

Results: Among the 488 patients included, 281 had sarcopenia before surgery and 207 did not. The COX proportional hazards regression model showed that sarcopenia was an independent risk factor for overall survival in pancreatic cancer patients [hazard ratio 1.43 (95% confidence interval: 1.02-1.99); P=0.04], while preoperative sarcopenia was not associated with postoperative disease-free survival (P>0.05).

Conclusion: Sarcopenia diagnosed based on preoperative CT is significantly correlated with the overall survival of patients with pancreatic cancer after surgery and is an independent risk factor for the overall survival of patients with pancreatic cancer after surgery.

Objective: To explore the clinical prognostic factors that affect the prognosis of patients with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), and to construct a relevant nomogram model to predict the overall survival rate of patients.

Methods: Cases of PTCL-NOS from 2010 to 2015 were selected from the SEER database. Univariate and multivariate COX regression analyses were used to identify factors affecting prognosis, and a nomogram model was constructed. The concordance index, receiver operating characteristic curve, calibration curve, and clinical decision curve were used to evaluate the model's discriminatory ability, predictive accuracy, and clinical utility, respectively.

Results: A total of 1 078 PTCL-NOS with PTCL-NOS were included. Univariate and multivariate COX regression analysis results indicated that gender, race, age, Ann Arbor stage, B-symptoms, treatment modality, and median annual household income were independent risk factors for overall survival (OS) in PTCL-NOS patients. The C-index for overall survival rate in the training set was 0.710 (95% confidence interval: 0.685-0.735), and the C-index for overall survival rate in the validation set was 0.684 (95% confidence interval: 0.643-0.725). The C-index, receiver operating characteristic curve, and calibration curve all demonstrated that the model had good predictive accuracy and discriminatory power. Decision curve analysis indicated that the model had certain clinical practicality.

Conclusion: The prognostic prediction model based on seven independent risk factors for clinical prognosis demonstrates good predictive accuracy and discriminative power, and can provide a reference for clinicians to formulate treatment plans for patients with PTCL-NOS to a certain extent.

Objective: To explore the clinical characteristics of patients with metastatic gastric tumor and to differentiate them from those with primary malignant gastric tumors.

Methods: This study retrospectively analyzed the clinical data of 21 patients with metastatic gastric tumor confirmed by gastroscopy biopsy and pathology. The clinical manifestations, gastroscopy characteristics, pathological results, and the time interval between the diagnosis of primary malignant tumor and the confirmation of gastric metastasis were summarized.

Results: The patient primarily exhibited symptoms related to gastric involvement; gastroscopy findings resembled those of primary malignant tumors of the stomach; pathological results were consistent with primary malignant tumors; the time interval between the diagnosis of primary cancer and the confirmation of metastatic gastric tumor varied significantly, ranging from up to 18 years to simultaneous detection.

Conclusion: Metastatic gastric tumors are similar to primary malignant tumors of the stomach in terms of clinical manifestations and endoscopic features, making clinical differentiation challenging. The main approach for distinguishing them is based on pathological examination.

Objective: To evaluate the accuracy and output stability of online general natural language processing (NLP) models for staging diagnosis and identifying medium- and high-risk factors in cervical cancer patients based on pathology reports.

Methods: Surgical pathological reports of 65 patients with cervical cancer who received postoperative adjuvant radiotherapy at Shanghai General Hospital from January 2022 to December 2023 were retrospectively selected. These reports were input into two online NLP models, Kimi and ChatGPT-4o, and their output staging diagnosis results were recorded. Then, the results were classified into 3 categories and scored as follows: correct (2 points), basically correct (1 point) and incorrect (0 point). Each pathologic report was tested 5 times to assess the stability of the outputs form Kimi and ChatGPT-4o, and the consistency between the NLP models and clinical physicians in cervical cancer staging was compared. Prompt-based questioning was used to evaluate Kimi’s ability to extract medium- and high-risk factors from the pathology reports of cervical cancer patients.

Results: There was no statistical significant difference in the staging diagnosis results between the two NLP models and the clinical physicians (χ²=5.740，P=0.057). Kimi and ChatGPT-4o respectively produced 56 and 47 correct results, 6 and 15 basically correct results, and 3 and 3 incorrect results. Their mean scores were 7.08±2.70 and 7.97±2.97, and the difference between them was statistically significant (P=0.040). In the extraction of risk factors from 65 cervical cancer patients, involving a total of 390 factors, Kimi made only three false-positive errors, with all other factors correctly identified.

Conclusion: Online general NLP models can stably output the stage of cervical cancer patients with diagnostic accuracy comparable to clinical physicians. With the assistance of prompt-based questioning, these NLP models can accurately extract medium- and high-risk factors from pathology reports of cervical cancer patients, demonstrating promising clinical application potential.

Objective: To investigate the distribution characteristics of CTLA-4 on the surface of CD4⁺ T cells in patients with breast cancer at different stages, and to evaluate its predictive value for the efficacy of radical mastectomy.

Methods: A retrospective study was conducted on 200 breast cancer patients admitted between January 2020 and December 2022. Patients were divided into four groups based on clinical staging: stage I (64 cases), stage II (57 cases), stage III (43 cases), and stage IV (36 cases). The clinical pathological characteristics of the four groups were compared, and the expression level of CTLA-4 on the surface of CD4⁺ T cells in peripheral venous blood (CTLA-4⁺ CD4⁺) was detected. Patients were divided into a poor prognosis group (52 cases) and a good prognosis group (148 cases) based on their prognosis, and the clinical pathological characteristics of the two groups were compared. A stratified regression model was used to analyze the relationship between CTLA-4⁺ CD4⁺ expression levels and different clinical characteristics. Logistic regression analysis was employed to evaluate the independent correlation between CTLA-4⁺ CD4⁺ expression levels and the risk of poor prognosis. An unconditional logistic regression model was used to analyze the multiplicative interaction effect of CTLA-4⁺ CD4⁺ expression levels and clinical staging on prognosis prediction. Restricted cubic spline analysis was used to investigate the relationship between CTLA-4⁺ CD4⁺ expression levels and poor patient prognosis.

Results: Significant differences were observed in tumor diameter, ECOG score, lesion multiplicity, lymph node metastasis, tumor differentiation degree, ER, PR, HER2, Ki-67, CA125, CA153, and CEA among patients with different clinical stages (P<0.05). Significant differences were also observed in CD3⁺, CD4⁺, CD8⁺, and CTLA-4⁺ CD4⁺ (P<0.05). As the clinical stage increased, the proportions of CD3⁺, CD4⁺, and CD8⁺ decreased, while the proportion of CTLA-4 on the surface of CD4⁺ T cells increased (P<0.05). Significant differences were observed in clinical stage, tumor diameter, lymph node metastasis, tumor differentiation degree, ECOG score, ER, PR, HER2, and CTLA-4⁺ CD4⁺ among patients with different prognosis groups (P<0.05). Hierarchical regression analysis indicated that clinical stage, tumor diameter, lymph node metastasis, tumor differentiation degree, ECOG score, and HER2 had a significant positive impact on CTLA-4⁺ CD4⁺ (P<0.05), while ER and PR had a significant negative impact on CTLA-4⁺ CD4⁺ (P<0.05). Logistic regression analysis showed that CTLA-4⁺ CD4⁺ was positively correlated with poor prognosis (P<0.05). CTLA-4⁺ CD4⁺ and clinical stage had multiplicative and additive interactions on prognosis. Regardless of the clinical stage, CTLA-4⁺ CD4⁺ on the surface of CD4⁺ T cells was significantly positively correlated with poor prognosis.

Conclusion: The expression level of CTLA-4⁺ CD4⁺ in patients with advanced breast cancer is significantly elevated, playing a crucial role in the clinical pathological characteristics of breast cancer. An elevated level may indicate a poor prognosis.