This systematic review aims to comprehensively examine and compare deep learning methods for brain tumor segmentation and classification using MRI and other imaging modalities,focusing on recent trends from 2022 to 20...This systematic review aims to comprehensively examine and compare deep learning methods for brain tumor segmentation and classification using MRI and other imaging modalities,focusing on recent trends from 2022 to 2025.The primary objective is to evaluate methodological advancements,model performance,dataset usage,and existing challenges in developing clinically robust AI systems.We included peer-reviewed journal articles and highimpact conference papers published between 2022 and 2025,written in English,that proposed or evaluated deep learning methods for brain tumor segmentation and/or classification.Excluded were non-open-access publications,books,and non-English articles.A structured search was conducted across Scopus,Google Scholar,Wiley,and Taylor&Francis,with the last search performed in August 2025.Risk of bias was not formally quantified but considered during full-text screening based on dataset diversity,validation methods,and availability of performance metrics.We used narrative synthesis and tabular benchmarking to compare performance metrics(e.g.,accuracy,Dice score)across model types(CNN,Transformer,Hybrid),imaging modalities,and datasets.A total of 49 studies were included(43 journal articles and 6 conference papers).These studies spanned over 9 public datasets(e.g.,BraTS,Figshare,REMBRANDT,MOLAB)and utilized a range of imaging modalities,predominantly MRI.Hybrid models,especially ResViT and UNetFormer,consistently achieved high performance,with classification accuracy exceeding 98%and segmentation Dice scores above 0.90 across multiple studies.Transformers and hybrid architectures showed increasing adoption post2023.Many studies lacked external validation and were evaluated only on a few benchmark datasets,raising concerns about generalizability and dataset bias.Few studies addressed clinical interpretability or uncertainty quantification.Despite promising results,particularly for hybrid deep learning models,widespread clinical adoption remains limited due to lack of validation,interpretability concerns,and real-world deployment barriers.展开更多
Liver cancer remains a leading cause of mortality worldwide,and precise diagnostic tools are essential for effective treatment planning.Liver Tumors(LTs)vary significantly in size,shape,and location,and can present wi...Liver cancer remains a leading cause of mortality worldwide,and precise diagnostic tools are essential for effective treatment planning.Liver Tumors(LTs)vary significantly in size,shape,and location,and can present with tissues of similar intensities,making automatically segmenting and classifying LTs from abdominal tomography images crucial and challenging.This review examines recent advancements in Liver Segmentation(LS)and Tumor Segmentation(TS)algorithms,highlighting their strengths and limitations regarding precision,automation,and resilience.Performance metrics are utilized to assess key detection algorithms and analytical methods,emphasizing their effectiveness and relevance in clinical contexts.The review also addresses ongoing challenges in liver tumor segmentation and identification,such as managing high variability in patient data and ensuring robustness across different imaging conditions.It suggests directions for future research,with insights into technological advancements that can enhance surgical planning and diagnostic accuracy by comparing popular methods.This paper contributes to a comprehensive understanding of current liver tumor detection techniques,provides a roadmap for future innovations,and improves diagnostic and therapeutic outcomes for liver cancer by integrating recent progress with remaining challenges.展开更多
Brain tumors require precise segmentation for diagnosis and treatment plans due to their complex morphology and heterogeneous characteristics.While MRI-based automatic brain tumor segmentation technology reduces the b...Brain tumors require precise segmentation for diagnosis and treatment plans due to their complex morphology and heterogeneous characteristics.While MRI-based automatic brain tumor segmentation technology reduces the burden on medical staff and provides quantitative information,existing methodologies and recent models still struggle to accurately capture and classify the fine boundaries and diverse morphologies of tumors.In order to address these challenges and maximize the performance of brain tumor segmentation,this research introduces a novel SwinUNETR-based model by integrating a new decoder block,the Hierarchical Channel-wise Attention Decoder(HCAD),into a powerful SwinUNETR encoder.The HCAD decoder block utilizes hierarchical features and channelspecific attention mechanisms to further fuse information at different scales transmitted from the encoder and preserve spatial details throughout the reconstruction phase.Rigorous evaluations on the recent BraTS GLI datasets demonstrate that the proposed SwinHCAD model achieved superior and improved segmentation accuracy on both the Dice score and HD95 metrics across all tumor subregions(WT,TC,and ET)compared to baseline models.In particular,the rationale and contribution of the model design were clarified through ablation studies to verify the effectiveness of the proposed HCAD decoder block.The results of this study are expected to greatly contribute to enhancing the efficiency of clinical diagnosis and treatment planning by increasing the precision of automated brain tumor segmentation.展开更多
BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investig...BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investigate the prognostic value and importance of peritumoral radiomics in locally advanced rectal cancer(LARC).METHODS This retrospective study included 409 patients with biopsy-confirmed LARC treated with neoadjuvant chemoradiotherapy and surgically.Patients were divided into training(n=273)and validation(n=136)sets.Based on intratumoral and peritumoral radiomic features extracted from pretreatment axial high-resolution small-field-of-view T2-weighted images,multivariate Cox models for progression-free survival(PFS)prediction were developed with or without clinicoradiological features and evaluated with Harrell’s concordance index(C-index),calibration curve,and decision curve analyses.Risk stratification,Kaplan-Meier analysis,and permutation feature importance analysis were performed.RESULTS The comprehensive integrated clinical-radiological-omics model(ModelICRO)integrating seven peritumoral,three intratumoral,and four clinicoradiological features achieved the highest C-indices(0.836 and 0.801 in the training and validation sets,respectively).This model showed robust calibration and better clinical net benefits,effectively distinguished high-risk from low-risk patients(PFS:97.2%vs 67.6%and 95.4%vs 64.8%in the training and validation sets,respectively;both P<0.001).Three most influential predictors in the comprehensive ModelICRO were,in order,a peritumoral,an intratumoral,and a clinicoradiological feature.Notably,the peritumoral model outperformed the intratumoral model(C-index:0.754 vs 0.670;P=0.015);peritumoral features significantly enhanced the performance of models based on clinicoradiological or intratumoral features or their combinations.CONCLUSION Peritumoral radiomics holds greater prognostic value than intratumoral radiomics for predicting PFS in LARC.The comprehensive model may serve as a reliable tool for better stratification and management postoperatively.展开更多
Tumor initiation and progression are highly intricate biolog-ical processes,and mutation-driven tumorigenesis is a pri-mary underlying cause.Personalized cancer vaccines have been developed to exploit these specific m...Tumor initiation and progression are highly intricate biolog-ical processes,and mutation-driven tumorigenesis is a pri-mary underlying cause.Personalized cancer vaccines have been developed to exploit these specific mutations,particu-larly in the form of tumor neoantigens,to induce immune responses,particularly the activation of CD8+T cells,which can attack malignant cells.Since tumor mutations result in protein sequence alterations distinct from those in normal tissues,therapies that precisely target these alterations could,in principle,confer effective tumor control while minimizing off-target effects.展开更多
BACKGROUND Ovarian sclerosing stromal tumors(OSSTs)are found most commonly in females at 20-30 years of age.They can also occur at any point during pre-puberty,puberty,or menopause.Clinical manifestations of OSSTs inc...BACKGROUND Ovarian sclerosing stromal tumors(OSSTs)are found most commonly in females at 20-30 years of age.They can also occur at any point during pre-puberty,puberty,or menopause.Clinical manifestations of OSSTs include abdominal pain,an abdominal mass,menstrual abnormalities,and infertility.Infrequently,patients will experience androgen-related manifestations of masculinization,such as increased hair,acne,or a low voice.Diagnosis must be confirmed by immunohistochemical analysis of the tissue as clinical symptoms and imaging studies are unreliable.CASE SUMMARY A 14-year-old female presented with amenorrhea.After a thorough medical examination,endocrine and tumor markers analysis,and imaging,a pelvic mass was discovered.The patient also exhibited endocrine dysfunction but was not positive for any tumor markers.The patient underwent surgery to remove the ovarian tumor.Immunohistochemical analysis of the resected specimen indicated an OSST.During the postoperative follow-up,the patient had attained menarche.CONCLUSION This case’s clinical manifestation of endocrine dysfunction due to OSST provides new insights that will assist clinicians in the diagnosis and treatment of this common tumor.展开更多
BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathologic...BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion,providing evidence-based guidance for optimal treatment strategy selection.METHODS This study retrospectively analyzed the sex,age,and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024.Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration,and the factors with statistical significance were included in multivariate logistic regression analysis.RESULTS A total of 422 patients,including 224 males and 198 females,aged 63.45±9.23 years,were included.There were 456 LST lesions in total.The length of the endoscopically resected specimens was 3.01±0.48 cm,and the length of the lesions was 2.37±1.59 cm.It was located in 115 rectums(25.2%),40 sigmoid colon(8.8%),26 descending colon(5.7%),109 transverse colon(23.9%),112 ascending colon(24.6%),and 54 ileocecal regions(11.8%).Endoscopic submucosal dissection(ESD)was performed in 237 patients(52.0%),and endoscopic mucosal resection(EMR)was performed in 95 patients(20.8%).There were 113 EMR with precutting cases(24.8%),11 ESD with snare cases(2.4%),4 delayed bleeding cases and 5 intraoperative perforations.The pathological results revealed 119 cases of low-grade intraepithelial neoplasia(26.1%),221 cases of high-grade intraepithelial neoplasia(48.5%),82 cases of intramucosal carcinoma(18.0%),and 34 cases of submucous invasive carcinoma(7.5%).Multiple logistic regression analyses revealed that lesion size(>2 cm),lesion location(rectal)and endoscopic classification[false depressed tubulovillous adenoma(LST-NG pseudodepressed type,LST-NG-PD),type 1 particles(LST-G homogenous type),and LST-G nodular mixed type],accompanied by large nodules(with)were independent risk factors for carcinogenesis;endoscopic classification(LST-NG-PD)and the presence of large nodules were independent risk factors for submucosal infiltration.CONCLUSION These risk factors provide practical guidance for treatment selection:LST-NG-PD with large nodules should prioritize ESD,while high-risk rectal lesions>2 cm may require additional imaging evaluation before endoscopic resection.展开更多
A tumor cell membrane(CM)-based biomimetic membrane tumor vaccine is an emerging prevention and treatment strategy in tumor immunotherapy.However,a single CM mostly has a weak immune-boosting effect.Here,a heterogenic...A tumor cell membrane(CM)-based biomimetic membrane tumor vaccine is an emerging prevention and treatment strategy in tumor immunotherapy.However,a single CM mostly has a weak immune-boosting effect.Here,a heterogenic fusion membrane tumor vaccine,EV–CM,was successfully constructed by fusing extracellular vesicles(EVs)from S.aureus and CM from B16F10 melanoma cells.Inheriting the advantages of parental components,the EV–CM combines tumor antigens with natural adjuvants that can be used for immunotherapy and can be easily synergistic with complementary therapies.In vivo vaccine tests have shown that EV–CM can activate immune antitumor responses and prevent tumorigenesis.To further enhance the immunotherapeutic and antimetastatic effects of EV–CM,Pt-porphyrin coordination polymer as an immunopotentiator(CPIP)was implanted into an EV–CM nanoplatform(CPIP@EV–CM),which combines localized sonodynamic/chemodynamic therapy-induced immunogenic cell death with heterogenic fusion membrane-mediated antigen-presenting functions.In vitro performance tests,cell experiments,and in vivo animal models have confirmed that the CPIP@EV–CM combined with US has better ROS production,tumor cell killing,and antimetastasis abilities.The heterogenic fusion membrane strategy and ultrasound-augmented nanoplatform present exciting prospects for designing tumor-immunogenic,self-adjuvant,and expandable vaccines,providing new ideas for exploring new melanoma immunotherapy and antimetastasis strategies,which is expected to be used as a safe and effective treatment in clinical practice.展开更多
This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patient...This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patients with familial GISTs.The actual incidence of GISTs may be underestimated due to diagnostic limitations and the long-term low-risk behavior of some GISTs.The molecular landscape of GISTs is primarily driven by mutations in the KIT and platelet-derived growth factor receptor alpha(PDGFRA)genes.A subset of GISTs without these mutations known as wild-type GISTs,may harbor other rare mutations,impacting their response to targeted therapies.Clinically,patients with GISTs present with nonspecific symptoms,often leading to delayed diagnosis.Genetic predispositions in familial GISTs provide insights into the genetic architecture and extragastrointestinal manifestations of GISTs.Management has evolved from surgical interventions to molecular-based therapies using tyrosine kinase inhibitors.The management of GISTs,especially in familial cases,requires a multidisciplinary approach.Cases of different gene mutations were reported in the same family,suggesting that incorporating genetic testing into routine clinical practice is crucial for the early identification of high-risk individuals and the implementation of tailored surveillance programs.展开更多
BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many...BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.展开更多
Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological,biological,and clinical characteristics that have increased in incidence and prevalence within the last few decades.They c...Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological,biological,and clinical characteristics that have increased in incidence and prevalence within the last few decades.They contain chromogranin A,synaptophysin and neuron-specific enolase which are necessary for making a diagnosis of neuroendocrine tumor.Ki-67 index and mitotic index correlate with cellular proliferation.Serum chromogranin A is the most commonly used biomarker to assess the bulk of disease and monitor treatment and is raised in both functioning and non-functioning neuroendocrine tumors.Most of the gastrointestinal neuroendocrine tumors are non-functional.World Health Organization updated the classification of neuroendocrine tumors in 2017 and renamed mixed adenoneuroendocrine carcinoma into mixed neuroendocrine neoplasm.Gastric neuroendocrine tumors arise from enterochromaffin like cells.They are classified into 4 types.Only type I and type II are gastrin dependent.Small intestinal neuroendocrine tumor is the most common small bowel malignancy.More than two-third of them occur in the terminal ileum within 60 cm of ileocecal valve.Patients with small intestinal neuroendrocrine tumors frequently show clinical symptoms and develop distant metastases more often than those with neuroendocrine tumors of other organs.Duodenal and jejunoileal neuroendocrine tumors are distinct biologically and clinically.Carcinoid syndrome generally occurs when jejuno-ileal neuroendocrine tumors metastasize to the liver.Appendiceal neuroendocrine tumors are generally detected after appendectomy.Colonic neuroendocrine tumors generally present as a large tumor with local or distant metastasis at the time of diagnosis.Rectal neuroendocrine tumors are increasingly being diagnosed since the implementation of screening colonoscopy in 2000.Gastrointestinal neuroendocrine tumors are diagnosed and staged by endoscopy with biopsy,endoscopic ultrasound,serology of biomarkers,imaging studies and functional somatostatin scans.Various treatment options are available for curative and palliative treatment of gastrointestinal neuroendocrine tumors.展开更多
Tumor-host interaction at the invasive front of colorectal cancer represents a critical interface encompassing a dynamic process of de-differentiation of colorectal carci-noma cells known as epithelial mesenchymal tra...Tumor-host interaction at the invasive front of colorectal cancer represents a critical interface encompassing a dynamic process of de-differentiation of colorectal carci-noma cells known as epithelial mesenchymal transition (EMT). EMT can be identified histologically by the presence of "tumor budding" ,a feature which can be highly specific for tumors showing an inf iltrating tumor growth pattern. Importantly,tumor budding and tumor border configuration have generated considerable interest as additional prognostic factors and are also recognized as such by the International Union Against Cancer. Evidence seems to suggest that the presence of tumor budding or an infiltrating growth pattern is inversely correlated with the presence of immune and inflammatory responses at the invasive tumor front. In fact,several tumor-associated antigens such as CD3,CD4,CD8,CD20,Granzyme B,FOXP3 and other immunological or inflammatory cell types have been identified as poten-tially prognostic in patients with this disease. Evidence seems to suggest that the balance between protumor (including budding and inf iltrating growth pattern) and anti-tumor (immune response or certain inflammatory cell types) factors at the invasive front of colorectal cancer may be decisive in determining tumor progression and the clinical outcome of patients with colorectal cancer. On one hand,the inf iltrating tumor border configuration and tumor budding promote progression and dissemination of tumor cells by penetrating the vascular and lymphatic vessels. On the other,the host attempts to fend off this attack by mounting an immune response to protect vascular and lymphatic channels from invasion by tumor buds. Whereas standard pathology reporting of breast and prostate cancer involves additional prognostic features,such as the BRE and Gleason scores,the ratio of pro-and anti-tumor factors could be a promising approach for the future development of a prognostic score for patients with colorectal cancer which could complement tumor node metastasis staging to improve the clinical management of patients with this disease.展开更多
Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the smal...Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine.Although the exact prevalence of GIST is not known,the incidence of GIST has been increasing.GISTs arise from interstitial cells of Cajal.Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene.15%of GISTs do not have these mutations and they are called wildtype GISTs.Almost all GISTs express KIT receptor tyrosine kinase.Histologically,GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type.The median size of GISTs varies from 2.7 cm to 8.9 cm.Clinically,patients with small GISTs remain asymptomatic but as the GIST size increases,patients present with various symptoms depending on the location of the GIST.Most of GISTs are located in the stomach or small bowel.Diagnosis is suspected on imaging and endoscopic studies,and confirmed by tissue acquisition with immunohistochemical staining.The aggressiveness of GISTs depends on the size,mitotic index and location.Surgical resection is the treatment of choice.But various endoscopic modalities of resection are increasingly being tried.Tyrosine kinase inhibitors are extremely useful in the management of large GISTs,unresectable GISTs and metastatic GISTs.Treatment options for metastatic GISTs also include radiotherapy,chemotherapy,hepatic artery embolization,chemoembolization and radiofrequency ablation.展开更多
Given the growing burden of colorectal cancer(CRC)as a global health challenge,it becomes imperative to focus on strategies that can mitigate its impact.Posttreatment surveillance has emerged as essential for early de...Given the growing burden of colorectal cancer(CRC)as a global health challenge,it becomes imperative to focus on strategies that can mitigate its impact.Posttreatment surveillance has emerged as essential for early detection of recurrence,significantly improving patient outcomes.However,intensive surveillance strategies have shown mixed results compared to less intensive methods,emphasizing the necessity for personalized,risk-adapted approaches.The observed suboptimal adherence to existing surveillance protocols underscores the urgent need for more tailored and efficient strategies.In this context,circulating tumor DNA(ctDNA)emerges as a promising biomarker with significant potential to revolutionize post-treatment surveillance,demonstrating high specificity[0.95,95%confidence interval(CI):0.91-0.97]and robust diagnostic odds(37.6,95%CI:20.8-68.0)for recurrence detection.Furthermore,artificial intelligence and machine learning models integrating patient-specific and tumor features can enhance risk stratification and optimize surveillance strategies.The reported area under the receiver operating characteristic curve,measuring artificial intelligence model performance in predicting CRC recurrence,ranged from 0.581 and 0.593 at the lowest to 0.979 and 0.978 at the highest in training and validation cohorts,respectively.Despite this promise,addressing cost,accessibility,and extensive validation remains crucial for equitable integration into clinical practice.展开更多
In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumo...In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.展开更多
In recent years,advancements in single-cell and spatial transcriptomics,which are highly regarded developments in the current era,particularly the emerging integration of single-cell and spatiotemporal transcriptomics...In recent years,advancements in single-cell and spatial transcriptomics,which are highly regarded developments in the current era,particularly the emerging integration of single-cell and spatiotemporal transcriptomics,have enabled a detailed molecular comprehension of the complex regulation of cell fate.The insights obtained from these methodologies are anticipated to significantly contribute to the development of personalized medicine.Currently,single-cell technology is less frequently utilized for prostate cancer compared with other types of tumors.Start-ing from the perspective of RNA sequencing technology,this review outlined the signifcance of single-cell RNA sequencing(scRNA-seq)in prostate cancer research,encompassing preclinical medicine and clinical applications.We summarize the differences between mouse and human prostate cancer as revealed by scRNA-seq studies,as well as a combination of multi-omics methods involving scRNA-seq to highlight the key molecular targets for the diagnosis,treatment,and drug resistance characteristics of prostate cancer.These studies are expected to provide novel insights for the development of immunotherapy and other innovative treatment strategies for castration-resistant prostate cancer.Furthermore,we explore the potential clinical applications stemming from other single-cell technologies in this review,paving the way for future research in precision medicine.展开更多
Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs ...Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs can directly replicate the current diagnostic and treatment standards for GISTs.This study aims to further elucidate the clinical and pathological characteristics,diagnosis,treatment,and prognosis of EGISTs by analyzing the research results of domestic scholars in the field of EGISTs in the past decade.Methods:A review was conducted on original Chinese and English research articles published from 2013 to 2022 focusing on EGISTs.A descriptive approach was used to extract key information from the literature,including patient demographics,tumor location,tumor diameter,mitotic figures,risk stratification,immunohistochemical markers,cell type,and prognostic factors.The data were subjected to statistical analysis.Results:A total of 12 articles containing 780 EGIST patients were included.The male-to female incidence of EGISTs was 0.92꞉1.The most common sites of EGISTs were mesentery(30.96%),peritoneum or retroperitoneum(28.53%),omentum(20.32%),and pelvic cavity(12.52%).52.77%of EGISTs had tumor diameters greater than 10 cm,and the proportions of EGISTs with nuclear fission patterns greater than 5/50 high power field(HPF)and greater than 10/50 HPF were 51.24%and 26.11%,respectively.The proportion of high-risk EGISTs was 79.05%.The positive rates of immune markers CD117,CD34,and DOG-1 in EGISTs were 82.3%,69.0%,and 79.5%,respectively.The proportion of Ki-67>5%was 49.2%,and the proportion of Ki-67>10%was 24.8%.The proportions of EGISTs in spindle cells,epithelial cells,and mixed cells were 74.4%,14.8%,and 13.1%,respectively.The diameter of the tumor,resection method,risk level,Ki-67 index,mitotic counts,presence of rupture/bleeding/necrosis/peripheral tissue invasion/recurrence and metastasis,as well as the use of imatinib treatment after surgery were important factors affecting the prognosis of EGISTs.Conclusion:Current medical research is relatively well cognizant of GISTs with primary sites in the gastrointestinal tract.Compared with GISTs,EGISTs have large tumor diameters,high mitotic counts,a high percentage of high-risk grades,relatively unique molecular expression,and high aggressiveness.EGISTs differ from GISTs in clinicopathological characteristics.Whether EGISTs and GISTs share a common origin remains unclear.If they are distinct tumor entities,separate diagnostic and treatment guidelines for EGISTs should be established.If EGISTs are ultimately confirmed to be a special subtype of GISTs,then directly applying existing GIST-based standards to EGISTs may be inappropriate.A more scientific approach would involve subclassifying EGISTs based on anatomical location and then tailoring treatment strategies accordingly with reference to GIST guidelines.展开更多
BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic...BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic gastritis and hypergastrinemia,makes up 75%–80%of G-NETs;(2)Type II,associated with Zollinger-Ellison syndrome(ZES)and multiple endocrine neoplasia,comprises 5%;and(3)Type III,sporadic tumors with a higher metastatic potential,accounting for 15%–25%.Diagnosis involves endoscopy,biopsy,and histological examination.Additional methods include serum gastrin testing,immunohistochemistry,and imaging techniques such as computer tomography or magnetic resonance imaging for detecting metastasis.Type I treatment usually involves endoscopic resection(ER),with surgical resection for recurrence.Somatostatin analogs(SSAs)can reduce tumor size,and the prognosis is generally excellent.Type II treatment centers on surgical removal of the gastrinoma,with ER for smaller lesions and SSAs for symptom management.Type III requires surgical resection(partial or total gastrectomy)with lymph node dissection,and possibly chemotherapy.This type has a worse prognosis due to its aggressive nature.Emerging treatments like Peptide Receptor Radionuclide Therapy are promising for advanced cases,and ongoing research into immunotherapies is expanding future treatment options.Regular endoscopic follow-up is crucial to monitor for recurrence or metastasis across all types.Our literature review explores the current perspectives on G-NETs and highlights the importance of further research to improve diagnostic precision and treatment,particularly for those associated with less favorable cases.AIM To improve diagnostic precision and treatment,particularly for those associated with less favorable cases.METHODS A systematic search was conducted in PubMed,Scopus,and Web of Science until September 2024.Two independent reviewers screened titles,abstracts,and full texts for eligibility based on G-NET treatment in adults.Eligible studies included cohort studies,clinical trials,case series,and case reports,while in vitro,pediatric,and non-English studies were excluded.Relevant data were extracted independently,and disagreements were resolved through discussion.Study quality was assessed using appropriate tools.RESULTS G-NETs are rare,classified into three types:(1)Type I;(2)Type II;and(3)Type III.Type I G-NETs,often associated with chronic atrophic gastritis,are typically slow-growing and low-grade,with favorable outcomes following surgical resection.Type II G-NETs arise in hypergastrinemia conditions like multiple endocrine neoplasia and ZES,showing moderate malignancy risk.Type III G-NETs,the most aggressive and least common,present with distant metastases and poor prognosis.Diagnosis relies on endoscopy,imaging,and biomarkers like chromogranin A.Treatment varies by type,ranging from ER to aggressive surgery and chemotherapy for advanced cases.Regular follow-up is essential to monitor recurrence,particularly for type III G-NETs.CONCLUSION G-NETs require tailored diagnosis and treatment based on type and stage.Types I and II generally have better prognosis,while types III and IV are linked to poorer outcomes due to invasion and metastasis.Treatment strategies vary from ER for type I to extensive surgery for type III.Emerging therapies,like somatostatin analogs and peptide-receptor radionuclide therapies,show promise in advanced cases.Further research is essential to improve early diagnosis and treatment,particularly for high-risk lesions.展开更多
BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the eti...BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the etiology,sources,classification,treatment,and prognosis of CMT.METHODS A total of 226 CMT patients from two centers(2013 to 2023)were reviewed,and 153 tumor patients from China Health and Retirement Longitudinal Study were used as controls.The survival rates of 96 CMT patients were tracked through medical records and telephone follow-ups.Logistic regression and survival analyses were conducted to characterize CMT.RESULTS CMTs were predominantly male(67.26%vs 39.47%,P<0.001).Intracardiac metastasis patients had worse heart and coagulation function than pericardial metastasis patients(prothrombin time:13.90 vs 13.30,P=0.002),D-dimer levels(2.16 vs 0.85,P=0.001),B-type natriuretic peptide(BNP)levels(324.00 vs 136.50,P=0.004),and troponin levels(5.35 vs 0.03,P<0.001)).Lung and liver cancers were the predominant primary tumor types in CMT.Patients with lung cancer(76.40%vs 30.77%)and thymoma(7.45%vs 1.54%)exhibited a higher prevalence of pericardial metastasis,while those with liver cancer(35.38%vs 0.62%)showed a higher prevalence of intracardiac metastasis.Overall survival was better for pericardial metastasis than for intracardiac metastasis patients(median survival:419 days vs 129 days,log-rank test P=0.0029).Cox proportional hazards model revealed that advanced age[hazard ratio(HR)=1.034,95%confidence interval(95%CI):1.011-1.057]and higher BNP and troponin levels(HR=1.011,95%CI:1.004-1.018)were associated with worse survival.Surgery significantly improved the survival rate of patients.The median survival time was 275 days for patients who did not undergo surgery and 708 days for those who had surgery(log-rank test P=0.0128)CONCLUSION Clinicians should consider CMT in the male lung or liver cancer patients with cardiac symptoms.Abnormal coagulation,impaired heart function,tumor location,and age are key prognostic factors for CMT.Surgical intervention is the preferred treatment option,as it significantly prolongs median survival.展开更多
Serotonin(5-hydroxytryptamine,5-HT),a neurotransmitter known for its roles in the central nervous system,showing dual effects in various pathological conditions,including tumor progression and wound healing.This revie...Serotonin(5-hydroxytryptamine,5-HT),a neurotransmitter known for its roles in the central nervous system,showing dual effects in various pathological conditions,including tumor progression and wound healing.This review explores the complex and context-dependent actions of 5-HT,highlighting its contrasting roles in promoting tumor growth and facilitating wound repair.5-HT can enhance tumor growth,survival,and metastasis via its receptors,but it also accelerates wound healing by stimulating cell proliferation,migration,and angiogenesis.This duality emphasizes the intricate balance of 5-HT and its receptors in the body.We discuss the synthesis,storage,secretion,and metabolism of 5-HT,as well as the classification and mechanisms of its receptors(5-HTRs)in different cell types under pathological conditions.We further examine the potential roles of 5-HT in both tumor progress and wound healing,proposing targeted strategies for each disease state.For tumors,“blocking therapy”involving receptor antagonists or gene silencing may inhibit tumor progression,while“activation therapy”can stimulate wound healing by enhancing receptor activation on skin cells.Challenges in clinical application,including issues related to targeting,specificity,and dosage,are addressed,alongside the promise of nanotechnology for improving targeted drug delivery.The review also explores emerging research on 5-HT's interaction with the immune system,offering insights into potential immunotherapeutic strategies for both cancer and wound healing.By balancing 5-HT's diverse effects,personalized treatments can be developed to optimize therapeutic outcomes in both contexts.展开更多
文摘This systematic review aims to comprehensively examine and compare deep learning methods for brain tumor segmentation and classification using MRI and other imaging modalities,focusing on recent trends from 2022 to 2025.The primary objective is to evaluate methodological advancements,model performance,dataset usage,and existing challenges in developing clinically robust AI systems.We included peer-reviewed journal articles and highimpact conference papers published between 2022 and 2025,written in English,that proposed or evaluated deep learning methods for brain tumor segmentation and/or classification.Excluded were non-open-access publications,books,and non-English articles.A structured search was conducted across Scopus,Google Scholar,Wiley,and Taylor&Francis,with the last search performed in August 2025.Risk of bias was not formally quantified but considered during full-text screening based on dataset diversity,validation methods,and availability of performance metrics.We used narrative synthesis and tabular benchmarking to compare performance metrics(e.g.,accuracy,Dice score)across model types(CNN,Transformer,Hybrid),imaging modalities,and datasets.A total of 49 studies were included(43 journal articles and 6 conference papers).These studies spanned over 9 public datasets(e.g.,BraTS,Figshare,REMBRANDT,MOLAB)and utilized a range of imaging modalities,predominantly MRI.Hybrid models,especially ResViT and UNetFormer,consistently achieved high performance,with classification accuracy exceeding 98%and segmentation Dice scores above 0.90 across multiple studies.Transformers and hybrid architectures showed increasing adoption post2023.Many studies lacked external validation and were evaluated only on a few benchmark datasets,raising concerns about generalizability and dataset bias.Few studies addressed clinical interpretability or uncertainty quantification.Despite promising results,particularly for hybrid deep learning models,widespread clinical adoption remains limited due to lack of validation,interpretability concerns,and real-world deployment barriers.
基金the“Intelligent Recognition Industry Service Center”as part of the Featured Areas Research Center Program under the Higher Education Sprout Project by the Ministry of Education(MOE)in Taiwan,and the National Science and Technology Council,Taiwan,under grants 113-2221-E-224-041 and 113-2622-E-224-002.Additionally,partial support was provided by Isuzu Optics Corporation.
文摘Liver cancer remains a leading cause of mortality worldwide,and precise diagnostic tools are essential for effective treatment planning.Liver Tumors(LTs)vary significantly in size,shape,and location,and can present with tissues of similar intensities,making automatically segmenting and classifying LTs from abdominal tomography images crucial and challenging.This review examines recent advancements in Liver Segmentation(LS)and Tumor Segmentation(TS)algorithms,highlighting their strengths and limitations regarding precision,automation,and resilience.Performance metrics are utilized to assess key detection algorithms and analytical methods,emphasizing their effectiveness and relevance in clinical contexts.The review also addresses ongoing challenges in liver tumor segmentation and identification,such as managing high variability in patient data and ensuring robustness across different imaging conditions.It suggests directions for future research,with insights into technological advancements that can enhance surgical planning and diagnostic accuracy by comparing popular methods.This paper contributes to a comprehensive understanding of current liver tumor detection techniques,provides a roadmap for future innovations,and improves diagnostic and therapeutic outcomes for liver cancer by integrating recent progress with remaining challenges.
基金supported by Institute of Information&Communications Technology Planning&Evaluation(IITP)under the Metaverse Support Program to Nurture the Best Talents(IITP-2024-RS-2023-00254529)grant funded by the Korea government(MSIT).
文摘Brain tumors require precise segmentation for diagnosis and treatment plans due to their complex morphology and heterogeneous characteristics.While MRI-based automatic brain tumor segmentation technology reduces the burden on medical staff and provides quantitative information,existing methodologies and recent models still struggle to accurately capture and classify the fine boundaries and diverse morphologies of tumors.In order to address these challenges and maximize the performance of brain tumor segmentation,this research introduces a novel SwinUNETR-based model by integrating a new decoder block,the Hierarchical Channel-wise Attention Decoder(HCAD),into a powerful SwinUNETR encoder.The HCAD decoder block utilizes hierarchical features and channelspecific attention mechanisms to further fuse information at different scales transmitted from the encoder and preserve spatial details throughout the reconstruction phase.Rigorous evaluations on the recent BraTS GLI datasets demonstrate that the proposed SwinHCAD model achieved superior and improved segmentation accuracy on both the Dice score and HD95 metrics across all tumor subregions(WT,TC,and ET)compared to baseline models.In particular,the rationale and contribution of the model design were clarified through ablation studies to verify the effectiveness of the proposed HCAD decoder block.The results of this study are expected to greatly contribute to enhancing the efficiency of clinical diagnosis and treatment planning by increasing the precision of automated brain tumor segmentation.
文摘BACKGROUND The peritumoral region possesses attributes that promote cancer growth and progression.However,the potential prognostic biomarkers in this region remain relatively underexplored in radiomics.AIM To investigate the prognostic value and importance of peritumoral radiomics in locally advanced rectal cancer(LARC).METHODS This retrospective study included 409 patients with biopsy-confirmed LARC treated with neoadjuvant chemoradiotherapy and surgically.Patients were divided into training(n=273)and validation(n=136)sets.Based on intratumoral and peritumoral radiomic features extracted from pretreatment axial high-resolution small-field-of-view T2-weighted images,multivariate Cox models for progression-free survival(PFS)prediction were developed with or without clinicoradiological features and evaluated with Harrell’s concordance index(C-index),calibration curve,and decision curve analyses.Risk stratification,Kaplan-Meier analysis,and permutation feature importance analysis were performed.RESULTS The comprehensive integrated clinical-radiological-omics model(ModelICRO)integrating seven peritumoral,three intratumoral,and four clinicoradiological features achieved the highest C-indices(0.836 and 0.801 in the training and validation sets,respectively).This model showed robust calibration and better clinical net benefits,effectively distinguished high-risk from low-risk patients(PFS:97.2%vs 67.6%and 95.4%vs 64.8%in the training and validation sets,respectively;both P<0.001).Three most influential predictors in the comprehensive ModelICRO were,in order,a peritumoral,an intratumoral,and a clinicoradiological feature.Notably,the peritumoral model outperformed the intratumoral model(C-index:0.754 vs 0.670;P=0.015);peritumoral features significantly enhanced the performance of models based on clinicoradiological or intratumoral features or their combinations.CONCLUSION Peritumoral radiomics holds greater prognostic value than intratumoral radiomics for predicting PFS in LARC.The comprehensive model may serve as a reliable tool for better stratification and management postoperatively.
基金supported by the National Natural Science Foundation of China(82341042 and 32270993)the PhD program of the Interdisciplinary Research Center,Sun Yat-sen University.
文摘Tumor initiation and progression are highly intricate biolog-ical processes,and mutation-driven tumorigenesis is a pri-mary underlying cause.Personalized cancer vaccines have been developed to exploit these specific mutations,particu-larly in the form of tumor neoantigens,to induce immune responses,particularly the activation of CD8+T cells,which can attack malignant cells.Since tumor mutations result in protein sequence alterations distinct from those in normal tissues,therapies that precisely target these alterations could,in principle,confer effective tumor control while minimizing off-target effects.
文摘BACKGROUND Ovarian sclerosing stromal tumors(OSSTs)are found most commonly in females at 20-30 years of age.They can also occur at any point during pre-puberty,puberty,or menopause.Clinical manifestations of OSSTs include abdominal pain,an abdominal mass,menstrual abnormalities,and infertility.Infrequently,patients will experience androgen-related manifestations of masculinization,such as increased hair,acne,or a low voice.Diagnosis must be confirmed by immunohistochemical analysis of the tissue as clinical symptoms and imaging studies are unreliable.CASE SUMMARY A 14-year-old female presented with amenorrhea.After a thorough medical examination,endocrine and tumor markers analysis,and imaging,a pelvic mass was discovered.The patient also exhibited endocrine dysfunction but was not positive for any tumor markers.The patient underwent surgery to remove the ovarian tumor.Immunohistochemical analysis of the resected specimen indicated an OSST.During the postoperative follow-up,the patient had attained menarche.CONCLUSION This case’s clinical manifestation of endocrine dysfunction due to OSST provides new insights that will assist clinicians in the diagnosis and treatment of this common tumor.
文摘BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion,providing evidence-based guidance for optimal treatment strategy selection.METHODS This study retrospectively analyzed the sex,age,and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024.Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration,and the factors with statistical significance were included in multivariate logistic regression analysis.RESULTS A total of 422 patients,including 224 males and 198 females,aged 63.45±9.23 years,were included.There were 456 LST lesions in total.The length of the endoscopically resected specimens was 3.01±0.48 cm,and the length of the lesions was 2.37±1.59 cm.It was located in 115 rectums(25.2%),40 sigmoid colon(8.8%),26 descending colon(5.7%),109 transverse colon(23.9%),112 ascending colon(24.6%),and 54 ileocecal regions(11.8%).Endoscopic submucosal dissection(ESD)was performed in 237 patients(52.0%),and endoscopic mucosal resection(EMR)was performed in 95 patients(20.8%).There were 113 EMR with precutting cases(24.8%),11 ESD with snare cases(2.4%),4 delayed bleeding cases and 5 intraoperative perforations.The pathological results revealed 119 cases of low-grade intraepithelial neoplasia(26.1%),221 cases of high-grade intraepithelial neoplasia(48.5%),82 cases of intramucosal carcinoma(18.0%),and 34 cases of submucous invasive carcinoma(7.5%).Multiple logistic regression analyses revealed that lesion size(>2 cm),lesion location(rectal)and endoscopic classification[false depressed tubulovillous adenoma(LST-NG pseudodepressed type,LST-NG-PD),type 1 particles(LST-G homogenous type),and LST-G nodular mixed type],accompanied by large nodules(with)were independent risk factors for carcinogenesis;endoscopic classification(LST-NG-PD)and the presence of large nodules were independent risk factors for submucosal infiltration.CONCLUSION These risk factors provide practical guidance for treatment selection:LST-NG-PD with large nodules should prioritize ESD,while high-risk rectal lesions>2 cm may require additional imaging evaluation before endoscopic resection.
基金supported by the National Natural Science Foundation of China(Grant nos.82272003,82302195,and 82371976)the China Postdoctoral Science Foundation(Grant no.2024M752237)+1 种基金the Sichuan Science and Technology Program(Grant no.2024YFHZ0271)PostDoctor Research Project,Sichuan University(Grant nos.2024SCU12029 and 2023SCU12070).
文摘A tumor cell membrane(CM)-based biomimetic membrane tumor vaccine is an emerging prevention and treatment strategy in tumor immunotherapy.However,a single CM mostly has a weak immune-boosting effect.Here,a heterogenic fusion membrane tumor vaccine,EV–CM,was successfully constructed by fusing extracellular vesicles(EVs)from S.aureus and CM from B16F10 melanoma cells.Inheriting the advantages of parental components,the EV–CM combines tumor antigens with natural adjuvants that can be used for immunotherapy and can be easily synergistic with complementary therapies.In vivo vaccine tests have shown that EV–CM can activate immune antitumor responses and prevent tumorigenesis.To further enhance the immunotherapeutic and antimetastatic effects of EV–CM,Pt-porphyrin coordination polymer as an immunopotentiator(CPIP)was implanted into an EV–CM nanoplatform(CPIP@EV–CM),which combines localized sonodynamic/chemodynamic therapy-induced immunogenic cell death with heterogenic fusion membrane-mediated antigen-presenting functions.In vitro performance tests,cell experiments,and in vivo animal models have confirmed that the CPIP@EV–CM combined with US has better ROS production,tumor cell killing,and antimetastasis abilities.The heterogenic fusion membrane strategy and ultrasound-augmented nanoplatform present exciting prospects for designing tumor-immunogenic,self-adjuvant,and expandable vaccines,providing new ideas for exploring new melanoma immunotherapy and antimetastasis strategies,which is expected to be used as a safe and effective treatment in clinical practice.
基金National Natural Science Foundation of China,No.82370569Basic and Applied Basic Research Foundation of Guangdong Province,No.2022A1515012647the Key Program for Science and Technology Projects of Social Development in Zhuhai,No.2220004000249(to Li XF).
文摘This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patients with familial GISTs.The actual incidence of GISTs may be underestimated due to diagnostic limitations and the long-term low-risk behavior of some GISTs.The molecular landscape of GISTs is primarily driven by mutations in the KIT and platelet-derived growth factor receptor alpha(PDGFRA)genes.A subset of GISTs without these mutations known as wild-type GISTs,may harbor other rare mutations,impacting their response to targeted therapies.Clinically,patients with GISTs present with nonspecific symptoms,often leading to delayed diagnosis.Genetic predispositions in familial GISTs provide insights into the genetic architecture and extragastrointestinal manifestations of GISTs.Management has evolved from surgical interventions to molecular-based therapies using tyrosine kinase inhibitors.The management of GISTs,especially in familial cases,requires a multidisciplinary approach.Cases of different gene mutations were reported in the same family,suggesting that incorporating genetic testing into routine clinical practice is crucial for the early identification of high-risk individuals and the implementation of tailored surveillance programs.
文摘BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.
文摘Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological,biological,and clinical characteristics that have increased in incidence and prevalence within the last few decades.They contain chromogranin A,synaptophysin and neuron-specific enolase which are necessary for making a diagnosis of neuroendocrine tumor.Ki-67 index and mitotic index correlate with cellular proliferation.Serum chromogranin A is the most commonly used biomarker to assess the bulk of disease and monitor treatment and is raised in both functioning and non-functioning neuroendocrine tumors.Most of the gastrointestinal neuroendocrine tumors are non-functional.World Health Organization updated the classification of neuroendocrine tumors in 2017 and renamed mixed adenoneuroendocrine carcinoma into mixed neuroendocrine neoplasm.Gastric neuroendocrine tumors arise from enterochromaffin like cells.They are classified into 4 types.Only type I and type II are gastrin dependent.Small intestinal neuroendocrine tumor is the most common small bowel malignancy.More than two-third of them occur in the terminal ileum within 60 cm of ileocecal valve.Patients with small intestinal neuroendrocrine tumors frequently show clinical symptoms and develop distant metastases more often than those with neuroendocrine tumors of other organs.Duodenal and jejunoileal neuroendocrine tumors are distinct biologically and clinically.Carcinoid syndrome generally occurs when jejuno-ileal neuroendocrine tumors metastasize to the liver.Appendiceal neuroendocrine tumors are generally detected after appendectomy.Colonic neuroendocrine tumors generally present as a large tumor with local or distant metastasis at the time of diagnosis.Rectal neuroendocrine tumors are increasingly being diagnosed since the implementation of screening colonoscopy in 2000.Gastrointestinal neuroendocrine tumors are diagnosed and staged by endoscopy with biopsy,endoscopic ultrasound,serology of biomarkers,imaging studies and functional somatostatin scans.Various treatment options are available for curative and palliative treatment of gastrointestinal neuroendocrine tumors.
文摘Tumor-host interaction at the invasive front of colorectal cancer represents a critical interface encompassing a dynamic process of de-differentiation of colorectal carci-noma cells known as epithelial mesenchymal transition (EMT). EMT can be identified histologically by the presence of "tumor budding" ,a feature which can be highly specific for tumors showing an inf iltrating tumor growth pattern. Importantly,tumor budding and tumor border configuration have generated considerable interest as additional prognostic factors and are also recognized as such by the International Union Against Cancer. Evidence seems to suggest that the presence of tumor budding or an infiltrating growth pattern is inversely correlated with the presence of immune and inflammatory responses at the invasive tumor front. In fact,several tumor-associated antigens such as CD3,CD4,CD8,CD20,Granzyme B,FOXP3 and other immunological or inflammatory cell types have been identified as poten-tially prognostic in patients with this disease. Evidence seems to suggest that the balance between protumor (including budding and inf iltrating growth pattern) and anti-tumor (immune response or certain inflammatory cell types) factors at the invasive front of colorectal cancer may be decisive in determining tumor progression and the clinical outcome of patients with colorectal cancer. On one hand,the inf iltrating tumor border configuration and tumor budding promote progression and dissemination of tumor cells by penetrating the vascular and lymphatic vessels. On the other,the host attempts to fend off this attack by mounting an immune response to protect vascular and lymphatic channels from invasion by tumor buds. Whereas standard pathology reporting of breast and prostate cancer involves additional prognostic features,such as the BRE and Gleason scores,the ratio of pro-and anti-tumor factors could be a promising approach for the future development of a prognostic score for patients with colorectal cancer which could complement tumor node metastasis staging to improve the clinical management of patients with this disease.
文摘Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine.Although the exact prevalence of GIST is not known,the incidence of GIST has been increasing.GISTs arise from interstitial cells of Cajal.Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene.15%of GISTs do not have these mutations and they are called wildtype GISTs.Almost all GISTs express KIT receptor tyrosine kinase.Histologically,GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type.The median size of GISTs varies from 2.7 cm to 8.9 cm.Clinically,patients with small GISTs remain asymptomatic but as the GIST size increases,patients present with various symptoms depending on the location of the GIST.Most of GISTs are located in the stomach or small bowel.Diagnosis is suspected on imaging and endoscopic studies,and confirmed by tissue acquisition with immunohistochemical staining.The aggressiveness of GISTs depends on the size,mitotic index and location.Surgical resection is the treatment of choice.But various endoscopic modalities of resection are increasingly being tried.Tyrosine kinase inhibitors are extremely useful in the management of large GISTs,unresectable GISTs and metastatic GISTs.Treatment options for metastatic GISTs also include radiotherapy,chemotherapy,hepatic artery embolization,chemoembolization and radiofrequency ablation.
文摘Given the growing burden of colorectal cancer(CRC)as a global health challenge,it becomes imperative to focus on strategies that can mitigate its impact.Posttreatment surveillance has emerged as essential for early detection of recurrence,significantly improving patient outcomes.However,intensive surveillance strategies have shown mixed results compared to less intensive methods,emphasizing the necessity for personalized,risk-adapted approaches.The observed suboptimal adherence to existing surveillance protocols underscores the urgent need for more tailored and efficient strategies.In this context,circulating tumor DNA(ctDNA)emerges as a promising biomarker with significant potential to revolutionize post-treatment surveillance,demonstrating high specificity[0.95,95%confidence interval(CI):0.91-0.97]and robust diagnostic odds(37.6,95%CI:20.8-68.0)for recurrence detection.Furthermore,artificial intelligence and machine learning models integrating patient-specific and tumor features can enhance risk stratification and optimize surveillance strategies.The reported area under the receiver operating characteristic curve,measuring artificial intelligence model performance in predicting CRC recurrence,ranged from 0.581 and 0.593 at the lowest to 0.979 and 0.978 at the highest in training and validation cohorts,respectively.Despite this promise,addressing cost,accessibility,and extensive validation remains crucial for equitable integration into clinical practice.
文摘In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.
基金Chinese Scholarship Council(202206240086)National Natural Science Foundation of China(81974099,82170785,81974098,82170784)+4 种基金National Key Research and Development Program of China(2021YFC2009303)programs from Science and Technology Department of Sichuan Province(2021YFH0172)Young Investigator Award of Sichuan University 2017(2017SCU04A17)Technology Innovation Research and Development Project of Chengdu Science and Technology Bureau(2019-YF05-00296-SN)Sichuan University-Panzhihua science and technology cooperation special fund(2020CDPZH-4).
文摘In recent years,advancements in single-cell and spatial transcriptomics,which are highly regarded developments in the current era,particularly the emerging integration of single-cell and spatiotemporal transcriptomics,have enabled a detailed molecular comprehension of the complex regulation of cell fate.The insights obtained from these methodologies are anticipated to significantly contribute to the development of personalized medicine.Currently,single-cell technology is less frequently utilized for prostate cancer compared with other types of tumors.Start-ing from the perspective of RNA sequencing technology,this review outlined the signifcance of single-cell RNA sequencing(scRNA-seq)in prostate cancer research,encompassing preclinical medicine and clinical applications.We summarize the differences between mouse and human prostate cancer as revealed by scRNA-seq studies,as well as a combination of multi-omics methods involving scRNA-seq to highlight the key molecular targets for the diagnosis,treatment,and drug resistance characteristics of prostate cancer.These studies are expected to provide novel insights for the development of immunotherapy and other innovative treatment strategies for castration-resistant prostate cancer.Furthermore,we explore the potential clinical applications stemming from other single-cell technologies in this review,paving the way for future research in precision medicine.
基金supported by the National Natural Science Foundation(81960508)。
文摘Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs can directly replicate the current diagnostic and treatment standards for GISTs.This study aims to further elucidate the clinical and pathological characteristics,diagnosis,treatment,and prognosis of EGISTs by analyzing the research results of domestic scholars in the field of EGISTs in the past decade.Methods:A review was conducted on original Chinese and English research articles published from 2013 to 2022 focusing on EGISTs.A descriptive approach was used to extract key information from the literature,including patient demographics,tumor location,tumor diameter,mitotic figures,risk stratification,immunohistochemical markers,cell type,and prognostic factors.The data were subjected to statistical analysis.Results:A total of 12 articles containing 780 EGIST patients were included.The male-to female incidence of EGISTs was 0.92꞉1.The most common sites of EGISTs were mesentery(30.96%),peritoneum or retroperitoneum(28.53%),omentum(20.32%),and pelvic cavity(12.52%).52.77%of EGISTs had tumor diameters greater than 10 cm,and the proportions of EGISTs with nuclear fission patterns greater than 5/50 high power field(HPF)and greater than 10/50 HPF were 51.24%and 26.11%,respectively.The proportion of high-risk EGISTs was 79.05%.The positive rates of immune markers CD117,CD34,and DOG-1 in EGISTs were 82.3%,69.0%,and 79.5%,respectively.The proportion of Ki-67>5%was 49.2%,and the proportion of Ki-67>10%was 24.8%.The proportions of EGISTs in spindle cells,epithelial cells,and mixed cells were 74.4%,14.8%,and 13.1%,respectively.The diameter of the tumor,resection method,risk level,Ki-67 index,mitotic counts,presence of rupture/bleeding/necrosis/peripheral tissue invasion/recurrence and metastasis,as well as the use of imatinib treatment after surgery were important factors affecting the prognosis of EGISTs.Conclusion:Current medical research is relatively well cognizant of GISTs with primary sites in the gastrointestinal tract.Compared with GISTs,EGISTs have large tumor diameters,high mitotic counts,a high percentage of high-risk grades,relatively unique molecular expression,and high aggressiveness.EGISTs differ from GISTs in clinicopathological characteristics.Whether EGISTs and GISTs share a common origin remains unclear.If they are distinct tumor entities,separate diagnostic and treatment guidelines for EGISTs should be established.If EGISTs are ultimately confirmed to be a special subtype of GISTs,then directly applying existing GIST-based standards to EGISTs may be inappropriate.A more scientific approach would involve subclassifying EGISTs based on anatomical location and then tailoring treatment strategies accordingly with reference to GIST guidelines.
文摘BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic gastritis and hypergastrinemia,makes up 75%–80%of G-NETs;(2)Type II,associated with Zollinger-Ellison syndrome(ZES)and multiple endocrine neoplasia,comprises 5%;and(3)Type III,sporadic tumors with a higher metastatic potential,accounting for 15%–25%.Diagnosis involves endoscopy,biopsy,and histological examination.Additional methods include serum gastrin testing,immunohistochemistry,and imaging techniques such as computer tomography or magnetic resonance imaging for detecting metastasis.Type I treatment usually involves endoscopic resection(ER),with surgical resection for recurrence.Somatostatin analogs(SSAs)can reduce tumor size,and the prognosis is generally excellent.Type II treatment centers on surgical removal of the gastrinoma,with ER for smaller lesions and SSAs for symptom management.Type III requires surgical resection(partial or total gastrectomy)with lymph node dissection,and possibly chemotherapy.This type has a worse prognosis due to its aggressive nature.Emerging treatments like Peptide Receptor Radionuclide Therapy are promising for advanced cases,and ongoing research into immunotherapies is expanding future treatment options.Regular endoscopic follow-up is crucial to monitor for recurrence or metastasis across all types.Our literature review explores the current perspectives on G-NETs and highlights the importance of further research to improve diagnostic precision and treatment,particularly for those associated with less favorable cases.AIM To improve diagnostic precision and treatment,particularly for those associated with less favorable cases.METHODS A systematic search was conducted in PubMed,Scopus,and Web of Science until September 2024.Two independent reviewers screened titles,abstracts,and full texts for eligibility based on G-NET treatment in adults.Eligible studies included cohort studies,clinical trials,case series,and case reports,while in vitro,pediatric,and non-English studies were excluded.Relevant data were extracted independently,and disagreements were resolved through discussion.Study quality was assessed using appropriate tools.RESULTS G-NETs are rare,classified into three types:(1)Type I;(2)Type II;and(3)Type III.Type I G-NETs,often associated with chronic atrophic gastritis,are typically slow-growing and low-grade,with favorable outcomes following surgical resection.Type II G-NETs arise in hypergastrinemia conditions like multiple endocrine neoplasia and ZES,showing moderate malignancy risk.Type III G-NETs,the most aggressive and least common,present with distant metastases and poor prognosis.Diagnosis relies on endoscopy,imaging,and biomarkers like chromogranin A.Treatment varies by type,ranging from ER to aggressive surgery and chemotherapy for advanced cases.Regular follow-up is essential to monitor recurrence,particularly for type III G-NETs.CONCLUSION G-NETs require tailored diagnosis and treatment based on type and stage.Types I and II generally have better prognosis,while types III and IV are linked to poorer outcomes due to invasion and metastasis.Treatment strategies vary from ER for type I to extensive surgery for type III.Emerging therapies,like somatostatin analogs and peptide-receptor radionuclide therapies,show promise in advanced cases.Further research is essential to improve early diagnosis and treatment,particularly for high-risk lesions.
文摘BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the etiology,sources,classification,treatment,and prognosis of CMT.METHODS A total of 226 CMT patients from two centers(2013 to 2023)were reviewed,and 153 tumor patients from China Health and Retirement Longitudinal Study were used as controls.The survival rates of 96 CMT patients were tracked through medical records and telephone follow-ups.Logistic regression and survival analyses were conducted to characterize CMT.RESULTS CMTs were predominantly male(67.26%vs 39.47%,P<0.001).Intracardiac metastasis patients had worse heart and coagulation function than pericardial metastasis patients(prothrombin time:13.90 vs 13.30,P=0.002),D-dimer levels(2.16 vs 0.85,P=0.001),B-type natriuretic peptide(BNP)levels(324.00 vs 136.50,P=0.004),and troponin levels(5.35 vs 0.03,P<0.001)).Lung and liver cancers were the predominant primary tumor types in CMT.Patients with lung cancer(76.40%vs 30.77%)and thymoma(7.45%vs 1.54%)exhibited a higher prevalence of pericardial metastasis,while those with liver cancer(35.38%vs 0.62%)showed a higher prevalence of intracardiac metastasis.Overall survival was better for pericardial metastasis than for intracardiac metastasis patients(median survival:419 days vs 129 days,log-rank test P=0.0029).Cox proportional hazards model revealed that advanced age[hazard ratio(HR)=1.034,95%confidence interval(95%CI):1.011-1.057]and higher BNP and troponin levels(HR=1.011,95%CI:1.004-1.018)were associated with worse survival.Surgery significantly improved the survival rate of patients.The median survival time was 275 days for patients who did not undergo surgery and 708 days for those who had surgery(log-rank test P=0.0128)CONCLUSION Clinicians should consider CMT in the male lung or liver cancer patients with cardiac symptoms.Abnormal coagulation,impaired heart function,tumor location,and age are key prognostic factors for CMT.Surgical intervention is the preferred treatment option,as it significantly prolongs median survival.
基金supported by Research Foundation of Education Bureau of Hunan Province,China(No.23A0002)。
文摘Serotonin(5-hydroxytryptamine,5-HT),a neurotransmitter known for its roles in the central nervous system,showing dual effects in various pathological conditions,including tumor progression and wound healing.This review explores the complex and context-dependent actions of 5-HT,highlighting its contrasting roles in promoting tumor growth and facilitating wound repair.5-HT can enhance tumor growth,survival,and metastasis via its receptors,but it also accelerates wound healing by stimulating cell proliferation,migration,and angiogenesis.This duality emphasizes the intricate balance of 5-HT and its receptors in the body.We discuss the synthesis,storage,secretion,and metabolism of 5-HT,as well as the classification and mechanisms of its receptors(5-HTRs)in different cell types under pathological conditions.We further examine the potential roles of 5-HT in both tumor progress and wound healing,proposing targeted strategies for each disease state.For tumors,“blocking therapy”involving receptor antagonists or gene silencing may inhibit tumor progression,while“activation therapy”can stimulate wound healing by enhancing receptor activation on skin cells.Challenges in clinical application,including issues related to targeting,specificity,and dosage,are addressed,alongside the promise of nanotechnology for improving targeted drug delivery.The review also explores emerging research on 5-HT's interaction with the immune system,offering insights into potential immunotherapeutic strategies for both cancer and wound healing.By balancing 5-HT's diverse effects,personalized treatments can be developed to optimize therapeutic outcomes in both contexts.
