Abstract:Over the past two decades, the field of thyroid oncology in China has undergone rapid development. Through improvements in standardization processes, continuous innovations in treatment methods, and in-depth basic research, the 5-year survival rate of thyroid cancer has significantly increased from 67.5% to 92.9%. In diagnostics, advancements in color Doppler ultrasound technology, the establishment of the TI-RADS classification system, and innovations in fine-needle aspiration biopsy methods, particularly the integration of molecular diagnostics, have greatly improved the accuracy of preoperative diagnosis. In terms of treatment, there has been a gradual shift from traditional surgery to individualized precision therapy. Combined with radioactive iodine therapy, endocrine regulation, targeted therapy, and immunotherapy, a multidisciplinary comprehensive diagnosis and treatment system has been formed, providing patients with more precise and effective treatment options. Significant progress has also been made in the treatment of advanced thyroid cancer, with the application of targeted drugs bringing new hope to patients. In research, Chinese scholars have greatly increased their publications in the field of thyroid cancer, with high-quality studies emerging continuously, reflecting China's rapid rise in this area. Meanwhile, the establishment of academic organizations and the promotion of professional guidelines have substantially enhanced the diagnostic and treatment capabilities of primary care physicians. Looking ahead, efforts will continue to focus on the development of next-generation targeted drugs, the application of artificial intelligence and intelligent decision-making systems in diagnosis and treatment, the construction of prognosis prediction models based on big data, and the popularization of 5G-enabled remote medical care. These advances will drive the development of thyroid oncology toward more precise, minimally invasive, and personalized directions, creating new brilliance once again.

Abstract:Perioperative rehabilitation aims to alleviate symptoms, restore function, and improve quality of life. These goals largely involve subjective patient experiences, which are not fully captured by traditional outcome measures. In recent years, patient-reported outcomes (PROs) have emerged as essential tools to quantify patients' perceptions of health and have been widely used in drug and device clinical trials. This review summarizes the current applications of PROs in general surgery, including symptom description, comparison of surgical methods, complication warning, and patient management. Practical cases and evidence from domestic and international studies are discussed. With the integration of electronic PROs (ePROs), artificial intelligence, and natural language processing, future efforts should focus on developing localized, specialty-specific tools and establishing stronger correlations between PROs and clinical outcomes to support the transition from disease-centered to patient-centered surgical care.

Abstract:With the continuous advancement of precision medicine, robotic surgical techniques have been rapidly promoted, and robotic thyroidectomy has been increasingly applied in China, demonstrating advantages such as refined manipulation, minimal invasiveness, and improved cosmetic outcomes. Since the initiation of this procedure, our center has completed over 4 000 cases of robotic thyroidectomy, accumulating extensive practical experience and establishing a comprehensive system for surgical coordination and assistant training. An excellent surgical assistant plays a pivotal role in ensuring procedural efficiency and patient safety. Based on our center's experience, this article systematically summarizes key training elements and intraoperative coordination techniques for assistants in robotic thyroidectomy. Key areas include preoperative preparation (such as patient selection, imaging review, and assessment of non-recurrent laryngeal nerve risk) and intraoperative cooperation (including Trocar placement, instrument exchange, gauze management, and hemostasis). This paper aims to provide practical reference for surgical teams engaged in robotic thyroidectomy, promote the standardization of related techniques, enhance team coordination and surgical quality, and ultimately deliver safer and more efficient medical services to patients.

Abstract:Traditional open thyroid surgery often leaves a scar on the neck, which can affect cosmetic outcomes. Therefore, various endoscopic thyroidectomy approaches via extra-cervical approaches have been developed. However, due to the unique anatomical characteristics of the neck and limitations of endoscopic instruments, conventional endoscopic techniques have certain drawbacks. Robot-assisted endoscopic thyroid surgery can help overcome these limitations. At present, robotic surgical systems remain expensive and the associated surgical costs are high, limiting their widespread adoption. Most surgeons are still relatively unfamiliar with the technique. Nevertheless, with ongoing technological advancements and cost reductions, robot-assisted surgery holds great promise for broader application. Based on years of large-scale experience in endoscopic thyroid surgery at our center, and drawing upon both domestic and international experiences with robotic thyroidectomy, this paper summarizes and proposes a seven-step protocol for robot-assisted endoscopic thyroidectomy via the bilateral axillo-breast approach, aiming to provide a practical reference for the clinical adoption of this technique.

Abstract:Thyroid cancer has become one of the fastest-growing malignancies in recent years, with a significant improvement in the 5-year relative survival rate among Chinese patients. Accurate diagnosis, standardized treatment, and effective follow-up are essential to improve clinical outcomes, while the promotion and implementation of clinical guidelines are critical for achieving standardized and homogeneous management. In 2022, the China Anti-Cancer Association (CACA) released the 2022 Chinese Guidelines for Integrated Diagnosis and Treatment of Tumors (CACA) — Thyroid Cancer, which systematically applied the concept of multidisciplinary integrated management to the entire care continuum of thyroid cancer, reflecting both Chinese characteristics and local experience. Building upon this, the 2025 edition of the guidelines was updated and revised based on the latest evidence and clinical practices. This article provides a systematic interpretation of the 2025 CACA guidelines, focusing on the diagnosis, treatment, and follow-up of thyroid cancer, with the aim of offering practical guidance for clinicians and promoting standardized, integrated management of thyroid cancer in clinical practice.

Abstract:Background and Aims To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach, such as restricted operative space and high complication risks, our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach (ETOSA). Preliminary studies have confirmed its safety and feasibility. This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA, explore the interactions among these variables, and construct a learning curve model to support its broader clinical adoption.Methods A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital, Central South University, between March 2022 and March 2023. Clinical characteristics, surgical parameters, and postoperative complications were extracted. A random forest model was employed to identify the major influencing factors for complications and operative time, as well as their interaction effects. Partial dependence plots based on case sequence were used to generate the learning curve.Results All 125 patients successfully underwent ETOSA with no conversion to open surgery. The median operative time was 95.0 min, and the median intraoperative blood loss was 15.0 mL. The overall postoperative complication rate was 16.0%, with no cases of permanent hypoparathyroidism or hypocalcemia. The average neck appearance score was 1.05, indicating high patient satisfaction. The random forest analysis identified case number, surgical extent, lymph node yield (LNY), Hashimoto's thyroiditis (HT), and body mass index (BMI) as the key predictors of postoperative complications, while surgical extent, case number, LNY, HT, and blood loss were the key factors affecting operative time. A significant positive interaction was observed between case number and both surgical extent and HT, particularly in the first 20 cases, suggesting a higher risk during the early learning phase. The learning curve analysis indicated that surgical proficiency stabilized after 20 cases. Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase (90.0 min vs. 102.5 min; 11.4% vs. 40.0%, both P<0.05).Conclusion ETOSA is a safe and feasible technique characterized by minimal invasiveness, favorable cosmetic outcomes, and a relatively short learning curve. case number, surgical extent, LNY, HT, BMI, and blood loss are key factors affecting complications and operation time.

Abstract:Background and Aims Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy in China, with cervical lymph node metastasis being a frequent and critical clinical feature that directly affects patient prognosis and recurrence risk. In recent years, with the rapid increase in the prevalence of overweight and obesity in China, the role of body mass index (BMI) in various tumors has attracted growing attention. This study aimed to investigate the association between overweight and cervical LNM in PTC, analyze sex-specific differences and influencing factors, and provide evidence for precise clinical management.Methods A retrospective analysis was conducted on the clinicopathologic data of 1 445 patients with classical PTC treated at Xiangya Hospital of Central South University between August 2021 and June 2022. Patients were divided into groups based on the presence or absence of lymph node metastasis. Restricted cubic spline analysis explored the nonlinear relationship between BMI and lymph node metastasis risk. Univariate and multivariate Logistic regression analyses were applied to identify independent risk factors. Furthermore, sex-stratified analysis was performed among overweight patients (BMI ≥24 kg/m2) to determine sex-specific risk factors for lymph node metastasis.Results Among all patients, 716 (49.6%) had lymph node metastasis. Univariate analysis showed that BMI, sex, age, tumor diameter, multifocality, and extrathyroidal extension were significantly associated with cervical lymph node metastasis in PTC patients (all P<0.05). A nonlinear positive correlation was observed between BMI and lymph node metastasis risk, which was more pronounced in male patients. Additionally, BMI was positively correlated with triglyceride levels and negatively correlated with high-density lipoprotein cholesterol. Sex-stratified analysis revealed that in overweight male patients, younger age (OR=0.954), larger tumor diameter (OR=1.085), and multifocality (OR=2.776) were independent risk factors for LNM; in overweight female patients, younger age (OR=0.943) and larger tumor diameter (OR=1.074) were the main influencing factors.Conclusion Overweight is closely associated with cervical lymph node metastasis in PTC, and the high-risk factors for LNM differ between male and female overweight patients. Young age, larger tumor size, and multifocality in overweight males, and young age and larger tumors in overweight females indicate a higher risk of metastasis. It is recommended that high-risk populations receive enhanced preoperative evaluation and individualized lymph node dissection strategies to achieve precise treatment and improved risk control.

Abstract:Background and Aims The BRAF^V600E mutation is the most common genetic alteration in papillary thyroid carcinoma (PTC) and is widely used to guide surgical extent and risk stratification. However, other genetic variants are increasingly identified in clinical practice, and their association with lymph node metastasis (LNM) remains unclear. Most existing studies have compared BRAF^V600E-mutated cases with BRAF wild-type cases without stratifying specific mutation types, potentially affecting the accuracy of risk assessment. This study aimed to compare the lymph node metastatic features between PTC patients with different common genetic alterations and those with the BRAF^V600E mutation.Methods A retrospective analysis was conducted on 4 795 PTC patients who underwent surgery and genetic testing at Fudan University Shanghai Cancer Center from January 2019 to January 2025. Patients with a single genetic alteration were included and grouped accordingly. Propensity score matching (PSM) was used to control for confounding factors including age, sex, and T stage. The number of metastatic lymph nodes and N stage were compared between each mutation group and the BRAF^V600E group.Results After PSM, patients in the CCDC6-RET and NCOA4-RET fusion groups had significantly higher numbers of metastatic lymph nodes and N1b stage rates compared to the BRAF^V600E group (all P<0.05). No significant differences were observed between the ETV6-NTRK3 fusion or RAS mutation groups and the BRAF^V600E group in terms of lymph node metastasis or N stage (all P>0.05).Conclusion PTC patients harboring CCDC6-RET or NCOA4-RET fusions exhibit a significantly higher lymph node metastatic burden than those with the BRAF^V600E mutation, suggesting more aggressive behavior. In contrast, ETV6-NTRK3 and RAS-mutated PTCs show similar metastatic profiles to BRAF^V600E-mutated cases. Preoperative genetic profiling may help identify patients at high risk of metastasis and guide individualized lymph node dissection strategies.

Abstract:Background and Aims With the widespread use of electrosurgical devices in open thyroid surgery, the surgical smoke generated during procedures has become a significant concern, as it compromises surgical visibility, reduces operational efficiency, and poses health risks to medical staff. Currently, local smoke evacuation is commonly performed by an assistant using a handheld suction device, which is limited in range, interferes with surgical procedures, and increases labor costs. This study aimed to evaluate the effectiveness, safety, feasibility, and staff satisfaction associated with a self-made annular smoke evacuation device constructed from readily available materials for use in open thyroid surgery.Methods A total of 82 patients undergoing open surgery for papillary thyroid carcinoma at Suqian First People's Hospital between March and June 2024 were randomly assigned to an observation group and a control group (41 patients each). During surgery, the observation group used a self-made annular smoke evacuation device for continuous smoke removal, while the control group used conventional manual suction via an assistant. Outcomes compared between the two groups included PM2.5 concentrations 30 cm above the surgical field, operative time, intraoperative blood loss, and medical staff satisfaction with smoke removal.Results During thyroid tissue dissection, the PM2.5 concentration in the observation group was (63.26±11.71) μg/m³, corresponding to a "good" air quality level, while in the control group it was (126.35±40.12) μg/m³, ranging from "mild to severe pollution"—a statistically significant difference (P<0.05). In the observation group, operative times for unilateral and bilateral procedures were (31.25±11.36) min and (71.13±17.12) min, respectively, with intraoperative blood loss of (10.5±5.3) mL and (18.6±5.5) mL. In the control group, times were (39.27±15.42) min and (78.35±22.35) min, with blood loss of (12.5±5.8) mL and (20.5±6.5) mL, respectively—all differences not statistically significant (all P>0.05). Staff satisfaction was significantly higher in the observation group compared to the control group (97.6% vs. 31.7%, P<0.05).Conclusion The self-made annular smoke evacuation device demonstrated favorable results in open thyroid surgery, effectively reducing surgical smoke concentration, improving visibility, and minimizing health risks to medical staff without compromising surgical efficiency or safety. The device is cost-effective, easy to assemble, and can be repurposed postoperatively as a drainage tube, requiring no additional consumables. Its reusability and ease of integration offer strong practical value and clinical applicability.

Abstract:Background and Aims As a core data source in the development of medical informatization, the front page of inpatient medical records plays a crucial role in determining the usability of research data and the scientific quality of clinical decision-making. Given the relatively standardized diagnostic and treatment protocols for thyroid malignancies, this disease serves as a representative model for evaluating the data quality of medical record front sheets. This study aimed to systematically assess the accuracy of diagnostic and surgical procedure coding for thyroid malignancies on the medical record front page, identify existing problems, and explore strategies for improvement and the potential for future application in clinical research.Methods A total of 3 361 patients who underwent initial surgical treatment and were pathologically confirmed with thyroid cancer at the Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 were retrospectively included. Postoperative pathology reports and surgical records were used as reference standards to evaluate the accuracy of primary and secondary diagnosis codes, as well as primary and secondary surgical procedure codes on the medical record front page.Results The accuracy rate of primary diagnosis coding reached 98.8%. However, among 1 368 patients with cervical lymph node metastasis, only 31.2% had correctly recorded secondary diagnosis codes and metastatic sites, with an omission rate as high as 67.8%. The overall accuracy rate for primary surgical procedure coding was 90.4%, with thyroid lobectomy (TL) and total thyroidectomy (TT) coding accuracies of 85.5% and 96.0%, respectively. Among the coding errors, 70.0% involved TL procedures being incorrectly coded as TT. Secondary surgical procedure codes—mainly for lymph node dissection—were highly inconsistent, with up to 14 different coding types, reflecting a lack of standardization and unified input criteria. Notably, the error rate for primary surgical coding in 2020 increased significantly compared with the previous two years, suggesting subjectivity and variability in manual data entry.Conclusion This study highlights major accuracy deficiencies in surgical procedure coding for thyroid malignancies on the medical record front page, which may compromise the scientific validity of real-world data. Going forward, leveraging artificial intelligence technologies to support structured documentation and automated coding, alongside establishing a proactive quality control system through multidisciplinary collaboration, may significantly improve data accuracy. These efforts are essential for strengthening data foundations for precision treatment, performance evaluation, insurance payment, and clinical research on thyroid cancer.

Abstract:Background and Aims Medullary thyroid carcinoma (MTC) is an aggressive malignancy that is frequently associated with cervical lymph node metastasis, significantly affecting patient prognosis. However, the risk factors for lateral cervical lymph node metastasis (LLNM) in MTC remain inconclusive. This study aims to identify the risk factors associated with LLNM in MTC patients, in order to inform individualized surgical decision-making.Methods The clinicopathologic data of 242 patients with MTC who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital from 2011 to 2019 were retrospectively collected. The relationships between preoperative tumor markers, including calcitonin and carcinoembryonic antigen (CEA), and LLNM were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM.Results Preoperative calcitonin level was significantly associated with tumor diameter, the number of lymph node metastases, and the extent of lymph node involvement, while preoperative CEA level was significantly associated with tumor diameter (all P<0.05). The area under the ROC curve for preoperative calcitonin in diagnosing LLNM was 0.750 (P=0.000), with an optimal cutoff value of 266.00 ng/L (sensitivity 0.854, specificity 0.577). The diagnostic value of preoperative CEA for LLNM was limited. Univariate analysis showed that sex, extracapsular extension, T stage, central lymph node metastasis (CLNM), bilateral lesions, preoperative calcitonin, tumor diameter, and multifocality were significantly associated with LLNM in MTC patients (all P<0.05). Multivariate analysis revealed that CLNM (OR=17.645, 95% CI=7.728-40.290) and preoperative calcitonin ≥266.00 ng/L (OR=7.832, 95% CI=3.132-19.582) were independent risk factors for LLNM.Conclusion CLNM and elevated preoperative calcitonin level are closely associated with LLNM in patients with MTC. The combination of these two indicators may help identify high-risk patients for LLNM, thereby and promoting individualized and precise treatment strategies for MTC.

Abstract:Background and Aims Secondary hyperparathyroidism (SHPT) is a common and difficult-to-treat complication of chronic kidney disease (CKD), significantly impairing patients' quality of life and prognosis. For patients who respond poorly to medical therapy, surgical intervention remains an effective treatment option. This study aimed to evaluate the clinical efficacy and safety of total parathyroidectomy with forearm autotransplantation (tPTX+AT) in the treatment of CKD-related SHPT.Methods A retrospective analysis was conducted on 40 patients with CKD complicated by SHPT who underwent tPTX+AT in Gaozhou People's Hospital between January 2020 and June 2023. Changes in intact parathyroid hormone (iPTH), serum phosphorus, calcium, alkaline phosphatase (ALP), and bone mineral density (BMD) were recorded preoperatively and at multiple postoperative time points. Postoperative symptom relief, complications, and follow-up outcomes were also analyzed.Results A total of 158 parathyroid glands were removed during surgery. Among the patients, 38 had four glands successfully excised, while two had only three glands removed. After operation, levels of iPTH, phosphorus, calcium, and ALP decreased significantly compared to preoperative values (all P<0.05), and BMD increased significantly at 3 months (P<0.05). Symptoms such as bone pain, pruritus, and restless leg syndrome improved markedly by 3 months postoperatively (all P<0.05). Hypocalcemia occurred in 34 cases (85.0%); one patient experienced transient recurrent laryngeal nerve injury and one had superior laryngeal nerve injury, both of which resolved after treatment. The two patients who had only three glands removed exhibited persistent SHPT postoperatively, with iPTH levels of 457 pg/mL and 609 pg/mL, respectively. Although their symptoms improved partially, the condition was medically controlled without the need for reoperation.Conclusion tPTX+AT can effectively correct mineral metabolism disorders and improve BMD and clinical symptoms in SHPT patients. The procedure achieves a high rate of complete gland resection and stable autograft function. Although postoperative hypocalcemia is common, overall complications are manageable. This surgical approach is safe and effective for the treatment of refractory SHPT.

Abstract:Background and Aims Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer. However, the incidence of postoperative complications remains significant, and the associated risk factors have not been fully elucidated. This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022. Patients were grouped according to the presence or absence of postoperative surgical complications, and multivariate Logistic regression was used to identify independent risk factors.Results A total of 545 patients with 602 reconstructed breasts were included. Surgical complications occurred in 13.6% (82/602) of the cases, including infection, wound dehiscence/poor healing, flap or nipple-areola necrosis, and implant leakage/rupture. Multivariate analysis revealed that nipple-areola complex resection (OR=1.934, 95% CI=1.056-3.542, P=0.033), postoperative radiotherapy (OR=2.483, 95% CI=1.527-4.036, P<0.001), implant volume ≥300 mL (OR=1.663, 95% CI=1.025-2.696, P=0.039), and surgeon experience with fewer than 10 cases (OR=1.804, 95% CI=1.092-2.979, P=0.021) were all independent risk factors for complications.Conclusion NAC resection, radiotherapy, large implant volume, and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction. Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.

Abstract:Background and Aims Oncoplastic breast-conserving surgery (OBCS) integrates oncologic and plastic surgical techniques and includes two primary approaches: volume displacement and volume replacement. The pedicled lateral thoracic artery perforator (LTAP) flap is a commonly used technique for volume replacement. Although recent studies in China have confirmed its safety in OBCS, its patient-reported outcomes have not been systematically evaluated, and comparative data with volume displacement techniques remain lacking. Therefore, this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty (volume displacement) in OBCS, to inform surgical decision-making.Methods A retrospective case-control study was conducted, including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024. Patients were divided into the LTAP flap group (27 cases) and the mammoplasty group (79 cases) based on the surgical technique. Intraoperative variables, cosmetic outcomes, postoperative complications, and Breast-Q scores before and after surgery were compared between the two groups.Results There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores (all P>0.05). The LTAP group had longer operative times, larger excised tissue volumes, and greater postoperative drainage volumes (all P<0.001). Postoperative cosmetic outcomes were significantly better in the LTAP group, with a higher rate of excellent-to-good cosmetic results (88.9% vs. 57.3%) and higher Breast-Q scores in breast satisfaction, psychosocial well-being, and physical well-being (all P<0.05). There were no significant differences in complication rates or local recurrence between the two groups (all P>0.05).Conclusion In OBCS, the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction. It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.

Abstract:Background and Aims Triple-negative breast cancer (TNBC) is a clinically aggressive subtype of breast cancer with limited treatment options. Immune checkpoint blockade (ICB) combined with chemotherapy has emerged as a key neoadjuvant therapeutic strategy for TNBC. However, significant variability in ICB efficacy exists among patients, and the underlying mechanisms related to the tumor immune microenvironment (TME) remain unclear. Cancer-associated fibroblasts (CAFs), as major stromal components, regulate TME and influence immunotherapy responses. Fibroblast activation protein (FAP), a key marker of CAFs, has been associated with poor prognosis in multiple solid tumors, yet its immunological role in TNBC has not been systematically investigated. This study aims to elucidate the expression pattern of FAP in TNBC, its impact on the immune microenvironment and ICB efficacy, and to explore its potential immunosuppressive mechanisms and clinical implications.Methods The data from TCGA and the I-SPY2 clinical trial were integrated to assess the association of FAP expression with prognosis, immune cell infiltration, and immune checkpoint molecule expression in TNBC. Immune landscape profiling was conducted using CIBERSORT, GSEA enrichment analysis, and differential gene expression analysis (DESeq2) to characterize the immune features associated with FAP expression and to identify downstream genes at the transcriptomic level. CAF models with FAP overexpression or knockdown were constructed and co-cultured with CD8? T cells to evaluate FAP's regulatory effects on CD8? T cell activity and apoptosis. The expression of COL1A1, a potential FAP-regulated gene identified from transcriptomic analysis, was validated using qPCR and Western blot. Finally, clinical data and multiplex immunofluorescence pathology samples from TNBC patients at Xiangya Hospital were analyzed alongside I-SPY2 data to determine the predictive value of FAP expression for pathological complete response (pCR) following neoadjuvant immunotherapy.Results FAP was significantly upregulated in TNBC tumor tissues compared to normal tissues and associated with shorter overall survival. Multivariate Cox regression analysis identified FAP as an independent adverse prognostic factor. High FAP expression was correlated with reduced infiltration of CD8? T cells, NK cells, and Tfh cells, as well as upregulation of immune checkpoints including CD276, TIM-3, and PD-L2. In CAF models, FAP overexpression suppressed CD8? T cell activity and promoted apoptosis, while FAP knockdown had the opposite effect. Transcriptomic analysis showed that COL1A1 and other collagen-related genes were significantly upregulated in the FAP-high group and positively correlated with FAP expression; qPCR and Western blot confirmed that FAP positively regulates COL1A1 expression. Analysis of I-SPY2 data revealed that FAP-low patients receiving pembrolizumab plus chemotherapy had significantly higher pCR rates compared to FAP-high patients. Consistently, clinical data from the Xiangya cohort showed reduced CD8? T cell infiltration and lower pCR rates in FAP-high patients, with a ROC AUC of 0.857 for predicting treatment response.Conclusion FAP-high CAFs contribute to the formation of an immunosuppressive TME in TNBC by promoting COL1A1 secretion, inhibiting CD8? T cell function, and upregulating immune checkpoint molecules. High FAP expression is associated with poor prognosis and reduced response to immunotherapy, highlighting FAP as both a prognostic biomarker and a potential therapeutic target for stratified and combination treatment strategies in TNBC.

Abstract:Background and Aims Surgical treatment is a cornerstone of breast cancer management; however, the physical trauma and psychological burden associated with surgery may adversely affect patients' quality of life (QoL). Based on data from a prospective cohort, this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL, thereby providing evidence for perioperative rehabilitation strategies.Methods Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled. The Constant-Murley Shoulder Score, EORTC QLQ-C30, and QLQ-BR23 questionnaires were used pre- and postoperatively to assess shoulder joint function, and QoL. Paired t-tests were used to analyze changes in scores before and after surgery. A mediation model was applied to explore the indirect pathways through which surgery impacts QoL. Additionally, subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results A total of 148 patients were included, with median age of 54 (46-60) years old Postoperative psychological health significantly improved, while shoulder function and overall QoL scores markedly declined (all P<0.001). According to QLQ-C30, functional domains such as physical and role functioning worsened, while symptom burden increased. The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively (both P<0.001). Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy (both P<0.05). QoL deterioration was comparable between mastectomy and breast-conserving surgery, although the former was associated with more prominent pain and breast symptoms. Mediation analysis indicated that shoulder function, breast symptoms, and physical functioning served as mediators in the impact of surgery on QoL, while better psychological health exerted a protective effect.Conclusion Surgical treatment significantly affects postoperative QoL in breast cancer patients, with local functional impairment and symptom exacerbation serving as key mediators. Different surgical approaches have varying impacts on QoL. Enhancing postoperative shoulder rehabilitation, symptom management, and psychological support may improve patients' QoL.

Abstract:Background and Aims Breast-conserving surgery, which balances tumor excision with preservation of breast tissue, has become a widely adopted surgical approach for breast cancer. However, postoperative tumor recurrence remains a major factor affecting patient prognosis. Accurate risk prediction tools are urgently needed to guide personalized treatment strategies. This study aimed to develop a risk prediction model for tumor recurrence after BCS based on admission clinical data and to evaluate its predictive performance to provide a scientific and practical tool for clinical decision-making.Methods A total of 224 breast cancer patients who underwent breast-conserving surgery between May 2017 and May 2019 were enrolled. Postoperative recurrence was recorded during follow-up. Multivariate Logistic regression analysis was used to identify independent risk factors for recurrence and to construct a risk prediction model. The model's discriminative ability was assessed using the receiver operating characteristic (ROC) curve, and its calibration was evaluated using a calibration curve.Results 208 patients completed follow-up, ranging from 32 to 84 months, with a mean duration of (58.41±7.33) months. The recurrence rate was 17.79%. Multivariate Logistic regression analysis revealed that TNM stage Ⅲ (OR=2.029), tumor diameter ≥4 cm (OR=1.782), ≥4 lymph node metastases (OR=1.958), lymphovascular invasion (OR=1.984), and HER2 positivity (OR=1.774) were independent risk factors for recurrence (all P<0.05). The Logistic regression model was established as follows: Y=-12.788+0.707X?+0.578X?+0.672X?+0.685X?+0.573X?. The model yielded an area under the ROC curve (AUC) of 0.934 (95% CI=0.891-0.963), with a sensitivity of 86.49% and specificity of 96.49%. The calibration curve demonstrated good agreement between predicted and observed outcomes (χ2=0.501, P=0.392).Conclusion TNM stage Ⅲ, tumor diameter ≥4 cm, ≥4 lymph node metastases, lymphovascular invasion, and HER2 positivity are independent risk factors for tumor recurrence after breast-conserving surgery. The risk prediction model based on these factors demonstrates favorable discrimination and calibration, offering valuable guidance for postoperative risk assessment and clinical intervention.

Abstract:Background and Aims Patients with end-stage liver disease (ESLD) frequently experience persistent pruritus, which significantly impairs their quality of life. Although relief of pruritus after liver transplantation is often attributed to the normalization of bilirubin levels, the role of skin microbiota in developing pruritus remains unclear. This study aimed to investigate the dynamic changes in skin microbiota during the perioperative period of liver transplantation in ESLD patients and to explore their association with pruritic symptoms.Methods Fifteen ESLD patients treated in the Third Xiangya Hospital between 2022 and 2023 were enrolled and skin swabs were collected from the anterior tibial region at three time points: before liver transplantation and on postoperative days 7 and 30. Skin samples from 15 age-matched healthy controls were collected at the same anatomical site. Microbial composition was analyzed using 16S rRNA sequencing. Meanwhile, pruritus severity was assessed using a visual analogue scale (VAS), and multiple serological indicators were measured to evaluate correlations between microbiota changes, pruritus severity, and liver function parameters.Results Compared with healthy controls, ESLD patients exhibited significantly altered β-diversity in skin microbiota and an increased relative abundance of Staphylococcus (LDA>4), which was strongly correlated with VAS scores for pruritus (r=0.93, P_adj=3.08×10?1?). On postoperative day 7, α-diversity decreased, and Staphylococcus abundance peaked, then gradually normalized by day 30 as pruritus improved. Further analysis revealed that Staphylococcus abundance was positively correlated with alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, total bile acids, and international normalized ratio, and negatively correlated with albumin (all P_adj<0.05). Notably, Staphylococcus levels were significantly higher in patients with moderate to severe pruritus (VAS score>5).Conclusion ESLD patients demonstrate marked dysbiosis of the skin microbiota during the perioperative period of liver transplantation, characterized by an abnormal proliferation of Staphylococcus, which may contribute to the development and exacerbation of pruritus. Targeting the skin microbiome, particularly interventions against Staphylococcus, may offer a novel therapeutic strategy for alleviating pruritus in ESLD patients.

Abstract:The 97th Annual Meeting of the Japanese Gastric Cancer Association was held from March 12 to March 14, 2025, in Nagoya, Japan. The conference was chaired by Professor Kazuhiro Uyama from Fujita Medical University and attracted nearly 2 000 scholars from around the world, including Japan, China, the republic of Korea, the United States, and Europe. With the theme of "Digital Innovation in Gastric Tumors," the conference focused on the application of artificial intelligence, robotic surgery, and other innovations in the treatment of gastric cancer. It explored how high-precision and highly reproducible robotic surgical techniques are transforming traditional approaches to gastric cancer surgery, along with topics such as digital innovation, future medical policies, and strategies that herald a new era in healthcare. The meeting featured one main venue and 60 sub-venues with different themes, ultimately accepting 1 003 submissions. A total of 158 oral presentations covering 80 topics and 203 poster presentations were delivered. Among them, approximately 145 lectures were related to robotic surgery for gastric cancer, and when including poster presentations, nearly 255 topics were associated with gastric cancer robotic surgery. Additionally, the 7th edition of the Japanese Gastric Cancer Treatment Guidelines was released during the meeting. Our team had the honor of participating in this prestigious event. Drawing from our experience at both this conference and the 17th Annual Meeting of the Japanese Society for Robotic Surgery held in Utsunomiya, Japan, from March 7 to March 8, 2025, we provide a detailed report on the latest advancements in robotic surgery for gastric cancer, hoping to offer valuable insights and references for fellow surgeons both in China and abroad.

Abstract:The incidence of thyroid cancer has been increasing, and early diagnosis and treatment are crucial for improving patient prognosis. With the advancement of artificial intelligence (AI) technology, significant progress has been made in its application in the diagnosis and treatment of thyroid cancer. AI technology has notably enhanced the diagnostic accuracy of thyroid cancer. By optimizing imaging examinations such as ultrasound and CT scans, it can more precisely identify malignant features of thyroid nodules. In fine-needle aspiration biopsy, the integration of AI with genetic testing technologies has improved both the accuracy and efficiency of diagnosis. In terms of treatment, AI assists in intraoperative functional preservation, reducing the risk of surgical trauma. For instance, it can accurately identify the locations of the recurrent laryngeal nerve and parathyroid glands. Additionally, AI is capable of predicting the efficacy of 131I treatment and the risk of complications, thereby guiding postoperative follow-up and management. The core strength of AI technology lies in its powerful data processing and analytical capabilities, enabling it to uncover latent patterns within data and provide a scientific basis for treatment decision-making. Looking ahead, with continuous technological advancements, AI is expected to propel the diagnosis and treatment of thyroid cancer towards greater intelligence and precision. However, challenges such as data privacy and algorithm transparency need to be addressed. This article provides a review of the research progress of AI technology in the fields of diagnosis, treatment, and prognosis prediction of thyroid cancer, explores the current strengths and weaknesses of AI technology, and looks forward to its future development directions while acknowledging challenges like data privacy and algorithm transparency.

Abstract:Calcitonin-negative medullary thyroid carcinoma (CNMTC) is a rare subtype of medullary thyroid carcinoma, characterized by normal serum calcitonin levels, which often leads to misdiagnosis or missed diagnosis. The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives. Diagnostic approaches include ultrasound-guided fine needle aspiration cytology, serum CEA and ProGRP measurements, and RET gene testing. Surgical resection remains the mainstay of treatment, while neoadjuvant therapy may be considered in selected cases. This review summarizes recent advances in the understanding, diagnosis, treatment, and prognosis of CNMTC, aiming to provide clinical guidance for better management of this challenging condition.

Abstract:Breast cancer is the most common malignancy among women worldwide and significantly impacts patients' quality of life. With advancements in medical technology, treatment strategies for breast cancer are increasingly shifting toward precision and minimally invasive approaches. High-intensity focused ultrasound (HIFU), characterized by its non-invasive and non-ionizing nature, has been widely applied in the treatment of various benign and malignant tumors. HIFU holds great potential in breast cancer therapy, demonstrating significant antitumor effects in thermal ablation, chemotherapy, immunotherapy, and targeted therapy combinations. HIFU not only ablates tumor tissue and activates antitumor immune responses, but also, when combined with drugs, enhances therapeutic efficacy, promotes drug accumulation in tumor tissues, reduces side effects, and improves long-term outcomes. This article reviews the application of HIFU in the treatment of breast cancer, providing a reference for clinical practice and research.

Abstract:Inflammatory breast cancer (IBC) is a rare but highly aggressive subtype of breast cancer characterized by rapid clinical progression and poor prognosis. Although it accounts for only 2%-4% of all breast cancer cases, it is responsible for 8%-10% of breast cancer-related mortality. The etiology of IBC is multifactorial, involving genetic, hormonal, environmental, and socioeconomic factors. Pathologically, IBC is marked by the presence of dermal lymphatic tumor emboli, and molecular subtypes are predominantly HER2-positive and triple-negative, indicating high tumor invasiveness. Diagnosis relies on characteristic clinical manifestations and histopathological confirmation, while imaging techniques such as MRI and PET/CT play important roles in evaluating disease extent and metastasis. Given that IBC is often diagnosed at a locally advanced or metastatic stage, there is currently no specific treatment protocol. Instead, management generally follows the treatment paradigm of non-IBC, emphasizing systemic therapy within a multidisciplinary framework. HER2-positive IBC benefits from chemotherapy combined with dual-targeted anti-HER2 therapy; triple-negative IBC may respond to immune checkpoint inhibitors; and CDK4/6 inhibitors show potential efficacy in hormone receptor-positive subtypes. Despite advancements, the prognosis remains poor, with a high risk of early recurrence and distant metastasis. Prognostic factors include lymph node involvement, molecular subtype, and response to neoadjuvant therapy. As research into the tumor microenvironment and molecular mechanisms deepens, targeted and individualized therapies hold promise for improving outcomes. This review summarizes the epidemiology, pathology, diagnostic criteria, treatment strategies, and prognostic factors of IBC, aiming to inform clinical practice and future research.