Identification of RUVBL2 as a novel biomarker to predict the prognosis and drug sensitivity in multiple myeloma based on ferroptosis genes

BACKGROUND

Multiple myeloma (MM) is a hematological malignancy with the proliferation of malignant plasma cells. Numerous studies have highlighted the critical role of ferroptosis in MM. However, how to use ferroptosis-related genes (FRGs) for prognostic prediction and treatment guidance in MM remains unknown.

METHODS

By analysis of GEO databases, the prognostic gene was identified and a therapeutic strategy for MM patients based on FRGs was explored. A total of 12 FRGs were identified, utilizing the STRING database and Cytoscape software, and the PPI networks were constructed to identify hub genes and further functional enrichment analyses. Based on the aforementioned data, this study analyzed the expression of RUVBL2 in MM patients by qRT-PCR and Western blotting. To validate the functional role of RUVBL2 in the MM cells, cellular experiments were ultimately conducted.

RESULTS

The analysis highlighted six hub genes, including TP53, MCM5, TLR4, RUVBL2, GCLM and ITGA6, and functional enrichment analyses indicating enrichment in DNA replication, regulation of apoptotic signaling pathway and PI3K/AKT signaling pathway. Prognostic analysis indicated that TP53, RUVBL2, and MCM5 are associated with MM prognosis, with RUVBL2 displaying a notable area under the curve (AUC) of 0.823 in ROC analysis. The study first determined that RUVBL2 is highly expressed in MM, siRUVBL2-mediated deletion of RUVBL2 inhibited proliferation, promoted apoptosis and increased the sensitivity of BTZ in MM cells, and also overcame BTZ resistance in CD138+ primary cells from MM patients.

CONCLUSIONS

Our study first suggested that RUVBL2 may be regarded as potential therapeutic targets and prognostic value in MM.

Brain-derived neurotrophic factor (BDNF) as biomarker in stem cell-based therapies of preclinical spinal cord injury models: A systematic review

Stem cell-based therapies offer promising treatment for spinal cord injury (SCI) by reducing inflammation, restoring plasticity, and supporting neuroprotection and nerve regeneration. Brain-derived neurotrophic factor (BDNF) is crucial in SCI pathophysiology. This study reviews the impact of stem cells on BDNF expression in preclinical SCI models. A thorough search was performed in PubMed, Scopus, and Web of Science until June 2023, identifying studies on the effects of stem cells on BDNF in SCI. Two researchers reviewed and extracted data from relevant studies. This review is registered in the Prospective Register of Systematic Reviews (PROSPERO) with the registration number [CRD42023441466]. Out of 923 records, 51 studies met the inclusion criteria, involving rats (46 studies) and mice (5 studies). The contusion or compression model was used in 40 studies, and the transection model in 11. The most common stem cell types were bone marrow mesenchymal stem cells (BM-MSCs), neural stem cells (NSCs), and adipose-derived stem cells (ADSCs). BM-MSCs increased BDNF expression in 16 studies, NSCs in 9 studies, and ADSCs in only one study. This review highlights that BM-MSCs and NSCs are effective in enhancing BDNF expression in preclinical SCI models, while other stem cell types may not significantly affect BDNF levels. These findings suggest variability in the effectiveness of different stem cell therapies in modulating BDNF production for SCI treatment.

Synchronous portal vein embolization of terminal branches with transcatheter arterial chemoembolization before planned major hepatectomy for hepatitis B virus-related hepatocellular carcinoma: a single-center retrospective cohort study

BACKGROUND

Terminal branches portal vein embolization (TBPVE) is a novel technical modification. The clinical effect of synchronous TBPVE with transcatheter arterial chemoembolization (TACE) before planned major hepatectomy in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unknown.

METHODS

From November 2016 to December 2021, the study enrolled 115 patients with HBV-related HCC who were scheduled for major hepatectomy but had insufficient future liver remnant (FLR). Patients were grouped according to whether they received TBPVE combined with TACE (the TBPVE group [n = 62]) or PVE combined with TACE (the PVE group [n = 53]). This study compared the outcomes of the procedures and the perioperative and long-term outcomes of patients who subsequently underwent major hepatectomy between the 2 groups.

RESULTS

FLR volume increment and degree of hypertrophy were significantly higher in the TBPVE group than in the PVE group (P ≤.003). FLR proliferation was pronounced remarkably within the first 2 weeks after TBPVE synchronous with TACE, and the kinetic growth rates were 17.4 mL/d (IQR, 12.7-21.9) in the first week and 6.9 mL/d (IQR, 4.1-11.1) in the second week. Of note, 54 patients in the TBPVE group and 41 patients in the PVE group finally underwent major hepatectomies. The Pringle maneuver time, intraoperative blood loss, transfusion, and postoperative hospital stays were lower in the TBPVE group than in the PVE group (P <.05). Disease-free survival (DFS) rates were better in the TBPVE group than in the PVE group (P =.042).

CONCLUSION

TBPVE synchronous with TACE induced safe and rapid FLR hypertrophy with satisfactory efficacy in patients with initially unresectable HBV-related HCC, improved the planned major hepatectomy resectability rate, and had better DFS.

Comparison of three reconstruction techniques performed after pancreaticoduodenectomy: Using external, internal, or no stent

BACKGROUND

Postoperative pancreatic fistula (POPF) is the most frequent cause of morbimortality after pancreaticoduodenectomy, but the best technique to use to prevent its development is unclear. The choice of drainage method external duct stent (EDS), internal duct stent (IDS), or non-ductal stent (NDS) is also controversial.

AIM

To compare the three groups (EDS, IDS and NDS), analyzing the patient characteristics, perioperative examinations and survival.

METHODS

Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020, were divided into the EDS, IDS and NDS groups.

RESULTS

Of the 244 patients included, 129 were in the EDS group, 71 in the IDS group, and 44 in the NDS group. Except for preoperative pancreatitis in the NDS patients, comorbidities were similar among the groups. Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas (P < 0.001). A lower rate of grade C POPF was observed in the EDS (1.6%) compared to the NDS (9.1%) and IDS group (14.1%) (P = 0.009). The groups showed similar findings for delayed gastric emptying, postoperative hemorrhage, reoperation, and 5-year survivals. Ninety-day mortality rate was significantly higher in the IDS group (5.6%) compared to the EDS (1.6%) and NDS (4.5%) groups (P = 0.046). Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF (P = 0.034), and 90-day mortality (P = 0.018). Additionally, a Wirsung duct diameter < 3 mm was the only risk factor for grade B/C POPF (P = 0.001), and 90-day mortality (P = 0.031).

CONCLUSION

The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality, and the Wirsung duct < 3 mm was a risk factor for grade B/C POPF and 90-day mortality.

Intraoperative Blood Transfusion has a Distinct Impact on the Long-Term Prognosis of Hepatocellular Carcinoma Patients With Different Alpha-Fetoprotein-Tumor Burden Scores After Liver Resection: A Large-Scale Multicenter Study

BACKGROUND

To identify the influence of intraoperative blood transfusion (IBT) on the long-term prognosis of patients with hepatocellular carcinoma (HCC) in patients with low/medium alpha-fetoprotein-tumor burden scores (ATSs) and high ATSs.

METHODS

Data from HCC patients (n = 3374) who underwent liver resection between 2014 and 2022 from a multicenter database were reviewed. The impact of IBT on overall survival (OS) and recurrence-free survival (RFS) in the whole cohort, low/medium ATS group, and high ATS group was evaluated via multivariate analyses, respectively.

RESULTS

Before propensity score matching (PSM), patients who underwent IBT had poorer RFS (5-year RFS: 37.7% vs. 49.6%, p < 0.001) and OS (5-year OS: 52.8% vs. 68.2%, p < 0.001) than those who did not undergo IBT. After PSM, both RFS (5-year RFS: 37.9%, vs. 45.8%, p = 0.207) and OS (5-year OS: 52.5% vs. 59.5%, p = 0.125) were similar between patients who did and did not receive IBT. Multivariate analysis revealed that the IBT was not associated with RFS or OS in the whole cohort or in patients with high ATSs. However, the IBT was independently related to both RFS (HR = 1.407, 95% CI = 1.089-1.818; p = 0.009) and OS (HR = 1.522, 95% CI = 1.114-2.080, p = 0.008) in patients with low/moderate ATSs.

CONCLUSION

Our study confirmed that the IBT had different effects on the prognosis of HCC patients with different ATSs after liver resection. The IBT negatively impacts on the prognosis of patients with low/medium ATSs patients, but not those with high ATSs.

Artificial intelligence in gastrointestinal surgery: A minireview of predictive models and clinical applications

BACKGROUND

Artificial intelligence (AI) is playing an increasingly significant role in predicting outcomes of gastrointestinal (GI) surgeries, improving preoperative risk assessment and post-surgical decision-making. AI models, particularly those based on machine learning, have demonstrated potential in predicting surgical complications and recovery trajectories.

AIM

To evaluate the role of AI in predicting outcomes for GI surgeries, focusing on its efficacy in enhancing surgical planning, predicting complications, and optimizing post-operative care.

METHODS

A systematic review of studies published up to March 2025 was conducted across databases such as PubMed, Scopus, and Web of Science. Studies were included if they utilized AI models for predicting surgical outcomes, including morbidity, mortality, and recovery. Data were extracted on the AI techniques, performance metrics, and clinical applicability.

RESULTS

Machine learning models demonstrated significantly better performance than logistic regression models, with an area under the curve difference of 0.07 (95%CI: 0.04–0.09; P < 0.001). Models focusing on variables such as patient demographics, nutritional status, and surgical specifics have shown improved accuracy. AI’s ability to integrate multifaceted data sources, such as imaging and genomics, contributes to its superior predictive power. AI has improved the early detection of gastric cancer, achieving 95% sensitivity in real-world settings.

CONCLUSION

AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes. However, challenges related to data quality, model transparency, and clinical integration remain.

Outcome prediction for cholangiocarcinoma prognosis: Embracing the machine learning era

We read with great interest the study by Huang et al. Cholangiocarcinoma (CC) is the second most common type of primary liver tumor worldwide. Although surgical resection remains the primary treatment for this disease, almost 50% of patients experience relapse within 2 years after surgery, which negatively affects their prognosis. Key predictors can be used to identify several factors (e.g., tumor size, tumor location, tumor stage, nerve invasion, the presence of intravascular emboli) and their correlations with long-term survival and the risk of postoperative morbidity. In recent years, artificial intelligence (AI) has become a new tool for prognostic assessment through the integration of multiple clinical, surgical, and imaging parameters. However, a crucial question has arisen: Are we ready to trust AI with respect to clinical decisions? The study by Huang et al demonstrated that AI can predict preoperative textbook outcomes in patients with CC and highlighted the precision of machine learning algorithms using useful prognostic factors. This letter to the editor aimed to explore the challenges and potential impact of AI and machine learning in the prognostic assessment of patients with CC.

Prognostic Significance of Volumetric Parameters on Pretreatment FDG PET/CT in Patients With Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab Therapy

BACKGROUND

This study aimed to assess prognostic significance of FDG PET/CT parameters in predicting progression-free survival (PFS) and overall survival (OS) in patients with hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab therapy.

PATIENTS AND METHODS

We retrospectively enrolled 78 patients with HCC who underwent FDG PET/CT before atezolizumab plus bevacizumab therapy and identified intrahepatic target tumor lesions on pretreatment imaging studies. From PET/CT images, we measured SUVmax, tumor-to-normal liver uptake ratio, metabolic tumor volume, and total lesion glycolysis (TLG) for intrahepatic tumor lesions, as well as SUVmax for extrahepatic metastatic lesions (extrahepatic SUVmax).

RESULTS

In comparisons of PET/CT parameters, patients with progressive disease demonstrated significantly higher TLG values than those achieving complete or partial response ( P < 0.05). In the multivariate survival analysis, TLG independently predicted both PFS ( P = 0.019) and OS ( P = 0.003). Metabolic tumor volume was significantly associated with OS alone ( P = 0.010), and extrahepatic SUVmax was significantly associated with only PFS ( P = 0.045). Patients with high TLG values experienced poorer PFS and OS than those with low TLG values ( P < 0.05).

CONCLUSIONS

TLG in intrahepatic HCC lesions was significantly associated with treatment response and served as an independent prognostic factor for PFS and OS. TLG could be a potential imaging biomarker for predicting clinical outcomes in patients with HCC receiving atezolizumab plus bevacizumab therapy.

The clinical applications of dual-layer spectral detector CT in digestive system diseases

OBJECTIVE

Dual-layer spectral detector CT (DLCT) has several advantages in clinical practice, this study aims to reveal the clinical applications of DLCT in digestive system diseases.

MATERIALS AND METHODS

We searched PubMed and Cochrane Reviews for articles published from January 1, 2010 to May 31, 2024, using the terms "dual-layer spectral detector CT" or "dual-layer CT" combined with "hepatic fat" or "hepatic fibrosis" "hepatocellular carcinoma" or "pancreatic ductal adenocarcinoma" or "pancreatic neuroendocrine tumors" or "gastric cancer" or "colorectal cancer" or "Crohn's disease" or "bowel ischemia" or "acute abdominal conditions".

RESULTS

DLCT consists of a top layer sensitive to lower-energy photons and a bottom layer sensitive to higher-energy photons. This configuration enables simultaneous acquisition of two energy spectra from a single X-ray beam ensuring consistent spatial alignment and temporal resolution. Spectral raw images allow image post-processing to improve image quality, reduce radiation doses and contrast media doses, and generate multiple quantitative parameters. It has broad potential for early detection, accurate staging, efficacy assessment, and prognosis prediction of liver, pancreatic, and gastrointestinal diseases, as well as for the assessment of digestive system vasculature.

CONCLUSIONS

DLCT not only provides valuable information for the clinical diagnosis and therapeutic effect evaluation of digestive system diseases but also may play a more important role in the overall management of digestive diseases and in the decision-making of individualized medicine.

KEY POINTS

Question What are the advantages of DLCT compared to traditional single-energy CT in the early detection, staging, and therapeutic evaluation of digestive system diseases? Findings DLCT enhances image quality, improves tissue characterization, and allows for multi-parametric analysis, making it superior in detecting and evaluating liver, pancreatic, and gastrointestinal diseases. Clinical relevance DLCT provides high-quality, multi-parametric imaging that improves the accuracy of diagnosing digestive diseases, facilitates more precise treatment planning, and enhances monitoring of treatment response, ultimately contributing to better patient management and prognosis.

Use of Histomorphological Features for the Prediction of Grade C Fistula after Whipple Procedure: A Difficult Task

Introduction

The prediction of occurrence and form of a postoperative pancreatic fistula (POPF) could decrease the risk after pancreatic resections. We developed a score based on histomorphological criteria to predict POPF earlier on. In this study, we test the scoring system to differentiate between patients developing grades B and C POPF.

Methods

We analysed 92 patients who underwent pancreatic head resection and developed a grade B or C POPF postoperatively. There were no exclusion criteria. Pancreatic resection margins were analysed histologically and pancreatic duct size, fibrosis, fat content, and signs of inflammation were transformed into a scoring system.

Results

Patients with a grade B fistula (n = 48) were compared to patients with grade C fistula (n = 44). The grade C group was characterized by higher mortality (0 vs. 22, p < 0.001), postpancreatectomy haemorrhage (3 vs. 24, p < 0.001), longer stays in intensive care unit (2.6 vs. 21.1, p < 0.001) and in hospital (29.8 vs. 44.6, p < 0.001). The scoring system was unable to predict grade C fistula. We calculated receiver operator characteristics for all assessed characteristics, which revealed an area under the curve of 0.561. The strongest predictors of POPF grade C were pancreatic fat and soft pancreatic tissue. A combination of only these two items led to a statistically significant difference (p < 0.001) and an AUC of 0.771.

Conclusion

Establishing a score to differentiate between grade B and grade C POPF is a difficult task. Pancreatic fat seems to be the most relevant histomorphological feature to be used in any scoring system, and it should be combined with other clinical features to enhance its precision and validity.

A Survey of Clinical Practices for Hepatocellular Carcinoma Among Experts at Tertiary Hospitals in China From 2020 to 2021

Background

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death in China. The rapid progress in systemic therapies has led to the approval of many therapeutic methods that have quickly changed clinical guidelines and practices. Because of the high heterogeneity of HCC, there are still some gaps between the guidelines and real-world clinical practice. The present study surveyed experts in China to investigate the current treatment concepts and clinical practice regarding HCC.

Methods

A questionnaire survey on the treatment concepts and clinical practice of HCC was administered to 310 experts with senior professional titles in 2020 and 312 experts in 2021. The results were analyzed and compared.

Results

For treating patients with resectable HCC, 28% of hepatobiliary surgeons indicated neoadjuvant therapy, and 7% chose systemic therapy ± locoregional therapy as 1 L therapy in 2021 compared with 20% and 1% in 2020. More experts chose adjuvant treatment within 1 month in 2021 compared with 2020, and 6 months and 12 months were the leading choices for the duration of adjuvant treatment. In 2021, 79% of surgeons and 19% of interventionalists were willing to conduct downstaging/conversion therapy for patients with potentially resectable HCC, and 78% chose tyrosine kinase inhibitors (TKI) + immunotherapy (IO) + locoregional therapy for cases in which R0 resection could not be achieved. For completely unresectable HCC, more experts preferred TKI + IO-based therapy as 1 L therapy in 2021 compared with 2020 (78% vs. 55%). The proportion of experts who indicated TKI + IO-based therapy as 2 L therapy increased from 32% in 2020 to 40% in 2021.

Conclusion

The survey results indicated that in 2021, compared with 2020, more experts opted to administer IO + TKI for the treatment of liver cancer, and more experts and patients were willing to participate in clinical research.

Solitary fibrous tumors from A to Z: a pictorial review with radiologic-pathologic correlation

Solitary fibrous tumors (SFTs) represent a rare subset of mesenchymal neoplasms, affecting 1-2 per million people, with no gender preference. They demonstrate indolent behavior, frequent asymptomatic presentation, and widespread anatomical involvement. At imaging, SFTs typically appear as well-defined, predominantly hypervascular masses with varying degrees of cystic change and necrosis, though calcification is rare. Avid heterogeneous enhancement is typical following intravenous contrast administration, with multiple blood vessels observed at the periphery. Although findings on CT and MRI alone are generally nonspecific, a frequent feature of SFTs at MRI is the presence of rounded or linear low signal intensity foci on T1- and T2-weighted images, corresponding to the fibrous and collagenous content. Nevertheless, because the imaging features of SFTs overlap with those of many benign and malignant tumors, histologic confirmation is required for the final diagnosis. A comprehensive understanding of SFTs' multifaceted clinical, pathological, and radiological presentations across various organs is crucial for accurate diagnosis and effective management. CRITICAL RELEVANCE STATEMENT: A comprehensive understanding of the classic radiological and pathological features of solitary fibrous tumors across various organs is crucial for accurate diagnosis and effective management. KEY POINTS: Solitary fibrous tumors (SFTs) are rare hypervascular fibrous tumors with indolent behavior. Imaging features of SFTs overlap with many other tumors, necessitating histologic confirmation. Understanding SFTs' radiological presentations is crucial for accurate diagnosis and effective management.

Applications and challenges of patient-derived organoids in hepatobiliary and pancreatic cancers

Hepatobiliary and pancreatic (HBP) cancers are among the most aggressive malignancies, with recurrence and metastasis driven by tumor heterogeneity and drug resistance, presenting considerable challenges to effective treatment. Currently, personalized and accurate treatment prediction models for these cancers are lacking. Patient-derived organoids (PDOs) tumor are three-dimensional in vitro models created from the tumor tissues of individual patients. Recent reports and our cultivation data indicate that the success rate of cultivating organoids for HBP cancers consistently exceeds 70%. The predictive accuracy of these tumor organoids has been shown to surpass 90%. However, PDOs still face notable limitations, especially in simulating the tumor microenvironment, including tumor angiogenesis and the surrounding cellular context, which require further refinement. While co-culture techniques and microfluidic platforms have been developed to mimic multi-cellular environments and functional vascular perfusion, they remain insufficient in accurately recapitulating the complexities of the in vivo environment. Additionally, PDOs are needed to fully assess their potential in predicting the efficacy of multi-drug combination therapies. This review provides an overview of the applications, challenges, and prospects for organoid models in the study of HBP cancer.

Arginase 1 drives mitochondrial cristae remodeling and PANoptosis in ischemia/hypoxia-induced vascular dysfunction

Ischemic/hypoxic injury significantly damages vascular function, detrimentally impacting patient outcomes. Changes in mitochondrial structure and function are closely associated with ischemia/hypoxia-induced vascular dysfunction. The mechanism of this process remains elusive. Using rat models of ischemia and hypoxic vascular smooth muscle cells (VSMCs), we combined transmission electron microscopy, super-resolution microscopy, and metabolic analysis to analyze the structure and function change of mitochondrial cristae. Multi-omics approaches revealed arginase 1 (Arg1) upregulation in ischemic VSMCs, confirmed by in vivo and in vitro knockout models showing Arg1's protective effects on mitochondrial cristae, mitochondrial and vascular function, and limited the release of mtDNA. Mechanistically, Arg1 interacting with Mic10 led to mitochondrial cristae remodeling, together with hypoxia-induced VDAC1 lactylation resulting in the opening of MPTP and release of mtDNA of VSMCs. The released mtDNA led to PANoptosis of VSMCs via activation of the cGAS-STING pathway. ChIP-qPCR results demonstrated that lactate-mediated Arg1 up-regulation was due to H3K18la upregulation. VSMCs targeted nano-material PLGA-PEI-siRNA@PM-α-SMA (NP-siArg1) significantly improved vascular dysfunction. This study uncovers a new mechanism of vascular dysfunction following ischemic/hypoxic injury: a damaging positive feedback loop mediated by lactate-regulated Arg1 expression between the nucleus and mitochondria, leading to mitochondria cristae disorder and mtDNA release, culminating in VSMCs PANoptosis. Targeting VSMCs Arg1 inhibition offers a potential therapeutic strategy to alleviate ischemia/hypoxia-induced vascular impairments.

Correlation between Salivary Oxidative Stress Biomarkers and Clinical Severity of Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients

Radiation-induced oral mucositis (RIOM) is the most common side effect of radiotherapy (RT) in head and neck cancer (HNC) patients. Oxidative stress plays a major role in the multistep pathogenesis of RIOM. However, the current understanding of the relationship between salivary biomarkers of oxidative stress and the clinical severity of RIOM remains limited. This study aims to analyze the correlation between salivary oxidative stress biomarkers and the clinical severity of RIOM.This cross-sectional study analyzed the levels of salivary oxidative stress biomarkers from 25 HNC patients who underwent RT using enzyme-linked immunosorbent assay and the clinical grades of RIOM in the cohort. The data were then analyzed using the Spearman's correlation statistical test (p-value < 0.05).The findings demonstrated a significant correlation between salivary glutathione levels (r: -0.396; p: 0.050), superoxide dismutase levels (r: -0.447; p: 0.025), malondialdehyde levels (r: 0.479; p: 0.015), and lactate dehydrogenase levels (r: 0.460; p: 0.025) with the clinical severity of RIOM.The higher salivary oxidative stress correlates with higher severity of RIOM.

Lactylation-regulated biomolecular condensates: metabolic control of phase separation in physiology and disease

Lactate has long been viewed as a "waste product" of anaerobic glycolysis, with its role in health and disease often overlooked. However, recent discoveries of lactylation-a novel post-translational modification involving lactate-have sparked a renewed understanding of lactate's functions. Lactylation alters the molecular structure of proteins with different cellular localizations, enabling the regulation of their functions and aggregation in specific spatiotemporal contexts, with its impact on biomolecular phase separation being one of its primary effects. However, it remains unknown how lactylation dynamically regulates the spatiotemporal specificity of phase separation and its role in diseases. This article provides an overview of the regulatory mechanisms of biomolecular phase separation driven by lactylation, aiming to offer fresh insights into the role of lactylation in normal and disease-related biological processes while deepening our understanding of its research value and biological significance.

Prognostic impacts of biological and conditional factors in patients with anatomically resectable pancreatic adenocarcinoma treated with preoperative chemoradiotherapy

The efficacy of preoperative chemoradiotherapy (CRT) for anatomically resectable pancreatic adenocarcinoma (R-PDAC) remains contentious. This study aims to elucidate the treatment outcomes of preoperative CRT for R-PDAC and to identify prognostic factors. This retrospective study included 109 R-PDAC patients treated with gemcitabine- or S-1 plus gemcitabine-based preoperative CRT from February 2005 to April 2023. Cox proportional hazards regression was employed to identify factors associated with worse overall survival (OS). Among the 109 cases, 90 patients (82.6%) underwent curative-intent resection following CRT. The median OS for the entire cohort was 36.5 months, significantly longer in resected cases than in unresected cases (40.6 vs 11.4 months). Multivariate analysis identified pretreatment serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) and the Eastern Cooperative Oncology Group performance status ≥1 as independent prognostic factors. When these factors were scored (risk score 0-3) using pre-CRT serum CA19-9 level (≥640 U/mL) and CEA (≥6.1 ng/mL), OS for risk scores 1 (n = 41), 2 (n = 20) or 3 (n = 6) was significantly shorter than for risk score 0 (n = 42) (score 0 vs 1 vs 2 vs 3: 49.1 vs 33.8 vs 16.1 vs 16.8 months). The presence of portal vein invasion on imaging and post-CRT serum CA 19-9 level (≥111 U/mL) were independent prognostic factors in resected cases. Biological factors, including serum levels of CA19-9 and CEA, along with conditional factor of Eastern Cooperative Oncology Group performance status ≥1, were identified as independent prognostic factors for R-PDAC patients treated with preoperative CRT. Preoperative CRT is considered effective for cases lacking these risk factors.

MRI Radiomics to Predict Early Treatment Response to TACE Combined with Lenvatinib Plus a PD-1 Inhibitor for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Purpose

To develop and validate a predictor for early treatment response in hepatocellular carcinoma (HCC) patients accompanied by portal vein tumor thrombus (PVTT) undergoing transarterial chemoembolization (TACE), lenvatinib and a programmed cell death protein 1 (PD-1) inhibitor (TLP) therapy.

Patients and Methods

In this retrospective study, patients with HCC and PVTT from two institutions receiving triple TLP therapy were enrolled. Radiomics features derived from pretreatment contrast-enhanced MRI were curated using intraclass correlation coefficient (ICC), Student's t-test, least absolute shrinkage and selection operator (LASSO), and recursive feature elimination (RFE) to ensure robust selection. Various machine learning (ML) algorithms were then used to construct the models. The meaningful clinical indicators were obtained via logistic regression analysis and ultimately integrated with radiomics features to develop a combined model. In addition, we used Shapley Additive exPlanation (SHAP) to clarify the model's operational dynamics.

Results

Our study ultimately included 115 patients (7:3 randomization, 80 and 35 in the training and test cohorts, respectively) in total. No patients achieved complete remission, 47 achieved partial remission, 29 achieved stable disease, and 39 experienced disease progression. Among objective response rates (ORRs) and disease control rates (DCRs), 40.9% and 66.1% were reported. One of the four ML classifiers with optimal performance, namely random forest, was adopted as the radiomics model after testing. Regarding the performance assessment, the radiomics model's area under the curve (AUC) values reached 0.92 (95% CI: 0.86-0.97) and 0.79 (95% CI: 0.61-0.95), inferior to the combined model's AUCs of 0.95 (95% CI: 0.68-0.98) and 0.84 (95% CI: 0.91-0.99). Moreover, the SHAP plots illustrate the importance of global variables and the prediction process for individual samples.

Conclusion

The model based on machine learning and radiomics showed favorable performance, and the operating mode was visualized through SHAP.

Molecular subtypes based on ferroptosis-related genes and tumor microenvironment infiltration characterization in small cell lung cancer

Background

Ferroptosis is an iron-dependent form of regulated cell death associated with cancer. However, the characteristics of ferroptosis in small cell lung cancer (SCLC) are still uncertain. This study aimed to explore the application value of ferroptosis-related genes (FRGs) classification in prognosis and characteristics prediction to provide clues for targeted SCLC therapy.

Method

We systematically characterized mRNA expression and genetic alterations of FRGs in SCLC, evaluating their expression pattern in 181 samples from 3 datasets. Unsupervised clustering analysis was performed to identify the molecular subtypes based on FRGs. We then conducted association analyses between FRG subtypes and various tumor microenvironment (TME) characteristics, traditional key transcript factor subtypes, clinical features, transcriptional and post-transcriptional regulation, drug response, and the efficacy of immunotherapy. Furthermore, the novel classification was validated in an independent cohort of 34 samples from Beijing.

Result

In this study, we identified three distinct ferroptosis subtypes in SCLC: S1, S2, and S3. We found that patients in S2 had the poorest prognosis. The FRG classification was correlated with the NOTCH pathway, MYC pathway, Neuroendocrine (NE), and epithelial-to-mesenchymal transition (EMT) process. Additionally, the FRG classification was strongly associated with TME 4 subtypes. To validate the classification, we employed an independent cohort. The FRG classification could also help to guide the prediction of chemical drugs. Finally, the heatmap showed the landscape of FRG subtypes, TME subtypes, NE subtypes, key transcription subtypes, age, gender, and stage.

Conclusion

Our identification of new SCLC subtypes provides novel insights into tumor biology and has potential clinical implications for the management of SCLC.

Depressive Disorder Affects TME and Hormonal Changes Promoting Tumour Deterioration Development

Cancer patients often suffer from depression, the presence of which promotes the deterioration of the cancer patient's condition and thus affects the patient's survival. However, the exact mechanisms underlying the relationship between depression and tumour progression remain unclear, and this complexity involves multi-system and multi-level interactions, with several key challenges remaining in current research. First, the extreme complexity of biological systems. Depression and tumors involve multiple pathways such as neuroendocrine, immune system, and metabolism, respectively, and there are nonlinear interactions between these pathways (e.g., HPA axis activation affects both immunosuppression and tumor angiogenesis), so it is difficult to isolate the predominant role of a single mechanism, and there are feedback loops (e.g., inflammatory factors (e.g., IL-6) can both induce depressive symptoms and promote tumor growth) form a "feedback loop between depression and tumors" that makes it difficult to determine the direction of causality. Second, the potential blind spot of mechanism research. There is insufficient direct evidence for the brain-tumor axis, and it is known that the vagus nerve or sympathetic nerves can directly modulate the tumor microenvironment (TME) (e.g., via β-adrenergic receptors), but there is a lack of technical support for in vivo imaging on how the CNS remotely affects tumors through the neural circuits; whereas depression-associated disturbances of the intestinal flora or in certain stages of tumor development (e.g., metastatic) or specific microenvironments (e.g., areas of hyper-infiltrating T-cells) may have long-term effects on the tumors, but such changes are difficult to capture in short-term experiments and cannot be precisely temporally resolved by existing technologies. However, there are limitations in current research methods. Existing studies have relied on mouse models of chronic stress (e.g., chronic unpredictable stress), but the "depression-like behaviour" of mice is fundamentally different from the clinical manifestations of depression in humans, and the TME (e.g., immune composition) is different from that of humans. Finally, for patients with cancer-associated depression, clinical treatment is usually a two-pronged strategy, but the combination of anticancer and antidepressant drugs has limitations, such as drug-drug interactions, safety issues, and the challenge of individualised treatment in clinical practice. Therefore, by elucidating the relationship between depression and tumour bidirectional effects, this review relatively clarifies how depression affects TME to promote tumour progression by influencing changes in immunosuppression, hormonal changes, glutamate/glutamate receptors, and intestinal flora. Further, some potential therapeutic strategies are proposed for the clinical treatment of this group of patients through the above pathological mechanism; at the same time, it was found that antidepressant drugs have potential antitumor activity, and their dual pharmacological effects may provide synergistic therapeutic benefits for patients with cancer-associated depressive disorders. This finding not only expands the choice of drugs for tumour therapy but also provides a new theoretical basis for comprehensive treatment strategies in the field of psycho-oncology.

Illuminating the black box: Machine learning enhances preoperative prediction in intrahepatic cholangiocarcinoma

The study by Huang et al, published in the World Journal of Gastroenterology, advances intrahepatic cholangiocarcinoma (ICC) management by developing a machine-learning model to predict textbook outcomes (TO) based on preoperative factors. By analyzing data from 376 patients across four Chinese medical centers, the researchers identified key variables influencing TO, including Child-Pugh classification, Eastern Cooperative Oncology Group score, hepatitis B status, and tumor size. The model, created using logistic regression and the extreme gradient boosting algorithm, demonstrated high predictive accuracy, with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation. The integration of the Shapley additive explanation technique enhances the interpretability of the model, which is crucial for clinical decision-making. This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC, opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.

A Mutual Interaction Between GSTP1 and p53 Improves the Drug Resistance and Malignant Biology of Pancreatic Cancer

Glutathione S-transferase P1 (GSTP1), a classic tumor biomarker, plays a controversial role in cancer progression. However, its specific role in pancreatic cancer (PC) has rarely been investigated. In the present study, we investigated the function and relationship between GSTP1 and mutant/wild-type p53 (mtp53/wtp53) in PC in vitro and in vivo. Compared with paired adjacent normal pancreas tissue, GSTP1 was downregulated in PC tissue, which was closely correlated with lymph node metastasis, Union for International Cancer Control (UICC) stage, and a better outcome of PC patients, processes dependent on wtp53 rather than mtp53. Moreover, a mutual regulation between GSTP1 and p53 was found in wtp53 PC cells. GSTP1 overexpression inhibited cell proliferation and chemotherapy resistance in vitro via wtp53/p21 and Bax/Bcl2 signaling, which was significantly reversed by wtp53 silencing, and vice versa. Similarly, the coordination of GSTP1 and p53 regulated the invasion and migration of PC cells, which was accompanied by changes in epithelial-mesenchymal transition (EMT) signaling (E-cad, ZO-1 and MMP9). Moreover, GSTP1 overexpression inhibited tumor growth and liver metastasis in vivo, as did high wtp53 and low ki67 expression. Interestingly, GSTP1 did not coimmunoprecipitate with either mtp53 or wtp53 in vitro. However, the wtp53 protein, as a transcription factor, could bind to the GSTP1 DNA promoter to transactivate GSTP1 mRNA expression as demonstrated via a Chip assay. Additionally, GSTP1 promoted the translocation of wtp53 into the nucleus but not mtp53. These results suggest that the positive feedback regulation of GSTP1 and wtp53 plays a significant role in cell proliferation, drug resistance, cell invasion and metastasis in PC.

Hepatic arterial infusion chemotherapy combined with lenvatinib and immune checkpoint inhibitor versus lenvatinib for advanced hepatocellular carcinoma: a multicenter study with propensity score and coarsened exact matching

PURPOSE

Hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib (Len) and immune checkpoint inhibitor (ICI) in treating advanced hepatocellular carcinoma (HCC) still needs further confirmation. We aimed to evaluate the efficacy of HAIC combined with Len and ICI (HAIC + Len + ICI) versus Len alone in advanced HCC.

METHODS

A total of 290 patients in Len group and 349 patients in HAIC + Len + ICI group were analysed. Propensity score matching (PSM), inverse probability treatment weighting (IPTW), and coarsened exact matching (CEM) analyses were used to balance the bias between two groups. Mediation analysis of treatment type in survival was performed for analysis.

RESULTS

The median progression-free survival (PFS) was 5.9 ± 0.2 months in Len group and 9.2 ± 0.5 months in HAIC + Len + ICI group. The HAIC + Len + ICI group demonstrated significantly better PFS than the Len group across the entire cohort (hazard ratio [HR], 0.50; 95% CI 0.43-0.60; P < 0.001). This advantage in PFS was sustained in the PSM, IPTW, and CEM cohorts. HAIC + Len + ICI group also showed better overall survival (OS) than the Len group (HR, 0.38; 95% CI 0.31-0.46; P < 0.001). The OS was also superior in the PSM, IPTW, and CEM cohorts. The objective response rate (ORR) in HAIC + Len + ICI group was twice as high as that in Len group. Further mediation analysis showed tumor response at 3 and 6 months had different mediation effect on survival.

CONCLUSIONS

HAIC combined with Len and ICI showed improved better OS and PFS than Len alone. This triple therapy could be considered as a first-line treatment for advanced HCC.

Comparison of initial treatments for resectable hepatocellular carcinoma within Milan criteria: an observational study based on a nationwide survey

Purpose

Treatment options for hepatocellular carcinoma (HCC) vary according to known guidelines among liver resection (LR), liver transplantation (LT), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). This study aimed to compare the outcomes of initial treatment for patients with resectable HCC within Milan criteria (MC) via nationwide data.

Methods

Patients with resectable HCC (Child-Pugh class A; platelet count, ≥100,000/µL) within MC from the Korean Liver Cancer Association databank were analyzed, retrospectively. Outcomes according to initial treatment and subgroups according to tumor size and number were analyzed. Overall survival (OS) rates after initial treatment were compared.

Results

A total of 3,241 patients who underwent LR (n = 1,371), LT (n = 12), RFA (n = 679), or TACE (n = 1,179) were included. The 5-year OS rates differed significantly between the groups (P < 0.05), except for LT (LR, 84.9%; LT, 82.5%; RFA, 76.2%; and TACE, 59.9%). For patients with a single tumor of any size, the 5-year OS rates of the LR group were significantly higher than RFA and TACE groups. For patients with multiple tumors, the 5-year OS rates were 78.2%, 100%, 74.3%, and 53.0% for the LR, LT, RFA, and TACE groups, respectively, but without significant difference between LR and RFA (P = 0.86).

Conclusion

For resectable HCC within MC, the LR had the highest OS rate for a single tumor of any size. LR and RFA showed no significant differences in OS rate for multiple tumors. LR has a much more optimistic outlook for HCC within MC.

Systemic therapy plus HAIC versus systemic therapy for hepatocellular carcinoma: a systematic review and meta-analysis

BACKGROUND

Hepatic arterial infusion chemotherapy (HAIC) exhibits synergistic anticancer effects with systemic therapy in treating hepatocellular carcinoma (HCC). The approach combining systemic therapy and HAIC is likely to establish a new survival benchmark for advanced HCC. However, related evidence is still lacking.

METHOD

PubMed, Embase, Cochrane Library, and Web of Science were searched from January 1990 to July 2024. The extracted data were pooled using fixed- or random-effects models and expressed as hazard ratios (HRs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs). Meta-regression, subgroup analysis, prognostic factor analysis, correlation analysis, as well as trial sequential analysis were further conducted.

RESULT

Seventeen trials involving 3070 participants were included. Patients receiving HAIC combined systemic therapy displayed superior overall survival (OS) (HR, 0.52; 95% CI, 0.48-0.58), progression-free survival (PFS) (HR, 0.54; 95% CI, 0.46-0.63), objective response rate (ORR) (RR, 2.20; 95% CI, 1.77-2.72) and disease control rate (RR, 1.21; 95% CI, 1.14-1.29) over systemic therapy. Combining HAIC resulted in higher incidences of grade ≥3 manageable adverse events. Subgroup analyses showed that HAIC could bring significant survival improvement for almost all specific populations; however, patients without portal vein tumor thrombosis might not benefit from it (HR, 0.74; 95% CI, 0.53-1.03). Prognostic factor analyses found extra HAIC was a protective factor for both OS (HR, 0.42; 95% CI, 0.34-0.51) and PFS (HR, 0.44; 95% CI, 0.36-0.53). Correlation analyses demonstrated a robust association between ORR and OS when applying systemic therapy with HAIC ( P -value = 0.031). In addition, trial sequential analyses visually showed the present data were compelling to draw reliable conclusions.

CONCLUSION

With manageable toxicity, integrating HAIC with systemic therapy could bring favorable survival benefits for HCC patients. Further evidence is necessary to standardize the integration of HAIC with first-line systemic therapy.

Effect of Recombinant Human Amelogenin on the Osteogenic Differentiation Potential of SHED

This study aimed to explore how amelogenin can improve stem cells from human exfoliated deciduous teeth (SHED)-based bone regeneration and promote tissue healing as a treatment for critical-sized bone defects. SHED was induced into bone differentiation by using osteogenic differentiation medium. Real-time polymerase chain reaction, alkaline phosphatase (ALP) staining and quantification, and Alizarin Red S staining, as well as calcium and osteocalcin quantification were performed to assess differentiation. On day 18, a significant increase was observed in the expression of RUNX2, CBFB, BGLAP, COL1, BMP2, BMP4, NOTCH1, NOTCH2, and NES. Osteocalcin gene expression continued to increase significantly. ALP activity was significantly higher in the amelogenin-treated group than in the control group on days 7, 10, and 14. On day 14, enhanced ALP staining was observed in the amelogenin-treated group. Calcium and osteocalcin levels were significantly higher in the amelogenin-treated group than in the control group on day 21. This study suggests that combining SHED and amelogenin may be effective for bone regeneration, offering a potential new approach in regenerative medicine.

Artificial intelligence in liver cancer surgery: Predicting success before the first incision

Advancements in machine learning have revolutionized preoperative risk assessment. In this article, we comment on the article by Huang et al, which presents a recent multicenter cohort study demonstrated that machine learning algorithms effectively stratify recurrence-free survival, providing a robust predictive framework for maximizing surgical outcomes in intrahepatic cholangiocarcinoma. By leveraging interpretable models, the research enhances clinical decision-making, allowing for more precise patient selection and personalized surgical strategies. These findings highlight the growing role of artificial intelligence in optimizing surgical outcomes and improving prognostic accuracy in hepatobiliary oncology.

Matching-Adjusted Indirect Comparison of Arterial FOLFOX and Atezolizumab-Bevacizumab in Unresectable Hepatocellular Carcinoma

Introduction

A previous phase 3 FOHAIC-1 study demonstrated that hepatic arterial infusion chemotherapy (HAIC) of FOLFOX regimen displayed favorable outcomes in advanced hepatocellular carcinoma (HCC) patients, including those with high-risk features (main portal tumor invasion and >50% liver infiltration). This study aimed to compare the treatment efficacy of HAIC-FOLFOX versus atezolizumab-bevacizumab in HCC patients.

Methods

Individual patient data from the Chinese FOHAIC-1 study and aggregate data from the global IMbrave150 study were used to conduct an anchored matching-adjusted indirect comparison. Hazard ratios (HR) and restricted mean survival times (RMST) were calculated to assess survival differences. Landmark analysis was performed to evaluate time-sensitive treatment effects, and simulated treatment comparison (STC) was conducted as a sensitivity analysis. Rates of treatment-related adverse events (TRAEs) and TRAE-related discontinuations were also compared.

Results

After matching baseline characteristics, HAIC showed a numerical OS benefit (HR 0.57, 95% CI, 0.30-1.08) and similar PFS benefit (HR 0.79, 95% CI, 0.43-1.47) compared to atezolizumab-bevacizumab in the overall population. In high-risk patients, HAIC demonstrated significantly improved OS (HR 0.30, 95% CI, 0.12-0.72) and 2.89-month longer RMST compared to atezolizumab-bevacizumab (95% CI, 0.15-5.64 months). Additionally, HAIC showed superior PFS (HR 0.25, 95% CI, 0.10-0.64) and 2.88-month longer RMST over atezolizumab-bevacizumab (95% CI, 0.90-4.86). Landmark analysis in the high-risk group revealed that HAIC was associated with significant improvements in both OS (HR 0.32, 95% CI, 0.13-0.79) and PFS (HR 0.24, 95% CI, 0.09-0.63) during the 0-12 months following treatment initiation. Sensitivity analysis using the anchored STC analysis yielded consistent results. HAIC was associated with lower rates of grade 3-4 TRAEs and TRAE-related discontinuation in both the overall population and the high-risk group.

Conclusion

HAIC treatment provided superior survival benefits and a favorable safety profile compared to atezolizumab-bevacizumab in high-risk HCC patients.

Development and validation of a nomogram for a prognostic model for resected pancreatic ductal adenocarcinoma

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor. Surgical resection is the most promising therapeutic strategy for PDAC, and how to improve the survival rate remains a vital key point. This study aimed to establish and validate a nomogram for predicting the prognosis of resected PDAC.

METHODS

A total of 174 patients with PDAC who underwent surgical resection at Lanzhou University Second Hospital and the First Affiliated Hospital of Zhengzhou University from January 2012 to July 2022 were enrolled. The clinicopathological characteristics and survival data were analyzed by R software (version 4.1.3). Univariate and multivariate Cox regression analyses were used to analyze the effects of clinicopathological characteristics on overall survival (OS).

RESULTS

Multivariate Cox regression showed that carbohydrate antigen 19-9 (CA19-9) ≥ 476 U/mL, carbohydrate antigen 125 (CA125) ≥ 32 U/mL, fasting blood glucose (FBG) < 6.86 mmol/L, aspartate aminotransferase (AST) ≥ 107 U/L, positive surgical margin, and more than 4 cycles of postoperative chemotherapy were independent prognostic factors for OS. Patients were divided into the high-risk and low-risk groups based on the median risk score calculated by multivariate Cox regression analysis. Kaplan-Meier survival curves revealed that the 5-year survival rates of the high-risk and low-risk groups in the training cohort were 5.79% and 24.3%, respectively, and those in the validation cohort were 0 and 19.0%, respectively (P < 0.05). Receiver operating characteristic (ROC) curve analysis revealed that area under the ROC curve (AUC) of the risk score in the training set and the validation set were 0.855 and 0.838, respectively. The C-indexes of the nomogram in the training set and validation set were 0.788 (95% CI: 0.745-0.831) and 0.773 (95% CI: 0.718-0.828), respectively.

CONCLUSIONS

We developed a nomogram that predicts OS in patients with resected PDAC, and the validation results showed that the nomogram model had a strong predictive ability. Particularly, FBG < 6.86 mmol/L and more than 4 cycles of postoperative chemotherapy can predict better OS of PDAC after surgery.

Non-programmed rehospitalizations after cholecystectomy

Cholecystectomy is one the most frequent procedures in digestive surgery. While the operation is generally associated with low rates of morbidity and mortality, frequency of occurrence can vary considerably according to surgical indication, time elapsed between symptom appearance and surgical intervention, anatomical area under treatment, and the experience of the different centers. Rehospitalization after cholecystectomy remains potentially problematic in numerous units, due in part to the ongoing development of day hospital treatment and short-term hospitalization. The objective of this update is to assess not only the rate, causes and risk factors of non-programmed hospitalizations subsequent to cholecystectomy, but also the available ways and means of prevention and management in the patient's best interests.

Identification of new HLA-A*0201-restricted cytotoxic T lymphocyte epitopes from LDHC in lung adenocarcinoma

Background

Lactate dehydrogenase C (LDHC) is a kind of cancer-testis antigen (CTA) that has been reported to be a biomarker for diagnosis, efficacy evaluation, and recurrence monitoring of lung adenocarcinoma (LUAD). This study aims to assess the value of LDHC in peptide-based vaccines for LUAD immunotherapy.

Methods

The LDHC recombinant protein was purified and its effect on PC9 cells was evaluated by wound healing assay, Transwell invasion, and migration assay. Ten HLA-A2-restricted LDHC-derived peptides were predicted and synthesized, and the affinity for the HLA-A2 molecule was analyzed by T2 binding assay and molecule docking. Enzyme-linked immunospot (ELISpot) and LDH cytotoxicity assay were performed to determine the interferon-γ (IFN-γ) release level and tumor cell lysis ability of peptide-induced specific cytotoxic T lymphocytes (CTLs).

Results

The LDHC recombinant protein promoted invasion and migration of PC9 cells. Three HLA-A2-restricted LDHC-derived peptides P2 (LDHC170-180, FRYLIGEKLGV), P5 (LDHC116-124, IMKSIIPAI), and P6 (LDHC172-180, YLIGEKLGV) had high affinity for the HLA-A2 molecule at 50 μg/mL. P6 (LDHC172-180, YLIGEKLGV) elicited the strongest IFN-γ-secreting cytotoxic T lymphocyte (CTL) response and exhibited potent cytotoxicity against HLA-A2-positive cells with high LDHC expression.

Conclusions

LDHC may serve as a targetable biomarker for peptide-based immunotherapy of LUAD.

Interventional oncology and immunotherapy: current status and future perspectives

Interventional oncology has become an important part of multidisciplinary cancer treatment following the development of interventional radiology. Tumors can release antigens, activate immunity, and cause an abscopal effect after interventional therapy. However, the activated immune response is limited and involves a complex process. New methods to solve the problems were developed following the advent of immunotherapy. The combination therapies enhanced the antitumor immune response and improved patient outcomes with good application prospects. In this review, we have summarized the interventional therapies used to improve immune efficacy and discussed the advancements in combining interventional therapy and immunotherapy.

Next‐Generation Flexible Embolic Systems: Targeted Transarterial Chemoembolization Strategies for Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) remains the gold standard for treating intermediate‐stage hepatocellular carcinoma (HCC), yet faces great challenges in overcoming tumor heterogeneity, hypoxia‐induced angiogenesis, and metastatic progression. The development of advanced flexible embolization materials marks a revolutionary leap in interventional therapy, offering opportunities to revolutionize embolization precision, drug delivery kinetics, and tumor microenvironment modulation. This comprehensive review systematically examines the paradigm shift toward next‐generation TACE technology, emphasizing the limitations of conventional approaches and innovations in flexible embolic agents. A detailed discussion of next‐generation nano‐flexible embolic systems is presented, emphasizing their unique coagulation dynamics, real‐time imaging capabilities, and therapeutic precision. The review delves into groundbreaking TACE strategies integrating hypoxia modulation, energy conversion therapeutics, and sophisticated tumor microenvironment engineering. Clinical translation aspects are thoroughly explored, including large‐scale trial outcomes, vascular recanalization dynamics, and patient‐specific treatment optimization. Looking forward, key frontiers in the field is identified: intelligent nanocomposite systems, synergistic combination therapies, and precision medicine approaches tailored to individual tumor biology. This work not only objectively evaluates current progress but also charts future research priorities, aiming to transform TACE from a palliative intervention to a precision medicine platform and ultimately reshaping the landscape of HCC treatment and patient care.

Precision surgery for hepatocellular carcinoma

Hepatocellular carcinoma arises in the setting of cirrhosis in most cases, requiring multidisciplinary input to define resectability. In this regard, more precise surgical management considers patient factors and anatomical states, including resection margins, tumour biology, and perioperative therapy. Together with advances in surgical techniques, this integrated approach has resulted in considerable improvements in patient morbidity and oncological outcomes. Despite this, recurrence rates in hepatocellular carcinoma remain high. As the systemic treatment landscape in hepatocellular carcinoma continues to evolve and locoregional options are increasingly used, we review current and future opportunities to individualise the surgical management of patients with hepatocellular carcinoma.

A Breast Cancer Prognostic Model Based on Folic Acid Metabolism-Related Genes to Reveal the Immune Landscape

Breast cancer (BC) threatens women's health, and the prognosis is dismal. Folic acid metabolism affects cancer prognosis, but research on folic acid metabolism-related genes (FMRs) in BC is scarce. We used TCGA-BRCA as the training set and GSE21653 as the validation set. Five FMRs (PLAT, SERPINA3, IFNG, SLC19A1, NFKB2) were screened via univariate and LASSO Cox regression analyses, and a prognostic model was built based on multivariate Cox regression analysis. The model showed excellent predictive performance. Differentially expressed genes in high- and low-risk groups were enriched in steroid hormone biosynthesis and neuroactive ligand-receptor interaction pathways. The low-risk group exhibited higher immune cell infiltration and better immunotherapy response. AM-5992 and 5-fluorodeoxyuridine 10mer may be potential BC drugs. This FMR-based model can accurately predict BC prognosis, offering a clinical reference.

Combination locoregional and systemic therapies in hepatocellular carcinoma

Locoregional therapies play a fundamental role in the treatment of patients with early and intermediate and locally advanced hepatocellular carcinomas. With encouraging recent advances in immunotherapy-based systemic therapies, locoregional therapies are being both promoted and challenged by new systemic therapy options. Combined locoregional and systemic therapies might enhance treatment outcomes compared with either option alone. This Series paper summarises the existing data on locoregional and systemic therapies for hepatocellular carcinoma, and discusses evidence from studies investigating their combination with a focus on their synergistic efficacy and safety.

Polyvinyl Alcohol Sponges Reduce Intraperitoneal Adhesions After Abdominal Surgery

INTRODUCTION

The use of cotton sponges in the operating room has been linked to intraperitoneal adhesion formation. Inert, nonlinting polyvinyl alcohol (PVA) sponges have been used as an alternative to reduce intraoperative tissue trauma and particle remnants in other surgical fields. We investigate the effect of PVA sponges on reducing postoperative intraperitoneal adhesions in a murine model.

METHODS AND METHODS

In total, 189 C57BL/6 mice were randomly divided into three groups by abdominal packing intervention. Following laparotomy on day 0, the abdominal cavity was packed with cotton gauze (n = 53), PVA wipe (n = 54), or no packing (sham; n = 58) for three rounds of 10 min each before packing was removed. Mice were euthanized, and necropsies were performed between postoperative days 13-15. Adhesions were graded by two blinded observers using a validated system composed of adhesion extent, tenacity, and density. Adhesion scores were compared between the three groups.

RESULTS

Compared to adhesions in gauze-packed mice, adhesions in PVA-packed mice were significantly less extensive, less tenacious, and less dense (P < 0.001 for all), which equated to lower total adhesion scores in PVA-packed mice (0 [0, 3] versus 5 [2, 7], P < 0.001). The adhesion scores for sham group mice were significantly lower than PVA and gauze mice in all categories.

CONCLUSIONS

This is the first study to directly compare postoperative intra-abdominal adhesion formation following the use of gauze and PVA sponges in an animal model. PVA sponges significantly reduce postoperative adhesions when compared to standard cotton gauze sponges. PVA should be further explored as a useful alternative to reduce postoperative adhesion-related morbidity.

Mitochondrial metabolism-related features guiding precision subtyping and prognosis in breast cancer, revealing FADS2 as a novel therapeutic target

BACKGROUND

Breast cancer is one of the most prevalent malignant tumors in women. Mitochondria, essential for cellular function, have altered metabolic activity in cancer cells, influencing tumor regulation and clinical outcomes. The connection between mitochondrial metabolism-related genes and breast cancer prognosis remains underexplored. This study aims to investigate the role of these genes in breast cancer by constructing risk models.

METHODS

Breast cancer transcriptome data were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), and mitochondrial gene data were sourced from the MitoCarta3.01 database. Clustering analysis was conducted using the "ConsensusClusterPlus" package, followed by Gene Set Enrichment Analysis (GSEA), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. A prognostic model was built using Cox regression and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms. Immune cell infiltration levels were assessed via CIBERSORT and MCPcounter algorithms. Validation of key gene expression was performed on breast cancer tissue specimens and cell models to explore their biological functions in breast cancer cells.

RESULTS

The LASSO regression analysis of the TCGA BRCA dataset identified four prognosis-related mitochondrial metabolism genes: MYH11, LTF, FADS2, and PSPHP1. Validation using the GEO dataset confirmed that patients with high-risk scores (based on these four genes) had shorter overall survival compared to those with lower risk scores. Immunological analysis revealed that high-risk patients were less responsive to immunotherapy but more sensitive to conventional chemotherapies. This suggests that combining chemotherapy with immunotherapy might enhance T cell-based treatments. Univariate and multivariate Cox regression confirmed that the mitochondrial gene model was an independent predictor of overall survival, and a nomogram was developed to predict patient prognosis. Tissue validation showed consistent expression patterns with bioinformatic predictions. Functional assays confirmed that FADS2 was highly expressed in breast cancer cells, and its knockout significantly reduced cell invasion, migration, and colony formation.

CONCLUSION

This study reveals that mitochondrial metabolism-related genes are closely associated with breast cancer progression, clinical outcomes, and genetic alterations. The findings may offer new avenues for treatment strategies, early intervention, and prognosis prediction in breast cancer.

Chinese expert consensus on the diagnosis and treatment of hepatocellular carcinoma with microvascular invasion (2024 edition)

Background

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Surgical resection is the preferred treatment for HCC, but the postoperative recurrence and metastasis rates are high. Current evidence shows that microvascular invasion (MVI) is an independent risk factor for postoperative recurrence and metastasis, but there are still many controversies about the diagnosis, classification, prediction, and treatment of MVI worldwide.

Methods

Systematic literature reviews to identify knowledge gaps and support consensus statements and a modified Delphi method to develop evidence- and expert-based guidelines and finalization of the clinical consensus statements based on recommendations from a panel of experts.

Results

After many discussions and revisions, the Chinese Association of Liver Cancer of the Chinese Medical Doctor Association organized domestic experts in related fields to form the "Chinese expert consensus on the diagnosis and treatment of hepatocellular carcinoma with microvascular invasion (2024 edition)" which included eight recommendations to better guide the prediction, diagnosis and treatment of HCC patients with MVI. The MVI pathological grading criteria as outlined in the "Guidelines for Pathological Diagnosis of Primary Liver Cancer" and the Eastern Hepatobiliary Surgery Hospital (EHBH) nomogram for predicting MVI are highly recommended.

Conclusions

We present an expert consensus on the diagnosis and treatment of MVI and potentially improve recurrence-free survival (RFS) and overall survival (OS) for HCC patients with MVI.

Short- and long-term outcomes following laparoscopic liver resection for hepatocellular carcinoma combined with type I/II portal vein tumor thrombus

BACKGROUND

Despite the expanding indications for laparoscopic liver resection (LLR), its role in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains unclear. The aim of the current study is to compare the short- and long-term outcomes following LLR and open liver resection (OLR) for HCC with PVTT.

METHODS

All HCC patients with PVTT registered for surgery between April 2015 and May 2022 were enrolled. Patients were divided into LLR and OLR groups, and postoperative recovery and oncological outcomes were analyzed.

RESULTS

Twenty-eight patients in the LLR group and one hundred seventeen patients in the OLR group were included for comparison. The blood loss was less and the postoperative hospital stay was shorter in LLR group compared to OLR group both before and after propensity score matching. The median recurrence-free survival (RFS) time did not significantly differ between the two groups (8.0 months [95% CI 3.1-13.0] vs. 7.5 months [95% CI 6.0-9.1]; P = 0.845). In stratified analysis, both the recurrence pattern and the median RFS time were comparable between the LLR group and the OLR group in type I PVTT (7.23 [95% CI 0.35-14.12] vs. 7.17 months [95% CI 3.49-10.85]; P = 0.794) and type II PVTT (8.96 [95% CI 0-19.56] vs. 7.60 months [95% CI 5.98-9.22], P = 0.651), respectively. The multivariate regression analysis showed that the tumor size ≥ 10 cm, AFP > 200 ng/ml, and HBV-DNA > 1000 copies/ml were independent risk factors for RFS.

CONCLUSION

LLR for HCC patients with type I/II PVTT could be safely performed with superior short-term recovery and similar long-term survival compared to OLR. Larger tumor size, higher AFP, and elevated HBV-DNA levels contribute to worse RFS.

Leveraging glycosylation for early detection and therapeutic target discovery in pancreatic cancer

Pancreatic cancer (PC) remains one of the most lethal malignancies, primarily due to late-stage diagnosis, limited biomarker specificity, and aggressive metastatic potential. Recent glycoproteomic studies have illuminated the crucial role of glycosylation in PC progression, revealing altered glycosylation patterns that impact cell adhesion, immune evasion, and tumor invasiveness. Biomarkers such as CA19-9 remain the clinical standard, yet limitations in sensitivity and specificity, especially in early disease stages, necessitate the exploration of alternative markers. Emerging glycoproteins-such as mesothelin, thrombospondin-2, and glycan modifications like sialyl-Lewis x-offer diagnostic promise when combined with CA19-9 or used in profiling panels. Furthermore, therapeutic strategies targeting glycosylation processes, including sialylation, and fucosylation, have shown potential in curbing PC metastasis and enhancing immune response. Translational platforms, such as patient-derived xenografts and advanced in vitro models, are pivotal in validating these findings and assessing glycosylation potential therapeutic impact. Continued exploration of glycosylation-driven mechanisms and biomarker discovery in PC can significantly advance early detection and treatment efficacy, offering new hope in the management of this challenging disease.

Balancing Image Quality and Iodine Intake: Insights from CT Spectral Imaging of the Portal Vein

BACKGROUND Portal vein tumor thrombus (PVTT) is a critical complication in hepatocellular carcinoma (HCC). Spectral computed tomography (CT) is increasingly used to enhance the diagnosis of such conditions. This study examines the effect of different iodine concentrations in contrast media on portal vein image quality and iodine intake using spectral CT to improve imaging techniques. MATERIAL AND METHODS A total of 88 patients were divided into 3 groups based on iodine concentration in contrast media: Group A (300 mgI/mL, n=30), Group B (320 mgI/mL, n=28), and Group C (350 mgI/mL, n=30). Each underwent a GSI scan with an injection rate of 4.5 mL/s and a dose of 1.5 mL/kg. Eleven sets of 40-140 keV images were reconstructed for each group. CT value, image noise, contrast noise ratio (CNR), signal-to-noise ratio (SNR), and subjective image scores of intra-hepatic and extra-hepatic portal veins were analyzed. Optimal monochromatic levels and iodine intake were assessed for each group. RESULTS The optimal monochromatic level for portal veins was between 80 keV-110 keV across groups. Significant differences were noted in CT values and image noise among groups (P<0.05), but not in CNR, SNR, or subjective scores (P>0.05). Iodine intake was reduced by 21.29% in Group A and 14.60% in Group B compared to Group C. CONCLUSIONS GSI scans with low-concentration contrast media effectively reduce iodine intake while maintaining image quality during liver CT-enhanced scans.

Deletion of ENO1 sensitizes pancreatic cancer cells to gemcitabine via MYC/RRM1-mediated glycolysis

Glycolysis is a critical metabolic pathway in cancer cells, fulfilling their energy requirements, supporting biosynthesis, maintaining redox balance, and enabling survival in hostile environments. Alpha-enolase (ENO1) has been identified as a key promoter of tumor progression through its involvement in glycolysis. This study aims to elucidate the relationship between ENO1, glycolysis, and gemcitabine sensitivity in pancreatic cancer (PC). The expression levels of ENO1 in PC were analyzed using the GEPIA2 database, Kaplan-Meier survival plots, and immunohistochemistry (IHC). To assess the impact of ENO1 on gemcitabine sensitivity, we manipulated ENO1 expression in PC cell lines through overexpression and silencing techniques. Subsequent analyses included flow cytometry assays, glucose uptake and lactate production measurements, and cytotoxicity assays. The underlying mechanisms by which ENO1 modulates gemcitabine sensitivity were explored using Western blotting (WB). ENO1 was found to be significantly overexpressed in PC tissues, and elevated ENO1 levels were associated with poorer prognosis in PC patients. Overexpression of ENO1 reduced the sensitivity of PC cells to gemcitabine, enhancing cell proliferation, migration, and invasion by altering the cell cycle and inhibiting apoptosis. Conversely, silencing ENO1 decreased glycolysis in PC cells and heightened their sensitivity to gemcitabine. Furthermore, glycolysis inhibition-achieved through ENO1 knockdown, glucose deprivation, or treatment with 2-Deoxy-D-glucose (2-DG)-further enhanced the susceptibility of PC cells to gemcitabine. Mechanistically, ENO1 was found to regulate the expression of gemcitabine resistance-related genes, particularly ribonucleotide reductase catalytic subunit M1 (RRM1), via MYC through the glycolytic pathway, thereby contributing to gemcitabine resistance. This study demonstrates that ENO1 plays a crucial role in PC progression and is closely linked to gemcitabine resistance through its regulation of the glycolytic pathway.

Adjuvant PD-1 inhibitors improve recurrence and survival outcomes in high-risk hepatocellular carcinoma patients after curative hepatectomy

BACKGROUND

Hepatocellular carcinoma (HCC) is the most prevalent malignancy in China, with liver resection recognized as the primary curative intervention. However, HCC patients face an elevated risk of recurrence, thereby significantly impacting prognosis.

PURPOSE

This study aimed to assess the impact of adjuvant programmed cell death protein-1 (PD-1) inhibitors on survival outcomes in patients with HCC who are at high risk for postoperative recurrence following curative hepatectomy.

MATERIALS AND METHODS

Among the 199 study participants, 77 received adjuvant PD-1 inhibitors. Propensity score matching (PSM) was used to balance baseline differences between patients who received adjuvant PD-1 inhibitors and those who did not. Assessment of overall survival (OS) and recurrence-free survival (RFS) was conducted using Kaplan-Meier curves, while Cox regression analysis was employed to identify prognostic factors influencing survival.

RESULTS

After PSM, the 1-year and 2-year RFS were 87.1% and 74.2% in the PD-1 inhibitors group and 44.6% and 37.8% in non-PD-1 inhibitors group (p < 0.001). The 1-year and 2-year OS were 98.5% and 95.7% in the PD-1 inhibitors group compared with 90.7% and 77.0% in non-PD-1 inhibitors group (p = 0.004). Multivariable analyses demonstrated that the use of adjuvant PD-1 inhibitors was significantly associated with improved RFS and OS. Subgroup analysis indicated that adjuvant PD-1 inhibitors group achieved longer RFS than the non-PD-1 inhibitors group in patients without adjuvant transarterial chemoembolization (TACE).

CONCLUSION

The administration of adjuvant PD-1 inhibitors may effectively reduce the risk of tumor recurrence and improve survival in HCC patients with high risk of recurrence after curative hepatectomy.

Ubiquinol-mediated suppression of mitochondria-associated ferroptosis is a targetable function of lactate dehydrogenase B in cancer

Lactate dehydrogenase B (LDHB) fuels oxidative cancer cell metabolism by converting lactate to pyruvate. This study uncovers LDHB's role in countering mitochondria-associated ferroptosis independently of lactate's function as a carbon source. LDHB silencing alters mitochondrial morphology, causes lipid peroxidation, and reduces cancer cell viability, which is potentiated by the ferroptosis inducer RSL3. Unlike LDHA, LDHB acts in parallel with glutathione peroxidase 4 (GPX4) and dihydroorotate dehydrogenase (DHODH) to suppress mitochondria-associated ferroptosis by decreasing the ubiquinone (coenzyme Q, CoQ) to ubiquinol (CoQH2) ratio. Indeed, supplementation with mitoCoQH2 (mitochondria-targeted analogue of CoQH2) suppresses mitochondrial lipid peroxidation and cell death after combined LDHB silencing and RSL3 treatment, consistent with the presence of LDHB in the cell fraction containing the mitochondrial inner membrane. Addressing the underlying molecular mechanism, an in vitro NADH consumption assay with purified human LDHB reveals that LDHB catalyzes the transfer of reducing equivalents from NADH to CoQ and that the efficiency of this reaction increases by the addition of lactate. Finally, radiation therapy induces mitochondrial lipid peroxidation and reduces tumor growth, which is further enhanced when combined with LDHB silencing. Thus, LDHB-mediated lactate oxidation drives the CoQ-dependent suppression of mitochondria-associated ferroptosis, a promising target for combination therapies.

Current impact in the treatment of advanced hepatocellular carcinoma: The challenge remains

Hepatocellular carcinoma remains a significant cause of mortality worldwide, particularly among patients with liver cirrhosis. In most cases, surveillance in cirrhotic patients is neglected, leading to a diagnosis when the neoplasm is at an advanced stage. Within this context, Zhou et al carried out a network meta-analysis to demonstrate the effectiveness of hepatic arterial infusion chemotherapy, concluding that it is a superior approach compared to sorafenib and transarterial chemoembolization in the treatment of advanced hepatocellular carcinoma. Unfortunately, the meta-analysis in question lacks methodological rigor, preventing the authors from making more definitive assertions. Additionally, we understand that transarterial chemoembolization, when properly indicated, is a highly effective therapeutic option, and that sorafenib, given the results of new therapies based on immune checkpoint inhibitors, is no longer the recommended drug for the treatment of these patients. Therefore, we believe the use of hepatic arterial infusion chemotherapy is increasingly limited and lacks strong scientific support.

Human dental pulp stem cells for spinal cord injury

Spinal cord injury (SCI) is a serious neurological disorder that causes loss of mobility, pain, and autonomic dysfunction, resulting in altered sensation and devastating loss of function. Current treatments for SCI mainly focus on surgery and drug therapy to promote neurological recovery. However, there are virtually no effective remedies for irreversible nerve damage that result in a victim's loss of motor function and sensory changes that occur after an injury. With the continuous development of medical technology, stem-cell-based regenerative medicine provides researchers with new treatment ideas. The effectiveness of mesenchymal stem cells and their derivatives from different sources in treating SCI varies. Recent studies have highlighted that dental pulp stem cells (DPSCs) may contribute to anti-inflammatory regulation, anti-apoptotic regulation, and axonal regeneration in the treatment of SCI patients. In addition, the combination of new biomaterials and dental pulp stem cells is promising in the treatment of SCI. This article reviews the role of DPSCs in SCI treatment in recent years, discusses the advantages of DPSCs, explores potential development directions, and looks forward to providing new insights for future research in this critical field.

Evaluation of the efficacy and safety of combined surgery with intraoperative radiotherapy and postoperative PVC for hepatocellular carcinoma with mPVTT

BACKGROUND

Hepatocellular carcinoma (HCC) accompanied by main portal vein tumor thrombosis (mPVTT) is associated with poor prognosis and limited treatment options. This study aimed to evaluate the efficacy and safety of a novel triple therapy approach combining surgery, intraoperative radiotherapy (IORT), and postoperative portal vein infusion chemotherapy (PVC) for HCC with mPVTT.

METHODS

A retrospective analysis was conducted on 56 patients diagnosed with HCC and mPVTT. Patients were divided into two groups: the surgery-IORT-PVC group (n = 21) and the transcatheter arterial chemoembolization (TACE) combined with hepatic arterial infusion chemotherapy (HAIC) group (n = 35). Baseline characteristics, treatment procedures, postoperative complications, and survival outcomes were compared between the two groups.

RESULTS

The surgery-IORT-PVC group (n = 21) demonstrated superior median overall survival (OS) (not reached vs. 7 months, P < 0.05 4.99(2.543-9.792)) and median progression-free survival (PFS) (not reached vs. 4 months, P < 0.05 5.268(2.765-10.03)) compared to the TACE-HAIC group (n = 35). Additional, the 1-year, 2-year, and 3-year OS (75.6 %, 60.5 %, 60.5 % vs 28.8 %, 8.2 %, 8.2 %) and PFS (73.3 %, 64.1 %, 64.1 % vs 9.5 %, 9.5 %, 9.5 %) of the surgery-IORT-PVC group significantly superior to that of the TACE-HAIC group. Multivariate analysis identified the treatment modality as an independent factor influencing both OS and PFS. Postoperative complications in the surgery-IORT-PVC group were manageable. No severe adverse events were reported in either group.

CONCLUSION

Overall, this novel treatment modality offers a potential effective therapy modality for patients with HCC and mPVTT who previously had limited therapeutic options.

Efficacy and safety of neoadjuvant therapy for hepatocellular carcinoma with portal vein thrombosis: A meta‑analysis

Hepatocellular carcinoma (HCC) with coexisting portal vein tumor thrombus (PVTT) is associated with poor patient outcomes. The efficacy and safety of neoadjuvant therapy in patients with HCC with PVTT remain a subject of debate. In the present study, a comprehensive search of electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, was conducted to identify studies evaluating the outcomes of neoadjuvant therapy in patients with HCC and PVTT. The primary outcomes assessed were overall survival (OS) and relapse-free survival (RFS), with complication rates as a secondary outcome. A total of six studies comprising 750 patients were included in the present meta-analysis. The neoadjuvant therapy group exhibited significantly superior OS [hazard ratio (HR), 0.39; P<0.001] and RFS (HR, 0.31; P<0.001) compared with the primary hepatectomy control group. Compared with the control group, neoadjuvant radiotherapy improved OS (HR, 0.34; P<0.001) and RFS (HR, 0.24; P=0.004). While the neoadjuvant intervention subgroup exhibited an improved OS compared with controls (HR, 0.37; P=0.001), no significant difference in RFS was observed (HR, 0.11; P=0.095). Geographical analysis revealed that the Chinese subgroup demonstrated a significantly improved OS and RFS (HR, 0.41 for both; P<0.001), compared with the control group. However, the Japanese and Korean subgroups showed no improvement in OS (HR, 0.25; P=0.057) compared with the control group, and the results did not reach statistical significance. There were no significant differences between the groups in terms of blood transfusion, blood loss, operation time, bile leakage, ascites, peritoneal infection, postoperative bleeding, complications or mortality (all P>0.05). Overall, neoadjuvant therapy significantly improved survival outcomes in patients with HCC and PVTT without increasing complication rates, supporting its efficacy and manageable safety profile.

Cholangiocyte organoids for disease, cancer, and regenerative medicine

The biliary tract is a ductal network comprising the intrahepatic (IHBDs) and extrahepatic bile duct (EHBDs). Biliary duct disorders include cholangitis, neoplasms, and injury. However, the underlying mechanisms are not fully understood. With advancements in 3D culture technology, cholangiocyte organoids (COs) derived from primary tissues or induced pluripotent stem cells (iPSCs) can accurately replicate the structural and functional properties of biliary tissues. These organoids have become powerful tools for studying the pathogenesis of biliary diseases, such as cystic fibrosis and primary sclerosing cholangitis, and for developing new therapeutic strategies for cholangiocarcinoma. Additionally, COs have the potential to repair bile duct injuries and facilitate transplantation therapies. This review also discusses the use of organoids in genetically engineered mouse models to provide mechanistic insights into tumorigenesis and cancer progression. Continued innovation and standardization of organoid technology are crucial for advancing precision medicine for biliary diseases and cancer.