World Journal of Surgical Oncology最新文献

{"title":"Robotic-assisted versus conventional nipple-sparing mastectomy with immediate implant-based breast reconstruction: a GRADE-assessed systematic review and meta-analysis of prospective studies.","authors":"Wajahat Mirza, Hania Iqbal, Mehak Ejaz Khan, Alishbah Khan, Hadi Mohammad Khan","doi":"10.1186/s12957-026-04473-6","DOIUrl":"10.1186/s12957-026-04473-6","url":null,"abstract":"<p><strong>Background: </strong>Robotic nipple-sparing mastectomy with immediate implant-based reconstruction is increasingly adopted to improve cosmetic outcomes and patient experience; however, its comparative perioperative value against conventional or open nipple-sparing mastectomy remains uncertain when restricted to prospective evidence.</p><p><strong>Methods: </strong>We performed a PRISMA-aligned systematic review and random-effects meta-analysis of prospective comparative studies and randomized trials comparing robotic versus conventional or open nipple-sparing mastectomy with immediate implant-based reconstruction. The primary outcome was the total operative time, and the secondary outcomes were major complications, nipple-areolar complex ischemia or necrosis, and length of hospital stay. The risk of bias was assessed using RoB 2 for randomized data and ROBINS-I for nonrandomized data. Leave-one-out sensitivity analyses were conducted for outcomes with substantial heterogeneity, and the certainty of the evidence was graded using GRADE.</p><p><strong>Results: </strong>Three prospective studies were included. Robotic surgery was associated with a significantly longer total operative time (mean difference 64.01 min, 95% confidence interval 8.54-119.47). Major complications did not differ between the approaches (risk ratio 0.63, 95% confidence interval 0.27-1.47), nor did nipple areolar complex ischemia or necrosis (risk ratio 0.56, 95% confidence interval 0.28-1.11) or length of hospital stay (mean difference 0.22 days, 95% confidence interval - 0.26 to 0.70). Heterogeneity was high for operative time and moderate to substantial for length of stay. The certainty of the evidence was low overall, driven by imprecision, heterogeneity, and limitations of the non-randomized design.</p><p><strong>Conclusions: </strong>Robotic nipple-sparing mastectomy is associated with a longer operative time than conventional or open approaches. No statistically significant differences were observed in major complications or nipple-areolar complex viability; however, the current prospective evidence base is limited, heterogeneous, and imprecise, and clinically important differences cannot be excluded. In experienced centers, robotic nipple-sparing mastectomy may be considered for carefully selected patients who prioritize scar concealment and minimally invasive access; however, its broader role in routine practice remains uncertain pending stronger prospective data on safety, patient-reported outcomes, and resource use.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":"24 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple primary synchronous liver cancer in one patient: the first case report and origin speculation through bioinformatics.","authors":"Zheng Zhou, Shuai Hu, Ting Liu, Danling He, Ting Bu, Lingqiu Mao, Xiyan Zheng, Maoyun Xie, Xianjie Shi","doi":"10.1186/s12957-026-04470-9","DOIUrl":"10.1186/s12957-026-04470-9","url":null,"abstract":"<p><strong>Introduction: </strong>A diagnosis of multiple primary liver tumors is extremely rare. Preoperative diagnosis based on imaging findings is difficult. Moreover, the clinical benefits of treatment strategies for multiple liver cancers remain unclear. Here, we report a case of three synchronous primary liver tumors with three distinct pathological types-hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined hepatocellular-cholangiocarcinoma (cHCC‑CCA)-in a single patient. Bioinformatics analysis supported at least two clonal origins, with cHCC‑CCA and ICC sharing a common lineage based on identical HBV integration sites.</p><p><strong>Case presentation: </strong>A 63-year-old female with a history of hepatitis B for several years presented with three lesions in hepatic segment VIII. Multiphase magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid revealed a diagnosis of multiple lesions, namely, cHCC‑CCA, with multiple intrahepatic metastases. The AFP level was normal, while the CA 19 - 9 level was mildly elevated (normal range ≤ 30.00 U/ml). Hepatectomy was performed, and postoperative assessment confirmed that the large lesion was cHCC‑CCA. However, the small lesions close to the large lesion were HCC and ICC. Gene testing revealed distinct mutational profiles among the three tumors. Similar gene mutations were detected in cHCC‑CCA and ICC. We also found that gene fragments of hepatitis B virus-C (HBV-C) were inserted into the genomes of ICC and cHCC‑CCA rather than that of HCC. The genomic integration site of HBV-C in cHCC‑CCA and ICC was the same.</p><p><strong>Conclusion: </strong>We report an extremely rare case of three synchronous primary liver tumors with three distinct pathological types (HCC, ICC, and cHCC‑CCA) in a single patient. Bioinformatics analysis supported at least two clonal origins, with cHCC‑CCA and ICC sharing a common lineage based on identical HBV integration sites. Hepatectomy represents a potential radical strategy for the treatment of multiple PLCs.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LncRNA ACTA2-AS1 acts as a bladder cancer prognostic biomarker and blocks malignant advance via miR-148b-3p/DNAJB4.","authors":"Xing Chen, Qunfu Tang, Yingjie Wang, Jianbin Zhang, Lei Zhou","doi":"10.1186/s12957-026-04447-8","DOIUrl":"10.1186/s12957-026-04447-8","url":null,"abstract":"<p><strong>Background: </strong>Long non-coding RNA (lncRNA) is crucial in bladder cancer (BCa) development. This research explores the clinical significance and underlying mechanisms of lncRNA ACTA2-AS1 in BCa.</p><p><strong>Methods: </strong>From the GEO database, differentially expressed lncRNAs (DElncRNAs) in BCa were identified, and tumor, along with adjacent non-tumor tissue samples from 132 patients, were collected. RT-qPCR was employed for the quantitative measurement of ACTA2-AS1, miR-148b-3p, and DNAJB4 expression. Chi-square analysis was employed to assess the association of ACTA2-AS1 with clinical features. Kaplan-Meier and Cox regression evaluated ACTA2-AS1's prognostic value. CCK-8, Transwell, and flow cytometry assays evaluated cell proliferation, migration, invasion, apoptosis, and cell cycle arrest. DLR and RIP tests confirmed miR-148b-3p's targeting of ACTA2-AS1 and DNAJB4.</p><p><strong>Results: </strong>ACTA2-AS1 showed significant downregulation in four GEO databases. Moreover, both ACTA2-AS1 and DNAJB4 were notably decreased in BCa tumor tissues, while miR-148b-3p increased significantly. Low ACTA2-AS1 expression correlates with poor tumor differentiation, positive lymph node metastasis, and TNM stage III-IV. Moreover, patients with low ACTA2-AS1 expression are associated with a significantly unfavorable prognosis. Mechanistically, miR-148b-3p targets ACTA2-AS1 and DNAJB4. The suppression impacts of ACTA2-AS1 on BCa cell proliferation, migration, and invasion, and its boost of apoptosis and cell cycle arrest were greatly reversed by miR-148b-3p.</p><p><strong>Conclusion: </strong>Low ACTA2-AS1 expression is a potential biomarker for unfavorable prognosis in BCa patients. Furthermore, ACTA2-AS1 may counteract BCa's malignant biological behaviors via targeting the miR-148b-3p/DNAJB4 axis.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HMGB1 promotes radiotherapy resistance in human cervical cancer HeLa cells through regulating the AMPK/mTOR signaling.","authors":"Youyou Xie, Changhui Yu, Miao Wang, Yaqin Lin, Biyun Wang","doi":"10.1186/s12957-026-04461-w","DOIUrl":"10.1186/s12957-026-04461-w","url":null,"abstract":"<p><p>Cervical cancer (CC) ranks as the third most common malignancy among women worldwide. Radiotherapy (RT) resistance represents a major cause of clinical treatment failure and disease progression. High-mobility group box-1 (HMGB1), a nuclear protein released during RT, has been implicated in the regulation of radiation resistance. This study aimed to establish HeLa RT-resistant (HeLa-R) cells and investigate the effect of HMGB1 on RT resistance and its underlying molecular pathway. HeLa-R cells were established through fractionated X-ray irradiation. Cell viability, proliferation, migration, and invasion were assessed using methyl thiazolyl tetrazolium (MTT), colony formation, Transwell migration, and invasion assays, respectively. HMGB1 expression was analyzed by quantitative RT-PCR, Western blot, and immunofluorescence. A phospho-kinase array was performed to evaluate phosphorylation levels of key kinase sites. Following fractionated X-ray irradiation, we successfully established HeLa-R cells, which exhibited significantly elevated HMGB1 expression compared to parental cells. HMGB1 knockdown suppressed RT resistance in HeLa-R cells, accompanied by increased phosphorylation of AMP-activated protein kinase (p-AMPK). Conversely, AMPK inhibition restored cell viability, colony formation, migration, and invasion in HMGB1-deficient HeLa-R cells. Mechanistically, in HeLa-R cells, mTOR was identified as a downstream effector of AMPK signaling. Separately, clinical analysis revealed that HMGB1 levels were significantly elevated, while p-AMPK levels were markedly reduced in tumor tissues from radioresistant patients compared with radiosensitive patients. In conclusion, our in vitro findings demonstrate that HMGB1 inhibition suppresses RT resistance in HeLa-R cells through activation of the AMPK/mTOR pathway. The clinical correlations between HMGB1, p-AMPK, and radiotherapy response support the potential relevance of this pathway, although further validation in patient tissues is required.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-omics integration and clinical validation identify CKAP2 as a diagnostic biomarker for bladder cancer.","authors":"Xinxin Li, Jinshan Yang, Jiazi Cha, Hao Xie, Changming Dong, Yufan Yang, Yue Li, Jiahao Guo, Chunhua Lin","doi":"10.1186/s12957-026-04464-7","DOIUrl":"10.1186/s12957-026-04464-7","url":null,"abstract":"<p><strong>Background: </strong>Bladder cancer (BC) remains a prevalent malignancy with a high recurrence rate; however, the lack of specific biomarkers hinders early detection and effective management. Although Cytoskeleton-Associated Protein 2 (CKAP2) has been implicated in tumorigenesis, its diagnostic value and biological function in BC have not been fully elucidated. This study aimed to identify and rigorously validate CKAP2 as an important diagnostic biomarker using a multi-omics approach integrated with clinical validation.</p><p><strong>Methods: </strong>Differential expression analysis and machine learning-based feature selection were employed to screen for candidate biomarkers, identifying CKAP2 as a key gene of interest. Mendelian randomization (MR) was used to assess the causal relationship between CKAP2 and BC risk. To evaluate clinical utility, a diagnostic model based on logistic regression was established and validated in an independent real-world cohort of 127 tissue samples, including 50 pairs of matched tumor and adjacent normal tissues, 21 independent tumor tissues, and 6 independent adjacent normal tissues. Additionally, single-cell RNA sequencing (scRNA-seq) and cell-cell communication analyses were performed to dissect the role of CKAP2 within the tumor microenvironment.</p><p><strong>Results: </strong>CKAP2 expression was significantly upregulated in BC tissues compared to that in normal tissues (log2FoldChange = 1.53, p < 10⁻⁵). MR analysis provided evidence supporting a potential causal association between elevated CKAP2 expression and increased BC risk. In the external clinical validation, the CKAP2-based model demonstrated exceptional discrimination with an Area Under the Curve (AUC) of 0.931. Calibration curves indicated a high agreement between the predicted and observed probabilities, while Decision Curve Analysis (DCA) confirmed a substantial clinical net benefit. Mechanistically, scRNA-seq localized high CKAP2 expression primarily to cancer cells, and cell-cell communication analysis suggested that CKAP2 may play an important role in modulating tumor-stroma interactions, particularly with fibroblasts.</p><p><strong>Conclusion: </strong>Our integrated analysis supports the potential utility of CKAP2 as a diagnostic biomarker for BC. By integrating multi-omics analysis, causal inference, and validation in an independent clinical cohort, these results consistently point to CKAP2's diagnostic potential and suggest its involvement in BC progression.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of phosphorylated ribosomal protein S6 (pS6) in the clinical outcomes of patients undergoing hepatectomy for metastatic colorectal cancer.","authors":"Rafaella Henriques Cavalcanti Torres de Melo, Paulo Goberlianio de Barros Silva, Heladio Feitosa E Castro Neto, Rayane Cardoso de Souza Nunes, José Ricardo de Moura Torres de Melo, Maria Julia Barbosa Bezerra, Conceição Aparecida Dornelas, Carlos Gustavo Hirth","doi":"10.1186/s12957-026-04453-w","DOIUrl":"10.1186/s12957-026-04453-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with up to 50% of patients developing metastatic disease, predominantly involving the liver. Hepatectomy remains the gold standard for resectable hepatic metastases; however, recurrence rates remain high and reliable prognostic biomarkers are lacking. Phosphorylated ribosomal protein S6 (pS6), a surrogate marker of PI3K/AKT/mTORC1 pathway activation, has been implicated in tumor aggressiveness across multiple cancer types, but its prognostic role after hepatectomy for metastatic colorectal cancer (mCRC) has not been established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the prognostic impact of pS6 expression and other molecular markers (BRAF V600E, p53, CERBB2, MSH6, PMS2, FUS, and HSPA9) assessed by immunohistochemistry on tissue microarray (TMA) on the clinical outcomes of patients undergoing hepatectomy for metastatic colorectal cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective cohort study was conducted including 64 patients who underwent hepatectomy for mCRC between 2012 and 2022 at a high-complexity oncology center in Northeast Brazil. Molecular marker expression was evaluated by immunohistochemistry on TMA constructed from paraffin-embedded hepatic metastasis specimens. Disease-free survival (DFS) at 1, 3, and 5 years and overall survival (OS) were analyzed using Fisher's exact test, Kaplan-Meier curves, and Cox regression multivariate analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Median OS was 23 months (95% CI = 18.33-27.66). Among all molecular markers assessed, only pS6 positivity (20.7% of cases) showed a statistically significant association with worse DFS at 1 year (p = 0.032), 3 years (p = 0.038), and 5 years (p = 0.018). A significant association was also identified between pS6 positivity and FUS positivity (p = 0.014). In multivariate analysis for DFS, pS6 positivity was an independent predictor of recurrence at 3 years (HRa = 9.710; p = 0.028) and 5 years (HRa = 11.857; p = 0.018), as were postoperative complications at 3 years (HRa = 8.671; p = 0.014) and 5 years (HRa = 6.912; p = 0.029). For overall survival, three independent predictors of mortality were identified: adjuvant chemotherapy (HRa = 0.052; p &lt; 0.001), absence of 1-year DFS (HRa = 3.641; p = 0.001), and pS6 positivity (HRa = 4.547; p = 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Median overall survival was 23 months, reflecting the high mortality burden of mCRC after hepatectomy. Among all molecular markers evaluated, pS6 was the only one independently associated with worse disease-free survival and higher mortality risk, consistent with its role as a surrogate marker of PI3K/AKT/mTORC1 pathway activation, though a direct causal relationship cannot be established from the present data. A significant association between pS6 and FUS positivity suggests a possible convergence of oncogenic pathways warranting further investigation. Postoper","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting RELA and STAT3 regulates TNFRSF10A-mediated apoptosis in a novel apoptosis-based prognostic model for clear cell renal cell carcinoma.","authors":"Yuyou Deng, Changzhen Hao, Xiaobing Yang, Chengfan Yu, Ming Xia, Tian Wang","doi":"10.1186/s12957-026-04462-9","DOIUrl":"10.1186/s12957-026-04462-9","url":null,"abstract":"<p><strong>Background: </strong>Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal malignancy and remains a major cause of cancer-related mortality worldwide. Although advances in surgery, targeted therapy, and immunotherapy have improved outcomes for patients, reliable biomarkers for predicting prognosis remain limited. Therefore, robust gene-based prognostic models are urgently needed to improve risk stratification and guide individualized treatment strategies.</p><p><strong>Methods: </strong>We developed a novel prognostic model integrating apoptosis and immune - related genes (AIRGs) to predict overall survival (OS) in patients with ccRCC.</p><p><strong>Result: </strong>Using Gene Set Enrichment Analysis (GSEA) combined with least absolute shrinkage and selection operator (LASSO) Cox regression, we identified 7 key prognostic genes, namely, CCR4, TNFRSF10A, TEK, TGFA, CD14, IFITM1, and SEMA3G, that collectively demonstrated strong predictive performance in TCGA cohort with c-index = 0.711. Functional enrichment analyses revealed that apoptosis, immune regulation, and multiple oncogenic signaling pathways were significantly associated with the risk score, highlighting the critical role of the tumor microenvironment in ccRCC progression. Transcription factor binding analysis based on the JASPAR database suggested that RELA and STAT3 with scores of 0.829 and 0.951, respectively are potential upstream regulators within the prognostic network, particularly influencing TNFRSF10A expression. External validation using the International Cancer Genome Consortium (ICGC) dataset confirmed the robustness of the prognostic model with c-index = 0.612 Furthermore, in vitro experiments demonstrated that RELA and STAT3 regulate TNFRSF10A-mediated apoptotic signaling in ccRCC cells, providing mechanistic support for the bioinformatic findings.</p><p><strong>Conclusion: </strong>This study establishes a biologically informed and clinically relevant prognostic framework for ccRCC. Our findings highlight the therapeutic potential of targeting the RELA/STAT3-TNFRSF10A axis and contribute to the advancement of precision medicine in ccRCC.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesopancreas excision in pancreatic ductal adenocarcinoma: recurrence patterns - a single-arm descriptive study.","authors":"Saleh Khairy Saleh, Abdelrhman Gamal Saleh, Tantawi Abdelnaeem Mohamed, Mina Makram Hendy, Mohamed Sadek Farahat, Sara Thabet Boushra, Christina Mosa Kamil, Rabeh Khairy Saleh","doi":"10.1186/s12957-026-04459-4","DOIUrl":"10.1186/s12957-026-04459-4","url":null,"abstract":"<p><strong>Background: </strong>Mesopancreas excision has emerged as a critical component of pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), potentially improving oncological outcomes. However, comprehensive data on recurrence patterns following mesopancreas excision remain limited.</p><p><strong>Objective: </strong>To analyze recurrence patterns in patients with PDAC who underwent pancreaticoduodenectomy with mesopancreas excision at a tertiary care center in Egypt.</p><p><strong>Methods: </strong>This single-arm, single-center, retrospective descriptive cohort study with prospective follow-up included 86 patients with PDAC who underwent pancreaticoduodenectomy with complete mesopancreas excision at Liver and GIT Hospital, Minia University, between February 2018 and February 2024. Patients were followed for a minimum of 24 months, with data collection concluding in February 2026. Data collected included demographics, tumor characteristics, surgical outcomes, pathological findings, and recurrence patterns. The primary outcome was disease recurrence; secondary outcomes included recurrence-free survival (RFS), overall survival (OS), and patterns of recurrence distribution.</p><p><strong>Results: </strong>Of 86 patients (mean age 58.4 ± 9.2 years, 61.6% male), R0 resection was achieved in 73 patients (84.9%). During follow-up, 52 patients (60.5%) developed recurrence at a median of 11.3 months. Local recurrence occurred in 18 patients (34.6%), distant metastases in 21 patients (40.4%), and combined recurrence in 13 patients (25.0%). The liver was the most common site of distant recurrence, involved in 42.3% of all recurrent cases, followed by lungs (23.1%) and peritoneum (19.2%). Median RFS was 13.2 months (95% CI: 10.8-15.6), and median OS was 18.7 months (95% CI: 16.3-21.1). Lymph node positivity (HR 2.34, p = 0.003), poor differentiation (HR 1.89, p = 0.012), and elevated CA19-9 (HR 1.67, p = 0.028) were independent predictors of recurrence.</p><p><strong>Conclusion: </strong>Despite complete mesopancreas excision, PDAC demonstrates high recurrence rates with a predominant distant metastatic pattern. Early systemic therapy and intensive surveillance protocols may be warranted for high-risk patients. This study describes the recurrence patterns following complete mesopancreas excision; however, due to the absence of a concurrent control group and the exclusion of patients requiring vascular resection/reconstruction, any superiority in the observed R0 resection rate cannot be directly attributed to the surgical technique itself, and prospective randomized controlled trials remain necessary to establish the oncological benefit of complete mesopancreas excision over standard pancreaticoduodenectomy.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An LSCC-specific R-loop-related model predicts prognosis and neoadjuvant immunotherapy response and identifies EIF5A2-mediated tumor-immune crosstalk.","authors":"Jie Dai, Ziyu Qiao, Jia Wang, Ze Chen, Ming Yan, Jian Qiao","doi":"10.1186/s12957-026-04456-7","DOIUrl":"10.1186/s12957-026-04456-7","url":null,"abstract":"<p><strong>Background: </strong>Laryngeal squamous cell carcinoma (LSCC) lacks robust biomarkers for prognostic stratification and immunotherapy prediction. R-loops have been increasingly implicated in transcriptional dysregulation and tumor progression, but their clinical significance in LSCC remains unclear.</p><p><strong>Methods: </strong>We generated an LSCC-specific R-loop-related gene set by intersecting R-loop-associated genes with differentially expressed genes in the TCGA-LSCC cohort, and constructed a prognostic model using LASSO-Cox regression. The model was externally validated in GSE25727 and GSE27020 and further evaluated for neoadjuvant immunotherapy relevance in GSE210287. Single-cell RNA sequencing data from GSE290927 were used to identify the core immune-regulatory gene within the model and explore its potential mechanism in tumor-immune interaction.</p><p><strong>Results: </strong>We identified 56 LSCC-specific R-loop-related candidate genes and established a three-gene model that successfully stratified patients into distinct risk groups, with stable performance in external validation cohorts. The model retained prognostic value, distinguished different immune microenvironment states, and was associated with neoadjuvant immunotherapy response. Among the model genes, EIF5A2 showed the greatest consistency with the overall model in terms of high-risk association, poor prognosis, and unfavorable immune-related changes, and was therefore identified as the core gene. Single-cell analysis further showed that EIF5A2 was mainly expressed in tumor cells, while cell-cell communication analysis revealed enhanced interactions between EIF5A2-high tumor cells and exhausted CD8 T cells, with MIF-CD74-related signaling representing the dominant ligand-receptor axis.</p><p><strong>Conclusions: </strong>We established an LSCC-specific R-loop-related model with value in prognostic stratification and neoadjuvant immunotherapy prediction, and further identified EIF5A2 as a core immune-regulatory gene within the model. These findings provide a biologically interpretable framework linking R-loop-related tumor states to prognosis, immunotherapy response, and immune remodeling in LSCC.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative prediction of thymoma risk classification with machine learning-based computed tomography radiomics features.","authors":"Kai Zhao, Yiming Liu, Honghao Xu, Wenhan Cai, Jiamei Jin, Leilei Shen, Zirui Zhu, Herui Han, Mingchuan Hu, Qiang Lu, Zhiqiang Xue","doi":"10.1186/s12957-026-04463-8","DOIUrl":"10.1186/s12957-026-04463-8","url":null,"abstract":"<p><strong>Background: </strong>Thymomas are primarily assessed using chest computed tomography (CT); however, this method has inherent limitations such as an overlap between the semantic features of thymomas presenting as localized lesions and other histological subtypes. Therefore, this study aimed to develop a combined radiomics model, based on non-contrast CT, and investigate its potential clinical utility in preoperatively differentiating between the thymoma risk classification.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical and imaging data of 436 patients with pathologically confirmed thymomas between January 2010 and October 2023. The cohort comprised 272 low-risk cases (types A, AB, and B1) and 164 high-risk cases (types B2 and B3), which were randomly divided into training (n = 306) and validation (n = 130) sets in a 7:3 ratio. Radiomic features were extracted from the volume of interest on non-contrast CT images. Feature selection was performed using principal component analysis, correlation analysis, least absolute shrinkage, and selection operator algorithms to identify the most discriminative features. A combined radiomics nomogram was developed by integrating significant clinical factors with radiomics scores. The discriminative performance of the model was assessed using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Two clinicoradiological and 11 radiomics features were identified and used to construct a radiomics nomogram. The diagnostic performance of the nomogram for thymoma risk stratification surpassed that of any single model. The nomogram yielded an area under the curve of 0.753 (accuracy, 71.2%; sensitivity, 62.4%; specificity, 76.7%) in the training cohort and 0.735 (accuracy, 70.8%; sensitivity, 58.8%; specificity, 78.5%) in the validation cohort.</p><p><strong>Conclusion: </strong>The nomogram model integrating clinical factors and radiomics features accurately differentiated the histological subtypes of thymoma. This tool may be helpful in formulating personalized treatment plans in clinical practice and is worthy of clinical promotion and application.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}