Guizhou Cancer Hospital

Despite cultural preferences for organ preservation in East Asia, choledochoscopic gallbladder-preserving surgery (CGPS) remains controversial given high recurrence rates. This study objectively quantified the increased technical complexity of laparoscopic cholecystectomy (LC) for recurrent cholecystolithiasis after prior CGPS using the Tokyo Guidelines 2018 (TG18). In this propensity-matched study (1:1, n = 220) conducted between 2020 and 2025, patients requiring LC due to recurrent cholecystolithiasis after prior CGPS were compared with patients with primary cholecystolithiasis undergoing LC. Investigators matched groups for TG18 severity grading, BMI, and biliary anomalies. Two blinded surgeons assessed the intraoperative findings using TG18 Delphi scoring (7-point scale). Primary outcomes included difficulty scores, critical view of safety (CVS) achievement, and bile duct injury. The CGPS group demonstrated significantly higher median TG18 scores (34 [IQR 30–39] vs. 21 [18–24]; adjusted mean difference: Δ 14.0 points, 95% CI: 11.2–16.8; p < 0.001), primarily due to fibrotic adhesions: Calot’s triangle dense fibrosis (49.1% vs. 6.4%), partial scarring (21.8% vs. 0.9%), and diffuse scarring (15.5% vs. 0%; all p < 0.001). Surgeons achieved CVS less frequently in the CGPS group (83.6% vs. 98.2%, p < 0.001). TG18 scores > 25 predicted a fivefold increased conversion risk (aOR = 4.9, 95% CI: 2.3–10.6). Prior CGPS induces irreversible fibrosis that significantly increases reoperative difficulty (Δ 14 TG18 points), highlighting the need for careful patient selection in organ-preserving procedures. Definitive management with primary cholecystectomy remains the gold standard.

This phase II study compared the efficacy and safety of lobaplatin versus cisplatin in concurrent chemoradiotherapy (CCRT) for elderly cervical cancer patients. Elderly cervical cancer patients aged ≥65 years were randomly assigned (1:1) to lobaplatin-based (2 cycles of lobaplatin 30 mg/m² every 3 weeks) or cisplatin-based (5 cycles of cisplatin 40 mg/m² every week) CCRT. Radiotherapy included external beam radiotherapy (50.4 Gy in 28 fractions) and intracavitary brachytherapy (30 Gy in 5 fractions). From January 1, 2020, to December 31, 2023, 64 patients were enrolled: 31 were randomly assigned to the lobaplatin group and 33 to the cisplatin group. The lobaplatin group showed higher chemotherapy completion rates compared to the cisplatin group (83.9% vs. 54.5%, p=0.011). The objective response rate and disease control rate were comparable between 2 groups (93.5% vs. 93.9%, 96.8% vs. 97.0%). The 1- and 2-year overall survival rates of the lobaplatin group and the cisplatin group were 96.0% vs. 96.6%, 90.7% vs. 96.6%, respectively (p=0.558). The lobaplatin group had a lower incidence of nephrotoxicity (39.4% vs. 9.7%, p=0.006), and there was also a trend of lower grade 2-3 gastrointestinal toxicity (30.3% vs. 12.9%, p=0.059), although the incidence of grade 3-4 thrombocytopenia was higher (16.1% vs. 6.1%, p=0.295), the difference was not statistically significant. Lobaplatin-based CCRT demonstrates comparable efficacy to cisplatin in elderly cervical cancer patients, with superior renal safety and improved gastrointestinal tolerability, establishing it as a viable alternative for cisplatin-intolerant populations.

BackgroundNutritional indicators play an important role in predicting the prognosis of digestive system cancers. Measures of adipose tissue distribution derived from computed tomography (CT), such as subcutaneous fat volume, are promising for assessing systemic inflammation and nutritional status. However, their integration into standardized prognostic models is still limited. This study aimed to increase the performance of the Cox regression model (Coxm) by adding the third lumbar vertebra centroid level subcutaneous fat volume (L3 CLSFV) and to assess its influence on prognostic prediction model.MethodsWe constructed two Cox regression models, Coxm1 and Coxm2, using clinical features and nutritional indicators from the training cohort of patients with digestive system cancers. The Coxm1 model contained seven features, while Coxm2 incorporated an extra L3 CLSFV measured by CT. Performance was evaluated using multiple metrics in the validation cohort, including time-dependent receiver operating characteristic (timeROC), time-dependent concordance index (timeC-index), calibration curve, and Kaplan-Meier curve. The predictive accuracy of the model was further assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsBoth models had high area under the curve (AUC) (range, 0.78–0.89) and C-index values (range, 0.74–0.80). The timeROC curve showed that the inclusion of L3 CLSFV in Coxm2 did not improve the model’s AUC, with similar values observed at 1-, 3-, and 5-year. Coxm2 did not improve time-dependent C-index in comparison with Coxm1. Calibration curves showed good agreement between predicted and actual survival probability in both models, with slight improvements seen in Coxm2 versus Coxm1 (Brier score, 0.166 vs. 0.168). NRI indicated that the inclusion of L3 CLSFV in Coxm2 improved the model’s performance. The category NRI of Coxm2 versus Coxm1 was 0.0768 [95% confidence interval (CI): −0.0768 to 0.128], while the continuous NRI was 0.0639 (95% CI: −0.0363 to 0.293). The IDI of Coxm2 versus Coxm1 was 0.006 (95% CI: −0.003 to 0.028). In the Kaplan-Meier curves, both Coxm1 and Coxm2 were accurately differentiated between high- and low-risk groups.ConclusionsThe addition of the L3 CLSFV to the Cox model improved the predictive accuracy and reclassification ability. These findings suggest that incorporating extra nutritional indicators can enhance the performance of prognostic models in digestive system cancer.

ObjectiveTo research the effects of diet on sarcopenia, and to examine the association of protein and amino acid sources with the risk of sarcopenia in older adults.MethodsFrom December 2023 to July 2024, 84 patients with sarcopenia and 173 without sarcopenia were included in the study at the Joint Logistics Support Force 925th Hospital. We compared the in diet and general characteristics between the two groups. Multivariate logistic regression analysis was performed to assess the effects of total protein, animal protein, plant protein, and amino acid on the risk of sarcopenia in older adults.ResultsIn terms of nutrient intake, the dietary intakes of energy, protein, fat, carbohydrates, and dietary fiber were significantly lower in the sarcopenia group than the non-sarcopenia group (P < 0.05). Analysis of protein showed that the highest tertile of total protein and animal protein intake was associated with lower incident sarcopenia risk (P < 0.05), while plant protein intake showed no significant association. Further analysis of amino acid showed that the highest tertile of leucine, glutamate, cystine, and tyrosine intake was associated with increased risk of sarcopenia, whereas arginine intake was linked to a lower incident sarcopenia risk (OR: 0.442, 95% CI: 0.200 ~ 0.979; P-trend = 0.038).ConclusionsThe insufficient intake of animal protein and amino acids may be closely associated with the risk of sarcopenia in older adults. Moderately increasing the intake of arginine and animal protein may help reduce the risk of sarcopenia in older adults.

BackgroundLow-dose radiotherapy (LDRT) is a localized irradiation technique that utilizes a relatively low radiation dose, typically ranging from 1 to 5 Gy, which is significantly lower than the dose of 20–60 Gy administered in conventional radical radiotherapy. Chemoimmunotherapy (CIT) is a combined therapeutic approach that integrates chemotherapy and immunotherapy, aiming to improve antitumor efficacy through the synergistic interaction of both modalities. This retrospective study aimed to evaluate the survival outcomes of LDRT combined with CIT vs. CIT alone among small cell lung cancer (SCLC) patients with liver metastasis (LM).MethodsThis retrospective analysis included 74 SCLC patients with LM from our hospital between September 1, 2019 and September 1, 2024. The 74 included patients were divided into two groups: the CIT group and the LDRT + CIT group. Kaplan-Meier analysis was used to estimate the progression-free survival (PFS) and overall survival (OS). Subgroup analyses based on the line of therapy and the number of metastatic organs were also performed via univariate Cox proportional hazards regression analysis.ResultsThe results revealed that the median PFS of the LDRT + CIT group was longer than that of the CIT group (5.1 months vs. 4.0 months, p = 0.016), and the beneficial effects of LDRT + CIT on PFS were observed across multiple subgroups. Most subgroups did not exhibit improvements in OS. However, when the patients were stratified on the basis of line of therapy, the median OS (11.0 months vs. 6.0 months, p = 0.047) improved in the LDRT + CIT group receiving later-line treatment.ConclusionAmong SCLC patients with LM, LDRT + CIT may yield superior survival outcomes compared with CIT alone, particularly when LDRT is administered in later-line therapy and among specific subgroups. The findings of this study offer new treatment options for improving survival and quality of life in this challenging patient population.