Peking University Cancer Hospital

With continuous advancements in therapeutic technologies for colorectal cancer, patient survival has been significantly prolonged, increasingly characterizing the disease as a chronic condition. Consequently, the traditional "disease-centered" model falls short of meeting patients' holistic needs for functional preservation, psychological support, and social reintegration. This article systematically reviews the necessity, feasibility, and practical challenges of whole-course management for colorectal cancer, proposing a patient-centered, continuous care system that spans the pre-hospital, in-hospital, and post-discharge phases. By integrating multidisciplinary collaboration, case management, digital platforms, and artificial intelligence-assisted decision-making, an innovative management pathway-exemplified by the "C-D-C" model-is constructed to facilitate the paradigm shift from "treating the disease" to "treating the whole person." Looking ahead, intelligent, personalized, and collaborative whole-course management models will be pivotal for driving high-quality development in colorectal cancer care.

Uncertainties persist regarding the allocation of apical lymph nodes in colorectal cancer, the approaches to lymph node dissection and mesocolic excision, which may contribute to inconsistent surgical practices. The aim of this study is to assess surgeons' practices in lymph node dissection and mesocolic excision approaches and to identify areas lacking standardization. A multinational pilot survey of 22 colorectal surgeons from 6 countries was conducted during the FICARE colorectal meeting. The survey consisted of 21 Likert-scale questions on surgical practices and lymph node allocation in colorectal cancer surgery. Majority of the respondents (90.9%) recognized conceptual differences in apical lymph node stratification between right- and left-sided colon cancers, whereas D3 LND for left-sided cancer should include mesocolic tissue along the inferior mesenteric artery from its origin to the last sigmoid artery. Complete lymph node dissection requires excision of mesocolic tissue along inferior mesenteric artery for left colon cancer and superior mesenteric artery for right colon cancer according to 81.8% of respondents. At the same time, 95.5% agreed that intermediate and paracolic lymph nodes are located within a 10-cm resection margin proximally and distally from tumor, while 81.9% of respondents supported the concept of tumor-specific mesocolic excision to be sufficient enough for adequate paracolic and intermediate lymph node dissection. A multinational snapshot showed an existing contraindication in surgeons' perception of lymph node stratification and the variability in mesocolic excision and LND. Further Delphi consensus is needed to prove the suggested concepts.

Progression to castration-resistant prostate cancer (CRPC) is shaped by dynamic interactions within the tumor microenvironment (TME). However, the specific cellular crosstalk driving therapeutic resistance and metastasis remains incompletely defined. This study aims to identify key signaling axes between therapy-resistant luminal progenitor (luminal-2) cells and immune components in the TME, particularly tumor-associated macrophages (TAMs), and to determine how these interactions promote immunosuppression and cancer stem-like cell expansion during disease progression. We employed an integrative phenomics approach combining single-cell transcriptomics with genetically engineered mouse models (GEMMs) and orthotopic allograft models of prostate cancer. Spatiotemporal changes in cell populations were profiled across disease stages. The functional contribution of the CX3CL1-CX3CR1 axis was evaluated through genetic ablation of Cx3cr1 in host mice, followed by assessment of TAM infiltration, luminal progenitor cell dynamics, tumor growth, and immunosuppression signature score. Single-cell profiling revealed a distinct luminal-2 progenitor population with high CX3CL1 expression that recruits CX3CR1+ TAMs and supports a pro-tumoral program. These CX3CL1hi luminal-2 cells and CX3CR1hi TAMs expand in a stage-specific manner and co-evolve during CRPC progression, forming an immunosuppressive and pro-metastatic niche. Host Cx3cr1 deletion disrupted this signaling axis, leading to reduced TAM infiltration, suppression of luminal progenitor cells expansion, and significant inhibition of tumor growth and progression. The CX3CL1-CX3CR1 axis functions as a critical mediator of reciprocal signaling between luminal-2 progenitors and TAMs that promotes immune evasion, stemness maintenance, and therapeutic resistance in prostate cancer. Disrupting this pathway impairs the pro-tumoral niche and may represent a promising therapeutic approach for advanced prostate cancer.

Leadership has become an essential component of medical professionalism; yet, China lacks leadership competency models grounded in physicians' clinical realities. This study aimed to develop a context-specific leadership competency model for Chinese oncologists, aligning international frameworks with local healthcare priorities. A three-round modified Delphi study was conducted between June and October 2024. The process began with a preliminary model comprising 6 domains and 30 competency items, derived from a scoping review and the National Health Service Medical Leadership Competency Framework. 40 oncology-related experts evaluated both the six proposed domains and the 30 competency items in round 1 using 9-point Likert scales and open-ended feedback. In round 2, experts screened the suggestions from round 1 through binary (yes/no) evaluations. The resulting refined list was subjected to a final rating in round 3, again using 9-point Likert scales to establish consensus. Quantitative data (mean scores, SD, percentage agreement) and thematic analysis of qualitative feedback were used to iteratively refine the model across rounds. Experts reached consensus on a final leadership competency model comprising 6 domains and 40 specific competencies. The highest-rated competencies included integrity, continuous personal development, healthcare quality management, learn and apply new technologies and ensur patient safety. New competencies, not present in the initial model, also emerged-such as clear expression, empathy, influence on the public, familiarity with end-of-life care, health economics evaluation and vision building-capturing the evolving expectations of oncologists as communicators, collaborators and system improvers in a rapidly changing healthcare environment. The resulting competency model reflects the multidimensional nature of oncologist leadership, encompassing professionalism, teamwork, service improvement and social responsibility. It offers a practical framework for leadership development and assessment in oncology and provides methodological guidance for building physician leadership competency models in other medical fields.

The prognosis for hepatocellular carcinoma remains grim. Combining radiotherapy with immune checkpoint blockade (ICB) has shown potential to enhance therapeutic outcomes, yet there is a pressing need for further advancements. Our previous research demonstrated that this combined approach suppresses ALKBH5 gene expression and increases m6A modification levels in hepatocellular carcinoma tissues. High-throughput sequencing and detailed molecular analysis revealed that inhibiting ALKBH5 amplifies CIITA m6A modifications post-therapy. This modulation triggers MHC II molecule expression in tumors, facilitating the presentation of tumor-associated antigens to CD4 + T lymphocytes and the recruitment of CD8 + T cells for an anti-tumor immune response. Building on these findings, we engineered a CIITA vector with a specific site mutation to confirm that the regulation of CIITA by the combined radiotherapy and immunotherapy is mediated through m6A methylation. Consequently, we established a comprehensive network involving ALKBH5, CIITA, MHC II, and CD4+ and CD8 + T cells. To elucidate the role and underlying molecular mechanisms of this combined therapy in reshaping the tumor immune microenvironment for hepatocellular carcinoma, we employed multi-omics approaches across in vitro, animal model, and clinical multi-dimensional studies, offering novel insights for enhancing treatment efficacy.

In the past 5 years, clinical trials on immune checkpoint inhibitors (ICIs) for the treatment of locally advanced rectal cancer (LARC) have flourished globally, and China has become one of the leading regions in this field. In response to the breakthrough progress and accumulation of evidence from key clinical trials, the Chinese Society of Colorectal Surgery has recognised the need for updated consensus guidance on the development of perioperative and organ-preserving treatment strategies for LARC. This expert consensus guidance provided unified standards for the indications, medication regimens, efficacy evaluations and follow-up of ICIs in this population, with a focus mainly on perioperative management and organ-sparing strategies. The diagnostic part of this consensus guidance is based on the internationally recognised definition of mismatch repair/microsatellite instability detection and emphasises the importance of multidisciplinary teams in treatment decision-making. In terms of treatment, based on the results of key trials that have changed clinical practice in the past 5 years, this expert consensus provides graded recommendations for the duration of preoperative immunotherapy and the necessity of postoperative adjuvant therapy, local resection and organ preservation strategies. Moreover, we refined the management process for the safety of perioperative immunotherapy. This document aims to provide a reference for surgeons; internal medicine, radiation therapy, pathology and imaging physicians; patients and nursing staff involved in the treatment of LARC, as well as health policy makers.

Gastric bronchogenic cyst constitutes a rare form of ectopic bronchogenic cyst, with an estimated incidence of less than 1 in 68,000 to 1 in 42,000. This study reported a case who was preoperatively misdiagnosed as gastrointestinal stromal tumor and reviewed the literature on gastric bronchogenic cyst to summarize its clinical features, diagnosis, treatment, pathological manifestations, and prognosis. A systematic search of the literature in the PubMed, Embase, Cochrane Library, Web of Science and Scopus databases was conducted by two independent reviewers focusing on cases of gastric bronchogenic cyst. Firstly, we report a rare case of bronchogenic cyst in a middle-aged female, with the lesion located near the gastric fundus. After literature review, 48 cases of gastric bronchogenic cyst (male-to-female ratio of 1:1.67, mean age was 47.54 ± 15.83 years) derived from 46 studies were enrolled. Abdominal pain (45.8%) was the most prevalent symptom, whereas 15 patients (31.3%) remained asymptomatic. Gastric bronchogenic cysts predominantly affected the gastric fundus (33.3%) and cardia (27.1%). Gastrointestinal stromal tumor (37.5%) was the most frequent misdiagnosis, while 9 patients (18.8%) were misdiagnosed as cysts originating from other abdominal organs. Laparoscopic surgery was the primary treatment (50.0%), followed by laparotomy (35.4%). Median follow-up was 10 months, no postoperative recurrence or mortality was reported in the pooled cases. Gastric bronchogenic cyst is a rare and diagnostically challenging congenital abnormality with limited evidence to guide preoperative diagnosis. It should be incorporated into the differential diagnosis of gastrointestinal neoplasms, surgical resection is regarded as the effective approach for definitive diagnosis treatment.