Objective To explore the influencing factors of early death （within 3 months） in adult glioma patients， and to construct a risk prediction model. Methods Retrospective analysis was performed on the clinical data of 228 adult glioma patients admitted to the 909th Hospital （Dongnan Hospital of Xiamen University） from June 2020 to June 2024. Patients were divided into a death group （n=32） and a survival group （n=196） based on whether death occurred within 3 months， and the clinical data between the two groups were compared. Multivariate logistic regression was used to analyze the influencing factors of death within 3 months， a logistic regression prediction model was constructed， and receiver operator characteristic （ROC） curve was plotted to analyze the predictive value of the model. Results There were no statistically significant differences between the two groups in age， gender， hypertension， diabetes， tumor location， tumor involvement， neurological impairment， maximum tumor diameter， chemotherapy， or radiotherapy （all P>0.05）. The death group showed higher proportions of cerebral herniation （χ²=20.74， P<0.001）， hospital admission Karnofsky performance status （KPS） score ≤70 （χ²=26.66， P<0.001）， tumor grade Ⅲ-Ⅳ （χ²=28.70， P<0.001）， MGMT promoter unmethylation （χ²=10.25， P=0.001）， IDH wild-type （χ²=6.18， P=0.013）， and incomplete tumor resection （χ²=10.37， P=0.001） compared with the survival group. Multivariate analysis revealed that cerebral herniation （OR=19.78， 95%CI： 5.33-73.41， P<0.001）， hospital admission KPS score ≤70 （OR=19.64， 95%CI： 5.54-69.59， P<0.001）， tumor grade Ⅲ-Ⅳ （OR=9.40， 95%CI： 3.02-29.27， P<0.001）， MGMT promoter unmethylation （OR=4.28， 95%CI： 1.18-15.54， P=0.027）， and incomplete tumor resection （OR=9.50， 95%CI： 2.72-33.23， P<0.001） were independent risk factors for early death in glioma patients. The risk prediction model for early death in glioma patients constructed based on these indicators was logit（P）=-18.04+2.96×cerebral herniation （with=1， without=0）+2.98×hospital admission KPS score （≤70=1， >70=0）+2.24×tumor grade （Ⅲ-Ⅳ=1， Ⅰ-Ⅱ=0）+1.45×MGMT promoter methylation （no=1， yes=0）+2.25×complete tumor resection （no=1， yes=0）. ROC curve analysis demonstrated that this model had predictive value for early death in glioma patients， with an area under the curve of 0.920 （95%CI： 0.868-0.972）， a sensitivity of 0.842， and a specificity of 0.906. Conclusions Cerebral herniation， hospital admission KPS score ≤70， tumor grade Ⅲ-Ⅳ， MGMT promoter unmethylation， and incomplete tumor resection are independent risk factors for early death in adult glioma patients. The risk prediction model constructed based on these indicators has good predictive value.

Objective To evaluate the prognostic value of ¹⁸F-fluorodeoxyglucose （¹⁸F-FDG） PET/CT metabolic parameters in small cell lung cancer （SCLC）. Methods A retrospective analysis was conducted on the clinical and imaging data of 156 SCLC patients， who underwent ¹⁸F-FDG PET/CT imaging and were diagnosed by histopathological examination at Nanjing Drum Tower Hospital， Affiliated Hospital of Nanjing University Medical School from September 2013 to February 2024. The metabolic tumor volume （MTV）， total lesion glycolysis （TLG）， linear regression slope， area under the curve of cumulative standard uptake value （SUV） volume histogram （AUC-CSH）， and coefficient of variation （CV） were calculated using LIFEx software with different SUV thresholds. Univariate and multivariate analyses were performed using Cox proportional hazards model. Patient stratification was based on the critical values determined by receiver operator characteristic （ROC） curve analysis. The survival curve was plotted using the Kaplan-Meier method and log-rank test was performed. Results Univariate analysis showed that MTV_40% （HR=2.91， 95%CI： 1.55-5.47， P=0.001）， MTV_60% （HR=2.31， 95%CI： 1.29-4.17， P=0.005）， TLG_40% （HR=2.07， 95%CI： 1.19-3.60， P=0.010）， linear regression slope （HR=0.45， 95%CI： 0.26-0.79， P=0.005）， and CV_40% （HR=0.27， 95%CI： 0.08-0.84， P=0.024） were factors affecting progression-free survival （PFS） in SCLC patients. MTV_40% （HR=1.98，95%CI： 1.22-3.22， P=0.005）， MTV_60% （HR=1.80， 95%CI： 1.12-2.88， P=0.015）， MTV_80% （HR=1.71， 95%CI： 1.08-2.74， P=0.024）， TLG_40% （HR=3.68， 95%CI： 1.59-8.49， P=0.002）， linear regression slope （HR=0.49， 95%CI： 0.30-0.80， P=0.004）， and AUC-CSH_80% （HR=0.44， 95%CI： 0.23-0.84， P=0.013） were found to be factors affecting overall survival （OS） in SCLC patients. Multivariate analysis revealed that MTV_40% （HR=4.76， 95%CI： 1.11-20.50， P=0.036） was an independent factor influencing PFS， and TLG_40% （HR=3.19， 95%CI： 1.02-9.92， P=0.046） was an independent factor influencing OS in SCLC patients. ROC curve analysis identified the optimal cutoff value for MTV_40% in predicting PFS as 5.5cm³ and the optimal cutoff value for TLG_40% in predicting OS as 41.5 g in SCLC patients. Survival analysis showed that patients with MTV_40%≤5.5 cm³ （n=33） had a median PFS that was not reached， while patients with MTV_40%>5.5 cm³ （n=123） had a median PFS of 10.3 months， with a statistically significant difference （χ²=12.09， P=0.001）. For patients with TLG_40%≤41.5 g （n=35）， the median OS was not reached， whereas for TLG_40%>41.5 g （n=121）， the median OS was 31.6 months， with a statistically significant difference （χ²=10.55， P=0.001）. Conclusions The ¹⁸F-FDG PET/CT metabolic parameter MTV_40% is an independent factor influencing PFS， while TLG_40% is an independent factor influencing OS in SCLC patients. The above two parameters may serve as indicators for assessing the prognosis of SCLC patients.

Objective To explore the diagnostic value of preoperative diffusion weighted imaging （DWI） histogram parameters in the depth of invasion of early rectal cancer. Methods A total of 180 patients with early rectal cancer admitted to 904th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from August 2020 to August 2024 were selected as the study objects. Patients were divided into intramucosal cancer group （n=102） and submucosal cancer group （n=78） according to the depth of tumor invasion. The general data of the two groups were compared. The intraclass correlation coefficient （ICC） was used to analyze the consistency of DWI histogram parameters extracted by the two radiologists， and the differences between the two groups were compared. Receiver operator characteristic （ROC） curve was used to analyze the predictive value of each parameter to the depth of tumor invasion. Multivariate logistic regression was used to analyze the independent influencing factors of invasion depth， and a predictive model was constructed. The ROC curve was drawn to analyze the predictive value of the model for tumor invasion depth， and the Hosmer-Lemeshow test was used to analyze the goodness of fit of the model. Results There were statistically significant differences in age （t=8.15， P<0.001）， maximum tumor diameter （χ²=29.29， P<0.001）， endoscopic type （χ²=20.96， P<0.001）， histological type （χ²=24.93， P<0.001） and differentiation degree （χ²=73.35， P<0.001） between intramucosal cancer group and submucosal cancer group. The mean， variance， skewness， kurtosis， the 1^st， 10^th， 50^th， 90^th， and 99^th percentiles of the histogram parameters of DWI had good consistency （all ICC>0.75）. There were statistically significant differences in the mean （t=5.69， P<0.001）， variance （t=9.75， P<0.001）， skewness （t=10.88， P<0.001）， kurtosis （t=10.06， P<0.001）， the 1^st percentile （t=3.43， P<0.001）， 10^th percentile （t=3.59， P<0.001）， 50^th percentile （t=9.97， P<0.001）， 90^th percentile （t=4.63， P<0.001）， and 99^th percentile （t=2.44， P=0.016） of the DWI histogram parameters between the intramucosal cancer group and the submucosal cancer group. ROC curve analysis results showed that mean [area under the curve （AUC）=0.77]， variance （AUC=0.88）， skewness （AUC=0.88）， kurtosis （AUC=0.78）， 50^th percentile （AUC=0.86） and 90^th percentile （AUC=0.82） had certain diagnostic value for submucous cancer. Multivariate analysis showed that age （OR=9.98， 95%CI： 1.10-90.70， P=0.041）， maximum tumor diameter （OR=7.36， 95%CI： 1.08-50.23， P=0.042）， and differentiation degree （OR=19.88， 95%CI： 1.21-327.92， P=0.037）， variance （OR=16.24， 95%CI： 2.26-116.68， P=0.006）， skewness （OR=21.13， 95%CI： 2.80-59.61， P=0.003）， 1^st percentile （OR=9.78， 95%CI： 1.17-81.76， P=0.035） were independent factors in predicting tumor invasion depth in patients with early rectal cancer. The predictive model based on the above indicators was logit（P）=1.51+2.30×age+2.00×maximum tumor diameter+2.99×differentiation degree+2.79×variance+3.05×skewness+ 2.28×the 1^st percentile. ROC curve analysis showed that the predictive model had an AUC of 0.97 （95%CI： 0.95-0.99） for judging the occurrence of submucosal cancer in patients with early rectal cancer， the sensitivity was 0.95， and the specificity was 0.88. The Hosmer-Lemeshow test results showed that the goodness of fit of the model was ideal （P=0.823）. Conclusions Age， maximum tumor diameter， differentiation degree， variance， skewness， and the 1^st percentile are independent factors in predicting tumor invasion depth in patients with early rectal cancer. The predictive model constructed based on these factors can effectively predict the risk of submucosal cancer in patients with early rectal cancer.

Objective To investigate the value of ¹⁸F-fluorodeoxyglucose （¹⁸F-FDG） PET/CT in the differential diagnosis of primary intestinal diffuse large B-cell lymphoma （PIDLBCL） and colon cancer in the ileocecal region. Methods A total of 42 patients with ileocecal tumors admitted to Nanjing Drum Tower Hospital， Affiliated Hospital of Nanjing University Medical School from June 2013 to December 2023 were selected as the study objects， including 17 cases of PIDLBCL and 25 cases of colon cancer. General data and ¹⁸F-FDG PET/CT parameters were compared between patients with PIDLBCL and colon cancer in the ileocecal region. Binary logistic regression was used to analyze the independent influencing factors for the differential diagnosis of PIDLBCL and colon cancer in the ileocecal region. The receiver operator characteristic （ROC） curve was used to evaluate the diagnostic efficacy of independent influencing factors. Results There were statistically significant differences in tumor length diameter （Z=-2.63， P=0.009）， maximum thickness （Z=-3.26， P=0.001）， ileal involvement （χ²=6.04， P=0.014）， intestinal dilation （χ²=10.38， P=0.001）， maximum standardized uptake value （SUV_max） （Z=-3.73， P<0.001）， SUV_mean （Z=-3.40， P<0.001）， metabolic tumor volume （Z=-2.37， P=0.018） and total lesion glycolysis （Z=-2.93， P=0.003） between patients with PIDLBCL and colon cancer in the ileocecal region. Multivariate analysis showed that SUV_max （OR=1.16， 95%CI： 1.04-1.31， P=0.011） and intestinal dilation （OR=6.64， 95%CI： 1.13-39.10， P=0.036） were both independent influencing factors for the differential diagnosis of PIDLBCL and colon cancer in the ileocecal region. ROC curve analysis showed that， the areas under the curve of SUV_max and intestinal dilation for the differential diagnosis of PIDLBCL and colon cancer in the ileocecal region were 0.84 （95%CI： 0.70-0.94） and 0.73 （95%CI： 0.58-0.86）， respectively. The optimal cut-off value for SUV_max was determined to be 19.14， with a sensitivity of 70.6% and a specificity of 88.0%， while intestinal dilation exhibited a sensitivity of 58.8% and a specificity of 88.0%. Conclusions ¹⁸F-FDG PET/CT can be used for the differential diagnosis of PIDLBCL and colon cancer in the ileocecal region， and SUV_max and intestinal dilation have high diagnostic efficacy.

Cancer cachexia is a complex multifactorial disease that can lead to significant reduction of skeletal muscle mass. MicroRNAs （miRNAs） are non-coding RNAs that are closely related to the development of cancer cachexia muscle atrophy. Studies have shown that miRNAs play an important role in the occurrence and development of cancer cachexia muscle atrophy by regulating various signaling pathways， but the mechanism by which miRNAs mediate cancer cachexia muscle atrophy has not been fully clarified. A systematic investigation of the role of miRNAs in cancer cachexia muscle atrophy may provide useful references for the precise treatment of patients with cancer cachexia muscle atrophy.

In recent years， programmed death-1/programmed death-ligand 1 inhibitors， as representatives of immune checkpoint inhibitors （ICIs）， have become an important advancement in the field of tumor therapy， significantly improving the survival and prognosis of tumor patients. However， immune-related adverse events associated with ICIs treatment pose challenges for clinical management. In particular， the emergence of active tuberculosis and reactivation of latent tuberculosis infection has attracted attention， and its mechanism may be closely related to the overactivation of the immune system and the changes of host-pathogen relationship. How to effectively predict and manage these adverse reactions has become a hot topic of current research.

Non-small cell lung cancer （NSCLC） is a malignant tumor with a high global incidence rate， accounting for about 10.54% of all new cancer cases and posing a serious threat to human health. Due to significant individual variations in the efficacy of immunotherapy among NSCLC patients， it is necessary to identify accurate detection indicators to screen appropriate populations， monitor treatment efficacy， and assist in prognosis assessment. Programmed death-ligand 1 （PD-L1）， as an immunosuppressive molecule expressed on the surface of tumor cells and various immune cell membranes， can serve as a "companion diagnostic" or "supplementary diagnostic" tool to guide clinical treatment decisions for metastatic NSCLC patients. Given that tumor tissue PD-L1 testing is an invasive procedure and its reliability is still under debate， the assessment of PD-L1 expression via liquid biopsies， such as circulating tumor cells， will play a significant role in predicting treatment response and prognosis in NSCLC patients.

Objective To investigate the dosimetric characteristics of intensity modulated proton therapy （IMPT） and photon volumetric modulated arc therapy （VMAT） in typical head and neck malignant tumors. Methods Three types of typical head and neck tumors （nasopharyngeal carcinoma， parotid gland carcinoma， laryngeal carcinoma） treated at Shandong Cancer Hospital and Institute from December 2023 to December 2024 were taken as research subjects. IMPT and VMAT radiotherapy plans were created according to clinical prescription requirements of target and organs at risk limits respectively. The conformity index （CI）， homogeneity index （HI） and gradient index （GI） for target coverage of two radiotherapy plans were evaluated for 3 patients， as well as the dosimetric indicators of organs at risk. Results The CI of IMPT for nasopharyngeal carcinoma， parotid gland carcinoma and laryngeal carcinoma were 0.70， 0.72 and 0.67， respectively. The HI were 0.11， 0.08 and 0.08， respectively. The GI were 3.08， 2.49 and 3.75， respectively. The CI of VMAT plans were 0.77， 0.82 and 0.91， respectively. The HI were 0.12， 0.10 and 0.04， respectively. The GI were 3.67， 2.63 and 3.45， respectively. The results showed that CI of IMPT plan was slightly lower than that of VMAT plan， and HI of IMPT plan was comparable to that of VMAT plan， the GI of the IMPT plan for patients with nasopharyngeal carcinoma and parotid gland carcinoma was lower than that of the VMAT plan， and the GI of the IMPT plan for patient with laryngeal carcinoma was higher than that of the VMAT plan， and all were within the clinically acceptable range. The IMPT plan has demonstrated significant dose advantages in the treatment of nasopharyngeal carcinoma， parotid gland carcinoma and laryngeal carcinoma. For patient with nasopharyngeal carcinoma， the IMPT plan reduced the D_max of the left and right crystals by 54.1% and 50.4%， respectively， compared to VMAT plan， and reduced the D_mean of the oral and laryngeal tissues by 40.5% and 49.6%， respectively. For patient with parotid gland carcinoma， IMPT plan reduced the D_max of the brainstem and spinal cord by 66.2% and 40.5%， respectively， compared to VMAT plan. For patient with laryngeal carcinoma， IMPT reduced spinal cord D_max by 77.0%， while thyroid cartilage D_mean increased by 8.0% compared to VMAT plan. For the additional dose in the patients' body， taking the absolute volumes occupied by the prescribed dose areas of 10%， 30%， and 50% in the patients' body as examples， IMPT plan of nasopharyngeal carcinoma patient decreased by 29.7%， 29.6%， and 34.9% compared to VMAT plan， respectively. IMPT plan of parotid gland carcinoma patient decreased by 61.0%， 39.7%， and 17.4% compared to VMAT plan， respectively. IMPT plan of laryngeal carcinoma patient decreased by 63.9%， 31.7%， and 4.1% compared to VMAT plan， respectively. Conclusions Compared with VMAT plan， IMPT plan can effectively reduce the irradiation dose of most organs at risk near the target of head and neck tumors， but the dose of string organs close to the target area may be higher， which needs attention.

Objective To investigate the dosimetric characteristics of intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） for lung cancers. Methods Three lung cancer patients （central-lower， central， and peripheral types） admitted to Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on the anatomical location of the clinical target volume and the dose constraints for organs at risk （OARs）. Dosimetric parameters， including conformity index （CI）， homogeneity index （HI）， and gradient index （GI） for target coverage， as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%， 30%， and 50% of the prescription dose. Results For all three cases， IMRT plans demonstrated higher CI values （0.80， 0.60， and 0.79） compared to IMPT plans （0.61， 0.57， and 0.34）. IMPT plans yielded lower HI values （0.07， 0.06， and 0.06） than IMRT plans （0.09， 0.15， and 0.09） and lower GI values （2.84， 2.47， and 4.56 vs. 4.91， 3.09， and 4.99 for IMRT plans）. Compared with the IMRT plans， the low-dose region in the ipsilateral lung was significantly reduced in IMPT plans （V₅ of the IMPT plans were 20.59%， 46.29%， 10.94%， respectively； V₅ of the IMRT plans were 48.91%， 60.63%， 19.92%， respectively）， but there was no significant advantage in the high-dose region compared to IMRT plans （V₂₀ of the IMPT plans were 12.88%， 34.75%， 5.21%， respectively；V₂₀ of the IMRT plans were 21.70%， 36.50%， 5.31%， respectively）. The dose to the contralateral lung and heart was significantly reduced in IMPT plans [the D_mean of the contralateral lung in the IMPT plans were 0.08， 0.04， and 0.00 Gy （RBE）， respectively， and those in the IMRT plans were 3.25， 1.18， and 0.55 Gy， respectively； the heart D_mean in the IMPT plans were 6.23， 7.04， and 0.00 Gy （RBE）， respectively， while those of the IMRT plans were 18.33， 10.27， and 0.08 Gy， respectively）. IMPT plans significantly reduced the volumes receiving 10% of the prescription dose by 65.94%， 25.57% and 72.47%， respectively， compared to IMRT plans. The volumes IMPT plans occupied by 30% of the prescription dose area in the body were reduced by 54.97%， 26.47% and 39.04%， respectively， compared to the IMRT plans. The volumes IMPT plans occupied by 50% of the prescription dose area in the body were reduced by 54.49%， 30.43% and 28.89%， respectively， compared to the IMRT plans. Conclusions IMPT plan significantly reduces the V₅ of the ipsilateral lung， the D_mean of the contralateral lung and the heart， while maintaining target coverage compared with IMRT plan for lung cancers. However， IMPT plan does not show much more advantage than IMRT plan in the ipsilateral lung V₂₀. IMPT can reduce the additional exposure volume within the body.

Objective To explore the dosimetric characteristics of proton radiotherapy plan and photon radiotherapy plan for esophageal cancer. Methods Four patients who were admitted to Shandong Cancer Hospital and Institute from January 2024 to April 2024 with esophageal cancer （cervical， middle thoracic and total esophageal tube， as well as the lymphatic drainage areas involved） and required radiotherapy were selected as the research subjects. Intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） plans were designed respectively based on the clinical target volume and the dose constraints for organs at risk （OARs）. Dosimetric parameters， including conformity index （CI）， homogeneity index （HI）， gradient index （GI） for target coverage， as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%， 30%， and 50% of the prescription dose. Results For all four cases， IMPT plans yielded lower HI values （0.12， 0.10， 0.06， and 0.08） than IMRT plans （0.15， 0.13， 0.10， and 0.11）， and the GI values of IMPT plans （3.11， 3.21， 2.43， and 2.72） was lower than IMRT plans （4.52， 5.14， 3.09， and 3.92）. Moreover， the CI of the IMPT plans （0.59， 0.60， 0.77， and 0.72） was inferior to IMRT plans （0.81， 0.77， 0.91， and 0.85）. Compared with the IMRT plans， in the whole lung dose indicators of the IMPT plans for the 4 patients， V₅ decreased by 34.1%， 55.0%， 79.7% and 60.3%， respectively； V₂₀ decreased by 48.3%， 43.9%， 65.8% and 40.8%， respectively， and D_mean decreased by 43.4%， 57.2%， 76.2% and 45.4%， respectively. V₃₀ of the heart decreased by 36.2%， 45.3%， 40.1% and 52.4%， respectively， and D_mean of heart decreased by 96.6%， 57.9%， 58.5% and 55.3%， respectively. For the middle and lower thoracic target area， the liver was significantly protected in the IMPT plan （D_mean decreased by 76.0% compared with the IMRT plan）. In terms of the additional dose deposition in the patient's body， IMPT plans reduced the volumes receiving 10%， 30% and 50% of the prescription dose by 45.0%-61.4%， 41.2%- 61.8% and 34.8%-61.6%， respectively， compared with the IMRT plans. Conclusions By comparing the dosimetric parameters of IMPT and IMRT plans for 4 cases of esophageal cancer， the IMPT plans have advantages in reducing the doses to lung tissue， heart， and liver， and can also reduce additional dose deposition in the patient's body.