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08 April 2026, Volume 53 Issue 4 Previous Issue   

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Original Article

Investigation of the causal relationship between gut microbiota and thyroid cancer Liu Lujia, Wang Yukun, Zheng Haitao 2026, 53 (4):  193-200.  doi: 10.3760/cma.j.cn371439-20250823-00032 Abstract ( 25 )   HTML ( 20 )   PDF (1882KB) ( 3 )   Save Objective To explore the causal relationship between gut microbiota and thyroid cancer using Mendelian randomization （MR） analysis. Methods An MR study was conducted using summary data from genome-wide association studies （GWAS） of gut microbiome and thyroid cancer， and the local microbiome sequencing data was used to validate the findings. GWAS summary data of gut microbiota were obtained from the MiBioGen consortium （n=18 340）， served as exposure. The summary data of thyroid cancer were obtained from the UK Biobank （649 cases and 431 controls）， served as outcome. The inverse-variance weighting （IVW） method was used as the primary analysis method， with assessments of heterogeneity and horizontal pleiotropy conducted. From June 28， 2024 to July 31， 2024， a total of 20 thyroid cancer patients （thyroid cancer group） and 20 healthy controls （healthy control group） were recruited as research subjects at Affiliated Yantai Yuhuangding Hospital of Qingdao University. Fecal samples from all participants were collected and subjected to 16S rRNA gene sequencing. Results Five bacterial genera were identified with potential causal relationship with thyroid cancer. Paraprevotella （IVW OR=4.72， 95%CI： 1.27-17.56， P=0.021） and Eubacterium coprostanoligenes （IVW OR=5.96， 95%CI： 1.27-28.01， P=0.024） were causally associated with an increased risk of thyroid cancer， while Blautia （IVW OR=0.10， 95%CI： 0.01-0.97， P=0.046）， Parasutterella （IVW OR=0.25， 95%CI： 0.07-0.88， P=0.030）， and Prevotella_9 （IVW OR=0.21， 95%CI： 0.07-0.68， P=0.009） were causally associated with a decreased risk of thyroid cancer. Microbiome sequencing results indicated that compared with the healthy control group， the relative abundance of Paraprevotella [0.41 （0.03， 1.23） vs. 0.06 （0.01， 0.23）， U=84.50， P=0.038] and Eubacterium coprostanoligenes [0.93 （0.43， 2.23） vs. 0.42 （0.09， 1.20）， U=85.50， P=0.041] was significantly higher in the thyroid cancer group， with statistically significant differences； while those of Blautia [0.35 （0.26， 0.57） vs. 0.56 （0.35， 1.03）， U=90.00， P=0.062]， Parasutterella [0.18 （0.13， 0.68） vs. 0.43 （0.13， 1.07）， U=117.00， P=0.357]， and Prevotella_9 [0.19 （0.11， 3.82） vs. 1.23 （0.17， 12.10）， U=93.50， P=0.079] was reduced， although the differences did not reach statistical significance. Conclusions Five bacterial genera may have causal associations with thyroid cancer. Among them， Paraprevotella and Eubacterium coprostanoligenes are associated with an increased risk of thyroid cancer， while Blautia， Parasutterella， and Prevotella_9 are linked to a decreased risk of thyroid cancer. Local microbiome sequencing results reveal that Paraprevotella and Eubacterium coprostanoligenes may contribute to the pathogenesis of thyroid cancer， whereas Blautia， Parasutterella， and Prevotella_9 may exert protective effects， although confirmation through larger-scale studies is required. Figures and Tables | References | Related Articles | Metrics

Efficacy of different treatment modalities in the real-world setting for advanced EGFR-mutant NSCLC patients after progression on third-generation EGFR-TKI treatment Yang Junling, Zhang Guifang, Mu Zhuqing, Huang Puchao, Ma Xiaoyan, Liang Jiaxin 2026, 53 (4):  201-206.  doi: 10.3760/cma.j.cn371439-20251015-00033 Abstract ( 22 )   HTML ( 8 )   PDF (1101KB) ( 1 )   Save Objective To investigate the efficacy of different treatment modalities in the real-world setting for patients with advanced epidermal growth factor receptor （EGFR） mutant non-small cell lung cancer （NSCLC） after progression on third-generation EGFR-tyrosine kinase inhibitor （TKI） treatment. Methods A retrospective analysis was performed on the clinical data of 104 patients with advanced NSCLC who received third-generation EGFR-TKI treatment at Xinxiang Central Hospital of Henan Province between January 1， 2021， and June 30， 2024. Based on the different treatment approaches after the progression of third-generation EGFR-TKI treatment， patients were divided into two groups： Group A （n=44） continued to receive third-generation EGFR-TKI treatment， whereas Group B （n=60） discontinued it and received other therapeutic regimens. The objective response rate （ORR）， disease control rate （DCR） and median progression-free survival （mPFS） were compared between the groups. The mPFS of the two treatment approaches in patients with oligoprogression， widespread progression， and brain metastases were compared. Survival analysis was conducted using Kaplan-Meier method. The adverse reactions were observed and compared between the two groups. Results The ORR in Group A and Group B were 20.45% （9/44） and 13.33% （8/60） respectively， and the DCR were 88.64% （39/44） and 80.00% （48/60） respectively， with no statistically significant differences （χ²=0.94， P=0.332； χ²=1.39， P=0.239）. The mPFS of patients in Group A and Group B were 8.3 and 6.0 months respectively， with a statistically significant difference （χ²=8.58， P=0.003）. Subgroup analysis showed that the mPFS in oligoprogression patients were 8.2 and 6.8 months in Group A （n=18） and Group B （n=14）， respectively； in patients with widespread progression， it was 8.4 months in Group A （n=26） and 6.0 months in Group B （n=46）， respectively； in patients with brain metastases， it was 8.4 months in Group A （n=27） and 6.0 months in Group B （n=32）， with statistically significant differences （χ²=4.03， P=0.045； χ²=4.51， P=0.034； χ²=8.05， P=0.005）. In terms of safety， the incidence rates of grade ≥3 adverse reactions in Group A and Group B were 25.00% （11/44） and 16.67% （10/60）， respectively， with no statistically significant difference （χ²=1.09， P=0.296）. All adverse reactions in both groups were relieved after symptomatic treatment， and no cases of drug discontinuation due to intolerable adverse reactions occurred. Conclusions For advanced EGFR-mutant NSCLC patients after progression on third-generation EGFR-TKI treatment， continued treatment with the EGFR-TKIs significantly prolongs mPFS compared to other therapeutic regimens that discontinue the EGFR-TKIs. However， no significant differences are observed in the ORR， DCR and safety between the two treatment approaches. Figures and Tables | References | Related Articles | Metrics

Relationship between pan-immune inflammation value and clinicopathological features of non-small cell lung cancer and predictive analysis for bone metastasis Wang Minjie, Lai Minghong, Cai Zhuoxin, Tang Yu, Zhang Caijin 2026, 53 (4):  207-212.  doi: 10.3760/cma.j.cn371439-20250919-00034 Abstract ( 13 )   HTML ( 3 )   PDF (896KB) ( 0 )   Save Objective To investigate the relationship between pan-immune inflammation value （PIV） and clinicopathological features of non-small cell lung cancer （NSCLC）， and its predictive effect on bone metastasis. Methods A retrospective analysis was conducted on the clinical data of 157 NSCLC patients admitted to the 909th Hospital （Dongnan Hospital of Xiamen University） from January 2020 to December 2022. According to the occurrence of bone metastasis， the patients were divided into bone metastasis group （n=57） and non-metastasis group （n=100）. The differences of PIV among NSCLC patients with different clinicopathological features were compared. The receiver operator characteristic （ROC） curve was used to analyze the predictive value of PIV for bone metastasis in NSCLC patients， and the differences of clinicopathological features between the two groups were compared. Multivariate logistic regression analysis was used to identify the influencing factors for bone metastasis in NSCLC patients. Results The PIVs of patients with tumor longest diameter ≥3 cm （t=-3.09， P=0.002）， lymph node metastasis （t=2.80， P=0.006）， TNM stage Ⅲ （t=-3.56， P=0.001）， and bone metastasis （t=13.39， P<0.001） were all higher than those of patients with tumor longest diameter <3 cm， without lymph node metastasis， TNM stage Ⅰ-Ⅱ， and without bone metastasis. ROC curve analysis showed that the area under the curve of PIV for predicting bone metastasis in NSCLC patients was 0.946 （95%CI： 0.912-0.979）， with the optimal cut-off value of 424.5， sensitivity of 0.732 and specificity of 0.990. The proportions of patients with tumor longest diameter ≥3 cm （χ²=10.24， P=0.001）， lymph node metastasis （χ²=5.63， P=0.018）， TNM stage Ⅲ （χ²=11.39， P=0.001）， and PIV ≥424.5 （χ²=34.59， P<0.001） in the bone metastasis group were higher than those in the non-metastasis group. Multivariate analysis showed that tumor longest diameter ≥3 cm （OR=3.02， 95%CI： 1.35-6.79， P=0.007）， lymph node metastasis （OR=2.38， 95%CI： 1.07-5.32， P=0.035）， TNM stage Ⅲ （OR=2.88， 95%CI： 1.31-6.32， P=0.009）， and PIV ≥424.5（OR=6.61， 95%CI： 2.99-14.59， P<0.001） were independent risk factors for bone metastasis in NSCLC patients. Conclusions PIV is elevated in NSCLC patients with tumor longest diameter ≥3 cm， lymph node metastasis， TNM stage Ⅲ， and bone metastasis. Elevated PIV has predictive value for bone metastasis， and may serve as a new biomarker for bone metastasis in NSCLC. Figures and Tables | References | Related Articles | Metrics

Construction of a prediction model for postoperative acute respiratory failure risk in patients with esophageal cancer based on SMOTE algorithm Xie Wenjuan, Zhu Yuan, Xu Jing 2026, 53 (4):  213-218.  doi: 10.3760/cma.j.cn371439-20250626-00035 Abstract ( 10 )   HTML ( 6 )   PDF (907KB) ( 0 )   Save Objective To construct a prediction model for postoperative acute respiratory failure （ARF） risk in patients with esophageal cancer based on the synthetic minority oversampling technique （SMOTE） algorithm. Methods A retrospective analysis was conducted on the clinical data of 450 patients who underwent surgical treatment for esophageal cancer in Jiangsu Province Hospital from March 2023 to March 2025. Based on the occurrence of ARF after surgery， the patients were divided into an ARF group （45 cases） and a non-ARF group （405 cases）. The clinical data were compared between patients in the two groups， and multivariate logistic regression analysis was used to identify influencing factors for ARF in patients with esophageal cancer after surgery. A logistic regression prediction model was constructed. A prediction model for the occurrence of ARF in patients with esophageal cancer after surgery was constructed using the SMOTE algorithm. Model calibration was assessed using Cox-Snell R². The predictive efficacy was evaluated using the receiver operator characteristic （ROC） curve. Results There were statistically significant differences in smoking history， surgery duration， anastomotic leakage， postoperative sputum obstruction， postoperative pneumonia， and postoperative mechanical ventilation duration between the ARF group and the non-ARF group （all P<0.05）. Multivariate analysis showed that smoking history （OR=3.57， 95%CI： 1.60-7.97， P=0.002）， surgery duration >4 h （OR=2.89， 95%CI： 1.49-5.98， P=0.002）， anastomotic leakage （OR=3.09， 95%CI： 1.04-9.17， P=0.042）， postoperative sputum obstruction （OR=2.69， 95%CI： 1.34-5.41， P=0.005）， postoperative pneumonia （OR=2.61， 95%CI： 1.24-5.50， P=0.011）， and postoperative mechanical ventilation duration >48 h （OR=4.26， 95%CI： 1.68-10.80， P=0.002） were independent risk factors for ARF in patients with esophageal cancer after surgery. The prediction model based on the SMOTE algorithm was logit（P）=-4.74+2.90×smoking history+2.52×surgery duration+1.69×anastomotic leakage+1.51×postoperative sputum obstruction+1.49×postoperative pneumonia+1.88×postoperative mechanical ventilation duration. The prediction model based on the SMOTE algorithm demonstrated good calibration （Cox-Snell R2=0.537； χ²=118.34， df=6， P<0.001）. The ROC curve analysis showed that the area under the curve of the prediction model based on the SMOTE algorithm was 0.835 （95%CI： 0.803-0.866）， which was higher than that of the logistic regression prediction model （the area under the curve was 0.783， 95%CI： 0.712-0.854； Z=2.35， P=0.019）. Conclusions The risk prediction model for ARF after esophageal cancer surgery based on the SMOTE algorithm exhibits excellent predictive efficacy， supporting its potential utility in identifying patients with high risk of ARF after esophageal cancer surgery. Figures and Tables | References | Related Articles | Metrics

Short-term efficacy and clinical outcomes of concurrent chemoradiotherapy followed by anlotinib maintenance treatment in patients with locally advanced cervical cancer Han Yufei, Li Fengmei, Zhang Weina, Zhang Ping, Hou Ping 2026, 53 (4):  219-223.  doi: 10.3760/cma.j.cn371439-20250520-00036 Abstract ( 9 )   HTML ( 3 )   PDF (1371KB) ( 0 )   Save Objective To observe the efficacy and safety of anlotinib maintenance treatment in patients with locally advanced cervical cancer （LACC） after concurrent chemoradiotherapy. Methods From October 2021 to August 2022， 68 patients with LACC admitted to Qingdao Municipal Hospital were selected as the research subjects. According to different treatment regimens， they were divided into an observation group of 32 cases （receiving anlotinib maintenance treatment after concurrent chemoradiotherapy） and a control group of 36 cases （receiving concurrent chemoradiotherapy alone）， with 21 days as one course of treatment. Serum tumor marker squamous cell carcinoma antigen （SCC） was reexamined after each course of treatment. Imaging MR was performed every 2 courses of treatment to evaluate the changes in the size of cervical lesions， and the occurrence of drug-related adverse reactions in the two groups of patients was observed. The progression-free survival （PFS） was compared between the two groups. Results By the end of follow-up，the SCC and maximum cervical lesion diameter in the observation group were （5.81±0.62） ng/ml and （3.66±0.84） cm， respectively， and those in the control group were （6.79±0.53） ng/ml and （4.32±0.68） cm， respectively， with statistically significant differences （t=8.50， P<0.001； t=4.32， P<0.001）. The complete remission rate of the observation group was 81.25% （26/32）， which was significantly higher than that of the control group （50.00%， 18/36）， with a statistically significant difference （χ2=7.24， P=0.007）. The incidence of secondary hypertension in the observation group was 46.88% （15/32）， higher than 22.22% （8/36） in the control group， with a statistically significant difference （χ2=4.60， P=0.032）， however， all were grade 1-2. There were no statistically significant differences in the incidence of hematological toxicity [62.50% （20/32） vs. 50.00% （18/36）， χ2=1.07， P=0.300]， gastrointestinal reactions [34.38% （11/32） vs. 25.00% （9/36）， χ2=0.72， P=0.397]， radiation cystitis [15.63% （5/32） vs. 11.11% （4/36）， χ2=0.30， P=0.584]， radiation proctitis [18.75% （6/32） vs. 11.11% （4/36）， χ2=0.79， P=0.375] and proteinuria [21.88% （7/32） vs. 19.44% （7/36）， χ2=0.06， P=0.805] between the observation group and the control group. The median PFS in the observation group was 23.75 months， which was significantly longer than 15.16 months of the control group， with a statistically significant difference （χ2=4.28， P=0.034）. Conclusions The complete remission rate of concurrent chemoradiotherapy followed by anlotinib maintenance treatment for LACC is higher than that of concurrent chemoradiotherapy alone， the adverse reactions are controllable， and can prolong the PFS of patients. Figures and Tables | References | Related Articles | Metrics

Review

Role and therapeutic potential of CC and CXC chemokines in the tumor microenvironment Yang Xinru, Cao Lili 2026, 53 (4):  224-228.  doi: 10.3760/cma.j.cn371439-20250528-00037 Abstract ( 13 )   HTML ( 3 )   PDF (775KB) ( 6 )   Save Chemokines are a class of cytokines with chemotactic functions that play important roles in the tumor microenvironment through receptor binding. Their functional mechanisms in tumor progression mainly include activating signaling pathways to promote tumor cell proliferation and metastasis， regulating tumor angiogenesis to alter blood supply and nutritional status， and mediating immune escape to evade host defense systems. Studies have demonstrated that targeting specific chemokine-receptor axes can effectively inhibit malignant behaviors of tumor cells and regulate immune cell infiltration， showing significant anti-tumor effects. Research on the critical roles of CC and CXC chemokines regulatory networks in the tumor microenvironment and their targeted therapeutic strategies provides an important theoretical basis and clinical application prospects for the treatment of malignant tumors. Figures and Tables | References | Related Articles | Metrics

Role of microchimerism in the occurrence and progression of malignant tumors Liu Kai, Liao Zhipeng, Du Aichao, Dong Zhiqiang 2026, 53 (4):  229-233.  doi: 10.3760/cma.j.cn371439-20250704-00038 Abstract ( 8 )   HTML ( 2 )   PDF (756KB) ( 5 )   Save Microchimerism， as a unique phenomenon of cellular coexistence， can be classified into fetal， maternal， and iatrogenic types. It plays a complex role in the occurrence and progression of malignant tumors. Studies indicate that microchimerism exerts bidirectional effects in tumors， functioning either as tumor-suppressive or tumor-promoting depending on factors such as cellular origin， host immune status， and tumor type. To date， the research focus is mainly on fetal microchimerism， while evidence regarding maternal and iatrogenic microchimerism remains limited， and their biological significance requires further clarification. Moreover， most existing studies rely on peripheral blood detection， with a lack of systematic investigation at the tissue level regarding lineage composition and causal mechanisms. Future studies should integrate multi-omics approaches and in vivo models to elucidate the dynamic roles of microchimerism within the tumor microenvironment and to evaluate its potential value in tumor diagnosis， prognosis， and immunotherapy. References | Related Articles | Metrics

Research progress of PD-1/PD-L1 inhibitor in the treatment of head and neck squamous cell carcinoma Zhang Ao, Cui Yu 2026, 53 (4):  234-239.  doi: 10.3760/cma.j.cn371439-20250513-00039 Abstract ( 13 )   HTML ( 3 )   PDF (819KB) ( 4 )   Save Head and neck squamous cell carcinoma （HNSCC） has a poor prognosis， and the survival rate of advanced patients is low. Immune checkpoint inhibitors have become an important treatment for recurrent or metastatic HNSCC， significantly improving the prognosis of patients. However， they still face challenges such as primary drug resistance， biomarker heterogeneity， and immune-related adverse reactions. Among them， programmed death-1/programmed death-ligand 1 inhibitors serve as cornerstone agents in cancer immunotherapy； thus， a comprehensive， multi-dimensional analysis of their resistance mechanisms is essential to overcoming current treatment limitations. To systematically explore the research progress of monotherapy and combined treatment strategies of programmed death-1/programmed death-ligand 1 inhibitors in HNSCC， and to reveal the regulatory role of multiple immune escape networks in the tumor microenvironment， can provide a theoretical basis for analyzing the mechanism of drug resistance and guiding precise treatment. References | Related Articles | Metrics

Current status and advances in the medical treatment of esophageal cancer Tong Xinyu, Yang Jing, Wang Minglei, Huang Chengsuo, Luo Yingshu, Peng Jieqiong, Han Shumei, Liu Bo 2026, 53 (4):  240-247.  doi: 10.3760/cma.j.cn371439-20250704-00040 Abstract ( 10 )   HTML ( 3 )   PDF (834KB) ( 3 )   Save The systemic treatment landscape has undergone profound transformation with breakthroughs in immunotherapy and targeted therapy. In cases of resectable locally advanced esophageal cancer， neoadjuvant therapy strategies continue to be optimized. For patients with unresectable locally advanced cancer， definitive concurrent chemoradiotherapy remains the standard treatment， and the exploration of subsequent immunotherapy consolidation is ongoing. First-line treatment for metastatic or recurrent esophageal cancer has entered the era of immunotherapy combined with chemotherapy， which has significantly improved patient survival. In terms of later-line treatment， immunotherapy alone has shown superior efficacy to chemotherapy in specific populations. Meanwhile， precise treatments targeting HER2， Claudin 18.2， FGFR2b， etc. have also provided new options for selected patients.Analyzing the progress of medical management of esophageal cancer across different disease stages （resectable， unresectable， metastatic or recurrent） and histological subtypes （squamous cell carcinoma and adenocarcinoma）， along with systematically reviewing key clinical evidence and current challenges， aims to provide reference for clinical practice. Figures and Tables | References | Related Articles | Metrics

Research progress on pathological response after neoadjuvant chemoradiotherapy in locally advanced middle and low rectal cancer Li Zhilei, Fang Jinman, Wei Dandan, Sun Ruixia, Zhang Yuanwei 2026, 53 (4):  248-252.  doi: 10.3760/cma.j.cn371439-20250727-00041 Abstract ( 10 )   HTML ( 3 )   PDF (763KB) ( 3 )   Save Neoadjuvant chemoradiotherapy for locally advanced rectal cancer significantly downstages tumors， which can improve the rate of radical surgical resection and anal sphincter preservation， reduce the local recurrence rate， thereby improving patients' prognosis. However， there is currently a lack of effective methods to identify patients' response to neoadjuvant therapy. Studies have found that biological indicators such as hematological markers， tumor markers， nucleic acid markers， as well as tumor imaging characteristics， are associated with the sensitivity of neoadjuvant therapy for rectal cancer and can predict the sensitivity of preoperative concurrent chemoradiotherapy. References | Related Articles | Metrics