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    08 July 2026, Volume 53 Issue 7 Previous Issue   
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    Humanities in Medicine
    Medical reflections on a century of cancer history—a critical engagement with The Emperor of All Maladies A Biography of Cancer
    Tian Jin
    2026, 53 (7):  385-387.  doi: 10.3760/cma.j.cn371439-20260323-00053
    Abstract ( 17 )   HTML ( 1 )   PDF (794KB) ( 7 )   Save

    American oncologist Siddhartha Mukherjee's The Emperor of All Maladies A Biography of Cancer traces over a century of cancer diagnosis and treatment, illuminating the cognitive costs and institutional challenges underlying the technological advances of modern oncology. This article reflects on three core propositions derived from the work. First, the modern rise in cancer incidence is partly a structural consequence of medicine's success in extending human lifespan, rather than a simple expansion of disease itself. Second, from the invention of radical mastectomy to the origins of chemotherapy, the history of cancer treatment is simultaneously a history of errors driven by excessive clinical certainty, the limitations of which were in each era historically inevitable. Third, there exists a systemic mismatch between the time benefits of preventive medicine and the incentive structures of contemporary medical institutions—a tension no less present in China's own oncology practice. On this basis, the article argues that framing cancer as a medical challenge requiring sustained engagement in an era of longevity carries greater epistemological value than the prevailing "war" metaphor, and better reflects the practical orientation of contemporary oncology.

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    Standard and Specification
    Chinese expert consensus on the correlation between intestinal microecology and hematopoietic stem cell transplantation (2026 Edition)
    Tumor and Microecology Committee of the Chinese Anti-Cancer Association
    2026, 53 (7):  388-397.  doi: 10.3760/cma.j.cn371439-20260308-00054
    Abstract ( 24 )   HTML ( 2 )   PDF (968KB) ( 12 )   Save

    Hematopoietic stem cell transplantation (HSCT) affects intestinal flora homeostasis, and intestinal microecology may also affect the prognosis of HSCT patients through multiple mechanisms. To gain a deeper understanding of intestinal microecology and HSCT to address the key issues of correlation, and to learn and absorb the latest research progress, the Tumor and Microecology Committee of the Chinese Anti-Cancer Association organized relevant experts to revise on the basis of the "Chinese expert consensus on the correlation between intestinal microecology and hematopoietic stem cell transplantation " (2021 Edition) and proposed the "Chinese expert consensus on the correlation between intestinal microecology and hematopoietic stem cell transplantation (2026 Edition)". This consensus, based on the latest domestic and international literature and combined with the latest technology and research in the discipline, presents 9 recommendations regarding issues such as the indications of intestinal microecology in hematopoietic stem cell transplantation, for clinicians to refer to in practice. This consensus can not only provide practical guidance for clinicians, but also lay a foundation for further in-depth research in the fields of oncology and microecology.

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    Intensive Reading of Guideline
    Interpretation of the "2025 Korean Thyroid Association clinical management guideline on active surveillance for low-risk papillary thyroid carcinoma"
    Wang Xingyue, Liu Qinjiang
    2026, 53 (7):  398-403.  doi: 10.3760/cma.j.cn371439-20251229-00065
    Abstract ( 11 )   HTML ( 0 )   PDF (1478KB) ( 4 )   Save

    In recent years, the clinical active surveillance (AS) for low-risk papillary thyroid carcinoma has been approached with extreme caution by both domestic and international guidelines, and there has even been controversy. The "2025 Korean Thyroid Association clinical management guideline on active surveillance for low-risk papillary thyroid carcinoma" comprehensively delineate the assessment and screening of the appropriate population for AS in low-risk papillary thyroid carcinoma. The guidelines recommend clinical management protocols during AS, and outline the indications for surgical intervention during the AS period. Based on relevant domestic and international guidelines, a comparative analysis is now conducted on the characteristics of patients with AS who are suitable for treatment at the age of 19 or above, the follow-up strategy dominated by ultrasound examinations, and the timing of surgical intervention in the event of tumor progression during AS, with the aim of offering references for clinical practice.

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    Original Article
    Comparison of curative effects between facial-submental artery island flap and free forearm flap in repairing post-resection defects of tongue squamous cell carcinoma
    Tan Chen, Dong Baoling, Han Shengwei
    2026, 53 (7):  404-411.  doi: 10.3760/cma.j.cn371439-20251015-00056
    Abstract ( 6 )   HTML ( 1 )   PDF (3170KB) ( 2 )   Save

    Objective To compare the curative effects of facial-submental artery island flap and free forearm flap in repairing post-resection defects of tongue squamous cell carcinoma. Methods A retrospective analysis was conducted on the clinical data of 133 patients with tongue squamous cell carcinoma who underwent radical tumor resection followed by defect reconstruction at the Affiliated Stomatological Hospital of Medical School of Nanjing University from January 2019 to January 2023. Patients were divided into two groups based on the flap type: the submental group (n=66, reconstructed with facial-submental artery island flap) and the forearm group (n=67, reconstructed with free forearm flap). The surgical related indicators (intraoperative blood loss, operative duration, length of hospital stay, and flap survival rate), pre- and post-operative oral function [mouth opening degree, Standardized Swallowing Assessment (SSA) score, and mastication score], quality of life [scores on the Generic Quality of Life Inventory 74 (GQOLI-74, including psychological function, physical function, social function, and material living status domains)], complications (hematoma, graded according to the Clavien-Dindo classification), donor site adverse events (scar hyperplasia, pigmentation, numbness/paresthesia) and lymph node metastasis rate within 18 months after surgery were compared between the two groups. Results The submental group exhibited significantly lower intraoperative blood loss [(242.57±25.39) ml vs. (326.29±35.94) ml, t=15.50, P<0.001], shorter operative duration [(356.28±32.68) min vs. (408.31±48.31) min, t=7.26, P<0.001], and shorter hospital stay [(13.84±2.92) d vs. (17.41±3.84) d, t=6.03, P<0.001] compared to the forearm group. The flap survival rates in the submental group and forearm group were 100% (66/66) and 95.52% (64/67), respectively, with no statistically significant difference (χ2=1.33, P=0.248). No significant intergroup differences were observed in post-operative mouth opening degree [(2.81±0.35) cm vs. (2.73±0.31) cm, t=1.40, P=0.165] or SSA score [(29.72±3.05) points vs. (30.28±3.34) points, t=1.01, P=0.315]. However, the submental group had a significantly higher post-operative mastication score [(3.36±0.35) points vs. (3.14±0.27) points, t=4.06, P<0.001]. Both groups showed significant improvements in mouth opening degree and mastication score, and a significant reduction in SSA score post-operatively (all P<0.05). In terms of quality of life, post-operatively, the submental group scored significantly higher compared with the forearm group in all GQOLI-74 domains: psychological function [(70.34±3.15) points vs. (68.52±2.95) points, t=3.44, P<0.001], physical function [(71.58±3.21) points vs. (69.34±3.76) points, t=3.69, P<0.001], social function [(70.25±3.77) points vs. (68.36±2.70) points, t=3.33, P=0.001], material living status [(72.48±3.20) points vs. (70.18±2.85) points, t=4.38, P<0.001]. Both groups demonstrated significant post-operative improvements in all GQOLI-74 domains (all P<0.05). Compared with the forearm group, the submental group had significantly lower rates of hematoma [1.52% (1/66) vs. 11.94% (8/67), χ2=4.19, P=0.041], scar hyperplasia [0 (0/66) vs. 14.93% (10/67), χ2=10.65, P=0.001], pigmentation [6.67% (4/66) vs. 29.85% (20/67), χ2=12.72, P<0.001], and numbness/paresthesia [7.58% (5/66) vs. 32.84% (22/67), χ2=13.11, P<0.001]. Clavien-Dindo classification revealed a significantly more favorable complication severity profile in the submental group [58 cases (87.88%) of grade 0, 6 cases (9.09%) of grade Ⅰ, 2 cases (3.03%) of grade Ⅱ] compared to the forearm group [20 cases (29.85%) of grade 0, 25 cases (37.31%) of grade Ⅰ, 15 cases (22.39%) of grade Ⅱ, 5 cases (7.46%) of grade Ⅲ, 2 cases (2.99%) of grade Ⅳ; Z=4.53, P<0.001]. There was no statistically significant difference in lymph node metastasis rates within 18 months postoperatively between groups [15.15% (10/66) vs. 13.43% (9/67), χ2=0.08, P=0.777]. Conclusions Both free forearm flap and facial-submental artery island flap are effective for reconstructing soft tissue defects after radical tongue cancer resection. However, the facial-submental artery island flap offers superior outcomes in reducing operative duration, blood loss, and complication rates, while improving mastication function and overall quality of life.

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    Predictive value of XGBoost model for pathological complete response after neoadjuvant chemotherapy in breast cancer patients
    Liu Yonghong, Zhang Bo, Xue Lingbo, Hu Pengfei, Zhang Zhenyu, Li Jie
    2026, 53 (7):  412-419.  doi: 10.3760/cma.j.cn371439-20251019-00057
    Abstract ( 5 )   HTML ( 0 )   PDF (2007KB) ( 4 )   Save

    Objective To investigate the predictive value of extreme gradient boosting (XGBoost) model for pathological complete response (pCR) after neoadjuvant chemotherapy in breast cancer patients. Methods The clinical data of 172 breast cancer patients admitted to the Main Campus of Cangzhou Central Hospital of Hebei Province from January 2010 to December 2024 (internal dataset) and 41 patients admitted to the Branch Campus (external validation dataset) were retrospectively analyzed. The 172 patients were divided into an internal training dataset and an internal validation dataset at a ratio of 7∶3. The internal training dataset was used to build the XGBoost model, and the internal validation dataset was used for internal validation. The data of 41 patients of the external validation dataset were used for external validation. The influencing factors affecting pCR in breast cancer patients receiving neoadjuvant chemotherapy were screened by logistic regression analysis, and the area under the curve (AUC) of the XGBoost model for predicting pCR were analyzed by receiver operator characteristic (ROC) curve. A nomogram model was constructed based on the influencing factors identified by logistic regression analysis, and the differences of AUC between the XGBoost and the nomogram model were compared by DeLong test. The Shapley additive explanation (SHAP) scatter plot was applied for interpretable analysis on the XGBoost model. Results Among 172 breast cancer patients in internal dataset, 30 (17.4%) cases achieved pCR after neoadjuvant chemotherapy. There were statistically significant differences in the maximum tumor diameter (χ2=5.07, P=0.024), axillary lymph node status (χ2=10.85, P<0.001), human epidermal grouth factor receptor 2 (χ2=3.97, P=0.046), Ki-67 expression (χ2=5.50, P=0.019), neoadjuvant chemotherapy regimen (P=0.047), and targeted therapy (χ2=4.22, P=0.040) between the pCR group and non-pCR group. Multivariate analysis showed that the maximum tumor diameter (OR=3.32, 95%CI: 1.12-9.91, P=0.031), axillary lymph node status (OR=7.86, 95%CI: 1.83-33.63, P=0.005), Ki-67 expression (OR=4.84, 95%CI: 1.16-20.25, P=0.031), and targeted therapy (OR=0.11, 95%CI: 0.02-0.60, P=0.011) were independent influencing factors for pCR in breast cancer patients undergoing neoadjuvant chemotherapy. SHAP analysis showed that the variable importance of XGBoost model were axillary lymph node status, Ki-67 expression, the maximum tumor diameter, and targeted therapy. Axillary lymph node positivity was the most important risk factor for pCR in breast cancer patients undergoing neoadjuvant chemotherapy. The ROC curve analysis showed that in the internal training dataset, the AUC of XGBoost model for predicting pCR in breast cancer patients undergoing neoadjuvant chemotherapy was 0.84, while that of the nomogram model was 0.79 (Z=0.68, P=0.496). In the internal validation dataset, the AUC of XGBoost model was 0.75, and that of the nomogram model was 0.70 (Z=0.37, P=0.714). In the external validation dataset, the AUC of the XGBoost model was 0.81, and that of the nomogram model was 0.79 (Z=0.15, P=0.884). There were no statistically significant differences. Conclusions The XGBoost model based on axillary lymph node status, Ki-67 expression, the maximum tumor diameter and targeted therapy can effectively predict pCR after neoadjuvant chemotherapy in breast cancer patients.

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    Predictive value of inflammatory burden index on postoperative bone metastasis in non-small cell lung cancer
    Hong Yanfen, Kui Guoju, Yu Le, Lai Minghong, Huang Jiangbin
    2026, 53 (7):  420-425.  doi: 10.3760/cma.j.cn371439-20250911-00058
    Abstract ( 6 )   HTML ( 1 )   PDF (1046KB) ( 1 )   Save

    Objective To investigate the predictive value of inflammatory burden index (IBI) on postoperative bone metastasis in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on the clinical data of 136 NSCLC patients admitted to the 909th Hospital from January 2020 to December 2021. The patients were divided into bone metastasis group (n=46) and non-bone metastasis group (n=90) according to the presence or absence of bone metastasis. General and clinical data of the patients were collected. Multivariate logistic regression analysis was used to identify risk factors for postoperative bone metastasis in NSCLC patients. Receiver operator characteristic (ROC) curve was plotted to analyze the predictive efficacy of IBI for postoperative bone metastasis in NSCLC and determine the optimal cut-off value. Kaplan-Meier curve was drawn to compare the difference in the incidence of postoperative bone metastasis in NSCLC patients with different IBI levels. Results There were no statistically significant differences in general data such as age, gender, family history of lung cancer, and smoking history between the two groups (all P>0.05). The levels of neutrophil count (t=3.62, P=0.001), C-reactive protein (t=2.73, P=0.007), and IBI (t=5.18, P<0.001) in the bone metastasis group were higher than those in the non-bone metastasis group. The proportions of carcinoembryonic antigen (CEA) ≥5 ng/ml (χ2=12.41, P<0.001), maximum tumor diameter ≥5 cm (χ2=8.57, P=0.003), lymph node metastasis (χ2=7.92, P=0.005), and TNM stage Ⅲ (χ2=10.13, P=0.001) in the bone metastasis group were higher than those in the non-bone metastasis group, while the level of lymphocyte count was lower than that in the non-bone metastasis group (t=-2.60, P=0.010). Multivariate analysis showed that IBI (OR=6.00, 95%CI: 1.85-8.41, P=0.004), CEA ≥5 ng/ml (OR=3.50, 95%CI: 1.31-9.34, P=0.012), maximum tumor diameter ≥5 cm (OR=5.04, 95%CI: 1.47-7.32, P=0.010), lymph node metastasis (OR=7.64, 95%CI: 2.38-11.53, P=0.001), and TNM stage Ⅲ (OR=3.08, 95%CI: 1.08-8.76, P=0.035) were independent risk factors for postoperative bone metastasis in NSCLC patients. ROC curve analysis showed that the area under the curve of IBI for predicting postoperative bone metastasis in NSCLC patients was 0.75 (95%CI: 0.66-0.84), with a specificity of 0.78, a sensitivity of 0.91, and the optimal cut-off value was 8.51. Kaplan-Meier risk curve analysis showed that the 3-year incidence of bone metastasis after surgery in NSCLC patients with IBI ≥ 8.51 was 45.16%, which was significantly higher than the 9.30% in patients with IBI < 8.51 (χ2=15.29, P<0.001). Conclusions The IBI is an independent influencing factor for postoperative bone metastasis in patients with NSCLC, and it has certain predictive value for the occurrence of bone metastasis in NSCLC patients 3 years after surgery.

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    Efficacy and safety of concurrent radiotherapy combined with tegafur suppositories and immune checkpoint inhibitors in the treatment of elderly patients with esophageal cancer
    Ma Chiluan, Jia Dianjun, Wei Dongdong, Wang Jingrun, Li Xinping, Zhao Boyan, Zhao Yue
    2026, 53 (7):  426-433.  doi: 10.3760/cma.j.cn371439-20251009-00059
    Abstract ( 9 )   HTML ( 1 )   PDF (1040KB) ( 0 )   Save

    Objective To analyze the efficacy and safety of concurrent radiotherapy combined with tegafur suppositories and immune checkpoint inhibitors in the treatment of elderly patients with esophageal cancer. Methods The clinical data of 52 elderly patients (aged ≥65 years) with unresectable esophageal squamous cell carcinoma who received concurrent chemoradiotherapy with or without immune checkpoint inhibitors in Cangzhou Central Hospital of Hebei Province from December 2019 to April 2025 were collected. According to whether the patients received immune checkpoint inhibitors during concurrent radiotherapy and tegafur suppository chemotherapy, they were divided into the concurrent chemoradiotherapy plus immunotherapy group [concurrent radiotherapy with tegafur suppositories combined with programmed death-1 (PD-1) inhibitors, tegafur suppositories combined with PD-1 inhibitors were administered for up to 2 years—or until disease progression, unacceptable toxicity, or patient withdrawal, n=27] and the concurrent chemoradiotherapy group (concurrent radiotherapy with tegafur suppositories, tegafur suppositories were administered for up to 2 years—or until disease progression, unacceptable toxicity, or patient withdrawal, n=25). All patients underwent comprehensive reassessment 1-3 months after treatment completion to determine tumor response. The objective response rate (ORR), progression-free survival (PFS), overall survival (OS), adverse reactions, etc. were analyzed and compared between the two groups. Survival outcomes were estimated using the Kaplan-Meier method and compared via log-rank tests. The Cox proportional risk regression model was performed to identify prognostic influencing factors. Results The ORR of the concurrent chemoradiotherapy plus immunotherapy group and the concurrent chemoradiotherapy group were 55.6% (15/27) and 24.0% (6/25), respectively, with statistically significant difference (χ2=5.37, P=0.020). The median PFS of the concurrent chemoradiotherapy plus immunotherapy group and the concurrent chemoradiotherapy group were 19.0 and 10.0 months, respectively; and the median OS were 33.3 months and 23.3 months, respectively, with statistically significant differences (χ2=10.60, P=0.001; χ2=5.10, P=0.024). Univariate analysis revealed that Eastem Cooperative Oncology Group (ECOG) performance status (PS) score (HR=5.02, 95%CI: 2.40-10.53, P<0.001; HR=10.32, 95%CI: 3.55-30.04, P<0.001), TNM stage (HR=6.14, 95%CI: 2.80-13.42, P<0.001; HR=5.93, 95%CI: 2.32-15.15, P<0.001), and treatment modality (HR=0.36, 95%CI: 0.19-0.68, P=0.002; HR=0.39, 95%CI: 0.17-0.91, P=0.030) were influencing factors of both PFS and OS of patients. Multivariate analysis confirmed TNM stage (HR=5.65, 95%CI: 2.07-15.43, P=0.001) and treatment modality (HR=0.32, 95%CI: 0.16-0.64, P=0.001) as independent factors influencing PFS, and ECOG PS score (HR=5.31, 95%CI: 1.59-17.73, P=0.007) and TNM stage (HR=3.36, 95%CI: 1.10-10.29, P=0.034) as independent factors influencing OS. Adverse reactions of the two groups of patients were mainly radiation esophagitis, radiation pneumonitis, hematological toxicity, nausea/vomiting, etc. which were mostly grade 1-2, and resolved after symptomatic treatment or termination of treatment. The incidence rates of radiation pneumonitis were 51.9% (14/27) in the concurrent chemoradiotherapy plus immunotherapy group and 44.0% (11/25) in the concurrent chemoradiotherapy group, with no statistically significant difference (χ2=0.32, P=0.571). Conclusions Concurrent radiotherapy combined with tegafur suppositories and immune checkpoint inhibitors demonstrates superior antitumor efficacy and acceptable safety in elderly patients with unresectable esophageal squamous cell carcinoma.

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    Review
    Research progress of oncolytic viruses in reversing tumor immune therapy resistance
    Gao Yuqiong, Diao Jie, Yin Hong
    2026, 53 (7):  434-438.  doi: 10.3760/cma.j.cn371439-20250727-00060
    Abstract ( 8 )   HTML ( 1 )   PDF (830KB) ( 2 )   Save

    Oncolytic viruses, as an innovative therapy with multiple anti-tumor mechanisms, have shown significant potential in reversing immune therapy resistance. Research on the technological evolution of oncolytic viruses indicates that they gradually overcome tumor drug resistance through mechanism innovation. In the field of tumor immunotherapy, oncolytic virus therapy is undergoing significant technological advancements. It has evolved from early virus selective replication to gene-engineered vectors capable of carrying multiple immune regulatory factors, which can reverse immune therapy resistance. In terms of clinical translation and application, both monotherapy and combination therapy have demonstrated good therapeutic potential. Exploring the synergistic mechanisms of oncolytic virus combination therapy and analyzing the challenges and future development directions in clinical translation can provide new ideas for overcoming tumor immune resistance.

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    Research progress on the malignant biological behavior of osteosarcoma based on epithelial-mesenchymal transition
    Zhang Tiantao, Xu Shihong, Wang Peixin, Wang Xiaoqiang, Li Kai, Zhao Jun
    2026, 53 (7):  439-444.  doi: 10.3760/cma.j.cn371439-20251128-00071
    Abstract ( 7 )   HTML ( 2 )   PDF (846KB) ( 2 )   Save

    Osteosarcoma is the most common primary malignant bone tumor in adolescents, characterized by strong invasiveness and poor prognosis. Despite continuous advances in diagnostic and therapeutic methods, patient survival rates have not shown significant improvement, making it particularly urgent to deeply elucidate the mechanisms underlying its occurrence and progression. Epithelial-mesenchymal transition (EMT) is a core biological process driving the malignant progression of osteosarcoma, influencing patient prognosis by promoting tumor cell migration, invasion, and proliferation, inducing cancer stem cell characteristics and chemotherapy resistance. However, the dynamic reversibility of EMT, the intratumoral heterogeneity, and the limitations of current in vitro/in vivo models constrain its clinical translation and application. Nevertheless, in-depth analysis of its regulatory mechanisms and targeted inhibition of EMT through epigenetic modulation, tumor microenvironment intervention, and key signaling pathway blockade in osteosarcoma hold promise for breaking through therapeutic bottlenecks, providing new directions for overcoming tumor metastasis and drug resistance, and ultimately improving patient prognosis.

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