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08 October 2026, Volume 53 Issue 10 Previous Issue   

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Humanities in Medicine

My science popularization odyssey：rooted in personal growth，branching across disciplines Zhang Mingxin 2026, 53 (10):  577-583.  doi: 10.3760/cma.j.cn371439-20260522-00092 Abstract ( 10 )   HTML ( 2 )   PDF (5391KB) ( 6 )   Save Medical science popularization has drawn growing attention for its role in improving public health literacy，promoting early screening and diagnosis of diseases，and facilitating the high-quality development of medical disciplines. Drawing on nearly a decade of practice in health communication on digestive system diseases，this article systematically summarizes the implementation pathways and outcomes of individual and team medical science popularization work. Through the integration of internet-based medical science popularization，the "Xiaohuaxin Qingnian" （Digestive Youth） team development，and the "1+3+N" integrated medical science popularization communication model，a multi-platform medical science popularization dissemination matrix and a work system centered on public health literacy enhancement have been established. These practices have achieved remarkable results in promoting the standardized management of Helicobacter pylori infection，the coverage of early digestive tract cancer screening，and the improvement of regional healthcare service capacity，while also promoting disciplinary development and talent cultivation. It is proposed that a systematic framework for medical science popularization can not only effectively improve public health literacy，but also serve as a critical driver for disciplinary advancement and healthcare service innovation，offering a replicable model for the implementation of the "Healthy China" initiative. Figures and Tables | References | Related Articles | Metrics

Original Article

Value of an interpretable machine learning model based on intratumoral and peritumoral ultrasound radiomics for predicting PD-L1 expression status in breast cancer Chen Qiaoliang, Qin Xinyan, Du Haiwen, Tan Shuangxiu 2026, 53 (10):  584-590.  doi: 10.3760/cma.j.cn371439-20260119-00093 Abstract ( 7 )   HTML ( 2 )   PDF (1383KB) ( 0 )   Save Objective To investigate the value of intratumoral and peritumoral ultrasound radiomics features in predicting programmed death-ligand 1 （PD-L1） expression status in breast cancer and to construct an interpretable machine learning model. Methods A total of 101 breast cancer patients admitted at Nanjing Drum Tower Hospital from July 2017 to May 2022 were selected as the study subjects， including 48 cases of PD-L1-positive and 53 cases of PD-L1-negative. Patients were randomly divided into a training set （n=71） and a validation set （n=30） at a 7∶3 ratio. The age， tumor location， maximum tumor diameter， minimum tumor diameter， breast imaging reporting and data system （BI-RADS） category， histological grade and molecular subtype were compared between patients with PD-L1 positive and PD-L1 negative. A total of 976 radiomics features were extracted from both intratumoral and peritumoral 5 mm regions. Optimal radiomics features were selected using t-test and least absolute shrinkage and selection operator （LASSO） regression， and a radiomics score （RS） was constructed. The extreme gradient boosting （XGBoost） machine learning algorithm was used to construct a combined model for predicting PD-L1 expression. Model performance was evaluated using receiver operator characteristic （ROC） curve analysis. Interpretability of the XGBoost model was assessed using Shapley additive explanation （SHAP） analysis. Results In the training set， there was a statistically significant difference in histological grade between PD-L1-positive （n=33） and PD-L1-negative （n=38） groups （Z=-2.56， P=0.010）， whereas there were no statistically significant differences in age， tumor location， maximum tumor diameter， minimum tumor diameter， BI-RADS category， or molecular subtype （all P>0.05）. A total of 9 and 8 optimal radiomics features were screened from the intratumoral and peritumoral regions， respectively. Based on the above features， the intratumoral RS and peritumoral RS were respectively constructed. The intratumoral RS=-0.514 + 0.428×original_ ngtdm_ Contrast-0.153×wavelet_ HL_ glcm_ Correlation-1.224×wavelet_ HH_ glcm_ Id + 0.376×exponential_ gldm_ SmallDependenceLowGrayLevelEmphasis + 0.034×exponential_ glcm_ Idmn-1.006×gradient_ ngtdm_ Busyness + 0.365×gradient_ ngtdm_ Coarseness-0.893×logarithm_ glcm_ DifferenceVariance + 0.291×square_ glcm_ DifferenceVariance. The peritumoral RS=-0.463 + 0.391×wavelet_ LH_ firstorder_ Mean-0.715×wavelet_ LH_ firstorder_ Skewness-0.421×wavelet_ LH_ glcm_ Correlation-0.444×wavelet_ LL_ gldm_ DependenceNonUniformityNormalized + 0.859×logarithm_ glcm_ Correlation + 0.835×logarithm_ glcm_ InverseVariance + 0.392×square_ glcm_ Imc2-0.463×square_ glrlm_ GrayLevelNonUniformityNormalized. A combined model incorporating intratumoral RS， peritumoral RS， and histological grade was built using the XGBoost model. ROC curve analysis demonstrated that， the area under the curve of the combined model for predicting PD-L1 expression status in breast cancer patients was 0.909 （95%CI：0.817-0.965） and 0.864 （95%CI：0.690-0.961） in the training and validation sets， respectively. SHAP analysis revealed that peritumoral RS was the most predictive feature in the XGBoost model， followed by intratumoral RS and histological grade. Conclusions The XGBoost model integrating ultrasound intratumoral RS， peritumoral RS， and histological grade effectively predicts PD-L1 expression status in breast cancer， with peritumoral RS being the most valuable predictive feature. Figures and Tables | References | Related Articles | Metrics

Predictive value of F-PLR score and LMR for the prognosis of patients with esophageal cancer receiving neoadjuvant immunotherapy combined with chemotherapy Cui Xiaohui, Miao Yanan, Cao Ranhua 2026, 53 (10):  591-599.  doi: 10.3760/cma.j.cn371439-20251223-00094 Abstract ( 6 )   HTML ( 1 )   PDF (1349KB) ( 0 )   Save Objective To explore the predictive value of the pre-treatment fibrinogen combined with platelet-to-lymphocyte ratio （F-PLR） score and the lymphocyte-to-monocyte ratio （LMR） for the prognosis of patients with esophageal cancer receiving radical surgery after neoadjuvant immunotherapy combined with chemotherapy. Methods A retrospective analysis was conducted on the clinical data of 113 patients diagnosed with esophageal cancer and underwent radical esophageal cancer surgery after neoadjuvant immunotherapy combined with chemotherapy at the Affiliated Hospital of Inner Mongolia Medical University from January 2020 to December 2023. Optimal cut-off values for fibrinogen， platelet-to-lymphocyte ratio （PLR）， and LMR in predicting overall survival （OS） were determined by receiver operator characteristic （ROC） curve analysis. Patients were stratified into groups based on the F-PLR score and LMR optimal cut-off. Between-group comparisons of clinicopathological characteristics were performed using the chi-square test. The survival curve was plotted using the Kaplan-Meier method， with differences assessed via the log-rank test. Univariate and multivariate prognostic analysis was conducted using Cox proportional hazards regression model. Results ROC curve analysis showed that the areas under the curve （AUCs） for fibrinogen， PLR， F-PLR score， and LMR were 0.635， 0.710， 0.757， and 0.757， respectively. The optimal cut-off values were 3.71 g/L for fibrinogen， 129.19 for PLR， and 4.36 for LMR. Patients with different F-PLR scores （0 point， n=60； 1 point， n=34； and 2 points， n=19） showed statistically significant differences in tumor length （χ2=8.56， P=0.014）， clinical stage （χ2=9.16， P=0.010）， and T stage （χ2=10.27， P=0.006）. There were statistically significant differences in the levels of LMR （≥4.36， n=40； <4.36， n=73） among patients with different smoking history （χ²=5.72， P=0.017） and clinical stage （χ²=4.51， P=0.034）. Kaplan-Meier analysis revealed that the median progression-free survival （PFS） for patients with F-PLR scores of 0， 1， and 2 points were not reached， 34 months， and 26 months， respectively， and the median OS were not reached， 35 months， and 29 months， respectively， with statistically significant differences （χ²=8.46， P=0.015； χ²=21.32， P<0.001）. The median PFS for the high-LMR group and low-LMR group were not reached and 34 months， respectively， and the median OS were not reached and 37 months， respectively， with statistically significant differences（χ²=4.56， P=0.033； χ²=18.44， P<0.001）. Univariate analysis showed that tumor location （HR=0.52， 95%CI：0.28-0.97， P=0.041）， clinical stage （HR=5.71， 95%CI：2.84-11.48， P<0.001）， T stage （HR=2.49， 95%CI：1.28-4.85， P=0.007）， N stage （HR=4.38， 95%CI：2.27-8.48， P<0.001）， PLR （HR=2.43， 95%CI：1.30-4.53， P=0.005）， and F-PLR score of 2 （HR=2.86， 95%CI：1.31-6.26， P=0.008） were the influencing factors of PFS in patients with esophageal cancer who underwent radical surgery following neoadjuvant immunotherapy combined with chemotherapy， while pathological type （HR=3.46， 95%CI：1.41-8.51， P=0.007）， clinical stage （HR=5.66， 95%CI：2.69-11.92， P<0.001）， T stage （HR=5.01， 95%CI：2.05-12.29， P<0.001）， N stage （HR=2.90， 95%CI：1.42-5.92， P=0.003）， fibrinogen （HR=2.69， 95%CI：1.34-5.42， P=0.005）， PLR （HR=4.27， 95%CI：2.01-9.05， P<0.001）， F-PLR score of 1 （HR=5.62， 95%CI：2.17-14.54， P<0.001）， F-PLR score of 2 （HR=6.46， 95%CI：2.36-17.65， P<0.001）， and LMR （HR=0.05， 95%CI：0.01-0.35， P=0.003） were the influencing factors of OS in these patients. Multivariate analysis showed that tumor location （HR=0.36， 95%CI：0.19-0.71， P=0.003） and N stage （HR=2.85， 95%CI：1.05-7.73， P=0.040） were independent influencing factors for PFS， whereas T stage （HR=4.34， 95%CI：1.51-12.42， P=0.006） and LMR （HR=0.06， 95%CI：0.01-0.48， P=0.008） were independent influencing factors for OS in patients with esophageal cancer who underwent radical surgery following neoadjuvant immunotherapy combined with chemotherapy. Conclusions Pre-treatment LMR has predictive value for OS， while the F-PLR score is not an independent influencing factor for either PFS or OS in patients with esophageal cancer receiving neoadjuvant immunotherapy combined with chemotherapy. Figures and Tables | References | Related Articles | Metrics

A progression-free survival prediction model based on KELIM score for patients with high-grade serous ovarian carcinoma after NACT+IDS treatment Li Ping, Chen Zhenyun, Niu Hongpeng 2026, 53 (10):  600-607.  doi: 10.3760/cma.j.cn371439-20251217-00095 Abstract ( 6 )   HTML ( 1 )   PDF (1879KB) ( 0 )   Save Objective To construct a progression-free survival prediction model based on the modeled carbohydrate antigen 125 （CA125） elimination rate constant K （KELIM） for patients with high-grade serous ovarian carcinoma （HGSOC） after neoadjuvant chemotherapy （NACT） and interval debulking surgery （IDS）. Methods The clinical data of 180 HGSOC patients who received NACT+IDS treatment at Linyi Cancer Hospital，Shandong Province from May 2022 to January 2024 were retrospectively collected. Patients were divided into a training set （126 cases） and a validation set （54 cases） in a 7∶3 ratio. The KELIM score during NACT was calculated. Kaplan-Meier method and log-rank test were used to compare the survival differences of patients with different KELIM scores，and multivariate Cox proportional hazard regression model was used to analyze the influencing factors of PFS. The prediction model of PFS after NACT+IDS treatment in HGSOC patients was constructed based on the KELIM score. The predictive efficacy of the PFS prediction model based on KELIM score were evaluated by receiver operator characteristic （ROC） curve and calibration curve. Results Among the HGSOC patients in the training set，59 cases had KELIM scores ≥1 point，and 67 cases had KELIM scores <1 point. Forty-five cases （35.71%） died due to disease progression or all-cause within one year after treatment. The restricted mean survival time （RMST） for PFS （11.3 months vs. 9.1 months） and for OS （11.7 months vs. 10.9 months） of the KELIM score ≥1 group were longer than those of the <1 group （χ2=14.07，P<0.001； χ2=4.74，P=0.030）. The proportion of patients aged ≥60 years with disease progression or all-cause mortality （χ2=6.37，P=0.012），patients in the International Federation of Gynecology and Obstetrics （FIGO） stage Ⅳ （χ2=7.62，P=0.006），postoperative non-R0 tumor residual （χ2=6.61，P=0.010），and KELIM score <1 （χ2=11.43，P<0.001） were higher than those who survived without progression. Multivariate analysis showed that age ≥60 years （HR=2.82，95%CI：1.50-5.29，P=0.001），FIGO stage Ⅳ （HR=2.23，95%CI：1.24-4.04，P=0.008），postoperative non-R0 tumor residual （HR=2.01，95%CI：1.10-3.65，P=0.022），KELIM score <1 （HR=3.30，95%CI：1.70-6.42，P<0.001） were all the independent risk factors of PFS after NACT+IDS treatment in HGSOC patients. Based on the above factors，a nomogram model was constructed，and the calibration curve showed that the predicted probabilities of the nomogram model in the training set and validation set were close to the actual probabilities，indicating good calibration. ROC curve analysis showed that the areas under the curve of the nomogram model for predicting PFS of the training and validation sets were 0.81 （95%CI：0.73-0.89） and 0.88 （95%CI：0.77-0.99），respectively. Conclusions The KELIM score is related to the PFS of HGSOC patients after NACT+IDS treatment. Patients with KELIM score <1 have shorter PFS and OS. The nomogram model constructed on the basis of the KELIM score demonstrates good performance in predicting PFS of HGSOC patients following NACT+IDS treatment. Figures and Tables | References | Related Articles | Metrics

Impact of different chemotherapy regimens on the occurrence of grade ≥ 3 neutropenia in middle-aged and elderly patients with ovarian cancer Jiang Ye, Ji Shuang, Lao Jiahui, Yan Li, Liu Yamin, Tang Fang 2026, 53 (10):  608-614.  doi: 10.3760/cma.j.cn371439-20260423-00096 Abstract ( 11 )   HTML ( 2 )   PDF (829KB) ( 1 )   Save Objective To analyze the impact of different chemotherapy regimens on the occurrence of grade ≥ 3 neutropenia within chemotherapy cycles in middle-aged and elderly patients with ovarian cancer. Methods A longitudinal cohort was established comprising 492 middle-aged and elderly patients with ovarian cancer who received chemotherapy at the First Affiliated Hospital of Shandong First Medical University （Shandong Provincial Qianfoshan Hospital） between January 2009 and June 2022. All chemotherapy cycles were categorized into a group with grade ≥ 3 neutropenia （215 cycles） and a group without grade ≥ 3 neutropenia （1 803 cycles）， according to whether grade ≥ 3 neutropenia occurred in each cycle. The two groups were compared with respect to clinical data within the chemotherapy cycles， pre-chemotherapy laboratory parameters， comorbidities， status of chemotherapy after relapse， chemotherapy regimens， and specific drugs. A generalized estimating equation （GEE） was employed to analyze the impact of different chemotherapy regimens and drugs on the occurrence of grade ≥ 3 neutropenia. And the confounding factors such as pre-chemotherapy laboratory parameters， comorbidities， chemotherapy after relapse， year， and number of chemotherapy cycles were adjusted in the model. Results There were statistically significant differences between the group with grade ≥ 3 neutropenia and the group without grade ≥ 3 neutropenia in pre-chemotherapy white blood cells， red blood cells， platelets， absolute neutropenia count， monocytes， lymphocytes， eosinophils， hemoglobin， serum total bilirubin， aspartate aminotransferase， chemotherapy after relapse， platinum， and paclitaxel （all P<0.05）. Univariate GEE results showed that platinum plus cyclophosphamide regimen （OR=0.273， 95%CI：0.080-0.936， P=0.039） and docetaxel （OR=0.612， 95%CI：0.390-0.960， P=0.033） were negatively associated with the risk of grade ≥ 3 neutropenia， whereas albumin-bound paclitaxel （OR=1.778， 95%CI：1.053-3.000， P=0.031） was positively associated with the risk of grade ≥ 3 neutropenia. Multivariate GEE analysis after adjusting for potential confounding factors revealed that the platinum plus cyclophosphamide regimen （OR=0.151， 95%CI：0.149-0.154， P<0.001）， solvent-based paclitaxel （OR=0.383， 95%CI：0.348-0.421， P<0.001）， and docetaxel （OR=0.644， 95%CI：0.431-0.960， P=0.031） were protective factors against grade ≥ 3 neutropenia， whereas carboplatin （OR=1.771， 95%CI：1.374-2.282， P<0.001） and albumin-bound paclitaxel （OR=1.937， 95%CI：1.216-3.087， P=0.005） were risk factors for grade ≥ 3 neutropenia. Conclusions Among middle-aged and elderly patients with ovarian cancer， the risk of grade ≥ 3 neutropenia during chemotherapy cycles varies across different chemotherapy regimens. Platinum plus cyclophosphamide， solvent-based paclitaxel， and docetaxel may reduce the risk of this adverse reaction， whereas close monitoring for the above-mentioned adverse reaction is recommended when using regimens such as carboplatin or albumin-bound paclitaxel. Figures and Tables | References | Related Articles | Metrics

Feasibility analysis of cone beam CT-based adaptive radiation therapy for prostate cancer Li Bao, Chen Yongzhong, Chen Jingsheng, Xu Liming, Jin Jun 2026, 53 (10):  615-622.  doi: 10.3760/cma.j.cn371439-20260228-00097 Abstract ( 7 )   HTML ( 1 )   PDF (2752KB) ( 0 )   Save Objective To investigate the feasibility and clinical value of establishing individualized target volumes for prostate cancer based on cone beam CT （CBCT） and implementing offline adaptive radiation therapy （ART）. Methods A retrospective collection was performed on the planning CT and CBCT images of 28 patients with localized prostate cancer who received radiotherapy at Ezhou Central Hospital of Hubei Province，between October 2022 and December 2025. An initial radiotherapy plan （Planp） was designed based on the planning target volume （PTVp） delineated on the planning CT images. Based on the daily CBCT images acquired in the 1st and 4th weeks of treatment，the clinical target volume （CTV） was delineated and superimposed to generate the individualized internal target volume，which was then expanded by the corresponding weekly mean setup errors to sequentially generate the ART plan target volumes for the 1st week （PTVa） and the 4th week （PTVb）. ART plans Plana and Planb were subsequently designed based on PTVa and PTVb，respectively. All three plans （Planp，Plana，and Planb） were calculated using identical optimization parameters for dose computation. The three groups of radiotherapy plans were compared in terms of target volume，prescribed dose coverage，and dosimetric parameters for both targets and organs at risk （OARs）. Results The target volumes of PTVp，PTVa，and PTVb were （281.6±52.8），（224.6±46.2），and （194.2±58.2） cm3，respectively，with a statistically significant difference （F=4.78，P=0.013）. Pairwise comparisons all showed statistically significant differences （all P<0.05）. The prescribed dose coverage rates for PTVp，PTVa，and PTVb were （97.4±2.1）%，（97.8±2.4）%，and （98.3±2.0）%，respectively，showing no statistically significant difference （F=0.55，P=0.582）. Regarding target dose hotspots，the D2% values for Planp，Plana，and Planb were （74.1±1.2），（73.9±1.2），and （73.6±1.3） Gy，respectively，with a statistically significant difference （F=3.88，P=0.027），and pairwise comparisons all reached statistical significance （all P<0.05）. No statistically significant differences were observed in D50%，D98%，or Dmean across the three plans （all P>0.05）. The homogeneity index values for the three plans were 0.051±0.019，0.046±0.021，and 0.042±0.018，respectively，with a statistically significant difference （F=4.28，P=0.019），and all pairwise comparisons were statistically significant （all P<0.05）. The conformity index （CI） values were 0.847±0.032，0.845±0.037，and 0.864±0.032，respectively，with a statistically significant difference （F=3.58，P=0.035）； pairwise comparisons showed a statistically significant difference only between Plana and Planb （P<0.05）. In terms of OARs dose，the V50，V60，and V70 of the rectum and bladder all showed statistically significant differences among the three plans （all P<0.05），and all pairwise comparisons were also statistically significant （all P<0.05）. Pelvic bone V30 showed a statistically significant difference （F=3.85，P=0.027），pairwise comparisons showed that both Plana and Planb differed significantly from Planp （both P<0.05）； however，pelvic bone Dmean showed no statistically significant difference （F=2.85，P=0.066）. No statistically significant differences were found in Dmean or V30 for either the left or right femoral heads （all P>0.05）. Conclusions Offline CBCT-based ART for prostate cancer can significantly reduce target volume，decrease hotspots within the target，improve dose homogeneity，and effectively reduce radiation doses to the rectum and bladder，all while maintaining prescribed dose coverage of the target. Figures and Tables | References | Related Articles | Metrics

Review

Research progress on anti-EGFR targeted therapy and immunotherapy for locally advanced nasopharyngeal carcinoma Zhao Bingying, Wen Miaowei, Hu Shanliang, Wang Yang, Song Yipeng 2026, 53 (10):  623-627.  doi: 10.3760/cma.j.cn371439-20260318-00098 Abstract ( 8 )   HTML ( 1 )   PDF (818KB) ( 1 )   Save In recent years，preliminary therapeutic efficacy of epidermal growth factor receptor inhibitors including cetuximab and nimotuzumab has been observed in the treatment of locally advanced nasopharyngeal carcinoma （LANPC）. Multiple clinical investigations on immunotherapy for LANPC have been conducted around strategies such as whole-course intensification，adjuvant consolidation，cisplatin-sparing detoxification regimens，and stratified intensification for high-risk populations. Exploration of therapeutic strategy optimization guided by biomarkers and novel combination regimens will facilitate the further clinical application of targeted therapy and immunotherapy in LANPC patients. References | Related Articles | Metrics

Duality of KRAS/STK11 co-mutation subtype in lung cancer：immunological paradox and therapeutic opportunities Gao Mi, Gan Kui, Zhu Jun, Huang Meijin 2026, 53 (10):  628-634.  doi: 10.3760/cma.j.cn371439-20251128-00099 Abstract ( 6 )   HTML ( 1 )   PDF (2269KB) ( 0 )   Save The co-mutation of KRAS and STK11 （also known as LKB1） defines a distinct molecular subtype （KL subtype） in lung cancer，which is characterized by an "immunological paradox" — the coexistence of a high tumor mutation burden and primary resistance to immune checkpoint inhibitors. This resistance of this subtype mainly stems from the immunosuppressive microenvironment established by multiple mechanisms，including aberrant recruitment of myeloid cells，metabolic reprogramming，and synergistic interactions with the KEAP1/NRF2 pathway. Current therapeutic strategies for the KL subtype have shifted toward multi-pronged combination interventions，such as directly targeting KRAS G12C，modulating the immune microenvironment，and exploring emerging therapies. Although clinical translation still faces challenges including model limitations，tumor heterogeneity，and combination-related toxicities，the integration of multi-omics analysis，innovative trial design，and novel therapeutic modalities holds promise for transforming the KL subtype from a treatment-refractory entity into a tractable therapeutic target. These advances collectively provide a theoretical foundation and clear direction for future therapeutic development targeting this specific subtype. Figures and Tables | References | Related Articles | Metrics

Research progress of immune checkpoint inhibitors in gastric cancer Min Xiyun, Ma Zhuaxiji, Guan Quanlin 2026, 53 (10):  635-640.  doi: 10.3760/cma.j.cn371439-20250919-00100 Abstract ( 7 )   HTML ( 1 )   PDF (814KB) ( 0 )   Save Gastric cancer is a major disease that poses a serious threat to human health. Currently，the primary treatment methods remain surgery combined with chemotherapy. In recent years，with the deepening of tumor immunology research，immune checkpoint inhibitors have shown significant efficacy in the treatment of gastric cancer. Both monotherapy and combination treatment regimens provide more options for patients with gastric cancer，demonstrating substantial therapeutic potential. Summarizing and discussing the research progress of immune checkpoint inhibitors in gastric cancer can offer new insights for better clinical management of the disease. References | Related Articles | Metrics