Researching | ZGAZZZ Volume 35 Issue 7,2025

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 1 (2025)

Exploring innovative models of surgical treatment for rectal cancer

LI Xinxiang and LUO Dakui

In recent years, the surgical treatment model for rectal cancer has undergone profound changes. The therapeutic goal has gradually shifted from single tumor radical resection to balancing functional preservation, and the therapeutic concept has transformed from merely emphasizing surgical techniques to attaching import In recent years, the surgical treatment model for rectal cancer has undergone profound changes. The therapeutic goal has gradually shifted from single tumor radical resection to balancing functional preservation, and the therapeutic concept has transformed from merely emphasizing surgical techniques to attaching importance to comprehensive treatment. Especially in the treatment of low rectal cancer, the neoadjuvant therapy model has been continuously optimized. For patients with good tumor regression after neoadjuvant therapy, “watch and wait” and transanal local excision have become important optional strategies. This not only avoids some severe surgery-related complications but also maximizes the preservation of patients' organ functions, bringing a qualitative leap in their quality of life. This treatment strategy is gradually expanding from locally advanced low rectal cancer to relatively early-stage low rectal cancer. In terms of surgical techniques, based on the traditional intermediate approach of “first plane, then vessels”, the concept of a “vessel-centered” approach is proposed. By managing vessels first and then expanding the plane, it enables thorough dissection of lymph nodes at the root of the inferior mesenteric artery while preserving the left colic artery. With the aid of dual-fluorescence intraoperative navigation technology [indocyanine green (ICG) fluorescence and intraoperative realtime imaging system (IRIS) ureter fluorescence imaging], real-time visualization of lymph nodes and ureters is achieved, ensuring the completeness of lymph node dissection and helping to reduce the risk of ureteral injury. The angulation-free double anastomosis technique used during surgery effectively reduces the incidence of anastomotic leakage and improves surgical safety. For patients with high-risk factors for anastomotic leakage, intestinal stent bypass is expected to replace the traditional prophylactic end ileostomy, thus avoiding complications associated with prophylactic end ileostomy and the trauma caused by secondary stoma closure. In general, the development trend of surgical treatment for rectal cancer is to minimize patient trauma, preserve organ functions, and improve quality of life under the premise of ensuring oncological efficacy, promoting the development of surgical techniques towards standardization and precision to maximize patients' perioperative safety..

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 631 (2025)

Artificial intelligence-based assessment of surgical skills in laparoscopic right hemicolectomy for colon cancer

WEI Pengyu, GAO Jiale, JI Maotong, TAN Yuanyuan, and YAO Hongwei

Laparoscopic right hemicolectomy is the standard surgical procedure for treating right-sided colon cancer, yet its complex anatomical layers and technically demanding operations pose significant challenges to surgeons' expertise. Currently, surgical skill assessment in clinical practice still predominantly relies o

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 637 (2025)

Advances and future perspectives of neoadjuvant immunotherapy in colorectal cancer

ZHANG Yuyang and LIU Qian

In recent years, significant progress has been made in neoadjuvant immunotherapy for colorectal cancer (CRC), particularly demonstrating breakthrough efficacy in mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) subtypes. Immune checkpoint inhibitor (ICI) has achieved complete response (CR) rates a

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 642 (2025)

Mechanism of immune escape mediated by T cell depletion induced by TOX signaling pathway in cervical cancer microenvironment

LIU Dan, ZHANG Guxiang, XIE Dan, XU Yan, XIE Chengfang, and TANG Yuxi

Background and purposeImmune checkpoint blockade (ICB) has become a promising strategy for treating cervical cancer (CC), but terminal T cell depletion still limits the therapeutic efficacy of ICB. The deletion of sorting nexin-9 (SNX9) can inhibit thymocyte selection-associated high mobility group box protein (TOX), a Background and purposeImmune checkpoint blockade (ICB) has become a promising strategy for treating cervical cancer (CC), but terminal T cell depletion still limits the therapeutic efficacy of ICB. The deletion of sorting nexin-9 (SNX9) can inhibit thymocyte selection-associated high mobility group box protein (TOX), alleviate T cell exhaustion, and provide new ideas for preventing T cell exhaustion and enhancing the efficacy of cancer immunotherapy. Therefore, this study aimed to explore the immune escape mechanism mediated by the depletion of CD8⁺ T cells induced by the SNX9/TOX signaling pathway in the CC microenvironment.MethodsFifty-four peripheral blood samples were collected, including 18 from CC patients, 18 from patients with high-grade squamous intraepithelial lesions (HSIL) and 18 from subjects with normal cervix. In addition, the study collected 153 pairs of CC and adjacent tissues from patients who received operation in our hospital for the first time. Clinicopathological features, tumor stages, follow-up records and other relevant clinicopathological data of CC patients were obtained from hospital records. The research was approved by the ethics committee of Changsha Fourth Hospital (approval number: 20220206). A total of 24 mice were randomly assigned to the following four groups: immunoglobulin G (IgG) group, Anti-SNX9 group, Anti-programmed death-1 (PD-1) group and Anti-SNX9⁺ Anti-PD-1 group, with 6 mice in each group. Each group received intraperitoneal injection of blocking antibody and isotype control treatment respectively. ELISpot was used to detect the ability of CD8⁺ T cells to secrete tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ). The expressions of TOX and SNX9 in cervical cancer tissues were detected by western blot and immunohistochemistry.ResultsThe expressions of SNX9 and TOX mRNA in peripheral blood mononuclear cell (PBMC) of CC patients were higher compared with HSIL and normal controls (P<0.05). The positive cell level of SNX9 and TOX immunohistochemical score were higher in CC tissue than in adjacent tissues (t=18.63, 21.10, P<0.001). The high expression of SNX9 in CC was related to low differentiation/undifferentiation, tumor size, parauterine infiltration, vaginal infiltration, late FIGO stage and pelvic lymph node metastasis (P<0.05). Compared with the low expression group of SNX9, the overall survival time of CC patients in the high expression group of SNX9 was shorter (P<0.05). The percentage of CD8⁺ SNX9⁺ T cells was significantly higher in CC patients than in normal controls and HSIL patients (P<0.05). The ability of CD8⁺ SNX9⁺ T cells to secrete cytokines (TNF-α and IFN-γ) was significantly lower compared with CD8⁺ SNX9^- T cells (P<0.05). Compared with the Anti-SNX9 group, the growth and proliferation of cervical tumor, the expression of SNX9 and TOX protein in tumor tissue in the Anti-SNX9+Anti-PD-1 group further decreased (P<0.05), and the level of infiltrating CD8⁺ T lymphocytes in tumor tissue and the ability of CD8⁺ T lymphocytes to secrete functional factors TNF-α and IFN-γ further increased (P<0.05).ConclusionSNX9/TOX signaling pathway exhibits enhanced activity in patients with cervical cancer and mouse models, and is related to immunosuppression. Targeting SNX9/TOX signaling pathway may be a potential therapeutic strategy for CC..

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 685 (2025)

Preoperative differentiation of vagal nerve cervical schwannomas from sympathetic chain cervical schwannomas based on diagnosis score and vascular displacement nomogram

XIANG Shiyu, LI Qiao, SHEN Changqing, GU Yajia, and WU Bin

Background and purposeAccurate preoperative differentiation between vagal nerve cervical schwannomas (SCCS) and sympathetic chain cervical schwannomas (SCCS) in the neck is crucial because of their different postoperative complication. This study aimed to construct and validate a Diagnosis Score and vascular displaceme Background and purposeAccurate preoperative differentiation between vagal nerve cervical schwannomas (SCCS) and sympathetic chain cervical schwannomas (SCCS) in the neck is crucial because of their different postoperative complication. This study aimed to construct and validate a Diagnosis Score and vascular displacement nomogram for the preoperative differentiation of VNCS from SCCS in the neck.MethodsThis cross-sectional study retrospectively analyzed patients with pathologically confirmed VNCS and SCCS at Fudan University Shanghai Cancer Center from January 2017 to April 2022. This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center (approval number: 1612167-18). Inclusion criteria: ① histopathological diagnosis of VNCS or SCCS through biopsy or surgical resection; ② patients with complete clinic data; ③availability of preoperative contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) examinations. Patients were excluded for: ① contrast agent contraindications; ② poor image quality; ③ severe artifacts; ④ non-standard scanning protocols. The cohort was randomly divided into training and validation sets in a 7∶3 ratio. Two radiologists (one resident and one attending physician) independently evaluated tumor characteristics (location, size and vascular displacement patterns) on preoperative imaging. Independent predictors were selected using LASSO regression analysis to construct a diagnostic scoring system and nomogram, with model performance evaluated by the receiver operating characteristic (ROC) curve.ResultsA total of 110 patients were enrolled, with 77 cases allocated to the training set and 33 cases to the validation set. The age range was 24-78 years, and the mean age was (51.22±12.36) years. There were no statistically significant differences in baseline characteristics including age, gender, tumor location and size between the two patient groups (P>0.05). ICA/ECA splaying was significantly associated with SCCS (P<0.001), while the ICA/IJV splaying was significantly associated with VNCS (P<0.001). Lateral and posterior ICA displacement were significantly associated with SCCS (P<0.001), and medial and anterior ICA displacement were significantly associated with VNCS (P<0.001). Five features including tumor size, ICA displacement direction, IJV displacement direction, ICA/ECA splaying and ICA/IJV splaying were used to establish the Diagnosis Score and nomogram. The nomogram combined imaging features showed favorable preference value for differentiating VNCS from SCCS, with area under curve (AUC) values of 0.953 (95% CI: 0.912-0.994) and 0.939 (95% CI: 0.885-0.993) for the training and validation cohorts, respectively.ConclusionThe Diagnosis Score and vascular displacement nomogram showed favorable predictive efficacy for differentiating VNCS from SCCS in the neck, and might be useful for clinical decision-making..

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 695 (2025)

Research progress of immune checkpoint inhibitors in the treatment of acral melanoma

QIAN Jiajia, RUAN Cong, LIU Jiyong, and XU Rui

In recent years, immune checkpoint inhibitor (ICI) has led to substantial advances in the treatment of recurrent or metastatic advanced cutaneous melanoma (CM), significantly prolonging overall survival. However, due to the biological heterogeneity across melanoma subtypes, the degree of immune responsiveness varies co In recent years, immune checkpoint inhibitor (ICI) has led to substantial advances in the treatment of recurrent or metastatic advanced cutaneous melanoma (CM), significantly prolonging overall survival. However, due to the biological heterogeneity across melanoma subtypes, the degree of immune responsiveness varies considerably. In particular, acral melanoma (AM) (the predominant melanoma subtype in Asian populations, including China) has demonstrated limited benefit from ICI therapy, especially in the context of monotherapy. Currently, no systematic staging and standardized treatment guidelines are available for AM, and clinical evidence supporting the use of ICI in this rare subtype remains insufficient. In the neoadjuvant setting, several large phase Ⅱ/Ⅲ international trials in CM, including SWOG 1801 and NADINA, have shown that ICI-based neoadjuvant combination therapy significantly improves pathological response rates compared with traditional adjuvant approaches. Nevertheless, neoadjuvant treatment in AM remains in the exploratory stage. Early-phase clinical studies in resectable stage Ⅲ/Ⅳ AM suggest that toripalimab combined with intratumoral oncolytic virus therapy, or camrelizumab in combination with apatinib and temozolomide, may offer clinical benefit; however, confirmation of long-term survival benefit requires further validation in larger, prospective cohorts. In the adjuvant setting, for AM patients with BRAF mutations, real-world data from China have shown no significant difference in survival outcomes between dabrafenib plus trametinib and programmed death-1 (PD-1) inhibitor monotherapy in high-risk resectable stage Ⅲ/Ⅳ disease, although direct head-to-head comparisons are lacking. For patients with resectable stage Ⅲ/Ⅳ wild-type AM, combination adjuvant regimens incorporating PD-1 inhibitors may provide superior recurrence risk reduction and survival benefit compared to monotherapy. In the advanced disease setting, in Chinese populations, the objective response rates of PD-1 inhibitors such as pembrolizumab, toripalimab and penpulimab remain suboptimal in AM. ICI-based combination strategies (including those with chemotherapy, anti-angiogenic agents, dual or triple immune checkpoint blockade) may improve the immune microenvironment and clinical prognosis, but concerns regarding safety and tolerability persist. For patients with ICI-refractory AM, various novel approaches combining immunotherapy, targeted agents and chemotherapy are under investigation. Additionally, several nextgeneration immunotherapeutic modalities [including T-cell receptor-engineered (TCR-T) therapies, therapeutic cancer vaccines, chimeric antigen receptor T (CAR-T) cell therapy and antibody-drug conjugate (ADC)] are currently in development. This review aimed to provide a comprehensive overview of current clinical evidence on the use of ICI in acral melanoma across the neoadjuvant, adjuvant, and advanced disease settings. We highlighted the efficacy and safety of existing strategies, exploreed emerging combination regimens and predictive biomarkers, and discussed key areas for future research to inform clinical decision-making and optimize outcomes in this challenging melanoma subtype..

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 702 (2025)

Expert consensus on BRCA1/2 gene testing and clinical application in Chinese breast cancer patients (2025 edition)

WANG Hongxia, YIN Yongmei and HU Xichun

Breast cancer remains one of the frequently diagnosed malignant tumors among Chinese women, with hereditary cases accounting for 5%-10% of all diagnoses, where BRCA1/2 gene mutations serve as the primary genetic predisposition factors. Although targeted therapies like poly (ADP-ribose) polymerase (PARP) inhibitors have Breast cancer remains one of the frequently diagnosed malignant tumors among Chinese women, with hereditary cases accounting for 5%-10% of all diagnoses, where BRCA1/2 gene mutations serve as the primary genetic predisposition factors. Although targeted therapies like poly (ADP-ribose) polymerase (PARP) inhibitors have significantly improved prognoses for patients with BRCA-mutated breast cancer in recent years, critical clinical challenges persist, including the standardization of genetic testing protocols, optimization of precision treatment approaches, and refinement of long-term management strategies. In response to these challenges, our expert panel has conducted a comprehensive update to the 2018 Edition of this consensus by integrating the latest global evidence-based medical research with China's unique clinical practice characteristics. This 2025 Edition provides systematic evaluations and recommendations on five key aspects: indications for BRCA1/2 gene testing, testing methodologies, result interpretation, treatment strategies, and risk management. The main updates include: ① Increasing the relationship between BRCA1/2 gene mutations and programmed death ligand-1 (PD-L1) expression, as well as related content on BRCAness types; ② Standardizing the application of genetic testing, such as increasing the significance, timing, and sample selection of clinical testing, and optimizing the BRCA testing population; ③ Updating treatment strategies, such as non-drug treatment of BRCA1/2 gene mutation, treatment of triple negative breast cancer (TNBC) patients with BRCA1/2 gene mutation, treatment decisions of hormone receptor (HR)⁺/human epidermal growth factor receptor 2 (HER2)^- breast cancer patients with BRCA1/2 gene mutation, clinical use of PARP inhibitors and adverse reaction management; ④ Addion of relevant content on long-term risk management, such as covering follow-up management, indications for preventive surgery, quality control and requirements for new genetic testing, updating genetic testing processes, report content and interpretation. This consensus aimed to establish standardized diagnostic and therapeutic frameworks for clinicians, advance precision medicine in BRCA-mutated breast cancer, and ultimately improve patient survival outcomes. As new evidence emerges, continuous updates will be implemented to incorporate the latest research findings. This consensus has been registered on the Practice guideline REgistration for transPAREncy (PREPARE) platform (registration number: PREPARE-2025CN1085)..

China Oncology

Publication Date: Aug. 22, 2025
Vol. 35, Issue 7, 710 (2025)