Ovarian cancer combined with internal rectal fistula is relatively rare in clinical practice.Currently,there is no standard protocol for balancing the urgency of intestinal fistula treatment with the timing and radicality of ovarian cancer surgery.This consensus is based on evidence-based medicine,combined with domestic and international literature,relevant guidelines,and expert opinions,to propose systematic and actionable diagnosis and treatment strategies.This consensus emphasizes that the diagnosis and treatment of rectal fistula should get a balance between tumor control and safe management of the fistula.It advocates individualized treatment plans(including conservative treatment,nutritional support,chemotherapy,optimized surgical timing,and endoscopic minimally invasive techniques),and recommends multidisciplinary team collaboration to develop comprehensive treatment plans,improve surgical safety,and enhance patients′ quality of life.

Objective The aim of this study was to evaluate the quality level of treatment process for hospitalized surgical patients with colorectal cancer and explore its influencing factors,providing reference for improving the clinical treatment quality of colorectal cancer. Methods Medical record data were collected for patients with colorectal cancer who underwent surgical treatment at Harbin Medical University Cancer Hospital from March 2018 to March 2023.Nine process quality evaluation indicators were selected to calculate an individual scores,and patients were categorized into the high-and low-quality groups based on the median scores.The differences were compared in clinical and baseline characteristics between the high-and low-quality treatment process quality groups and to analyze the factors influencing treatment process quality. Results A total of 12,502 patients were included,with a median treatment process quality score of 0.44.There were statistically significant differences in family history of colorectal cancer,smoking status,body mass index(BMI),medical insurance type,fecal examination,endocrine therapy,chemotherapy,and alcohol consumption between the high-and low-treatment quality groups(P＜0.05).Multivariable logistic regression analysis showed that undergoing fecal testing,receiving endocrine therapy,receiving chemotherapy,and alcohol consumption were associated with a lower quality of the treatment process(P＜0.05).A family history of colorectal cancer,higher BMI,smoking,and having other types of medical insurance were associated with a higher quality of the treatment process(P＜0.05). Conclusion In clinical treatment,the application of process indicators should be strengthened,with a focus on the management of patients without a family history of colorectal cancer,underweight,and alcohol consumption.The associations between not receiving fecal examination and not receiving endocrine therapy and higher treatment process quality still needs further investigation,explanation,and verification.

Objective The aim of this study was to identify the direct and indirect factors influencing adverse outcomes in patients with colorectal cancer after treatment,and to explore the causal effects of these factors on adverse outcomes,providing a basis for improving patient prognosis. Methods Medical record information of patients admitted to Harbin Medical University Cancer Hospital and diagnosed with colorectal cancer from 2013 to 2015 was collected.Adverse outcomes were defined as death,metastasis,or recurrence within two years after treatment.The fast greedy equivalence search algorithm was used to construct a causal graphical model and analyze the direct and indirect factors influencing adverse outcomes.Based on this,the intervention calculus when the directed acyclic graph is absent(IDA)algorithm was employed to evaluate the causal effects of these factors on adverse outcomes. Results A total of 2,332 patients were included,with an average age of(68.0±10.9)years and an adverse outcome incidence of 6.22%.The causal graph contained 20 nodes and 36 edges.The direct factors influencing adverse outcomes included chemotherapy,pathological type,surgical treatment,and length of hospital stay(｜IDA｜ values were 0.039,0.059,0.255,and 0.054,respectively).The indirect influencing factors included age,alcohol consumption,body mass index,differentiation degree,radiotherapy,and surgery nature(｜IDA｜ values were 0.011,0.021,0.012,0.042,0.021,and 0.030,respectively). Conclusions Based on identifying key factors influencing adverse outcomes in colorectal cancer through the causal graph,the IDA algorithm can quantify the causal effects of influencing factors on adverse outcomes.The study suggests that in the clinical treatment of colorectal cancer,increasing the acceptance rate of surgery and chemotherapy in patients without surgical or chemotherapy contraindications can reduce the incidence of adverse outcomes and thereby improve prognosis.

Objective The objective of this study was to analyze the influencing factors of treatment quality in patients with non-small cell lung cancer(NSCLC)based on generalized estimating equations(GEE),and to provide evidence for improving the treatment quality of NSCLC patients. Methods Medical record data of NSCLC patients from Harbin Medical University Cancer Hospital from 2010 to 2021 were collected.Based on the evaluation index system for NSCLC treatment quality previously constructed by our research team,16 evaluation indicators for NSCLC treatment quality were selected to calculate the comprehensive score of patients.Patients were divided into high-and low-quality groups based on the median comprehensive score.Baseline characteristics of patients were used as independent variables,and the treatment quality groups were used as dependent variables.The GEE method was used to analyze the influencing factors of treatment quality in NSCLC patients. Results A total of 4,234 NSCLC patients were included in the study.The median comprehensive score of patients was 0.428 5(0.333 3,0.571 4),with 2,321 patients in the high-quality group(≥0.428 5)and 1,913 patients in the low-quality group(＜0.428 5).There were significant differences in hospitalization duration and payment method between the two groups(P＜0.05).The results of the generalized estimating equation analysis showed that patient age,body mass index(BMI),payment method,and lung cancer stage had a statistically significant effects on the comprehensive score of treatment quality(P＜0.05).Patients with lower BMI and those over 60 years old had poorer treatment quality,while patients in the early stages of lung cancer and those paying fully out of pocket had better treatment quality.Patients with poorer treatment quality had lower completion rates for electrocardiogram examination,radical resection rates in early-stage patients,and utilization rates of standardized chemotherapy indicators. Conclusion Individualized treatment plans should be developed for patients over 60 years old,those with low BMI,and patients with advanced lung cancer during the treatment process of NSCLC;Early screening and treatment are recommended to improve the treatment quality for NSCLC patients.

Objective The aim of this study was to describe the changes of breast cancer treatment quality in hospitals over time,evaluate the effect of the intervention measures on the treatment quality of breast cancer that have been implemented in hospitals,and provide a scientific basis for improving breast cancer treatment quality and enhancing patient prognosis. Methods A total of 209 hospitals that participated in the study from October 1,2019 to January 31,2025 were selected.According to the intervention time,they were divided into four groups:baseline time(T₀),intervention phase Ⅰ(T₁),intervention phase Ⅱ(T₂),and intervention phase Ⅲ(T₃).The quality scores of preoperative examinations,treatment,and diagnosis of breast cancer and the comprehensive scores of treatment process indicators were calculated,respectively;According to the reported data,19 intervention hospitals were included in the intervention measures,and 190 control hospitals were matched by the propensity score matching method according to the hospital grade,ownership form,and the scores of breast cancer treatment quality dimensions of“T₀”time hospitals.Latent profile analysis(LPA)was used to classify the treatment quality of breast cancer in hospitals.Latent transition analysis(LTA)was further used to explore the impact of intervention measures on the change of treatment quality in hospitals. Results The treatment quality of breast cancer was divided into two categories by LPA analysis:“class1”was the high treatment quality group,and“class2”was the low treatment quality group.The comprehensive dimension score had improved to some extent in both groups:the score in the low treatment quality group had increased from 0.31 at the“T₀”stage to 0.36 at the“T₃”stage,while the score of the high treatment quality group had increased from 0.54 to 0.58.The change in the treatment quality of breast cancer obtained by LTA,the proportion of the potential category in“high treatment quality”increased from 35.89% at“T₀”to 96.17% of“T₃”,an increase of about 1.68 times;When the intervention was included as an explanatory variable in LTA model,the results showed that the intervention significantly influenced latent class transitions. Conclusions The study shows that intervention is an effective strategy to improve the treatment quality of breast cancer,and the intervention measures show positive effects on the inspection,treatment and diagnosis dimensions.It is suggested to improve the intervention measures in the treatment dimension to achieve the overall improvement of breast cancer treatment quality in the hospital.

Objective The evaluation indicators of breast cancer treatment quality were used to analyze the longitudinal trend and influencing factors of breast cancer treatment quality based on the latent growth curve models(LGCM),so as to provide a basis for improving the treatment quality of breast cancer. Methods The medical records of breast cancer patients in Chinese hospitals from January 1,2021 to January 1,2023 were collected.Based on the evaluation index system for treatment quality of invasive breast cancer established by the research group in the early stage,19 evaluation indexes of breast cancer treatment quality were used to calculate the utilization rate of hospital indicators and the comprehensive scores of treatment quality.Based on LGCM,model parameters(intercept and slope)were used to evaluate the longitudinal trend of breast cancer treatment quality,and incorporate covariates into the model to evaluate their impact on the changing trend. Results The level information of 340 hospitals in China and the medical records of 104,812 breast cancer patients were obtained.Among 19 breast cancer treatment quality indicators,340 hospitals had the highest utilization rate(97.84%±9.73%)for the indicators of tumor diameter recorded in the pathological report,and the lowest utilization rate(1.91%±8.38%)for the indicators of postoperative complications;The median(quartile)of the comprehensive score for breast cancer treatment quality in the hospital was 0.475(0.348,0.596).The longitudinal trend analysis for treatment quality of breast cancer showed that the comprehensive scores for treatment quality of breast cancer in hospital showed an upward trend with time,the variance of intercept was 0.022(P＜0.001),and the variance of slope was 0.001(P＜0.001).The differences were statistically significant.The analysis of influencing factors on the trend of breast cancer treatment quality showed that the influence of the hospital region,the hospital level and the annual average number of people diagnosed and treated by the hospital on the initial comprehensive scores for treatment quality of breast cancer during the study period was statistically significant(P＜0.05),and the proportion of hospital medical insurance types was not statistically significant(P=0.307).The influence of hospital region(P=0.854),hospital level(P=0.472),the proportion of hospital medical insurance types(P=0.053),and the annual average number of hospital visits(P=0.569)on the trend of comprehensive scores of breast cancer treatment quality was not statistically significant. Conclusions In 2021,the treatment quality of breast cancer in China and the rate of change in three years are different among hospitals,and the overall trend is rising,which proves that the diagnosis and treatment process of breast cancer is constantly standardized and improved.In order to further improve the treatment quality of breast cancer,it is necessary to focus on hospitals in Western and Northern regions,secondary hospitals and hospitals with less average diagnosis and treatment of breast cancer.

Objective The aim of this study was to analyze the incidence and mortality of malignant tumors in the urban areas of Nantong City in 2020,and the changing trends from 2011 to 2020. Methods The tumor registration data of Nantong urban cancer registry from 2011 to 2020 were used to calculate the incidence,mortality and age-standardized incidence by Chinese standard population(ASIRC),age-standardized mortality by Chinese standard population(ASMRC),age-standardized incidence by world standard population(ASIRW)and age-standardized mortality by world standard population(ASMRW)of malignant tumors in Nantong urban areas by gender,age,and cancer type in 2020.Joinpoint 4.7.0.0 software was used to calculate the average annual percentage change(AAPC)of the incidence,mortality,ASIRC and ASMRC of malignant tumors in the Nantong urban areas from 2011 to 2020,and to analyze the changing trends of the incidence and mortality of all malignant tumors. Results In 2020,9,324 new cases of malignant tumors(5,038 males and 4,286 females)were reported in the Nantong urban areas,with an incidence of 432.63/100,000,ASIRC of 188.82/100,000,and ASMRC of 182.05/100,000.The incidence of top five cancer types in the Nantong urban areas was lung cancer,colorectal cancer,gastric cancer,liver cancer,and female breast cancer,accounting for 56.75% of all cases.A total of 5,442 deaths from malignant tumors(3,371 males and 2,071 females)were reported in the Nantong urban areas,with a crude mortality of 252.51/100,000,ASMRC of 86.00/100,000,and ASMRW of 84.94/100,000.The mortality of top five cancer types in the Nantong urban areas was lung cancer,gastric cancer,liver cancer,colorectal cancer,and esophageal cancer,accounting for 63.93% of all deaths.From 2011 to 2020,the age-standardized incidence and age-standardized mortality of malignant tumors in the Nantong urban areas showed a downward trend,with an average annual decrease of 1.42%(95% CI:-2.69%-0.13%,P＜0.05)and 3.84%(95% CI:-6.07%-1.56%,P＜0.05),respectively. Conclusion Although the incidence and mortality of malignant tumors in the Nantong urban areas are at a high level,the age-standardized incidence and age-standardized mortality are at a low level and are on a downward trend.We should focus on the prevention and control of lung cancer,digestive tract cancer,and female breast cancer,and take different prevention and control measures for different types of cancer to reduce the burden of cancer.

Objective The aim of this study was to investigate the epidemiological characteristics of cervical cancer mortality in Chinese women and its impact on lifespan and labor loss,so as to provide scientific basis for the development of targeted cervical cancer prevention and control strategies. Methods Data were sourced from the “Chinese Cause of Death Surveillance Dataset” from 2004 to 2021,including cervical cancer mortality cases and demographic data.Joinpoint regression models were used to analyze trends of cervical cancer mortality,potential years of life lost(PYLL),average potential years of life lost(APYLL),work years of potential life lost(WYPLL),and average work years of potential life lost(AWYPLL).The annual percentage change(APC)and average annual percentage change(AAPC)were calculated. Results The average annual mortality of cervical cancer among Chinese women from 2004 to 2021 was 4.65/100,000,with a significantly higher rate in rural areas(4.85/100,000)than that in urban areas(4.26/100,000),and the difference was statistically significant(χ²=244.322,P＜0.001).The overall mortality of cervical cancer among Chinese women from 2004 to 2021 showed an upward(AAPC=3.89%,P=0.021).Time period analysis showed that the upward trend was most significant from 2012 and 2015(APC=25.53%,P=0.024).The mortality in rural areas was higher than that in urban areas,and it showed an upward trend over the years(AAPC=4.34%,P=0.005),while the trend of urban mortality change was not statistically significant(P=0.311).The age-specific mortality gradually increased with age,and significantly increased after the age of 50.The overall,rural,and urban populations reached their highest values in the age group ≥85 years old.From 2004 to 2021,the potential years of life lost(PYLL)due to cervical cancer was 1,283,829.79 years,with an average PYLL(APYLL)of 20.51 person-years.The PYLL in rural areas was 866,304.72 years(APYLL:20.12 person-years),while in urban areas it was 417,525.07 years(APYLL:21.36 person-years).The APYLL for the overall population,rural areas,and urban areas all showed a declining trend over time(AAPC:-1.33%,-1.35%,and-1.35%,respectively,P＜0.001).During the same period,the working-years potential of life lost(WYPLL)was 197,579 years,with an average WYPLL(AWYPLL)of 7.83 person-years.The WYPLL in rural areas was 130,083 years(AWYPLL:7.78 person-years),while in urban areas it was 67,496 years(AWYPLL:7.93 person-years).The AWYPLL for the overall population,rural areas,and urban areas also demonstrated a declining trend(AAPC:-2.24%,-2.53%,and -1.72%,respectively,P＜0.001). Conclusion From 2004 to 2021,the overall disease burden of cervical cancer among Chinese women was heavy,and its mortality showed an upward trend.However,the life expectancy and work years lost due to cervical cancer declined annually.Middle aged and elderly women aged 50 and above are still the key population for prevention and control,and rural areas are the key areas for prevention and control.In the future,it is necessary to continue exploring suitable comprehensive prevention and control models for cervical cancer to reduce the disease burden.

Objective Based on methods such as network pharmacology,molecular docking and molecular dynamic simulation,this study aimed to explore the potential targets and molecular mechanism of lomustine in the treatment of glioma,providing a theoretical basis for clinical precision medicine. Methods Potential drug targets were obtained by searching SwissTargetPrediction,Comparative Toxicogenomics database,and Genecards databases.Protein-protein interaction(PPI)networks were constructed through the STRING database to screen core targets,and perform GO functional enrichment analysis on the core targets.Molecular docking technology was used to predict the binding mode and binding energy between lomustine and core targets,and evaluate the stability of target binding through molecular dynamics simulation and related methods.Differential expression and survival analysis were performed using the GEPIA database,and the correlation between the final core target genes and overall survival(OS)and disease-free survival(DFS)of patients was assessed.Finally,in vitro experiments were performed to evaluate the effects of targetCDKN1A knockdown and lomustine treatment on the biological behaviors of the human glioma U-87MG cells.RT-qPCR and Western blot were used to detect the levels of CDKN1A knockdown at mRNA and protein expression in U-87MG cells.Wound healing assay was conducted to evaluate cell migration ability;CCK-8 assay was used to assess cell proliferation ability;Flow cytometry was performed to detect cell apoptosis in U-87MG cells. Results As a result of screening,113 potential targets of lomustine and 3 935 targets associated with glioma were identified,and 10 candidate targets were obtained by taking the intersection.Six core targets were identified through PPI network screening,followed by further screening of five final analytical targets through molecular docking.Molecular dynamic simulation ultimately determined CDKN1A as the core target of action.This target was highly expressed in glioma tissues and was associated with poor OS and DFS(P＜0.05),mainly localized in the nucleus.knockdown of CDKN1A gene and lomustine treatment could significantly inhibit cell migration and proliferation(P＜0.01),and promoted apoptosis(P＜0.05)in U-87MG cells,and their effects were comparable. Conclusion CDKN1A may be as a key potential target for the treatment of glioblastoma with lomustine,providing new theoretical basis for further elucidating the anti-glioma mechanism and clinical application of lomustine.

Objective This study aimed to explore the efficacy and safety of ramucirumab in Chinese patients with advanced gastric cancer / gastroesophageal junction cancer(GC/GEJC)using real world data,and analyze the impact of different clinical characteristics and combination treatment regimens on patient survival. Methods This was a dual-center,retrospective real world study involving 72 patients with advanced GC/GEJC who received ramucirumab treatment at Shanxi Medical University Cancer Hospital and Harbin Medical University Cancer Hospital from July 2017 to January 2024.Overall survival(OS)was the primary endpoint,while progression free survival(PFS)and other outcomes served as secondary endpoints.Survival analysis methods were employed to evaluate and compare OS and PFS,and Cox proportional hazards model was used to analyze influencing factors of OS and PFS. Results The median PFS was 4.27 months(95% CI:3.38-5.15 months),and the median OS was 9.66 months(95% CI:7.09-12.23 months)for all patients.Among 49 evaluable patients,the objective response rate(ORR)was 16.3%,and the disease control rate(DCR)was 67.4%.Multivariate Cox regression analysis showed that ramucirumab combined with immune checkpoint inhibitor(ICI)was an independent risk factor for OS(HR=4.600,95% CI:1.700-12.452,P=0.003),while male(HR=0.282,95% CI:0.116-0.685,P=0.005)and a history of prior surgery(HR=0.401,95% CI:0.184-0.876,P=0.022)were independent protective factors for OS.In terms of safety,75.0%(54/72)of patients experienced adverse events,with neutropenia(8.3%)being the most common grade 3-4 adverse event.No new safety signals were identified. Conclusion This real world study confirms that ramucirumab demonstrates consistent efficacy and a manageable safety in patients with advanced GC/GEJC as observed in pivotal clinical trials.However,ramucirumab combined with ICIs may be associated with reduced survival,necessitating cautious assessment of patient suitability and potential confounders in clinical practice,with further prospective research required for validation.

Pancreatic cancer is a malignant tumor of digestive tract with an extremely poor prognosis.It is highly invasiveness and drug resistance.The 5-year survival rate of patients is only approximately 10%.Currently,Surgical resection,chemotherapy,and radiotherapy are the standard treatment methods,but there are still many limitations and are prone to tumor recurrence and drug resistance.Therefore,exploring new therapeutic targets has become an urgent need in current research.As a key component of tumor microenvironment,the extracellular matrix plays an important role in the progression and drug resistance of pancreatic cancer.Recent studies have shown that targeted intervention of the extracellular matrix is expected to bring new breakthroughs in the treatment of pancreatic cancer.Based on the latest research progress at domestically and abroad,this paper systematically reviews the theoretical basis of extracellular matrix as a therapeutic target for pancreatic cancer.

Gastric cancer is a malignant tumor with high incidence and poor prognosis worldwide,ranking fifth and fourth,among all malignancies interms of incidence and mortality.In China,the proportion of patients with advanced gastric cancer diagnosed for the first time is 64.37%.In recent years,with the in-depth research of molecular targets,targeted therapy for gastric cancer has made significant progress,and related target drugs such as HER2 and tight junction protein 18.2 subtypes(Claudin18.2,CLDN18.2)have shown clear clinical efficacy.From the first anti-HER2 monoclonal antibody trastuzumab approved for the treatment of gastric cancer,to the recently launched CLDN18.2 monoclonal antibody zolbetuximab,as well as many new targeted drugs in clinical research,it provides more treatment options for gastric cancer patients with different molecular subtypes.This article comprehensively reviews the research progress on targeted therapy and drug resistance mechanisms of gastric cancer,aiming to provide reference for clinical treatment decision-making and related basic research of gastric cancer.