The study used routine-care records from two campuses of Anhui No. 2 Provincial People’s Hospital in Hefei, China. The Main Campus development cohort included 445 adults who underwent endoscopic sinus surgery between January 2021 and July 2024, while the Huangshan Road Campus held-out cohort included 360 treated between February 2021 and November 2024. The surgery periods overlapped, and both campuses belonged to the same institution, so the second group was a non-overlapping, different-campus held-out evaluation rather than a temporal or fully external validation cohort. Twelve-month outcomes were available for 400 members of the development cohort and 320 members of the held-out cohort; 85 participants, or 10.6% of the full sample, lacked an evaluable endpoint.

SIRI is calculated from the absolute neutrophil, monocyte and lymphocyte counts in the same preoperative blood sample: neutrophils multiplied by monocytes, then divided by lymphocytes. For this analysis, positive values were transformed with a base-2 logarithm, allowing the main odds ratio to represent the change associated with a doubling of SIRI. Participants were required to have a blood count obtained zero to seven days before surgery, no systemic glucocorticoid exposure during the preceding 14 days, and no recorded acute infection or fever at baseline. A total of 44 participants were classified as having aspirin-exacerbated respiratory disease, defined from the clinical record as chronic rhinosinusitis with nasal polyps and asthma accompanied by a respiratory reaction to aspirin or another cyclooxygenase-1-inhibiting anti-inflammatory drug.

Among participants whose outcomes could be evaluated, recurrence occurred in 124 of 400 in the development cohort, or 31.0%, and in 99 of 320 in the held-out cohort, or 30.9%. The endpoint was defined as a total bilateral nasal polyp score of at least one on either side at the planned postoperative assessment. Visits were scheduled at approximately three, six and 12 months, with an allowable 12-month window of 11.3 to 13.0 months after surgery. Earlier documented recurrence also contributed to the binary outcome. Because the analysis was visit-based rather than a time-to-event analysis, the results do not estimate the exact probability of recurrence on postoperative day 365 or address the timing of recurrence between visits.

Descriptive comparisons showed that participants with recurrence generally had greater disease burden, including higher baseline nasal polyp, endoscopic and CT scores, more blood eosinophils, and higher C-reactive protein and total immunoglobulin E concentrations. Median SIRI was 1.367 in development participants with recurrence, compared with 0.847 among those without recurrence. The same pattern appeared in the held-out cohort, where the corresponding medians were 1.512 and 0.842. These unadjusted comparisons establish only that high SIRI was more common among people whose polyps returned; they do not show that SIRI causes recurrence or identifies a distinct inflammatory subtype of chronic rhinosinusitis with nasal polyps.

The researchers fitted three unpenalized logistic regression models in the development cohort: one using log-transformed SIRI alone, one using eight routine clinical predictors, and an extended model that added SIRI to those predictors. The clinical model included age, sex, asthma, AERD, number of previous sinus operations, Lund–Mackay CT score, total baseline nasal polyp score and blood eosinophil count. Continuous predictors were retained continuously rather than selected through univariable significance testing. In the extended model, each doubling of SIRI was associated with an adjusted odds ratio of 1.47 for recurrence, with a 95% confidence interval of 1.06 to 2.04 and a P value of 0.022. A five-point increase in CT score was also associated with higher adjusted odds, with an odds ratio of 1.73 and a 95% confidence interval of 1.23 to 2.44. The adjusted SIRI estimate represents higher odds, not a 47% increase in absolute recurrence probability for each individual patient.

All three models showed moderate discrimination, but adding SIRI changed performance only marginally. In the development cohort, the area under the receiver operating characteristic curve was 0.708 for the SIRI-only model, 0.757 for the clinical model and 0.764 for the extended model. Adding SIRI therefore increased AUC by 0.007; a paired refit-bootstrap 95% confidence interval of −0.002 to 0.026 included no change. The corresponding Brier score improved by 0.0036, with a 95% confidence interval of 0.00006 to 0.0108. When the development coefficients were applied unchanged to the held-out cohort, the three AUCs were 0.726, 0.781 and 0.791. SIRI increased the held-out AUC by 0.010, but its confidence interval ranged from −0.016 to 0.030, while the Brier-score improvement of 0.0044 had a confidence interval of −0.0025 to 0.0111.

The association was broadly stable under alternative assumptions about incomplete follow-up. Stabilized inverse-probability weighting produced an odds ratio of 1.46 per doubling of SIRI, and pooling 200 proper stochastic imputations produced 1.47. Assigning all 85 missing outcomes to non-recurrence yielded 1.44, whereas assigning every missing outcome to recurrence attenuated the estimate to 1.31, with a 95% confidence interval of 0.99 to 1.74 and a P value of 0.062. The latter was a deliberately extreme scenario rather than a plausible estimate of the missing cases, but it demonstrated that the statistical result depends partly on how outcomes absent from the records are handled. Excluding 25 participants with general hypersensitivity to non-steroidal anti-inflammatory drugs who did not meet the clinical AERD definition did not materially change the SIRI estimate, which remained 1.46 with a 95% confidence interval of 1.05 to 2.04.

Several limitations constrain the interpretation of the result. The cohorts shared an institutional system and overlapping operating periods, so the held-out analysis did not establish transportability to independent hospitals. Follow-up was incomplete and its absence was associated with younger age, although fixed-model predicted risks were similar for participants with and without an endpoint. Retrospective records may also contain residual confounding, incomplete treatment information and imperfect clinical ascertainment of AERD, particularly because no uniform study-mandated aspirin challenge was used. The number of AERD cases was small, making its adjusted estimate imprecise. The unpenalized models also showed signs of overfitting, and the clinical comparator omitted some measured inflammatory variables, including C-reactive protein, so the estimated contribution of SIRI was conditional on the predictors included. No clinical-impact evaluation, decision-curve analysis or prespecified treatment threshold was available.

Overall, the results position SIRI as an accessible candidate marker for prospective prognostic research rather than a ready-made clinical test. Its components are already measured in routine complete blood counts, making the index readily obtainable for future prediction studies. The present evidence supports an association between higher preoperative systemic inflammation and endoscopic polyp recurrence after sinus surgery, but it does not establish that the index should guide postoperative anti-inflammatory treatment, biologic therapy, surveillance or revision surgery. Independent prospective validation, better follow-up completeness, recalibration and assessment of a defined clinical decision are needed before the modest predictive gain could be judged useful in practice.

Subject of Research: Preoperative systemic inflammation response index as a prognostic marker for nasal polyp recurrence after endoscopic sinus surgery

Article Title: Preoperative systemic inflammation response index and 12-month endoscopic recurrence after endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: association and incremental predictive performance in a same-institution, two-campus cohort

Article References: Qian, X., Tong, S., Wei, P., & Wu, F. (2026). Preoperative systemic inflammation response index and 12-month endoscopic recurrence after endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: association and incremental predictive performance in a same-institution, two-campus cohort. Frontiers in Medicine, 13, Article 1983990. https://doi.org/10.3389/fmed.2026.1983990

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1983990

Keywords: systemic inflammation response index, chronic rhinosinusitis, nasal polyps, endoscopic sinus surgery, postoperative recurrence, clinical prediction model, aspirin-exacerbated respiratory disease, blood count, retrospective cohort, Preoperative, systemic, inflammation

The study included patients treated between 2018 and 2023. Of the 275 participants, 183 were classified as having de novo stage IV disease and 92 as having postoperative recurrence. The difference in progression-free survival was statistically significant, with a reported P value below 0.0001, and the difference in overall survival was also statistically significant at P = 0.0030.

Both analyses compared patients who received first-line osimertinib, making the study a prognostic comparison within a treated cohort rather than a direct test of the drug against another treatment or an untreated control group. Analyses by EGFR mutation subtype showed that the survival pattern was consistent among patients with an exon 19 deletion and those with the L858R mutation. The postoperative-recurrence association with longer survival also remained statistically significant after adjustment for age, sex, Eastern Cooperative Oncology Group performance status and EGFR mutation subtype.

These results indicate that the measured demographic, clinical and molecular factors did not fully account for the observed difference. However, the retrospective design leaves the contribution of other differences between the groups unresolved, and the study cannot determine whether postoperative recurrence itself produced the more favorable outcomes. The researchers additionally examined whether the tumor–node–metastasis ninth-edition M1 subclassification was associated with outcomes among patients with de novo stage IV disease.

In exploratory subgroup analyses, those classified as M1c2 had numerically shorter survival than patients in the other M categories. The authors described M1c2 as representing high multi-organ metastatic burden, but the comparative analysis was exploratory and the findings require validation. Overall, the study reports a substantial survival association between postoperative recurrence and comparatively favorable outcomes in EGFR-mutant lung adenocarcinoma treated with osimertinib.

Its strongest evidence comes from the significant comparisons of progression-free and overall survival, together with the persistence of the association after adjustment for several measured characteristics and across two EGFR mutation subtypes. Nevertheless, the analysis was based on retrospective clinical data from six institutions, and its subgroup results remain exploratory.

Subject of Research: Comparative survival in surgically recurrent versus de novo stage IV EGFR-mutant lung adenocarcinoma treated with osimertinib

Article Title: Survival advantage of postoperative recurrence compared to de novo stage IV disease in EGFR-mutant lung adenocarcinoma treated with osimertinib: a multicenter retrospective study

Article References: Sato, M., Tanaka, I., Hori, K., Koyama, J., Kodama, Y., Matsui, A., Miyazawa, A., Miyamatsu, S., Asano, S., Hibino, Y., Yokoyama, T., Kimura, T., Yoshida, N., Sato, M., & Ishii, M. (2026). Survival advantage of postoperative recurrence compared to de novo stage IV disease in EGFR-mutant lung adenocarcinoma treated with osimertinib: a multicenter retrospective study. BMC Cancer. https://doi.org/10.1186/s12885-026-17153-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17153-1

Keywords: EGFR mutations, lung adenocarcinoma, osimertinib, postoperative recurrence, stage IV disease, progression-free survival, overall survival, retrospective cohort, TNM staging, M1c2 metastases, Survival, advantage

The study is designed as a multicenter, double-blind, randomized, placebo-controlled trial, the gold standard architecture of modern clinical research. It will be conducted across twelve hospitals in China, a scale that lends the investigation considerable statistical and external validity. In total, 302 elderly patients who have undergone D2 resection, the meticulous surgical removal of the stomach along with regional lymph nodes, will be enrolled. Each participant must have pathologically confirmed stage pII or pIII disease, ensuring that the study population reflects the patients who face the highest residual risk after curative-intent surgery. Once enrolled, patients will be randomized in a one-to-one ratio into an experimental group and a control group of 151 participants each.

The experimental arm will receive the herbal decoction alongside chemotherapy for six months, while the control group will receive an indistinguishable placebo with the same chemotherapy. The double-blind design means that neither the patients nor the treating clinicians will know who is receiving the active herbal preparation, a crucial safeguard against the placebo effects and observer bias that have historically undermined studies of traditional medicine. The six-month treatment window is strategically timed to overlap with the postoperative period, when micrometastatic disease, invisible residual cancer cells that have already spread beyond the surgical field, is most vulnerable to systemic therapy.

The primary endpoint of the trial is disease-free survival, a measure of the length of time after treatment during which the patient survives without any signs of cancer returning. Disease-free survival is considered the most clinically meaningful yardstick for adjuvant therapies in solid tumors, because it directly captures whether an intervention actually delays or prevents relapse rather than merely improving surrogate markers. Secondary outcomes include overall survival, the ultimate measure of treatment benefit, as well as the overall chemotherapy completion rate, a particularly important metric in elderly populations where treatment interruptions and dose reductions are common.

Beyond these hard oncological endpoints, the researchers will also track Traditional Chinese Medicine syndrome scores and quality of life assessments, tools designed to quantify the subjective symptoms, fatigue, appetite loss, and general wellbeing that matter enormously to older patients. Safety will be monitored through adverse events graded according to the Common Terminology Criteria for Adverse Events, the internationally standardized vocabulary for describing the severity of treatment side effects. Serious adverse events will be captured as well, ensuring that any added toxicity from the herbal formula is detected promptly and transparently.

What distinguishes this protocol from many previous studies of herbal medicine is its embrace of modern exploratory science. The investigators plan to incorporate big data analytics and assessments of gut microbiota diversity, reflecting a growing recognition that the trillions of microbes inhabiting the digestive tract can influence both cancer progression and chemotherapy efficacy. In gastric cancer, where the organ under treatment is itself a central hub of the digestive system, the interplay between the herbal decoction, the microbiome, and the cytotoxic drugs could prove mechanistically revealing. Subgroup analyses are also planned to explore whether the effects of the decoction vary across patient characteristics, an approach that can uncover heterogeneity that a single average treatment effect would mask.

The clinical problem the trial addresses is genuinely unmet. Elderly gastric cancer patients often tolerate dual-drug chemotherapy poorly, experiencing excessive toxicity that forces dose reductions or complete discontinuation, while monotherapy regimens deliver only limited benefit. This therapeutic bind leaves a large population with high rates of postoperative recurrence and metastasis and few good options. If the herbal decoction can genuinely reduce recurrence while easing the burden of chemotherapy, the implications for geriatric oncology would be substantial, particularly in East Asia where gastric cancer incidence remains among the highest in the world and where traditional medicine is already widely used alongside conventional care.

The trial has cleared the essential regulatory and ethical hurdles that lend credibility to its design. It was approved by the Ethics Committee of the Affiliated Hospital of Nanjing University of Chinese Medicine in December 2024, with final approval for the amended protocol granted in August 2025 after two revisions informed by expert recommendations. It is registered with the International Traditional Medicine Clinical Trial Registry, a step that commits the investigators to publishing their methods in advance and reduces the risk of outcome switching, a notorious problem in complementary medicine research. Written informed consent will be obtained from all enrolled patients before any study-related procedures, and the protocol was developed by a broad consortium of oncologists spanning hospitals in Nanjing, Changzhou, Xuzhou, and Jiangyin.

The study is supported by significant national funding, including China’s Noncommunicable Chronic Diseases National Science and Technology Major Project and the National Natural Science Foundation of China, signals that the country’s research establishment is taking integrative oncology seriously. The corresponding author, Peng Shu of the Affiliated Hospital of Nanjing University of Chinese Medicine, leads a team whose affiliations span traditional Chinese medicine institutions and mainstream Western-medicine cancer centers alike, a collaboration model that may prove as important as any single result. Bridging these two medical cultures under the strict discipline of placebo-controlled methodology is precisely what rigorous evaluation of traditional therapies has often lacked.

Caution remains warranted, as it always should be when a trial protocol, rather than completed results, is the subject of discussion. A well-designed protocol guarantees rigor but not efficacy, and the history of complementary medicine is littered with promising hypotheses that dissolved under controlled scrutiny. Yet the stakes of this particular experiment are high and its design is sound. If Yiqi Huayu Jiedu Decoction demonstrates a genuine disease-free survival benefit with acceptable safety, it would represent a rare and consequential example of a classical herbal formula earning a place in evidence-based adjuvant cancer care. If it fails, the trial will still deliver valuable, honest data in a field that badly needs more of it. Either way, the 302 elderly patients who enroll will be contributing to an answer that clinicians and patients around the world have been waiting for.

Subject of Research: A randomized controlled trial of Yiqi Huayu Jiedu Decoction combined with chemotherapy to prevent postoperative recurrence and metastasis in elderly gastric cancer patients

Article Title: Chinese herbal medicine (Yiqi Huayu Jiedu Decoction) combined with chemotherapy for preventing postoperative recurrence and metastasis in elderly gastric cancer patients: protocol for a multicenter, double-blind, randomized, placebo-controlled trial

Article References: Yang, P., Wang, J., Wu, X., Yang, J., Sun, Y., Wei, X., Wu, J., Han, Z., Bi, Y., Zhao, Z., Yang, R., Yang, M., & Shu, P. (2026). Chinese herbal medicine (Yiqi Huayu Jiedu Decoction) combined with chemotherapy for preventing postoperative recurrence and metastasis in elderly gastric cancer patients: protocol for a multicenter, double-blind, randomized, placebo-controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05561-6

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05561-6

Keywords: gastric cancer, Yiqi Huayu Jiedu Decoction, traditional Chinese medicine, randomized controlled trial, chemotherapy, disease-free survival, elderly patients, postoperative recurrence, metastasis, gut microbiota, adjuvant therapy, clinical trial protocol

Lung cancer remains the most commonly diagnosed and deadliest malignant tumor worldwide, and while radical surgical resection is the treatment of choice for early-stage disease, postoperative recurrence continues to undermine long-term outcomes for a substantial fraction of patients. The clinical dilemma is familiar to every thoracic oncologist: two patients with seemingly identical tumor stage and histology can follow radically different trajectories after surgery, one remaining disease-free for a decade, the other relapsing within a year. Traditional staging, based on tumor size, nodal involvement and metastatic status, captures only part of this biological heterogeneity. The Shanghai team set out to determine whether the mutational landscape of resected tumors could close that gap, systematically delineating the gene mutation profile of a large real-world Chinese cohort and assessing the predictive value of critical mutations for postoperative disease-free survival (DFS).

The methodology was comprehensive. All 1,674 enrolled patients, treated between long follow-up windows and retrospectively identified from clinical records, had undergone NGS-based molecular profiling of their resected tumor specimens. The investigators collected detailed clinicopathological data, treatment information and survival outcomes, then constructed mutation profiles for the overall population and for clinically relevant subgroups. Statistical machinery included Kaplan-Meier survival curves to visualize differences in disease-free survival, univariate and multivariate Cox proportional-hazards regression to isolate the independent contribution of each genetic and clinical variable, and co-mutation analysis to test whether pairs of altered genes interact to shape prognosis more than either alteration alone.

The mutational census that emerged was broad: 144 relevant mutated genes were detected across the cohort, and the team mapped their frequencies across the population. Two alterations dominated the landscape. EGFR, the epidermal growth factor receptor gene long known to be unusually frequent in East Asian lung cancer populations, was mutated in 61.2 percent of patients, while TP53, the canonical guardian-of-the-genome tumor suppressor, was altered in 31.9 percent. The high EGFR prevalence itself underscores why population-specific genomic studies matter; mutation frequencies observed in predominantly Western cohorts do not simply translate to Chinese patients, and treatment guidelines built on foreign data risk misaligning with the biology of the patients they are meant to serve.

The prognostic signal, however, came less from EGFR than from a set of other genes. Univariate analysis revealed that patients harboring mutations in TP53, KRAS, MET, ROS1 or CDKN2A experienced significantly shorter disease-free survival than patients without those alterations. In contrast, and perhaps counterintuitively, ERBB2 mutations were associated with longer DFS, a finding that held up when the investigators pushed the data through multivariate modeling. That final model, which adjusted for confounders simultaneously, confirmed TP53 mutation, ERBB2 mutation, tumor and nodal stage (T/N classification) and pleural invasion as independent prognostic factors for postoperative disease-free survival. In other words, even after accounting for how advanced a tumor appeared anatomically, the mutational status of these genes carried genuine, standalone predictive information about whether a patient’s cancer would return.

The most consequential result concerned gene pairs. When the team performed co-mutation analysis, patients whose tumors carried both TP53 and MET mutations had the poorest prognosis of any molecular subgroup, with disease-free survival significantly worse than that of patients carrying either single mutation and dramatically worse than those wild-type for both genes. This synergistic worsening of outcome is biologically plausible: TP53 loss disables apoptotic safeguards and genomic integrity checks, while MET activation drives invasive growth and metastatic signaling pathways, and the combination may equip residual micrometastatic disease with a particularly aggressive phenotype. Critically, the TP53-MET co-mutation signal remained consistent when the analysis was repeated in the subgroup of patients whose disease did progress, reinforcing the robustness of the association rather than reflecting a statistical artifact of the full cohort.

For clinical practice, the implications are tangible. Postoperative risk stratification for lung cancer currently leans heavily on pathological stage, with adjuvant therapy decisions guided largely by nodal status and tumor size. This study provides evidence that NGS profiling of resected specimens can refine that stratification: a patient with a TP53-mutant tumor, or worse, a TP53 and MET co-mutant tumor, could be flagged for intensified surveillance imaging, consideration of adjuvant targeted therapy or chemotherapy trials, and earlier detection of recurrence through molecular monitoring. Conversely, an ERBB2-mutant patient with otherwise favorable anatomy may face a lower recurrence risk than staging alone would suggest, information that could spare unnecessary treatment toxicity. The authors explicitly frame the results as a reliable molecular basis for postoperative risk stratification and individualized adjuvant therapy in lung cancer.

The study’s scale and design give its conclusions unusual weight. Retrospective cohort studies of this kind are vulnerable to selection bias and to the vagaries of heterogeneous treatment patterns, but a sample of 1,674 consecutively sequenced patients with long-term follow-up is rare in the literature on resected lung cancer, and the concordance between univariate, multivariate and co-mutation analyses, together with validation in the progression subgroup, argues that the signals are genuine properties of the disease rather than artifacts. The work was approved by the Ethics Committee and Institutional Review Board of Shanghai Chest Hospital under reference number LS1808, conducted in line with the Declaration of Helsinki, and supported by the National Natural Science Foundation of China and the Chinese Society of Clinical Oncology. Corresponding authors Zhi-qiang Gao, Jun Lu and Bao-hui Han led the effort, with Feng Pan and Liang Zheng contributing equally as first authors.

What remains to be established is prospective validation. Retrospective association, however robust, must ultimately be tested in trials that assign adjuvant treatment based on mutational profile and measure whether outcomes improve; ongoing studies of adjuvant targeted therapy in EGFR-mutant disease suggest this paradigm is already moving into the clinic. The Shanghai data add momentum by identifying which patients, within the large EGFR-mutated population, are most and least likely to benefit from closer surveillance. As NGS testing becomes routine and cheaper for resected lung cancer specimens, studies like this one chart the path from genomic description to genomic prognosis, where every surgical specimen yields not just a diagnosis but a personalized forecast, and where the risk of recurrence, lung cancer’s most feared late event, can be anticipated and countered before the first recurrent cell ever shows up on a scan.

Subject of Research: Postoperative gene mutations as prognostic predictors of disease-free survival in Chinese patients with resected lung cancer

Article Title: Relationship between postoperative gene mutation and prognosis in chinese patients with lung cancer: a long-term follow-up retrospective cohort study

Article References: Pan, F., Zheng, L., Zhang, L.-L., Wang, X., Lu, A.-T., Zhou, C., Gao, Z.-Q., Lu, J., & Han, B.-H. (2026). Relationship between postoperative gene mutation and prognosis in chinese patients with lung cancer: a long-term follow-up retrospective cohort study. BMC Cancer. https://doi.org/10.1186/s12885-026-16960-w

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16960-w

Keywords: lung cancer, gene mutation, TP53, EGFR, MET, disease-free survival, next-generation sequencing, postoperative recurrence, prognostic factors, co-mutation, retrospective cohort study, adjuvant therapy