Aims and Scope The Chinese Clinical Oncology (CCO; Chin Clin Oncol; Print ISSN 2304-3865; Online ISSN 2304-3873) is an Open Access, peer-reviewed, bimonthly journal (quarterly published from Sep 2012-Dec 2015). It has been indexed in MEDLINE/PubMed since 2014 and Web of Science [Emerging Sources Citation Index (ESCI)] since 2016, and has attained its latest impact factor of 2.7 for the year 2025. CCO publishes original articles, editorials, case reports and reviews. The main focus of the journal is to describe new findings in the field of oncology and to provide current and practical information on diagnosis, prevention and clinical investigations of cancer. Specific areas of interest include, but are not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention and technical advances related to cancer. CCO is the official journal of the Society of Translational Medicine (STM). CCO is published by AME Publishing Company, with support from Wolters Kluwer (the journal content will be made available on Wolters Kluwer Health’s Lippincott and Ovid platforms). Indexing and Archiving Chinese Clinical Oncology is indexed and covered by PubMed/MEDLINE Google Scholar Medscape MDlinx Web of Science [Emerging Sources Citation Index (ESCI)] Scopus Ovid Digital Preservation Portico Information for Authors CCO is a member of Committee on Publication Ethics (COPE) and it follows the Committee on Publication Ethics (COPE)'s guidelines and the ICMJE recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journal. Manuscripts submitted must be the original work of the author(s) and must not be published previously or under consideration for publication elsewhere. Submission Turnaround Time In-house review: 1-3 weeks. External peer review: 1-3 months. 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Example of statements in published articles: https://actr.amegroups.org/article/view/8875; https://med.amegroups.org/article/view/8358/html. Contact with Editorial Office Mira Wu, Corresponding Editor, Chinese Clinical Oncology Email: editor@thecco.net Publisher Information CCO is published by AME Publishing Company. Address: Hong Kong branch office: Flat/RM C 16F, Kings Wing Plaza 1, NO. 3 on Kwan Street, Shatin, NT, Hong Kong, China. Updated on July 10, 2026
Preliminary study on efficacy and safety of pixantrone in relapsed/refractory aggressive B-cell lymphomas: multicenter, retrospective cohort study by Polish Lymphoma Research Group (PLRG)
Background: Pixantrone (PIX) is an anthracycline derivative with reduced cardiotoxicity, registered in Poland for monotherapy in relapsed/refractory (R/R) aggressive B-cell non-Hodgkin lymphoma (B-NHL) in the third or fourth line of treatment. As R/R population is difficult to treat due to comorbidities including circulatory system pathologies we evaluate polish patients treated with PIX. This is the first real life study evaluating patients treated with PIX in Poland with emphasis on efficacy and cardiovascular toxicity. Methods: The retrospective study assessing safety and effectiveness of PIX administered in patients with aggressive de novo or transformed B-NHL [according to the Revised European American Lymphoma (REAL) and World Health Organization (WHO) classifications], who relapsed or were refractory to two or three previous lines of chemotherapy regimens, including at least one standard anthracycline-based regimen. Patients who did not remain sensitive to anthracyclines were excluded from this study. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), complete response (CR) rate, overall response rate (ORR) and safety. Results: The data of 17 patients were collected in 6 study sites. The median age was 72 (range: 58–82) years old with male predominance (65%). In observed group10 patients had diffuse large B-cell lymphoma (DLBCL), 6 mantle cell lymphoma (MCL) and 1 patient had Richter syndrome. Five subjects responded to PIX (CR 2 and partial response 3)—ORR was 29%. The median of PFS was 12.9 months [standard error (SE) 2.2; 95% confidence interval (CI): 8.5, 17.2]. The median of survival time was 22.6 months (SE 7.3; 95% CI: 8.3, 36.8). The PIX compliance was good, with incidental dose omission or delay. The main reason for discontinuation was disease progression. Conclusions: Administration of PIX to patients with R/R aggressive B-NHL treated with multiple lines of chemotherapy containing maximal cumulative dose of anthracycline and with numerous concomitant diseases may be a potentially valuable therapeutic option but data from larger clinical studies will help in confirming PIX as an effective and safe option.
A nomogram integrating clinical and multimodal ultrasound features for pretreatment prediction of HER2 status in breast cancer: a retrospective study
Background: The effective management of heterogeneous breast cancer relies on accurate human epidermal growth factor receptor 2 (HER2) status assessment to guide targeted therapy. Currently, core needle biopsy remains the gold standard for accurately determining HER2 status. However, its high cost and invasive nature render it unsuitable for large-scale screening or for dynamic monitoring of HER2 status during treatment. Furthermore, due to intratumoral heterogeneity, a single invasive biopsy sample may not fully represent the entire lesion. Additionally, HER2 expression in breast cancer can change during chemotherapy. These limitations highlight the need for a non-invasive assessment tool. To address this gap, this study aims to develop a predictive model for HER2 status by integrating clinical and multimodal ultrasound features. Methods: We retrospectively enrolled 142 consecutive breast cancer patients from Yunnan Cancer Hospital’s Breast Center (March 2022–August 2024). The least absolute shrinkage and selection operator (LASSO) regression method was applied to filter variables and select predictors, and multivariate logistic regression was used to construct a nomogram. Model performance was assessed through: (I) calibration curves with Hosmer-Lemeshow test, (II) discrimination via area under the ROC curve (AUC), and (III) clinical utility by decision curve analysis. Internal validation was performed using bootstrap resampling with 1,000 replicates and optimism correction. Results: Six variables of breast cancer patients were selected through the LASSO regression method: maximum lesion diameter, hyperechoic halo presence, Adler grade, shape, lymph node status, and calcifications. Multivariate analysis confirmed three independent predictors of HER2 status (P<0.05): hyperechoic halo presence [odds ratio (OR) =2.655; 95% confidence interval (CI): 1.204–5.990], lymph node status (OR =0.325; 95% CI: 0.133–0.745), and Adler grade (OR =3.093; 95% CI: 1.672–6.110). The resulting nomogram demonstrated good discrimination (AUC =0.728; 95% CI: 0.639–0.817), with bootstrap-corrected AUC of 0.708 (95% CI: 0.620–0.796). The model also exhibited good calibration (calibration slope =0.928; Hosmer-Lemeshow test P=0.86). Furthermore, decision curve analysis confirmed the clinical utility of the nomogram, showing a superior net benefit across a wide range of risk thresholds. Conclusions: The validated nomogram offers a clinically valuable tool for the pretreatment assessment of HER2 status. While it cannot replace pathological biopsy, it may serve as a complementary approach to identify patients with a high likelihood of HER2 positivity. This could potentially guide biopsy strategies or aid treatment decisions, particularly in cases where biopsy is inconclusive or not feasible.
Research progress and trends in clinical trials for older people with colorectal cancer from 2005 to 2025: a bibliometric analysis
Background: Colorectal cancer is one of the most common cancers in older people, yet older patients remain underrepresented in clinical trials, and evidence to guide their treatment is limited. This study aimed to conduct a bibliometric analysis of clinical trial research among older people with colorectal cancer. It presents the research landscape, highlights advancements, and reveals research hotspots, evolutionary trends, and gaps to identify areas for future research. Methods: We analyzed publications on all types of clinical trials among older people with colorectal cancer indexed in the Web of Science Core Collection database between 2005 and 2025. We used CiteSpace software to develop visual maps showing the current research status and the evolution of research hotspots and gaps. Results: In total, 1,354 publications were included, with the volume of publications increasing over time. The top 10 authors published approximately 5% of the research in the field. Most of the top institutions were North American, and few strong collaboration networks were identified between authors or between institutions. Key research hotspots centered on clinical studies, with primary outcome measures focusing on quality of life, improvement in symptoms, and overall survival. There were important gaps in the literature, with few trials of immunotherapy and the gut microbiota among older people, suggesting a lack of evidence on how these therapeutic advances might benefit this group. Conclusions: This bibliometric analysis has highlighted the predominance of North American institutions and the lack of international collaboration in this field, both of which may have implications for the future. Our findings also suggest a progressive shift from a treatment-oriented approach toward risk stratification and individualized interventions within the framework of precision medicine but indicate a slower pace than in many other areas of cancer. Future studies must consider how to fill these gaps.
Improving Asian American lung cancer screening awareness through virtual physician-led community outreach: quality improvement initiative
Background: Despite a significant lung cancer burden, Asian American populations have persistently low lung cancer screening (LCS) rates in the United States. This quality improvement initiative evaluated the impact of virtual, physician-led community education sessions to inform LCS outreach efforts in the Asian American community, using knowledge and perceptions as formative metrics. Methods: Three physician-led virtual outreach sessions were conducted in 2023–2024 in Northern California, centered on LCS in the Asian American community. Multidisciplinary Asian American lung cancer physicians reviewed the 2021 United States Preventive Services Task Force (USPSTF) LCS eligibility criteria, benefits, and misconceptions. Anonymous pre- and post-event surveys assessed participant knowledge. Responses were analyzed using descriptive statistics, Fisher’s exact tests, Chi-squared tests, and thematic qualitative analysis. Results: A total of 267 responses were collected (25 pre-event, 242 post-event). Among post-event surveys from 2024 (n=94), most participants were Kaiser Permanente members (93%) and non-smokers (96%), with nearly half reporting a family history of lung cancer (45%). Before the session, 28% reported general knowledge of LCS and 52% knew screening was available. Only 20% reported knowledge of eligibility criteria in pre-event surveys compared with 42% in post-event surveys, an exploratory, descriptive comparison given the unpaired survey design. Despite this shift, 58% of participants remained uncertain about eligibility. Conclusions: Virtual, physician-led outreach supported quality improvement efforts to enhance LCS awareness among Asian Americans in Northern California. Persistent knowledge gaps about USPSTF criteria highlight the need for continued, targeted education and iterative engagement strategies.
Vagus nerve management in lung cancer surgery: anatomical preservation, functional modulation and postoperative outcomes—a narrative review
Background and Objective: The vagus nerve plays a fundamental role in regulating bronchomotor tone, cardiac rhythm, cough reflex pathways, and neuroimmune inflammatory responses. During lung cancer surgery, particularly during mediastinal lymphadenectomy, cardiopulmonary vagal branches may be exposed to traction, thermal injury, or intentional transection. With the progressive development of minimally invasive and robotic-assisted thoracic surgery, increasing attention has been directed toward functional preservation and postoperative quality of life in addition to oncological radicality. This narrative review aimed to summarize the current anatomical, physiological, and clinical evidence regarding vagus nerve management during lung cancer surgery. Methods: A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, and manual bibliography screening to identify relevant anatomical, physiological, clinical, and translational studies addressing vagus nerve management during lung cancer surgery. No strict temporal restriction was applied. Clinical studies evaluating preservation or transection of vagal branches during thoracoscopic lung resection were qualitatively analyzed. Key Content and Findings: Current evidence suggests that preservation of pulmonary vagal branches may reduce postoperative cough, inflammatory response, autonomic dysfunction, and impairment of postoperative recovery. Conversely, selective transection of specific pulmonary vagal afferents has also shown potential benefit in selected patients with refractory postoperative cough. Recent advances in robotic magnification, intraoperative neuromonitoring, and neuromodulatory strategies such as transcutaneous auricular vagus nerve stimulation (taVNS) may further improve perioperative functional outcomes. Conclusions: The vagus nerve represents both a critical anatomical structure and a major functional regulator during thoracic oncologic surgery. Integration of autonomic preservation strategies into modern minimally invasive lung cancer surgery may contribute to improved postoperative recovery and quality of life. Further prospective multicenter studies are required to standardize vagus nerve preservation and neuromodulatory approaches.
Locoregional therapies for intrahepatic cholangiocarcinoma: a stage-stratified, biology-informed multidisciplinary framework—a narrative review
Background and Objective: Intrahepatic cholangiocarcinoma (iCCA) is an aggressive primary liver malignancy with rising global incidence; most patients present with unresectable disease, and intrahepatic recurrence is common after curative-intent surgery. Locoregional therapies (LRTs), including future liver remnant (FLR) augmentation, percutaneous ablation, transarterial chemoembolization (TACE), transarterial radioembolization (TARE), hepatic arterial infusion chemotherapy (HAIC), and stereotactic body radiotherapy (SBRT), are increasingly applied across the disease continuum. This narrative review focuses primarily on unresectable iCCA, while also addressing surgical-adjunct and downstaging roles, and aims to clarify how each modality is best integrated within modern multimodal management. Methods: We performed a focused literature search of PubMed/MEDLINE for English-language publications from January 2000 through March 2026, combining population terms (“cholangiocarcinoma”, “intrahepatic cholangiocarcinoma”, “iCCA”, “biliary tract cancer”) with intervention terms covering the principal locoregional modalities. Supplementary targeted searches were performed for context on epidemiology, systemic and targeted therapy, biology, imaging, and current guidelines. Randomized trials, prospective cohort studies, large multicenter retrospective series, systematic reviews, and current clinical practice guidelines were prioritized. Key Content and Findings: FLR augmentation with portal vein embolization or liver venous deprivation expands the pool of surgical candidates but requires careful interval management to limit disease progression. Thermal ablation can yield outcomes comparable to repeat resection in selected patients with small recurrent or solitary lesions; SBRT offers a non-invasive option for centrally located or perihilar tumors not amenable to ablation. TACE and TARE achieve comparable survival in selected patients, with TARE often preferred for infiltrative, unilobar, or portal-vein-compromised disease. The strongest prospective evidence for LRT integration with first-line systemic chemotherapy comes from the MISPHEC trial of concomitant Y-90 SIRT plus gemcitabine/cisplatin, the PUMP-2 trial of hepatic arterial infusion pump floxuridine plus systemic gemcitabine/cisplatin, and pooled comparative analyses. Emerging retrospective data suggest a survival benefit when LRT is added to first-line chemoimmunotherapy, but prospective confirmation is awaited. Conclusions: LRTs have evolved from salvage interventions to integral components of multidisciplinary iCCA care. Stage-stratified, biology-informed selection and integration with modern systemic backbones offer the most promising path forward. Prospective, modality-stratified trials with standardized endpoints are needed to translate promising signals into evidence-based practice.
Separate the wheat from the chaff: the limited and context-dependent role of immune checkpoint inhibitors in platinum-resistant ovarian cancer
Revisiting neoadjuvant strategies in HER2-positive early breast cancer: are chemotherapy-sparing ADC-based approaches the next frontier?
An interview-based study of Asian American non-smoker lung cancer in the United States