The benefit of postoperative adjuvant therapy for patients with resectable esophageal squamous cell carcinoma (ESCC) is not yet supported by high-level evidence. This review analyzes the role of adjuvant therapy by examining the discrepancy between clinical needs and guidelines, its historical evolution, recent advances in high-risk factors, and future outlooks. We provide a detailed discussion of high-risk factors used for patient selection, including lymph node positivity, and for node-negative patients, features such as tumor length, location, T stage, extent of lymph node dissection, differentiation, vascular and neural invasion, laboratory indices, and molecular markers. The goal is to inform the development of individualized precision treatment strategies for resectable ESCC.
Colon cancer exhibits marked molecular heterogeneity, and molecular testing has become a central component throughout screening, diagnosis, treatment, and prognostic management, while also playing a pivotal role in surgical decision-making. The “NCCN clinical practice guidelines in oncology: colon cancer (version 1. 2026)”, systematically update the molecular testing framework and its clinical applications. The guidelines establish multigene panel testing as a standardized testing strategy based on next-generation sequencing platforms, promoting a transition in colon cancer molecular testing from single-gene, single-site detection toward comprehensive molecular profiling. Multigene panel testing enables the simultaneous detection of key molecular targets including RAS mutations, BRAF mutations, HER2 amplification, mismatch repair deficiency/microsatellite instability, and rare targetable alterations such as POLE/POLD1, RET, and NTRK mutations. In addition, the guidelines recognize the clinical value of circulating tumor DNA testing using peripheral blood as an alternative approach in cases of limited tissue availability. The guidelines further standardize routine biomarker testing workflows and clarify the principles for precise matching between distinct molecular subtypes and targeted therapeutic strategies. Stratified targeted treatment approaches for patients with BRAF V600E mutations and HER2 amplification have been continuously refined. The clinical application of immunotherapy-related biomarkers has been substantially advanced and that is no longer limited to later-line salvage treatment in the metastatic setting. Results of microsatellite instability-high/mismatch repair-deficient and POLE/POLD1 mutation testing have also been incorporated into the decision-making process for neoadjuvant therapy and perioperative stratified treatment for stage Ⅱ/Ⅲ colon cancer. The guidelines first incorporate PI3K pathway testing into routine evaluation for stage Ⅱ/Ⅲ colon cancer and recommend aspirin as a prognostic intervention strategy. In the field of pharmacogenomics, DPYD testing has been included as a pre-treatment screening requirement prior to fluoropyrimidine administration in order to improve the safety management system for chemotherapy. Meanwhile, the guidelines clearly define local treatment strategies for oligometastatic liver and lung lesions, emphasizing the rational selection of surgery, ablation, and radiotherapy. Overall, this update expands the role of molecular testing from treatment guidance to comprehensive whole-course management and promotes its deep integration with surgical practice, thereby providing an important foundation for precise, standardized, and safe treatment of colon cancer.
ObjectiveTo summarize recent advances in the preoperative differential diagnosis, pathological risk stratification, and standardized management of follicular thyroid carcinoma (FTC), aiming to inform clinical decision-making. MethodRecent domestic and international literature regarding the preoperative diagnosis, pathological typing, surgical strategies, radioactive iodine (RAI) therapy, and systemic treatments for FTC was comprehensively reviewed and summarized. ResultsRegarding preoperative diagnosis, the integration of neoplasm-specific ultrasound risk stratification systems, multimodal imaging, radiomics integrated with artificial intelligence models, and molecular biomarkers—including genetic profiling via tissue and liquid biopsies—demonstrates utility in refining the preoperative risk stratification of follicular thyroid neoplasms. Nevertheless, definitive diagnosis of FTC remains contingent upon histopathological examination following surgical resection. Therapeutic strategies emphasize individualized, risk-based management aligned with the 2022 WHO Classification and the 2025 American Thyroid Association Guidelines, stratifying interventions based on tumor invasiveness and vascular involvement. Thyroid lobectomy is recommended as sufficient therapy for low-risk FTC (minimally invasive, non-vascularly invasive tumors), offering a favorable prognosis while minimizing surgical morbidity. For low-to-intermediate-risk FTC (<4 sites of vascular invasion), management necessitates a personalized approach incorporating patient age, tumor dimensions, and informed patient preferences. Total thyroidectomy with adjuvant RAI therapy is advocated for high-risk patients exhibiting extensive vascular invasion (≥4 sites), significant extrathyroidal extension, or distant metastases; subsequent management is tailored based on dynamic risk stratification. Thermal ablation is not endorsed as a primary curative modality for surgically eligible candidates. For progressive, unresectable, or RAI-refractory FTC, upfront molecular profiling and multidisciplinary tumor board review are imperative. Identification of actionable drivers (e.g., BRAFV600E mutation, RET fusion, and NTRK fusion) warrants matched targeted therapies as first-line treatment. In the absence of specific targets, multikinase inhibitors such as lenvatinib or sorafenib remain the systemic therapy mainstay. ConclusionThe clinical management of FTC has gradually shifted from treatment decisions based on a single indicator to a whole-course individualized management model encompassing preoperative risk stratification, standardized surgery and pathological examination, postoperative dynamic risk stratification surveillance, with molecular subtyping and targeted therapy integrated for advanced disease.