Distant metastasis is among the main reasons for treatment failure in nasopharyngeal carcinoma (NPC) patients. To identify patients with a high risk of distant metastasis is important to guide posttreatment surveillance, appropriate time treatments, and prolonging their long-term survival. In this study, we systematically examined the associations between a series of nodal-related characteristics and distant metastasis-free survival (DMFS) by detailed MRI reading and established a nomogram for DMFS in NPC patients. T-stage, age group, Epstein–Barr virus (EBV) level, central nodal necrosis, and nodal number were identified as independent risk factors for distant metastasis and were included into the final nomogram. The calibration plot showed a high agreement between the prediction by the nomogram and actual observations. Our established nomogram achieved a high C-index in predicting distant metastasis in both of the training cohort (0.737) and the validation cohort (0.718). This nomogram incorporated several readily available nodal features from the MR images, and it might be useful for guiding clinical decision and NPC patients' posttreatment surveillance. It also provides cues for how to redefine N-stage. Additional research is needed to confirm our conclusions.

Objectives: We aimed to reconstitute T2 and T3 stage classification in nasopharyngeal carcinoma (NPC) cases and verify its utility in clinical settings.Materials and Methods: We enrolled 792 NPC patients. Cox proportional hazards model was used to compare the effect sizes (hazard ratio [HR]) of the cranial structure invasion on survival and select the structures for up‐staging or downstaging T2 and T3 NPC. The samples were reclassified and the survival curves for T2 and T3 stages were analyzed. The proposed new staging system was validated on an external sample (n = 433).Results: Thirteen cranial structures were examined. American Joint Committee on Cancer (AJCC) T3 stage patients with the invasion of the base of the sphenoid (HR = 2.58, 95% CI = 1.16‐5.77) or base of the pterygoid (HR = 2.00, 95% CI = 0.84‐4.77) had significantly lower hazard ratios than T2 stage patients with the invasion of soft tissues in the bilateral parapharyngeal space (HR = 5.26, 95% CI = 2.02‐13.68) and single/bilateral carotid sheath (HR = 7.78, 95% CI = 3.06‐19.76). T3 stage with the invasion of the above‐mentioned bones was reclassified as T2, and T2 stage with the invasion of the above‐mentioned soft‐tissue structures was reclassified as T3. Survival analysis showed a significant difference between the reclassified T2 and T3 stages (P < 0.001). The results were replicated in the validation samples.Conclusion: The proposed staging system for defining T2 and T3 stage NPC appears to be superior to the AJCC 8th edition. It could improve prognosis and optimize the treatment selection.

Objective: The association between gestational diabetes mellitus (GDM) and maternal breast cancer risk was controversial and inclusive. In this study, we aimed to examine the association between GDM and maternal breast cancer using meta-analysis method. Methods: Researchers searched and reviewed the topic related articles comprehensively. For each eligible article, we extracted the effect size (odds ratio/relative risk or OR/RR) and its 95% confidence interval (CI). We used random effect models to combine the effect sizes. Subgroups analysis were used to examine whether the effects of GDM on breast cancer risk differed across GDM ascertainment methods, breast cancer ascertainment method, risk of bias, and country of study origin. Results: Five case-control studies and six cohort studies which met the eligible criteria were included into analysis. Overall, we didn’t find significant associations between GDM and breast cancer among case-control studies (pooled OR = 0.85, 95%CI = 0.65, 1.10) and cohort studies pooled RR = 1.00, 95%CI = 0.80, 1.25). However, our subgroup analysis showed that GDM was a protective factor for breast cancer among the case-control studies in which breast cancer was ascertained via cancer registry system (OR = 0.73, 95%CI = 0.54, 1.00). Conclusions: GDM during pregnancy is not associated with breast cancer in our study, suggesting that GDM mothers are not needed to be too anxious about their future breast cancer risk.