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Background: This study aimed to compare oral sulfate solution (OSS) with polyethylene glycol (PEG) for bowel preparation before colonoscopy. Methods: A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA). Results: A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS. Conclusion: The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes. [ABSTRACT FROM AUTHOR]

Summary: We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. Purpose: The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. Methods: On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. Results: The height-to-width ratio of the half vertebrae varied 1.32–1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. Conclusion: We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs. [ABSTRACT FROM AUTHOR]

Immunochemotherapy (ICT) has emerged as the first-line treatment for metastatic esophageal squamous cell carcinoma (ESCC), yet its efficacy in improving progression-free survival (PFS) and overall survival (OS) remains limited. While radiotherapy is typically used to alleviate symptoms in metastatic ESCC, our retrospective findings indicated a favorable outcome when radiotherapy was delivered if an objective response to first line ICT was observed. Low-dose radiotherapy (LDRT) has been shown to enhance immune cell infiltration and modulate tumor microenvironment, potentially overcoming immunotherapy resistance. Here, we investigated the incorporation of LDRT with ICT, followed by conventionally fractionated radiotherapy (CFRT) and immunotherapy as the first-line treatment for metastatic ESCC, evaluating its efficacy and safety. Patients aged over 18 with treatment-naïve metastatic ESCC were recruited and underwent two steps of treatment. In Step 1, patients received four 3-week cycles of LDRT (2Gy/2Fx over 2 days) immediately followed by ICT (paclitaxel 150mg/m2 d1 + carboplatin AUC = 5 d1 + PD-1 inhibitor 200mg d1). The gross target volume (GTV) of LDRT covered all visible lesions identified on baseline imaging. In Step 2, patients underwent CFRT (40-50Gy/20-25Fx) and PD-1 inhibitor maintenance Q3W for up to 24 months. The GTV of CFRT covered the residual tumor and metastatic regional lymph nodes identified by PET/CT and endoscopy after Step 1. Primary endpoint was median PFS, and secondary endpoints comprised median OS and grade 3 or higher treatment-related adverse events (TRAEs) assessed by Common Terminology Criteria for Adverse Events (CTCAE) 5.0. OS and PFS were estimated using the Kaplan-Meier method. From October 2022 to October 2023, 24 eligible patients (median age: 67.5; 83.3% male) from two institutions were enrolled, 21 (87.5%) completing Step 1 and proceeding to Step 2. Nineteen patients (79.2%) completed CFRT and continued with immunotherapy. Evaluation after Step 1 revealed an objective response rate (ORR) of 65.2%, which increased to 71.4% after Step 2. With a median follow-up of 6 months, the median PFS was 9.3 months (95% CI, 8.7-NA months), and the median OS was 11.6 months (95% CI, 9.8-NA months). Most common grade 3 or higher TRAEs included leukopenia (33.3%), neutropenia (20.8%), anemia (16.7%) and dermatitis (8.3%). One patient died from immune-related colitis. Preliminary findings of the trial showed promising efficacy and relatively mild toxicity, which deserves further follow-up. Larger randomized controlled trials are needed to illustrate the benefit of the combination of radiotherapy and ICT over ICT alone in metastatic ESCC. [ABSTRACT FROM AUTHOR]

This is a Phase 2, single arm, single-site study of Pembrolizumab as maintenance therapy in muscle-invasive bladder cancer (MIBC) participants who has received maximum Transurethral resection of bladder tumor (TURBT) and tri-modality treatment (TMT) and achieved complete response (CR). This trial includes Patients with cT2-4N0M0 MIBC who declined or were ineligible for cystectomy (RC), ECOG PS 0/1, urothelial carcinoma > 50%, and achieved CR after receiving maximal TURBT then Stereotactic ablative radiotherapy (SABR) boost to bladder tumor or tumor bed and concurrent radio-chemotherapy. Patients received SABR to the tumor or tumor bed in the bladder followed by conventionally fractionated RT (CFRT) to pelvis and total bladder with concomitant weekly low-dose Gemcitabine chemotherapy. During SABR, intravesical installation of isovolumetric saline through urinary catheter ensured adequate bladder filling. After TMT, patients who achieved CR will receive Pembrolizumab as maintenance therapy. Pembrolizumab (200 mg q3w) monotherapy will begin on Day 1 of each 3-week cycle and will continue for up to 17 cycles. The primary endpoint was progression-free survival (PFS). From January 11, 2022, to March 7, 2024, forty-six patients with MIBC were enrolled. The median age of included patients was 69 years (IQR = 34-86 years) and clinical stage ranged from cT2 (n = 39) to cT3 (n = 7). TURBT was visibly complete in eighteen cases. Nine patients received neoadjuvant chemotherapy before chemoradiotherapy. Forty-four patients received concurrent weekly Gemcitabine chemotherapy during RT. After a median follow-up time of 10 months, ten patients completed Pembrolizumab for 17 cycles. Seventeen patients stopped immunotherapy, one due to death caused by pulmonary infection, one due to severe hematuria, two due to local recurrence, two due to distant metastasis, three due to concomitant diseases (high blood pressure, atrial fibrillation and coronary heart disease), and eight due to immune-related adverse effects (AEs). Eleven of 46 (24%) patients reported immune-related AEs, of which 3 (7%) patients experienced severe toxicity (G3) including myocarditis, pneumonitis, and cystitis. The estimated 1-year PFS, overall survival and local control rate was 85%, 97% and 93%. Two patients experienced intravesical recurrence, two patients reported bone and lung metastasis respectively. One patient received salvage cystectomy due to severe hematuria. One patient died from pulmonary infection related to COVID-19, the others are alive with no evidence of cancer and with intact well-functioning urinary bladder at median follow-up of 10 months. Pembrolizumab maintenance therapy after SABR boost to bladder tumor and concurrent radio-chemotherapy was well-tolerated with promising efficacy in the early analysis. Immune related toxicity was consistent with prior monotherapy trials. Selected correlative analyses from serially collected blood and tissue specimens will be presented. [ABSTRACT FROM AUTHOR]

Summary: We propose a new class of priors for Bayesian hypothesis testing, which we name 'cake priors'. These priors circumvent the Jeffreys–Lindley paradox (also called Bartlett's paradox) a problem associated with the use of diffuse priors leading to nonsensical statistical inferences. Cake priors allow the use of diffuse priors (having one's cake) while achieving theoretically justified inferences (eating it too). We demonstrate this methodology for Bayesian hypotheses tests for various common scenarios. The resulting Bayesian test statistic takes the form of a penalised likelihood ratio test statistic. Under typical regularity conditions, we show that Bayesian hypothesis tests based on cake priors are Chernoff consistent, that is, achieve zero type I and II error probabilities asymptotically. We also discuss Lindley's paradox and argue that the paradox occurs with small and vanishing probability as sample size increases. [ABSTRACT FROM AUTHOR]

To develop a technology for producing coronavirus-neutralizing antibodies in duck eggs (Anas platyrhynchos) immunized with a recombinant fragment of the S-antigen of the SARS CoV-2 virus, and to analyze the possibility of their use as an active substance in the development of local inhalation drugs to prevent the aerosol spread of respiratory viral infections, including a new coronavirus. Methods. Recombinant antigen production in the yeast expression system, production of antibodies from duck eggs, affinity purification, ELISA. Results. We describe an efficient method for obtaining functional yolk antibodies (IgY) from the hyperimmune duck eggs. We have shown that the average yield of total yolk antibodies from duck eggs is 0.25±0.05 grams per yolk. The obtained antibodies showed the virus neutralization activity at 70.6 % inhibition (PI) in blocking ELISA, which was comparable to the human serum antibodies after vaccination with coronavirus vaccine PI at 87 % (p≤0.05). Conclusions. The results obtained indicate that S-specific yolk antibodies can be used as an active substance for the development of topical inhalation drugs that prevent coronavirus infection. [ABSTRACT FROM AUTHOR]

The postharvest lifespan of horticultural products is closely related to loss of nutritional quality, accompanied by a rapid decline in shelf life, commercial value, and marketability. Melatonin (MT) application not only maintains quality but also delays senescence in horticultural products. This paper reviews biosynthesis and metabolism of endogenous MT, summarizes significant effects of exogenous MT application on postharvest horticultural products, examines regulatory mechanisms of MT‐mediated effects, and provides an integrated review for understanding the positive role of MT in senescence delay and quality maintenance. As a multifunctional molecule, MT coordinates other signal molecules, such as ABA, ETH, JA, SA, NO, and Ca2+, to regulate postharvest ripening and senescence. Several metabolic pathways are involved in regulation of MT during postharvest senescence, including synthesis and signal transduction of plant hormones, redox homeostasis, energy metabolism, carbohydrate metabolism, and degradation of pigment and cell wall components. Moreover, MT regulates expression of genes related to plant hormones, antioxidant systems, energy generation, fruit firmness and colour, membrane integrity, and carbohydrate storage. Consequently, MT could become an emerging and eco‐friendly preservative to extend shelf life and maintain postharvest quality of horticultural products. [ABSTRACT FROM AUTHOR]

In view of the difficulties such as coarse microstructure, performance degradation and excessive residual stress during the preparation of Ti-6Al-4V layers by laser cladding, the microstructure and mechanical properties of such a Ti-6Al-4V coating were optimized and improved based on the plastic deformation effect caused by laser shock peening (LSP). The characteristics of phase composition, changes in microstructure and morphology, grain plastic deformation and the influence of mechanical properties of the laser clad Ti-6Al-4V coating were studied pre- and post-LSP. The results indicate that the α/α' phase content increases and the β phase content decreases after LSP. The β phase and acicular martensite α' phase is refined significantly and divided, and the basket structure presents a more dense and staggered distribution after LSP. Laser cladding causes the grains in the Ti-6Al-4V coating to undergo plastic strain and the degree of grain refinement was significantly improved following LSP. The microhardness at the top of the laser clad Ti-6Al-4V coating increases from 23 to 30% compared after LSP. At the same time, the LSP promotes the transformation of residual tensile stress to compressive stress on the surface of the laser clad Ti-6Al-4V coating, with an average residual compressive stress value of about 339 MPa. This study provides theoretical and methodological references for optimizing the microstructure and properties of Ti-6Al-4V coatings. [ABSTRACT FROM AUTHOR]

This article discusses a study that identified two novel mutations in the GREB1L gene in two Chinese families with renal agenesis (RA), a developmental disorder of the kidney. The mutations were associated with bilateral RA with deafness and unilateral RA with uterine abnormalities. The findings expand the understanding of the mutation spectrum of GREB1L and can improve prenatal counseling for future pregnancies. The study highlights the importance of retinoic acid signaling in kidney development and provides evidence of GREB1L mutations as a cause of renal abnormalities. [Extracted from the article]

Context. Coronal mass ejections (CMEs) are large-scale structures of magnetized plasma that erupt from the corona into interplanetary space. The launch of Solar Orbiter (SolO) in 2020 enables in situ measurements of CMEs in the innermost heliosphere, at such distances where CMEs can be observed remotely within the inner field of view of heliospheric imagers (HIs). It thus provides the opportunity for investigations into the correspondence of the CME substructures measured in situ and observed remotely. We studied a CME that started on 2022 March 10 and was measured in situ by SolO at ∼0.44 au. Aims. Combining remote observations of CMEs from wide-angle imagers and in situ measurements in the innermost heliosphere allows us to compare CME properties derived through both techniques, validate the estimates, and better understand CME evolution, specifically the size and radial expansion, within 0.5 au. Methods. We compared the evolution of different CME substructures observed in images from the HIs on board the Ahead Solar Terrestrial Relations Observatory (STEREO-A) and the CME signatures measured in situ by SolO. The CME is found to possess a density enhancement at its rear edge in both remote and in situ observations, which validates the use of the signature of density enhancement following the CMEs to accurately identify the CME rear edge. We also estimated and compared the radial size and radial expansion speed of different substructures in both observations. Results. The evolution of the CME front and rear edges in remote images is consistent with the in situ CME measurements. The radial expansion (i.e., radial size and radial expansion speed) of the whole CME structure consisting of the magnetic ejecta and the sheath is consistent with the in situ estimates obtained at the same time from SolO. However, we do not find such consistencies for the magnetic ejecta region inside the CME because it is difficult to identify the magnetic ejecta edges in the remote images. [ABSTRACT FROM AUTHOR]

In the immune era, chemo-immunotherapy (CIT) has shown exciting efficacy both in the neoadjuvant setting and in the first-line systemic treatment of non-small cell lung cancer (NSCLC). Here, we discussed the value of CIT in local-advanced NSCLC (LA-NSCLC) and explore the best treatment modalities for LA-NSCLC. Consecutive patients with inoperable or refusing surgery stage II-III NSCLC receiving immunotherapy for the first-line systemic therapy from January 2018 to December 2022 were included. Survival outcomes, failure patterns and the best induction times were analyzed. The overall survival (OS), progression free survival (PFS) and local recurrence free survival (LRFS) were calculated using Kaplan-Meier methodology. 410 eligible cases were identified, 173 patients received thoracic radiotherapy before disease progression (RT group) and 237 patients received systemic CIT only without thoracic radiotherapy before disease progression (non-RT group). The median OS, PFS (mOS, mPFS) for RT group and non-RT group were 55.5 months, 21.3 months and 26.6 months, 14.1 months, respectively (POS <0.0001, HR = 0.49, 95% CI = 0.34-0.70; PPFS <0.0001, HR = 0.55, 95% CI = 0.42-0.72). The local recurrence free survival (LRFS) of RT group is obviously better than non-RT group (P <0.0001, HR = 0.38, 95% CI 0.28-0.52), the median LRFS (mLRFS) of was 22.2 months and not reached in RT and non-RT groups. In addition, the mOS of CIT induction prior to concurrent chemo-radiotherapy (cCRT) group is better than the cCRT/sequential chemo-radiotherapy (sCRT) followed by ICI maintenance group (not reached VS 53.4 months, P = 0.089, HR = 0.31, 95% CI = 0.13-0.78). Subgroup analysis revealed that patients with ≤ 4 cycles CIT inductions prior to radiotherapy (RT) have a better prognosis than patients with > 4 cycles CIT inductions (P = 0.036, HR = 0.42, 95% CI = 0.18-0.97). And patients who respond well to CIT induction prior to RT have a trend of better OS than those who respond poorly (P = 0.08, HR = 0.52, 95% CI = 0.24-1.14). Exploring the optimal dose of RT showed that there was no significant difference in OS and PFS between 50Gy and 60Gy (P = 0.141, HR = 0.63, 95% CI = 0.31-1.29). In the immune era, RT remains indispensable for inoperable LA-NSCLC. The CIT induction of no more than 4 cycles before cCRT and followed by ICI consolidation therapy has achieved an exciting survival benefit for LA-NSCLC patients. And the best RT dose needs to be determined in a further study, 50Gy and 60Gy may not be different for selected patients. [ABSTRACT FROM AUTHOR]

Although surgery and stereotactic body radiation therapy (SBRT) are curative treatment strategies for patients with early-stage non-small cell lung cancer (NSCLC), tumor recurrence is not uncommon after both treatments leading to poor survival outcomes, suggesting the necessity of subsequent medical treatments for specific patients with poor prognosis. Therefore, we tried to construct a 3D CNN model based on the pretreatment CT images to predict prognosis of clinical stage I NSCLC patients undergoing surgery, and then applied it in an SBRT cohort to help improve their prognosis prediction performance which might be poorer due to the lack of definitive pathological data, thus benefiting more precise individualized treatment. Our review retrospectively included a surgical cohort made up of clinical stage I NSCLC patients with surgical resection between 2015 and 2017 and an SBRT cohort with clinically-diagnosed early-stage lung cancer from 2014 to 2020 in our institution. A 3D CNN model was constructed from preoperative chest CT images of the surgical cohort to achieve accurate prediction risk scores of DFS and stratify different risk patients according to the best cutoff value, which was then test in the SBRT cohort using their pretreatment CT examinations. Kaplan-Meier method and log-rank test were used to estimate survival differences of different risk groups. The hazard ratios were calculated with the risk score and clinical factors by using the multivariate Cox regression. The concordance index (C-index) was analyzed to evaluate discrimination of our model in both cohorts. A total of 2489 and 153 patients who met the inclusion criteria were included in this study to form the surgical and SBRT cohort, respectively. Based on CT images, a DFS predictive model built by deep learning capable of performing accurate prognostic risk stratification for surgical patients with clinical stage I NSCLC was developed with a C-index significantly better than the clinical model (0.857 vs 0.747, 0.855 vs 0.750 and 0.847 vs 0.764 in the training, validation and testing set, P<0.001). When applied in the SBRT cohort with clinical diagnosis of early-stage lung cancer, external verification was carried out and the K-M curve could significantly distinguish high- and low-risk groups (P<0.0001). Besides, the multivariate Cox regression analysis showed that our model output was one of the independent predictors of DFS in both cohorts (P<0.001). An end-to-end 3D CNN model for prognosis prediction of patients with early-stage lung cancer was successfully constructed for different risk stratification of recurrence both in surgical and SBRT patients, and was demonstrated as a factor independent from other clinical features for DFS prediction. [ABSTRACT FROM AUTHOR]

Two recent Phase III studies showed no survival benefit from postoperative radiotherapy (PORT) in completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC), suggesting a need for more precise PORT application. Based on our prior work establishing patient stratification by locoregional recurrence (LRR) risk, we conducted a propensity score-matched (PSM) analysis to assess whether PORT provided survival benefits for the high-risk LRR group. We conducted a prospective, randomized clinical trial from June 2016 at 5 hospitals to explore the optimal timing of PORT in a high-LRR-risk group of patients with completely resected pathologic stage IIIA(N2) NSCLC. Patients were randomly assigned to receive early or late PORT following the institutional CTV guideline, in addition to four cycles of chemotherapy. To assess the value of PORT for high-LRR-risk patients, entire patients in this trial were selected as the PORT cohort for analysis. In addition, we identified high-risk IIIA(N2) patients without PORT in a retrospective cohort from our institution, which served as the non-PORT cohort. A PSM analysis was conducted to compare survival endpoints between the two cohorts, including overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Between June 2016 and January 2022, 132 patients were included in the prospective clinical trial, serving as the PORT cohort. The median follow-up was 49.3 months (range, 8.8-100.2). The 3-year-OS rate was 83.2% and 3-year-DFS rate was 35.0%. PORT was well-tolerated, with only 3 patients (2.3%) experiencing grade 3 radiation pneumonitis. 10 patients did not receive planned PORT, leaving 122 patients serving as the per-protocol (PP) population. For 132 intention-to-treat patients, a PSM analysis was performed with the high-risk non-PORT cohort (n = 307), and 130 patients in each group were successfully matched. Results suggested a clinical benefit of PORT with LRFS (3-year-LRFS, 77.6% for PORT vs 57.3% for non-PORT; p = 0.00014), DFS (3-year-DFS, 35.2% for PORT vs 28.6% for non-PORT; p = 0.038), and OS (3-year-OS, 83.0% for PORT vs 60.7% for non-PORT; p = 0.00017), while there was no difference in DMFS (p = 0.17). PSM analysis was also conducted for 122 PP patients, yielding consistent results with improved LRFS (p = 0.00028), DFS (p = 0.027), and OS (p<0.0001), and no difference in DMFS (p = 0.16). According to our PSM analysis, PORT could considerably enhance local control and even DFS, and should thus be considered for completely resected pathologic stage IIIA(N2) NSCLC patients at high risk of LRR. Multi-dimensional data should be used in future research to pinpoint more precise patient subgroups that benefit from PORT, and prospective trials should be planned and undertaken to validate these results. (NCT02974426). [ABSTRACT FROM AUTHOR]

Gleason grade group 5 prostate cancers (Pca) are aggressive, have high metastasis rates, and are not sensitive to androgen deprivation therapy (ADT). Even those with a limited (i.e., tertiary) Gleason pattern 5 component may exhibit highly aggressive biological behavior. Selecting an appropriate intensified systemic therapy strategy for the high-malignant population is the focus of intensified treatment. This study aims to conduct a prospective, interventional cohort study by selectively enrolling high Gleason Score Pca patients, in order to validate the efficacy and patient tolerability of adjuvant chemotherapy strategies. A prospective cohort study was conducted to compare the efficacy and safety of adjuvant chemotherapy versus no adjuvant chemotherapy following standard radical treatment (i.e. post-operative radiotherapy or definitive radiotherapy) in patients with non-metastatic, high-risk Pca. Enrollment criteria include patients diagnosed with Pca by biopsy or surgical pathology, with a Gleason Grade Group 5 or containing a Gleason pattern 5 component, and no evidence of distant metastasis on systemic evaluation. The primary study endpoint is Failure-Free Survival (FFS). Secondary endpoints include Biochemical Relapse-Free Survival (BRFS), Metastasis-Free Survival (MFS), Overall Survival (OS), and adverse events. Additionally, we explored the mutation status of homologous recombination repair (HRR) genes in these patients. (1) A total of 362 patients meeting the inclusion and exclusion criteria were consecutively enrolled, including 84 patients in the chemotherapy group and 278 patients in the standard treatment group. (2) In terms of efficacy, with a median follow-up of 23 (1~53) months, the 4-year FFS was 89.4% and 71.36% in the chemotherapy group and the standard treatment group, respectively (p = 0.035). After propensity score matching based on baseline characteristics, the FFS was 89.4% and 70.4% (p = 0.024), and the BRFS was 89.4% and 69.2% (p = 0.050) in the two groups, respectively. The other endpoints did not reach statistical significance before and after matching. Subgroup analysis showed that the postoperative radiotherapy subgroup benefited more from the addition of adjuvant chemotherapy compared to the radical radiotherapy subgroup. (3) In terms of safety, the overall tolerability was acceptable. Grade 3 or higher adverse events in the chemotherapy group were mainly hematological toxicity, fatigue, and alopecia. (4) Furthermore, we found a higher prevalence of HRR gene mutations in patients with high Gleason scores, with 13.6% harboring mutations in the HRR pathway. BRCA2 was the most common mutation, with a mutation rate of 4.5% in the overall population, followed by ATM mutations (3.3%). The interim analysis results suggest that adjuvant chemotherapy may reduce the overall risk of relapse and metastasis in patients with high Gleason score Pca. However, further follow-up is needed. [ABSTRACT FROM AUTHOR]