Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases.

This study compares 4 guidelines on RAI indications and potentially missed metastases.

DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines.

In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%).

Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.

The objective of this study is to investigate the risk and prognostic factors for radioactive iodine (RAI)-refractory (RAIR) differentiated thyroid cancer (DTC) with distant metastasis.

A total of 128 patients with distant metastasis-DTC who underwent iodine-131 radiotherapy were included in this cohort study. After exclusion, 75 DTC patients who were resistant to radioiodine therapy and 53 patients in whom the treatment was successful were finally included. Clinical data as well as BRAF V600E and telomerase reverse transcriptase (TERT) promoter mutations were compared between these two groups to predict the risk of RAIR. Patients with RAIR-distant metastasis-DTC were followed up to further investigate the risk factors for disease progression after the cancer became iodine-refractory.

Univariate analysis showed that TERTp mutation, age at diagnosis, mean maximum tumor diameter, lymph node metastasis, synchronous metastasis or heterochronous metastasis, mean cumulative dose of RAI, and preoperative Tg were statistically different between the RAIR and RAIE (radioiodine efficient) groups. Logistic regression analysis further found that the TERTp mutation may be risk factor for iodine refractory occurrence. During the follow-up of RAIR-distant metastasis-DTC patients, 41 patients developed disease progression, and 24 patients had good disease control.

We found that TERTp mutation is correlated with the poor curative effect of RAI therapy in distant metastasis-DTC. Once iodine refractory occurs, patients aged 55 years or older are more likely to develop disease progression.

The neutrophil-to-lymphocyte ratio (NLR) not only indicates the inflammatory response within the tumor microenvironment but may also correlate with tumor biological behavior (such as aggressiveness). The present study aimed to systematically review and conduct a meta-analysis on the impact of the NLR on the prognosis of patients with renal cell carcinoma (RCC). To this aim, a comprehensive search of multiple relevant databases, including PubMed, Embase and the Cochrane Library, was conducted to identify literature related to NLR and RCC prognosis. Following rigorous literature screening and quality assessment, a systematic quantitative analysis was ultimately performed on several studies that met the inclusion criteria. The results indicated a significant association between elevated NLR levels and poor prognosis in patients with RCC, suggesting that high NLR levels may serve as an independent predictor of unfavorable outcomes. Therefore, the present study provides important evidence for clinical decision-making, further demonstrating that NLR can serve as an independent prognostic indicator for patients with RCC, aiding healthcare professionals in making more precise judgments in patient management and treatment strategy formulation.

This study aimed to assess the occurrence of post-traumatic stress symptoms (PTSS) in head and neck cancer (HNC) patients. The goal also was to explore potential associations between PTSS, demographic factors, psychological variables, and specific genetic variants.

This study included a total of 155 HNC patients, divided into pre-pandemic (n = 76) and COVID-19 pandemic (n = 79) groups. PTSS assessments were conducted using a standardized questionnaire. The assessment of adverse childhood experiences (ACEs) involved specific questionnaire items. Genetic variants were identified via RT-PCR. Statistical analysis employed linear multivariate regression, while mediation analysis examined gene-environment interactions.

In the pre-pandemic, higher PTSS scores were found to be associated with younger age (p = 0.02) and a history of cumulative ACEs (p = 0.001). Mediation analysis revealed that ACEs had a direct impact on PTSS scores, with the FKBP5 CC genotype (rs1360780, C>T) mediating this association by 29%. In the pandemic, elevated PTSS scores were correlated with a history of depression (p = 0.001), the negative impact of the pandemic (p = 0.007), and undergoing palliative treatment (p = 0.02).

Our findings provide insights into the psychosocial and genetic factors contributing to PTSS in HNC patients, considering the additional stressors introduced by the COVID-19 pandemic.

Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Immunotherapy, a promising therapeutic approach, often faces challenges due to the immunosuppressive tumor microenvironment. This study explores the innovative use of CRISPR-Cas9 technology in conjunction with FCPCV nanoparticles to target and edit the C-C Motif Chemokine Ligand 5 (CCL5) gene, aiming to improve the efficacy of breast cancer immunotherapy. Single-cell RNA sequencing (scRNA-seq) and TCGA-BRCA data identified CCL5 as a key immune-related gene in breast cancer. Using CRISPR-Cas9, sgRNA targeting CCL5 was designed and delivered to breast cancer cells and humanized mouse models via FCPCV nanoparticles. In vitro experiments demonstrated that FCPCV nanoparticles effectively silenced CCL5, enhanced CD8+ T cell activity, and increased the production of cytokines such as IFN-γ, TNF-α, and GZMB. In vivo studies revealed significant tumor suppression, improved immune microenvironment, and increased CD8+/CD4+ ratios in treated mice, without notable toxic side effects. These findings highlight the potential of CRISPR-Cas9 nanoparticle-mediated gene editing as a novel strategy for enhancing breast cancer immunotherapy, providing a new direction for personalized and effective cancer treatment.

Wernicke's encephalopathy (WE) is an acute or subacute neuropsychiatric condition associated with thiamine deficiency that is more often seen in cases of alcohol abuse. The current study presents a rare case of primary cervical cancer complicated by WE. A 44-year-old woman who underwent a laparoscopic radical hysterectomy with endoscopic pelvic lymphadenectomy for primary cervical adenocarcinoma in 2014 developed multiple metastases in the pelvic and abdominal cavities, right iliopsoas muscle and iliac wing 2 years post-surgery. The patient was hospitalized due to the rupture of a mass in the right lower abdomen in August 2019. A computed tomography scan demonstrated the spreading of primary cervical cancer to the right lower abdomen, which broke through the skin. In this terminal stage of cervical cancer accompanied with malnutrition, the patient suddenly presented with cognitive impairment, particularly in recent and immediate memory, as well as bilateral sustained nystagmus during hospitalization. Brain magnetic resonance imaging showed hyperintensity in the periaqueductal midbrain on T2 fluid-attenuated inversion recovery imaging. Based on these findings, a diagnosis of WE was made, and thiamine (100 mg) was immediately administered intramuscularly three times a day. After a week, the patient's eye movement disorder and recent memory improved gradually. The present case report with literature review aims to demonstrate the significant comorbidity between cancer and WE, raising awareness about the importance of recognizing the risk of thiamine deficiency in advanced cancer to prevent the development of WE.

To explore the value of histogram parameters derived from intravoxel incoherent motion (IVIM) for predicting response to neoadjuvant chemoradiation (nCRT) in patients with locally advanced rectal cancer (LARC).

A total of 112 patients diagnosed with LARC who underwent IVIM-DWI prior to nCRT were enrolled in this study. The true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and microvascular volume fraction (f) calculated from IVIM were recorded along with the histogram parameters. The patients were classified into the pathological complete response (pCR) group and the non-pCR group according to the tumor regression grade (TRG) system. Additionally, the patients were divided into low T stage (yp T0-2) and high T stage (ypT3-4) according to the pathologic T stage (ypT stage). Univariate logistic regression analysis was implemented to identify independent risk factors, including both clinical characteristics and IVIM histogram parameters. Subsequently, models for Clinical, Histogram, and Combined Clinical and Histogram were constructed using multivariable binary logistic regression analysis for the purpose of predicting pCR. The area under the receiver operating characteristic (ROC) curve (AUCs) was employed to evaluate the diagnostic performance of the three models.

The values of D_ kurtosis, f_mean, and f_ median were significantly higher in the pCR group compared with the non-pCR group (all P < 0.05). The value of D*_ entropy was significantly lower in the pCR group compared with the non-pCR group (P < 0.05). The values of D_ kurtosis, f_mean, and f_ median were significantly higher in the low T stage group compared with the high T stage group (all P < 0.05). The value of D*_ entropy was significantly lower in the low T stage group compared with the high T stage group (P < 0.05). The ROC curves indicated that the Combined Clinical and Histogram model exhibited the best diagnostic performance in predicting the pCR patients with AUCs, sensitivity, specificity, and accuracy of 0.916, 83.33%, 85.23%, and 84.82%.

The histogram parameters derived from IVIM have the potential to identify patients who have achieved pCR. Moreover, the combination of IVIM histogram parameters and clinical characteristics enhanced the diagnostic performance of IVIM histogram parameters.

Cancer metastasis is the dissemination of tumor cells from the primary tumor site to other parts of the body via the lymph system or bloodstream. Metastasis is the leading cause of cancer associated death. Despite the significant advances in cancer research and treatment over the past decades, metastasis is not fully understood and difficult to predict in advance. In particular, distant metastasis is more difficult to predict than lymph node metastasis, which is the spread of cancer cells to nearby lymph nodes. Distant metastatic sites is even more difficult to predict than the occurrence of distant metastasis because the problem of predicting distant metastatic sites is a multi-class and multi-label classification problem; there are more than two classes for distant metastatic sites (bone, liver, lung, and other organs), and a single sample can have multiple labels for multiple metastatic sites. This paper presents a new method for predicting distant metastatic sites based on correlation changes of miRNAs with competing endogenous RNAs (ceRNAs) in individual cancer patients. Testing the method on independent datasets of several cancer types demonstrated a high prediction performance. In comparison of our method with other state of the art methods, our method showed a much better and more stable performance than the others. Our method can be used as useful aids in determining treatment options by predicting if and where metastasis will occur in cancer patients at early stages.

Accurate staging of nodal involvement in pediatric sarcoma patients is important to determine correct systemic and local therapy, with the goal to reduce subsequent recurrences. However, differences in lymph node staging strategies, definitions, and treatment protocols between the Children's Oncology Group (COG), European paediatric Soft tissue sarcoma Study Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS) complicate comparisons. In this article, we aim to establish internationally recognized recommendations for lymph node assessment and treatment of children and adolescents diagnosed with rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) according to the Consensus Conference Standard Operating Procedure methodology.

Sialylation, a key post-translational modification essential for protein function, is regulated by steroid hormones, along with other glycosylations like fucosylation. These modifications influence tumor growth and metastasis by modulating immune activation. MicroRNAs (miRNAs), crucial in gene expression, affect sialylation and are emerging as promising biomarkers in breast cancer, though their prognostic value remains unclear. Sialylation-related miRNAs were identified through Pearson correlation analysis, and an eight-miRNA risk signature was developed using univariate and Least Absolute Shrinkage and Selection Operator (LASSO) regression in the TCGA dataset. The prognostic value was validated in two independent GEO datasets. Multivariate analysis confirmed that the miRNA risk score is an independent predictor of overall survival (OS). A nomogram integrating clinical characteristics and the risk score was created to predict 1-, 3-, and 5-year OS, assessed through calibration curves, ROC curves, and area under the ROC curve (AUC). Biological pathways were explored using GSEA and GSVA, while immune infiltrates were identified through CIBERSORT and TIMER. The eight-miRNA signature effectively predicted OS, recurrence-free survival, and disease-free survival. High-risk patients exhibited increased macrophage and neutrophil levels, indicative of a poor prognosis. High-risk patients, especially those with triple-negative breast cancer, had significantly worse outcomes. This risk score could inform personalized treatment strategies in breast cancer management.

Currently, there are no clinically predictive models that can prognosticate the response of rectal cancers to Contact X-ray brachytherapy (CXB). This review aims to critically evaluate existing models that have attempted to predict the response of rectal cancer to external beam radiotherapy, with the objective of laying the foundation for the development of a CXB-specific prediction model.

A random-effects meta-analysis was employed to calculate pooled estimates of the discriminative ability of published models. Using the Prediction Model Risk Of Bias Assessment Tool (PROBAST), each model was evaluated for its risk of bias and applicability. Additionally, the frequency of commonly utilised predictive factors was documented.

Twelve papers discussed fifteen models based on pre-treatment factors. Models predicting response based on the Tumour regression grade (TRG) classified responders as patients who achieved a complete response or near complete response and achieved a pooled AUC of 0.82 (95% CI 0.74-0.89). Models that predicted pathologic complete response (pCR) had a pooled AUC of 0.76 (95% CI 0.71-0.82). The most utilised predictive parameters were age, tumour grade and T stage. However, these models were prone to significant risk of bias and had limited applicability to the general population.

Although the existing models were statistically robust, they lacked broad applicability. This was primarily due to a lack of external validation, which limits their clinical utility. A future CXB-specific model should prioritise dedicated data collection based on pre-calculated sample size and include the predictive factors identified in this review.

Prostate cancer (PCa) diagnosis faces significant challenges due to its complex pathological characteristics and insufficient pathologist resources. While deep learning-based image analysis (DLIA) shows promise in enhancing diagnostic accuracy, its application to radical prostatectomy (RP) specimens remains underexplored. In this study, we evaluated the clinical feasibility and prognostic value of a DLIA algorithm for Gleason grading and tumor quantification on whole RP specimens. Using 29,646 digitized H&E-stained slides from 992 patients who underwent RP, we compared the case-level algorithm results with pathologist assessments for the International Society of Urological Pathology grade groups (GG), tumor volumes (TV), and percent tumor volumes (PTV). We also evaluated their prognostic performance in predicting biochemical progression-free survival (BPFS). Pathologists identified cancer in 986 cases and assigned GG in 980, while the DLIA algorithm identified cancer and assigned GG to all cases without omission. DLIA-assigned GG showed fair concordance with pathologist assessments (linear-weighted Cohen's kappa: 0.374) and demonstrated similar efficacy in predicting BPFS (c-index: 0.644 for DLIA vs. 0.654 for pathologists; p = 0.52). In tumor quantification, DLIA-measured TV and PTV were strongly correlated with pathologist-based measurements (Pearson's correlation coefficient: 0.830 and 0.846, respectively), but showed stronger efficacy in BPFS prediction, with c-index values of 0.657 and 0.672 compared to 0.622 and 0.641, respectively. Incorporating DLIA-derived PTV into the CAPRA-S score significantly improved its predictive accuracy for BCR (p = 0.006), increasing the c-index from 0.704 to 0.715. Our findings indicate that DLIA algorithms can enhance the accuracy of Gleason grading and tumor quantification in RP specimens, providing valuable support in clinical decision-making for PCa management.

In Sub-Saharan Africa (SSA), resource-stratified guidelines for breast cancer treatment are increasingly recommended, but treatment receipt and outcomes according to these guidelines are underreported. Here, we describe breast cancer treatment patterns by stage and curative-intent guideline-concordant treatment (GCT) receipt among Malawian women.

A prospective cohort of breast cancer patients were enrolled from December 2016 to October 2018 at Kamuzu Central Hospital with an assessment of demographics, stage, and treatment received, including neoadjuvant (NAC), adjuvant (AdC) and palliative chemotherapy and breast surgery. Curative-intent GCT was defined as having completed breast surgery and at least 4 cycles of chemotherapy. Overall survival (OS) was calculated using Kaplan Meier methods and odds ratios using logistic regression.

91 patients were included, of whom 13 (14%) presented as stage II, 54 (59%) as stage III, and 24 (26%) as stage IV. Curative treatment was recommended for 65 of 91 (71%) patients, of whom 47 (72%) were initiated on NAC, 14 (22%) on upfront breast surgery, and 4 (6%) received no treatment. Only 63% (41/65) of patients received curative-intent GCT as recommended with non-GCT associated with stage III (vs. stage II) disease (OR 0.10 CI (0.01-0.89)), HIV positivity ((OR 0.25 CI (0.06-0.99)) and hormone receptor (HR) negative/HER2 positive subtype ((OR 0.07 CI (0.01-0.49)). Curative-intent GCT was associated with improved OS (44.1 vs. 23.2 months; p = 0.00) compared to non-GCT.

While curative-intent GCT was associated with improved survival in this Malawian cohort, treatment completion rates were suboptimal. Resource-stratified guidelines must be paired with locally relevant, multilevel implementation strategies to target barriers to treatment completion.

To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites.

We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed.

Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively.

The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.

HER2-positive advanced esophageal adenocarcinoma (EAC) cases demonstrate a poor prognosis because of drug resistance that develops after standard first-line trastuzumab therapy. The patient was initially diagnosed with stage cT2N1M0 III EAC. He underwent neoadjuvant chemotherapy, radical esophageal resection, and postoperative adjuvant radiotherapy. However, four months after treatment, the lesion relapsed and progressed to the right back, rendering the case inoperable. Pathological analysis revealed HER2 amplification. Given a poor tolerance to chemotherapy, the patient was administered cadonilimab and trastuzumab for three months. Subsequently, the second-line therapy was switched to pyrotinib monotherapy as a salvage treatment. Remarkably, after one month of treatment, the tumor showed significant reduction, with mild toxic side effects. Pyrotinib can be used for salvage later-line therapy in HER2-positive advanced EAC with trastuzumab resistance or poor chemotherapy tolerance, which deserves further promotion.

Breast cancer presents significant challenges in low- and middle-income countries (LMICs) due to disparities in healthcare access and outcomes. This umbrella review synthesizes data on breast cancer characteristics-age at diagnosis, staging, and molecular subtypes-to guide targeted healthcare strategies in LMICs. Our umbrella review was conducted following PRISMA 2020 and JBI guidelines. Systematic reviews from 2009 to 2024 were sourced from PubMed, Google Scholar, and Cochrane. Reviews were assessed with AMSTAR 2, and only those rated moderate or higher were included. Data synthesis and meta-analyses were performed using R. From 1165 records, 35 systematic reviews met initial criteria; nine were included in the final synthesis, representing 305 primary studies (195 relevant to LMICs). Of those, 50 % were hospital-based and 22 % population-based, limiting the generalizability of the data and the importance of promoting more population-based studies. The overall quality of systematic reviews was variable, with only a few meeting high standards. Geographic analysis revealed a significant underrepresentation of high-quality reviews in sub-Saharan Africa and Latin America. Age at diagnosis varied: sub-Saharan Africa (45-52 years), Middle East (36-56 years), and Latin America (∼49-53 years). Advanced-stage diagnoses (stages III and IV) were common, worsening prognostic outcomes. Molecular subtype analysis indicated a predominance of luminal A but highlighted treatment challenges due to limited targeted therapy access. The results emphasize a pressing need to enhance the availability and quality of primary data, including both hospital-based and population-based studies, particularly in underrepresented regions like sub-Saharan Africa and Latin America. Addressing these gaps with rigorous, locally focused studies is essential for improving breast cancer prevention, diagnosis, and treatment. Enhancing methodological standards and expanding research in these areas will be crucial to bridging global breast cancer outcomes disparities.

Radiation therapy is commonly used to treat head and neck cancer patients, and response may be improved by combining radiation with preexisting medications. Based on recent preclinical and retrospective patient data, we hypothesized that antihypertensive drugs may improve radiotherapy outcomes.

Retrospective analyses were conducted on 1077 oropharyngeal squamous cell carcinoma and 608 nasopharyngeal carcinoma patients, all of whom received radiation therapy. Univariate and multivariate analyses were conducted to assess overall survival, disease-specific survival, and locoregional control for cancer patients taking angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors, calcium channel blockers, or beta blockers compared with propensity score-matched groups of patients not taking these medications.

Oropharyngeal squamous cell carcinoma patients taking antihypertensive medications were statistically older and had higher Charlson Comorbidity Indices at diagnosis. However, these patients had statistically significant improved overall survival, disease-specific survival, and locoregional control compared with propensity score-matched oropharyngeal squamous cell carcinoma patients who were not taking antihypertensive medications, with ARB users showing the greatest improvements. Antihypertensive drugs did not affect outcomes in the nasopharyngeal carcinoma patient cohort.

The use of antihypertensive medications, and particularly ARBs, was associated with improved outcomes in oropharyngeal squamous cell carcinoma patients who had more advanced age and higher Charlson Comorbidity Indices at diagnosis. This study supports future prospective testing of ARBs in conjunction with radiation therapy in this group of higher risk oropharyngeal squamous cell carcinoma patients. Additionally, this study illustrates the need to use propensity score matching to identify patient subgroups that may benefit from a given treatment in retrospective analyses.

Locally advanced gastric cancer presents significant challenges in treatment, often limiting the effectiveness of surgical interventions. Chemotherapy, especially the SOX regimen (combining oxaliplatin and tegafur/gimeracil/oteracil), has been explored as a potential alternative in the management of advanced gastric cancer. While studies on SOX have been conducted in other regions, its impact on immune function and tumor markers remains inadequately evaluated, particularly in China.

This study aimed to assess the toxicological profile, immune function modulation, and tumor marker reduction of the SOX regimen in patients with advanced gastric cancer.

A retrospective analysis was conducted on 100 patients diagnosed with advanced gastric cancer, excluding eight ineligible cases. Based on clinical records, patients were grouped into either the oxaliplatin monotherapy group (reference group) or the SOX regimen group (observation group), with 50 patients in each group. The primary endpoint was clinical effectiveness, while secondary endpoints included immune function, tumor marker levels, and chemotherapy-related toxicity.

The SOX regimen demonstrated significantly higher disease control and objective remission rates compared to oxaliplatin monotherapy (P<0.05). In the SOX group, immune function was enhanced, with increased levels of immunoglobulins (IgA, IgG, IgM) and lymphocyte subsets (CD3+, CD4+, NK cells), and a decrease in CD8+ levels (P<0.05). Additionally, tumor markers such as CA125, CEA, MRP14, SDF-1, FSP-1, and CXCR4 showed a significant reduction (P<0.05). The SOX regimen also exhibited a more favorable safety profile, with lower incidences of chemotherapy-related nausea, vomiting, and leukopenia (P<0.05).

The SOX regimen is an effective and promising treatment option for advanced gastric cancer, offering significant improvements in clinical outcomes, immune function, and tumor marker reduction, with fewer chemotherapy-related toxicities. This study provides valuable insights into the application of the SOX regimen in Chinese patients with advanced gastric cancer.

To evaluate the prognostic value of the presence and number of tumor deposits (TDs) and the combination of TDs and number of positive lymph nodes (PLNs) in patients undergoing colorectal cancer (CRC) surgery, and to modify N staging.

The clinical data of 1470 patients with stage I-IV CRC who underwent surgery in Wuhan Union Hospital from February 2014 to May 2018 were collected. The optimal cutoff value for TD + PLNs was obtained using X-tile software, and patients were regrouped accordingly. Cox univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive ability of independent prognostic factors for overall survival (OS) and disease-free survival (DFS) of patients.

The presence of TD was associated with poor OS (HR = 2.478, 95%CI: 1.794-3.422, P<0.001) and DFS (HR = 2.516, 95%Cl: 1.874-3.377, P<0.001). Combined with TD and PLNs, a total of 128 of 395 N1 patients were reclassified re-staged as N2(TD + PLNs ≥ 3), which had a worse prognosis than those diagnosed with N1. Compared with Tumor Node Metastasis stage and TD number, the multivariate model constructed using independent prognostic factors showed better predictive power for OS (AUC:0.769 vs. 0.681 vs. 0.650) and DFS (AUC:0.757 vs. 0.702 vs. 0.650).

TD significantly affects the long-term prognosis of CRC patients. Combining TD and PLNs to redefine the tumor staging of CRC patients can improve the accuracy of long-term prognosis of surgical patients.

Breast cancer is the leading cancer type among women, accounting for 24.5% of female cancer cases worldwide.

The purpose of this study is to systematically review and conduct a meta-analysis to evaluate the effects of exercise interventions on breast cancer patients at different stages of treatment.

Databases including PubMed, Cochrane Library, and Embase were searched for English-language randomized controlled trials (RCTs) published since 2000. The study included data from women aged 18 and above with breast cancer, either undergoing treatment or after treatment. Effect sizes were calculated using the standardized mean difference.

Out of 2845 studies, 40 met the inclusion criteria, with 17 studies focusing on patients undergoing treatment and 23 on after treatment patients. Exercise significantly reduced fatigue both undergoing (d =  - 0.20) and after treatment (d =  - 1.11). After treatment exercise interventions resulted in improvements in lean mass (d = 1.27), fat mass (d =  - 1.33), percentage body fat (d =  - 1.22), and waist circumference (d =  - 0.69). Additionally, biomarkers such as IL-6, HDL, LDL, glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed improvements after treatment.

Exercise interventions are effective in reducing fatigue and enhancing fitness while undergoing treatment and have positive effects on body composition and biomarkers after treatment. Low-to-moderate intensity exercise is recommended undergoing treatment, while moderate-to-high intensity exercise is beneficial after treatment.

Personalized exercise programs should be incorporated as a standard part of care in clinical settings to alleviate fatigue undergoing treatment and improve body composition and biomarkers following treatment.

Background/Objectives: Oral squamous cell carcinoma (OSCC) with bone infiltration is categorized as a T4 tumor regardless of its size. T4 tumors are an indication for postoperative radiotherapy, which could be overtreatment for small oral squamous cell carcinoma (SOSCC) with bone infiltration. Methods: A retrospective study of 189 patients with OSCC with the potential for mandibular infiltration was performed. The influence of the predictive variables on overall survival (OS) and disease-free survival (DFS) was assessed using the Kaplan-Meier method. A random forest approach was applied to determine the importance of each variable for survival in a multivariate context, and a partial correlation analysis was performed. Results: A statistical analysis of the effects of covariates suggested only a small influence of bone infiltration on OS. Patients with bone infiltration had a 5-year OS of 69%, and those without bone invasion had a 5-year OS of 71%. Age, lymph node metastasis, depth of invasion (DOI), and tumor size had the most decisive prognostic influence on survival. Conclusions: Bone infiltration appears to have less prognostic explanatory power than other known variables regarding OS. Therefore, adjuvant therapy should be carefully evaluated.

Standard neoadjuvant regimens for human epidermal growth factor receptor 2 (HER2)-positive breast cancer include trastuzumab and pertuzumab combined with chemotherapy, and the efficacy and safety of third-generation HER2-directed antibody-drug conjugate (ADC) remain to be elucidated.

This open-label, randomized, phase II study enrolled patients aged ≥18 years with stage II-III HER2-positive breast cancer. Patients were randomly assigned (1 : 1 : 1) to receive neoadjuvant treatment either with SHR-A1811 monotherapy, SHR-A1811 with pyrotinib, or nab-paclitaxel combined with carboplatin, trastuzumab, and pertuzumab (PCbHP) for 24 weeks. The primary endpoint was pathological complete response (pCR). Safety was analysed in patients who received at least one dose of study medication.

Between 27 December 2022 and 11 February 2024, 265 patients were randomly allocated to neoadjuvant, mono-SHR-A1811 (n = 87), SHR-A1811 plus pyrotinib (n = 88), or PCbHP (n = 90). The baseline characteristics were well balanced; ∼45% of the patients were hormone receptor (HR) positive, and 70% of the patients were stage III. The pCR rate was 63.2% for mono-SHR-A1811 (50% for HR positive and 74.5% for HR negative), 62.5% for SHR-A1811 plus pyrotinib (44.7% for HR positive and 76% for HR negative), and 64.4% for PCbHP (54.1% for HR positive and 71.7% for HR negative), with no significant difference between the groups. Grade ≥3 treatment-related adverse events occurred in 44.8% of patients with mono-SHR-A1811, 71.6% with SHR-A1811 plus pyrotinib, and 38.8% with PCbHP. One patient experienced grade 2 interstitial lung disease in SHR-A1811, 9.1% of patients experienced grade 3 diarrhoea in SHR-A1811 plus pyrotinib, and no treatment-related deaths occurred.

This is the first study to report the efficacy and safety of third-generation HER2-directed ADC in the neoadjuvant setting for HER2-positive breast cancer. SHR-A1811 showed robust activity, with a tolerable safety profile.

Background/Objectives: Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches. Methods: A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open. Results: The cohort included 526 patients with a median age of 64 years (range 31-89), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively, p < 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively, p = 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively, p < 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively, p = 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively, p = 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively, p < 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively, p = 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively (p = 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively (p = 0.2). Conclusions: The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery.

This study evaluated the quality of cancer recurrence data in the National Cancer Database (NCDB) to determine if missingness and reporting consistency have improved enough to support national research.

This multi-methods study included NCDB analyses and a cancer registry staff survey. Trends in recurrence data missingness from 2004 to 2021 and multivariable analyses of factors associated with missingness from 2017 to 2021 were evaluated for 4,568,927 patients with non-metastatic cancer. A survey of cancer registry staff at Commission on Cancer-accredited hospitals investigated challenges with recurrence data abstraction.

From 2004 to 2021, recurrence data missingness decreased from 15.7 to 8.4% for breast, 19.8 to 9.3% for colon, 20.5 to 7.4% for lung, 17.6 to 6.6% for melanoma, 29.3 to 9.0% for pancreas, and 18.5 to 9.2% for thyroid cancers. Driving distance ≥100 miles (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.90-2.02) and Southern geographic region (OR 2.86, 95% CI 2.80-2.93) were associated with increased data missingness. Of 565 completed surveys (39.1% response rate), the most common challenges identified were inadequate physician documentation of no evidence of disease (67.8%) and inadequate documentation of recurrence (50.5%). High variability was noted in the interpretation of registry rules specific to the assignment of cancer recurrence or new primary cancer, with discordant assignment occurring 25.5-40.8% of the time.

Despite overall low rates of recurrence data missingness in the NCDB, data quality concerns remain related to inadequate clinical documentation and discrepancies with abstracting practices. Multi-organizational efforts are underway to improve the abstraction of high-quality recurrence data to support outcomes research.

The aim of this study was to assess the prognostic value of the weight loss percentage (WLP) over the 2 years pre-treatment for operated patients with advanced oral squamous cell carcinoma (OSCC). This cohort study included 506 operated patients who were diagnosed with advanced primary OSCC between October 2001 and March 2022, and who were followed up until July 2022. Fine-Gray models, marginal structural models with stabilized inverse probability of treatment weighting, and Cox proportional hazards models were utilized to evaluate the prognostic significance of pre-treatment WLP for disease-specific survival (DSS). The median follow-up time was 32.6 months (interquartile range 13.0-71.6 months). A high pre-treatment WLP (>9.23%) was significantly associated with worse DSS (multivariate Fine-Gray model: hazard ratio (HR) 2.04, 95% confidence interval (CI) 1.29-3.22, P = 0.002; multivariate Cox: HR 2.01, 95% CI 1.28-3.16, P = 0.002). In the weighted cohort, a similar association pattern was observed (marginal structural model: HR 2.26, 95% CI 1.28-3.98, P = 0.005; multivariate Cox: HR 2.28, 95% CI 1.38-3.76, P = 0.001). In subgroup analyses, high WLP could predict worse DSS among patients with buccal mucosa/other cancer sites (not including the oral tongue), moderate tumor differentiation, and larger cancer size (>1.8 cm) (all P < 0.05). Pre-treatment WLP over 2 years might be a useful tool to predict the prognosis of operated patients with advanced OSCC.

The effect of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX (combination leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin in full or modified dosing) chemotherapy on overall survival (OS) is unclear because current studies do not account for the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen.

To investigate the association of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX with OS, taking into account the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen.

This retrospective cohort study included patients with localized pancreatic adenocarcinoma treated with 2 to 11 cycles of preoperative (m)FOLFIRINOX followed by resection across 48 centers in 20 countries from 2010 to 2018. Patients who died within 3 months after surgery were excluded (landmark). Data were analyzed from February 1 to December 31, 2023.

Preoperative (m)FOLFIRINOX chemotherapy followed by resection and eventually followed by adjuvant chemotherapy.

The primary outcome was OS, calculated from the 3-month landmark. Cox regression analysis, including interaction analyses, was performed to investigate the association of adjuvant chemotherapy with OS.

Overall, 767 patients were included after resection of pancreatic adenocarcinoma (median [IQR] age, 62 [55-67] years; 404 [52.7%] male). Adjuvant chemotherapy was independently associated with prolonged OS (hazard ratio [HR], 0.66; 95% CI, 0.49-0.87), confirmed by adjusted OS curves. The interaction analysis to assess estimated treatment effect across subgroups was not statistically significant. The forest plot and interaction test suggest that the association of adjuvant chemotherapy was lower among patients receiving 8 or more cycles of preoperative (m)FOLFIRINOX, those who had radiological response, and those with ypN0 disease. Compared to no adjuvant chemotherapy, both adjuvant (m)FOLFIRINOX (HR, 0.57; 95% CI, 0.40-0.80) and other multiagent adjuvant regimens (HR, 0.61; 95% CI, 0.41-0.92) were associated with prolonged OS, whereas single-agent adjuvant chemotherapy was not (HR, 0.75; 95% CI, 0.55-1.03).

In this cohort study, adjuvant (m)FOLFIRINOX and other multiagent chemotherapy regimens were associated with improved OS following resection of localized pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX, whereas single-agent adjuvant chemotherapy was not. The impact of adjuvant chemotherapy on OS may be lower in subgroups such as patients with 8 or more preoperative cycles of (m)FOLFIRINOX, those having radiological response, and those with ypN0.

The prognostic value of negative regulators of ferroptosis in patients with colorectal cancer (CRC) has not yet been fully elucidated. The present study performed a systematic in silico identification and selection of candidate negative regulators of ferroptosis using The Cancer Genome Atlas data cohort (n=367), followed by clinical validation through immunohistochemistry of samples from patients with CRC (n=166) and further in vitro evaluation. In silico analysis identified specific light-chain subunit of the cystine/glutamate antiporter, AIFM2, NFE2L2, FTH1, GLS2, glutathione peroxidase 4 (GPX4) and heat shock protein β-1 (HSPB1) genes as possible candidates. Furthermore, patients with high expression of GPX4 or HSPB1 exhibited significantly worse overall survival (OS) compared with those with low expression (P<0.01 for both). Immunohistochemical analysis revealed that both OS and recurrence-free survival (RFS) of patients with CRC and high GPX4 or HSPB1 expression were significantly worse compared with in patients with low expression (P<0.01 for all). Furthermore, multivariate analysis showed that high GPX4 and HSPB1 expression were independent risk factors for poor oncological outcome for OS and RFS (GPX4: RFS, P=0.03; HSPB1: OS, P=0.006 and RFS, P<0.0001). Moreover, the effects of GPX4 and HSPB1 small interfering RNAs on two CRC cell lines (DLD-1 and SW480) indicated that GPX4 and HSPB1 may exhibit important roles in attenuating the cytotoxic effect of 5-fluorouracil-based chemotherapy. In conclusion, the current study confirmed that GPX4 and HSPB1 may serve as substantial prognostic- and recurrence-predictive biomarkers in patients with CRC.

Nasopharyngeal carcinoma (NPC), characterized by its aggressive nature and sensitivity to radiation, demands accurate staging for optimal clinical outcomes. The purpose of this review was to provides a comprehensive overview of the evolution of the TNM staging system for NPC based on recent and previously published studies, with particular emphasis on the transition from the 7th to the 9th edition.

The 9th edition introduces critical changes, particularly in the N and M classifications, to enhance prognostic accuracy. Our analysis also incorporates the burgeoning roles of biomarkers, especially Epstein-Barr virus (EBV)-DNA, and the potential of Artificial Intelligence (AI) in refining NPC staging. Each iteration of the TNM staging system for NPC has successfully enhanced the prognostic precision of NPC, with notable advancements from the 7th to the 9th edition. We also delves into the incorporation of biomarkers, such as EBV-DNA, and the potential of AI in refining staging accuracy. These innovations are anticipated to offer personalized prognoses and inform tailored treatment strategies for NPC patients in the future.

This prospective study aimed to assess the predictive value of mono-exponential and multiple mathematical diffusion-weighted imaging (DWI) models in determining the response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).

The study included 103 LARC patients scheduled for preoperative chemoradiotherapy between December 2021 and June 2023 Magnetic resonance imaging (MRI) scans were performed using a 3.0-T MR scanner, encompassing sagittal, axial, and oblique coronal T2-weighted images without fat saturation, along with DWI perpendicular to the rectum's long axis. Various DWI parameters, including apparent diffusion coefficient (ADC), stretched exponential model (SEM), continuous-time random-walk model (CTRW), and fractional-order calculus model (FROC), were measured. The pathologic complete response (pCR) rate and tumor downstaging (T-downstage) rate were determined.

After nCRT, SEM-α, SEM-DDC, CTRW-α, CTRW-β, CTRW-D, FROC-β, and ADC values were significantly higher in the pCR group compared to the non-pCR group (all P < 0.05). SEM-DDC, CTRW-α, CTRW-D, FROC-β, FROC-µ, and ADC values were significantly higher in the T-downstage group (ypT0-1) than in the non-T-downstage group (ypT2-4) (P < 0.05). The combination of CTRW (α + β + D) exhibited the best diagnostic performance for assessing pCR after nCRT (AUC = 0.840, P < 0.001). Pre-nCRT CTRW (α + β) demonstrated a predictive AUC of 0.652 (95%CI: 0.552-0.743), 90.3% sensitivity, and 43.1% specificity for pCR. Regarding T-downstage assessment after nCRT, the combination of CTRW (α + D) yielded the best diagnostic performance (AUC = 0.877, P = 0.048).

In LARC patients, imaging markers derived from CTRW show promise in predicting tumor response before nCRT and assessing pCR after nCRT.

The utilization of complementary medicine (CM) in patients with cancer brings substantial challenges to optimal cancer care by posing a risk of side effects and drug interaction, and might delay cancer care delivery. We aimed to characterize the patterns and predictors of CM utilization in patients with breast cancer (BC) and patients with colorectal cancer (CRC), and the impact on presentation and diagnosis interval.

We interviewed patients with BC and patients with CRC using a semistructured questionnaire to gather sociodemographic, clinical, presentation and diagnosis interval, and CM utilization data. The domains of CM used were categorized according to the classification of the National Institutes of Health/National Center for Complementary and Integrative Health.

One hundred forty-two patients with BC and 227 patients with CRC (N = 369) were included. The prevalence of CM utilization was 69.9%, with biologically based therapies being the most commonly used type. Younger age, higher educational attainment, and a greater number of health facility visits before diagnosis were significantly associated with higher odds of CM utilization (odds ratio [OR], 2.05 [95% CI, 1.19 to 3.54]; P = .010; OR, 1.07 [95% CI, 1.02 to 1.11]; P = .007, respectively). The diagnosis interval was significantly longer in patients who used CM compared to nonusers (incidence rate ratio [IRR], 2.74 [95% CI, 1.77 to 4.26]; P < .001). A greater number of CM modalities used were significantly associated with longer presentation and diagnosis intervals (IRR, 1.68 [95% CI, 1.06 to 2.66]; P = .027; IRR, 1.62 [95% CI, 1.04 to 2.52]; P = .033, respectively).

A significant portion of the local patients with BC and patients with CRC used CM. CM utilization was associated with age, education, number of health facility visits, and prolonged diagnosis interval. These findings underscore the need for CM disclosure among patients for better patient education and monitoring.

Sinonasal mucosal melanoma has poor survival despite multimodality treatment. While the impact of immunotherapy (IT) on metastatic cutaneous melanoma is well-defined, there are relatively little data on sinonasal mucosal melanoma.

We sought to define immunotherapy outcomes in patients with sinonasal mucosal melanoma.

A retrospective cohort study evaluated patients treated with IT during their overall treatment strategy for SNMM. Patient demographics, treatment, and survival outcomes were recorded.

52 patients had IT treatment for SNMM from 2000 to 2022, with an average age of 69.1 ± 11.9 years. The most common treatment was surgery with radiation and IT (n = 26, 50%). Most regimens consisted of a combination of Nivolumab and Ipilimumab (n = 17, 32.7%) or pembrolizumab (n = 14, 26.9%). 44.2% of patients experienced reported complications. Overall survival at 1-, 2-, and 5 years was 86.9%, 74.1%, and 39.1%, respectively.

Approximately half of patients will have a local response following immunotherapy, but it is rare to have improvement at metastatic locations. Further research within our group will assess optimal timing and markers that are predictive of response.

Disease-free survival is the main outcome of interest considered when assessing the effectiveness of surgical management of papillary thyroid carcinoma (PTC). Specific characteristics of nodal metastases have been demonstrated to impact the risk of recurrence.

Verify the oncologic rationale of prophylactic central compartment neck dissection (pCCND) in the management of PTC by comparing the pathologic spectrum of lymph nodes in patient's undergoing pCCND vs. therapeutic CCND (tCCND).

Between May 2017 and October 2018, 257 patients underwent total thyroidectomy for PTC. pCCND was performed for clinically uninvolved nodes, and tCCND for clinically apparent nodal disease. Harvested metastatic nodes from each group were compared in terms of number, size, and the presence of extranodal extension. Cut-off values for the size and number were 2 mm and 5, respectively. Patients were followed until October 2023.

78 patients underwent tCCND. Whereas pCCND was performed in 179 patients. The mean number of nodes harvested in tCCND was 14 (9-31), and 9 (5-24) in pCCND (p < 0.0001). Node positivity was 84.6, and 37.4%, respectively (p < 0.0001). ≥5 metastatic nodes were harvested in 66.6% of tCCND vs. 7.5% of pCCND (p < 0.0001). 73% of tCCND had a metastatic node ≥2 mm in size vs. 2.5% of pCCND (p < 0.0001). Extranodal extension occurred in 25% of tCCND vs. 2.5% of pCCND (p = 0.01). Recurrence rate was 3.8% in tCCND vs. none in pCCND (p = 0.008).

Clinically inapparent nodal disease has a pathological spectrum with insignificant impact on disease recurrence. Therefore, pCCND does not seem to be oncologically meaningful.

The World Health Organization Global Breast Cancer Initiative aims to reduce breast cancer (BC) mortality through three pillars, whose key performance indicators (KPIs) and benchmarks are: (KPI-1) ≥60% BC diagnosed at early stage (I/II), (KPI-2) all suspected BC diagnosed ≤60 days from health system presentation, and (KPI-3) ≥80% of BC patients completing recommended treatment. We aimed to inform measurement of these KPIs in the context of a multi-country hospital-based study.

We included all women who participated to the African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study (excluding South Africa), recruited between 2014 and 2017, across five population-race groups spanning low to high survival: Nigeria, Uganda, Zambia, Namibian black and Namibian non-black women. Follow-up was up to five years post-diagnosis. For each KPI, we reported challenges, assumptions and consistencies in measuring them; completeness and group-level estimations of each KPI were assessed using descriptive analyses. To evaluate their discriminatory ability, we assessed group-level correlations between KPI estimates and five-year net survival.

KPI-1 was extracted from study or medical records for 1389/1473 (94%). KPI-2 relied upon the woman's recall of her date of first contact with the healthcare system and a pathology date, both of which were available for 1222/1473 (83%) but inconsistent for 114/1222 (9.3%). KPI-3, estimated using dates of receipt of multiple therapies from medical records and patient interviews over 12 months, was estimated for 1129/1188 (95%), but uncertain in 113/1129 (10%). For each population group, KPIs achievements were similar for KPI-1 and KPI-2, at 22-49%, and lowest for KPI-3 (<30%). Highest KPIs values were observed in Namibian non-black women who had the highest survival.

Data collection systems specifically set up for prospective hospital-based studies can be used to collect the necessary data to measure these three GBCI KPIs.

National Cancer Institute (United States).

Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC.

We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group.

Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma in situ, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model.

The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.

To investigate the predictive value of changes in segmental myocardial 18F-fluorodeoxyglucose (FDG) uptake for major adverse cardiac events (MACEs) in patients with locally advanced esophageal cancer undergoing definitive radiation therapy (RT).

Between August 2012 and January 2019, 482 patients with stages II and III esophageal cancer from 2 institutions were enrolled and divided into the training (n = 285) and external validation (n = 197) cohorts. All patients underwent 18F-FDG positron emission tomography within 1 week before treatment and within 3 months of treatment. Myocardial delineation was performed using the Carimas software based on the American Heart Association 17-segment model and was automatically divided into basal, middle, and apical regions. The main endpoint was the occurrence of MACEs, including unstable angina, myocardial infarction, coronary revascularization, hospitalization for heart failure or urgent visits, and cardiac death. Analyses included competing risk and Cox regression. Model performance was assessed using the area under the receiver operating characteristic curve and Brier score.

Thirty-four patients (11.9%) developed MACEs at a median follow-up of 78 months. The basal region (median, 19.44 Gy) of the myocardium received the highest radiation dose, followed by the middle (median, 13.02 Gy) and apical regions (median, 9.32 Gy). Multivariate analysis showed that the change ratio in pretreatment and posttreatment basal myocardial mean standardized uptake value (SUV) remained significant after adjusting for age, pre-existing cardiac disease, and dosimetric parameters. The area under the receiver operating characteristic curves and Brier scores demonstrated favorable predictive accuracies of models integrating variables with significant differences in the multivariate analysis when predicting MACEs in the training and validation cohorts.

The basal change ratio of mean SUV was an independent predictor of MACEs in patients with locally advanced esophageal cancer receiving definitive RT. Changes in basal myocardial FDG uptake are promising biomarkers for predicting radiation-induced cardiotoxicity.