In Japan, approximately 1 million individuals are newly diagnosed with cancer each year, and 56,000 patients have children under 18years old. Children of patients with cancer face many challenges, and many parents struggle with how and when to talk to their children about their illness. This retrospective study involved patients with cancer who consulted child life specialists (CLS) for their children at a cancer center between January and December 2021. Patients' demographic and clinical information, their children's ages, and consultation topics were extracted from medical records. In total, 138 patients consulted CLS regarding concerns about their children. Most patients were women in their 40s, with breast cancer as the most common diagnosis (46%). Consultations mainly occurred at diagnosis (43%) or during primary treatment (36%). Issues related to children aged 7-12years were the most common. Of 294 consultation topics analyzed, the most common topic was how and when to tell children about treatment details and schedules (17%). Emotional support for children was a major concern among patients with recurrent diseases. Patients with breast cancer most often sought advice on discussing physical changes, whereas patients with gastrointestinal and gynecological cancers prioritized communication about diagnosis. Patients with cancer that have minor children have diverse and complex concerns. Our findings highlight the importance of integrating psychosocial support services in standard oncology care to address families' unique needs. Tailored interventions, particularly for school-aged children, and ongoing support throughout the disease trajectory are essential to improve family outcomes.

Patients with advanced renal cell carcinoma (RCC) undergoing hemodialysis are often excluded from clinical trials. We aimed to evaluate real-world outcomes of first-line molecular targeted therapy (MTT) and immuno-oncology (IO) combination therapies in patients with advanced RCC receiving hemodialysis. We retrospectively analyzed data from 88 patients undergoing hemodialysis who received first-line systemic therapy for advanced RCC at 18 institutions in Japan between 2008 and 2023. Patients were divided into three groups by first-line regimen: MTT (n = 53), IO-IO (n = 18), or IO-tyrosine kinase inhibitor (IO-TKI, n = 17). Treatment response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were evaluated. Prognostic factors were identified using univariate and multivariate Cox regression analyses. The median PFS and OS were 3.9 and 18.9months, respectively. The IO-IO and IO-TKI groups achieved significantly longer PFS than that in the MTT group (median PFS 3.5, 5.4, and 7.5months, respectively; p = 0.003); OS did not differ significantly between the groups. Grade ≥ 3 TRAEs occurred in 30.2%, 33.3%, and 41.2% of the MTT, IO-IO, and IO-TKI groups, respectively. Multivariate analysis identified poor Eastern Cooperative Oncology Group performance status, longer hemodialysis duration (≥ 10years), and first-line regimen as independent PFS predictors. International Metastatic RCC Database Consortium risk classification and hemodialysis duration independently predicted OS. Systemic therapy, including IO-IO and IO-TKI regimens, demonstrated acceptable safety profiles for patients with advanced RCC undergoing hemodialysis. IO combination therapy significantly improved PFS, supporting its utility as a first-line treatment option.

Non-small cell lung cancer (NSCLC) represents over 80% of lung cancer cases. Neoadjuvant therapy (NAT) improves overall survival (OS) of NSCLC patients. We explored clinicopathological significance of pre- and post-NAT CD47 and PD-L1 (SP142) changes [ΔCD47, ΔPD-L1 (SP142)] in stage IIIA-N2 NSCLC patients. Totally 137 stage IIIA-N2 NSCLC patients underwent post-NAT surgery were selected, with tissues and clinical data collected. CD47 and PD-L1 (SP142) were determined by RT-qPCR and immunohistochemistry, with their relationships with chemotherapy efficacy and the tumor regression grade (TRG) score analyzed. The predictive value of CD47 and PD-L1 (SP142) for poor prognosis and their effects on OS and progression-free survival (PFS), and independent risk factors (IRFs) for poor 5-year prognosis were analyzed by receiver operating characteristic, Kaplan-Meier curves, and COX univariate/multivariate regression models. Post-NAT CD47 and PD-L1 (SP142) were reduced in stage IIIA-N2 NSCLC patients. Higher ΔCD47 and ΔPD-L1 correlated with worse chemotherapy efficacy. Post-NAT ΔCD47 and ΔPD-L1 (SP142) were reduced in patients with major pathological response. ΔCD47 and ΔPD-L1 positively correlated with TRG scores. Elevated ΔCD47, ΔPD-L1 (SP142) were IRFs for poor prognosis in NSCLC patients. The area under the curve of ΔCD47, ΔPD-L1 (SP142) and their combination for predicting NSCLC poor prognosis were separately 0.801, 0.797 and 0.891. Elevated ΔCD47 and ΔPD-L1 (SP142) shortened OS, PFS, and increased mortality risk in patients. Post-NAT CD47 and PD-L1 (SP142) levels were reduced in IIIA-N2 NSCLC patients. ΔCD47 and ΔPD-L1 (SP142) levels linked to clinicopathological characteristics and predicted prognosis.

Systematic pelvic and aortic lymphadenectomy in stage IIB-IVB patients with epithelial ovarian cancer, undergoing complete abdominal macroscopic resection with normal lymph nodes, was revealed to have no prognostic significance for survival in the LION trial. However, the proportion of patients with ovarian clear cell carcinoma (OCCC) in the LION trial was only 2.2%, so the significance of systematic retroperitoneal lymphadenectomy in patients with OCCC remains unclear. We conducted an ancillary analysis of 619 patients enrolled in a randomized phase III trial (JGOG 3017) in patients with OCCC. Of these, 89 were stage IIB to IVB, underwent a complete macroscopic resection, and had no grossly enlarged lymph nodes intraoperatively. Patients were divided into two groups: group A with lymphadenectomy and group B without lymphadenectomy. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) and the log-rank test and Cox proportional hazard model were used to compare the two groups. Among the 89 patients, 77 (86.5%) underwent a lymphadenectomy (group A), while 12 (13.5%) did not (group B). Three-year PFS were 62.3% in group A and 58.3% in group B (p = 0.7705). Three-year OS were 73.0% in group A and 65.6% in group B (p = 0.6346). No significant differences were observed between two groups. This study did not demonstrate a definitive survival benefit from systematic lymphadenectomy in advanced OCCC patients with complete resection and clinically negative nodes. Given the small sample size, these results should be interpreted with caution and regarded as exploratory.

Comprehensive genomic profiling (CGP) has been publicly reimbursed in Japan for 5years, yet its impact on survival in real-world provincial settings remains unclear. We retrospectively analyzed 914 patients with solid tumors who underwent tissue- or blood-based CGP at our institute between December 2019 and July 2023. The median age of patients was 66years. Colorectal (18.9%) and pancreatic (16%) cancers were most common. Actionable alterations were detected in 87.5%, and druggable alterations in 58.3% of patients. Genomically matched therapy was administered to 10.9% of patients, who had better survival than those with druggable alterations who did not receive therapy [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.42-0.74] or those without actionable alterations (HR 0.63, 95% CI 0.47-0.83). A progression-free survival ratio > 1.3 was observed in 39.4% of patients. Multivariate analysis confirmed matched therapy was an independent favorable prognostic factor. Despite lower detection and treatment rates with blood-based CGP because of false negatives, survival benefit was preserved. Patients referred from external institutions had delayed CGP testing, but treatment benefit was slightly greater. Survival improvement was not observed in patients undergoing four or more prior regimens. CGP-guided matched therapy may improve survival even in provincial settings. To optimize clinical utility, the appropriate CGP panel must be offered to the appropriate patient at the optimal time.

Cervical cancer remains a major health problem, and HPV-independent subtypes such as gastric-type adenocarcinoma carry dismal outcomes. Although immune checkpoint inhibitors (ICIs) have improved survival in large trials, their real-world effectiveness including HPV-independent tumors is not well established. We conducted a retrospective multicenter study of two surrogate cohorts representing refractory cervical cancer: patients treated with bevacizumab (Bev-cohort, n = 65) and those undergoing comprehensive genomic profiling (CGP-cohort, n = 42). Early ICI administration was evaluated using landmark analysis (Bev: 180days; CGP: 6months), with differences in restricted mean survival time (ΔRMST) as the primary endpoint. Multivariable Cox models adjusting for stage, histology, and treatment interval were performed as secondary analyses. Exploratory analyses assessed HPV and molecular status for associations with ICI response. In the Bev-cohort, 14 ICI-treated patients achieved significantly longer survival than 48 non-ICI patients (ΔRMST + 19.4days at 180days; + 56.2days at 360days). Multivariable Cox confirmed ICI as an independent predictor of survival (HR 0.15, 95%CI 0.01-0.69). In the CGP-cohort, 11 ICI-treated patients also experienced superior survival compared with 20 non-ICI patients (ΔRMST + 1.05months at 6months; + 2.33months at 12months). Among 36 ICI-treated cases overall, efficacy was not clearly associated with PD-L1 or tumor mutation burden status. Importantly, HPV-independent tumors, including gastric-type adenocarcinoma, demonstrated progression-free survival comparable to HPV-associated tumors. ICIs improved survival in advanced refractory cervical cancer across two real-world cohorts. HPVI may respond favorably, but further studies are needed.

Fat-free mass index (FFMI) is a prognostic influence in cancer patients. However, for the prognosis of Chinese lung cancer (LC) patients, the threshold and impact of FFMI are not known. The aim of the present study was to examine the association between FFMI and the prognosis of Chinese patients with LC. Totally 1,881 adult patients with LC were enrolled. During a median follow-up of 41.0months (range 23.8-64.3), we reported 938 deaths. The optimal stratification method was used to determine the gender-specific optimal threshold for FFMI. Cox regression model and Kaplan-Meier curve were used to evaluate the relationship between FFMI and prognosis. Mediation analysis was used to determine the mediating effect of inflammation. The optimal cutoff points for low FFMI in males and females were 17.27kg/m2 and 14.84kg/m2, respectively. Low FFMI was an independent prognostic indicator for LC patients. Patients who experienced a low FFMI were 29% more likely to die than patients who did not have a low FFMI (P < 0.001, HR = 1.29, 95%CI: 1.12-1.49). The impact of low FFMI on prognosis in LC patients exhibited significant staging dependence, particularly in advanced non-small cell LC and extensive-stage small cell LC. NLR mediated 9.2% of the associations between FFMI and LC all-cause mortality. In this prospective study, low FFMI, as determined by cutoff values, was an independent prognostic factor for patients with LC in both males and females. The association between FFMI and LC prognosis was significantly mediated by NLR.

The conventional histomorphology-based risk classification for endometrial cancer (EC) does not consider the molecular heterogeneity that influences prognosis and treatment response. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) system uses next-generation sequencing to assess DNA polymerase epsilon (POLE) mutations, but its high cost limits its accessibility. This study evaluated the prognostic value of a novel algorithm that combined immunohistochemistry (IHC) testing with conventional risk factors. This retrospective study included 237 patients with stage I-III EC who underwent surgery. Low-risk patients were classified without IHC, while intermediate- and high-risk patients were categorized as MMR-deficient (MMRd), p53-abnormal (p53abn), or nonspecific molecular profile (NSMP) groups based on IHC. Additionally, L1CAM expression was also evaluated. Survival outcomes were analyzed using Kaplan-Meier curves and Cox regression models. Data from 233 cases were analyzed; the median follow-up duration was 63months. Among 87 low-risk patients, only 1 experienced recurrence. The intermediate- and high-risk groups were subdivided into 42 MMRd, 16 p53abn, and 88 NSMP patients. The 5-year disease-free survival (DFS) rates were 98.8% (low-risk), 94.7% (NSMP), 80.6% (MMRd), and 59.8% (p53abn), highlighting the poorer prognosis of p53abn. p53abn independently predicted recurrence (hazard ratio [HR], 10.1) and mortality (HR, 25.6). L1CAM positivity correlated with worse DFS but was not an independent prognostic factor. Conventional risk classification combined with IHC classification using p53 and MMR is a cost-effective prognostic tool that enables risk stratification and personalized treatment decisions, even when genetic testing is unavailable.

Gastric cancer (GC) is a prevalent malignancy with a substantial impact on public health. Muscle quality and function may serve as predictors of poor clinical outcomes in GC. The aim of this updated meta-analysis was to evaluate the prognostic significance of hand grip strength (HGS) in patients undergoing gastrectomy for GC. A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane CENTRAL till August 2023, using keyword combinations of "hand grip strength", "gastric resection", and "gastrectomy". Eligible studies were those focused on outcomes of GC patients undergoing gastrectomy, with a comparison of preoperative HGS. The primary outcome was overall survival (OS); postoperative complications were assessed as a secondary outcome. Newcastle-Ottawa scale was used for quality assessment. Nine studies involving 3,496 patients met our inclusion criteria, conducted primarily in China and Japan. A low HGS was significantly associated with worse OS (pooled adjusted hazard ratio [HR] = 2.29, 95% confidence interval [CI] 1.47-3.57) and increased postoperative complications (pooled adjusted odds ratio [OR] = 1.91, 95% CI 1.55-2.36). Sensitivity analysis confirmed the robustness of the results. This meta-analysis highlights the prognostic relevance of preoperative HGS in GC patients undergoing gastrectomy. The findings strongly link low HGS to decreased OS and postoperative complications risk. This relationship suggests the potential of HGS as a valuable marker for a preoperative risk assessment and stratification.