This study aimed to evaluate the prognostic significance of preoperative inflammation-based biomarkers, with a particular focus on the Prognostic Nutritional Index (PNI), in predicting recurrence-free survival (RFS) in patients with non-muscle-invasive bladder cancer (NMIBC). We conducted a retrospective analysis of 210 patients with primary NMIBC diagnosed between January 2019 and June 2020. Various inflammatory indices were calculated from preoperative laboratory data, including PNI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), neutrophil-to-platelet ratio (NPR), and albumin-to-globulin ratio (AGR). The optimal PNI cutoff was determined using receiver operating characteristic (ROC) curve analysis for 2-year recurrence. Univariable and multivariable Cox proportional hazards models were employed to identify independent prognostic factors for RFS. Survival curves were generated using the Kaplan-Meier method and compared with the log-rank test. A restricted cubic spline (RCS) model was used to examine the dose-response relationship between PNI and recurrence risk. The optimal PNI cutoff for recurrence was 47.5, with an area under the curve (AUC) of 0.816. Multivariable analysis identified high pathological grade (adjusted hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.37-4.81; p = 0.003) and low PNI (≤47.5) (adjusted HR: 2.40; 95% CI: 1.31-4.40; p = 0.005) as independent risk factors for reduced RFS. PNI exhibited high discriminative performance, and DeLong pairwise comparisons confirmed its AUC was significantly higher than all other evaluated biomarkers (all p < 0.001). Incorporating PNI into the EAU risk model significantly improved model fit (likelihood-ratio test p = 0.008) and increased the C-index from 0.68 to 0.74. Kaplan-Meier analysis confirmed that patients with low PNI had significantly worse RFS than those with high PNI (log-rank p = 0.005). The RCS model revealed a significant linear inverse relationship between PNI and recurrence risk (P for overall association < 0.001; P for nonlinearity = 0.214). These findings suggest that preoperative PNI is a promising biomarker for recurrence risk stratification in NMIBC, with good prognostic discrimination in this cohort, although external validation is required.

Breast cancer is among the most common malignancies in women worldwide, and identifying modifiable dietary factors may support prevention efforts. Calcium has been hypothesized to influence carcinogenesis via effects on cell proliferation, differentiation, apoptosis, and estrogen-related pathways, but epidemiologic findings remain inconsistent. We performed a systematic review and meta-analysis of cohort studies to clarify the association between calcium intake and breast cancer risk. Online databases were systematically searched through December 2025. Eligible studies reported risk estimates comparing the highest versus the lowest calcium intake categories. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed-effect models. Fourteen cohort studies (38 effect sizes) were included. Overall, higher calcium intake was associated with a significantly lower risk of breast cancer (RR: 0.93; 95%CI: 0.90–0.96; p < 0.001; I2 = 35%). In subgroup analyses, inverse associations were observed in both premenopausal and postmenopausal women, across shorter and longer follow-up periods, and in European and American cohorts. Dietary calcium intake, alone or combined with supplements, was associated with a reduced risk, whereas supplemental calcium alone was not. These findings suggest that higher calcium intake, particularly from dietary sources, may modestly reduce breast cancer risk. Further research is needed to confirm causality and clarify mechanisms.

Ketogenic dietary interventions (KDIs) are increasingly explored as adjuncts in oncology due to their metabolic and immunomodulatory effects. One mechanism by which KDIs are expected to modulate the immune system is by altering the gut microbiome, which has been shown to affect treatment outcomes, particularly in the context of immunotherapies. This review synthesized findings from 43 clinical trials to evaluate the current landscape of KDIs in cancer care, with a focus on the gut microbiota and immunotherapy. Although 47% of identified trials are completed, none have yet published results combining KDIs with immunotherapy. Since 2020, however, there has been a significant increase in ongoing studies investigating this combination and incorporating microbiome endpoints. While KDIs may help shape an immunotherapy-permissive environment, further clinical evaluation is necessary to determine the full extent of KDIs on the microbiome. Future research should prioritize longitudinal microbiome profiling and standardized adherence reporting to clarify the therapeutic potential of KDIs as a metabolic adjuvant to immune checkpoint inhibitors.

Bladder cancer is a major public health concern worldwide. While smoking and occupational exposures are established risk factors, the role of dietary fatty acids (FAs) in bladder cancer risk remains unclear. Data were collected from 711 bladder cancer cases and 3,297 controls in the IROPICAN study (2017–2020) across ten Iranian provinces. Dietary intake was assessed using a validated food frequency questionnaire. Intakes of total fat, saturated FAs (SFAs), monounsaturated FAs (MUFAs), polyunsaturated FAs (PUFAs), and trans FAs (TFAs) were analyzed. Principal component analysis (PCA) identified fatty acid consumption patterns. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounders. PCA suggested that balancing FA intake, specifically increasing omega-3 FAs, moderating omega-6, and reducing saturated fats, was associated with a favorable profile for bladder cancer risk. OR for stearic acid intake was 0.28 (95% CI: 0.12–0.67). Conversely, OR for high intake of palmitoleic acid, alpha-linolenic acid (ALA), and docosapentaenoic acid (DPA) was elevated. Sex-specific effects were found stearic acid was protective in men, while PUFAs were protective in women. No associations were observed for total fat or cholesterol. These results highlight the importance of FA subtypes, rather than total fat intake, in dietary recommendations.

Cancer-associated cachexia (CAC) is common in cervical cancer (CC) patients. This condition affects the Health-related quality of life (HRQL). This study aims to assess the impact of CAC on HRQL, comparing the Quality of Life Questionnaire (QLQ) QLQ-C30/QLQ-CAX24 and the Functional assessment of anorexia/cachexia therapy (FAACT) instruments. A cohort of CC patients answered the QLQ-C30/QLQ-CAX24 and the FAACT instruments between October 2020 and October 2021. The psychometric/clinimetric characteristics of the instruments were compared. 244 CC patients were included in the study. Correlations between scales ranged from 0.008 to 0.81. The summary score of QLQ-C30 correlated well with the FAACT total score (r = 0.684) and the FAACT Physical Well-being subscale (r = 0.81). The correlation with five nutritional parameters and prognostic indices was poor (r < 0.364). Most symptom scales of the QLQ-CAX24 presented a floor effect, and those of the FAACT did not. The Nausea/vomiting score of the QLQ-C30, and the Loss of control and Forced to eat scales of the QLQ-CAX24 were independently associated with overall survival. The QLQ-C30/QLQ-CAX24 and FAACT instruments differ substantially, but some scales are comparable. We propose an algorithm to select the appropriate instrument to asses HRQL for a research protocol.

Cancer-related anorexia–cachexia syndrome (CACS) is a multifactorial disorder characterized by progressive weight loss, muscle wasting, and systemic inflammation, leading to reduced survival and quality of life. Despite various pharmacological interventions, their efficacy and safety remain unclear. We conducted an umbrella review of systematic reviews and meta-analyses of randomized controlled trials evaluating pharmacological treatments for CACS, searching PubMed, Scopus, and Web of Science up to May 2025. Methodological quality was assessed using AMSTAR 2, and certainty of evidence was evaluated with GRADE. Primary outcomes included body weight, lean body mass, appetite, quality of life, and adverse events. Seventeen reviews covering 61 trials (6,075 participants) were included. Anamorelin consistently improved lean body mass, grip strength, and body weight. Megestrol acetate modestly enhanced quality of life without consistent effects on weight or appetite, whereas omega-3 fatty acids showed small benefits, and cannabinoids were largely ineffective. Overall, most outcomes were of low or very low certainty due to methodological limitations and heterogeneity. Anamorelin appears most promising for improving muscle mass and selected clinical outcomes in CACS. High-quality, long-term trials and multimodal interventions integrating pharmacological, nutritional, and supportive strategies are urgently needed. Registration PROSPERO registration no. CRD420251131074