The optimal size of circular staplers for esophagojejunostomy remains a subject of debate, with concerns that smaller staplers may increase the risk of postoperative complications and impair quality of life (QoL). The purpose of this study was to evaluate the impact of circular stapler size and anastomotic lumen diameter, measured via postoperative computed tomography (CT) imaging, on patient-reported quality of life following esophagojejunostomy. This prospective observational cohort study included patients who underwent esophagojejunostomy using circular staplers. Anastomotic lumen diameter was measured using postoperative CT imaging. Quality of life was assessed at a 6-month follow-up using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-STO22 and Eastern Cooperative Oncology Group (ECOG) performance status scales. Outcomes were compared across stapler sizes and corresponding lumen diameters. No statistically significant differences in EORTC QLQ-STO22 or ECOG scores were observed between stapler size groups. Additionally, anastomotic lumen diameter showed no correlation with quality-of-life outcomes. Smaller circular staplers, often used due to intraoperative anatomical limitations, do not adversely affect postoperative quality of life. These findings suggest that insisting on larger stapler sizes may be unnecessary and that smaller staplers can be used safely when indicated.

Immune checkpoint inhibitors (ICIs) have reshaped the therapeutic landscape of head and neck squamous cell carcinoma (HNSCC). However, only a subset of patients derives durable benefit, highlighting the need for reliable predictive factors of response. A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science (2015-2026) using relevant keywords. This narrative review summarizes and categorizes currently available evidence on biological, inflammatory and clinical biomarkers associated with response to immunotherapy in HNSCC, with particular attention to PD-L1 expression, HPV status, tumor mutational burden, immune microenvironment, systemic inflammatory indices and performance status. PD-L1 expression assessed by Combined Positive Score (CPS) remains the only validated clinical biomarker, although its dynamic and heterogeneous nature limits accuracy. HPV positivity, high tumor mutational burden, favorable immune microenvironment, low neutrophil-to-lymphocyte ratio and good Eastern Cooperative Oncology Group Performance Status (ECOG PS) are consistently associated with improved outcomes. No single marker adequately predicts. Response to immunotherapy in HNSCC is multifactorial. Integrating biological and clinical parameters may support a personalized approach to immunotherapy.

Thiamine deficiency (TD) has been increasingly reported among patients undergoing active cancer treatment. However, its status in end-of-life cancer patients admitted to palliative care units remains unclear. This study aimed to determine the prevalence of TD and associated factors in end-of-life cancer patients on initial admission to a palliative care unit. This single-centre descriptive cross-sectional study included end-of-life cancer patients admitted for the first time to a palliative care unit between 1 January 2020 and 31 December 2023. Whole blood thiamine concentrations measured on admission were analysed using high-performance liquid chromatography. The TD group was defined as <24.0 ng/mL and the thiamine normal group as 24.0-66.0 ng/mL. Patient characteristics were summarised using descriptive statistics, and factors associated with TD were examined using multivariable logistic regression, adjusting for age and clinical background variables. TD was identified in 85 (36%) of 234 patients. Multivariable logistic regression showed that only a serum albumin level <3.0 g/dL was significantly associated with TD (adjusted OR 2.05, 95% CI 1.10 to 3.90; p=0.023). Age, body mass index, Eastern Cooperative Oncology Group performance status, a history of chemotherapy within 1 month prior to admission and gastrointestinal malignancy were not significantly associated with TD. TD was identified in 36% of end-of-life cancer patients and found to be associated with serum albumin level. In end-of-life cancer patients, particularly those with low serum albumin levels, clinicians should be mindful of the possibility of TD.

Mucosal melanoma (MM) carries a high risk of postoperative relapse and poorer survival than cutaneous disease. Prospective data from China support adjuvant temozolomide-cisplatin (TMZ/DDP) in resected MM, while radiotherapy (RT) may augment antitumour immunity and synergise with programmed death 1 (PD-1) inhibitor. We therefore designed an adjuvant regimen combining short-course RT (SCRT) with chemotherapy and PD-1 inhibitor after curative-intent resection. This investigator-initiated, single-arm, prospective, phase II study at Fudan University Shanghai Cancer Centre enrols adults (≥18 years) with histologically confirmed MM after R0/R1 resection, Eastern Cooperative Oncology Group (ECOG) performance status 0-1 and M0 disease. Patients receive six 3-week cycles of systemic therapy: pucotenlimab 200 mg IV on day 1; TMZ 200 mg/m² orally on days 1-5 and DDP 25 mg/m² IV on days 1-3. (SCRT; 25 Gy in five fractions) is delivered after the first two cycles of systemic therapy, followed by four additional cycles of systemic therapy without RT. The primary endpoint is 1-year recurrence-free survival (RFS). Secondary endpoints include locoregional RFS, distant metastasis-free survival, overall survival and safety (CTCAE V.5.0). The planned sample size is 47 (44 evaluable), providing 80% power (one-sided α of 0.10) to detect an improvement in 1-year RFS from 55% to 70%. Time-to-event endpoints will be estimated using Kaplan-Meier methods with 95% CIs. The protocol was approved by the Ethics Committee of Fudan University Shanghai Cancer Centre (approval number: 2407300-5), and all participants will provide written informed consent. Findings will be disseminated in peer-reviewed journals and at scientific conferences. ChiCTR2400093001.

Adjuvant nivolumab has become the new standard of care for patients with oesophageal and gastroesophageal junction cancer (OEC/GEJC) following neoadjuvant chemoradiotherapy (neoCRT) and surgical resection. In Slovenia, this treatment has been in use since January 2022. Here, we report the first Slovenian real-world experience with adjuvant nivolumab. We conducted a retrospective, observational cohort study of patients with OEC/GEJC who received adjuvant nivolumab after neoCRT and radical resection between January 2022 and December 2023. Data on patient characteristics, treatment completion, disease progression, and immune-related adverse events (irAEs) were collected from medical records and analysed via descriptive statistics. A total of 17 patients were included. The median follow-up was 34.6 months (range 11.2-55.7). The cohort included 14 (82%) males, with a mean age of 59 years. The Eastern Cooperative Oncology Group (ECOG) performance status was 0 for 15 (88%) patients and 1 for 2 (12%) patients. The tumor location was the esophagus in 9 (53%) patients and the gastroesophageal junction in 8 (47%) patients. At diagnosis, 13 (76%) patients were stage III (8th TNM classification). Histology revealed adenocarcinoma (AC) in 12 (71%) patients and squamous cell carcinoma (SCC) in 5 (29%) patients. Only 6 (35%) patients completed one year of adjuvant nivolumab. Treatment was discontinued in 5 (29%) patients due to disease progression and in 6 (35%) patients due to irAEs. Overall, 11 (65%) patients experienced irAEs of any grade. Grade 3 or 4 irAEs occurred in 4 (24%) patients: myocarditis G4 in 1 (6%) patient and colitis G3 in 3 (18%) patients. No irAE-related deaths were reported. The median disease-free survival (DFS) was 21.4 months (95% confidence interval [CI], 14.6-28.9). Real-world data from Slovenia indicate that 65% of patients discontinued adjuvant nivolumab prematurely due to disease progression or irAEs. These findings highlight the need for careful patient selection and monitoring when using adjuvant immunotherapy in this population.

Evidence describing temporal changes in disease stage, molecular testing, treatment patterns, and survival outcomes in non-small cell lung cancer (NSCLC) from low- and middle-income countries remains scarce. We assessed longitudinal real-world trends in NSCLC management and outcomes at a provincial oncology center in Vietnam over more than six years. This retrospective observational study included consecutive adults with histologically confirmed NSCLC treated at Nghe An Oncology Hospital, Vietnam between January 2018 and August 2024 (n = 3,087). Trends in stage at diagnosis (AJCC 8th edition), biomarker testing uptake (primarily epidermal growth factor receptor [EGFR]; limited anaplastic lymphoma kinase [ALK]), and first-line treatment modalities were evaluated. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across diagnosis periods using log-rank tests. Multivariable Cox proportional hazards models were used to identify independent prognostic factors. The median age was 64 years (range, 24-97), 73.5% were male, 71.6% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and adenocarcinoma accounted for 77.0% of cases. The proportion of early-stage disease (stage I-II) increased from 3.1% in 2018 to 9.8% in 2023-2024, while stage III disease declined from 33.3% to 20.4%. Molecular testing uptake increased from 28.7% to a peak of 65.1% in 2022 and remained approximately 60% thereafter. Use of first-line targeted therapy rose from 7.7% to 20.8%, and immunotherapy from 0% to 2.5%. Median OS improved from 12.0 months in 2018 to 21.7 months in 2023-2024 (log-rank p < 0.001). Diagnosis during 2021-2024 was independently associated with lower mortality compared with 2018-2020 (adjusted HR 0.80, 95% CI 0.73-0.87). Substantial improvements in diagnosis, molecular testing, and treatment adoption were observed over time and were associated with significantly improved survival in a large real-world Vietnamese NSCLC cohort.

Background/AimThe combination of nivolumab and ipilimumab is the standard first-line treatment for patients with metastatic renal cell carcinoma (mRCC) of intermediate or poor IMDC risk. However, real-world data in unselected populations remain limited. We aimed to evaluate the effectiveness and safety of nivolumab-ipilimumab in a real-world cohort and to describe subsequent therapies after progression.Patients and MethodsWe conducted a retrospective, observational, real-world study at a Spanish tertiary hospital. All adults with intermediate- or poor-risk mRCC who received first-line nivolumab-ipilimumab between January 2018 and June 2025 were included. Overall survival (OS), progression-free survival (PFS), second progression-free survival (PFS2), overall response rate (ORR), disease control rate (DCR), duration of response (DOR) and immune-related adverse events (irAEs) were evaluated. Survival was estimated using the Kaplan-Meier method. Exploratory subgroup analyses were performed according to Eastern Cooperative Oncology Group performance status (ECOG PS), histology, metastatic sites and presence of irAEs.ResultsForty-three patients were included; median age was 64 years and 83.7% were male. Most patients had ECOG PS 0-1 (79%), clear-cell histology (86%) and 28% had sarcomatoid features. Brain metastases were present in 14%. After a median follow-up of 32.2 months, median OS was 18.4 months; the 12 and 36-month OS rates were 59.0% and 44.0%, respectively. Median PFS was 5.1 months; the 12 and 36-month PFS rates were 29.4% and 25.7%, respectively. ORR was 27.9% (4.7% complete responses, 23.2% partial responses) and DCR was 46.5%. Among responders, median DOR was not reached; 81.8% and 68.2% remained free of progression at 12 and 36 months, respectively. Any-grade irAEs occurred in 51.2% of patients, grade ≥3 irAEs in 34.8%, and 16.3% discontinued treatment due to toxicity. ECOG PS ≥2 was associated with significantly worse OS (HR 8.59; p = 0.0029), whereas the occurrence of irAEs was associated with improved OS (HR 0.14; p = 0.001).ConclusionIn this real-world cohort of intermediate/poor-risk mRCC, nivolumab-ipilimumab showed lower median OS and PFS than in pivotal trials and some real-world series, likely reflecting poorer baseline prognostic features. Nevertheless, a clinically relevant subgroup of long responders achieved durable benefit, and the safety profile was consistent with previous reports. Nivolumab-ipilimumab remains an effective first-line option in real-world practice, particularly in patients achieving early disease control.

To propose an integrative clinical-biological hypothesis whereby progressive functional deterioration in advanced cancer constitutes the final common pathway of systemic decline, driven by persistent inflammation, catabolic metabolic dysregulation and impairment of stress-response systems. Narrative synthesis drawing on observations from established prognostic models (eg, Palliative Prognostic Score, Palliative Prognostic Index) and translational evidence concerning systemic inflammation, cachexia, metabolic mediators and stress-system dysregulation in advanced malignancy. Performance status measures-Eastern Cooperative Oncology Group (ECOG) Performance Status, Karnofsky Performance Status and Palliative Performance Scale-consistently demonstrate independent and often dominant prognostic value across diverse clinical settings and modelling strategies. Converging clinical and biological observations suggest that progressive functional decline reflects cumulative erosion of physiological reserve and adaptive capacity, mediated by persistent low-grade systemic inflammation, a predominantly catabolic metabolic state and chronic dysregulation of stress-response pathways. This interplay leads to diminished homeostatic flexibility, resulting in disproportionate decompensation to minor intercurrent stressors and acceleration of terminal decline. Functional status may represent more than a descriptive prognostic indicator; it could embody the clinical manifestation of progressive loss of systemic resilience. The proposed resilience-threshold model frames a non-linear trajectory, leading to irreversible functional collapse once a critical threshold of adaptive reserve is exceeded. This conceptual framework has the potential to refine prognostic interpretation, inform proportionate therapeutic decisions and encourage prospective validation in palliative oncology.

Treatment decision-making in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) is increasingly complex, especially with the emergence of novel, high-cost therapies such as chimeric antigen receptor (CAR) T-cell therapy. Understanding how physicians weigh various clinical and nonclinical treatment attributes is essential for aligning healthcare decisions with both clinical value and economic sustainability. This study aims to quantify Japanese physicians' preferences in health outcomes and patient experience outcomes through eliciting trade-offs in a choice experiment for specific treatment characteristics in R/R DLBCL. We performed a discrete choice experiment (DCE) with Japanese hematologists and oncologists. Participants completed an online best-worst scaling three alternative discrete choice experiment featuring a series of hypothetical treatment outcomes for DLBCL. The DCE included two patient vignettes: patient Q, a 70-year-old male with two prior treatment lines and Eastern Cooperative Oncology Group (ECOG) performance status 1; and patient R, a 58-year-old female with three prior treatment lines and ECOG performance status 2. Predefined attributes included: overall survival (OS) rates at 12 and 24 months, change in ECOG status at 6 months, CAR-T related side effects (risk of severe cytokine release syndrome (CRS), and risk of severe neurological events), duration of hospitalization, time until treatment initiation, and total treatment cost. A conditional logit model was used to calculate odds ratios (OR) for each attribute's influence on selecting the preferred treatment recommendation. ORs were translated into willingness-to-pay (WTP) estimates for the health outcomes, changes in adverse event risks and waiting time/hospitalization duration. A total of 231 Japanese hematologists and oncologists participated, each making six treatment decisions for two patient vignettes. Across both profiles, 12- and 24-month overall survival (OS), hospitalization duration, waiting time, and treatment cost significantly influenced preferences. For patient Q, reduced CRS risk was significant, while for patient R, ECOG improvement was influential. Willingness to pay (WTP) for a 1% increase in 24-month OS was approximately JPY 1.4 million (~USD 9520) for patient Q and JPY 1.8 million (~USD 12,240) for patient R; corresponding estimates for 12-month OS were slightly lower. A 1-week reduction in hospital stay was valued at JPY 1.1-1.9 million (USD 7480-12,920), and a 1-week reduction in waiting time at JPY 600,000-1.5 million (USD 4080-10,200). Overall, physicians prioritized long-term survival more strongly for the younger, more severe patient, whereas preferences were more balanced for the older patient. Clinical improvement (ECOG) weighed more heavily for the younger patient, while safety concerns were more salient in the older case. Our findings suggest that Japanese hematologists are cost-aware in their treatment decision-making. While improved OS remains the most valued outcome, reducing hospital length of stay is associated with substantial WTP, highlighting the importance of logistical and economic factors. The severity of prognosis shifted physician priorities to short-term survival and rapid access to care with more tolerance of adverse event risks. Future research should explore how these physician preferences align with patient perspectives.

Pain and health-related quality-of-life outcomes with darolutamide in metastatic hormone-sensitive prostate cancer (ARANOTE): secondary and exploratory analyses of a multicentre, randomised, placebo-controlled, phase 3 trial.

Genomic Determinants of Response to Alpelisib Plus Fulvestrant in the SOLAR-1 Trial.

Benmelstobart plus anlotinib versus pembrolizumab as first-line treatment for PD-L1-positive, advanced non-small-cell lung cancer (CAMPASS): a blinded, randomised, controlled, phase 3 trial.

177Lu]Lu-PSMA-617 in combination with pembrolizumab for treatment of metastatic castration resistant prostate cancer (PRINCE): a single-arm, phase 1b/2 study.

Advanced sarcomas have limited treatment options. Gemcitabine and docetaxel (GD) regimen showed efficacy in soft tissue sarcomas (STSs) in phase II studies but failed in first-line phase III trial. Adding cisplatin to GD showed efficacy in other types of cancer. mTOR pathway has been shown to play a role in resistance to these drugs. Inflammatory biomarkers have been identified as potential prognostic indicators in various malignancies, but their role in patients with advanced sarcomas is not clear. We retrospectively enrolled 77 patients with advanced or metastatic sarcomas (STSs, n = 71; bone sarcomas, n = 6) receiving a novel combination with gemcitabine-gemcitabine/docetaxel/cisplatin plus everolimus (G-GDC + E). Primary endpoints included overall survival (OS) and progression-free survival (PFS). Inflammatory biomarkers were calculated, and their prognostic influence was evaluated. The median OS and PFS were 16.8 months (95% CI, 13.6-23.9) and 5.4 months (95% CI, 4.3-8.3), respectively. Undifferentiated pleomorphic sarcoma/myxofibrosarcoma (UPS/MFS) demonstrated superior PFS compared to round cell sarcoma/translocation-related sarcoma (7.8 vs. 3.6 months, p = 0.009) and bone sarcoma (7.8 vs. 2.3 months, p < 0.001). Eastern Cooperative Oncology Group Performance Status ≥ 2, unfavorable histology (round cell sarcoma/translocation-related sarcoma and bone sarcoma), lower albumin level, and lymphocyte-to-monocyte ratio < 2.7 were independent predictors of OS. Grade 3-4 toxicities included neutropenia (68.8%), thrombocytopenia (59.7%), anemia (49.4%), diarrhea (18.2%), and skin toxicities (28.6%). G-GDC + E demonstrates histology-specific efficacy in advanced/metastatic sarcomas, with substantial hematologic toxicity (Grade 3-4 thrombocytopenia 59.7%, neutropenia 68.8%) and notable non-hematologic events (Grade 3-4 diarrhea 18.2%, skin reactions 28.6%), all controllable with close monitoring, dose modifications and supportive care. Inflammatory biomarkers provide independent prognostic values.

Fulzerasib plus cetuximab in first-line KRASG12C-mutated non-small-cell lung cancer (KROCUS): a single-arm, multicentre, phase 1b/2 trial.

TAPUR is a phase II basket trial evaluating the antitumor activity of commercially available targeted agents in patients with advanced cancer and genomic alterations who have no standard treatments available. Results of four cohorts of patients with PIK3CA-mutated tumors treated with temsirolimus are reported: breast cancer (BC), colorectal cancer (CRC), uterine cancer (UC) and other solid tumors (histology-pooled [HP]). Eligible patients had advanced solid tumors, measurable disease (RECIST), Eastern Cooperative Oncology Group performance status 0-2, adequate organ function, and no standard treatment options. The primary end point was disease control (DC), defined as objective response (OR) or stable disease (SD) of at least 16 weeks duration. For the histology-specific cohorts, Simon's two-stage design was based on a null DC rate of 15% versus 35% (power = 0.85; α = .10). For the HP cohort, the hypothesized null DC rate of 15% was rejected if the lower limit of a one-sided 90% CI was >15%. Secondary end points were OR, progression-free survival, overall survival, duration of response, duration of SD, and safety. Patients with PIK3CA-mutated BC (N = 12), CRC (N = 11), UC (N = 30), or other advanced cancers (HP cohort; N = 30) were enrolled. The BC and CRC cohorts did not reach the criteria to expand to stage II and were closed for futility. The DC rates with one-sided 90% CI were 37% (23 to 100, P = .0074) and 31% (20 to 100) for the UC and HP cohorts, respectively. The null hypothesized 15% DC rate was rejected for the UC and HP cohorts but not for the BC and CRC cohorts. Twenty-nine of 83 patients (35%) experienced treatment-related grade 3 adverse events (AEs) or serious AEs. Temsirolimus demonstrated antitumor activity in patients with PIK3CA-mutated cancer within the UC and HP cohorts but not the BC or CRC cohorts.

Ifinatamab deruxtecan, a B7-H3-directed antibody-drug conjugate, in patients with advanced solid tumours (IDeate-PanTumor01): dose-escalation results from a phase 1/2 trial.

Safety and efficacy of moderately hypofractionated radiotherapy after radical prostatectomy: A phase II trial.

A randomized clinical study comparing trabectedin combined with regional hyperthermia with trabectedin in patients with advanced soft tissue sarcoma: HyperTET, a German Interdisciplinary Sarcoma Group trial.

Accurately estimating physiological fitness and life expectancy is challenging in older patients with early-stage non-small cell lung cancer (NSCLC) considered for stereotactic body radiotherapy (SBRT). Noninvasive biological age metrics may improve assessment beyond chronological age. To evaluate whether a photography-based age estimating algorithm (face age) and spirometry-based estimated age (lung age) are associated with overall survival and early mortality. This retrospective cohort study included patients aged 60 years and older with early-stage NSCLC treated with definitive SBRT from June 2009 to March 2023. Participants were recruited from 6 radiation oncology clinics affiliated with a single academic cancer center and had a median follow-up of 44 months. Pretreatment identification photographs were available for face age estimation in all patients; baseline pulmonary function tests were available for a subset and used to compute lung age. Face age used a validated deep learning model to estimate age from pre-SBRT photographs; lung age was derived from spirometry using validated equations. Primary outcomes were overall survival and 2-year mortality. Multivariate Cox models adjusted for clinical covariates. Among 670 patients (median [range] age, 77 [60-98] years; 406 [61%] female), the median (range) face age was 79 (range, 47-98) years. Overall, 113 participants (17%) vs 149 (22%) were 85 years or older by chronological age vs face age, respectively. The median overall survival was 47 (95% CI, 42-54) months, and 161 (24%) died within 2 years. On multivariate analysis adjusting for sex, Eastern Cooperative Oncology Group performance status, cancer stage, smoking pack-years, and histology, older face age was associated with worse overall survival (adjusted hazard ratio [HR] per decade, 1.39; 95% CI, 1.13-1.71; P = .002), whereas chronological age was not. Older face age and face age of 85 years or older were associated with increased 2-year mortality (adjusted HR per decade, 1.35; 95% CI, 1.03-1.78; P = .03; age ≥85 years: adjusted HR, 1.59; 95% CI, 1.06-2.40; P = .03), whereas chronological age per decade and age of 85 years or older were not. In the subset of 477 participants with spirometry data, median lung age was 98 (range, 22-139) years and showed minimal correlation with face age (r = 0.07). Face age remained independently associated with survival in sensitivity analyses adjusting for lung age. In this cohort study of older patients with early-stage NSCLC receiving SBRT, face age was an independent biomarker associated with survival and early mortality and complemented lung age. These noninvasive measures, obtainable from routine photographs and spirometry, may aid individualized risk stratification and treatment planning.