Oncological Outcomes In Patients Research Articles

Efficacy and safety of camrelizumab combined with chemotherapy as second-line treatment for locally advanced, recurrent, or metastatic esophageal squamous cell carcinoma

BackgroundThis study aims to evaluate the efficacy and safety of camrelizumab in combination with chemotherapy as a second-line treatment for patients with locally advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC).MethodsIn this retrospective, single-center observational study, we collected medical records of patients with locally advanced, recurrent, or metastatic ESCC who received either camrelizumab combined with chemotherapy or chemotherapy alone as second-line treatment between July 1, 2019, and May 31, 2023. We evaluated short-term efficacy, including overall response rate (ORR) and disease control rate (DCR), as well as survival outcomes, including progression-free survival (PFS) and overall survival (OS). Safety was also assessed. Additionally, factors influencing OS in ESCC patients were analyzed.ResultsA total of 60 patients with locally advanced, recurrent, or metastatic ESCC were included, with 30 receiving camrelizumab combined with chemotherapy and 30 receiving chemotherapy alone as second-line treatment. There were no statistically significant differences in ORR (33.33% vs. 13.33%) and DCR (73.33% vs. 56.67%) between the combination therapy and chemotherapy-alone groups (P > 0.05). However, the median PFS was significantly longer in the combination therapy group compared to the chemotherapy group (4.7 months vs. 3.4 months, P = 0.048). Additionally, the median OS was significantly improved in the combination therapy group compared to the chemotherapy group (11.7 months vs. 6.5 months, P = 0.003). Age and history of radical surgery were significantly associated with OS in patients receiving camrelizumab combined with chemotherapy as second-line treatment (P < 0.05).ConclusionSecond-line treatment with camrelizumab combined with chemotherapy is well-tolerated and associated with favorable oncological outcomes in patients with locally advanced, recurrent, or metastatic ESCC. Furthermore, younger patients and those who have undergone radical surgery may derive greater benefit from camrelizumab combined with chemotherapy as a second-line treatment.

Impact of obesity on outcomes following surgery for gastric adenocarcinoma: a European multi-institutional study

IntroductionThe impact of overweight and obesity on pathological outcomes, complications, and oncologic outcomes following surgery for gastric adenocarcinoma has been poorly reported in Western populations. This study aimed to better understand the impact of overweight and obesity on both surgical and oncological outcomes in patients who underwent surgery for gastric cancer. MethodsData were retrospectively collected from a multi-institutional European database. 1589 patients underwent surgery for gastric adenocarcinoma between 2007 and 2017. Patients were divided into three groups according to their body mass index (BMI): 722 normoponderal patients (45.4%), 585 overweight patients (36.8%), and 282 obese patients (17.7%). ResultsThe tumor stage, administration of perioperative chemotherapy, number of harvested lymph nodes, and reoperation rates were similar. Tumor location differed between the groups, with more distal locations in normoponderal patients than in overweight patients (51.4% vs. 44.1%, p = 0.04). Surgical complications were more frequent in obese patients than in normoponderal patients (34.8% vs. 24.2%, p= 0.005), and severe postoperative complications too. The medical complication rate was higher in overweight and obese patients (31.5% and 32.6% vs. 24.1%, p= 0.003). There was no difference in the overall survival. ConclusionsObesity was not related to tumor stage, pre- or intraoperative strategies, or survival in patients undergoing surgery for gastric adenocarcinoma. However, postoperative morbidity increases in patients with obesity. Surgery for gastric adenocarcinoma should be proposed for all patients and should be performed as usual, regardless of their BMI. However, obese patients should be counseled regarding the higher risk of postoperative complications.

Patterns of lymph node metastasis and long-term outcomes of splenic flexure colon cancer: a descriptive study from a Japanese high-volume center.

The pattern of lymph node metastasis and the appropriate extent of lymph node dissection in splenic flexure colon cancer remain unclear. This study aimed to describe the clinical characteristics, lymph node metastasis patterns, and oncological outcomes of patients with splenic flexure colon cancer. The data of patients with splenic flexure cancer diagnosed with pathological stages I-III were extracted from a hospital database. Lymph nodes were mapped and numbered according to the guidelines of the Japanese Society for Cancer of the Colon and Rectum. Five-year disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. Among 151 patients, 37.1% had lymph node metastasis. The proportion of lymph node metastasis were 30.1% at station 221, 5.1% at station 222, 2.8% at station 223, 19.8% at station 231, 2.7% at station 232, and 0% at station 253. Among the 59 patients with an accessory middle colic artery, 19 had lymph node metastasis only at stations 221 (14/47) and 231 (5/47). The 5-year estimated DFS rates were 100% for stage I, 94.4% (95% CI, 83.6-98.2) for stage II, and 79.9% (95% CI, 65.6-88.8) for stage III. Ten patients experienced distant recurrence: liver (n = 5), peritoneum (n = 2), para-aortic lymph node (n = 2), and lung metastasis (n = 1). No local recurrence was observed. In splenic flexure colon cancer, lymph node dissection around the IMA route may be omitted. Similarly, dissection along the left branch of the middle colic artery or the left colic artery may be unnecessary in the presence of an accessory middle colic artery.

THE ROLE OF MUSHROOMS AND THEIR BIOACTIVE COMPOUNDS IN CANCER PREVENTION AND TREATMENT

Background: Cancer remains one of the most significant global health concerns, contributing to high morbidity and mortality rates. Conventional treatments such as chemotherapy, radiation therapy, and targeted therapies are widely used but often come with significant limitations, including severe side effects, resistance development, and compromised quality of life. The search for safer and more effective complementary therapies has led to growing interest in natural compounds with anticancer potential. Medicinal mushrooms have long been valued in traditional medicine for their nutritional and therapeutic properties, offering a promising alternative for cancer prevention and treatment. Body: Mushrooms are a rich source of bioactive compounds, including polysaccharides, terpenoids, phenolic compounds, sterols, and lectins, which exhibit diverse pharmacological properties such as antioxidant, immunomodulatory, and tumor-suppressive effects. Notable species, including Shiitake (Lentinula edodes), Reishi (Ganoderma lucidum), Maitake (Grifola frondosa), and Turkey Tail (Trametes versicolor), have been extensively studied for their ability to enhance immune function, induce apoptosis, and inhibit angiogenesis and metastasis. Preclinical and clinical studies have demonstrated that mushroom-derived compounds can influence key cancer-related pathways, including immune regulation, oxidative stress reduction, and cell cycle arrest, suggesting their potential as adjunct therapies alongside conventional treatments. Conclusion: The existing body of research provides compelling evidence supporting the anticancer potential of medicinal mushrooms. However, challenges such as standardization of bioactive compounds, dose optimization, and regulatory validation remain. Further large-scale clinical trials and mechanistic studies are essential to fully harness their therapeutic benefits and facilitate their integration into conventional cancer treatment strategies. Medicinal mushrooms hold promise as natural, well-tolerated agents that could complement existing therapies and improve patient outcomes in oncology.

Osteopenic occult vertebral fracture is associated with poor oncological outcome in patients with hepatocellular carcinoma after hepatic resection

AbstractBackgroundAlthough osteopenia has been associated with poor outcomes in patients with hepatocellular carcinoma (HCC), the oncological impact of occult vertebral fracture (OVF) has not been investigated.MethodsThe study comprised 235 patients who had undergone primary hepatic resection for hepatocellular carcinoma between 2008 and 2019. Osteopenia was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. OVF was defined if the ratios of central/anterior or central/posterior heights of the vertebrae, measured using sagittal computed tomography reconstruction between 11th thoracic vertebra to 5th lumber vertebrae, &lt;0.8. Multivariate Cox proportional hazard models were conducted to assess disease‐free and overall survival adjusting for potential confounders.ResultsOccult vertebral fracture was identified in 93 patients (40%), while osteopenia in 65 patients (28%). Osteopenic OVF was identified in 27 patients (12%). In multivariate analysis, gender (p &lt; 0.001), serum PIVKA‐II level ≥ 200 mAU/ml (p = 0.005), C‐reactive protein‐to‐albumin ratio ≥0.04 (p = 0.03), multiple tumors (p &lt; 0.001), type of resection (p &lt; 0.001), low skeletal muscle index (p = 0.002), and osteopenic OVF (HR 3.07, 95% CI 1.78–5.28, p &lt; 0.001) were independent and significant predictors of cancer recurrence, while gender (p = 0.002), Child–Pugh grade B (p = 0.009), C‐reactive protein‐to‐albumin ratio ≥0.04 (p = 0.03), multiple tumors (p = 0.005), low skeletal muscle index (p &lt; 0.001), and osteopenic OVF (HR 4.75, 95% CI 2.41–9.39, p &lt; 0.001) were independent predictors of overall survival.ConclusionsOsteopenic OVF is associated with poor oncological outcomes in patients with hepatocellular carcinoma after hepatic resection. Our findings provide a compelling rationale for the further investigation of the interplay between tumor and bone metabolism.

Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome.

To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement. Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability. International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders. Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]). In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.

Incidence and Outcomes of Secondary Bladder Cancer Following Radiation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis.

There is an established association between secondary bladder cancers (SBCs) and radiotherapy (RT) for prostate cancer (PC), which remains a significant concern. Our aim was to update the evidence on SBC incidence across different RT modalities and to compare oncological outcomes for patients diagnosed with SBC to those diagnosed with primary bladder cancer (PBC). We searched MEDLINE, Scopus, and Web of Science for studies on SBC following PC. Pairwise meta-analyses were conducted to compare SBC incidence in terms of odds ratios (ORs) between RT modalities (external beam radiation therapy [EBRT], brachytherapy [BT], and BT + EBRT) and PBC incidence after radical prostatectomy (RP). SBC incidence data are presented as proportions, and pairwise meta-analyses were used to compare overall survival (OS) between SBC and PBC using hazard ratios (HRs). Thirty-one studies (n=576 341) were included. All RT modalities significantly increased the risk of SBC in comparison to RP at all time points investigated. BT alone had similar long-term SBC risk in comparison to EBRT (OR 0.56, 95% confidence interval [CI] 0.25-1.23 at 10yr; OR 0.51, 95% CI 0.24-1.06 at 15yr). There was no significant difference in OS between SBC and PBC in the overall cohort. However, among patients requiring radical cystectomy (RC), SBC resulted in a significant decrease in OS in comparison to PBC (HR 1.55, 95% CI 1.06-2.26; p=0.02). All RT modalities increased the risk of SBC at each post-RT time point investigated. SBC patients requiring RC have worse survival than those with PBC. Our results highlight the need for ongoing surveillance and early detection. Despite the rarity of SBC, clinicians should monitor bladder symptoms in PC patients after RT. These data need to be included in the shared decision-making process with patients regarding therapeutic decisions to raise awareness of SBC in this setting.

Clinicopathological characteristics and survival outcomes of women aged ≤45 and >45 years with endometrial adenocarcinoma in tertiary referral hospital: a 21-year cohort study

ObjectiveThis study aimed to compare clinicopathological characteristics and oncological outcomes in patients with endometrial cancer aged ≤45 and >45 years, with a focus on identifying distinct traits and prognostic factors...

Colon and rectal peritoneal carcinomatosis: are we mixing apples with oranges? A propensity score-matched analysis.

Rectal cancer is universally considered a different disease entity as compared to colon cancer, except when dealing with colorectal peritoneal carcinomatosis (PC), in which the two cancers are deemed as the same one. The present study aims to investigate the influence of primary tumor location (colon vs. rectum) on oncologic outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases. Data from three referral centers undergoing CRS plus HIPEC for PC of colorectal origin were prospectively collected. The primary outcomes were overall survival (OS) and disease-free survival (DFS) according to primary tumor location (colic vs. rectal). Univariate and multivariate analyses were performed using the Cox proportional hazard model first on the total number of patients. Then, a propensity score matching using the nearest-neighbour method with a 1:1 ratio was performed. The study included 167 patients: 126 colic and 41 rectal PC. After propensity score matching, rectal primary tumor location was independently predictive of a lower DFS (HR 1.91; 95%CI 1.06-3.45; p = 0.031) but not of a lower OS (HR 1.12; 95%CI 0.57-2.21; p = 0.73). Post-matching 3-year DFS rates were 49.2% (95%CI 34,3-70,5%) and 19.4% (95%CI 9,4-40,2%) for colic and rectal PC, respectively. The present study shows a significantly worse DFS for rectal cancer PC undergoing CRS and HIPEC compared to colon cancer PC, suggesting a possible need for dedicated pathways for rectal PC patients and posing a question for rectal PC to be considered as a unique disease entity.

Association of Body Composition Parameters with the Short- and Long-Term Efficacy of Neoadjuvant Immunotherapy Combined with Chemotherapy in Advanced Gastric Cancer

Background Immunotherapy has become a prevalent strategy in the neoadjuvant treatment of advanced gastric cancer (AGC). This study investigates the predictive value of computed tomography (CT)-derived body composition parameters on the efficacy of neoadjuvant immunotherapy for AGC. Methods Data on 103 patients with resectable AGC who received neoadjuvant immunotherapy combined with chemotherapy at a teaching hospital between March 2020 and August 2022 were collected. Body composition parameters, including the subcutaneous adipose index (SAI), visceral adipose index (VAI), and skeletal muscle index (SMI), were calculated from pretreatment CT images. Logistic regression and Cox proportional hazards models assessed the impact of these parameters on pathological responses and survival outcomes following treatment. Results Of the patients, 34 (33.0%) achieved a major pathological response (MPR). Higher SAI, VAI, and SMI values were significantly linked to an increased likelihood of achieving MPR (p < 0.05). Multivariate regression analysis revealed that only SAI independently predicted MPR (OR 1.042, 95% CI 1.009–1.077, p = 0.013). Furthermore, patients with a high SAI had significantly improved 2-year overall survival (76.9% vs. 54.9%, log-rank p = 0.012) and 2-year event-free survival (71.2% vs. 51.0%, log-rank p = 0.022) compared to those with low SAI. The survival benefit associated with high SAI was partly due to its higher MPR rate (mediating proportion: 37.5%, 95% CI: 12%–110%). Conclusion Pretreatment SAI independently correlates with MPR and better oncological outcomes in patients with AGC receiving neoadjuvant immunotherapy.

An Updated Systematic Review and Network Meta-Analysis of First-Line Triplet vs. Doublet Therapies for Metastatic Hormone-Sensitive Prostate Cancer.

Purpose: The addition of androgen receptor pathway inhibitors (ARPIs) to androgen deprivation therapy (ADT), with or without docetaxel (Doc), is currently recommended for metastatic, hormone-sensitive prostate cancer (mHSPC). Recently, the ARANOTE trial evaluated the efficacy and safety of Darolutamide + ADT in this setting. We aimed to update a network meta-analysis (NMA) of these combination therapies. Methods: We conducted a systematic search for RCTs on systemic therapies for mHSPC using MEDLINE, Embase, and the Web of Science Core Collection in September 2024. An NMA utilizing random-effects models was performed to compare progression-free survival (PFS), overall survival (OS), and adverse event (AE) incidence (PROSPERO: CRD42024591458). Results: A total of 12 RCTs (n = 11,954) were included in our NMAs. Triplet therapies were associated with significant improvements in PFS compared to ARPI-based doublet therapies (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.59-0.93; p = 0.01), but the difference did not reach the conventional levels of statistical significance for OS (HR: 0.82; 95% CI: 0.67-1.01; p = 0.059). In a subset analysis, compared to ARPI-based doublet therapies, triplet therapies showed a significant improvement in PFS in patients with high-volume disease (HR: 0.64; 95% CI: 0.47-0.88; p < 0.01), whereas no significant improvement was observed in those with low-volume disease (HR: 0.86; 95% CI: 0.45-1.67; p = 0.7). No significant difference in grade ≥ 3 AEs was observed between triplet therapies and ARPI-based doublet therapies. The main limitations include patient heterogeneity and limited follow-up in some studies. Conclusions: Triplet therapies can improve the oncologic outcomes of patients with mHSPC compared to ARPI-based doublet therapies, without significantly increasing severe AEs. These findings warrant further confirmation in a head-to-head trial powered for overall survival.

Role of dehydrated human amnion/chorion membrane in enhancing functional outcomes after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

Dehydrated human amnion/chorion membrane (dHACM) has shown potential in enhancing neurovascular recovery and functional outcomes in robot-assisted radical prostatectomy (RARP). To evaluate the effects of dHACM on continence recovery, sexual function, and oncological outcomes in patients undergoing RARP. A systematic review and meta-analysis were conducted following PRISMA guidelines, analyzing data from PubMed, Cochrane, and EMBASE. Six retrospective studies comparing RARP with and without dHACM were included. Odds ratios (OR) and standardized mean differences (SMD) were calculated using a random-effects model. The primary outcomes were continence and potency recovery, and secondary outcomes included biochemical recurrence (BCR). The meta-analysis included 4072 patients (1699 experimental and 2373 control). dHACM significantly improved early continence recovery (SMD 1.78, 95% CI 1.26-2.34) at <3, 3, and 6months postoperatively (OR 1.95, 95% CI 1.13-3.36; OR 2.17, 95% CI 1.52-3.09; and OR 1.70, 95% CI 1.10-2.63, respectively). Time to potency recovery was shorter (SMD -0.55, 95% CI -0.67 to -0.43), with significant improvements at <3, 3, 6, and 9months (OR 1.67, 95% CI 1.25-2.23; OR 1.27, 95% CI 1.06-1.53; OR 1.41, 95% CI 1.15-1.72; and OR 1.51, 95% CI 1.16-1.97, respectively). There were no significant differences in BCR (OR 0.85, 95% CI 0.54-1.35). dHACM offers potential as an adjunct to enhance functional recovery following RARP without compromising oncologic safety, but further high-quality studies are needed. Strengths include a comprehensive analysis of early functional outcomes and low heterogeneity in early potency and continence data. Limitations include reliance on retrospective studies and lack of randomized controlled trials. dHACM may accelerate continence and sexual function recovery in early period after RARP while maintaining oncological outcomes, but further randomized studies are necessary to confirm these findings.

Prognostic value of the pretreatment Naples prognostic score in patients with colorectal cancer: a systematic review and meta-analysis.

The prognostic significance of the Naples prognostic score (NPS) in colorectal cancer remains uncertain. This study aims to investigate the correlation between the pretreatment NPS and long-term oncological outcomes in patients with colorectal cancer. A comprehensive literature search of electronic databases, including PubMed, Embase, and Web of Science, was conducted up to July 1st, 2024. The primary outcomes assessed were survival outcomes. Subgroup analysis and sensitivity analysis were performed during the pooled analysis. Eight studies including 2571 patients were included. The pooled results indicated that patients in the high NPS group exhibited significantly worse overall survival (HR= 2.08 95%CI: 1.74-2.48; P<0.01; I2 = 0%) and disease-free survival (HR=2.03; 95%CI: 1.49-2.77; P<0.01; I2 = 30%). Notably, the prognostic significance of NPS on both overall survival and disease-free survival was consistent across different geographical regions, tumor stages, and primary treatments examined in this study. Furthermore, sensitivity analyses confirmed the robustness of these combined results. The pretreatment NPS could serve as a valuable biomarker for predicting long-term oncological outcomes in patients diagnosed with colorectal cancer.

Maxillectomy Guided by 3D Printing Versus Conventional Surgery for Patients with Head and Neck Cancer.

This study evaluates the impact of three-dimensional (3D) printing-guided maxillectomy compared with conventional maxillectomy on surgical precision and oncological outcomes in patients with head and neck cancer. A retrospective analysis was conducted on 42 patients undergoing maxillectomy (16 in a 3D printing-guided group and 26 in a conventional group). Patient demographics, tumor characteristics, and outcomes were compared. Survival outcomes were analyzed using the Kaplan-Meier method. The 3D printing group showed higher rates of negative resection margins (81.3% vs. 76.9%) compared with the conventional group and a trend toward improved 5-year local recurrence-free survival (87.5% vs. 58.7%, respectively) and overall survival (84.4% vs. 70.1%, respectively). However, the differences were not statistically significant. Maxillectomy guided by 3D printing may offer enhanced surgical precision and improved local control in patients undergoing head and neck cancer surgeries. Further research with larger cohorts is necessary to confirm these findings.

Defining the Optimal Radiation-induced Lymphopenia Metric to Discern Its Survival Impact in Esophageal Cancer.

A detrimental association between radiation-induced lymphopenia (RIL) and oncologic outcomes in patients with esophageal cancer has been established. However, an optimal metric for RIL remains undefined but is important for the application of this knowledge in clinical decision-making and trial designs. The aim of this study was to find the optimal RIL metric discerning survival. Patients with esophageal cancer treated with concurrent chemoradiation therapy (CRT; 2004-2022) were selected. Studied metrics included absolute lymphocyte counts (ALCs) and neutrophil counts-and calculated derivatives-at baseline and during CRT. Multivariable Cox regression models for progression-free survival (PFS) and overall survival (OS) were developed for each RIL metric. The optimal RIL metric was defined as the one in the model with the highest c-statistic. Among 1339 included patients, 68% received photon-based and 32% proton-based CRT (median follow-up, 24.9 months). In multivariable analysis, the best-performing models included "ALC in week 3 of CRT" (corrected c-statistic 0.683 for PFS and 0.662 for OS). At an optimal threshold of <0.5 × 103/μL (ie, grade ≥3 RIL), ALC in week 3 was significantly associated with PFS (adjusted hazard ratio, 1.64; 95% CI, 1.27-2.13) and OS (adjusted hazard ratio, 1.56; 95% CI, 1.15-2.08), with 5-year PFS of 29% vs 40% and OS of 38% vs 51%, respectively. Reaching grade ≥3 RIL in week 3 of CRT for esophageal cancer is the strongest RIL metric to distinguish survival outcomes. We suggest that this metric should be the target for lymphopenia-mitigating strategies and propose this metric to be included in future trials.

Fertility results and oncologic outcomes in patients with stage II and III serous borderline ovarian tumors

Fertility results and oncologic outcomes in patients with stage II and III serous borderline ovarian tumors

Clinical Profile and Outcomes of Oncology Patients Requiring Critical Care Admission–A Single Center Tertiary Care Experience

Clinical Profile and Outcomes of Oncology Patients Requiring Critical Care Admission–A Single Center Tertiary Care Experience

Clinical Outcomes of Stage IIA/IIB Seminoma Treated With Radiation Therapy and Chemotherapy: Should Regional Therapy be Considered the Preferred Treatment Approach?

The optimal management of patients with de novo clinical stage IIA/B (CSIIA/B) or relapsed CSIIA/B (Rel-CSIIA/B) seminoma remains debated because of a lack of randomized evidence. Here, we sought to evaluate outcomes after radiation therapy and chemotherapy in this setting. A prospectively maintained single-institutional database was retrospectively queried for patients diagnosed between 1995 and 2016 with de novo or Rel-CSIIA/B. Patients with Rel-CSIIA/B were managed similarly to de novo CSIIA/B. All patients were reviewed by the multidisciplinary team. Although the preferred management policy was radiation therapy, the treatment decision was individualized at the physician/patient level. There were 153 patients: 67 had de novo CSIIA/B (IIA-32, IIB-35) and 86 patients had Rel-CSIIA/B seminoma (IIA-51, IIB-35). Of the total, 120 patients (78%) received radiation therapy (IIA-78, IIB-42) and 33 (22%) received platinum-based chemotherapy (IIA-5, IIB-28). Median follow-up was 7.1 years (interquartile range, 4.3-9.9 years). Eleven patients (IIA-9/78, IIB-2/42) relapsed after radiation therapy and 1 patient (IIB) relapsed after chemotherapy, corresponding to 5-year relapse rates of 10% (95% CI 6%-18%) for radiation therapy and 3% (95% CI, 0%-23%) for chemotherapy. All 12 patients who relapsed were treated with subsequent chemotherapy. Radiation therapy and chemotherapy result in excellent oncologic outcomes for patients with de novo or Rel-CSIIA/B seminoma. All patients should be informed about both management options. However, radiation therapy with its favorable acute toxicity profile could be considered the treatment of choice in most patients.

Solid-type adenocarcinoma on thin-section CT: quantitative parameters from dual-energy CT associated with spread through air spaces.

Spread through air spaces (STAS) is a well-established factor associated with poor oncological outcomes in patients undergoing surgery for solid lung adenocarcinoma. There could potentially be a disparity in iodine uptake between patients with positive and negative airway spread of solid lung adenocarcinoma. To explore the associations and find correlations of iodine uptake with STAS status in patients who underwent surgery for solid lung adenocarcinoma. Patients who underwent solid lung adenocarcinoma resection between January and June 2022 were included in this retrospective study. Iodine concentration and CT features were assessed using contrast-enhanced dual-energy computed tomography (DECT) scans, and these were compared with the status of STAS. Of 52 patients included, 25 (48%) were STAS-positive and 27 (52%) were STAS-negative. There were no statistically significant differences in CT features between the two groups (P > 0.05). STAS-positive was significantly associated with low arterial phase iodine concentration (ICA), normalized arterial phase iodine concentration (NICA), and venous phase iodine concentration (ICV), with a cutoff established at 1.15 mg/mL, 0.11, and 1.35 mg/mL, respectively (P < 0.05). The AUCs for ICA, NICA, and ICV in predicting STAS in solid lung adenocarcinoma were 0.82, 0.83, and 0.73, respectively. ICA and NICA were identified as independent risk factors for STAS in solid lung adenocarcinoma, with a combined AUC of 0.89. This study suggests that solid lung adenocarcinoma patients with low ICA, NICA, and ICVA were associated with STAS-positive, as well as a worse survival outcomes.

Impact of neurovascular bundle preservation on biochemical recurrence after robot-assisted radical prostatectomy for high-risk prostate cancer.

To evaluate functional and oncological outcomes in patients who underwent unilateral or bilateral nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer. The cohort comprised 2683 patients with clinical stage T1-4, N0M0 high-risk prostate cancer who underwent RARP in Japanese tertiary care centers from August 2011 to April 2023. High risk was defined using the European Association of Urology risk stratification criteria. Patients were classified as high risk if they had clinical stage T2c-T4, a serum prostate-specific antigen concentration (PSA) of > 20ng/dL, or an International Society of Urological Pathology (ISUP) grade of 4-5. Patients were grouped into NS and non-NS surgery groups. Propensity score matching was performed (1:1 ratio) to reduce confounding bias. The primary outcome was biochemical recurrence (BCR)-free survival (BCR-FS). The impact of NS surgery on BCR-FS was examined in the propensity score-matched cohort using Cox proportional hazards regression. The propensity score-matched cohort comprised 1722 patients. In the matched cohort, median follow-up was 31.9months. The 5-year BCR-FS was 70.2% in the NS group and 71.9% in the non-NS group (HR 1.05; 95% confidence interval, 0.85-1.29). NS surgery did not increase the risk of BCR in subgroups of patients stratified according to ISUP grade, T stage, percent cancer core involvement, and PSA. Neurovascular bundle preservation during RARP for high-risk prostate cancer appears feasible without increasing the BCR rate. However, the retrospective study design carries the potential influence of selection bias.