This study aims to evaluate the clinical efficacy of combining spleen‑nourishing and qi‑tonifying therapy with programmed cell death protein 1 (PD‑1)/programmed death‑ligand 1 (PD‑L1) inhibitors in patients with stage IIIB-IV non‑small cell lung cancer (NSCLC), and to develop a survival prediction model based on progression‑free survival (PFS) and overall survival (OS). A retrospective cohort of 246 patients with stage IIIB-IV NSCLC receiving immunotherapy at the Tumor Medicine Center of the First Hospital of Hunan University of Chinese Medicine from September 2019 to October 2024 is assembled. Patients are categorized into a traditional Chinese medicine (TCM) group (n = 174) or a control group (n = 72) according to use of TCM decoctions. Baseline clinical and pathological characteristics and treatment data are collected. Cox proportional hazards regression is used to analyze survival‑related factors. Kaplan-Meier curves and log‑rank tests are used to compare survival. Logistic regression is used to identify factors associated with the objective response rate (ORR). Survival prediction models based on PFS and OS are constructed and validated. Median PFS is 5.9 months in the TCM group versus 2.9 months in the control group (P < 0.001), and median OS is 22.3 versus 14.8 months (P < 0.001). On multivariable analysis, TCM intervention, PD‑L1 expression, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and cytokeratin fragment 21‑1 (CYFRA21‑1) are independent predictors of PFS; TCM intervention, brain metastasis, and carcinoembryonic antigen (CEA) independently influence OS. The 6‑month PFS rate, 1‑year PFS rate, and 1‑year OS rate are significantly higher in the TCM combination group than in controls (P < 0.05). TCM intervention and sex are independent predictors of ORR (P < 0.05). Model validation shows areas under the curve (AUCs) of 0.705 (PFS) and 0.636 (OS) in the prediction-model group, and 0.879 (PFS) and 0.765 (OS) for internal validation. The addition of TCM to PD‑1/PD‑L1 inhibitors prolongs PFS and OS in patients with stage IIIB-IV NSCLC. A survival prediction model based on routine clinical characteristics demonstrates predictive utility, offering a potential tool to inform clinical decision‑making.

PD-1/PD-L1 inhibitors combined with chemotherapy (PIC) has significantly reshaped treatment approaches in advanced non-small-cell lung cancer (NSCLC). However, whether PIC provides superior long-term efficacy compared to standard chemotherapy in advanced non-squamous NSCLC (nsqNSCLC) still requires comprehensive analysis using recent data from phase 3 randomized controlled trials (RCTs). Relevant studies comparing PIC with chemotherapy in stage IIIB-IV nsqNSCLC were identified through six databases. The key measures of interest were overall survival (OS) and progression-free survival (PFS), while additional endpoints encompassed tumor response and safety. Twelve multicenter phase 3 RCTs including 5,054 participants were analyzed. In comparison to chemotherapy alone, the PIC therapy resulted in significant improvements in both OS (HR: 0.73 [0.68-0.79], P < 0.00001) and PFS (HR: 0.59 [0.55-0.63], P < 0.00001). Survival benefits in both endpoints were consistently greater in the combination arm over a 6-60 month observation period. Stratified analysis revealed that the presence of brain metastases (OS, HR: 0.47; PFS, HR: 0.44) and a PD-L1 expression above 50% (OS, HR: 0.64; PFS, HR: 0.62) were predictive of enhanced efficacy for the combination strategy. Regarding treatment response, patients receiving PIC experienced a prolonged duration of response (HR: 0.57 [0.50-0.65], P < 0.00001) and a markedly increased objective response rate (RR: 1.69 [1.55-1.84], P < 0.00001). Nevertheless, both overall (RR: 1.95 [1.32, 2.87], P = 0.0007) and grade 3-5 immune-mediated adverse events (irAEs) (RR: 2.28 [1.64, 3.18], P < 0.00001) occurred more frequently in the PIC group. PIC therapy provides significant survival benefits and enhances anti-tumor efficacy in stage IIIB-IV nsqNSCLC, although it carries a higher toxicity burden, including both acute hematologic AEs and potentially chronic irAEs that require continuous clinical monitoring. CRD420251066166.

A national study of lung cancer patients below 50 years: Variations in characteristics and outcomes by age.

Beyond the third lumbar vertebra (L3): Thoracic computed tomography-derived muscle mass and quality assessment as a practical alternative for body composition analysis.

Lymphovascular Invasion is Predictive for Adjuvant Platinum Therapy Benefit in Urothelial Bladder Cancer.

This study aimed to compare 5-year overall survival between primary debulking surgery and neoadjuvant chemotherapy followed by interval surgery in patients with stage IIIB to IVB epithelial ovarian cancer, using global real-world data. Secondary objectives included evaluation of progression-free survival and the influence of race, post-operative complications, and residual disease. SUROVA is a retrospective, international cohort study involving patients treated between 2018 and 2019 across 174 centers in 55 countries. Patients underwent primary surgery or received neoadjuvant chemotherapy followed by interval surgery, per institutional protocols. Propensity score matching was based on 7 baseline variables: age, race, Eastern Cooperative Oncology Group performance status at diagnosis, CA125 level at diagnosis, FIGO (International Federation of Gynecology and Obstetrics) stage IV disease, presence of ascites, and final tumor grade. Cox regression models with time-dependent effects and interaction terms were applied. A clinical risk calculator was developed and internally validated. A total of 3286 patients had a mean age of 60.0 years (SD 12); 2978 (90.6%) had high-grade serous carcinoma, and 795 (24.7%) presented with FIGO stage IV disease. A total of 1666 patients (50.7%) underwent primary cytoreductive surgery, and 1620 (49.3%) received neoadjuvant chemotherapy. The median follow-up duration was 43.8 months (interquartile range; 22.6-59.3). After propensity score matching (n=1524), overall survival was similar between groups (67.2 vs 65.0 months; HR 1.002, 95% CI 0.85 to 1.18, p=.98). Outcomes differed by ethnicity, residual disease, and post-operative complications. Post-operative complications (28%) significantly worsened survival (66 vs 46 months; HR 1.5, 95% CI 1.2 to 1.9, p<.001), especially among patients undergoing primary surgery (73 vs 46 months; HR 1.85, 95% CI 1.43 to 2.37, p<.001). The most favorable outcomes were observed among patients with primary surgery, complete resection, and no complications, with median overall survival not reached (HR 1.25, 95% CI 1.12 to 1.40, p<.001). Although overall survival was similar between groups, treatment effects differed by ethnicity, residual disease, and complications. Post-operative complications were associated with significantly worse survival, particularly among patients undergoing primary surgery, while the best outcomes were achieved in those who had primary surgery with complete resection and no complications.

Incidence and clinical features of venous thromboembolism in patients with lung cancer in Japan: results from the CS-Lung-003 prospective observational registry study.

The primary role of 18F-FDG PET/CT at the initial diagnosis of breast cancer is to detect distant metastases. This study aimed to investigate locoregional characteristics associated with distant metastasis, based on clinicopathological factors, standard-of-care (SOC) imaging, and 18F-FDG PET/CT-including a novel PET parameter, subcutaneous/cutaneous uptake (SCU). This retrospective study included patients with newly diagnosed, unilateral invasive breast cancer who underwent pretreatment 18F-FDG PET/CT. Associations between distant metastasis and the following parameters-including age, SOC imaging-based clinical T and N stage, histology, histological grade, and subtype, as well as tumor SUVmax, subareolar SUV ratio (sSUVr), and subcutaneous/cutaneous uptake (SCU) on PET-were assessed using the Mann-Whitney U test, Fisher's exact test, and logistic regression. Subgroup analyses were also performed after stratifying patients by locoregional clinical stage (I-IIIA vs. IIIB-C). Among 197 women (mean age, 56 ± 14 years), distant metastasis was identified in 23 (11.6%). The prevalence of distant metastasis at each locoregional stage in SCU-positive versus SCU-negative patients was as follows: 0% vs. 0% for stage I; 22% vs. 1% for stage IIA; 25% vs. 14% for stage IIB; 25% vs. 13% for stage IIIA; 25% vs. 33% for stage IIIB; and 50% vs. 50% for stage IIIC, with a statistically significant difference observed at stage IIA. In the total cohort, univariate analysis showed that clinical T stage (p = .005), clinical N stage (p < .001), sSUVr (p = .002), and SCU (p < .001) were significantly associated with distant metastasis. In multivariate analysis, only clinical N stages (Odd ratio [OR], 6.5-32.6; p < .001-0.02) remained independent predictors. In the stage I-IIIA subgroup, SCU (OR, 4.86; p = .048) independently predicted distant metastasis, along with age (OR, 1.07; p = .01) and clinical N stages (OR, 8.40-30.26; p = .002-0.008). In the stage IIIB-C subgroup, none of the explanatory variables had significant associations with distant metastasis. Age, clinical N stages, and SCU were associated with an elevated risk of distant metastasis in the stage I-IIIA disease. SCU may serve as a novel imaging marker of systemic disease and aid in the diagnosis of distant metastasis-particularly in patients with early-stage breast cancer, where such findings can critically influence treatment strategy.

Osimertinib is recommended, alongside afatinib, as first-line treatment for patients with advanced non-small cell lung cancer (NSCLC) with atypical mutations in the epidermal growth factor receptor gene (EGFR), a population for whom real-world data are limited. We present outcomes and subsequent treatment patterns for this population in routine US practice. Medical records from a manually curated oncology database were analyzed for adults with stage IIIB-IV NSCLC harboring atypical EGFR mutations, treated with first-line osimertinib (April 2018-March 2020). Data were analyzed overall and by EGFR mutation subgroups: compound EGFR mutations, comprising classical (exon [Ex] 19 deletion or L858R) and atypical (G719X, L861Q, S768I, E709X, Ex19 insertions, or Ex18-25 duplications) mutations or de novo T790M only (group A), and atypical EGFR mutations only (group B). Outcomes included real-world progression-free survival (rwPFS) and overall survival (OS). A total of 55 patients were included in the study (female 76%/male 24%; group A, n = 20; group B, n = 35). After a median follow-up of 11 months, median (95% confidence interval) rwPFS and OS, respectively, were 8.8 (5.5-17.2) and 28.5months (11.4-41.8) overall, 20.3 (10.0-44.5) and 42.5months (27.0-not estimable) in group A, and 6.6 (4.9-24.8) and 20.0months (9.2-32.9) in group B. At follow-up, 13% of patients (n = 7) remained on first-line osimertinib (group A, 30%; group B, 3%), 54% (n = 30) had discontinued due to death (group A, 40%; group B, 63%), and 33% (n = 18) had received subsequent treatment (group A, 30%; group B, 34%), most commonly osimertinib combinations (28%; n = 5). First-line osimertinib may provide real-world clinical benefits for patients with advanced NSCLC with atypical EGFR mutations, with results suggesting greater benefit in those harboring compound EGFR mutations.

Background: Limited real-world data (RWD) may provide important information regarding diagnostic and treatment patterns in patients (pts) with AL Amyloidosis. The aim was to analyze the characteristics, treatment approach and clinical outcome of patients in the real-world settings. Materials and Methods: RWD of 60 pts diagnosed with AL amyloidosis were analyzed. Advanced cardiac involvement, Mayo Clinical Stage (CS) IIIa and IIIb, and Revised-Mayo CS III and IV, has been found in 26.7%, and 16.7%, or 33.3% and 16.7%, respectively. Bortezomib (Bz)-based regimens were applied in 36 pts (60%), and alkylating-based regimens in 24 pts (40%). In 8 pts (13.3%) treated initially with CyBorD induction, high-dose therapy with Melphalan and autologous stem cell transplantation (HDT + ASCT) was applied as the first line of treatment. Results: The overall response rate (ORR, ≥partial response) was achieved in 40 pts (70%). Patients treated with Bz-based induction followed by HDT + ASCT achieved significantly better hematologic (p = 0.001), cardiac (p = 0.004) and renal response rates (p = 0.002) in comparison to CyBorD or Alk-based regimens alone. There was no difference in PFS between those groups (p = 0.733), but patients treated with CyBorD + HDT + ASCT had significantly durable OS (p = 0.039). Univariate analysis pointed out the predictive influence of cardiac involvement (Mayo CS and Revised Mayo CS), ASCT eligibility, and hematologic, cardiac, renal and composite response rates. Conclusions: Advanced cardiac involvement and cardiac and hematologic response still retain adverse prognostic impact on the clinical outcome. Bz-based combinations significantly improved the survival of patients with AL amyloidosis, regardless of HDT + ASCT treatment.

BackgroundThis study investigates the relationship between the systemic immune-inflammation index (SII) and all-cause mortality (ACM) risk in individuals with stages IIIB–IV epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma.MethodsThe clinical data of 187 individuals with stages IIIB–IV EGFR-mutated lung adenocarcinoma from Anhui Chest Hospital, collected from June 2017 to December 2023, were retrospectively analyzed. SII was calculated as platelet count × neutrophil count/lymphocyte count. The receiver operating characteristic (ROC) curve was employed to determine the optimal threshold SII, and individuals were classified as low and high SII groups. ACM serves as the primary endpoint. Univariate and multivariate analyses were conducted using Cox proportional hazards models. The robustness of the findings was tested by subgroup and sensitivity analyses.ResultsThe ACM risk was notably elevated in the high SII group (p = 0.001) compared with the low SII group. Multivariate Cox analysis demonstrated that SII can independently predict poor prognosis. In the fully adjusted model, compared with the low SII group, the ACM risk was 1.985 times higher in the high SII group (hazard ratio [HR] = 1.985; 95% confidence interval [CI] = 1.216–3.240; p = 0.006). Subgroup analyses showed that SII was more strongly associated with ACM risk in men (HR = 3.245; p = 0.005), and this relationship was also significant among female patients (HR = 2.036; p = 0.048). In individuals aged ≥ 65 years, a high SII was significantly associated with an elevated ACM risk (HR = 2.675; p = 0.004). No such relationship was observed in individuals aged under 65. Sensitivity analyses indicated that high SII remained significantly correlated with elevated ACM risk after excluding individuals with special types of adenocarcinoma, stage III lung adenocarcinoma, or diabetes (all p< 0.05), supporting its potential as an independent prognostic indicator. ROC curve analysis demonstrated that SII had a moderate predictive ability for ACM, with an AUC of 0.669 (95% CI = 0.527–0.812; p = 0.021).ConclusionElevated SII is an independent biomarker for predicting ACM in individuals with stages IIIB–IV EGFR-mutated lung adenocarcinoma, with a stronger predictive value in male and older populations.

Introduction: Bradycardia, Renal failure, Atrioventricular (AV) nodal blockade, Shock, and Hyperkalemia (BRASH) syndrome is a rare reversible clinical condition that can be life-threatening through a vicious cycle of bradycardia, exacerbated by AV nodal blocking agent use, hyperkalemia and renal failure. We report a case that was refractory to vasopressor treatment, medical therapy and transvenous pacemaker for which a permanent pacemaker was needed. Case Presentation: We report a 64-year-old female patient with a medical history of Chronic Kidney Disease Stage IIIb, Diabetes Mellitus Type II, Hypertension and coronary artery disease with multiple coronary artery bypass grafts (CABG), who presented to the emergency department complaining of dizziness and lightheadedness for the past 12 hours. Upon presentation, patient was hypotensive, bradycardic, hyperkalemic and with acute kidney injury, raising suspicion of BRASH syndrome. Treatment resolved the patient’s condition except the bradycardia which eventually needed a permanent pacemaker insertion. Bradycardia in BRASH syndrome, an already rare condition, necessitating permanent pacemaker insertion, and not resolving by stopping amiodarone and metoprolol, is not commonly reported. Discussion: AVNB agent, amiodarone and metoprolol, caused bradycardia which decreased cardiac output and renal blood flow. The subsequent acute kidney injury led to decreased clearance of metoprolol, amiodarone and worsening hyperkalemia. This has resulted in a further decrease in cardiac output which has put the patient in a continuous vicious cycle until she reached cardiogenic shock. Hence, rapid diagnosis and correct management with medical therapy, vasopressors and temporary pacemaker is necessary to reverse and stop the cycle. Nevertheless, a non resolving bradycardia may need a permanent pacemaker insertion as in our case.

Long-term follow-up of a prospective phase 2 Study of daratumumab plus bortezomib and dexamethasone in newly diagnosed mayo 2004 stage IIIA and IIIb light-chain amyloidosis

A new validated staging system for AL amyloidosis with stage IIIc defining an ultra-poor prognostic in systemic AL amyloidosis in the modern treatment era

Teclistamab induced rapid and deep hematologic response in relapsed/refractory light chain amyloidosis: A multicenter retrospective study

Prognostic analysis of newly diagnosed systemic light-chain amyloidosis patients treated with daratumumab

Survival trends in systemic amyloidosis over two decades: A real-world cohort analysis

Polatuzumab vedotin, zanubrutinib, rituximab, lenalidomide, and prednisone (Pola-ZR2P) as frontline immunochemotherapy in previously untreated DLBCL patients

Cardiac complete response in AL amyloidosis: Phenotypic characteristics, functional recovery, and survival outcomes of 63 patients

The role of palliative care in the multidisciplinary treatment of immunoglobulin light chain amyloidosis