Search Results (7,356)

Postoperative venous thromboembolism (VTE) after minimally invasive surgery (MIS) for gynecologic malignancy is uncommon. Our objective was to characterize the rates and identify risk factors of postoperative VTE. A retrospective cohort study of patients undergoing MIS for gynecologic malignancy at three Canadian institutions from 2014 to 2020 was performed. The primary outcome was incidence of VTE within 90 days post-operatively. Descriptive statistics were used for clinicopathologic factors, and univariate analysis compared differences between groups. Rate and 95% confidence interval for VTE per 1000 surgeries were calculated. A total of 1786 patients met inclusion criteria, 85.3% uterine, 11.5% cervical, and 2.3% had ovarian cancer. Modes of surgery included robotic (49.4%), laparoscopic (20.7%), or combined laparoscopic/vaginal (29.9%). There were 15 VTE events at 90 days post-operatively (0.84%). Rates of VTE were lowest in patients who underwent robotic surgery, followed by combined laparoscopic/vaginal, and highest in a laparoscopic approach (p = 0.047). Pelvic lymphadenectomy (p = 0.038) and adjuvant chemotherapy (p = 0.022) were the only significant factors associated with risk of VTE. The incidence of VTE after MIS for gynecologic malignancy is low. Robotic surgery was associated with a lower incidence, although event rates are low, and further research is warranted. Full article

Lung squamous cell carcinoma (LUSC) is the second most prevalent type of lung cancer worldwide. Despite its global health burden, the molecular mechanisms driving LUSC remain poorly characterized, posing considerable challenges for the development of targeted preventive therapies. Here, by integrating human plasma proteomes (n = 54,219) with GWAS summary data for LUSC (7426 cases and 55,627 controls), we performed genome-wide Mendelian randomization (MR) and colocalization analyses to identify potential druggable targets associated with LUSC risk. After applying Bonferroni correction, sensitivity analyses, and reverse causation detection, we identified 12 potential druggable proteins significantly associated with LUSC risk. Five of these proteins (DOK2, FKBPL, NCF2, PDIA3, and TCL1A) showed strong evidence of colocalization. Furthermore, protein–protein interaction (PPI) networks and druggability assessments were used to refine therapeutic target selection. Additionally, mediation analyses were performed to elucidate the mediating effects of modifiable risk factors on the relationship between plasma proteins and LUSC risk, and we identified 14 modifiable risk factors that could mitigate LUSC risk through targeted interventions. More importantly, we stratified the 12 proteins into four tiers based on colocalization, differential expression, PPI networks, and druggability potential. Notably, DOK2 emerged as a Tier 1 target, while FKBPL, NCF2, AXL, and PDIA3 were classified as Tier 2 targets, representing promising candidates for further drug development. Overall, we identified 12 proteins with druggable potential associated with LUSC risk and demonstrated how modifiable risk factors mediate these associations. These findings advance our understanding of LUSC etiology and provide a foundation for developing targeted therapeutic strategies while emphasizing the importance of addressing modifiable risk factors in both prevention and treatment efforts. Full article

Background: Currently there are no clinically validated biomarkers recommended for prostate cancer (PCa) risk stratification other than prostate-specific antigen (PSA). Objective: This study aimed to identify urine metabolites that are associated with the presence of high-grade PCa at the time of radical prostatectomy. Methods: Urine samples were collected from patients who underwent radical prostatectomy. High-resolution metabolomics were implemented using liquid chromatography mass spectrometry (LC-MS). To enhance metabolic feature identification, sample extracts were analyzed in two modes, C18 chromatography [reverse-phase (RP)] and hydrophilic interaction chromatography (HILIC). Results: This analysis included a total of 22 patients with PCa (10 high-grade and 12 low-grade) and identified 52 differential metabolites, 40 in RP and 12 in HILIC, at the p-value 0.05 level. Among these, methyl alpha-aspartyl phenylalaninate was most significantly differentiated, while 3-methylbutanoicacid had the largest difference (slope −3.488). In the pathway analysis, the histidine metabolism pathway was significantly enriched (p < 0.05) with an enrichment factor of 3.5. Although not statistically significant, alterations were also observed in the vitamin B12, B7 (biotin), B6, and B3 (niacin) pathways. Conclusions: These findings suggest that urinary metabolites may have the potential to differentiate high-grade from low-grade PCa. Our study also highlights the metabolic reprogramming that occurs as PCa becomes more aggressive and potential differences in dietary patterns. Full article

Background/Objectives: This study aimed to investigate the preoperative clinicopathologic and imaging features associated with subsequent breast cancer events detected on postoperative abbreviated MRI in early-stage breast cancer patients following breast and axillary surgery. Methods: A retrospective analysis was conducted on 1171 patients (median age, 53 years; range, 24–90 years) diagnosed with clinical stage I or II breast cancer between January 2013 and December 2017. Logistic regression analysis was used to evaluate preoperative imaging features—including breast density assessed on mammography and MRI descriptors—along with clinicopathologic characteristics, to identify factors independently associated with subsequent breast cancer events during abbreviated MRI screening. Results: Among the patients, 57 (4.9%) experienced subsequent breast cancer events at a median follow-up of 74 months. In the multivariable analysis, high nuclear grade (odds ratio [OR] = 2.821; 95% confidence interval [CI], 1.427–5.577; p = 0.003), dense breast tissue on mammography (OR = 4.680; 95% CI, 1.113–19.684; p = 0.035), and absence of heterogeneous internal enhancement on preoperative MRI (OR = 0.429; 95% CI, 0.206–0.891; p = 0.023) were independently associated with subsequent breast cancer events detected using an abbreviated breast MRI protocol. Age ≥ 40 years (OR = 0.448; 95% CI, 0.193–1.039; p = 0.061) and clinical T2 stage (OR = 1.744; 95% CI, 0.969–3.139; p = 0.064) showed borderline significance. Conclusions: High nuclear grade, dense breast tissue on mammography, and absence of heterogeneous internal enhancement on preoperative MRI were associated with an increased risk of subsequent breast cancer events in patients undergoing abbreviated MRI surveillance following surgery for early-stage breast cancer. Full article

Background: Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a rare and highly aggressive malignancy with limited prognostic biomarkers available for clinical use. Inflammatory markers derived from complete blood count (CBC) have been shown to reflect the systemic immune response and tumor progression in various cancers, but their prognostic value in SCNEC remains unclear. Methods: We retrospectively analyzed clinical data from patients diagnosed with SCNEC between 2004 and 2024 across two centers. Internal validation was performed by dividing patients into training and test cohorts. Cox regression analyses and Kaplan–Meier survival analyses were used to evaluate prognostic factors and treatment outcomes. Inverse probability of treatment weighting (IPTW) was applied to reduce baseline imbalances. Patients were randomly divided into training and test cohorts. A nomogram was constructed to predict 3-year and 5-year progression-free survival (PFS) with performance evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results: 196 participants were included in the study. Age, FIGO 2018 stage, surgery, neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) were independently associated with PFS. High MLR (>0.19) was significantly linked to shorter PFS. After IPTW adjustment, the protective effect of low MLR on PFS remained significant (p = 0.029). The constructed nomogram demonstrated excellent predictive performance, with area under the curve (AUC) values of 0.799 and 0.787 for 3-year and 5-year PFS in the training cohort, and 0.802 for endpoints in the test cohort. Conclusions: MLR was identified as an independent prognostic biomarker for PFS in SCNEC, with potential value in risk stratification and personalized treatment strategies. Additionally, we developed a reliable nomogram that accurately predicts 3-year and 5-year PFS, serving as a practical tool for individualized prognosis and clinical decision-making. Full article

Background: Regular physical activity benefits people of all ages by enhancing both mental and physical health, whereas inactivity raises the risk of noncommunicable diseases (NCDs) like cardiovascular diseases, cancer, and diabetes, which can result in premature death. The objective of this cross-sectional study was to determine the prevalence and associated factors of physical inactivity among adults in Malaysia. Methods: Data on physical inactivity were extracted from the 2023 National Health and Morbidity Survey (NHMS), conducted from July to September 2023 among adults aged 18 and above across all states of Malaysia. Physical activity was assessed using the Global Physical Activity Questionnaire, with individuals classified as inactive if they did not achieve at least 600 metabolic equivalents of task (MET) minutes per week. Logistic regression was used to identify factors associated with physical inactivity. Results: A total of 10,858 out of 13,616 respondents participated in the study, resulting in a response rate of 79.7%. The overall rate of physical inactivity was 29.9%. The multivariable logistic regression analysis showed that physical inactivity was significantly higher among urban residents (aOR 1.42; 95% CI: 1.16, 1.75), individuals who were single/divorced/widowed (aOR 1.16; 95% CI: 1.01, 1.33), those not working (aOR 1.61; 95% CI: 1.24, 2.09), and those with sedentary time exceeding four hours per day (aOR 1.46; 95% CI: 1.20, 1.76). Inactivity was also more likely among individuals with diabetes (aOR 1.17; 95% CI: 1.00, 1.37) or disabilities (aOR 1.67; 95% CI: 1.39, 2.02). Conclusions: About one-third of Malaysian adults are physically inactive, with higher rates among urban residents, single/divorced/widowed, those not working, those with extended sedentary time, diabetes, or disabilities. Targeted interventions are needed to encourage behaviour change, foster active urban design, and strengthen policies that support active lifestyles. Full article

Background: Viral respiratory infections pose a significant risk for pediatric cancer patients and may lead to a delay in chemotherapy, prolonged hospitalization, and mortality. Limited data exist regarding the contributors to adverse clinical outcomes. The present study aims to describe the associations between clinical, epidemiological, and laboratory factors and severe outcomes of respiratory viral infections among children with cancer. Methods: This was a retrospective cohort study among pediatric cancer patients treated in the Pediatric Hematology–Oncology Department at Rambam Health Care Campus from 2016 to 2022. Patients with a positive rt-qPCR test for one of the following viruses were included: Adenovirus, Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), SARS-CoV-2, Parainfluenza, or Influenza. Demographic, clinical, and laboratory data were collected for each case. GEE analyses were conducted to assess the associations between independent variables and severe outcomes (admission to the Pediatric Intensive Care Unit (PICU), hospitalizations exceeding seven days, co-bacterial infections, and mortality within 30 days). Results: A total of 366 viral infections episodes were identified among 238 patients. There were 187 (51%) children with hematological malignancies, 113 (31%) with solid tumors, and 66 patients (18%) who had undergone bone marrow transplantation. Influenza was the most frequently detected virus, accounting for 89 events (24%), followed closely by Adenovirus, with 82 events (23%). Among the 38 severe events, prolonged hospitalization was the most prevalent outcome, occurring in 33 cases. Adenovirus infection was significantly associated with severe outcomes (OR = 2.97, p = 0.010), and antibiotic therapy was associated with 3.62 times higher odds of severe outcomes (p = 0.010). Patients presenting with O2 saturation levels below 92% had 5.71 times higher odds of experiencing severe outcomes. Among the subgroup of hematological malignancies, RSV was positively associated with severe outcomes (OR = 4.08, p = 0.048). Conclusions: Adenovirus was associated with severe outcomes in pediatric cancer patients, highlighting its prevalence and potential for treatment. Similarly, RSV was associated with adverse outcomes specifically among hematological cancer patients, emphasizing the importance of vaccination. A very low mortality from viral infection was also notable. Full article

Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, offering significant efficacy and a generally favorable safety profile. However, they are associated with a spectrum of immune-related adverse events (irAEs), among which pneumonitis stands out due to its relatively high mortality. This condition is characterized by nonspecific clinical manifestations and a broad differential diagnosis, often requiring the involvement of pulmonologists for accurate diagnosis and management. Given its potential severity, it is crucial for pulmonologists to be well-versed in recognizing and addressing checkpoint inhibitor pneumonitis (CIP). In this narrative review, we examine reported cases of pneumonitis in patients with various types of cancer treated with ICIs. The article explores the mechanisms of action of ICIs, the underlying pathophysiology of pneumonitis, associated risk factors, clinical presentation, diagnostic approaches, and current treatment strategies, intended to support pulmonologists in improving early detection and implementing evidence-based management of this potentially life-threatening complication. Full article

Background: Social determinants of health critically impact outcomes along the care continuum of patients with hepatocellular carcinoma (HCC). This systematic review summarizes the effect of socioeconomic status (SES) factors on HCC outcomes in the United States. Methods: Electronic databases were queried for the concepts of “liver cancer”, “health disparities”, and “socioeconomic factors” on 1 March 2021. Eligible studies included an individual- or area-level SES measure such as income, education, employment, and insurance and one of the following outcomes across the clinical continuum of HCC care: incidence, screening/surveillance, diagnosis, treatment, survival, and end-of-life. Results: Of 3331 studies screened, a total of 63 studies encompassing 179 separate analyses were included in our narrative synthesis: 13 on incidence, 5 on surveillance, 19 on diagnosis, 79 on treatment, 61 on survival, and 2 on end-of-life. Insurance was the most frequent SES measure represented (50%), followed by mostly area-level income (39%), education (9%), and employment (2%). The included studies were heterogeneous regarding both SES definitions (e.g., individual vs. area-level measures) and outcome reporting. Trends of worse outcomes were generally observed with lower indicators across all SES domains and HCC outcomes, particularly in analyses using national cancer registry data (e.g., SEER and NCDB). Unadjusted racial and ethnic disparities in outcome were attenuated in six out of 23 analyses that adjusted for an SES measure. Conclusions: Our findings highlight the need for social risk screening and interventions early in the HCC care pathway. Future research should focus on HCC surveillance and end-of-life/survivorship, with greater emphasis on examination of modifiable individual-level social determinants. Full article

Background/Objectives: While smoking, areca nut chewing, and alcohol are established risk factors, Hepatitis C virus (HCV) infection has emerged as a potential risk for oral neoplasia. This study explores any association of HCV infection with oral potentially malignant disorder (OPMD) and oral cancer, following adjustment for HCV-related liver disease in a large screening cohort. Methods: Data from 37,720 participants in the Changhua Community-Based Integrated Screening Program (2005–2014) with smoking or areca nut use history were analyzed. OPMD and cirrhosis were identified at screening, while oral and liver cancers were diagnosed during follow-up. Information on demographics, lifestyle, and clinical factors, including chronic and active HCV infection, was collected. Multinomial logistic regression was used to assess associations between HCV status and disease outcomes. Results: The prevalence of hepatitis C viremia was higher in the OPMD group (4.4%) and oral cancer group (3.3%) compared to the screen-negative group (2.7%), and highest in the cirrhosis/liver cancer group (23.3%). The odds ratios of OPMD and oral cancer were 1.59 (95% CI: 1.20–2.01) and 1.22 (95% CI: 0.67–2.23), respectively, in subjects with hepatitis C viremia compared to those without. After adjusting for confounding factors, individuals with hepatitis C viremia were at increased risk of OPMD by 50% (aOR = 1.50; 95% CI: 1.17–1.92) but not a statistically significant elevated risk for oral cancer (aOR = 1.09; 95% CI: 0.59–2.01), which was possibly attenuated due to HCV-related liver disease (aOR = 11.59; 95% CI: 8.33–16.13). Conclusions: HCV infection may act as an early risk factor for OPMD, though its progression to oral cancer may occur alongside the risk of HCV-related liver diseases. Including HCV status in screening may aid early detection and secondary prevention of oral cancer in high-risk groups. Full article

Background/Objectives: Gastric cancer (GC) remains a major global health burden, but its long-term association with pneumonia risk has not been comprehensively investigated. This study aimed to evaluate the long-term risk of pneumonia among GC survivors using a nationwide Korean cohort, focusing on chronic post-cancer susceptibility rather than perioperative or treatment-related complications. Methods: We conducted a nationwide, population-based cohort study using the Korean National Health Insurance Service database, including 9212 GC patients and 36,848 age-, sex-, income-, and region-matched controls (1:4 ratio). Participants were followed for up to 17 years. Propensity score overlap weighting was applied to minimize confounding, achieving exact covariate balance and optimal precision, with standardized differences used to confirm balance. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for pneumonia were estimated via Cox proportional hazards models. Results: During follow-up from 2002–2003 through 2019 (maximum 17 years), GC showed a significant relationship with increased risk of pneumonia (aHR 1.06; 95% CI: 1.01–1.11; p = 0.014). Subgroup analyses revealed higher risks among men, socioeconomically disadvantaged individuals, urban residents, and unexpectedly, patients without comorbidities. Conclusions: This large nationwide cohort study demonstrated that GC may be linked to a slightly elevated long-term risk of pneumonia, varying across demographic and clinical subgroups. These findings underscore the need for continued respiratory health monitoring in GC survivors while acknowledging that the observed association may be influenced by underlying comorbidities and survivorship factors. Full article

Chemotherapy for breast cancer includes pertuzumab and trastuzumab regimens with docetaxel (PHD) or paclitaxel (PHP). Current approaches for using supportive care drugs to manage the side effects of PHD and PHP are unclear. Here, we investigated the occurrence of side effects before and after supportive care medications were modified by discontinuing antipyretic analgesics. We retrospectively analyzed adverse events that occurred within 24 h of treating 76 patients with PHD or PHP. The frequencies of adverse effects in the groups before and after modification did not differ significantly (45.5% [15/33] and 44.2% [19/43], respectively). Severity also did not significantly differ between the groups. Therefore, discontinuing antipyretic analgesics as supportive care drugs had little effect on the frequency of side effects. Symptoms of feeling hot, pyrexic, and flushed were frequent, and their severity increased in the group after the support drugs were modified. Discontinuation of supportive care medications, including antipyretic analgesics, might affect the severity of certain symptoms and lead to the development of side effects that require medical intervention. Overall, our findings indicate the need to consider premedication with antipyretic analgesics, including further analysis of the risk factors that can predict symptoms. Full article

Host genetic factors influencing immune regulation are believed to modulate susceptibility to hepatitis C virus (HCV) and related hepatocellular carcinoma (HCC). This study aimed to investigate the association of Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) genetic variants with HCV-related HCC risk, soluble CTLA-4 (sCTLA-4) levels, and disease severity. 225 age- and sex-matched participants (75 controls, 75 HCV, and 75 HCV-HCC) were enrolled. TaqMan allelic discrimination assays were used for genotyping three CTLA-4 SNPs, and sCTLA-4 was quantified by ELISA. Our results demonstrated that the rs231726 TT genotype and T-allele were significantly associated with HCC. The rs11571317 CC genotype and C-allele, alongside the rs13384548 GG genotype and G-allele, conferred increased risk for both HCV and HCC. Clinically, these high-risk genotypes correlated with worse liver function (Child–Pugh C), higher MELD/Na scores, and larger tumors. Moreover, sCTLA-4 levels showed a stepwise elevation from controls to HCV to HCC patients, peaking in carriers of the rs231726 TT and rs13384548 GG genotypes. In conclusion, this study identifies rs231726, rs11571317, and rs13384548 as robust genetic markers for HCV-related HCC susceptibility and cancer aggressiveness. Our findings provide novel evidence of their role in immune evasion through sCTLA-4 upregulation, offering new perspectives into genotype-based risk stratification and tailored immunotherapeutic strategies. Full article

Background: Non-melanoma skin cancer (NMSC) is the most frequent cancer in fair-skinned populations and represents a growing public health concern due to its impact in terms of morbidity and treatment costs. While some meta-analyses have investigated cigarette smoking as a risk factor for NMSC, less is known about its prognostic implications in patients with NMSC. This systematic review and meta-analysis aims to fill this gap by assessing the association between smoking habits and survival in patients with NMSC. Methods: A systematic search was conducted in PubMed and EMBASE up to 25 February 2025, to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. Study-specific hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random effects meta-analysis models. Results: A total of five studies published between 2015 and 2022 were included. The meta-analysis revealed that being a current or ever smoker at diagnosis was associated with a worse overall survival (summary HR 2.42, 95% CI 1.91–3.06). A similar result was observed when smoking exposure was assessed in terms of pack-years or number of cigarettes per day (summary HR 2.44, 95% CI 2.02–2.93). Conclusions: Our findings indicate that cigarette smoking is a negative prognostic factor in these patients, despite the generally excellent prognosis of NMSC. It is reasonable to assume that this unfavourable effect is largely due to the increased risk of developing other life-threatening conditions, in which smoking plays a causal role. These results underscore the clinical relevance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC. Full article

High-risk human papillomavirus (HPV) is the leading etiological factor in cervical cancer, creating a pressing need for less invasive and more objective diagnostic tools. This pilot study pioneers the application of Raman spectroscopy to cell-free cervicovaginal lavage (CVL) for distinguishing between low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL) in HPV-positive patients. Raman spectra were acquired at 532-nm excitation from cell-free CVL samples of 20 patients with histologically confirmed LSIL (n = 9) or HSIL (n = 11). Comparative analysis of Raman bands revealed a significant biochemical shift in HSIL, presumably characterized by reduced glycogen and lactate/lactic acid levels alongside substantially elevated heme proteins. A diagnostic model based on key spectral intensity ratios achieved differentiation between LSIL and HSIL with 80% sensitivity and 86% specificity. These findings demonstrate that Raman spectroscopy of cell-free CVL effectively captures profound metabolic and microvascular alterations characteristic of neoplastic progression, showcasing its strong potential as a rapid, cost-effective, non-invasive, and objective tool for cervical lesion risk stratification. Full article