To assess how obstructive jaundice and socioeconomic determinants (residence, literacy, gender) affect treatment initiation and curative surgical eligibility among patients with gallbladder cancer in North India.

In this prospective observational cohort, adults with radiological or histological gallbladder cancer presenting between September 2023 and May 2024 were enrolled at a tertiary cancer centre. Baseline demographics, stage, obstructive jaundice status, biliary drainage (PTBD/ERCP), treatment initiation, and surgical eligibility were recorded. Associations were examined using chi-square and relative risk, followed by multivariable logistic regression including variables with p < 0.10.

Of 1,500 enrolled patients, 1,409 were evaluable; 643 (45.6%) had obstructive jaundice. Treatment non-initiation occurred in 330/643 (51.3%) with obstructive jaundice versus 24/766 (3.1%) without obstructive jaundice (p < 0.001). Curative surgery was feasible in 51/643 (7.9%) with obstructive jaundice compared with 223/766 (29.1%) without obstructive jaundice (RR 0.27; 95% CI 0.20-0.36). Illiteracy (57.6%) and rural residence (69.4%) predominated. On multivariable analysis, independent predictors of treatment non-initiation were obstructive jaundice (aOR 11.2; 95% CI 7.6-16.5), metastatic disease at presentation (aOR 3.9; 95% CI 2.1-7.4), rural residence (aOR 2.7; 95% CI 1.9-3.9), and illiteracy (aOR 1.8; 95% CI 1.3-2.6).

Obstructive jaundice and socioeconomic disadvantage synergistically drive early care discontinuity and reduce curative opportunities in gallbladder cancer, supporting decentralized decompression, patient navigation, and socioeconomic support in high-incidence regions.

To examine the association between the preoperative G8 score and urinary continence recovery after robot-assisted radical prostatectomy (RARP).

This study included 1794 patients enrolled in SUPER-PC-RP prospective cohort who underwent RARP and completed G8 questionnaire preoperatively. Patients were classified into high (G8 score ≤ 14) and low (G8 score > 14) frailty groups. Continence recovery, defined as the use of less than one pad per day, was assessed three months and one year postoperatively. Factors affecting continence recovery were identified using multivariable logistic analysis. Kaplan-Meier analysis evaluated continence recovery over two years according to frailty and nerve-sparing status.

Overall, 649 and 1145 patients were assigned to high- and low-frailty groups, respectively. At three months, continence group was significantly younger and had a lower prevalence of diabetes, lower International Society of Urological Pathology grade, lower pathological T stage, higher nerve-sparing rate, and lower frailty than incontinence group. At one year, patients who recovered continence were younger and had a higher nerve-sparing rate and lower frailty. Multivariable analysis showed age (3-month odds ratio (OR) 0.973, 1-year OR 0.947), nerve-sparing (3-month OR 2.39, 1-year OR 1.77), and low frailty (3-month OR 1.56, 1-year OR 1.75) as significant factors affecting continence recovery (all P < 0.05). In cumulative Kaplan-Meier analysis, low-frailty group showed better continence recovery than high-frailty group, with a greater difference observed in non-nerve-sparing group (P < 0.001).

Frailty assessment using G8 questionnaire is associated with urinary continence recovery after RARP, which provides an advantage for preoperative patient counseling and surgical planning.

To test a moderated mediation model linking physical activity (PA) to health-related quality of life (HRQoL) via symptom burden, with hope as a moderator, in lung cancer patients.

A cross-sectional study of 203 adults with stage III-IV lung cancer (205 enrolled, 2 excluded due to incomplete data) from a Chinese hospital analyzed PA (IPAQ-LF), symptom burden (MDASI-C), hope (HHI), and HRQoL (SF-8). Covariates were identified via univariable screening (p < 0.05). Spearman correlations, hierarchical regression, and PROCESS (Model 7; 5000 bootstraps) tested the moderated mediation model, with simple-slope probing at hope ± 1 SD.

PA correlated with higher HRQoL (ρ = 0.53) and lower symptom burden (ρ = -0.48), while symptom burden negatively predicted HRQoL (ρ = -0.71) and hope positively predicted HRQoL (ρ = 0.59) and lower symptom burden (ρ = -0.56). Hierarchical models explained 57.7% of HRQoL variance, with PA (0.132), symptom burden (0.231), and hope (0.046) as key predictors. The PA-by-hope interaction was significant (B = 0.018, p = 0.008), with stronger PA effects on reduced symptom burden at low hope (B = -0.270, p < 0.001). The moderated mediation index was -0.017 (95% CI -0.032 to -0.003).

PA improves HRQoL via reduced symptom burden, with this effect stronger at lower hope levels. Enhancing hope in interventions may maximize HRQoL benefits.

The mesenchymal-epithelial transition (MET) receptor plays a key role in cell growth and survival. The MET exon 14 (METex14) skipping mutation occurs in 3% to 4% of patients with non-small cell lung cancer (NSCLC) and leads to prolonged MET signaling and oncogenesis. MET tyrosine kinase inhibitors (TKIs), such as tepotinib and capmatinib, are effective for METex14-altered NSCLC; however, their impact on patients with a poor performance status (PS) is unclear. We retrospectively analyzed clinical outcomes of MET-TKI treatment for NSCLC with the METex14 skipping mutation.

We reviewed 59 cases of NSCLC with the METex14 skipping mutation diagnosed at the National Cancer Center Hospital between June 2020 and April 2024. Clinical data included demographics, PS, histology, PD-L1 expression, treatment response, progression-free survival (PFS), and overall survival (OS).

Forty-nine patients (median age, 72 years; range=50-87 years; 53.1% male) received MET-TKIs (tepotinib or capmatinib). Thirty-seven patients and 12 patients had PS scores of 0 or 1 and ≥2, respectively. The median PFS and median OS of patients who received MET-TKI treatment were 5.6 months and 18.7 months, respectively. Thirty-seven patients who received first-line MET-TKI treatment had median PFS, median OS, and a median overall response rate (ORR) of 5.6 months, 21.3 months, and 48.6%, respectively. For patients with a PS score ≥2 (n=9), the median PFS, median OS, and median ORR were 0.95 months, 1.3 months, and 11.1%, respectively. A PS score ≥2 was strongly associated with shorter OS. Two of nine (22.2%) patients with a poor PS experienced improvement.

MET-TKIs are effective for NSCLC with the METex14 skipping mutation; however, their efficacy for patients with a poor PS is limited.

Postoperative severe complications (PSC) are key indicators of surgical quality because they increase healthcare costs, delay adjuvant chemotherapy, and impair long-term survival. Hepato-biliary-pancreatic surgeons perform both liver and pancreatic procedures, which differ substantially in technical complexity; therefore, identifying field-specific risk factors for complications is essential. This study aimed to determine perioperative predictors of PSC following major liver and pancreatic surgery.

This single-center retrospective study included 675 patients who underwent major liver or pancreatic surgery between January 2010 and December 2023 at Gifu University Hospital, Japan. Perioperative variables were analyzed in 328 patients, consisting of those with PSC (n=167; liver n=49, pancreas n=118; Clavien-Dindo ≥III) and those without PSC (n=161; liver n=53, pancreas n=108; Clavien-Dindo <III). Univariate and multivariate analyses were performed to identify independent predictors.

In major pancreatic surgery, PSC were significantly associated with male sex (p=0.01), higher body mass index (p=0.03), smoking history (p=0.02), prior malignancy (p=0.02), respiratory comorbidity (p=0.04), and elevated C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) on postoperative day (POD) 3 (p<0.001, p<0.01, and p<0.01). Multivariate analysis identified CAR on POD3 (>5.0) as the sole independent predictor [odds ratio (OR)=4.27; 95% confidence interval (CI)=2.05-9.13; p<0.001]. In major liver surgery, PSC were associated with abnormal CONUT score (p=0.04) and cardiac comorbidity (p=0.04) in univariate analysis, whereas multivariate analysis demonstrated abnormal CONUT score as the only independent predictor (OR=3.40; 95%CI=1.37-8.81; p<0.01).

Postoperative inflammatory markers, particularly CAR on POD3, may function as early indicators of complication severity after major pancreatectomy. Conversely, preoperative nutritional status assessed by CONUT independently predicted PSC following major hepatectomy. These results support inflammation-guided postoperative management in pancreatic surgery and highlight the importance of nutritional optimization before liver surgery.

Afatinib is an irreversible EGFR-TKI effective against uncommon EGFR mutations in non-small cell lung cancer (NSCLC), but the influence of mutation subtype and starting dose on treatment outcomes remains unclear. This study aimed to evaluate the clinical outcomes of patients with uncommon EGFR-mutated NSCLC treated with afatinib, focusing on whether a reduced starting dose (30 mg) provides comparable efficacy and tolerability to the standard 40 mg dose. Additionally, we sought to explore the potential impact of specific uncommon EGFR mutation subtypes on treatment response.

We retrospectively analyzed patients with stage IV NSCLC harboring uncommon EGFR mutations who received afatinib 30 mg or 40 mg daily at two university affiliated hospitals. Mutations were categorized as single uncommon, compound (rare + common), or double rare (rare + rare). Clinical characteristics, treatment response, and survival outcomes were compared between mutation subgroups and dosing cohorts. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier analysis and compared with the log-rank test.

A total of 46 patients were included (30 mg: n=28; 40 mg: n=18). The objective response rate was 71.7%, and disease control rate 93.5%. Patients with double-rare mutations had significantly longer survival than those with single uncommon mutations (median PFS 37.1 vs. 12.3 months, p=0.01; median OS 63.7 vs. 19.6 months, p=0.042). In the 30 mg group, this benefit was more pronounced (PFS p=0.0039; OS p=0.0287), whereas survival differences by mutation subtype were not significant in the 40 mg cohort. Treatment was well tolerated, with fewer grade ≥3 adverse events in the 30 mg group.

Afatinib 30 mg daily achieved comparable efficacy and better tolerability than 40 mg, with significantly longer PFS and OS in patients harboring compound or double-rare EGFR mutations. These findings suggest that lower-dose afatinib may optimize efficacy and safety in patients with uncommon EGFR-mutant NSCLC.

Inferior vena cava (IVC) leiomyosarcoma is a rare malignant tumor, with fewer than 500 cases described in literature. Prognosis is poor, and radical surgical resection remains the gold standard of treatment. However, the optimal surgical technique is a subject of ongoing debate.

From October 1993 to December 2024, 33 patients (23 females, 10 males; median age 52.2 years) underwent surgical resection of IVC leiomyosarcoma with vascular reconstruction using a polytetrafluoroethylene (PTFE) graft. A multidisciplinary team evaluated all patients. The surgical procedure involved en bloc resection of the tumor with a minimum 1 cm healthy margin. The reconstruction was cavo-caval, cavo-bi-iliac, cavo-caval with right renal vein resection and right nephrectomy and cavo-caval with left renal vein resection and reimplantation. Study's primary endpoints were overall survival, disease-free survival and graft patency. Secondary endpoints were intraoperative and postoperative complications.

No 30-day postoperative mortality was observed. Five- and 10-year survival rates were 57.7% and 15.2%, respectively. Five- and 10-year disease-free survival rates were 36.4% and 18.2%, respectively. Graft thrombosis was observed in 13 patients (39.4%). Median follow-up was 48 months (range=12-120 months; IQR=24.0-68.5). No cases of prosthetic infection or acute graft thrombosis were observed in this series. Postoperative complications included acute kidney injury (AKI) in four patients (12.1%), respiratory distress in two patients (6.1%) distress and postoperative bleeding in three patients (9.1%).

Type I and II IVC leiomyosarcomas resection with subsequent PTFE vascular reconstruction is safe, with a low rate of disease-free survival and a risk of graft thrombosis at medium follow-up.

T-cell priming within tumor-draining lymph nodes (TDLNs) is essential for optimal immune checkpoint inhibitor (ICI) activity. Because neck dissection (ND) removes cervical lymph nodes that may function as TDLNs in head and neck cancer (HNC), its impact on subsequent ICI efficacy remains clinically relevant. This study investigated whether prior ND influences treatment outcomes with nivolumab in recurrent or metastatic HNC.

Fifty-four patients with recurrent or metastatic HNC treated with nivolumab between 2017 and 2025 were retrospectively analyzed. Patients were stratified into locoregional disease (LRD; n=41) and distant metastasis (DM; n=13) cohorts. Within each cohort, outcomes were compared between patients with and without prior ND.

In the LRD cohort (n=41), the median progression-free survival was 2.3 vs. 4.0 months (p=0.089) and median overall survival was 9.8 vs. 18.8 months (p=0.044) for the ND and non-ND groups, respectively. In the DM cohort (n=13), outcomes were unaffected by ND. Multivariate analysis showed a non-significant trend toward worse outcomes in the ND group.

Prior ND was associated with inferior survival in LRD but not in DM-only disease, suggesting that an ND-related loss of TDLN function reduces ICI efficacy.

The Controlling Nutritional Status (CONUT) score, calculated using the serum albumin level, total cholesterol level (T-cho), and peripheral lymphocyte count, is a widely accepted prognostic marker for colorectal cancer (CRC). However, T-cho is often not measured in clinical practice, limiting its applicability. In the recently proposed modified CONUT (mCONUT) score, T-cho was replaced with hemoglobin concentration. This study evaluated the prognostic utility of the mCONUT score in patients with CRC undergoing curative resection.

This study included 290 patients who underwent curative surgery for CRC at our institution between January 2017 and December 2019. The CONUT and mCONUT scores were calculated, and their prognostic values were assessed using the Cox proportional hazards regression analysis.

Among 290 patients, 42 and 248 were assigned to the high and low CONUT groups, and 88 and 202 to the high and low mCONUT groups, respectively. Overall survival (OS) was significantly lower in the high CONUT and mCONUT groups (p<0.001). Multivariate analysis identified a high mCONUT score as an independent prognostic factor for poor OS (p=0.014).

Preoperative nutritional status affects CRC prognoses. Thus, the mCONUT score may be a useful prognostic marker.

Recent investigations have highlighted the prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index across various malignancies. However, its prognostic relevance in patients with intrahepatic cholangiocarcinoma (ICC) treated with surgical resection remains to be fully clarified. This study aimed to evaluate whether the prognostic significance of preoperative CALLY index for long-term outcomes in patients with intrahepatic cholangiocarcinoma undergoing surgical resection.

We retrospectively examined 131 patients who underwent curative-intent hepatectomy for ICC between January 2007 and June 2022. The optimal cutoff value of the CALLY index for predicting overall survival (OS) was identified using the minimum p-value method. Clinicopathological features and survival outcomes were then compared between patient groups with high and low CALLY index, and multivariate statistical analyses were subsequently performed to determine independent prognostic indicators.

The median preoperative CALLY index was 3.5 (interquartile range=1.1-10.1). A cutoff value of 3.0 best stratified OS, classifying 73 patients into the high CALLY group and 58 into the low CALLY group. Patients with CALLY ≤3.0 had significantly poorer disease-free survival (DFS) and OS compared with those with CALLY >3.0 (5-year DFS: 27.1% vs. 49.7%, p<0.001; 5-year OS: 31.2% vs. 62.2%, p=0.003). Multivariate analysis, using pre/intra-operative variables, confirmed a low CALLY index as an independent predictor of both DFS (hazard ratio=2.05, p=0.004) and OS (hazard ratio=1.79, p=0.046).

A preoperative CALLY index threshold of 3.0 provides significant prognostic discrimination in patients undergoing resection for ICC. This easily measurable biomarker may serve as a valuable tool for prediction of long-term outcomes in clinical practice.