Locoregional lymph node involvement significantly worsens the prognosis of muscle invasive urothelial carcinoma of the bladder. Depending on disease burden, systemic chemotherapy is administered preoperatively either as a neoadjuvant treatment for localized cases, or as induction systemic therapy, when radiologic evidence suggests locoregional nodal involvement. Current lymph node assessment relies on CT imaging, but the added value of [18 F]-FDG PET-CT remains unclear. The objective of this study was to evaluate the prognostic value of lymph node assessment using [18 F]-FDG PET-CT performed before and after preoperative chemotherapy.

We conducted a retrospective single-center study on consecutive patients who received preoperative chemotherapy (neoadjuvant or induction systemic therapy) followed by radical cystectomy for MIBC between 2017 and 2025. Patients who underwent both pre and post-chemotherapy [18 F]-FDG PET-CT were included and categorized into three groups based on nodal metabolic uptake, before and after chemotherapy: (-)/(-), (+)/(-), and (+)/(+). The primary objective was to assess disease-free survival (DFS) according to nodal [18 F]-FDG uptake before and after chemotherapy.

Forty-one patients were included, with a median age of 66 years (range 36-78), Preoperative chemotherapy consisted of ddMVAC in 65.9% of cases, with a median of 4 cycles (range 1-6). Seven patients (17.1%) were ypN1 and three (7.3%) were ypN2. At 7 months, all patients with persistent positive uptake experienced disease progression. DFS was significantly lower in the (+)/(+) group (log-rank p < 0.001), followed by (+)/(-), and (-)/(-) groups. In multivariate Cox analysis, persistent lymph node uptake on [18 F]-FDG PET-CT ((+)/(+)) was an independent prognostic factor of worse DFS (HR 6.24; 95% CI 1.64-23.7; p = 0.007), regardless of final T stage and nodal invasion.

Persistent lymph node [18 F]-FDG uptake on PET-CT after chemotherapy is an independent adverse prognostic factor for disease-free survival.

RISE UP (Revolutionizing Investigations to StEp Up Prevention) for breast cancer brought together leading cancer specialists, women's health providers, basic and population scientists, regulators, politicians, industry leaders, patient advocates, and more from around the world to discuss and chart a radical rethinking of breast cancer prevention and risk reduction through a lens of hormonal management across a woman's life course. The presentations at RISE UP were organized to outline a path forward by leveraging what we know about breast cancer biology, early detection, treatment, and endocrine therapy toward a better and sustainable approach for breast cancer prevention. Important conference considerations were to expand our thinking about prevention by broadly considering how the hormonal environment during different life phases or common benign conditions could be better managed to minimize breast cancer risk. This set the stage for transitioning to advances in risk prediction, promising risk-reducing agents, and biomarker-driven trials to test them. Biomarker-based trials discussed focused on 1) lower or intermittent doses of standard prevention agents, 2) drugs already approved for other health purposes, and 3) maximizing benefits from lifestyle interventions alone or in combination. Throughout RISE UP, there was a strong focus on promoting health equity, including comprehensive reproductive health access, equitable representation in clinical trials, and strategies to educate women, providers, and advocates about disparities in care and how to successfully reduce them. The meeting concluded with a competition for innovative approaches to breast cancer prevention that could be integrated into hormonal and women's health interventions. RISE UP was an innovative conference that provided a forum for cross-cutting topics in women's health that do not currently exist. The insights shared at RISE UP will be paradigm shifting in breast cancer prevention and women's health space in the years to come.

Ovarian cancer (OC) is frequently diagnosed at a late, advanced stage, resulting in poor survival outcomes. PARP inhibitors like niraparib have shown significant efficacy in high-grade OC, particularly in tumors with homologous recombination deficiency, including BRCA mutations. This study aimed to evaluate dose modifications, safety, tolerability, and the impact on quality of life associated with niraparib in real-world clinical practice.

This non-interventional, register-based study included patients with platinum-sensitive recurrent OC who received niraparib as part of the compassionate-use program (CUP) in Germany. Clinical baseline characteristics, treatment data, adverse events (AEs), and quality-of-life measures were collected both prospectively and retrospectively across 14 centers. Data analysis was performed using descriptive statistical methods.

Overall, 68 female patients were enrolled in the CUP register. Most patients had good performance status, with no significant comorbidities or concomitant medications. The most frequently reported AEs associated with niraparib were thrombocytopenia, fatigue, and nausea. Approximately half of patients required dose adjustments. AEs were less common in patients with normal physical examination findings, better ECOG performance status, and absence of comorbidities. Prior use of PARP inhibitors or previous treatment-related side effects increased the likelihood of AEs during niraparib therapy. The median treatment duration was 182 days, with disease progression being the most common reason for discontinuation.

Niraparib treatment within the German CUP demonstrated favorable safety and tolerability profiles, supporting its effectiveness in a real-world setting for patients with recurrent OC. These findings are consistent with results from clinical trials, further reinforcing the role of niraparib in this patient population.

Prostate-specific membrane antigen (PSMA) has been identified as a therapeutic target for metastatic castration-resistant prostate cancer (mCRPC). The recent success of radioligands targeting PSMA spurred development of new PSMA-targeting agents including immunotherapy. JNJ-80038114 is a bispecific antibody that binds PSMA on tumor cells and CD3 on T cells to induce anti-tumor activity.

This was a phase 1, open-label, multicenter study of JNJ-80038114 in participants with mCRPC and ≥ 1 prior systemic therapy. JNJ-80038114 was administered subcutaneously every 3 weeks (Q3W), starting at 0.1 mg. The primary endpoint was safety. Secondary endpoints included pharmacokinetics (PK), immunogenicity, and prostate-specific antigen (PSA).

At final analysis, 39 participants received 0.1-180 mg JNJ-80038114 across 11 dose-escalation cohorts for a median of 9.3 weeks (range, 0.1-31.1). The most common treatment-related adverse events (TRAEs; ≥20%) included cytokine release syndrome (CRS, 51.3%, all Grade 1-2), injection-site reactions (46.2%), and fatigue (30.8%). Related Grade ≥ 3 TRAEs occurred in 51.3% of participants; dose-limiting toxicities occurred in 3 (7.7%). Four participants (10.3%) developed clinically significant neuropathies. In 37 PK-evaluable participants, mean exposure (C_max, AUC) increased with increasing doses. Anti-drug antibodies (ADA) were reported in 56.8% (21/37) participants. One participant had confirmed PSA decrease ≥ 50%. Three participants had radiological responses in the context of rapidly rising PSA. Following a review of data, the study was terminated.

This first-in-human study of JNJ-80038114 was discontinued early due to its lack of preliminary clinical activity, neurologic toxicities, high rates of CRS, and the development of ADAs impacting PK.

NCT05441501, Registered July 1, 2022.

Background The documentation of clinically significant incidental findings (S modifiers) in low-dose CT lung cancer screening varies among radiologists. Although the Korean National Lung Cancer Screening Program adopted structured reporting for seven standardized S modifiers, the prognostic value of standardized S modifiers has not been evaluated comprehensively. Purpose To evaluate the implementation of structured reporting for prespecified S modifiers by analyzing their prevalence, mortality associations, and co-occurrence patterns. Materials and Methods This retrospective study included baseline screening participants from the Korean National Lung Cancer Screening Program between August 2019 and December 2020. The prevalence of seven S modifiers was calculated, and their prognostic value for all-cause mortality was assessed using multivariable Cox regression. Latent class analysis (LCA) was performed to identify co-occurrence patterns, which were analyzed for mortality risk stratification. Results Among 125 600 participants (mean age ± SD, 62 years ± 5.3; 123 331 men), 2.69% (n = 3380) died over a median follow-up of 3.7 years. Coronary artery calcification was most prevalent (15.07% [18 892 of 125 366 participants]), followed by emphysema (13.77% [17 300 of 125 600 participants]), interstitial lung abnormalities (ILAs) (2.65% [3324 of 125 600 participants]), and pulmonary infection (0.90% [1123 of 124 477 participants]). Extrapulmonary malignancy (74 of 125 257 participants), aortic aneurysm (78 of 125 256 participants), and pleural and/or pericardial effusion (75 of 125 253 participants) were each observed in less than 0.1% of participants. All S modifiers were associated with increased all-cause mortality, with adjusted hazard ratios (HRs) of 8.28 (95% CI: 5.48, 12.51) for pleural and/or pericardial effusion, 3.58 (95% CI: 1.97, 6.49) for extrapulmonary malignancy, 3.28 (95% CI: 1.71, 6.32) for aortic aneurysm, 2.16 (95% CI: 1.89, 2.47) for ILAs, 1.41 (95% CI: 1.30, 1.53) for coronary artery calcification, and 1.15 (95% CI: 1.05, 1.25) for emphysema (P < .001 for all except for emphysema, with P = .002). LCA helped identify four distinct classes with a stepwise increase in mortality from isolated emphysema (adjusted HR, 1.22; 95% CI: 1.10, 1.36; P < .001) to high-risk modifiers (adjusted HR, 5.35; 95% CI: 3.40, 8.41; P < .001). Conclusion In a nationwide lung cancer screening group, structured reporting using seven standardized S modifiers revealed both their prevalence and associations with all-cause mortality, validating their clinical utility in identifying clinically significant abnormalities. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by White and Gierada in this issue.

Evaluate the gamma-glutamyl transpeptidase-to-albumin ratio (GAR) as a prognostic biomarker in acute myeloid leukemia (AML).

We retrospectively analyzed the data of 162 patients with AML. Receiver operating characteristic (ROC) curve analysis determined the optimal cutoff value for GAR. Multivariate analysis was performed to assess the independent prognostic role of GAR for overall survival (OS) and event-free survival (EFS). Subgroup analysis was conducted to explore the impact of GAR in specific patient groups.

ROC curve analysis showed an optimal cutoff value of 0.84 for GAR. Multivariate analysis revealed that GAR was an independent prognostic factor for OS and EFS. Subgroup analysis demonstrated that a high GAR was associated with shorter OS and EFS in patients with intermediate-risk stratification, those aged ≥60 years, or those that have not undergone hematopoietic stem cell transplantation.

GAR reflects nutrition, inflammation, and oxidative stress. This study shows its potential to supplement existing AML risk stratification. Future prospective studies are needed to validate its clinical utility.

We propose GAR as a prognostic biomarker in AML cases, providing a new perspective for prognostic assessment.

To evaluate the association between uterine tumor localization and lymph node metastasis (LNM) in endometrial cancer through pathological uterine mapping.

This multicenter retrospective cohort study included 427 patients with endometrial carcinoma who underwent total hysterectomy, bilateral salpingo-oophorectomy, and systematic lymphadenectomy. Tumor localization was classified based on a six-site pathological mapping model: isolated lower uterine segment (LUS), LUS + corpus, corpus-only, corpus+fundus, fundus-only, and total uterine cavity. LNM patterns and pathological features were compared across sites. Logistic regression was used to determine independent predictors of LNM.

The highest LNM rates were observed in tumors involving the LUS + corpus (37.0%) and total uterine cavity (32.4%), whereas the lowest rate was seen in corpus-only tumors (10.2%) (p < 0.001). Tumors in high-risk sites featured significantly higher rates of deep myometrial invasion, substantial LVSI, and high-grade histology. In multivariate analysis, substantial LVSI (OR: 9.2, p < 0.001), any LUS involvement (OR: 2.6, p = 0.001), aggressive histology (OR: 2.1, p = 0.017), and BMI (OR: 1.08, p = 0.025) independently predicted LNM.

Pathological uterine mapping reveals that LUS involvement is an independent risk factor for lymphatic dissemination in endometrial cancer. Tumor site classification may enhance preoperative risk stratification and guide individualized surgical strategies.

Human papillomavirus (HPV) causes over 95% of cervical cancers. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines support a risk-based approach using the most informative test, which may include high-risk (HR) or extended genotyping. Most laboratories perform partial genotyping. This study reports findings from the comprehensive genotyping of all 14 HR HPV genotypes in cervical samples from the Singapore population.

A total of 2497 cervical specimens collected in ThinPrep PreservCyt vials underwent full HPV genotyping using real-time polymerase chain reaction TOCE technology (Seegene Inc, Seoul, South Korea). Among these, 327 (13.1%) tested positive for HPV. Cytology results were available for 275 (84.1%) of these HPV-positive cases. The authors examined genotype prevalence and cytology correlations, and compared follow-up management under the Society for Colposcopy & Cervical Pathology of Singapore (SCCPS) guidelines versus ASCCP 2019 guidelines.

HPV52 and 58 were the most prevalent genotypes, accounting for 32.2% of all detected HPV genotypes. Co-infections were seen in 20.2% of samples. Among 31 (9.5%) HPV16/18 cases, most had normal cytology, though some showed atypical or low-grade changes. Under the ASCCP guidelines for primary screening, 16.8% of cases could defer to repeat HPV testing in 1 year instead of immediate cytology triage under SCCPS. In co-testing, ASCCP-guided management reduced colposcopy referrals by 7.4% since these cases would only require repeat HPV testing in 1 year.

Comprehensive HPV genotyping enhances risk stratification and enables more efficient patient management. Compared to SCCPS, the ASCCP guidelines reduce unnecessary procedures while preserving safety, supporting broader adoption of full genotyping and risk-based triage in cervical screening programmes in Singapore.

Primary liver cancer constitutes a significant public health issue in China. The hepatitis B virus (HBV) remains the primary etiological agent of liver cancer, whereas the role of metabolic liver diseases, particularly non-alcoholic steatohepatitis (NASH), is escalating. It is imperative to examine the temporal progression of liver cancer etiology to establish a scientifically grounded framework for developing targeted prevention and control strategies tailored to China's national context. This study aims to utilize the Global Burden of Disease (GBD) 2021 database to systematically evaluate the temporal trends in the liver cancer disease burden in China from 1990 to 2021, analyze the changing contributions of different etiologies [including HBV, hepatitis C virus (HCV), and NASH], assess the impact of sociodemographic factors, and predict future trends, thereby providing a scientific basis for formulating targeted prevention and control strategies tailored to China's national context.

This study performed long-term, large-scale time-series trend comparisons of liver cancer burden in China from 1990 to 2021, focusing on five primary etiologies (HBV, HCV, alcohol consumption, NASH, and other causes) using the GBD 2021 database. The Joinpoint regression model identified trend inflection points, while the age-period-cohort (APC) model elucidated the determinants of disease burden. The Slope Index of Inequality (SII) and Concentration Index (CI) assessed the correlation between various disease burden indicators and the Socio-Demographic Index (SDI), and the Autoregressive Integrated Moving Average (ARIMA) and Bayesian Age-Period-Cohort (BAPC) models were employed for future burden projections.

Between 1990 and 2021, the age-standardized incidence rate (ASIR) of liver cancer in China experienced a modest decline [estimated annual percentage change (EAPC) =-0.31], while the total number of cases escalated significantly (+103.91%), with aging contributing to a 141.91% rise in disability-adjusted life years (DALYs). The incidence of HBV-associated liver cancer diminished dramatically (ASIR EAPC =-0.55), whereas NASH-associated liver cancer escalated rapidly (ASIR EAPC =0.73). China, categorized as a medium-to-high SDI region, exhibits a greater incidence of liver cancer and various etiologies of the disease compared to other regions with equivalent SDI levels. Future forecasts indicate that liver cancer connected with alcohol consumption and NASH may persist in increasing.

The prevention and management of HBV infection in China have been efficient; however, the prevalence of metabolic illnesses in the etiology of liver cancer has escalated, and aging alongside population expansion has positively contributed to the increasing burden of liver cancer.

Prostate cancer (PCa) is one of the leading malignancies in males worldwide. Accurate assessment of Gleason scores (GSs) preoperatively is critical for making appropriate treatment decisions. However, GS discrepancies between biopsy and post-surgery pathology are common. This study aimed to evaluate the incidence of GS upgrading and downgrading and to identify related clinical and pathological factors. Understanding the clinical and pathological factors associated with GS upgrading and downgrading is essential to enhance predictive accuracy and optimize PCa management.

This study retrospectively analyzed 218 PCa patients diagnosed by transperineal prostate biopsy and subsequent treated with radical prostatectomy from January 2021 to February 2024. Patients were categorized into upgrading, downgrading, or concordant groups based on GS comparisons. Univariate analysis was adopted to identify predictive factors.

Among the 218 patients included in this study, 80 (36.7%) exhibited pathological upgrading postoperatively, 39 (17.9%) showed pathological downgrading, and 99 (45.4%) maintained consistent pathological results. Pathological upgrading was more frequently observed in patients with a biopsy GS 3+3 (P<0.001) and was associated with the total number of biopsy cores (P=0.043). In contrast, pathological downgrading was more common in patients with biopsy GS 4+3, 5+3, 3+5, or 4+4 (P=0.03) and correlated with the number of positive biopsy cores (P=0.03) and the positive core percentage (P=0.02). Most discrepancies involved ±1 grade group shifts (89, 40.8%), with ≥2 grade group changes occurring in only 13.8% of cases. For patients with GS 3+3 in biopsy, univariate analysis revealed that prostate-specific antigen (PSA), PSA density (PSAD), and the total number of biopsy cores were factors influencing pathological upgrading. Furthermore, 7 (9.8%) of upgraded GS 3+3 cases presented with locally advanced PCa vs. 0% in non-upgraded patients.

These findings highlight significant limitations of pre-surgery biopsy-based grading evaluation. The high rate of upgrading or downgrading suggests current risk stratification systems may underestimate or overestimate clinical impact. This study identified several variables that may assist clinicians in accurately determining the true pathological GS of PCa. This may help to optimize clinical-decisions and improving cancer-specific outcomes in Chinese PCa patients.