Although immunotherapy combined with platinum-based chemotherapy is now the standard first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), the benefit of continuing immune checkpoint inhibitors (ICIs) after disease progression (PD) remains uncertain. This real-world study assessed the efficacy and safety of second-line immunotherapy in ES-SCLC patients using propensity score matching (PSM).

ES-SCLC patients who received second-line treatments following first-line chemoimmunotherapy at Zhejiang Cancer Hospital from January 2019 to December 2023 were included. Clinical baseline characteristics were collected and balanced. The efficacy and safety of patients who continued to receive second-line immunotherapy were compared with those who did not.

A total of 187 patients were analyzed. The median overall survival (OS) and progression-free survival (PFS) for the entire cohort were 8.5 months (95% CI: 7.1-9.9) and 3.3 months (95% CI: 2.5-4.1), respectively. After PSM, each group included 76 patients. No significant differences in OS (median OS: 8.3 vs. 7.8 months; HR, 0.97; 95% CI: 0.68-1.39; p = 0.87) or PFS (median PFS: 3.45 vs. 3.1 months; HR, 1.07; 95% CI: 0.77-1.49; p = 0.69) were observed between the rechallenge and non-rechallenge groups. Subgroup analysis suggested in an exploratory manner that immunotherapy rechallenge was associated with poorer outcomes in non-smokers (mOS: 8 vs. 16.6 months; HR, 2.9; 95% CI: 1.1-7.9; p = 0.004). The rate of all-grade immune-related adverse events (irAEs) was higher in the rechallenge group (36.8% vs. 17.1%).

Rechallenge with immunotherapy after first-line chemoimmunotherapy may not demonstrate a significant survival benefit in ES-SCLC patients, particularly among never smokers, and may lead to more frequent irAEs.

For locally advanced oesophageal carcinoma, multimodal therapy is the standard of care, but prognosis remains poor. Obesity has risen markedly in the last decades. The impact of obesity on response to neoadjuvant treatment remains unclear. This study evaluates the association between body mass index (BMI) and histopathological tumour regression following neoadjuvant therapy in oesophageal cancer.

We performed an analysis using the prospective database from the DGAV|registry oesophageal surgery provided by the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV). The primary outcome was histopathological tumour regression grade by the Becker classification. The primary explanatory variable was BMI. Descriptive statistics were followed by uni- and multivariate regression analyses adjusted for tumour histology, neoadjuvant regimen, age, sex, ECOG status, comorbidities, dysphagia and weight loss. Associations were evaluated using a multivariate regression (partial proportional odds) model.

Six hundred and forty-seven patients were included, comprising 432 adenocarcinomas (including AEG I/II) and 215 squamous cell carcinomas (SCC). After adjustment for clinical and tumour-related covariates, higher BMI was independently associated with a favourable histopathological response: No association was observed for the transition to Becker grade ≥ 1b; however, higher BMI was associated with reduced odds of Becker grade ≥ 2 (OR 0.97, 95% CI 0.94-1.00, p = 0.04) and Becker grade ≥ 3 (OR 0.93, 95% CI 0.90-0.96, p < 0.001). In addition, SCC, absence of dysphagia, radiochemotherapy and low ECOG score were independently associated with favourable regression, whereas no independent associations were observed for age, sex, diabetes status, comorbidities or pretherapeutic weight loss.

Analysis of the German DGAV|registry revealed that higher BMI was significantly associated with improved histopathological tumour regression following multimodal therapy for oesophageal cancer. These findings suggest potential differences in tumour biology among patients with elevated BMI, underscoring the need for further mechanistic investigation.

Cancer stem cells (CSCs) are increasingly recognized as metabolically plastic subpopulations within malignant tissues that drive tumor initiation, metastatic dissemination, and relapse after therapy. Although traditional models of cancer metabolism have emphasized aerobic glycolysis, CSCs rarely exhibit a single, clearly defined bioenergetic phenotype. Rather, they dynamically remodel glucose utilization, oxidative phosphorylation, redox regulation, de novo fatty acid synthesis, lipid uptake, lipid sequestration, and fatty acid oxidation in response to hypoxic conditions, nutrient restriction, stromal interactions, and therapeutic perturbations. This review focuses on two interconnected aspects of metabolic flexibility: lipid flux and mitochondrial plasticity. We examine how de novo lipogenesis, CD36-mediated fatty acid uptake, fatty acid-binding protein trafficking, cholesterol biosynthesis, and lipid-droplet turnover contribute to stemness, membrane remodeling, metastatic potential, and resistance to cytotoxic agents. We also examine how mitochondrial dynamics, including fusion, fission, mitophagy, and biogenesis, together with reactive oxygen species buffering and shifts in oxidative phosphorylation, facilitate CSC survival during chemotherapy, radiotherapy, targeted therapy, and immune-mediated cytotoxicity. Particular emphasis is placed on the integration of fatty acid oxidation to respiratory metabolism, on the epigenetic consequences associated with the acetyl-CoA availability, and the metabolic crosstalk linking CSCs to adipocytes, fibroblasts, mesenchymal cells, and immune cell populations in the tumor microenvironment. Finally, we evaluate therapeutic strategies involving inhibitors of fatty acid synthase (FASN), acetyl-CoA carboxylase (ACC), stearoyl-CoA desaturase-1 (SCD1), carnitine palmitoyltransferase-1 (CPT1), and OXPHOS. We also discuss combination therapies, nanotechnology-based drug delivery, and emerging artificial intelligence (AI)-guided approaches. Taken together, current evidence identifies the lipid-mitochondrial axis as a critical systems-level driver of therapeutic resistance and a promising target for improving long-term cancer control.

This study aimed to evaluate whether a standardized oral care protocol is associated with reduced oral mucositis (OM) severity among leukemia patients receiving induction chemotherapy. Baseline characteristics were comparable between groups. Severe OM occurred in 17/90 (18.9%) in the protocol group versus 30/90 (33.3%) with usual care (odds ratio 0.46; P = .027); the association remained significant after adjustment (adjusted odds ratio 0.50; P = .044). OM duration was shorter with the protocol (median 6 vs 8 days; P = .003), with faster time to resolution (14 vs 16 days; P = .04). The protocol group reported lower maximum pain (median 3 vs 5; P < .001), less opioid use (44.4% vs 60.0%; P = .036), lower morphine milligram equivalents (60 vs 120 mg; P = .006), and reduced parenteral nutrition use (13.3% vs 24.4%; P = .049). Febrile neutropenia, blood culture positivity, intensive care unit transfer, and length of stay did not differ significantly. A standardized oral care protocol was associated with reduced severe OM and meaningful improvements in OM duration and symptom burden during leukemia induction chemotherapy. Prospective studies are warranted to confirm effectiveness and implementation fidelity. We conducted a single-center retrospective cohort study including adult leukemia inpatients receiving induction chemotherapy. Patients were grouped by exposure to a standardized oral care protocol with per-shift documentation versus usual care (90 vs 90). OM was graded each shift using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v5.0 from induction day 1 to hospital discharge. The primary outcome was peak OM severity; severe OM was defined as CTCAE grade ≥ 3. Secondary outcomes included OM incidence (CTCAE ≥ 1), time to onset, duration, time to resolution, maximum oral pain score (0-10 Numeric Rating Scale), opioid use and cumulative morphine milligram equivalents, parenteral nutrition use, febrile neutropenia (temperature > 38.3°C with neutropenia), blood culture positivity, intensive care unit transfer, and length of stay. Group comparisons used Pearson χ2/Fisher exact tests and appropriate parametric/nonparametric tests. Multivariable logistic regression assessed the association between protocol exposure and severe OM.

This retrospective comparative study evaluated the effect of tranexamic acid (TXA) on perioperative transfusion requirements and clinically documented thromboembolic events in patients undergoing proximal femoral tumor resection and megaprosthetic reconstruction for metastatic bone disease. A total of 32 patients who underwent proximal femoral tumor resection and megaprosthetic reconstruction between 2019 and 2026 were included. The patients were divided according to perioperative TXA administration (TXA group, n = 15; control group, n = 17). TXA was administered intravenously at 10 to 15 mg/kg prior to skin incision. Primary outcomes included transfusion requirements and the number of transfused erythrocyte units. The secondary outcomes included perioperative hemoglobin change, length of hospital stay, postoperative complications, and mortality. Perioperative blood transfusion was required in 60.0% and 82.4% of the patients in the TXA and control groups, respectively (P = .243). The transfusion requirement was numerically lower in the TXA group, corresponding to an absolute difference of 22.4 percentage points (relative risk, 0.73). The mean number of transfused units was similar between groups (1.27 ± 1.22 vs 1.35 ± 0.99, P = .829). Hospital stay was numerically shorter in the TXA group (9.53 ± 4.73 vs 13.94 ± 10.52 days, P = .202). No clinically documented symptomatic thromboembolic events were observed in either group of patients. In this small retrospective cohort, TXA use was associated with a numerically lower perioperative transfusion requirement, although the difference was not statistically significant. These findings should be considered exploratory and hypothesis-generating and require confirmation in larger, adequately powered prospective studies.

The aim of this study was to assess the prognostic value of tumor mutational burden (TMB) as a biomarker for metastatic colorectal cancer (mCRC) in patients receiving immunotherapy-containing regimens. This retrospective cohort study analyzed 221 patients with mCRC. From January 1, 2020 to December 31, 2021, patients diagnosed with unresectable mCRC at the time of initial diagnosis were screened and stratified into 2 groups according to baseline TMB status: a TMB-H group (high tumor mutational burden, n = 113) and a TMB-L group (low tumor mutational burden, n = 108). All patients received anti-PD-1/PD-L1 immunotherapy combined with standard chemotherapy. Data on patient characteristics, tumor molecular features, survival outcomes, adverse events, and posttreatment quality of life were collected and compared between groups. Patients in the TMB-H group demonstrated significantly improved progression-free survival (PFS) and overall survival (OS) compared to the TMB-L group (P < .001). The TMB-H group also demonstrated higher scores across all functional domains of the EORTC QLQ-C30 questionnaire. TMB-H status was positively associated with progression-free survival, overall survival, and quality of life, while adverse event rates were comparable between groups (P = .989). High TMB status is associated with improved survival outcomes and better quality of life in mCRC patients receiving immunotherapy, without an increase in adverse events. These findings support the prognostic value of TMB in this population and warrant prospective validation.

While some retrospective studies have reported that certain dietary habits may affect rectal cancer, the types of dietary habits involved are limited. We employed a classical 2-sample Mendelian randomization approach to investigate the causal relationship between dietary habits and rectal cancer. Rigorous instrumental variable selection included P-value filtering, linkage disequilibrium assessment, and sensitivity analyses utilizing methods like Steiger filtering and Mendelian Randomization Pleiotropy RESidual Sum and Outlier to ensure robust inference. Utilizing Mendelian randomization, we assessed the influence of dietary habits on rectal cancer using data from 706 single nucleotide polymorphisms derived from the UK Biobank. Our analysis, incorporating rigorous instrumental variable (IV) selection and sensitivity checks, revealed significant associations for 5 dietary habits with rectal cancer. Notably, herbal tea intake (raw P = .007; odds ratio = 0.998; 95% confidence interval (CI) 0.997-0.999), average weekly beer plus cider intake (raw P = .038; OR = 0.867; 95% CI: 0.757-0.992), pancake intake (raw P = .040; OR = 0.753; 95% CI: 0.574-0.987), and salad/raw vegetable intake (raw P = .049; OR = 0.809; 95% CI: 0.6554-0.9995) were found to have a protective effect against rectal cancer. Conversely, we found the average weekly spirits intake (raw P = .041; OR = 1.261; 95% CI: 1.010-1.575) to be a potential risk factor for rectal cancer. Our findings suggest that several genetically proxied dietary traits may be associated with rectal cancer risk. These findings should be interpreted cautiously and require validation in independent and ethnically diverse populations before informing dietary recommendations.

Thoracoscopic radical resection for lung cancer is widely performed, but postoperative pulmonary complications (PPCs) remain one of the most common and severe perioperative adverse events, which prolong hospital stay and increase postoperative morbidity. Esketamine exerts anti-inflammatory and lung-protective properties, while its effect on reducing PPCs after thoracoscopic lung cancer surgery still requires further clinical verification. This study aimed to investigate whether perioperative application of esketamine could reduce the incidence of PPCs in patients undergoing thoracoscopic radical resection for lung cancer.

A total of 80 adult patients scheduled for thoracoscopic radical lung cancer surgery were enrolled. The primary outcome was the overall incidence of PPCs on postoperative day 1. Secondary outcomes included the incidence of PPCs on postoperative days 3 and 7, PPC severity score, postoperative nausea and vomiting, postoperative hospital stay, indwelling time of the thoracic drainage tube, 24-hour postoperative resting visual analog pain score, unplanned intensive care unit admission, and postoperative mortality.

The incidence of PPCs on postoperative day 1 was significantly lower in the esketamine group than in the control group (37.5% vs 72.5%, P = .002). No significant between-group differences were observed in the incidence of PPCs on postoperative days 3 and 7 or in any of the other secondary outcomes.

Perioperative esketamine administration can effectively decrease the early postoperative (postoperative day 1) incidence of PPCs in patients undergoing thoracoscopic radical lung cancer surgery, with no obvious impact on other secondary clinical outcomes.

This study evaluates the clinical efficacy of transperineal 3D image registration combined with AI-electromagnetic navigation-guided mpMRI-TRUS fusion biopsy versus transrectal cognitive fusion biopsy for prostate cancer diagnosis. This retrospective cohort study analyzed 283 patients undergoing prostate biopsy at Yongchuan Hospital of Chongqing Medical University (January 2022 to December 2024). Participants were stratified into transrectal cognitive fusion (n = 146) and transperineal AI-navigated fusion (n = 137) groups. Detection rates of clinically significant prostate cancer (csPCa) and complication profiles were compared. Multivariable logistic regression identified independent predictors of csPCa detection. The transperineal AI-navigated fusion group demonstrated a significantly higher csPCa detection rate compared to the transrectal cognitive fusion group (55.5% vs 45.2%, P = .043). Multivariable logistic regression revealed that advanced age (OR = 1.05, 95% CI: 1.01-1.17), PI-RADS score > 3 (OR = 9.4, 95% CI: 3.95-16.74), and transperineal approach (OR = 3.65, 95% CI: 1.22-4.75) independently predicted csPCa detection. The AI-navigated group showed no hematochezia (0% vs 9.6%, P = .003), no sepsis (0% vs 2.1%, P = .246), and a significantly lower urinary tract infection rate (13.9% vs 28.8%, P = .035). However, urinary retention was significantly more frequent in the transperineal group (14.4% vs 7.3%, P = .012), although all cases resolved within 72 hours with conservative management. Transient perineal pain was also more frequent in the transperineal group (24.1% vs 8.9%, P = .017). AI-navigated transperineal fusion biopsy was associated with improved csPCa detection and a lower infectious complication rate compared to transrectal cognitive fusion biopsy, but with a significantly higher incidence of transient, self-limiting urinary retention. These findings support its potential as an effective diagnostic strategy, with the caveat that patients should be counseled regarding post-biopsy voiding function.

Desmoid tumors are classified as borderline malignancies and are characterized by a high rate of local recurrence despite the absence of distant metastasis. Low-dose methotrexate combined with vinblastine, known as the methotrexate and vinblastine (MV) regimen, has been reported as an effective treatment for desmoid-type fibromatosis (DF). At our institution, we adopt a treatment strategy beginning with celecoxib as the first-line therapy, escalating to the MV regimen only in cases showing disease progression. This study evaluates treatment outcomes based on this protocol. At our institution, 10 patients diagnosed with DF between 2003 and 2025 received surgical resection and/or pharmacotherapy. The standard approach involved initiating treatment with oral celecoxib; if no clinical improvement was observed, therapy was escalated to the MV regimen. Treatment response was assessed using Response Evaluation Criteria in Solid Tumors 1.1 criteria. Of the 10 cases, 1 achieved complete response, 5 showed partial response, 2 maintained stable disease, and 2 exhibited progressive disease, yielding a response rate of 60%. Among patients treated with the MV regimen, extended dosing intervals did not lead to tumor progression, and sustained suppression was observed in several cases. No grade 3 or 4 adverse events were reported. Celecoxib and the MV regimen appear to be effective and well-tolerated options for DF. Given its low toxicity and favorable tolerability, celecoxib should be considered the first-line treatment, especially since tumor control was achieved in half of the cases. Although tumor progression occurred in the remaining cases, disease control was subsequently achieved by introducing the MV regimen. These findings support recent trends favoring nonsurgical management and suggest that the celecoxib followed by the MV regimen strategy should be considered a primary therapeutic approach.