We tried to evaluate the comparative effectiveness of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using nationwide real-world data within a target trial framework. Nationwide claims were used to identify individuals with bladder cancer who received transurethral resection during 2007-2020. Surgical strategies were defined according to receipt of RARC or ORC during a 1-year grace period. Cloning, censoring, and weighting were used to align treatment strategies from a common time zero and account for treatment-selection and immortal-time biases. The primary outcome was overall survival, with perioperative outcomes and healthcare expenditures examined secondarily. Among 45,595 eligible individuals, surgery within the grace period consisted of ORC in 3,681 and RARC in 358. Weighted analysis showed no evidence of a difference in overall survival (HR, 1.18; 95% CI, 0.96-1.45). Postoperative hospitalization was shorter with RARC than with ORC (18.4 vs. 22.5 days; P < 0.001), and transfusion was required in 51.1% and 70.6%, respectively (P < 0.001). RARC was associated with lower covered healthcare expenditure between surgery and discharge (P = 0.030), but cumulative expenditures at 2 and 5 years were comparable between groups. In this nationwide target trial emulation, assignment to RARC did not materially alter overall survival relative to ORC but yielded more favorable perioperative findings. These findings support RARC as a surgical alternative to ORC while highlighting the value of target trial emulation for evaluating real-world surgical outcomes.

Growing evidence indicates that dysregulation of circadian clock genes and cell cycle regulators plays a role in the pathogenesis of malignancies. BMAL1, a core circadian clock gene, and WEE1, a key regulator of the G2/M cell cycle checkpoint, are involved in controlling cell proliferation and maintaining genomic stability. The present study aimed to evaluate the expression pattern of these two genes in children with acute myeloid leukemia.

In this study, bone marrow samples from 40 newly diagnosed pediatric AML patients and 20 non-malignant control subjects were analyzed. The expression levels of BMAL1 and WEE1 were measured using real-time quantitative PCR. The association between gene expression and hematological parameters, including white blood cell count, hemoglobin, platelet count, and blast percentage, was also assessed.

The expression levels of both BMAL1 and WEE1 were significantly lower in AML patients compared with the control group (P < 0.001). The relative expression levels of BMAL1 and WEE1 were 0.18 and 0.31-fold of the control group, respectively. In addition, a significant negative correlation was observed between BMAL1 expression and white blood cell count (r = -0.440, P = 0.004) as well as blast percentage (r = -0.418, P = 0.007). In contrast, WEE1 expression showed no significant correlation with any of the evaluated hematological parameters.

The significant downregulation of BMAL1 and WEE1 in pediatric AML suggests a potential role of disrupted circadian clock and cell cycle regulatory pathways in the pathogenesis of this disease.

The ketogenic diet (KD) is increasingly being recognized as more than a simple metabolic intervention in cancer therapy. Emerging evidence suggests that KD may function as a systems-level immunometabolic sensitization strategy capable of enhancing therapeutic responsiveness through interconnected biologic mechanisms. Modern cancer therapies, including chemotherapy, targeted therapy, radiotherapy, and immunotherapy, are often limited by tumor adaptability and immune suppression. Tumors shift metabolism via the Warburg effect and fuel switching, promoting resistance under hypoxic and nutrient stress. KD is a high-fat and low-carb eating plan that increases ketone bodies such as β-hydroxybutyrate while lowering glucose availability. Under ketogenic conditions, cancer cells reduce glycolytic flux, while immune cells can oxidise ketones to sustain mitochondrial function and effector activity. KD also remodels the gut microbiome and induces epigenetic regulation through histone deacetylase inhibition. These combined effects may enhance chemotherapy, radiotherapy, targeted therapy, and immunotherapy by inducing metabolic stress, improving immune cell fitness, and altering tumour microenvironment signaling. Importantly, KD may function not as a standalone treatment but as a therapy-sensitization platform. However, current evidence remains preliminary and heterogeneous, and further mechanistic investigations and well-designed prospective clinical trials are necessary to determine optimal patient selection and long-term safety.

Adolescents and young adults (AYAs, 15-39 years) with cancer face unique medical, psychosocial and developmental challenges. Existing conceptual models help explain AYA cancer experiences but are often limited by age or national context. The aim of this study was to develop a comprehensive conceptual model reflecting the diversity and complexity of AYA cancer experiences across Europe.

Within the STRONG AYA project, an exploratory qualitative study was conducted. Fifty-two semi-structured online interviews were completed with AYAs with lived experience of cancer and healthcare, allied health and other professionals involved in AYA cancer care, from European countries. Participants were asked about outcomes most important to AYAs. Data were analysed thematically, and the resulting themes informed a conceptual model.

Four themes were identified: (1) healthcare delivery, access, quality of care and navigation, (2) economic instability and hardship in the cost of survival, (3) fertility and family planning: inequalities in counselling and preservation access and (4) liminal survivorship and societal reintegration. The model encompasses the following cross-cutting domains: structural/contextual factors (healthcare systems, policies, societal and cultural influences), mediators (information access, social support, financial coverage), processes (delayed decisions, fragmented care) and individual AYA outcomes (mental/physical health, identity, autonomy, education/work trajectories, relationships).

This conceptual model highlights how AYA cancer experiences/outcomes are shaped and influenced by interacting structural, societal, country-level factors, healthcare systems, cultural contexts and policies across settings. This model may be used to further develop and test culturally sensitive AYA-specific assessments/tools and interventions to improve care and support.

Circulating tumor cells (CTCs) carry a migration risk, prone to forming metastatic foci and exacerbating the disease. Therefore, it is of great importance to improve the capture efficiency and killing effect of CTCs. First, Ni-doped covalent organic framework (Ni-COF) is used as a precursor for calcination at 900 °C, which reduces Ni²⁺ to magnetic Ni nanoparticles, and COF evolve into carbon nanospheres exhibiting enzyme activity (Ni-C-900). Then, with the photosensitizer meso-Tetrakis (4-carboxyphenyl) porphyrin (TCPP) as the first ligand and (2,5-dicarboxyphenyl) boronic acid (DCBA) as the second ligand, a metal-organic framework shell is in-situ grown on the surface of Ni-C-900 to obtain Ni-C@MOF. Finally, the aptamers are orderly linked via DCBA ligands to obtain Ni-C@MOF-Apt microspheres. Ni-C@MOF-Apt exhibits excellent targeting towards MCF-7 cancer cells, with a capture efficiency of 82.6% in whole-blood samples (1000 cells per milliliter), and the capture efficiency can still be maintained at 71% within a relatively low cell-concentration range (50 cells per milliliter). In addition, under weakly acidic conditions, Ni-C@MOF-Apt exhibits peroxidase (POD) and oxidase (OXD) activities, which can generate reactive oxygen species (ROS) to eliminate MCF-7 cells in synergy with photodynamic effects. This strategy combines nanozyme activity with photodynamic effects and improves the killing efficacy against MCF-7 cells.

A single-step ethanolamine-functionalized boron-doped diamond (BDD) immunosensor for the dual detection of carcinoembryonic antigen (CEA) and cytokeratin fragment 21-1 (CYFRA 21-1). Unlike conventional multi-step carbodiimide-based coupling strategies, the ethanolamine (ETA) modification provides a simplified amine-terminated surface for efficient antibody immobilization. Comprehensive characterization confirmed successful layer-by-layer assembly: scanning electron microscopy (SEM) revealed surface morphological evolution, while X-ray photoelectron spectroscopy (XPS), Contact angle measurements and attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR) verified amine group integration and biomarker attachment. The platform showed concentration-dependent current responses across the range of 0.001-400 ng/mL and achieved statistically calculated limits of detection of 0.085 pg/mL for CEA and 0.043 pg/mL for CYFRA 21-1. The sensor exhibited good selectivity, reproducibility, stability, and reliable performance in spiked human serum samples with minimal matrix interference. In addition, an Arduino-based portable readout closely matched bench-top measurements, supporting the potential of the platform for point-of-care lung cancer screening.

The clinical significance of variation in the timing of treatment intensification after androgen deprivation therapy (ADT) initiation in metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We evaluated whether time to upfront treatment initiation was associated with outcomes in a multicenter cohort.

In a retrospective study, we performed a 4-month landmark analysis in patients with mHSPC treated with upfront androgen receptor signaling inhibitor-based or taxane-containing regimens who had evaluable CRPC data and complete baseline covariates. The cohort included 1,103 patients, classified as earlier initiation (< 4 months from ADT start; n=1,036) or later initiation (≥ 4 months; n=67). CRPC-free survival (CRPC-FS) and overall survival (OS) were evaluated using Kaplan-Meier and inverse probability of treatment weighting (IPTW)-adjusted Cox analyses. Restricted cubic spline analyses examined the continuous association between treatment delay and outcomes. Sensitivity analysis used a 3-month landmark.

In the 4-month landmark IPTW cohort, later initiation was not significantly associated with either CRPC-FS (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.80-1.37; p=0.737) or OS (HR 0.77, 95% CI 0.45-1.32; p=0.338). Delay distributions differed by regimen, with docetaxel-containing regimens showing longer intervals to upfront treatment. Adjusted spline analyses did not suggest a clear threshold at which longer delay was associated with marked deterioration in CRPC-FS or OS. Results were consistent in the 3-month landmark sensitivity analysis.

Among patients who remained alive and CRPC-free at the 4-month landmark and ultimately received treatment intensification, later initiation was not significantly associated with CRPC-FS or OS.

To culturally adapt and initially evaluate the psychometric properties of the Latvian versions of the EORTC QLQ-C30 and breast cancer-specific EORTC QLQ-BR45 in women with breast cancer.

The study was conducted within a pilot project implementing the ICHOM Breast Cancer Standard Set in a specialised university hospital in Latvia. Translation and cultural adaptation followed the EORTC procedure and included expert review and cognitive debriefing. Psychometric evaluation used baseline data from 142 women and six-month follow-up data from 47. Analyses included item-level indicators, internal consistency, multitrait scaling, inter-scale correlations, correlations with the Stress Symptom Scale, and paired change analyses. Conditional QLQ-BR45 items were treated as structurally missing when not applicable.

Expert review and cognitive debriefing supported linguistic, conceptual, and cultural appropriateness. Reliability and item-scale correspondence were acceptable for several domains, with particularly strong multitrait scaling results for QLQ-BR45 Body Image, Sexual Functioning, and Breast Symptoms. Correlations between EORTC functioning and symptom domains and the Stress Symptom Scale were generally in the hypothesised directions. Six-month findings showed clinically plausible changes in functioning and treatment-related symptoms, but estimates were based on a smaller follow-up sample and reduced valid samples for some conditional scales.

The Latvian EORTC QLQ-C30 and QLQ-BR45 showed acceptable preliminary psychometric performance. The findings provide initial support for their use to assess HRQoL and breast cancer-specific symptoms in Latvia, while larger multicentre and longitudinal studies are needed to evaluate additional measurement properties and responsiveness.

Large prospective studies in high-income countries have enabled the estimation of preventable cancer cases, guiding cancer control strategies. With breast cancer incidence rising rapidly in Malaysia, there is an urgent need for locally relevant data to inform effective prevention and control measures. We quantified the population-level contribution of risk factors in Malaysia using population-specific prevalence and literature-based relative risks.

We calculated population attributable risk using: (1) Malaysia-specific prevalence from national surveys and local epidemiological studies and (2) relative risks derived from meta-analyses of Asian prospective cohorts or case-control studies. We estimated attributable proportions using Levin's formula, adjusted for the joint effects of risk factors with a multiplicative model, and generated simulation-based confidence intervals to quantify their impact on overall disease burden.

Mammographic density (MD) accounted for 32.8% of breast cancer burden in Malaysian women, followed by modifiable risk factors-elevated body mass index (BMI, 14.7%) and passive smoking (8%). Family history and genetic factors collectively contributed 12.1%. Reproductive factors play a pronounced role before menopause, whereas BMI predominate after menopause. Their impact varies across ethnic groups: MD was most influential among Chinese women, while elevated BMI played a greater role among Malays and Indians.

A notable proportion of the breast cancer burden in Malaysia may be attributable to lifestyle and reproductive factors, while genetic susceptibility and MD also contribute importantly to disease burden. These findings support a balanced approach to breast cancer control, combining targeted prevention with risk-based early detection tailored to age and ethnic differences.

Purpose To compare artificial intelligence-based breast cancer detection and short-term breast cancer risk prediction models in their intended and nonintended settings over a single mammography screening round. Materials and Methods In this retrospective study, the Cohort of Screen-Age Women-Case Control dataset from Sweden (May 2008-December 2016; Hologic) was used, including patients with screen-detected and interval cancers, with interval cancers defined as a diagnosis more than 60 days after screening. Two examination-based settings were evaluated: detection (screening examinations) and short-term risk (screen-negative examinations). Mirai Risk, RSNA Detection (2023 challenge winner), Transpara Detection, and Transpara Risk models were assessed in both intended and nonintended settings. Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and then clinically relevant sensitivity and specificity thresholds were compared. Results A total of 20 187 examinations (7430 women) were included, with 741 examinations leading to diagnosis within 2 years (524 screen-detected and 217 interval cancers) and 19 446 examinations without cancer. Transpara Detection and Transpara Risk achieved similar performance for detection (AUC for each, 0.92; 95% CI: 0.91, 0.93; P = .93) and outperformed the other models (all P < .001). Transpara Detection demonstrated the highest specificity (97.1%; 95% CI: 96.8, 97.3) at double-reading sensitivity (all P < .001). There was no evidence of a difference in specificity of Transpara Risk and RSNA Detection at this sensitivity (P = .29). For risk, Transpara Risk performed best (AUC, 0.81; 95% CI: 0.78, 0.84), with 49.8% sensitivity at 90% specificity (all P ≤ .002) for interval cancers. There was no evidence of a difference in AUC between Mirai Risk and Transpara Detection (P = .96). Conclusion Artificial intelligence-based mammographic detection and short-term breast cancer risk prediction models performed best in their intended settings. Keywords: Mammography, Breast, Computer Applications, Detection/Diagnosis, Screening, Technology Assessment, Model Validation Supplemental material is available for this article. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.