Epithelioid angiomyolipoma (E-AML) is a rare renal tumor, which can exhibit malignant potential. Because angiomyolipomas frequently harbor TSC1/TSC2 alterations, mTOR inhibitors are commonly used. However, durable disease control remains inconsistent. The potential for long-lasting response with immune checkpoint inhibitors supports exploring their role in E-AML. We report a patient with highly symptomatic, locally advanced renal E-AML treated with first-line ipilimumab plus nivolumab. The patient experienced rapid symptomatic and radiographic improvement after treatment initiation. She subsequently developed immune-related sarcoidosis, which resolved after discontinuation of immunotherapy and with corticosteroids. Given sustained disease control, she underwent delayed nephrectomy demonstrating complete pathologic response in the primary tumor. Genomic analysis revealed a germline mutation in FLCN consistent with Birt-Hogg-Dubé syndrome. T-cell receptor sequencing identified a shared expanded T-cell clone in peripheral blood and within the tumor. With extended follow-up for over 5 years, she remains in durable remission after dual immune checkpoint blockade. To our knowledge, this is the first report of dual immune checkpoint blockade in renal E-AML. This case demonstrates that first-line ipilimumab plus nivolumab can induce deep, durable response-including complete pathologic response-in a rare malignancy with limited standard treatment options, supporting further evaluation of immunotherapy in this disease.

We aimed to estimate the time required to review and report cervical cytology slides within a Human Papillomavirus (HPV)-primary cervical cancer screening programme, where cytology is used for triage following a positive HPV test, comparing Artificial Intelligence (AI)-assisted digital cytology (Genius) with manual microscopy.

A decision-tree model of the flow of slides through the National Health Service (NHS) England cervical screening cytology laboratory workflow, parameterised using published evidence and expert input.

Cytology laboratories within the NHS Cervical Screening Programme in England and Scotland.

Screening and reporting 479,125 cytology slides annually in England was estimated to require 31,842 staff hours with AI-assisted digital cytology versus 103,151 hours with manual microscopy. The mean time per slide review and reporting was 4.0 vs 12.9 minutes, respectively, corresponding to a potential 69% increase in overall productivity.

AI-assisted digital cytology can support more resilient cervical screening programmes in the UK and other countries by reducing staff time required for slide review and reporting. These findings may inform policymakers considering strategies to mitigate workforce shortages.

Inconsistent reporting of age at cancer diagnosis limits the utility of non-interventional studies focused on adolescents and young adults (AYAs), defined by the National Cancer Institute as individuals diagnosed between ages 15 and 39. Standardised reporting is essential to synthesise evidence and develop targeted interventions to address this population's unique needs. While initiatives have emphasised reporting age at study enrolment in reporting results, there is a lack of guidance on specifying age at diagnosis-an essential detail for accurately identifying AYA status.To estimate the scope of this problem, we reviewed 734 non-interventional cancer studies published between 2018 and 2022 and found that 33% did not report age at diagnosis sufficiently to determine AYA inclusion, with no improvement over time. We recommend that future reporting guidelines explicitly require age-at-diagnosis metrics, including mean, median, range and count of participants diagnosed between ages 15 and 39, to improve data comparability of non-interventional AYA cancer research and accelerate targeted interventions. We further recommend that studies with mixed-age samples report outcomes stratified by AYA status wherever sample size permits.

Large-cell neuroendocrine carcinomas (LCNECs) of the lung are rare tumours with poor prognosis. A platinum-based regimen is currently the recommended first-line treatment for advanced LCNECs. Retrospective studies suggest potential benefit from immune checkpoint inhibitors (ICIs) but prospective data is lacking.

The ongoing phase II FIRST-NEC (First-line treatment for NeuroEndocrine Carcinoma) externally-controlled trial evaluates the efficacy and safety of durvalumab combined with platinum-etoposide as first-line treatment in locally advanced, ineligible for local therapy or patients with metastatic LCNEC. Histopathological diagnosis is centrally confirmed. All patients receive four induction cycles once every 3 weeks with durvalumab 1500 mg and platinum-etoposide. Durvalumab is maintained once every four weeks for up to 24 additional cycles. The primary endpoint is the 12-month progression-free rate (12M-PFR) as per central radiological review. Secondary endpoints include progression-free survival (PFS), overall survival (OS) and safety. Efficacy is assessed every 10 patients using a Bayesian approach, with a futility rule stopping the trial if the probability that 12M-PFR ≤15% exceeds 80%. Based on an A'Hern-Fleming design, 51 evaluable patients are required. Given the rarity of LCNEC, we developed an innovative approach based on target trial emulation to compare the survival outcomes of ICI plus chemotherapy (PFS and OS) to an external control arm (real-world PFS and OS), using real-world data from the Epidemiological Strategy and Medical Economics-Advanced and Metastatic Lung Cancer database.

This clinical trial received approval from the competent authorities on 14 March 2024. The results from the final clinical report will be published in medical journals.

V.2.0 dated 11 December 2024.

NCT06393816.

Management of bladder cancer changes markedly once a tumor invades the muscularis propria, making reliable separation of non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) a key clinical decision point. Multiparametric MRI (mpMRI), interpreted with the Vesical Imaging-Reporting and Data System (VI-RADS), standardizes local staging by integrating T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced MRI (DCE-MRI). As evidence has matured, the central challenge has shifted from diagnostic accuracy alone to implementation and clinical utility: ensuring interpretable image quality across scanners and workflows, reducing inter-reader variability, and translating VI-RADS categories into appropriate clinical pathways. Bladder MRI is also being evaluated for treatment response assessment after neoadjuvant systemic therapy and bladder-preserving approaches, supported by emerging post-therapy scoring systems such as nacVI-RADS, quantitative biomarkers, and machine-learning methods. The VI-RADS Quality Score and related quality-control concepts may help separate technically inadequate examinations from biologically equivocal cases. Near-term artificial intelligence applications are likely to be most useful for scan acceleration, automated quality auditing, semi-automated segmentation, and reader support for equivocal lesions. This narrative review synthesizes acquisition and interpretation essentials, diagnostic performance, recurrent pitfalls, and scalable solutions for VI-RADS implementation, response assessment, radiomics, and artificial intelligence.

We aimed to describe the implementation of pertuzumab and identify factors associated with its use among patients with de Novo HER2-positive metastatic breast cancer (HER2+ MBC) in the Netherlands.

Using Netherlands Cancer Registry data, we identified patients diagnosed with de Novo HER2+ MBC in 2013-2023 who received systemic therapy. Pertuzumab uptake by year of diagnosis was assessed, and segmented regression was used to estimate the time point at which a plateau was reached. Factors associated with pertuzumab use during the plateau period were evaluated using multivariable logistic regression, with adjusted odds ratios converted to adjusted relative risks (aRR).

Among 1,982 patients with de Novo HER2+ MBC, pertuzumab use increased from 9% in 2013 to 49% in 2014, 61% in 2016 and 78% in 2018, after which it plateaued at a rate of 78%. In 2018-2023, pertuzumab use was independently associated with age [50-74 years (aRR 0.75, 95% CI: 0.61-0.87) and ≥75 years (aRR 0.04, 95% CI: 0.02-0.07) vs < 50 years]; socioeconomic status [middle (aRR 0.88, 95% CI: 0.75-0.99) and low (aRR 0.80, 95% CI: 0.65-0.94) vs high]; hormone receptor status [positive (aRR 0.46, 95% CI: 0.34-0.60) vs negative disease]; and grade [3 (aRR 1.06, 95% CI: 1.01-1.10) vs 1-2].

Pertuzumab uptake reached a plateau five years after approval of reimbursement in the Netherlands. Nowadays, around 80% of patients with de Novo HER2+ MBC received first-line pertuzumab-based therapy. Factors associated with pertuzumab non-use provide important insights for health policymakers aiming to ensure optimal access to effective cancer therapies.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality. Although chronic hepatitis C virus (HCV) infection has historically been a major driver of HCC, the proportion of HCC related to metabolic, alcohol-associated, and other nonviral liver diseases has been increasing. In the era of direct-acting antivirals, the clinical profile and outcomes of HCV-related HCC may differ from those of HCC from other causes. We evaluated differences in inpatient outcomes and complications among hospitalized patients with HCC with versus without chronic HCV infection in the United States.

We performed a retrospective study using the National Inpatient Sample (NIS) from 2020-2022, a weighted national database of U.S. hospitalizations. Adults aged ≥18 years with HCC, with or without chronic HCV infection, were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), total hospital charges, and complications including hepatic failure, hepatorenal syndrome (HRS), sepsis, variceal bleeding, and spontaneous bacterial peritonitis (SBP). Multivariable logistic and linear regression models adjusted for demographics, comorbidities, insurance, income quartile, and hospital characteristics.

Among 148,475 HCC hospitalizations, 16% had chronic HCV infection. Compared with non-HCV HCC hospitalizations, HCV-related cases were younger, more often male, had a higher proportion of Black patients and fewer White patients, and were more likely to have Medicaid coverage and lower income status (all p<0.05). In adjusted analyses, chronic HCV was not associated with higher in-hospital mortality (OR 0.94; p=0.33) or longer LOS, but was associated with lower total hospital charges (-$9,900; p<0.05). HCV-positive patients had lower odds of sepsis (OR 0.86), but higher odds of hepatic failure (OR 1.14) and variceal bleeding (OR 1.27), with no significant differences in HRS or SBP.

Chronic HCV accounted for a minority of recent HCC hospitalizations and was not associated with worse short-term inpatient outcomes. Differences in complications likely reflect underlying liver disease burden rather than HCV status alone.

Nipple reconstruction following total mastectomy with breast reconstruction is often a crucial final step in restoring natural breast aesthetics and improving patient self-image. Among available techniques, the C-V flap is widely utilized due to its technical simplicity, reliability, and high patient satisfaction rates. However, lasting nipple projection is limited by its reliance on subcutaneous fat to fill dead space beneath the elevated flaps. To address this limitation, implants - such as synthetic or biologic cylindrical grafts - have demonstrated long-term maintenance of cosmetic outcomes. Despite improved nipple projection, inserts are associated with a higher risk of complications, including graft extrusion or exposure, necrosis, and wound dehiscence. Furthermore, some patients may desire optimal cosmesis while declining implants for financial considerations or personal preference. In this technical report, we describe a novel modification of the C-V flap that uses de-epithelialized, vascularized dermal V flaps to provide internal structural support and maintain nipple projection following implant-based breast reconstruction after total mastectomy.

Prostate cancer is the most common malignancy among men in the U.S. Despite therapeutic advances, outcome disparities driven by racial and socioeconomic factors persist. This study uses the National Inpatient Sample (NIS) to evaluate inpatient outcomes by race and socioeconomic status among older adults hospitalized with prostate cancer.

We conducted a retrospective analysis using the NIS (2020-2022), identifying men aged ≥65 years with a prostate cancer using ICD-10 codes. Primary outcomes included in-hospital mortality, length of stay (LOS), discharge disposition, and total hospital charges (THC). Race was categorized as White (reference), Black, Hispanic, and Other. Multivariate regression analyses adjusted for demographic, clinical, and hospital-level factors.

An estimated 437,810 hospitalizations were identified. White patients comprised 69.2%, followed by Black (16.3%), Hispanic (7.2%), and Other (7.4%). Most had a high comorbidity burden (Charlson index ≥3 in 85.1%). Black patients were younger, with a higher proportion aged 65-74 years (71.0% vs. 59.2%) and were more often from the lowest income quartile (46.3% vs. 28.1%) compared with White. Medicare was the predominant payer (87.9%), and 75.1% of admissions occurred at urban teaching hospitals. Nearly half were discharged home (44.6%), 50.1% to facilities or home health, and 5.3% died in-hospital. After adjustment, Black (OR 1.24), Hispanic (OR 1.19), and Other (OR 1.17) patients had higher odds of inpatient mortality. LOS was longer for Black (+1.17 days) and Other (+0.47 days). Black patients had higher odds of non-home discharge (OR 1.31), and THC were higher for Black (+$3,394), Hispanic (+$15,985), and Other (+$10,934) patients compared with White (all p < 0.05).

Racial and socioeconomic disparities persist in prostate cancer hospitalizations. Disparities were seen as they related to number of hospitalizations, inpatient mortality, income, LOS, odds of non-home discharge, and THC. Thoroughly addressing these disparities will promote better outcomes for all patients.

HPV vaccine hesitancy remains a critical barrier to cervical cancer prevention in China despite a series of strategic policy initiatives. Our study conducted two large-scale online cross-sectional surveys in 2022 and 2025 among nationally representative samples of female university students, applying propensity score matching to enhance comparability. HPV vaccine hesitancy, assessed on a 0-10 scale (including graded hesitancy and refusal), increased significantly over time, with prevalence rising from 8.8% to 21.6%, and mean hesitancy scores also increasing. Although HPV knowledge improved and exposure to negative information declined, the perceived necessity of vaccination fell markedly, and trust eroded across several domains, including trust in health professionals' advice and in both domestic and imported vaccines. Multivariable analyses identified perceived necessity, healthcare professional recommendation, and trust in professionals and domestic vaccines as protective factors, while prior self-payment for other vaccines was also associated with lower hesitancy. These determinants remained stable over time, underscoring the need for targeted strategies to counter rising hesitancy.