Patients unable to receive cisplatin due to age, comorbidities, or reduced performance status are commonly treated with concurrent radiotherapy (RT) and cetuximab. This study evaluated the prognostic significance of the Geriatric 8 (G8) score and the Charlson Comorbidity Index (CCI) in predicting survival outcomes in this population.

We retrospectively analyzed data from 52 patients with locally advanced or loco-regional recurrent head and neck squamous cell carcinoma (HNSCC) who were treated with RT and cetuximab between 2011 and 2024. Patients with p16-positive oropharyngeal or nasopharyngeal cancers were excluded. Overall survival (OS) and cancer-specific survival (CSS) were assessed according to G8 and CCI scores using ROC analysis, Kaplan-Meier curves, and Cox regression.

The median follow-up was 50 months. A G8 cut-off of 9.75 was identified (AUC: 0.713, p < 0.01). Patients with G8 ≥ 9.75 showed significantly improved OS (median: 47 vs. 7 months, p < 0.01) and 4-year CSS (66% vs. 32%, p < 0.01). In the definitive treatment group, 4-year CSS was 68% in high-G8 patients vs. 42% in low-G8 patients. In the recurrence group, 4-year CSS was 63% among high-G8 patients, whereas no patient with a low G8 score survived beyond 4 years. Multivariate analysis identified G8 < 9.75 (HR: 4.72, p < 0.01) and RT dose < 60 Gy (HR: 3.01, p = 0.01) as independent predictors of poor OS. No significant association was observed between CCI and survival.

The G8 score is a valuable prognostic tool for cisplatin-ineligible HNSCC patients treated with RT and cetuximab. Low G8 scores were strongly associated with worse outcomes, highlighting the need for alternative therapeutic strategies in this high-risk subgroup.

In women with polycystic ovary syndrome (PCOS), IVF/ICSI outcomes may be influenced by systemic inflammation (neutrophil-to-lymphocyte ratio, NLR) and by sperm preservation method.

We retrospectively studied 276 first eligible autologous PCOS IVF/ICSI cycles. NLR was dichotomized at 2.6 (low n = 136; high n = 140), whereas adjusted models used continuous NLR after exploratory spline assessment showed no convincing nonlinearity. Clinical pregnancy was defined cumulatively from the index retrieval cycle, including fresh or frozen transfer(s) derived from that cycle. Male-factor/semen characteristics were summarized by sperm method. Multivariable logistic regression evaluated cumulative clinical pregnancy in all cycles and an exploratory composite adverse pregnancy/neonatal outcome among 144 clinical pregnancies. Sensitivity analyses repeated the adjusted models using the dichotomized high-versus-low NLR grouping.

Cumulative clinical pregnancy was lower with high versus low NLR (42.9% vs 61.8%; p = 0.002). Among clinical pregnancies, the exploratory composite adverse outcome was more frequent with high versus low NLR (58.3% vs 27.4%; p < 0.001). In adjusted analyses, each 1-unit increase in NLR was associated with lower odds of cumulative clinical pregnancy (aOR 0.71, 95% CI 0.53-0.95; p = 0.023) and higher odds of the exploratory composite adverse outcome (aOR 2.32, 95% CI 1.44-3.74; p < 0.001). Sensitivity models using dichotomized NLR were directionally consistent for cumulative clinical pregnancy (high vs low NLR: aOR 0.52, 95% CI 0.31-0.86; p = 0.011). Sperm preservation method was not independently associated with either outcome, and NLR × sperm interaction terms were not significant. Exploratory ROC analysis for the pregnancy cohort showed modest discrimination (AUC 0.67, 95% bootstrap CI 0.57-0.76); the Youden-derived cutoff of 3.16 yielded sensitivity 53.4% and specificity 84.9%.

Higher baseline NLR was associated with lower cumulative clinical pregnancy and higher subsequent obstetric/neonatal risk in PCOS IVF/ICSI cycles. After accounting for baseline covariates and male-factor differences, fresh versus frozen ejaculated sperm was not independently associated with either outcome in this analysis. The ROC-derived cutoff should be viewed as exploratory only.

Upper-limb pain is a frequent and disabling sequela following breast cancer treatment, often persisting beyond the acute postoperative period and substantially impairing function, self-management, and quality of life. Telerehabilitation has emerged as a strategy to expand access to physiotherapy-based care; however, its effectiveness for pain management in this population remains unclear.

To systematically evaluate the effectiveness of telerehabilitation interventions in reducing upper-limb pain in women after breast cancer treatment.

This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261332939). PubMed, CINAHL, Web of Science, and EMBASE were searched through December 2025. Randomized controlled trials evaluating telerehabilitation-based physiotherapy interventions and reporting outcomes related to upper-limb pain were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE framework.

Six randomized controlled trials involving 517 women were included. Telerehabilitation interventions varied in delivery format (synchronous, asynchronous, app-based, or telephone-based), intensity, and duration. One trial demonstrated a significant reduction in the proportion of women reporting chronic arm pain, and another reported greater improvement in pain interference, but not pain intensity. The remaining studies showed pain outcomes comparable to usual care or no significant benefit. Methodological limitations included heterogeneity in pain assessment tools, limited individualization of interventions, attrition, lack of blinding, and inconsistent reporting of analgesic use. Overall certainty of evidence was rated as low.

Telerehabilitation appears feasible and comparable to usual care for upper-limb pain management after breast cancer treatment; however, consistent superiority has not been demonstrated. Evidence of benefit is primarily associated with structured, high-frequency, and multimodal programs. Further well-designed trials with standardized pain-specific outcomes are needed.

Management of upper-limb pain after breast cancer treatment through telerehabilitation requires coordinated input from multidisciplinary healthcare teams, including nurses and physical therapists. Telerehabilitation may facilitate remote pain monitoring, patient education, and self-management across survivorship care, provided that interventions are structured, clearly protocolized, and focused on pain-specific outcomes.

We sought to compare real-world outcomes of robotic hysterectomy (RH) with laparoscopic (LH) and open (OH) hysterectomy among adults living with endometrial cancer in Alberta, Canada.

We used administrative data to identify adults living with endometrial cancer who underwent a total hysterectomy (2012 to 2022) in Alberta. We applied generalized linear regression models and adjusted for confounders using propensity score overlap weighting. We presented predicted means and estimated probabilities with 95% confidence intervals (CIs).

We included 4555 patients. In adjusted analyses, patients who underwent RH had a shorter length of hospital stay (1.2 [95% CI 1.2 to 1.3] d) than those who underwent LH (2.0 [95% CI 1.9 to 2.1] d) or OH (3.7 [95% CI 3.6 to 3.8] d). Duration of surgery for RH was shorter than LH (172 [95% CI 169 to 174] min v. 186 [95% CI 183 to 189] min), and longer than OH (173 [95% CI 171 to 175] min v. 169 [95% CI 167 to 171] min). Compared with patients who underwent OH, those who underwent RH had reduced probabilities of blood transfusions (2.2% [95% CI 1.3% to 3.9%] v. 6.6% [95% CI 4.8% to 9.0%]), perioperative complications (12.7% [95% CI 10.2% to 15.8%] v. 20.5% [95% CI 17.3% to 24.0%]), infections (16.5% [95% CI 13.6% to 19.8%] v. 33.8% [95% CI 30.0% to 37.9%]), and 30-day acute care readmissions (11.7% [95% CI 9.2% to 14.6%] v. 17.9% [95% CI 14.9% to 21.3]); no differences were observed in comparisons with LH.

Among adults living with endometrial cancer in Alberta, RH was associated with a shorter length of hospital stay than LH and OH; we also noted fewer blood transfusions, complications, infections, and readmissions for RH compared with OH but not LH. Findings can be used in the context of surgical volumes and outcomes, along with other considerations, to guide decisions.

To investigate the association between exposure to specific endocrine-disrupting chemicals (EDCs), air pollutants and the risk of localised prostate cancer (PCa) and to evaluate the combined effect of mixed EDC exposures.

A case-control study.

Secondary care; a single tertiary hospital in Western China.

A total of 580 patients with histologically confirmed localised PCa who underwent radical prostatectomy between May 2021 and June 2023 were included as cases. They were matched 1:2 with 1160 cancer-free controls from the same cohort on age (±5 years) and date of biological sample collection. Key exclusion criteria were a history of other malignancies, androgen deprivation therapy prior to surgery or acute urinary infection.

The primary outcome was the odds of PCa associated with individual and mixed exposures. Primary exposures were urinary concentrations of nine bisphenols (BPs) and nine phthalate metabolites (quantified via high-performance liquid chromatography-tandem mass spectrometry) and estimated ambient air pollution exposure (sulphur dioxide (SO₂) and PM_₂.₅) based on geocoded residential addresses.

A total of 580 cases and 1160 controls were included in the final analysis. Exposure to the highest quartile of sulphur dioxide (SO₂) over 5 years (9.37-28.79 µg/m³) was significantly associated with PCa, yielding an OR of 1.65 (95% CI 1.08 to 2.72; p<0.001) compared with the lowest quartile (3.61-6.89 µg/m³). Urinary concentrations of multiple phthalate metabolites (MECPP, MEHHP and MEHP) and BPs (bisphenol A (BPA) and BPZ) were significantly higher in cases (all p<0.05). Weighted quantile sum (WQS) regression analysis demonstrated a significant positive association between the mixture of EDCs and PCa risk (WQS OR=1.26, 95% CI 1.20 to 1.33; p<0.001).

Exposure to SO₂ and specific EDCs (both individually and as a mixture) is significantly associated with localised PCa.

ChiCTR1900024623.

Acute radiation dermatitis is a common adverse reaction in radiotherapy, especially in patients with rectal cancer undergoing radiotherapy. At present, acute radiation dermatitis of the perianal skin has received widespread attention; however, acute radiation skin injury of the anal canal skin has not received sufficient attention. These patients mainly complain of anal pain, which seriously affects their quality of life. Mepilex Lite dressings have been recommended for the treatment of acute radiation dermatitis and have a definite effect. However, there is limited research on the use of this dressing for the treatment of acute radiation-induced dermatitis of the anal canal skin and its clinical efficacy and safety in this context need further verification.

This study is an assessor-blinded randomised controlled trial designed to evaluate the efficacy and safety of Mepilex Lite dressings combined with indomethacin suppositories for the treatment of acute radiation dermatitis of the anal canal skin. A total of 274 eligible patients from the tumour radiotherapy ward of the First Affiliated Hospital of Shandong First Medical University will be randomly assigned to either the experiment or control group (1:1). The control group will be given 30 mg of indomethacin suppositories for rectal administration, and the experiment group will be given Mepilex Lite dressings in addition to the measures taken by the control group. The 5 cm × 5 cm dressing will be inserted into the anal canal for 3 cm through the anus and exposed for 2 cm. The main outcome indicator is the treatment efficiency of the acute radiation dermatitis of the anal canal skin on the 14th day after the intervention. The secondary outcome indicator is the treatment efficiency of the acute radiation dermatitis of the anal canal skin on the seventh and 21st days after the intervention. Concurrently, the Numeric Rating Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and Skin Disease Patient Quality of Life Scale-16 will be used to assess patient pain, depression and anxiety, sleep quality and quality of life, respectively. A table questionnaire survey will be conducted at baseline and on 7, 14 and 21 days after intervention.

The research protocol has obtained ethical approval from the Ethics Committee of the First Affiliated Hospital of Shandong First Medical University (approval number: YXLL-KY-2024 (162)). The results will be published in peer-reviewed journals and abstracts will be submitted to domestic and international conferences to disseminate our research findings.

NCT06837831.

The aim of this study was to evaluate the validity and reliability of the Turkish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-ELD14 in older patients with cancer.

One hundred thirteen older patients with cancer were included in the study. The validity and reliability of the EORTC QLQ-ELD14 were evaluated via exploratory and confirmatory factor analyses, correlation analyses with the EORTC QLQ-C30, known-group comparisons, Cronbach's alpha, test-retest and the intraclass correlation coefficient. Known-group comparisons were evaluated in patient groups divided according to cancer stage, Karnofsky performance status and Charlson Comorbidity Index.

Factor analysis results demonstrated that the Turkish EORTC QLQ-ELD14, with its seven-factor structure, is a sufficient measurement instrument. Moderate to high correlations were observed between the EORTC QLQ-ELD14 and the QLQ-C30 (r = -0.40 to -0.83; p < 0.05). The clinical validity of the EORTC QLQ-ELD14 has been demonstrated by its ability to discriminate between different clinical profiles. Cronbach's α coefficient was determined to be 0.719. The intraclass correlation coefficients of all subscales were above 0.80. Excellent agreement was observed in test-retest reliability.

The Turkish version of EORTC QLQ-ELD14 is valid and reliable and is suitable for use by researchers and clinicians.

Longitudinal cancer biomarker studies aim to identify markers useful for long-term associations with cancer risk and early detection of cancer diagnosis. Early detection biomarkers show acute associations, meaning longitudinal trajectory changes sharply just before diagnosis, while long-term risk prediction biomarkers are often represented as changes in slopes or levels. We compare three common approaches to identify longitudinal biomarkers associated with survival outcomes: joint models, conditional models, and Cox models with time-varying covariates. Each of the three methods uses a different modeling framework for the joint density of the biomarkers and survival time. Thus, they have distinct advantages and disadvantages for detecting acute and long-term associations. We investigate the power and Type I error rates for the three approaches under different data-generating settings with regular yearly visits and moderate measurement error to evaluate robustness to assumptions and the power gain from using test statistics that match the data's association structure. The Cox model controlled Type I errors rates and maintained high power to detect associations across the scenarios considered. The conditional and joint models had inflated Type I errors under longitudinal model misspecification and only outperformed the Cox model for power when the correct model is used. However, only the conditional model can effectively disentangle the acute and long-term effects. The Cox model's convex likelihood also provides the fastest convergence. We apply all three approaches to a study of the association between CA-125 and ovarian cancer in the National Cancer Institute Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The results follow similar patterns to those of our simulations.

Autologous haematopoietic cell transplantation (auto-HCT) is the recommended treatment for chemosensitive relapsed Hodgkin lymphoma, while allogeneic haematopoietic cell transplantation (allo-HCT) is indicated for patients who had unsuccessful auto-HCT. The introduction of novel therapeutic agents, alongside advances in donor selection, conditioning regimens, and graft-versus-host disease prophylaxis, might improve post-transplantation outcomes, however supporting data remain limited. We aimed to evaluate changes in post-transplantation outcomes over the period 2010-22, and to identify predictors of these outcomes.

We conducted a retrospective, registry-based cohort study of patients aged 18 years or older with relapsed or refractory classical Hodgkin lymphoma undergoing first auto-HCT or first allo-HCT between Jan 1, 2010, and Dec 31, 2022, registered with the European Society for Blood and Marrow Transplantation (EBMT), with data from more than 600 transplantation centres, across 53 countries, reporting all HCTs and yearly follow-ups. Patients who received allo-HCT for relapse after auto-HCT were included but tandem transplantations were excluded. For allo-HCT, we included patients who received grafts from matched related donors, mismatched related donors, and unrelated donors. The primary endpoints were overall survival and progression-free survival, which were assessed with the Kaplan-Meier method at 2 years and 5 years after HCT. Multivariate analyses were performed using the Cox proportional-hazards regression model to identify predictive factors.

We identified 22 047 patients who received a first transplantation for relapsed or refractory Hodgkin lymphoma, after excluding 1324 patients with missing follow-up data and 1225 patients with nodular lymphocyte predominant Hodgkin lymphoma, 19 498 patients were retained: 15 648 received auto-HCT (6772 [43%] were female and 8839 [57%] were male, data were missing for 37 patients); median age at HCT was 35 years [IQR 27-47]; median follow-up was 2·4 years [IQR 2·3-2·5]), and 3850 received allo-HCT (1572 [41%] female and 2273 [59%] were male, data were missing for five patients; median age at HCT 32 years [IQR 26-42]; median follow-up was 3·9 years [IQR 3·8-4·1]). For auto-HCT, from years 2010-14 to years 2019-22, the 2-year progression-free survival increased from 63% (95% CI 62-65) to 73% (71-74) and overall survival increased from 85% (95% CI 84-86) to 93% (91-94). Partial response (hazard ratio [HR] 1·92 [95% CI 1·74-2·11]) or stable or progressive disease (2·45 [2·17-2·76]) at transplantation negatively affected progression-free survival. For allo-HCT, from years 2010-14 to years 2019-22, the 2-year progression-free survival, and overall survival, increased from 44% (95% CI 41-46) to 62% (58-66), and from 66% (63-68) to 72% (68-75), respectively. Partial response (HR 1·58 [95% CI 1·39-1·78]) or stable/progressive disease (2·28 [2·02-2·58]) at transplantation negatively affected progression-free survival.

To our knowledge, this is the largest study on HCT for Hodgkin lymphoma in recent years, and our findings that outcomes after auto-HCT and allo-HCT improved over time provide relevant information that could set the basis for prospective trials or additional studies.

None.

Urine offers a noninvasive and low-cost source of disease biomarkers, yet most proteomic studies have targeted single conditions. Using deep proteomic profiling and machine learning, we evaluated whether urinary protein signatures distinguish early-stage cancer, neurologic, and metabolic diseases from healthy controls.

This case-control diagnostic accuracy study analyzed urine samples from the Ukraine Association of Biobank (UAB), collected during routine medical check-ups. The study included 22 patients each with kidney, bladder, melanoma, prostate, ovarian, endometrial, and cervical cancers; 22 with multiple sclerosis (MS); 22 with metabolic dysfunction-associated steatohepatitis (MASH); and 66 healthy controls, yielding 264 samples analyzed in September 2023. Proteomic assays were performed using the Olink Explore 3072 platform, with laboratory personnel blinded to disease status. Urine proteomes were profiled to identify disease-specific protein signatures. The primary outcome was diagnostic accuracy of multiprotein urine panels for each disease compared with healthy controls, expressed as the area under the receiver operating characteristic curve (AUC), along with sensitivity and specificity calculated at a prespecified threshold.

Expected sex‑specific differences (KLK3, MSMB higher in males; KLK8, KLK13 higher in females) supported assay validity. Three expression patterns were observed: (1) few strong, symmetric signals in melanoma and endometrial cancer; (2) asymmetry with many up‑regulated proteins in cervical, ovarian, and prostate cancers and in MS; and (3) broad up‑regulation in kidney and bladder cancers and in MASH. Multiprotein models outperformed single proteins, plateauing at five to seven. Maximum AUCs ranged from 0.88 (MS) to 0.98 0.97 (ovarian cancer), with AUCs ≥ 0.95 for seven of nine diseases. Some proteins (e.g., C9orf40, PPY) showed cross‑disease importance.

Urine proteomics identified disease‑related signals across cancer and metabolic conditions and may enable accurate, noninvasive classification using multiprotein panels, but given the exploratory design and its limitations, the reported accuracies should be regarded as upper-bound estimates requiring prospective validation.