This review provides a summary of the current understanding of the mental well-being, burden, and quality of life (QoL) of the head and neck cancer informal caregivers (ICs). Our goal is to enhance recognition of ICs' challenges and inform the development of targeted social support interventions for this population.

PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched on October 8, 2024. Quantitative data on ICs were extracted and coded into themes of burden, anxiety, or QoL, with synthesis of the data undertaken.

Fifty studies (15 cohort studies, 35 cross-sectional studies), including 4289 informal caregivers, were included in the review. The majority were female (70.48%), and spouses/partners of the patients (63.35%). We categorized data into three key themes: caregiver burden, anxiety (mental well-being), and QoL. Fourteen cross-sectional studies were rated as high quality, while twenty-one were evaluated as moderate quality. One cohort study was rated as high quality, six as moderate quality, and eight as low quality. Research indicates that caregivers of head and neck cancer patients commonly experience mental health issues, including anxiety, depression, post-traumatic stress disorder, and cancer-related fear, alongside significantly increased caregiving burdens and reduced QoL.

Substantial heterogeneity is observed across included studies. The mental health, caregiving burden, and QoL of primary caregivers for HNC patients exhibit dynamic temporal interdependence. Key correlates include female caregivers, patient symptom burden, financial toxicity, and patient-caregiver dyadic interdependence. Future interventions should target high-risk groups during critical treatment phases through skill-building and psychosocial support to enhance caregiving resilience.

PROSPERO CRD42024617454.

Central nervous system solitary fibrous tumors (CNS SFTs) are rare mesenchymal neoplasms. The 2021 World Health Organization (WHO) classification recognizes a single SFT entity characterized by NAB2::STAT6-associated biology. This study evaluated clinicopathologic and immunohistochemical features, with particular emphasis on STAT6, CD34, and p16 expression.

We retrospectively reviewed 25 CNS SFTs identified between 2004 and 2024. Clinical, radiologic, histologic, immunohistochemical, treatment, and outcome data were collected. Histologic slides were reviewed by two neuropathologists. Immunohistochemistry for STAT6, CD34, and p16 was performed; molecular testing was unavailable.

The cohort included 13 men and 12 women, with a mean age of 51 years. Among tumors with available site data, most were intracranial. WHO grades were grade 1 in 40%, grade 2 in 24%, and grade 3 in 36%. Nuclear STAT6 expression was present in all cases. CD34 expression was greatest in grade 1 tumors, whereas p16 expression was numerically highest in grade 3 tumors; neither marker showed a statistically significant association with recurrence. Tumor size increased across WHO grades. Outcome analyses were limited by few events and heterogeneous follow-up.

CNS SFTs are clinicopathologically heterogeneous. STAT6 was a consistent diagnostic marker in this cohort. CD34 and p16 showed grade-related numerical patterns, but their prognostic value was not established. Larger, molecularly confirmed cohorts with standardized long-term follow-up are required.

To identify screening intervals and BI-RADS-specific management pathways that balance cancer detection yield against recall burden in ultrasound-based breast cancer screening in China.

We analysed 1,694,838 ultrasound examinations reported with BI-RADS (2018-2023). For BI-RADS 1/2, inter-screen intervals were evaluated by recall rate, cancer detection rate (CDR), positive predictive value (PPV), and early-stage proportion. For BI-RADS 0/3/4/5, we assessed associations between biopsy waiting time and PPV/early-stage proportion, and examined imaging follow-up outcomes for BI-RADS 4A.

Among 337,497 screening intervals following BI-RADS 1/2, longer intervals were associated with higher CDR (0.13-0.54 per 1,000) but higher recall (17.4%-22.1%) and lower PPV (61.1%-31.0%), while early-stage proportion remained stable. The interval that best balanced yield and downstream burden was 13-24 months for women aged ≥ 40 years and 25-36 months for women aged < 40 years, achieving higher detection yield and PPV without a material increase in recall. Among 1,949 BI-RADS 4/5 biopsies, PPV was low for 4A (12.3%-25.0%), declined markedly with biopsy delay for 4B (60.5% to 25.0%), and remained consistently high for 4C/5 (> 60%/>93%). Among BI-RADS 4A lesions 64.7% (10,909/16,871) showed imaging downgrading during follow-up. In 487 BI-RADS 3 cases undergoing biopsy, delayed biopsy increased PPV without changing early-stage proportion.

A 2-year screening interval is recommended for women aged 40-64 years, extendable to 3 years for those aged < 40. Prompt biopsy is warranted for BI-RADS 4B/4C/5. The high image downgrade rate of BI-RADS 4A suggests overestimation and supports imaging-based triage, requiring further validation. Imaging surveillance is preferable for BI-RADS 3 lesions.

Impaired glymphatic function has been associated with shorter survival in glioblastoma. However, the relationship between glymphatic dysfunction and survival has not yet been evaluated in the context of established prognostic factors, including extent of resection, adjuvant therapy, MGMT promoter methylation status, and clinical performance status.

Single-center retrospective study including patients undergoing surgery for unifocal glioblastoma IDHwt CNS WHO grade 4 (GBM), with preoperative DTI studies in comparison to healthy controls (HC). Glymphatic impairment was assessed using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS), which is an accepted surrogate marker for glymphatic function. This study follows the STROBE guidelines for cohort studies.

We included 47 patients with GBM and 50 HC. The hemispherically averaged ALPS index was lower in GBM patients (1.15 vs. 1.27, p = 0.01). There were no differences between contralateral ALPS and HC (1.22 vs. 1.27, p = 0.29). Ipsilateral ALPS was lower compared to HC (1.05 vs. 1.27, p < 0.001) and to the contralateral hemisphere (1.1 vs. 1.22, p = 0.01). Univariable Cox regression showed no association between overall survival and ALPS parameters (ipsilateral HR 2.25 95% CI 0.49-10.31 p = 0.3, contralateral HR 2.96 95% CI 0.57-15.32 p = 0.2). In multivariate analysis significant associations were found for female and extent of resection but not for MGMT status, age, ipsi- or contralateral ALPS indices.

In patients with GBM, glymphatic function might be impaired as expressed by decreased ALPS index in the ipsilateral hemisphere. Ipsi- or contralateral ALPS index reduction did not predict overall survival independent of known predictors. Because DTI-ALPS has inherent limitations, further investigation of glymphatic dysfunction using different methods in glioblastoma is warranted.

Prehabilitation prior to gastric cancer resection aims to optimise pre-operative physical and nutritional status to improve perioperative resilience. However, the current evidence-base is fragmented. This review synthesized randomized controlled trial (RCT) evidence evaluating effectiveness of prehabilitation interventions prior to gastric cancer resection and characterized reported outcomes.

A systematic review was conducted following PRISMA guidelines (PROSPERO registration -CRD420251233981). MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL were searched up to August 2025. Eligible studies were RCTs investigating unimodal or multimodal prehabilitation interventions (minimum duration 7 days) prior to gastric cancer resection. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Heterogeneity precluded meta-analysis and results were synthesized narratively.

Fourteen RCTs were included: four multimodal, and ten unimodal interventions (nutritional (n = 9), spirometry (n = 1)), duration range (7-days to 15-weeks). Fifty-three unique outcomes were reported across five domains: clinician/observer-reported outcomes, performance outcomes, patient-reported outcomes, biomarkers, and non-health outcomes. Multimodal prehabilitation programs suggest potential benefits; fewer postoperative complications, and improved functional capacity. Short-duration unimodal nutritional interventions demonstrated mixed effects, although immune-nutrition and targeted supplementation reduced infectious complications in malnourished patients. Findings were limited by risk-of-bias (some concerns (n = 7), high (n = 7)).

Prehabilitation in gastric cancer surgery demonstrated a potential benefit, particularly when delivered as multimodal interventions. However, the evidence base is limited by substantial heterogeneity, variable methodological quality, and inconsistent outcome reporting. Development of a disease-specific core outcome set is urgently required, in addition to adequately powered, risk-stratified trials to advance evidence synthesis and implementation of gastric cancer prehabilitation.

Acquired bilateral nevus of Ota-like macules (ABNOM) is a common dermal melanocytosis predominantly affecting East Asian women. Q-switched (QS) and picosecond (PS) lasers are widely used, but their comparative efficacy and dose-response relationships have not been quantified. We conducted the first systematic review and dose-response meta-analysis to compare PS versus QS laser efficacy for isolated ABNOM. Eleven databases were searched from inception to May 27, 2026. Forty studies (50 treatment arms) of predominantly single-arm case series were included. The primary analysis used generalized linear mixed models (GLMM) for ≥ 75% clearance, complemented by dose-response meta-regression with cluster-robust standard errors. Pooled ≥ 75% clearance was 47.8% (95% CI 13.4-84.4) for PS and 53.1% (95% CI 30.3-74.6) for QS lasers (P = 0.95). Each additional treatment session was associated with a 3-fold increased odds of clearance (OR 3.2; 95% CI 2.4-4.3; P < 0.001). As an exploratory analysis, the dose-response relationship was monotonic across sessions 1-7. The PS estimate was fragile, ranging from 47.8% to 88.7% across sensitivity analyses. GRADE evidence certainty was very low. Treatment session number, rather than laser type, appeared more strongly associated with clearance. However, this dose-response finding remains hypothesis-generating due to very low certainty of evidence and requires validation in randomized trials. The absence of a statistically significant difference between laser types does not establish equivalence; PS efficacy estimates were highly fragile and based on sparse data. Wavelength may be an independent determinant of clearance and warrants further comparative study.

This study identified key intra-tumor microbial signatures distinguishing head and neck cancers from gastrointestinal cancers and explored their diagnostic and prognostic potential. Intra-tumor microbial data of five cancer types were obtained from the Cancer Microbiome Atlas, and corresponding clinical data were retrieved from the Cancer Genome Atlas. The Wilcoxon test was used to analyze differences in microbial populations. Univariate logistic regression, least absolute shrinkage and selection operator, and recursive feature elimination were sequentially applied to screen optimal microbial markers, and a support vector machine classification model was constructed. A nomogram model and Kaplan-Meier curves were used to validate the predictive and prognostic value of the optimal microbes, respectively. Overall, 463 tumor samples and 47 controls were included. Twenty-three microbes showed significant differences in distribution between head and neck and gastrointestinal tumors; among these, eight overlapping microbes were selected as optimal markers. The SVM model based on these eight microbes achieved AUCs of 0.937 and 0.856 in the training and validation datasets, respectively. The nomogram model constructed with these markers showed high predictive accuracy (C-index = 0.8944 in training, 0.8023 in validation). Kaplan-Meier analysis revealed that high abundance of Capnocytophaga, Lachnospiraceae, and Bacteroidales was significantly associated with longer overall survival in both head and neck tumors and gastrointestinal tumors (all P < 0.05). The eight intra-tumor microbial communities serve as a robust signature for distinguishing head and neck tumors from gastrointestinal tumors. Among these, Capnocytophaga, Lachnospiraceae, and Bacteroidales have potential as prognostic biomarkers to improve survival prediction in cancers.

Cancer affects over 1,000 active-duty military personnel annually, directly undermining force readiness. To address this challenge, the Department of Defense, Department of Veterans Affairs (VA), and the National Cancer Institute established the Applied Proteogenomics Organizational Learning and Outcomes (APOLLO) Consortium as part of the Cancer Moonshot Program. APOLLO collects standardized pathology data to advance research and clinical care, but integrating the College of American Pathologists (CAP) electronic Cancer Checklists (eCC) has traditionally been left to individual institutions and vendors, making implementation challenging. We developed eCC2Db, a software system that automates parsing of CAP eCC XML templates, generates Oracle database objects and metadata, and renders forms exactly as they appear on cap.org. The tool integrates with the Data Tracking System for APOLLO (DTS-APOLLO), enabling interactive completion of CAP eCC forms with data stored for audit tracking, reporting, and secure transfer to a centralized Data Warehouse. No human subjects or identifiable patient data were used. This research was conducted under the APOLLO protocol. Implementation of the tool eliminated manual database tables and relationship design, reduced transcription errors, and improved compliance with CAP standards although demonstrating scalability across CAP's semiannual updates. As of this writing, the system has implemented a total of 134 CAP eCC templates, including 17 biomarker templates. Among these, 117 organ templates, demonstrating broad coverage across cancer types. This level of implementation confirms that DTS-APOLLO can support nearly all CAP-defined cancer protocols, including complex biomarker forms, which are essential for precision oncology. By automating CAP eCC template management, DTS-APOLLO strengthens APOLLO's data infrastructure, enhances readiness, and produces AI-ready, CAP-compliant datasets that provide a foundation for predictive analytics, treatment decision support, and next-generation precision oncology research.

Concerns regarding cancer incidence, particularly non-Hodgkin lymphoma, among U.S. Air Force missile community members prompted the initiation of the Missile Community Cancer Study. This phased, retrospective process study was designed around the unique needs of the Missile Community and adapted to these requirements.

A cohort of all active duty Department of the Air Force (DAF) service members from 1976 to 2010 (N∼1.82 million), including approximately 65,000 personnel in missile-related career fields, was created via multiple data sources through a phased approach. Phase 1A examined Department of Defense (DoD) electronic health records (EHR) (2001-2020); Phase 1B added DoD and Department of Veterans Affairs (VA) cancer registry data (1976-2020) and VA EHR (1991-2020); and Phase 1C analyzed cancer mortality using National Death Index data (1979-2020). Armed Forces Health Surveillance Division and Surveillance, Epidemiology, and End Results cancer incidence and mortality case definitions were applied.

In Phase 1A, 4,865 incident cancers were identified from the DoD EHR across the cohort, including 198 cases in the missile community. After adding DoD and VA registry data and VA EHR data in Phase 1B, an additional 50,359 cases were identified, including 1,641 missile community cases. Mortality analysis (Phase 1C) identified 37,100 cancer deaths across the cohort, including 1,145 in the missile community. Across Phases 1A, 1B, and 1C, no statistically significant excess incidence or mortality of non-Hodgkin lymphoma or the 13 other study cancers was observed in the missile community compared to other DAF members or the U.S. population. The overlap between EHRs and cancer registries within both the VA and DoD systems found over half of EHR-identified cases were also included in their respective cancer registries and 76.1% of all Phase 1 cancer cases were captured in a registry.

This study's multi-phase approach with both internal and external comparison groups enhanced the comprehensiveness and accuracy of cancer case identification. The phased data linkage and validation approach provided a replicable framework for epidemiological cancer studies in military populations, illustrating methods for integrating and prioritizing data sources to address health concerns. The findings may ultimately guide future epidemiologic studies of cancer in the military to select optimal datasets, optimizing resource utilization and streamlining study timelines.

Congress, the United States Department of the Air Force (DAF) leadership, and other individuals frequently request military-specific cancer cluster investigations as concerns over cancer clusters within the military community continues to be a public health topic. The Intercontinental Ballistic Missile (ICBM) missile community is involved in the operation and maintenance of long-range ballistic missiles that have the capability to deliver nuclear warheads as part of the U.S. nuclear deterrence mission. They experience unique working conditions that are demanding and highly regulated due to the sensitive and critical nature of their work. The purpose of this study is to further evaluate cancer incidence and cancer mortality among missile community (MC) members serving from 1976 to 2010 utilizing multiple data sources from the Department of Defense (DoD) electronic health record, the Veteran's Administration (VA) electronic health record, both the DoD and VA cancer registries, and National Death Index data.

For both incidence and mortality, an internal comparison (MC compared to DAF non-missile community [non-MC]) and an external comparison (MC compared to the U.S. general population) were conducted. For the internal comparisons, regression analyses were adjusted for sex, age, race, and rank (officer vs. enlisted). Incidence rate ratios (IRRs) and mortality rate ratios and corresponding 95% confidence intervals were estimated using the log link function, with individual person-years accounted for using the offset option. For the external comparisons, standardized incidence ratios and standardized mortality ratios were adjusted for age, sex, race, and year of death and were generated for the MC as compared to the U.S. general population for each of the 14 cancers individually and collectively.

Males accounted for 92.92% of the MC, compared to 84.10% of the non-MC. Most individuals in both groups were White, accounting for 84.41% in the MC and 80.25% in the non-MC. Prostate cancer was the most common type among both the MC (n = 577, 31.38%) and non-MC (n = 16,845, 31.55%). Cancer incidence in the MC was statistically similar or lower compared to both the U.S. general population and the non-MC. Likewise, cancer mortality in the MC was statistically similar or lower compared to both comparison groups.

Although this study did not find an increased risk of cancer incidence or mortality in the MC, additional analysis is planned using data from the Virtual Pooled Registry. Not only does this study provide a more comprehensive and reliable assessment of cancer risks in this military population than previous investigations, but it also informs important decisions about the design of future cancer epidemiology studies in military populations.