We evaluated the association between hepatitis C virus (HCV) infection and the risk of intrahepatic and extrahepatic cancers. Specifically, we compared "1st" versus "1st or 2nd" primary cancers to capture the true disease burden, which is often underestimated in conventional analyses. Additionally, we evaluated the chemopreventive effect of direct-acting antiviral (DAA) therapy on these risks.

Using the Korean National Health Insurance database (2005-2023), we compared 119 565 HCV-infected individuals with 2 267 700 controls. Adjusted subdistribution hazard ratios (aHRs) were calculated using competing risk models. Direct-acting antivirals (DAA) effectiveness was evaluated in a sub-cohort of 23 147 patients (2016-2020) using time-dependent Cox models to account for immortal time bias.

In the analysis of 1st or 2nd cancers, HCV infection significantly increased the risk of intrahepatic (aHR 16.35; 95% CI, 15.81-16.90) and extrahepatic cancers (aHR 1.14; 95% CI, 1.12-1.16). Notably, expanding the endpoint to include 2nd cancers increased the aHR for extrahepatic cancer from 1.09 to 1.14, indicating that traditional analyses underestimate the true burden. Significant risk elevations were observed for haematological, biliary, pancreatic, and renal cancers. In the DAA sub-cohort analysis using the time-dependent model, DAA treatment significantly reduced the risk of intrahepatic cancer (aHR 0.54-0.61) and extrahepatic cancers (aHR 0.77) after adjusting for competing risks.

HCV infection significantly increases both intrahepatic and extrahepatic cancer risks. Excluding 2nd cancer underestimates this burden. Given that DAA therapy significantly reduces the risk of both intrahepatic and extrahepatic cancers, accelerating HCV elimination policies is imperative.

IntroductionAchieving the global goal of cervical cancer elimination faces major challenges, particularly in ensuring the large-scale and sustained implementation of proven technologies. In Argentina, HPV testing as primary screening was introduced through the Jujuy Demonstration Project (JDP) in 2012. The aim of this study is to analyze barriers and facilitators of the implementation of HPV testing in two provinces-Jujuy, and Catamarca-a decade after the JDP's completion.MethodsWe carried out a descriptive in-depth case study using a mixed-method approach, using qualitative and quantitative methods. Data were collected through participant observations in health services, semi-structured interviews with key informants, analysis of secondary sources, and program indicators. Barriers and facilitators were analyzed using an adapted Health System Framework focusing on four key dimensions: stewardship, organizational capacity, financing, and technology.ResultsRegarding stewardship, reduced technical support and monitoring from the National Program emerged as significant barrier. About financing, the most critical obstacle was the national interruption in the provision of HPV tests. Although both provinces have initiated procedures to purchase tests using provincial funds, this process was constrained by limited financial resources and competing priorities. Finally, regarding organizational capacity, challenges persisted in maintaining laboratory centralization, sustaining the offer of self-collection, and fully utilizing information systems for program monitoring. Facilitators related to stewardship included the stability of human resource in both provinces and the long-standing institutional recognition and leadership of provincial program staff. Sustained adherence to national guidelines and the existence of provincial resolutions were key enablers of continuity. In addition, acceptability of the technology remained high, with HPV testing continuing to be widely accepted in both provinces.ConclusionsOur findings reveal barriers and facilitators in the implementation ten years after JDP finalization, providing valuable lessons for scaling up HPV-based screening in national cancer control programs.

Prostate cancer significantly impacts not only the individuals diagnosed but also their partners, who frequently undertake extensive caregiving responsibilities. Despite their crucial role, the experiences and needs of partners remain underrepresented in cancer care literature and policy, particularly in Ireland.

A qualitative descriptive study exploring the lived experiences of nine partners of men with prostate cancer in Ireland was employed. Semi-structured interviews were conducted in person, by phone, or virtually. Data were analysed using Braun and Clarke's thematic analysis, supported by NVivo software, and interpreted through Meleis' Transition Theory.

Five major themes emerged: (1) Invisible Needs: Experience in Care, (2) Alone Together: Missing Couple-Centred Support, (3) Knowledge Deficit and Under preparedness, (4) Hesitancy, Silence and Emotional Restraints and (5) The Cost of Caring: Strain, Self-Care and Advocacy. Participants highlighted critical issues of marginalisation, emotional burden, under preparedness, and lack of inclusion for a specific group within a normal conventional care setting, which are precisely the experiences that need to be understood and addressed, not dismissed as representing a minority.

Partners of men with prostate cancer, especially those from LGBTQ+ communities, face significant psychosocial challenges that are often overlooked by the healthcare system. Findings underscore the urgent need for inclusive, couple-centred support models and tailored educational interventions. Enhancing caregiver involvement and wellbeing through systemic and policy-level changes could improve outcomes for both patients and their partners.

Patients and members of the public were not involved in the design or conduct of this research. Although participants contributed their perspectives as part of the qualitative study, there was no formal PPI in shaping the research process. The authors recognise the importance of involving patients and the public in co-designing research and will consider this in future studies.

IntroductionImmune checkpoint inhibitors (ICIs) are standard therapy for metastatic non-small cell lung cancer (NSCLC). Blood transfusions, particularly erythrocyte suspension (ES) transfusions, may induce immunomodulatory effects and potentially influence cancer outcomes. This study investigated the association between transfusions and survival in NSCLC patients treated with nivolumab.MethodsWe retrospectively reviewed 88 patients with metastatic NSCLC who received nivolumab between January 2018 and December 2023. Transfusion status, baseline inflammatory markers, progression-free survival (PFS), and overall survival (OS) were evaluated. Survival outcomes were assessed using Kaplan-Meier analysis and univariable statistical methods.ResultsThe median patient age was 64 years (range, 41-76). Median PFS was 5.93 months (95% Confidence Interval [CI], 3.72-8.14), and median OS was 8.23 months (95% CI, 6.19-10.27). Patients who received ES transfusions during nivolumab therapy experienced shorter PFS (p=0.033) and OS (p=0.039), predominantly driven by the non-squamous subgroup (PFS: p=0.002; OS: p=0.008). In univariable analyses, nivolumab cycle count, pre-treatment hemoglobin, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and systemic immune-inflammation index were associated with PFS, while programmed cell death ligand-1 (PD-L1) status, treatment line, number of cycles, pre-treatment hemoglobin, NLR, CAR, and prognostic nutritional index were associated with OS (all p< 0.05).ConclusionES transfusions administered during nivolumab therapy were associated with poorer PFS and OS in patients with metastatic NSCLC, particularly in those with non-squamous histology. Given the retrospective design and limited number of transfused patients, these findings should be interpreted with caution and considered hypothesis-generating. Larger, prospective multicenter studies are warranted to further clarify the relationship between transfusion exposure and ICI outcomes.

Introduction Postoperative temporary facial nerve dysfunction (TFND) is a common complication after parotidectomy, and the tumor location is believed to influence its risk. This study aimed to evaluate the relationship between tumor location and postoperative TFND, as well as to assess the effects of lobe involvement and surgical approach. Methods This prospective observational study was conducted at Bangladesh Medical University, Dhaka, between June 2022 and December 2023, and 35 patients with parotid neoplasms who underwent surgery were enrolled in this study. Preoperative magnetic resonance imaging was used to determine the tumor location (anterior/posterior, superior/inferior, superficial/deep), and lobe involvement was confirmed intraoperatively. Facial nerve function was assessed via the House-Brackmann grading system on postoperative day 2 and at one and three months. Univariate and multivariate logistic regression were performed to analyze the TFND risk factors. Results The participants had a mean age of 48.80 ± 11.92 years, with a female predominance. Pleomorphic adenoma was the most common tumor type (60%). TFND occurred in 54.3% of patients on postoperative day 2, 51.4% at one month, and 45.7% at three months, most commonly involving the marginal mandibular branch. On multivariate analysis, anterior tumor location (OR: 25.05; 95% CI: 1.29-484.05; p = 0.033), bilobar involvement (OR: 21.84; 95% CI: 1.13-421.84; p = 0.041), and total conservative parotidectomy (OR: 20.89; 95% CI: 1.05-413.72; p = 0.046) were significantly associated with increased risk of TFND on postoperative day 2. At one month, anterior tumor location remained a significant predictor (OR: 31.75; 95% CI: 2.02-497.19; p = 0.014). At three months, anterior tumor location (OR: 13.59; 95% CI: 1.72-107.22; p = 0.013) and bilobar involvement (OR: 10.14; 95% CI: 1.39-73.92; p = 0.022) remained independently associated with persistent TFND. No significant association was observed between TFND and age, sex, tumor size, or histopathology. Conclusion Anterior tumor location, bilobar involvement, and extensive surgery significantly increase TFND risk and persistence. These findings suggest that careful preoperative imaging-based localization and meticulous surgical planning may help reduce the risk of TFND in parotid surgery.

Anorectal melanoma is a rare and aggressive malignancy arising from melanocytes within the mucosal epithelium of the anorectal region. Because presenting symptoms such as rectal bleeding frequently mimic benign anorectal conditions, diagnosis is often delayed until advanced stages of the disease. Mucosal melanoma is characterized by aggressive local invasion and early metastatic spread. We present the case of a 54-year-old female with metastatic rectal melanoma whose disease course was complicated by extensive pelvic tumor burden, malignant venous compression leading to deep venous thrombosis, obstructive uropathy, and tumor-associated hemorrhage. Cross-sectional imaging demonstrated a massive posterior pelvic mass occupying the rectouterine space with displacement of surrounding structures, additional rectal tumor extension, metastatic lesions in the liver, and locally invasive disease adjacent to the patient's colostomy. Diagnosis was confirmed through sequential biopsy, molecular analysis, and definitive surgical pathology, demonstrating a poorly differentiated malignant neoplasm with melanocytic differentiation and immunohistochemical positivity for S100, SOX10, Melan-A, and HMB45. Despite thrombectomy with iliac vein stenting, percutaneous nephrostomy tube placement, arterial embolization, and multidisciplinary oncologic management, the patient experienced progressive metastatic disease and ultimately transitioned to hospice care. This case highlights the aggressive nature of anorectal melanoma and illustrates how advanced pelvic malignancy may produce complex multisystem complications requiring multidisciplinary management.

Giant hepatic hemangiomas, particularly those involving central hepatic segments (IV, V, and VIII), present unique surgical challenges due to their proximity to major hepatic veins and first-order portal structures. While laparoscopic approaches have been described, detailed guidance for open enucleation across a range of lesion locations and complexities remains limited. This technical report describes a systematic open parenchyma-preserving enucleation technique and presents a retrospective consecutive case series of six patients who underwent the described procedure over an eight-year period at a tertiary hepatobiliary center (American University of Beirut Medical Center, AUBMC). Patient demographics, tumor characteristics, operative details, and postoperative outcomes were retrospectively extracted from medical records following a structured chart review. All patients were followed clinically postoperatively, with no evidence of recurrence or late complications during the available follow-up period. Six patients (5 female, 1 male), with ages ranging from 26 to 50 years, underwent open enucleation using a uniform Cavitron Ultrasonic Surgical Aspirator (CUSA)-guided pseudocapsular technique without inflow occlusion (Pringle maneuver). Tumor locations included purely central segments (n=2), mixed central and peripheral segments (n=3), and a complex suprahepatic lesion with inferior vena cava (IVC) involvement (n=1). Preoperative tumor sizes ranged from 7 to 12.9 cm. Documented estimated blood loss ranged from 150 to 500 mL; five of six cases required no transfusion. One case involving direct IVC adherence required primary suture repair and intraoperative transfusion (3 units; Clavien-Dindo grade III). One patient experienced urinary retention (Clavien-Dindo grade I). No conversions to formal hepatectomy, bile leaks, postoperative liver failure, or mortality occurred. Length of hospital stay ranged from 5 to 10 days. All pathology specimens confirmed cavernous hemangioma. The described CUSA-guided pseudocapsular enucleation technique without the Pringle maneuver is feasible and safe for giant hepatic hemangiomas across central, peripheral, and complex tumor locations. This technical report provides detailed operative guidance applicable across central and peripheral tumor locations, with particular attention to centrally located lesions where proximity to major hepatic veins and portal structures demands structured operative planning and heightened technical vigilance.

The aim of this study was to identify independent prognostic factors and develop predictive nomograms for overall survival (OS) and progression-free survival (PFS) in patients with high-grade serous ovarian carcinoma (HGSOC).

Information on patients primarily diagnosed with HGSOC at the Affiliated Hospital of Qingdao University from June 2008 to June 2018 was extracted. Kaplan-Meier (K-M) analyses were used to generate survival curves. We employed univariate and multivariate Cox regression analyses to determine independent prognostic factors, and prognostic nomograms for OS and PFS were developed.

A total of 573 patients were included in the final study. The age at diagnosis, first-visit interval, peripheral blood neutrophil-to-lymphocyte ratio, the immunohistochemical expressions of estrogen receptor and progesterone receptor, and Federation of Gynecology and Obstetrics (FIGO) stage were independent prognostic factors associated with OS and PFS. Additionally, the immunohistochemical expression of Wilms' tumor-1 (WT-1) and neoadjuvant chemotherapy were also related to the OS, whereas the serum carbohydrate antigen 125 (CA125) level, the immunohistochemical expression of CK7, omentum metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors linked to PFS. The area under the time-dependent receiver operating characteristic curve values of the nomograms were higher than those of the FIGO staging system. The calibration curves and decision curve analysis demonstrated the clinical applicability of the nomograms.

We developed two new risk stratifications based on the total points of the nomograms. This study could provide a foundation for the development of more accurate predictive models that can assist clinicians in creating individualized treatment plans and improving the prognosis of HGSOC.

Background: Plasma cell neoplasms (PCNs) are a heterogeneous group of hematologic malignancies that require accurate and timely diagnosis for effective management. Despite the availability of multiple diagnostic tools, challenges remain due to clinical and morphological variability. This study aimed to compare the diagnostic performance of three key modalities, including flow cytometry (FCM), bone marrow aspiration (BMA), and bone marrow biopsy with immunohistochemistry (BMB+IHC), in patients with plasma cell neoplasms. Materials and Methods: A cross-sectional study was conducted on 52 patients with confirmed PCNs. Diagnostic outcomes from FCM, BMA, and BMB+IHC were evaluated and compared. Sensitivity, specificity, predictive values, and inter-method agreement were calculated using SPSS version 27. Results: BMB+IHC achieved the highest diagnostic yield (100%), followed by BMA (55.8%), while FCM demonstrated the lowest diagnostic rate (32.7%). Flow cytometry showed excellent specificity and a positive predictive value of 100%, but limited sensitivity (32.7-58.6%), resulting in a high rate of false negatives. BMA frequently underestimated plasma cell burden due to sampling variability and hemodilution. Collectively, the integration of all three methods provided complementary diagnostic value, reducing the risk of misclassification. Conclusion: Bone marrow biopsy with immunohistochemistry remains the gold standard for diagnosing PCNs. However, combining it with aspiration and flow cytometry offers a more comprehensive diagnostic framework, improving accuracy, minimizing false negatives, and supporting optimal patient management.

Tumors of the accessory parotid gland are rare and often misdiagnosed because of their anterior location and proximity to the facial nerve. We report a case of pleomorphic adenoma arising from the accessory parotid gland in a middle-aged man presenting with a mid-cheek swelling for 20 years. Magnetic resonance imaging demonstrated a well-circumscribed lesion along Stensen's duct. Complete surgical excision was achieved with preservation of facial nerve function. Awareness of this uncommon entity and appropriate surgical planning are essential to ensure optimal outcomes.