Japan's aging population presents significant healthcare challenges, particularly in colorectal cancer care, where nutritional assessment is vital for improving outcomes. This study evaluated the prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing curative colorectal cancer surgery.

We retrospectively analyzed 113 patients with stage II / III colorectal cancer who underwent curative surgery. Patients were categorized into GNRI Low (≤ 92) and High (> 92) groups. Clinicopathological characteristics, immunonutritional indicators, postoperative complications, and survival outcomes were compared.

The GNRI Low group (24.8%) had significantly older age, lower BMI, poorer ASA classification, frailty, and larger tumor size compared with the GNRI High group. Immunonutritional indicators, including albumin, CRP, NLR, and PNI, were also worse in the GNRI Low group. However, no significant difference in perioperative complications was observed between the groups. Five-year OS was 76.0% in GNRI Low versus 89.2% in GNRI High (p = 0.05), and 5-year DFS was 53.8% versus 74.2% (p = 0.04).

Low GNRI was associated with poor prognosis in colorectal cancer patients, despite no increase in surgical complications. Preoperative nutritional assessment using GNRI may help identify high-risk patients and support targeted interventions. J. Med. Invest. 73 : 101-105, February, 2026.

Aortoesophageal fistula (AEF) after esophagectomy is a rare but catastrophic complication, often occurring after anastomotic leakage and mediastinal contamination. Evidence regarding fatal trajectories and rescue failure points remains limited.

We performed a retrospective, single-center study among esophageal cancer patients who developed AEF after esophagectomy between 2013 and 2024. Cases were identified from institutional databases and mortality records, followed by manual screening. Clinical course, antecedent complications, diagnostic workup, rescue interventions, and causes of death were summarized descriptively.

Among 5543 esophagectomies, 17 patients (0.31%) developed AEF: 16 fatal (94.1%) and 1 survivor (5.9%). All were male, median age 63 years. Anastomotic leak occurred in 16 patients (94.1%), all with mediastinal infection. Sentinel bleeding preceded hemorrhage in 14 patients (82.4%); the median interval to fatal hemorrhage was 1 day.

Post-esophagectomy AEF is highly lethal. Sentinel bleeding represents a critical intervention window. Prompt recognition and multidisciplinary escalation may enable survival even in high-risk patients.

Colorectal cancer peritoneal metastases (CRC-PM) are highly aggressive and present distinct therapeutic challenges. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have emerged as potential therapeutic approaches, but their roles remain controversial following recent clinical trials. This review summarizes the evolving landscape of CRC-PM management, including diagnostic challenges, conflicting views of CRS and HIPEC, systemic therapies and new treatment approaches, overview of recent and ongoing landmark clinical trials, and discussion of variations in societal and global guideline recommendations.

Macitentan is an oral, dual ET_A/ET_B endothelin receptor antagonist, currently approved in adults for the treatment of pulmonary arterial hypertension (PAH) at a once-daily dose of 10 mg. Pre-clinical and clinical data suggest that greater ET_B receptor inhibition may result in greater efficacy. This hypothesis is being tested in the Phase 3 UNISUS study (NCT04273945), comparing once-daily macitentan 75 mg versus macitentan 10 mg. The present Phase 1 study (NCT04211272) evaluated the pharmacokinetics and safety of concomitant administration of once-daily macitentan 75 mg at steady state with substrates of either breast cancer resistance protein (BCRP) transporter (e.g., riociguat and rosuvastatin) or cytochrome P450 3A4 (CYP3A4) enzymes (e.g., sildenafil and tadalafil) in healthy male adults. Macitentan was administered once daily at 10 mg on Days 1 and 2, 37.5 mg on Days 3-5, and 75 mg on Days 6-13. Participants received a single oral dose of sildenafil (20 mg) on Days -4 and 13, riociguat (1 mg) on Days -3 and 10, or rosuvastatin (10 mg) on Days -4 and 10. Geometric mean ratios for the maximum concentration and area under the curve of the substrate and 90% confidence intervals showed no clinically relevant effects on exposure for sildenafil, riociguat, or rosuvastatin when administered alone or with macitentan 75 mg. Co-administration of macitentan and the substrates was generally well tolerated. Due to the lack of clinically relevant drug-drug pharmacokinetic interactions, no dose adjustment is deemed necessary when co-administering once-daily macitentan 75 mg with BCRP or CYP3A4 substrates.

Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin's ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis.

We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools.

A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively.

Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.

Bacillus Calmette-Guérin (BCG) immunotherapy remains the standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). While the European Association of Urology (EAU) guidelines recommend initiating BCG treatment no later than 4-6 weeks following transurethral resection of bladder tumors (TURBT), delays in BCG administration are not uncommon due to factors such as pathological assessment timelines, patient-related issues, healthcare system limitations, and drug shortages. This systematic review aims to evaluate the impact of delayed BCG therapy or unconventional schedules on oncological outcomes, trying to establish the best treatment option for these patients.

A comprehensive literature search was conducted across multiple databases (PubMed, Scopus, Web of Science) for studies published from January 2010 to the present. After screening 262 publications, relevant prospective and retrospective studies, systematic reviews, and meta-analyses were included.

We retrieved 14 manuscripts evaluating different BCG schedule or doses. Only two papers specifically referred to the delay in the treatment of high risk NMIBC. The findings highlight that the delays in initiating the BCG therapy beyond 6 weeks are associated with worse recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) rates. However, evidence on the progression to MIBC or metastatic disease remains inconclusive, with only a few studies suggesting a potential impact. Despite these delays, even reduced dose or shortened BCG regimens appear to offer some level of protection against disease progression.

This review emphasizes the importance of adhering to standard BCG treatment schedules to minimize the risk of recurrence and suggests that, in cases of unavoidable delay, strict endoscopic follow-up is crucial and an optimal treatment in case of cancer relapse must be offered. Further prospective studies are needed to conclusively determine the long-term effects of delayed therapy.

This review explores the metabolic pathways involved in the survival and apoptosis of head and neck cancer (HNC) cells, with a focus on how altered metabolism supports tumour growth and resistance to therapy.

Relevant literature was retrieved from Scopus using the keywords: 'head and neck squamous cell carcinoma', 'glycolysis', 'the Warburg effect', and 'metabolism'. Articles published in English were included without time restrictions.

Head and neck cancers (HNCs) exhibit dynamic and adaptable metabolic activity that supports proliferation and survival. Cancer cells often reprogramme their metabolism based on cell type, genetic alterations, and environmental conditions. A prominent feature is their reliance on glucose, demonstrated by elevated glucose uptake and increased glycolysis even under normoxic conditions-a phenomenon known as 'the Warburg effect'. However, nutrient limitation may paradoxically promote tumour aggressiveness. Beyond glycolysis, evidence shows that HNC cells can exploit alternative metabolic pathways, such as lipid and amino acid metabolism, particularly when glucose becomes scarce. These metabolic adaptations present potential pharmaceutical targets for therapeutic intervention.

HNCs rely on flexible metabolic pathways to support growth and resist treatment. Their dependence on glucose and ability to shift to lipid and amino acid metabolism offer promising targets for therapy.

Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), is a rare EBV-associated malignancy characterized by destructive tumors in the nasal cavity, often causing delayed diagnosis due to tissue necrosis. Artificial intelligence (AI) has potential to assist in complex diagnostic challenges.

This study aimed to evaluate the diagnostic performance and clinical relevance of publicly accessible AI-driven platforms in identifying ENKTL based on a real, challenging clinical case.

Clinical data from a 26-year-old male patient with protracted and complicated symptoms initially suggesting infectious conditions were used. Eight AI symptom assessment platforms were tested for diagnostic outputs using identical anonymized case inputs at early and advanced disease stages. Diagnostic suggestions, alignment with the final histopathological diagnosis, and quality of recommendations were analyzed.

Six of eight platforms provided valid differential diagnoses consistent with clinical data. Early-stage data mainly generated infectious diagnoses like peritonsillar abscess. Advanced-stage data shifted diagnoses toward invasive fungal, autoimmune, and malignant diseases, with platforms such as Doctronic and Symptomate explicitly including lymphoma. Diagnostic pathways varied, with recommendations for comprehensive laboratory tests, imaging, biopsies, and immunological assays. AI systems demonstrated oncologic vigilance when EBV viral data were included, emphasizing clinician oversight for accurate diagnosis.

AI-based diagnostic platforms show promise in supporting preliminary assessment and differential diagnosis in rare, complex cases such as ENKTL. While AI can guide diagnostic reasoning and propose investigations, it does not replace clinical judgment. Further development and validation of AI tools are needed to enhance their reliability and integration into medical practice.

Mucin 1 (MUC1), a transmembrane glycoprotein, is aberrantly expressed in multiple cancers and implicated in tumor progression. This study investigated MUC1 expression in glioma tissues and cell lines, its correlation with tumor malignancy, and the effect of differential expression on patient prognosis. Bioinformatics analysis using the GEPIA database evaluated MUC1 expression in pan-cancer and its effect on the prognosis of glioma patients. Clinical samples from 9 glioma patients with WHO grades II-IV and 2 normal brain tissues with traumatic brain injury controls were analyzed via immunohistochemistry. RT-qPCR and Western blot were used to analyze MUC1 expression in glioblastoma (GBM) cell lines (U251, U87, A172, LN229) and normal human astrocytes (NHA). MUC1 was significantly overexpressed in glioma tissues compared to normal brain tissue (p < 0.05), with higher expression correlating with advanced tumor grade. High MUC1 levels predicted poor patient survival (p < 0.01). GBM cell lines exhibited elevated MUC1 mRNA and protein levels vs. NHA (p < 0.001). MUC1 correlation with glioma malignancy and patient outcomes represents a prognostic biomarker and potential therapeutic target, underscoring its relevance in neuropathology practice.

Axillary lymph nodes are a common site of metastatic carcinoma, particularly from the breast. Epithelial inclusions within axillary lymph nodes are uncommon but well recognized, most frequently encountered as small, incidental clusters of mammary-type epithelium; squamous, Müllerian, and mixed types are also sporadically identified. Hidradenoma is a benign adnexal neoplasm classically composed of epidermoid/squamoid, intermediate/basaloid, and mucinous cells that most commonly originates in the skin but can arise in the breast parenchyma, with morphologic and genetic features that overlap with mucoepidermoid carcinoma. Rare instances of hidradenomas within pelvic and axillary lymph nodes have been reported, raising the specter of metastasis. We report 3 cases of axillary lymph node hidradenoma presenting without a concurrent breast or cutaneous lesion. Morphology, immunohistochemistry, and molecular studies were evaluated. Two cases were found to harbor CRTC1::MAML2 rearrangements, while a rarer CRTC3::MAML2 fusion was identified in a third case. Following excision, the 3 patients were without evidence of residual disease, with clinical follow-up of ∼2 years each. Recognition of this entity is essential to avoid misclassification as metastatic carcinoma and prevent overtreatment.