Rare cancers are usually defined as an incidence of <6/100,000 persons per year. Gynecological oncology is characterized by a paradoxical high prevalence of rare cancer subtypes, especially in ovarian tumors. Ovarian germ cell tumors, clear cell ovarian cancer and gestational trophoblastic disease encompass this set of gynecologic tumors. The WHO classification distinguishes epithelial cell tumors (85% of malignant tumors) from non-epithelial tumors, sex cord stromal tumors (8% of malignant tumors), and germ cell tumors (6% of malignant tumors). The current treatment for these tumors is similar to that for ovarian cancer but advancing quickly to incorporate targeted therapy. Gestational trophoblastic tumors are usually curable, even when widely metastatic disease is present. Ovarian clear-cell carcinoma (OCCC) remains a challenging disease characterized by intrinsic chemoresistance and distinct molecular features. A more biologically aligned treatment strategy has emerged. Continued integration of molecular selection and microenvironmental modulation will likely define the next phase of therapeutic development in OCCC. The clinical features, staging, and current treatment of each of these tumors is reviewed.

To review the prognostic impact of spread through air spaces (STAS) and visceral pleural invasion (VPI) in early-stage non-small-cell lung cancer (NSCLC), assess their relevance to the increasing use of sublobar resection, and describe current limitations in their preoperative and intraoperative assessment.

A comprehensive literature review was conducted to summarize key original studies, meta-analyses, and major clinical trials addressing STAS, VPI, diagnostic modalities, and surgical strategies for early-stage NSCLC.

Spread through air spaces is associated with a higher risk of loco-regional recurrence after sublobar resection, and this risk is not adequately reduced by wider surgical margins. Anatomic resection, such as segmentectomy, provides more favourable outcomes than non-anatomic wedge resection in STAS-positive disease. Visceral pleural invasion is associated with an increased risk of distant metastasis, which may contribute to the comparable survival observed between segmentectomy and lobectomy in small VPI-positive tumours. The preoperative and intraoperative identification of both features remains limited due to the low sensitivity of frozen-section analysis for STAS and the modest accuracy of current radiologic predictors.

Tumour size alone is insufficient to guide surgical planning in early-stage NSCLC. Spread through air spaces and VPI have measurable prognostic effects and should be considered when determining the extent of resection. Improved predictive tools and prospective studies incorporating these pathological factors are needed to optimize surgical decision-making and treatment selection.

Minimally invasive thymectomy has transformed the surgical management of thymic epithelial tumours and myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) is well established, whereas robot-assisted thoracoscopic surgery (RATS) provides technical and ergonomic advantages but at a higher cost. We reviewed current evidence to clarify the indications, oncological validity, perioperative performance, and economic implications of RATS compared with VATS and open thymectomy.

A structured narrative review was conducted, drawing on multi-institutional cohorts, registry-based propensity-matched studies, and systematic reviews. Evidence was organized by tumour characteristics, special populations (MG, obesity, recurrent thymoma), perioperative and long-term outcomes, surgeon-centred considerations, and cost-effectiveness.

In early-stage thymoma and MG, both VATS and RATS achieve R0 resection rates ≥95% and recurrence outcomes comparable with sternotomy. Robot-assisted thoracoscopic surgery is associated with lower blood loss, fewer conversions, and signals of faster recovery, with particular advantages in obese or redo cases. Long-term survival appears equivalent across minimally invasive approaches, without evidence of oncological superiority. However, RATS incurs higher per-case costs, primarily from instrumentation and platform expenses.

VATS remains efficient for straightforward cases, whereas RATS may safely extend minimally invasive eligibility to anatomically complex scenarios while maintaining oncological integrity. Adoption should be indication-driven and resource-conscious. Further multicentre studies with long-term follow-up, patient-reported outcomes, and cost-effectiveness analyses are needed to define the sustainable role of RATS in thymectomy.

Not applicable.

The role of upper mediastinal lymph node dissection (UMLND) in distal oesophageal and oesophagogastric junction (AEG) cancers remains debated, requiring a balance between potential oncologic benefit and surgical risk. This review provides an updated perspective on its role.

We analysed current evidence from retrospective studies, meta-analyses, and ongoing clinical trials, focusing on histology, tumour location, staging, neoadjuvant therapy response, and surgical outcomes.

Routine UMLND is not supported for all distal oesophageal and AEG cancers. A standard 2-field dissection is sufficient for most patients with AEG adenocarcinoma. Extended 2-field dissection may be beneficial for squamous cell carcinoma of the upper and middle oesophagus and for adenocarcinoma with high-risk features, such as clinically positive upper mediastinal nodes or bulky abdominal/low-mid-mediastinal nodes. Current evidence highlights the need for a tailored surgical approach rather than uniform application.

UMLND should not be considered routine but applied selectively according to tumour biology, location, and response to multimodal therapy. Future randomized data, particularly incorporating immunotherapy and advanced imaging and surgical techniques, will better define the optimal extent of lymphadenectomy in distinct patient subgroups.

Antigen heterogeneity substantially limits the efficacy of chimeric antigen receptor-modified T (CAR T) cell therapy against solid tumors. Our study highlights the potent antitumor activity of low-dose decitabine-primed CAR T (dCAR T) cells in solid tumor models, a benefit previously confirmed in hematologic malignancies. Notably, dCAR T cell infusion in immunocompetent mice led to substantial elimination of mixed tumor masses containing both antigen-positive and antigen-negative cells, without the need for prior lymphodepletion. Our analysis showed notable proinflammatory remodeling of the tumor immunosuppressive microenvironment. Crucially, antigen-activated dCAR T cells sustained high levels of interferon-γ production, which induced immunogenic cell death in tumor cells and activated conventional dendritic cells. This, in turn, stimulated endogenous CD8⁺ T cells, enhancing their antigen-spreading capacity and aiding in the clearance of abscopal antigen-negative tumors. These findings reveal the robust antigen-spreading capability of dCAR T cells, underscoring their clinical potential in addressing solid tumors with inherent antigen heterogeneity.

Cancer is one of the leading causes of death worldwide. Oncology nurses play an essential role in the care of oncology patients. Providing care for cancer patients and managing complex treatment processes can be challenging for oncology nurses. The psychological effects of caring for cancer patients and facing their illness and death are often overlooked. The relationships between aging anxiety, job stress, and psychological resilience remain unclear. The aim of this study was to determine the relationship between aging anxiety, job stress, and psychological resilience in oncology nurses.

This cross-sectional, correlational and descriptive study was conducted with 220 nurses working in an oncology hospital from December 2023 to February 2024. The Personal Information Form, Relational Aging Anxiety Scale (RASS), Nurse Stress Scale (NSS), and Resilience Scale for Nurses (RSN) were used to collect the data. Descriptive analyses, correlation analysis, and Structural Equation Modeling (SEM) were performed.

Correlation analyses revealed a statistically significant low positive correlation between the relational aging anxiety subscale and NSS scores (r = 0.240, p < 0.05), and a low negative correlation with RSN scores (r = - 0.182, p < 0.05). SEM indicated that RAAS scores were a significant negative predictor of RSN scores (β = -0.214, p < 0.05) and a significant positive predictor of NSS scores (β = 0.608, p < 0.05). No significant direct effect between RSN and NSS scores (β = -0.007, p > 0.05).

These findings suggest that higher aging anxiety among nurses is associated with greater stress and lower psychological resilience, highlighting the need for comprehensive training programs to reduce aging anxiety and job stress, and to enhance psychological resilience among oncology nurses. Interventions focusing on stress management, emotional regulation, and self-care are recommended. Experimental studies to evaluate the effectiveness of these interventions are encouraged.

Breast-related symptoms are common in primary care and frequently prompt imaging or referral. While a palpable breast lump is strongly associated with breast cancer, isolated mastalgia is generally considered low risk. Most evidence comes from secondary care, limiting applicability to general practice.

To estimate the likelihood of breast cancer associated with breast-related symptoms in primary care and to evaluate current GP management of women with isolated mastalgia.

Retrospective cohort study using electronic health records from a Dutch primary care research network.

We included women aged ≥ 30 years presenting with breast-related symptoms or diagnosed with breast cancer between 2014 and 2021. Multivariable logistic regression assessed associations between symptoms and breast cancer. Mastalgia was classified as either isolated (without any other breast-related symptoms) or in combination with other symptoms. In women with isolated mastalgia, GP-initiated imaging and referrals were recorded and evaluated.

We included 2073 episodes from 1752 women (median age: 45.0 years, range 30-100 years); 189 episodes (9.1%) resulted in breast cancer. Presentation with a breast lump (OR 10.57, 95%-CI 4.89-22.84), skin or nipple retraction (OR 5.54, 95%-CI 2.28-13.48), and increasing age (OR 1.07 per year, 95%-CI 1.05-1.08) were independently associated with breast cancer. Mastalgia was associated with lower odds (OR 0.56, 95%-CI 0.34-0.92). Mastalgia was reported in 26 episodes that ultimately resulted in a breast cancer episode, but no cases occurred among women with isolated mastalgia (0 of 588 episodes). Despite this, 39.6% of women with isolated mastalgia underwent breast imaging, nearly half within three months.

In primary care, breast cancer is strongly associated with a palpable lump, skin or nipple retraction, and increasing age. Isolated mastalgia was not associated with breast cancer. However, mastalgia occurring in combination with other breast-related symptoms may indicate a higher risk. Imaging and referral may often be safely deferred in women presenting with short-duration isolated mastalgia.

Poorly differentiated gastric carcinomas (PDGC) comprise 30% of gastric cancers and are associated with poor prognosis, correlating with tumor size and microvascular invasion. PDGC may be subcategorized as Epstein-Barr virus (EBV)-positive or EBV-negative. Based on prior work with EBV-positive nasopharyngeal carcinomas, we interrogated 33 PDGC samples for EBV DNA/RNA/protein, CD8, PDL1, PD1, Inducible T cell Co-Stimulator Ligand (ICOSL), ICOS, MHC-I, Suppressor of cytokine signaling 1 (SOCS1), and miR-155. The 13 EBV-positive tumors each showed intense PD1, PDL1, and CD8+ T cell responses that were largely absent in EBV-negative tumors. EBV EBER-1/2 RNA strongly colocalized with miR-155 in cancer cells with a concomitant loss of ICOSL expression as well as downregulation of cytokine signaling suppressor, SOCS1. In contrast, the 20 EBV-negative PDGCs showed weak to no miR-155 expression, with strong ICOSL and SOCS1 expression. On the other hand, the MHC-I expression was lost in both PDGC types. These data suggest that, despite the similar histological patterns of the cancer cells, EBV-driven induction of miR-155 suppresses SOCS1 expression, resulting in intense cytotoxic T cell infiltration, but also loss of the other miR-155 target, ICOSL, making tumor cells invisible to the surrounding intense T cell infiltration. Conversely, EBV-negative tumors retain ICOSL/SOCS1 expression, but exhibit minimal T cell infiltration, partly due to high SOCS1 expression, preventing immune-mediated clearance. Overall, our data indicate that SOCS1 expression, regulated by EBV-induced miR-155, along with ICOSL status determines whether tumors attract T cells and whether those T cells can effectively eradicate cancer cells.

Accurate hospital bed occupancy forecasting is essential for effective resource planning and patient flow management. While complex machine learning models have gained popularity in healthcare forecasting, their operational utility often falls short due to high maintenance costs and limited interpretability. This study evaluates the performance and practicality of Prophet, a parsimonious time-series model, for mid-term hospital bed occupancy forecasting.

We applied the Prophet model to daily bed occupancy data from the Medical Center - University of Freiburg (2010-2023), incorporating public holidays and a COVID-19 pandemic indicator as exogenous regressors. Prophet decomposes time series into trend, seasonality, and holiday effects, offering interpretable components. Forecast accuracy was assessed via rolling cross-validation over 2022-2023 for horizons of 30, 60, 90, and 180 days. A production-ready forecasting pipeline and dashboard were also implemented using cloud-native tools.

Prophet achieved low MAPE values across all horizons (3.21%-3.53%) with coverage above 80%, demonstrating reliable accuracy comparable to or better than more complex models that often require higher computational resources and operational costs, such as deep neural networks. Component analysis revealed patterns aligned with hospital operations; weekly and yearly cycles, and holiday effects, highlighting the model's interpretability.

This study shows that mid-term hospital bed occupancy can be accurately forecasted using a simple, interpretable model like Prophet. In contrast to more complex architectures, Prophet offers robust performance with minimal tuning, faster deployment, and clearer insights that are critical in operational settings. These findings reinforce the argument that, for structured forecasting tasks like bed occupancy, simple models can rival complex ones, not only in accuracy, but also in reproducibility, scalability, and operational value.

The COVID-19 pandemic and accompanying social distancing measures might have caused adverse health consequences. We aimed to describe changes in participants' self-rated health and mental health (depression, anxiety, and stress), and investigate factors associated with them.

We collected data from the German National Cohort (NAKO). We first described changes in participants' self-rated health and mental health from the baseline examination (1 to 6 years earlier) to the early phase of the COVID-19 pandemic. We then applied the multinomial logistic regression model (self-rated health) and the quantile regression model (mental health) to investigate the potential factors associated with the health status and changes.

After a median of 3.1 [2.1, 4.1] years from baseline to the early pandemic phase (N = 91,809), 39.3% of participants with good health and 69.7% with less good health status at baseline reported better health. However, the percentage of participants with high depression, anxiety, and stress scores (≥ 10) increased from 6.2%, 4.1%, and 4.3% to 8.6%, 5.6%, and 10.1%, respectively. In the multivariable models, we found that being younger, being male, highly educated, being employed, having higher life satisfaction at baseline, being more physically active, drinking heavily, and experiencing improved anxiety symptoms were associated with improved self-rated health. In contrast, smoking and having mental health disorders were all associated with worse self-rated health. Our results showed that being younger, being female, smoking, drinking heavily, and drinking more since baseline were associated with higher depression scores. Having had a coronavirus test was associated with worse self-rated health and more severe anxiety and stress.

During the early COVID-19 pandemic, many participants experienced improvements in self-rated health but suffered deterioration in mental health and physical activity engagement. Female participants, those who were physically inactive, and those with pre-existing mental disorders were more likely to report poorer health.