Durvalumab plus tremelimumab (DT) therapy has demonstrated overall survival benefit in a clinical trial and is now widely used as first-line treatment for unresectable hepatocellular carcinoma (u-HCC). However, evidence supporting the efficacy of lenvatinib (LEN) as subsequent therapy after DT progression remains limited.

This multicenter study enrolled patients who received LEN as first-line therapy (1^st-line LEN) and those who received LEN as second-line therapy following DT treatment (2^nd-line LEN following DT). The primary endpoints were disease control rate (DCR) and objective response rate (ORR), which were compared between the 1^st-line LEN and 2^nd-line LEN following DT. Treatment responses were assessed using mRECIST.

In the intention-to-treat analysis, DCR was 69.1% in the 1^st-line LEN group and 69.2% in the 2^nd-line LEN following DT group (p=0.95); ORR was 38.2% and 30.8%, respectively (p=0.44). No significant differences were observed between the two groups. After adjusting for age, sex, and ALBI score, treatment line was not associated with DCR; the odds ratio for 2^nd-line LEN following DT versus 1^st-line LEN (reference) was 0.83 (95% confidence interval=0.17-4.13, p=0.816).

LEN following DT therapy demonstrated equivalent antitumor efficacy to first-line LEN, supporting LEN as a viable second-line option after DT progression in u-HCC.

Predicting local recurrence remains challenging in carbon-ion radiotherapy (CIRT) for non-small cell lung cancer (NSCLC). In this study, we aimed to develop and validate a machine learning model to predict local recurrence after CIRT for early-stage peripheral NSCLC.

We retrospectively analyzed patients treated with CIRT at our institution between 2010 and 2020. An Extreme Gradient Boosting classifier using clinical parameters was developed to predict local recurrence within 24 months after CIRT using a nested threefold cross-validation framework. The optimization objective was the area under the receiver operating characteristic curve (ROC-AUC). The prediction model was evaluated using the area under the precision-recall curve (PR-AUC) and survival analysis. The patients were stratified into risk groups for 2-year local control. Model interpretability was explored using SHapley Additive exPlanations (SHAP).

A total of 124 patients were evaluated. Ten (8.1%) patients experienced local recurrence within two years. The 2-year local control rate was 91.0%, with a median follow-up period of 44.9 months. The prediction model showed an ROC-AUC of 0.622. Furthermore, the PR-AUC was 0.145, and the 2-year local control rates were 94.0% in the low-risk group and 65.0% in the high-risk group (log-rank test, p<0.01). SHAP highlighted the importance of the Brinkman Index, C-reactive protein level, and solid component tumor diameter.

A machine learning model based on clinical parameters may predict 2-year local recurrence after CIRT for early-stage peripheral NSCLC.

The OGSG1108 trial evaluated the effect of oral elemental nutritional supplementation (ONS) on one-year compliance with adjuvant S-1 chemotherapy after gastrectomy for pathological stage II/III gastric cancer. It remains unknown whether intervention with ONS affords survival benefits, along with enhanced compliance with adjuvant chemotherapy.

Two groups of patients registered in the OGSG1108 trial were compared. The on-protocol group included 81 patients with pathological stage II/III gastric cancer and good acceptability (≥60%) in an ONS compliance test, who were eligible for the second registration and received protocol-based treatment with adjuvant S-1 and ONS. The off-protocol group included 24 patients with pathological stage II/III gastric cancer and poor acceptability (<60%) in an ONS compliance test, who were ineligible for the second registration and received optional adjuvant S-1 as an off-protocol treatment. Supplemental data were collected for both groups. Patient characteristics, biochemical and oncological factors, postoperative complications, number of S-1 chemotherapy courses, overall survival (OS), and relapse-free survival (RFS) were compared and prognostic factors were analyzed.

The number of S-1 courses was comparable between the two groups (on-protocol vs. off-protocol: 6.3±2.5 vs. 5.9±3.3). No significant differences were observed in 5-year OS (71.9% vs. 66.7%, p=0.700) or RFS (58.4% vs. 62.5%, p=0.972). A multivariate analysis identified pathological stage and number of S-1 courses as independent prognostic factors, but not acceptability of ONS.

Postoperative intervention with ONS did not seem to improve the prognosis of patients receiving adjuvant S-1 treatment. The number of S-1 courses was a prognostic factor.

This study aimed to evaluate the preventive effect of anti-adhesive materials (AAMs) on the incidence of small bowel obstruction (SBO) and to investigate the risk factors for SBO within five years after gastrectomy for gastric cancer.

This multicenter cohort study included 2,077 patients with gastric cancer who underwent total gastrectomy (TG) or distal gastrectomy (DG). Patients were followed for five years after surgery. Clinical characteristics associated with AAM use and risk factors for postoperative SBO were analyzed.

Among the included patients, 959 received AAMs and 1,118 did not. Intraoperative blood loss and operative time were greater in the AAM group. Open surgery and drain placement were more frequently performed in the AAM group. SBO occurred in 4.8% of patients in the AAM group and 4.7% in the non-AAM group. A higher incidence of postoperative intra-abdominal abscess was observed in the AAM group than in the non-AAM group (6.6% vs. 3.7%, p=0.003). Multivariate analysis identified TG [odds ratio (OR)=1.81, p=0.004], postoperative ileus (OR=2.61, p=0.043), and reoperation (OR=4.88, p<0.001) as independent risk factors for SBO within five years after gastrectomy.

The use of AAMs did not demonstrate a significant preventive effect on postoperative SBO after radical gastrectomy for gastric cancer and may be associated with an increased risk of postoperative intra-abdominal abscess.

Depression and other psychological disorders significantly affect cancer patients' quality of life and treatment outcomes. Despite this recognition, comprehensive data on antidepressant prescription patterns in cancer care settings throughout the world remain limited. This study aimed to analyze antidepressant prescription patterns among patients with cancer and variations across medical departments, pharmacological effects, clinical symptoms, and treatment modalities.

A retrospective chart review of antidepressant prescriptions was conducted at Chiba Cancer Center between January 1 and December 31, 2022. Patient demographics, primary department visits, types of antidepressants, reasons for prescription, and concurrent cancer treatments were evaluated.

Among 20,440 patients with cancer, 214 (1.1%) received antidepressant prescriptions. The mean age was 63.9±13.0 years, with female patients (61%) receiving prescriptions more frequently than males (39%). The prescription proportions were highest for patients who visited multiple departments (2.7%), those receiving palliative care (1.9%), and those who underwent breast surgery (1.6%). Serotonin-norepinephrine reuptake inhibitors (29%) and serotonin antagonists and reuptake inhibitors (28%) were the most commonly prescribed antidepressants. The primary reasons for prescription were insomnia (38%), pain and numbness (31%), and depression (23%). The majority of prescriptions were initiated during chemotherapy (33%) or surgery (19%).

This study revealed a relatively low proportion of antidepressant prescriptions among patients with cancer compared with previous reports. Prescriptions were more common in female patients and in those receiving care from multiple departments. Physical symptoms, rather than depression, are the primary drivers of antidepressant prescriptions. These findings suggest a need for enhanced psychological assessment and support in cancer care settings.

Outcomes in cutaneous melanoma have improved significantly with the introduction of immune checkpoint inhibitors (ICIs). However, a subset of patients remains refractory to ICIs. Dacarbazine is a well-established chemotherapy option for melanoma, and National Institute for Health and Clinical Excellence (NICE) guidelines continue to recommend it as a systemic anticancer treatment for unresectable stage III and IV melanoma. With the introduction of ICI and targeted treatments, BRAF/MEK inhibitors, the role of conventional chemotherapy has become less clear. This study aimed to determine real-world outcomes with dacarbazine, alone or in combination chemotherapy, in patients with advanced melanoma treated in this setting.

We conducted a retrospective single-centre observational study of patients with unresectable stage IV melanoma treated with dacarbazine alone or in combination with cisplatin between January 2014 and June 2023. Outcomes included overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and time-to-treatment failure (TTF), assessed using RECIST 1.1 criteria where available.

Forty patients were included. Median age was 64 years (range=28-82 years). Median OS was 7.6 months, median PFS was 2.9 months, and median TTF was 3.5 months. DCR was 37.8%, with partial response in 27% and stable disease in 10.8%. No complete responses were observed and 30% of patients survived ≥12 months.

Dacarbazine-based chemotherapy retains modest activity in selected patients with advanced melanoma in the immunotherapy-refractory setting. Further multicenter studies are required to define predictive biomarkers and optimize patient selection.

Leucovorin is the standard folinic acid rescue agent after high-dose methotrexate, whereas levoleucovorin is the pharmacologically active L-isomer of leucovorin. During a leucovorin supply interruption in Japan, levoleucovorin was used as an alternative; however, comparative data in patients with primary or secondary central nervous system lymphoma (PCNSL/SCNSL) are limited.

We retrospectively studied adult patients with PCNSL or SCNSL who received high-dose methotrexate with or without rituximab between April 2019 and March 2026 at a single center. Patients were categorized into the leucovorin and levoleucovorin groups according to the rescue agent used. The analysis between the two groups was based on the first high-dose methotrexate course. Outcomes included delayed methotrexate elimination, hematologic and nonhematologic adverse events, rescue utilization, and direct rescue drug cost.

Fifty-three patients were included (leucovorin, n=33; levoleucovorin, n=20). No significant differences between groups were observed in delayed methotrexate elimination, nonhematologic adverse events, or hematologic adverse events other than grade ≥3 thrombocytopenia, which was less frequent in the levoleucovorin group than in the leucovorin group (0.0% vs. 24.2%, p=0.019). However, total rescue vial/ampule use per course was lower in the levoleucovorin group (14 vs. 75, p<0.001), as was direct rescue drug cost per course (5,516 vs. 19,200 JPY, p<0.001).

In this study of patients with PCNSL or SCNSL receiving high-dose methotrexate, the use of levoleucovorin in place of leucovorin during a supply interruption was not associated with worse short-term safety outcomes and was associated with lower rescue utilization and direct rescue drug cost in our setting.

Pembrolizumab plus lenvatinib is first-line treatment for metastatic renal cell carcinoma (mRCC) with favorable outcomes. However, clinicopathological factors associated with treatment outcomes are unclear. We evaluated the effectiveness and safety of pembrolizumab plus lenvatinib, and explored factors associated with progression-free survival (PFS) in a Japanese multicenter cohort.

We retrospectively analyzed 160 patients with mRCC who received first-line pembrolizumab plus lenvatinib. We assessed objective response rate (ORR), disease control rate (DCR), PFS, overall survival (OS), treatment exposure, and adverse events. Factors associated with PFS were evaluated using Cox proportional hazards models.

The ORR and DCR in the overall cohort were 66% and 91%, respectively. Median PFS was 35 months, whereas median OS was not reached. DCR was significantly higher in patients with prior primary tumor resection (98% vs. 86%, p<0.01), metachronous metastasis (98% vs. 88%, p=0.03), and no high-risk metastasis (96% vs. 84%, p=0.01). Any-grade adverse events and grade ≥3 adverse events occurred in 85% and 55% of patients, respectively. Pembrolizumab and lenvatinib were discontinued because of adverse events in 23% and 22% of patients, respectively. In multivariable analysis, clear-cell histology was independently associated with longer PFS [hazard ratio (HR)=0.40, 95% confidence interval (CI)=0.21-0.72], whereas multiple metastatic organs were independently associated with shorter PFS (HR=1.91, 95%CI=1.07-3.37).

First-line pembrolizumab plus lenvatinib showed favorable activity and manageable toxicity in real-world practice. Histologic subtype and metastatic extent were independently associated with PFS.

Minimally invasive liver resection (MILR) of the posterosuperior segments (segments 7 and 8) for hepatocellular carcinoma (HCC) remains technically challenging. This study aimed to compare the perioperative and oncological outcomes between MILR and open liver resection (OLR) using propensity score matching.

A total of 157 consecutive patients underwent liver resection for HCC located in segments 7 and/or 8 at our institution between January 2010 and February 2026 [80 MILR (58 laparoscopic and 22 robotic) and 77 OLR]. After propensity score matching, each group included 39 patients. Perioperative and long-term oncological outcomes were retrospectively analyzed.

None of the patients in the MILR group required conversion to open surgery. The MILR group showed significantly lower intraoperative blood loss (55 vs. 330 ml; p<0.0001), lower transfusion rate (0% vs. 18%; p=0.0056), shorter operative time (288 vs. 338 min; p=0.0179), lower postoperative morbidity (0% vs. 33.3%; p<0.0001), and shorter postoperative hospital stay (8 vs. 15 days; p<0.0001) than the OLR cohort. The 1-, 3-, and 5-year overall survival rates were 100%, 96.2%, and 90.1% in the MILR group and 100%, 91.2%, and 86.0% in the OLR group, respectively (p=0.6579). The corresponding recurrence-free survival rates were 100%, 69.1%, and 41.9% in the MILR group and 81.2%, 47.6%, and 44.6% in the OLR group, respectively (p=0.1491).

MILR for HCC involving the posterosuperior segments is safe and feasible, providing superior perioperative outcomes while maintaining oncological outcomes comparable to those of OLR. These findings support the use of minimally invasive approaches for carefully selected patients.

Postoperative complications may adversely affect long-term outcomes after resection for non-small cell lung cancer (NSCLC), but their independent prognostic significance remains uncertain.

We retrospectively analyzed 1,690 patients who underwent lobectomy or segmentectomy for NSCLC at 12 institutions between January 2017 and December 2018. Patients were categorized into complication (n=313) and no-complication (n=1,377) groups. Overall survival (OS) and recurrence-free survival (RFS) were assessed using the Kaplan-Meier method and Cox proportional hazards models with backward elimination.

Postoperative complications occurred in 18.5% of patients. The most common complications were prolonged air leak (4.6%), atelectasis (3.7%), arrhythmia (3.4%), and pneumonia (3.0%). The 5-year OS and RFS were significantly lower in the complication group than in the no-complication group (82.1% vs. 88.5% and 80.1% vs. 87.9%, respectively; both p<0.001). In multivariable analysis, age ≥70 years [hazard ratio (HR=1.636, p=0.007)], positive lymph node metastasis (HR=1.942, p<0.001), non-adenocarcinoma histology (HR=1.633, p=0.005), postoperative complications (HR=1.657, p=0.005), and vascular invasion (HR=3.274, p<0.001) independently predicted worse OS. For RFS, age ≥70 years, male sex, pathological T2 or higher, positive lymph node metastasis, non-adenocarcinoma histology, lymphatic invasion, and vascular invasion were independent predictors, whereas postoperative complications were not.

Postoperative complications were independently associated with worse long-term OS, but not with RFS, after NSCLC resection. These findings suggest that postoperative complications may affect prognosis through mechanisms other than recurrence and highlight the importance of optimizing perioperative management.