Immune checkpoint inhibitors (ICIs) are widely used in advanced non-small cell lung cancer (NSCLC) but can lead to immune-related adverse events (irAEs) that may disrupt care. Although irAEs are well described clinically, there is limited evidence quantifying their downstream health care use and costs in Medicare beneficiaries with advanced NSCLC.

To evaluate health care use and costs associated with clinically impactful irAEs among older adults receiving ICI therapy.

Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients (fee-for-service beneficiaries) aged 66 to 85 years with advanced NSCLC and who initiated nivolumab, pembrolizumab, or atezolizumab, alone or in combination with each other or chemotherapy, between 2015 and 2017 (patient identification window), with follow-up through 2019. These agents represent ICIs approved for advanced NSCLC during the identification period. Clinically impactful irAEs were defined using irAE diagnosis codes accompanied by evidence of systemic immunosuppressant use and treatment interruption and were modeled as a time-varying exposure. Health care use and costs were assessed using weighted longitudinal models accounting for time-varying confounding (marginal structural models with stabilized inverse probability weights). Two-part generalized estimating equations estimated per-patient-per-month (PPPM) and cumulative outcomes over 6, 12, and 24 months, with sensitivity analyses including models incorporating ICI drug costs and alternative approaches to account for censoring.

Among 4,867 patients, 1,667 (34.3%) experienced a clinically impactful irAE. Adjusted all-cause health care use was higher among patients with irAEs (mean 15.8 [SE = 0.12] vs 12.0 [SE = 0.12] visits PPPM; difference, 3.9; 95% CI = 2.9-4.8), with more than double the odds of inpatient hospitalization (odds ratio, 2.21; 95% CI = 2.15-2.29). Adjusted all-cause medical costs averaged $16,042 (SE = 14.7) vs $12,721 (SE = 13.1) PPPM (difference, $3,322; 95% CI = $3,283-$3,361), driven primarily by inpatient care ($2,922; 95% CI = $2,903-$2,941). At 24 months, cumulative costs per patients were $846,013 (SE = 12,786) for patients with irAEs compared with $751,606 (SE = 11,358) for those without (difference, $94,407; 95% CI = $91,606-$97,207). Findings were consistent in sensitivity analyses.

Clinically impactful irAEs were associated with substantially higher health care use and costs among older adults with advanced NSCLC receiving ICIs, with inpatient care accounting for most excess costs. These findings have implications for managed care strategies focused on toxicity monitoring, hospitalization prevention, and value-based ICI management.

Many patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer (eBC) experience recurrence despite treatment with adjuvant endocrine therapy; recurrences bear a substantial cost and can impact life expectancy and quality of life.

To estimate the lifetime clinical and economic value of ribociclib for the treatment of patients with HR+/HER2- stage II/III eBC at high risk of recurrence including select node-negative and all node-positive patients.

A 4-state Markov model comparing ribociclib+nonsteroidal aromatase inhibitor (NSAI) with NSAI alone estimated the expected lifetime costs and effectiveness for patients with eBC (mean age = 53 years). High risk of recurrence in HR+/HER2- eBC was based on the NATALEE trial criteria: all node-positive and node-negative patients with tumor size larger than 5 cm or 2-5 cm with Grade 3 or Grade 2 and high genomic risk. Model outcomes included invasive disease-free survival (IDFS), locoregional recurrence (LR), distant recurrence (DR), overall survival, adjuvant treatment costs, adverse event costs, disease management costs by health state, and DR treatment costs. Patient-level IDFS for the first 4.5 years observed in the NATALEE trial was parametrically extrapolated thereafter. DR and LR progression risks and treatment utilization patterns were obtained from the literature. Model outputs included total costs, quality-adjusted life-years (QALYs), life-years (LYs), equal-value LYs (evLYs), and the incremental cost-effectiveness ratio (ICER) of ribociclib+NSAI vs NSAI when using IDFS as the effectiveness outcome.

Ribociclib+NSAI improved IDFS (13.08 vs 11.09 years) and reduced DR (DR state = 1.28 vs 2.35 years), generating QALY gains of 0.68 (ribociclib+NSAI = 11.45; NSAI = 10.77), LY gains of 0.69 (ribociclib+NSAI = 14.98; NSAI = 14.29), and evLY gains of 0.75 (ribociclib+NSAI = 11.52; NSAI = 10.77). Total lifetime incremental costs were $52,385 (ribociclib+NSAI = $831,433; NSAI = $779,047). The ICER was $77,448/QALY, and the probability of ribociclib+NSAI being cost-effective was 68.5% at a willingness to pay of $150,000/QALY.

Based on model estimation, ribociclib+NSAI is projected to be a cost-effective therapy in the United States vs NSAI alone by reducing the rate of high-cost metastatic recurrences and increasing QALYs.

Among the estimated 234,580 patients diagnosed with lung or bronchus cancer in 2024, an estimated 66%, or 154,823 patients, were diagnosed with advanced or metastatic non-small cell lung cancer (mNSCLC). More than half of patients have a genomic variant that can be treated with targeted therapy. Despite widespread evidence supporting the survival benefits of biomarker-driven management of patients with mNSCLC, real-world implementation of precision oncology has not kept pace with recommendations.

To quantify the potential survival deficit from underutilization of precision oncology (genomic testing and matched therapy) for patients with newly diagnosed mNSCLC in the United States.

We developed a simulation model comparing Observed Practice with Optimal Practice in which all eligible patients receive biomarker testing and appropriate treatment. We assessed a mix of 3 testing pathways assessed: (1) guideline-concordant biomarker testing consistent with National Comprehensive Cancer Network (NCCN) Guideline recommendations, (2) nonguideline biomarker testing, and (3) no biomarker testing. Input values and probabilities for each pathway were obtained from published data. Survival deficit was estimated as life-years lost in Observed Practice vs Optimal Practice.

Among the estimated 92,401 patients with new metastatic adenocarcinoma or large cell carcinoma histology, 49,427 patients were projected to have at least 1 of the 10 NCCN-recommended mutations with a known targeted first-line therapy. Among those harboring actionable mutations, 46,757 were assumed to be identified and treated with precision-matched targeted therapy (PMTT) in Optimal Practice vs 28,177 in Observed Practice. The 46,757 patients receiving PMTT in Optimal Practice realized a total of 113,417 life-years, a gain of 20,901 over the patients treated in Observed Practice.

Among patients with mNSCLC in the United States, suboptimal use of recommended panel testing and implementation of precision medicine for newly diagnosed mNSCLC is associated with life-years lost. Investments in effective programs that improve adherence to NCCN guideline recommendations and test-concordant therapy would result in increased life expectancy for up to 20,000 patients annually.

Human papillomavirus (HPV) causes multiple cancers. Understanding HPV-related cancer burden may help implement effective strategies for cancer prevention. The aim was to examine incidence and survival trends of eight HPV-related cancer sites in Estonia and estimate the number of cases attributable to HPV. Patient/material and methods: The Estonian Cancer Registry provided data on all cases of eight HPV-related cancer sites diagnosed in Estonia during 1995-2022. Age-standardized incidence trends were analyzed using joinpoint regression, estimating annual percentage change (APC). The number of HPV-attributable cases was estimated using internationally derived site-specific attributable fractions, as tumor HPV status was not available. Five-year relative survival ratios were calculated from national life tables.

In all, 11,266 cases of HPV-related cancer sites were diagnosed, of which 6,263 were estimated to be attributable to HPV; over 40% occurred before age 55. In women, estimated average annual number of HPV-attributable cases nearly quadrupled for oropharyngeal cancer (OPC) and tripled for anal cancer. A significant increase in OPC and anal cancer incidence was observed among women (APC 10.0 and 3.8, respectively). Cervical cancer incidence declined after 2012 (APC -5.6). Survival improved for OPC in men (from 13 to 44%) and vaginal cancer in women (from 45 to 73%).

HPV-related cancer patterns in Estonia are shifting from cervical to non-cervical cancers. Increasing oropharyngeal and anal cancer incidence highlights the need for prevention strategies beyond cervical screening alone. Strengthening HPV vaccination uptake and sustaining organized cervical screening are critical for reducing future cancer burden.

To determine whether repetition-based saccadic fatigability measured with three-dimensional video-oculography (VOG) distinguishes myasthenia gravis (MG) from unilateral ocular motor cranial nerve palsy (CNP) in patients with diplopia.

In this prospective cross-sectional diagnostic study conducted from August 2022 to July 2024, consecutive patients with MG or unilateral third, fourth, or sixth CNP, and healthy controls underwent repetitive horizontal and vertical saccade testing (±°15 targets; 75 cycles at 0.25 Hz). Prespecified index metrics were percentage change in saccadic range and time to target acquisition from the second saccade to the mean of the last five saccades. Diagnostic discrimination was assessed using receiver operating characteristic (ROC) curves.

The cohort comprised 231 participants: 93 with MG, 54 with CNP and 84 healthy controls. MG showed greater repetition-related range decrement and longer time to target acquisition than healthy controls and axis-matched CNP. In the horizontal comparison (MG vs. sixth CNP), AUCs were 0.800 for percentage range change and 0.787 for percentage time-to-target change. In the vertical comparison (MG vs. third/fourth CNP), percentage range change showed the best discrimination (AUC 0.868, 95% CI 0.783 to 0.934); a threshold of -5.95% yielded 79.6% sensitivity and 87.5% specificity. CNP showed early baseline slowing, whereas MG showed progressive hypometria with relatively preserved peak velocity.

Repetition-based VOG captures a dynamic fatigability signature in MG that differs from the more static deficit of unilateral ocular motor CNP. Quantitative saccadic fatigability may provide a useful objective adjunct to the neuro-ophthalmic evaluation of diplopia.

To compare follow-up preferences and health-related quality of life between newly operated endometrial cancer patients and those already enrolled in a traditional hospital-based follow-up program, and to explore whether preferences differ depending on follow-up experience. Patient/material and methods: In this prospective cross-sectional study, patients who underwent primary surgery for endometrial cancer in northern Sweden were included. Group 1 consisted of newly operated patients recruited before entering follow-up, and Group 2 included patients already participating in the standard hospital-based follow-up program. Participants completed questionnaires on sociodemographic characteristics, follow-up preferences, and quality of life (EORTC QLQ-C30). Clinical data were obtained from medical records. The primary outcome was follow-up preference; secondary outcomes included quality of life and associations with clinical and demographic variables.

Of the 121 invited patients, 92 (76%) responded, and 90 were included in the analysis (48 in Group 1; 42 in Group 2). The groups were comparable in baseline characteristics. Newly operated patients demonstrated more diverse follow-up preferences, with 51.1% preferring physician-led hospital visits compared to 82.9% in Group 2 (p = 0.035). Global quality of life did not differ significantly (p = 0.165), although Group 1 reported lower functional scores, particularly in role and emotional functioning. Appetite loss was the only symptom that differed significantly between groups.

Newly operated patients are more open to alternative follow-up models despite similar overall quality of life. Integrating patient preferences into follow-up care may enhance personalization and sustainability.

This study aims to evaluate the radiologic outcomes of lateral access corpectomy to identify perioperative predictors associated with mechanical failure.

We retrospectively reviewed 42 patients who underwent single-level lateral access corpectomy with posterior instrumentation between January 2019 and July 2024. Clinical indications included osteoporotic vertebral fractures (n = 23), spinal metastases (n = 10), and destructive spondylitis (n = 9). Radiologic parameters including total interbody height (TIH) and local segmental angle (SA) were assessed at each time point. Univariate and logistic regression analyses were performed to identify risk factors for mechanical failure.

Postoperatively, the mean TIH gain was 8.42 mm and the mean kyphosis correction was 9.85°. Mechanical failure occurred in 6 cases (14.3%), including pedicle screw pullout (n = 3), rod fracture (n = 1), and severe endplate destruction (n = 2). Logistic regression analysis identified short-segment fixation as a significant risk factor for mechanical failure (OR 8.00, 95% CI 1.19-53.93, p = 0.033). All mechanical failure cases occurred in patients with expandable cages. While expandable cages achieved greater initial TIH gain and kyphosis correction compared with mesh cages, they also demonstrated a greater degree of correction loss at final follow-up (TIH loss 6.62 mm vs. 3.93 mm, p = 0.061).

Among patients undergoing lateral access corpectomy, short-segment fixation was the only factor significantly associated with mechanical failure, and its combination with an expandable cage carried the highest failure rate. Given the small number of failure events, these findings are hypothesis-generating and suggest that long-segment fixation should be prioritized whenever clinically feasible.

Microwave ablation (MWA) has emerged as a minimally invasive alternative to surgery for selected patients with low-risk papillary thyroid carcinoma (PTC). While thyroid autoimmunity is frequently observed in PTC, the impact of preoperative thyroid autoantibodies (TAb) on post-ablation absorption kinetics remains unclear.

This retrospective study included 150 patients with PTC who underwent MWA between December 2019 and December 2024 with a median follow-up of 18 months (range: 6-54 months). Patients were categorized according to preoperative thyroid autoantibody status. Volume reduction rate, complete absorption rate, tumor recurrence rate, incidence of new nodules, and thyroid function were evaluated during follow-up. Kaplan-Meier analysis and Cox proportional hazards regression were used to assess factors associated with time to complete absorption.

During follow-up, ablation zone volume gradually decreased in all patients, but absorption was significantly slower in TAb-positive patients. The TAb-positive group exhibited a longer median time to complete absorption than the TAb-negative group (median: 30 vs. 19 months; log-rank p = 0.01). Subgroup analyses demonstrated that preoperative thyroglobulin antibody (TgAb) positivity, but not thyroid peroxidase antibody (TPOAb) positivity, was significantly associated with delayed absorption. TgAb positivity remained independently associated in multivariate Cox analysis (adjusted hazard ratio = 0.27; 95% confidence interval: 0.09-0.78; p = 0.015). No malignant recurrence occurred. TPOAb-positive patients showed a higher incidence of newly detected benign nodules. Thyroid function remained stable throughout follow-up.

Preoperative TgAb positivity is associated with delayed absorption of the ablation zone after MWA for PTC without compromising treatment completeness.

Aggressive angiomyxoma is a rare mesenchymal tumor involving soft tissue of the vulvovaginal and perineal region in females of reproductive age. A 42-year-old, para-2 female presented with an elongated swelling on the left labia majora for 10 years. She presented to us because she was feeling uncomfortable while sitting. Local examination showed an elongated mass measuring 8 x 6 cm in the longitudinal direction protruding from the lower part of the left labia majora. The mass was soft, spongy, and non-tender without any involvement of adjacent structures. Sonography of the local area showed an echogenic soft-tissue mass with increased color flow, likely a lipoma of the vulva. She underwent a wide local excision of the tumor. On histopathology, it was diagnosed as an aggressive angiomyxoma of the vulva. Angiomyxoma arises from the mesenchymal tissue, and it is locally invasive with a high recurrence rate. It has to be differentiated from Bartholin cyst, lipoma, Gartner cyst, and pelvic hernia. The diagnosis can be aided by imaging modalities such as ultrasonography, magnetic resonance imaging, and computed tomography. Wide excision is the treatment of choice. Histology, along with immunohistochemistry, can confirm the lesion. Long-term follow-up is needed as recurrences are high.

Ameloblastic carcinoma (AC) is a highly aggressive malignant odontogenic epithelial tumor. It may occur in a pre-existing ameloblastoma, odontogenic cyst, or de novo. The condition is typically painful, highly invasive, and multifocally metastasizing in nature, with the lungs being the most common secondary tumor site. The condition is most often encountered in adult men during the sixth decade, with a propensity towards the posterior mandible. Radiographic examinations typically exhibit ill-defined and aggressive lesions with massive bone loss. Histopathological examination shows classic cytonuclear atypia in the ameloblastic element. The immunohistochemical staining is generally found to be intense in markers such as Ki-67, p53, and p63. The majority of cases also carry mutations in the BRAF V600E gene. In this case report, we discuss the presentation pertaining to AC in a 29-year-old male patient, with an emphasis on the relevant clinical-radiological-pathological diagnostic aspects. The primary treatment of AC is surgical removal, occasionally in conjunction with dissection of the neck or radiation therapy to manage local and metastatic spread. In our case, surgical removal was performed. AC is a rare, aggressive, and invasive odontogenic epithelial malignant neoplasm. Further future studies regarding its pathogenesis, molecular genetics, and immunohistochemical aspects will help researchers in better understanding this novel entity.