Objective: To explore the clinical characteristics and prognosis of acute erythroid leukemia (AEL). Methods: A retrospective case series study was conducted. Clinical data from 23 patients with AEL admitted to the Department of Hematology at the First Affiliated Hospital of Nanjing Medical University from January 2015 to May 2025 were collected. Laboratory features and prognostic outcomes were summarized. Overall survival (OS) was analyzed using the Kaplan-Meier method, and log-rank test was used for comparisons between groups. Results: Among the 23 patients with AEL, 13 were male (56.5%) and 10 were female (43.5%), with a median age of 62 years (range: 13-80 years). Of these patients, 10 (43.5%) had primary AEL, 5 (21.7%) had treatment-related AEL, and 8 (34.8%) had AEL secondary to other myeloid diseases. Among the secondary AEL cases, 5 were associated with myelodysplastic syndrome, 2 with chronic myeloid leukemia, and 1 with aplastic anemia. Regarding TP53 abnormalities, 38.1% (8/21) of patients had TP53 deletions, and among the 16 patients who underwent next-generation sequencing, all had TP53 mutations. The most frequent TP53 mutation sites were R248Q/W/L/P (3/16), H193R/D/L (2/16), and C242 frameshift mutations (2/16). The median OS was 1.23 months (range: 0.27-13.53 months). The median OS was 1.00 month (95%CI 0.77-1.23) in patients with TP53 mutation frequency >40% (n=8), compared with 3.07 months (95%CI 0-6.81) in those with TP53 mutation frequency ≤40% (n=8). The difference in OS between the two groups was statistically significant (χ²=7.65, P=0.006). There was no statistically significant difference in OS between patients receiving intensive chemotherapy and those receiving low-intensity chemotherapy (P=0.161). The median OS was 2.20 months (95%CI 1.06-3.34) in the primary group, 7.20 months (95%CI 0-20.01) in the treatment-related group, and 0.93 months (95%CI 0.66-1.21) in the secondary group. Survival differed significantly among the three etiological groups (χ²=11.53, P=0.003). Conclusion: AEL is a subtype of acute myeloid leukemia with extremely poor prognosis that is highly associated with TP53 gene abnormalities.

Objective: To characterize the longitudinal evolution of thyroid nodules across ultrasound-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) categories with respect to nodule size, ultrasonographic features, and the presence of abnormal cervical lymph nodes. Methods: A single-center retrospective cohort study. Clinical and follow-up data were collected for patients with thyroid nodules who initially attended the Endocrinology Outpatient Clinic of the First Medical Center of Chinese PLA General Hospital from January 2018 to March 2022 (the first month of each quarter served as the enrollment period). Collected variables included gender, age, nodule size, number of nodules, and ultrasonographic features. Nodules were classified according to the ACR-TIRADS criteria. Generalized estimating equations were used to compare changes in indicators such as nodule size and ultrasonographic features during follow-up. Results: In total, 5 467 patients with 12 668 nodules were included. The mean age of the enrolled patients was (49.6±13.0) years, and 76.2% (4 164/5 467) were female. Multiple nodules were present in 83.7% (4 575/5 467) of patients. Among the 12 668 nodules at baseline, the proportions of nodules in ACR-TIRADS categories 1-2, 3, 4, and 5 were 70.7% (8 957/12 668), 19.6% (2 485/12 668), 6.1% (769/12 668), and 3.6% (457/12 668), respectively. The mean follow-up duration was (48.2±3.8) months. During follow-up, regardless of the ACR-TIRADS category, only 25.6% (3 246/12 668) of nodules showed significant enlargement, and most remained stable in size. The difference in nodule size changes across different ACR-TIRADS categories was statistically significant (Wald χ²=126.37, P<0.001). ACR-TIRADS category 5 nodules had the highest proportion of stable size, reaching 75.7% (346/457), while ACR-TIRADS category 3 nodules had the highest proportion of enlargement (29.2%, 726/2 485). Overall, 12.7% (1 605/12 668) and 3.9% (490/12 668) of nodules were upgraded or downgraded, respectively, due to changes in ultrasonographic features. The difference in ultrasonographic feature changes across different categories was statistically significant (Wald χ²=1 872.45, P<0.001). The highest rates of classification upgrade and downgrade were observed in ACR-TIRADS category 4 nodules (25.9%, 199/769) and category 5 nodules (21.4%, 98/457), respectively; ACR-TIRADS categories 1-2 nodules had the highest proportion of stable classification (87.4%, 7 826/8 957). During follow-up, the papillary thyroid carcinoma (PTC) detection rates for nodules that underwent fine-needle aspiration biopsy due to simple enlargement, classification upgrade alone, or enlargement combined with classification upgrade were 21.8% (47/216), 35.7% (71/199), and 41.8% (41/98), respectively. The overall difference in PTC detection rates among the three biopsy indications was statistically significant (Wald χ²=18.62, P<0.001), and the detection risk showed a significant increasing trend with the elevation of ACR-TIRADS category, with the highest risk observed in the enlargement combined with classification upgrade (OR=2.78, 95%CI 2.15-3.59, P<0.001). Among the 5 467 patients with thyroid nodules, 102 had abnormal cervical lymph nodes on ultrasound at baseline. During follow-up, abnormal lymph nodes resolved spontaneously in 42 cases, while 53 patients developed new abnormal lymph nodes. Conclusions: For thyroid nodules with different ultrasound-based ACR-TIRADS categories, most clinical characteristics including nodule size and ultrasonographic features remain stable during approximately 4 years of follow-up. The overall incidence of abnormal cervical lymph nodes is low and some can resolve spontaneously. Both nodule enlargement and classification upgrade indicate an increased probability of malignancy of thyroid nodules, and the malignant risk is higher when ACR-TIRADS classification upgrade occurs alone or in combination with nodule enlargement.

Objective: To analyze the oncological outcomes of transoral laser microsurgery (TLM) for T1b glottic carcinoma and to investigate the impact of anterior commissure (AC) involvement on prognosis. Methods: This retrospective case series study included 107 patients with T1b glottic carcinoma who underwent TLM at the Department of Otorhinolaryngology, Second Affiliated Hospital of Zhejiang University School of Medicine, from January 1, 2012, to June 30, 2024. The cohort comprised 101 males and 6 females, aged from 43 to 85 years (median age, 64 years), with a follow-up duration of 12.0 to 146.6 months (median follow-up, 34.6 months). Patients were stratified by AC involvement grade (AC0-3: 19, 24, 39, and 25 cases, respectively). The primary endpoints were the 3-year and 5-year local control rate (LCR) and disease-specific survival (DSS). Statistical analysis was performed using SPSS software (version 25.0). Results: Among the 107 patients, the overall 3 year and 5 year LCR were 93.1% and 86.6%, respectively; the corresponding DSS rates were 99.1% and 95.7%. Tumor recurrence occurred in 9 patients, showing an increasing trend with higher AC grades. The 5 year LCR for AC0, AC1, AC2, and AC3 was 94.4%, 95.7%, 87.3%, and 61.3%, respectively. Of the 9 recurrent patients, 7 underwent re-TLM, and 2 died of the disease. No severe complications occurred. Anterior commissure thickness was significantly correlated with tumor recurrence (t=-2.181, P=0.032). Postoperative complications included vocal cord leukoplakia (n=7), vocal cord adhesion (n=6), and persistent granulation tissue (n=4), all managed with secondary surgery. Staged surgery was performed in 10 patients, and ventricular band mucosal flaps were applied in 15 patients. Conclusion: TLM demonstrates favorable oncological efficacy in the treatment of T1b glottic carcinoma. TLM should be used with caution in patients with severe AC involvement. Although LCR tends to decrease with higher AC grades, this trend lacks statistical significance, and the conclusion awaits further validation.

South Asia bears a high cancer burden, low universal health coverage and high out-of-pocket expenditure. Access to anticancer medicines is challenging and is influenced by determinants-National Essential Medicines List (NEML), registration and local production-yet these are rarely evaluated. This study evaluates these determinants in eight South Asian countries.

Multimethod study using a document analysis phase and semistructured interviews.

Eight South Asian countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) for document analysis, with stakeholder interviews conducted in six countries, excluding Bhutan and Maldives.

Data were collected from eight regulatory authorities and 30 interviews with drug supply chain stakeholders across six South Asian countries.

The inclusion of 67 anticancer medicines from the 2023 WHO Essential Medicines List (EML) into NEML, their registration and local production, along with macrolevel indicators and stakeholders' perspectives regarding them.

The median number of medicines included in NEMLs, registered and locally produced was 23.5, 45 and 6.5, respectively. Local production correlated positively with NEML inclusion (ρ=0.884, p=0.004) and negatively with healthcare expenditure (r = -0.732, p=0.039). Three countries listed >50% of the WHO EML medicines on their NEMLs; six had >50% registered. Local production remained limited, with imports dominating supply. Qualitative analysis identified three key barriers to improving availability: financial constraints, a weak regulatory system and insufficient strategic planning.

Access to anticancer medicines is constrained by systemic misalignment between NEML inclusion, registration and local production, undermined by weak regulatory coordination, limited strategic planning and financial constraints. Strengthening regulatory coordination, improving registration efficiency and supporting regional production strategies aligned with guided WHO guidance may help improve equitable access to cancer medicines in the region.

BackgroundLung adenocarcinoma is a multifaceted disease with diverse locations and timings of gene mutations, histology, and molecular pathogenesis. Thus, identifying therapeutic target genes for lung adenocarcinoma has become a major challenge.MethodWe downloaded the gene expression profiles of 220 patients with lung adenocarcinoma from the Gene Expression Omnibus database and identified the differentially expressed genes between noncancer tissue and cancer tissue groups. Mendelian randomization analysis was performed using the exposure gene expression quantitative trait locus dataset and outcome dataset (ieu-a-965) to obtain genome-wide association studies summary data. Sensitivity analysis was used to assess the presence of pleiotropy and heterogeneity in the instrumental variables. Additionally, we performed Mendelian randomization analysis to explore the potential intersecting genes between differentially expressed and specific genes. Moreover, gene set enrichment and overall survival analyses were performed on the intersection gene.ResultsWe combined Gene Expression Omnibus and genome-wide association studies data to identify one upregulated and two downregulated genes associated with lung adenocarcinoma risk using inverse variance weight analysis as the primary analytical method. We observed that survival was significantly higher in the groups with high expressions of ANGPT1 and CD36 than in those with low expressions of these genes. POU2AF1 demonstrated inconsistency with the results obtained using Kaplan-Meier analysis and lacked statistical significance in the GSE130779 cohort.ConclusionOur results confirmed two specific target genes, CD36 and ANGPT1, based on Mendelian randomization analysis, providing new insights into the role of these target genes in mediating the development of lung adenocarcinoma.

People with CNS cancer and their caregivers need and deserve not only innovative cancer-directed care but also high-quality person-centered care for navigating living their lives in the face of their cancer diagnosis and treatment. Palliative care aims to be an extra layer of support for people with cancer and their caregivers by focusing on what matters most to them and helping people live as well as they can for as long as they can. Palliative care is appropriate starting from time of diagnosis when many palliative care needs begin and is most beneficial when integrated earlier in the disease trajectory, yet the provision of palliative care remains underutilized in neuro-oncology. Centered on illness experience and the multidimensional composition of a person's biological, psychological, and social factors, palliative care is an approach to person-centered care focused on optimizing management of distress arising from physical, psychological, social, existential, and spiritual concerns to reduce and mitigate suffering while promoting coping, patient autonomy, choice, and access to information per the values, goals, priorities, beliefs, and culture of the patient, caregiver, and family members. Fundamental aspects of palliative care, referred to as primary palliative care, should be provided by all clinicians, with specialty palliative care clinicians augmenting as needed where available. In this article, teachable, learnable, and adaptable serious illness communication frameworks leveraged in the palliative care approach are featured in two vignettes. The use of these serious illness communication frameworks actualizes the translation of cancer science into high-quality person-centered cancer care.

The treatment of adults with Philadelphia chromosome-positive ALL (Ph+ ALL) has evolved significantly over the past 25 years. These changes have been driven largely by the development of potent BCR::ABL1 tyrosine kinase inhibitors (TKIs) such as ponatinib, more accurate risk stratification and monitoring of measurable residual disease (MRD) and, most recently, the frontline use of blinatumomab-based, chemotherapy-free regimens. Although the historical standard of care for newly diagnosed Ph+ ALL was intensive chemotherapy followed by allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in first remission, now most patients can achieve deep and durable remissions-and even cure-with a chemotherapy-free regimen, without the routine need for allo-HSCT. Although the role of allo-HSCT in first remission is diminishing in this new treatment landscape, allo-HSCT remains a reasonable consolidative option for patients with high-risk clinical or molecular features or in treatment settings where frontline blinatumomab and/or high-sensitivity MRD monitoring are not routinely available. With optimal frontline therapy and close disease monitoring, relapses of Ph+ ALL are increasingly uncommon but still pose a significant clinical challenge. Several new agents, including novel TKIs, bispecific antibodies, and chimeric antigen receptor T-cell therapies, are being evaluated in the relapsed/refractory setting and may eventually also play a role in frontline treatment of this disease.

Ordinary differential equation mathematical models of tumor volume dynamics can accurately describe tumor growth and treatment response. Here, we extend such continuous models to also simulate outcomes. We conceptualize post-treatment viable tumor burden distributions across a treatment population and a novel model of tumor regrowth that can simulate population-level recurrence patterns.

We use a mathematical model of tumor regrowth dynamics that is attenuated by a minimum viable tumor burden threshold (ε_V) below which the tumor will be cured. Tumor regrowth is simulated until the tumor burden exceeds a detection threshold (ω_d), which allows for the modeling of Kaplan-Meier curves.

We then explore the effect of the different model parameters and growth laws on the shapes of simulated Kaplan-Meier curves and demonstrate how this model can be used to further our understanding of clinical trial results. We also present qualitative fitting of this model to real-world recurrence data from a clinical trial comparing different radiation therapy protocols in head and neck cancer (RTOG 9003).

The theoretical framework described in this brief report provides a means to connect models of tumor dynamics to recurrence patterns. We foresee that it will also provide a new methodology for interpreting the shapes of Kaplan-Meier curves and provide insights as to why particular clinical trials failed and guide how to redesign them for success.

Wearable devices are becoming more ubiquitous and are capable of capturing health-relevant information that patients may be interested in sharing with their providers. However, limited research has been conducted on oncology provider perspectives on how these data could be used to inform cancer care.

The goal of this study was to understand oncology clinicians' preferences about which data would be most clinically valuable and in what clinical scenarios, the benefits and barriers to integrating wearable device data into cancer care, and perspectives on how wearable device data could impact decision-making using 3 clinical vignettes.

A total of 13 oncology care clinicians completed an online questionnaire to assess the perceived value of different types of wearable device data in different clinical scenarios and participated in semistructured interviews to gather preferences around integrating these data into clinical workflows. During the interviews, providers were also presented with 3 clinical vignettes and asked for clinical recommendations both before and after seeing the patient's wearable device data. Descriptive statistics were calculated to summarize quantitative data from questionnaires and structured interview questions, and interviews were transcribed and coded using an iterative thematic analysis approach.

Survey responses indicated that providers were most interested in tracking vital sign metrics, followed by data related to falls and functioning, and then by data on sleep and activity. Clinicians thought that wearable device data might be especially useful for remotely monitoring patients at high-risk moments in their care trajectory, such as after an acute hospitalization or after starting a new outpatient treatment. Four main themes were discussed by providers in the interviews: (1) corroborating reports, (2) identifying new issues, (3) coordinating care, and (4) patient-provider communication. Although there were no statistically significant differences in clinical recommendations before and after viewing wearable device data for any vignette (all P>.25), all clinicians reported that the wearable device data impacted their decision-making confidence, and most rated the wearable device data as helpful.

Oncology providers highlighted the potential clinical value of vital sign and physical functioning data from wearable devices, particularly when outpatients might be at risk for readmissions or other acute deteriorations between clinic visits. Providers noted that the objective data captured by consumer wearable devices can be helpful complements to patient and caregiver subjective reports and that this information could improve patient-provider communication and care coordination. During the interviews, most providers found wearable device data to be helpful when making decisions. While there are challenges to address on how to integrate this information into the clinical workflow and communicate alerts with patients, there is cautious enthusiasm among clinicians about how these data could inform and improve cancer care.