With the increasing global burden of cancer, there is a growing need for innovative strategies to improve oncology care. Health-related quality of life (HRQoL) is an outcome measure for assessing the overall wellbeing of patients with cancer. We used machine learning to predict HRQoL and to identify key factors that can inform patient-centered cancer care.

We conducted a cross-sectional study enrolling patients diagnosed with lung, breast, or colorectal cancer across two provinces in China. We collected data on demographics, clinical characteristics, and patient-centered features. HRQoL was assessed using the widely accepted EQ-5D-5L instrument in cancer care. We trained and evaluated seven machine learning models. SHapley Additive exPlanations (SHAP) analysis was employed to assess feature importance.

Data from 924 patients with cancer were available. The random forest and extreme gradient boosting models had superior predictive performance. Positive SHAP values were primarily observed in patients with early-stage cancer and those enrolled in Urban Employees Basic Medical Insurance. Negative SHAP values were mainly associated with longer duration of chronic comorbidities, colorectal cancer, and ongoing chemotherapy. Age and time since cancer diagnosis exhibited bidirectional impacts.

Our study demonstrates the potential of machine learning models to predict HRQoL in patients with cancer. We identified key predictors of patient HRQoL, like duration of chronic comorbidities, early-stage cancer diagnosis, age, and health insurance coverage. Our findings would facilitate early identification of patients with lower HRQoL and promote the provision of patient-centered oncology care.

Neuro-immune interactions are critical in cancer, yet their molecular features in bladder cancer remain unclear. We analyzed transcriptomic data from TCGA and UCSC Xena to investigate the expression profiles and molecular subtypes of neuro-immune-related genes, and constructed a neuro-immune-related score (NAS) model. Single-cell transcriptomic data were integrated to explore the immune microenvironmental features, and functional validation was performed by knocking down SERPINE2 with shRNA in T24 cells. The results showed that six core genes (SERPINE2, NXPH4, SERPINB2, C2orf40, SERPINB12, SERPINB10) were identified to stratify patients into high- and low-risk groups, with robust predictive power across clinical subgroups and validation cohorts. Single-cell RNA-seq data revealed significant NAS heterogeneity among cell populations. The NAS-high state was enriched in TGFβ, EGF, and FGF signaling with activation of EZH2 and SMARCA4, while the NAS-low state showed immune-regulatory features. Functional assays confirmed that SERPINE2 knockdown suppressed proliferation, migration, invasion, while increasing apoptosis of T24 cells, highlighting its oncogenic role. Moreover, genome-wide association studies (GWAS) suggested that genetic variants in SERPINE2 and related genes may increase bladder cancer susceptibility. Collectively, our findings provide novel insights into neuro-immune-driven tumor heterogeneity and immune remodeling, establish the NAS model as an innovative prognostic tool, and identify SERPINE2 as a promising therapeutic target for precision management of bladder cancer.

Swallowing dysfunction (dysphagia) is a devastating and highly prevalent sequela following radiotherapy (RT) for head and neck cancer (HNC), severely impairing patients' quality of life and nutritional status. While rehabilitation is the cornerstone of management, the translation of evidence into effective clinical practice is hampered by significant heterogeneity in interventions, conflicting outcomes, and poor adherence.

This narrative review critically synthesizes current evidence from systematic reviews, randomized controlled trials, and prospective cohort studies published between January 2015 and March 2025. A structured literature search was conducted in the PubMed, Web of science and Embase databases using combinations of keywords including "head and neck neoplasms," "dysphagia," "radiotherapy," "rehabilitation," "swallowing exercises," "adherence," "frailty," and "precision medicine." The selection focused on high-impact studies that addressed key challenges, controversies, and emerging paradigms in the field. It moves beyond a descriptive summary to evaluate the contradictions in the literature and propose a framework for precision rehabilitation.

The efficacy of swallowing exercises is well-documented, but critical controversies persist. These include the optimal timing (prophylactic vs. reactive), the superiority of specific exercise regimens, and the unpredictable impact of radiotherapy dose constraints on functional outcomes beyond traditional pharyngeal constrictors. A pivotal, yet often overlooked, factor is patient adherence, which is multifactorial and can be improved through behavioral change techniques and technology-assisted strategies (e.g., mHealth, wearable sensors). Furthermore, emerging evidence highlights the need to consider specific patient phenotypes, such as pre-treatment frailty and the presence of internal lymphedema, which significantly influence rehabilitation success. The integration of objective assessments (e.g., HRM, DIGEST) is crucial for quantifying dysfunction and tailoring interventions.

The field of dysphagia rehabilitation in HNC is evolving from a one-size- fits-all approach towards precision medicine. Future efforts must focus on developing personalized rehabilitation pathways based on individual risk stratification (e.g., frailty, dose to specific musculature), integrating technology for monitoring and motivation, and fostering interdisciplinary collaboration among oncologists, speech-language pathologists, and behavioral scientists to bridge the gap between research evidence and lasting functional recovery.

This study aims to develop a comprehensive physical activity (PA) intervention tailored for overweight and obese patients with endometrial cancer (EC). It integrates theoretical frameworks, empirical evidence, expert opinions, and stakeholder perspectives to assist clinical providers in implementing standardized PA guidelines.

Obesity is a significant risk factor for EC and is closely linked to treatment outcomes. Although previous studies have focused on the role of PA in weight loss and survival, they lack detailed, evidence-based guidance specifically tailored for EC patients.

We developed a PA instruction program using the Evidence-Based Nursing Practice Pathway and the Medical Research Council's Framework for Complex Interventions. The development process consisted of three phases: a preparatory phase, the development and implementation of evidence-based interventions, and the refinement of the program through Delphi consultation.

The program framework was developed using multiple methods, including evidence searches (guidelines and expert consensus), semistructured interviews, and expert consultations. It encompasses preinstruction, implementation methods, and strategies for maintaining PA. Instructional materials such as posters, brochures, videos, and checklists were created to facilitate clinical integration.

This study is the first to develop a tailored PA program for overweight EC patients. The rigorous design, based on complex intervention frameworks and expert input, has the potential to improve clinical practice, enhance tumor remission rates, and improve fertility outcomes.

Utilizing the MRC framework, this study integrated evidence and stakeholder feedback to develop a tailored intervention program. It aims to increase PA among overweight and obese EC patients by providing educational materials for clinicians and patients, thereby promoting its adoption in clinical practice. Trial Registration: ClinicalTrials.gov_identifier: NCT06312917.

Cell surface receptors play vital roles in cancer growth and metastasis. Integrin αvβ3 is overexpressed in various cancer cells and interacts with different growth factors to stimulate cancer progression. Thyroid hormone binds to αvβ3 to activate signal transduction and cell proliferation. However, thyroxine (T₄) deaminated analogue, tetraiodothyronine (tetrac), competes for the binding on integrin and inhibits cancer cell growth and metastasis. The current study investigated the pathogenic role of integrin αvβ3 and the potential of a novel therapeutic strategy targeted to integrin αvβ3. Pathogenetic studies of clinical samples revealed integrin αvβ3 cross-talked with EGFR and downstream signal transduction networks affected by thyroid hormone and EGF related to the progression of cholangiocarcinoma malignancy. Thyroxine and EGF stimulated PD-Ligand 1 (PD-L1) expression and cancer growth in cholangiocarcinoma. The thyroxine-induced PD-L1 accumulated in the nuclei and colocalized with p300. Alternatively, EGF increased cytosolic PD-L1 and nuclear accumulation of β-catenin. Targeting integrin αvβ3 with lipo-tetrac and its Dox-derivative induced anti-proliferation in vitro and in the xenografted animal model. Our research provides a fundamental understanding of the therapeutic role of integrin αvβ3 and the potential therapeutic approach in cholangiocarcinoma treatment.

Cervical cancer, a serious gynecological malignancy, often leads to poor patient prognosis due to distant metastasis. The metastasis mechanism is not fully understood. This study explores the link between gene mutations and distant metastasis in cervical cancer. PDGFRA, TP53, and PIK3CA mutations significantly influence metastasis. Despite its low incidence, PDGFRA mutation is closely tied to lymph node and distant metastasis. TP53 mutation disrupts p53 protein function, promoting tumor cell proliferation, inhibiting apoptosis, and enhancing metastasis. PIK3CA mutation activates the PI3K/Akt pathway, stimulating cell proliferation and migration. Detecting these mutations is crucial for diagnosing distant metastasis. It helps identify high-risk patients early, improving diagnostic accuracy and specificity, and guiding clinical treatment decisions. Targeted therapies for PDGFRA and PIK3CA mutations can control tumor growth and metastasis but face challenges like drug resistance and high costs. This study offers a new theoretical basis and treatment strategy for cervical cancer, pointing to future research directions. Gene mutation detection enhances early identification of high-risk patients, improving diagnostic accuracy. Targeted therapies for PDGFRA and PIK3CA mutations control tumor growth but face drug resistance and cost issues. This study provides a new theoretical basis and treatment strategy for cervical cancer, guiding future research.

Triple-negative breast cancer (TNBC) is an aggressive subtype lacking targetable hormone receptors, making conventional chemotherapy the primary treatment option, despite its associated toxicity and potential for drug resistance. Melatonin, a natural hormone with anticancer and immunomodulatory properties, has shown promise in multiple cancers; however, its role in TNBC remains unclear.

We analyzed serum melatonin levels in TNBC patients and healthy controls. The biological effects of melatonin were then evaluated in human (MDA-MB-231, MDA-MB-468) and murine (4T1) TNBC cell lines. In vitro assays assessed proliferation, apoptosis, migration, epithelial-mesenchymal transition (EMT), and chemosensitization. Mechanistic pathways were analyzed, and an orthotopic 4T1 syngeneic mouse model was employed to confirm antitumor and immunomodulatory effects in vivo.

We found that TNBC patients had significantly lower serum melatonin levels than healthy controls. In vitro, melatonin reduced cell viability, migration, and tumorsphere formation, and promoted apoptosis. Mechanistically, it downregulated focal adhesion kinase (FAK) and programmed death-ligand 1 (PD-L1). FAK inhibition increased melatonin sensitivity, whereas FAK overexpression conferred resistance. Melatonin also enhanced cisplatin cytotoxicity. In vivo, melatonin treatment suppressed tumor growth, increased CD8⁺ T-cell infiltration, and decreased PD-L1 expression and the number of FOXP3⁺ regulatory T cells in the tumor microenvironment.

Melatonin suppresses TNBC progression by inhibiting proliferation and migration and by modulating the immune microenvironment through the FAK-PD-L1 axis. These findings highlight melatonin as a potential low-toxicity adjunct to enhance the efficacy of current TNBC therapies.

To report a rare case of giant mediastinal desmoid-type fibromatosis (DTF) in the puerperium, with emphasis on the challenges of determining optimal surgical timing in the early postpartum period.

Retrospectively analyzed clinical data of a 25-year-old postpartum woman with giant mediastinal DTF presenting with chest pain, dyspnea, and dysphagia after cesarean section. Imaging revealed a massive tumor causing severe cardiac and pulmonary compression. The patient underwent surgical resection 27 days postpartum.

The successfully resected tumor weighed approximately 5.5 kg. Postoperative pathology confirmed DTF. The patient recovered well without serious complications.

Giant mediastinal DTF in the puerperium is extremely rare and presents significant surgical challenges. For postpartum cases presenting with severe compressive symptoms, individualized assessment of surgical timing is crucial, weighing the risks of early postpartum intervention against potential life-threatening cardiopulmonary compromise. Multidisciplinary collaboration is key to successful management.

Spigelman stage IV duodenal polyposis (SP-stage IV DP) is associated with high duodenal cancer risk in patients with familial adenomatous polyposis (FAP). This study evaluated the surgical and oncological outcomes of pancreas-sparing total duodenectomy (PSTD) as a surgical prophylaxis for severe duodenal polyposis in FAP.

Medical records were reviewed to evaluate factors concerning short- and long-term clinical and oncological outcomes in consecutive patients with FAP who underwent PSTD for SP-stage IV DP.

There were twenty-seven patients (median age: 48 years) from 26 families, of whom 12 were female. Clavien-Dindo grade IIIa/IIIb complications included delayed gastric emptying (n = 14) and pancreatic fistula (n = 10); no mortalities were observed. Histopathological examinations revealed no malignant neoplasms deeper than T1a in the duodenum and ampulla. Follow-up (median 6.4 years) revealed anastomotic stricture of the reconstructed neo-common channel (n = 5), anastomotic ulcer of the gastrojejunostomy site (n = 5), acute pancreatitis (n = 4), and acute cholangitis (n = 2), all of which were successfully treated endoscopically or conservatively. Malignant neoplasms after PSTD included gastric cancer (n = 3), remnant ano-rectal cancer (n = 3), ileal cancer (n = 1), ileal pouch cancer (n = 1), and endometrial cancer (n = 1). The cumulative 10-year survival rate following PSTD was 87.4%.

PSTD for the prophylactic management of SP-stage IV DP was associated with notable but manageable postoperative morbidity. Long-term surveillance remains essential for the development of extraduodenal malignancies to confirm the oncological efficacy of this type of surgery.

Natural orifice specimen extraction (NOSE) in colon cancer surgery raises concerns about intra-abdominal infection, peritoneal seeding, and local recurrence due to possible tumor cell implantation. This systematic review and meta-analysis compares complete intracorporeal resection with NOSE versus conventional laparoscopic colon resection, focusing on short-term outcomes and long-term oncological safety.

A systematic literature search was conducted for English-language human studies published until April 2025. Meta-analyses were performed. They evaluated postoperative outcomes that included operative time, intraoperative blood loss, overall morbidity, severe morbidity, time to first flatus, and length of hospital stay. Oncological outcomes included local and overall recurrence rates.

A total of 15 studies met the inclusion criteria, comprising 3 randomized controlled trials and 12 retrospective studies, involving 1683 patients, 733 in the NOSE group and 950 in the conventional group. Pooled analyses demonstrated significantly reduced intraoperative blood loss, lower overall postoperative morbidity, and shorter time to first flatus and postoperative hospital stay in the NOSE group. However, operative time was significantly longer in the NOSE group. The average of median follow-up periods across studies was 38.9 months, and no significant differences were observed between the two groups in terms of oncological outcomes.

This study supports NOSE as a practical and effective surgical approach in selected patients with colon cancer. It offers significant benefits, including fewer postoperative complications and faster patient recovery, while maintaining oncological outcomes comparable to conventional techniques. NOSE should be considered in clinical practice, tailored to patient preferences and individual clinical factors.