Accurate prognostication of malignant pleural effusion (MPE) is essential to guide management decisions and provide patients with meaningful survival estimates. LENT and PROMISE scores are widely recognised MPE-specific prognostic tools, although with limited uptake in clinical practice. More objective, serum-based indices such as the Prognostic Index for Cancer Outcomes (PICO) and Modified Glasgow Prognostic Score (mGPS) have shown robust prognostic value in oncology and may offer advantages by allowing reproducible, treatment-responsive reassessment.

Retrospective cohort study including patients with MPE, defined by cytological and/or histopathological confirmation, between 2012-2022 at a Portuguese tertiary hospital. Demographic, clinical and biochemical data were extracted from medical records, enabling calculation of LENT, PROMISE, mGPS and PICO scores, as well as a novel serum-based index (SIMPLE).

678 patients were included in the cohort. LENT and PROMISE prognostic scoring models underperformed when compared with their serum-based counterparts. PROMISE showed the lowest area under the curve [AUC = 0.735 (95% CI 0.675-0.794)], followed by LENT [AUC = 0.758 (95% CI 0.710-0.808)], PICO [AUC = 0.781 (95% CI 0.725-0.837)] and mGPS [AUC = 0.819 (95% CI 0.745-0.893)]. The most significant serum-based factors (albumin, white blood cell counts and C-reactive protein) were selected for a new prognostic model. SIMPLE showed the highest numerical discriminatory performance [AUC = 0.852 (95% CI 0.782-0.921)], statistically outperforming MPE-specific scores, while demonstrating comparable discrimination to general oncology scores.

SIMPLE is a promising, accessible prognostic tool for patients with MPE, demonstrating strong discriminatory performance and outperforming LENT and PROMISE in our sample. External validation is required before routine clinical implementation.

We sought to assess the real-world impact of the Genius Digital Diagnostics System (Genius Dx [Hologic, Inc]) on workload, efficiency, and turnaround time in a high-volume cervical cytology laboratory.

The laboratory information system was retrospectively queried for all Papanicolaou test cases performed between January 1, 2023, and March 31, 2025. A total of 512 177 cases (655 468 reviews) were included. Genius Dx was implemented on August 1, 2024, and cases were classified as preimplementation or postimplementation. Daily caseload, number of reviewers, number of cases per reviewer, and accession-to-sign-out times were compared using independent-samples t tests. Diagnostic distributions were compared using ꭓ2 tests.

Average daily cytologist (CT) reviews were similar before and after Genius Dx (747.8 vs 758.4 cases) but required fewer CTs per day (10.4 vs 8.1; P < .001), increasing cases per CT per day from 74.5 to 94.7 (P < .001). Pathologist reviews per day increased (106.0 vs 145.3; P < .001) with fewer pathologists (4.4 vs 3.4; P < .001). Average daily CT case workload increased by 53.5% after implementation. Accession-to-sign-out times decreased for all diagnoses (P < .001). A small but statistically significant shift in diagnostic proportions was observed, with a decrease in negative results and an increase in atypical squamous cells of uncertain significance or higher (ASC-US+) findings with negligible effect size.

Implementation of Genius Dx substantially increased reviewer efficiency and reduced turnaround times without compromising diagnostic performance. The increased detection of ASC-US+ findings observed in this study are in line with results from the Genius Dx clinical trial and other published literature.

The molecular subtype characterized by co-occurring MYD88 and CD79B alterations (MCD) represents a biologically distinct subset of diffuse large B-cell lymphoma (DLBCL) with chronic active B-cell receptor signaling and a high risk of central nervous system (CNS) involvement. The clinical impact of Bruton tyrosine kinase inhibitors (BTKi) in this subtype remains unclear. We retrospectively analyzed 155 patients with newly diagnosed DLBCL harboring genetic features consistent with the MCD subtype. At a median follow-up of 34.1 months, the estimated 3-year progression-free survival (PFS) rate was 76.1%. BTKi exposure (n = 56) was associated with significantly improved PFS compared with no BTKi exposure (3-year PFS: 93.8% vs. 66.6%, p < 0.001) and remained independently associated with improved PFS after adjustment for IPI risk (HR 0.16, p < 0.001). Overall survival did not differ significantly between groups. Notably, all 15 CNS relapse events occurred in patients who did not receive BTKi, whereas no CNS relapse was observed in the BTKi-treated group. BTKi exposure was independently associated with a markedly reduced risk of CNS relapse (HR 0.06, p = 0.002) after adjustment for CNS-IPI risk and CNS prophylaxis. These findings suggest that BTK inhibition may improve outcomes and mitigate CNS relapse in MCD DLBCL.

The Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) supports the management and operations of central cancer registries (registries) across the United States through funding and technical assistance (TA).

To examine barriers and facilitators to program evaluation among NPCR-funded cancer registries, assess registries' TA needs related to evaluation and implementation, and evaluate satisfaction with CDC-provided TA.

We used a mixed-methods approach. Quantitative analysis examined 114 TA requests submitted between June 2022 and September 2023 through an administrative TA management platform. Qualitative data were collected during routine monthly check-in calls with 23 registries from October 2023 to January 2024, during which evaluators facilitated conversations on program evaluation experiences, TA needs, and satisfaction.

TA requests submitted by 32 cancer registries and routine check-in calls with 23 registries, representing 38 unique registries across data sources.

Cancer registry program evaluation barriers and facilitators, TA needs, and satisfaction with CDC-provided TA.

Most TA requests addressed operations and reporting (69.3%), followed by data submission (15.8%), evaluation and data management plans (8.8%), education and training (5.3%), and registry software/informatics (0.9%). Among resolved requests, more than 75% were addressed within 7 days. Qualitative findings indicated that registries were generally satisfied with TA timeliness and quality. Barriers to program evaluation included limited resources, insufficient training, and leadership transitions. Facilitators included adequate staffing and funding, evaluation competency, strong partnerships, and effective registry operations. Registries identified overlapping TA needs related to organizational support, targeted expertise, guidance and expectations, training, technical infrastructure, and peer learning.

Program evaluation capacity within cancer registries is shaped by resources, training, partnerships, and operational context. Findings highlight opportunities for TA providers to strengthen evaluation through targeted training, clearer guidance, and peer learning to support consistent program implementation across multisite public health programs.

Lung cancer screening has demonstrated survival benefits among heavy smokers, forming the basis of current age- and smoking intensity-based eligibility criteria. However, applicability of these criteria in Asia remains uncertain, where many cases occur outside current criteria, including among persons with no smoking history.

To evaluate the proportions, characteristics, and survival outcomes of Korean patients with lung cancer according to international screening eligibility.

This nationwide, population-based cohort study included individuals newly diagnosed with lung cancer in Korea between 2013 and 2018, prior to implementation of the national lung cancer screening program. Participants were followed up until December 31, 2021. Patients were classified as meeting the 2023 American Cancer Society screening eligibility criteria (aged 50-80 years with a smoking history of ≥20 pack-years [PY]) were compared with individuals with less than 20 PY, and persons with no smoking history within the same age range. Data were analyzed from August to December 2025.

Age and smoking intensity in PY.

The primary outcome was all-cause mortality. Lung cancer-specific mortality was evaluated as a secondary outcome.

Of 89 860 patients with lung cancer (mean [SD] age at diagnosis 67.8 [10.2]; 63 003 [70.1%] male), 31 804 (35.4%) met screening eligibility criteria, 39 627 (44.1%) had no smoking history, and 4232 (4.7%) were aged younger than 50 years. Among individuals aged 50 to 80 years, screening eligibility differed markedly by sex, with 31 277 men (56.8%) and 527 women (2.3%) meeting the screening criteria. Distant metastatic disease was present in 13 023 patients (40.9%) in the screening-eligible group, 5233 patients (41.1%) with less than 20 PY, and 12 192 patients (36.9%) with no smoking history. Compared with the screening-eligible group, risks of both all-cause and lung cancer-specific mortality were significantly lower among individuals with less than 20 PY of smoking (all-cause mortality: adjusted hazard ratio [aHR], 0.95; 95% CI, 0.93-0.98; lung cancer-specific mortality: adjusted subdistribution HR [aSHR], 0.96; 95% CI, 0.93-0.99) and individuals with no smoking history (all-cause mortality: aHR, 0.86; 95% CI, 0.84-0.88; lung cancer-specific mortality: aSHR, 0.86; 95% CI, 0.84-0.88) aged 50 to 80 years.

In this cohort study of Korean patients with lung cancer, international screening guidelines excluded 64.6% of patients, a substantial proportion of whom had no smoking history. Ineligible patients had lower mortality risk than screening-eligible patients. These findings suggest that population-specific strategies are needed to improve early detection among individuals not captured by current screening criteria.

Black men are more than 2 times more likely to die of prostate cancer than White men. Identifying mechanisms underlying racial disparities is a critical prerequisite to health equity.

To assess differences in treatment trajectories after primary treatment and their associations with mortality outcomes comparing Black and White patients with localized prostate cancer.

This retrospective, population-based cohort study used SEER-Medicare data from non-Hispanic Black and White men 66 years or older enrolled in Medicare and diagnosed with localized prostate cancer between January 1, 2004, and December 31, 2017. Analyses were conducted between January 2025 and January 2026.

Race.

Hazard ratios (HRs) assessed differences by race in secondary treatment receipt (ie, any treatment received >1 year after primary treatment) and mortality. Secondary analyses examined differences in the type of secondary treatment received (ie, secondary radiation therapy, novel systemic therapies, and/or androgen deprivation therapy).

Participants were divided into 2 cohorts based on primary treatment type: surgery (22 271 participants; 1312 [5.9%] Black and 20 959 [94.1%] White; mean [SD] age, 70 [4] years) and radiation therapy (60 885 participants; 6052 [9.9%] Black and 54 833 [90.1%] White; mean [SD] age, 73 [5] years) to enhance comparability within cohorts. Among participants who received primary surgery, 4275 (19.2%) received secondary treatment with no significant differences by race. Among participants who received primary radiation therapy, 17 058 (28.0%) received secondary treatment with no significant differences by race. In both cohorts, no differences were found in mortality outcomes among those who received secondary treatment. However, significant differences were found for those who did not receive secondary treatment, with Black patients at higher risk for both prostate cancer-specific and all-cause mortality. Secondary analyses suggest that the type of secondary treatment received differed by race.

In this cohort study of men treated for localized prostate cancer, treatment receipt after primary definitive treatment was similar by race. No mortality differences were found among those who received secondary treatment; however, observed mortality disparities among those who did not receive secondary treatment raise concerns about potential health care inequities.

Troponin monitoring is recommended for the early detection of immune checkpoint inhibitor (ICI)-associated myocarditis, but its utility as a universal screening tool for all cardiovascular (CV) toxic effects in patients with cancer treated with ICIs remains uncertain.

To evaluate whether systematic troponin screening is associated with reduced major adverse CV events (MACEs) and mortality in patients receiving ICI therapy for cancer.

This retrospective, multicenter cohort study assessed adults treated with ICIs between January 1, 2017, and December 31, 2022, at 2 tertiary oncology centers. Patients undergoing systematic troponin screening (≥2 measurements during the first trimester of ICI therapy not prompted by symptoms) were compared with those undergoing clinical assessment without screening. Cross-sectional follow-up was undertaken between June 1, 2023, and June 30, 2024.

ICI therapy for solid cancer.

The primary outcomes included adjudicated MACEs (ICI-associated myocarditis, acute coronary syndrome, heart failure requiring hospitalization, sudden cardiac death, and CV death). Multivariate Cox proportional hazards regression, Fine-Gray competing risk models, and propensity score matching were applied, with death from cancer considered a competing risk.

Of 859 patients (mean [SD] age, 70.1 [10.8] years; 517 [60.2%] male; 585 [68.1%] with lung cancer), 40 (4.7%) developed MACEs, including 6 (0.7%) with ICI-associated myocarditis; 484 (56.3%) died at a median follow-up of 3.3 (IQR, 1.3-7.2) months, mainly from cancer (436 [90.1%]). Routine troponin screening was associated with lower mortality combined with MACEs in multivariable models (hazard ratio, 0.56 [95% CI, 0.45-0.70]) (P < .001) but was not associated with MACEs after competitive risk analysis (hazard ratio, 0.56 [95% CI, 0.20-1.55]) (P = .27) or in a propensity score-matched cohort of 354 patients (hazard ratio, 0.49 [95% CI, 0.20-1.24]) (P = .13).

In this cohort study, systematic troponin screening was not associated with MACEs in an older population with metastatic solid cancer after competitive risk analysis or propensity score matching. These findings suggest that the benefits of universal troponin monitoring are questionable among unselected patients with cancer who are receiving ICIs; further investigation is needed to determine whether risk-adapted screening improves outcomes while avoiding unnecessary interruptions of treatment.

Delivering devastating news of cancer is a universal challenge, but cultural and religious contexts impact disclosure. In Saudi Arabia, family engagement frequently influences communication, yet little is known about stakeholders' perspectives on gynecological cancer.

This mixed-methods study used validated questionnaires and semi-structured interviews.

A total of 737 participants were included (54.1% public, 18.5% physicians, 16.0% relatives, and 11.4% patients); the majority were female (67.8%) and Saudi citizens (81.9%), with a median age of 38 years.

Overall, 90.5% of participants preferred that a cancer diagnosis be disclosed to the patient rather than withheld. However, only 25-36% supported disclosing a bad prognosis, with physicians being the least supportive (6.7%, p < 0.0001). Most groups supported the use of the term "chemotherapy" (88-98%). 94% of clinicians favored disclosing treatment failure, but only 61% of patients and 53% of the public agreed (p < 0.0001). More than half of patients (51.5%) and three-quarters of clinicians (73.1%) were opposed to concealing diagnoses at the request of the family. Patients greatly preferred engagement in treatment (66.3%) and end-of-life talks (80.7%), whereas physicians showed less support. In terms of communication dynamics, most patients preferred that the head of the medical team disclose directly to them, face-to-face, and framed with "Allah's will."

Although patients, family, the public, and clinicians mostly supported direct disclosure, there were still disagreements over prognosis and end-of-life talks. These findings emphasize the importance of culturally sensitive, ethically based communication training to enhance patient-centered treatment in gynecological oncology.

Intracranial meningiomas are the most common primary intracranial tumors, with rising detection rates due to increased neuroimaging. We examined surgical management trends to determine whether surgical incidence is independent of detection rate and to characterize shifts in surgical indications and patient demographics.

This retrospective cohort study included 2,278 consecutive adults undergoing primary surgical resection for meningiomas at Helsinki University Hospital (2005-2023). Trends in absolute surgical caseload and patient demographics were analyzed. Surgical incidences were standardized to the European Standard Population (ESP 2013), and age-specific Observed-to-Expected (O/E) ratios were calculated against baseline incidences (2005-2008).

Absolute annual surgical caseload remained stable (range: 83-160 cases; crude incidence 3.8-7.7 per 100,000 person-years; p = 0.868), while the median age of operated patients increased significantly by 2.9 months per year (p = 0.018). The most common presenting symptoms were seizures (19%) and visual symptoms (14%); symptom relief was the most common surgical indication (62%). Age-standardized (ESP) surgical incidences declined over time (3-year sliding average p < 0.006 for all age groups), and demographic-adjusted O/E ratio analysis supports this decline, particularly in the 30-69 years age range. Prophylactic surgeries declined significantly (p < 0.001), while surgeries prompted by tumor growth (p = 0.031) and large tumor size (p < 0.001) increased.

Despite increased detection and an aging population, age-adjusted surgical incidence for meningiomas declined over 19 years, supporting the interpretation of a shift toward a more selective, risk-stratified approach. Surgery is increasingly reserved for cases with documented growth, mass effect, or functional deficits.

The purpose of the study is to compare the efficacy and safety of available interventions for infantile hemangioma against oral propranolol and to evaluate the certainty of the comparative evidence. We conducted a Bayesian network meta-analysis in accordance with PRISMA-NMA guidelines and systematically searched PubMed, Embase, the Cochrane Library, and CNKI from January 2008 to June 2026. A random-effects consistency model was fitted using the BUGSnet package. Evidence certainty was assessed using the CINeMA framework, and risk of bias was evaluated using the revised Cochrane RoB 2 tool. Thirty randomized controlled trials (RCTs) including 2,639 patients across nine treatment nodes were included in the efficacy analysis, and 12 RCTs involving 1,143 patients across eight nodes were included in the safety analysis. Using oral propranolol as the reference treatment, no active intervention demonstrated statistically significant superiority in efficacy, whereas placebo was significantly inferior. Corticosteroids were the only intervention associated with substantially higher adverse event rates, whereas atenolol showed a trend toward fewer adverse events. By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.

 By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.

• Oral propranolol is the established first-line systemic therapy for infantile hemangioma. • Previous network meta-analyses have reported treatment rankings, but the clinical meaning of these rankings relative to oral propranolol remains uncertain.

• Despite favorable point estimates for combination therapy and nadolol, this benchmark-anchored analysis found no included active intervention statistically superior to oral propranolol. • Certainty assessment showed that treatment rankings were limited by heterogeneity, inconsistency, risk of bias, and imprecision; atenolol had the largest body of direct comparative evidence among the alternatives.