Metabolic syndrome (MetS) is a group of interconnected conditions that include central obesity, insulin resistance, dyslipidaemia, and hypertension. Although the cardiovascular and endocrine effects of this syndrome are well-recognized, its impact on the function of the lower urinary tract is often overlooked. Bladder dysfunction often presenting as diabetic cystopathy in diabetes- may stem from the wider metabolic environment of MetS. In this review, we propose the term Metabolic Cystopathy. We detail the pathophysiological connections, clinical manifestations, diagnostic methodologies, and treatment options. We stress the importance of multifactorial management approach, including urology, endocrinology, nephrology, dietetics and physiotherapy, to effectively address this condition.

BackgroundType 2 diabetes mellitus (T2DM) is associated with a higher risk of mild cognitive impairment (MCI), but conventional structural MRI (sMRI) metrics lack sensitivity for detecting early hippocampal alterations. Radiomic analysis of hippocampal subfields may capture diabetes-related microstructural abnormalities.ObjectiveTo develop and interpret a structural MRI-based model incorporating hippocampal subfield radiomic features for identifying MCI in T2DM patients.MethodsThis retrospective study included 149 T2DM patients. Based on Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores, participants were classified into T2DM-MCI and T2DM-NC groups. A total of 2232 radiomic features were extracted from 24 hippocampal subfields segmented by FreeSurfer. Maximum relevance minimum redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were used to construct the hippocampal radiomics score (Hip-Radscore). Additional models were built using gray matter volume (sMRI-Radscore), subfield volumes (SFV-Score), and clinical variables. Model performance was evaluated by bootstrap resampling, ROC analysis, and SHapley Additive exPlanations (SHAP) interpretation.ResultsThe Hip-Radscore model achieved an AUC of 0.76 (95% CI: 0.68-0.84), outperforming the gray matter volume (0.62) and SFV-Score (0.63) models. The combined model integrating imaging and clinical variables reached the highest accuracy (AUC = 0.87, 95% CI: 0.81-0.93), significantly superior to the clinical-only model (AUC = 0.70, p < 0.05). The Hip-Radscore correlated positively with diabetes duration (ρ = 0.47) and HbA1c (ρ = 0.56), and negatively with MMSE (ρ = -0.63) and MoCA (ρ = -0.65) (all p < 0.001).ConclusionsHippocampal subfield radiomics significantly improves the detection of MCI in T2DM and reflects diabetes-specific structural alterations linked to metabolic status and cognitive decline.

To analyze current vulvar squamous cell carcinoma (VSCC) data with respect to age groups and determine if gynecologic cancer screening guidelines address the burden of VSCC on the ≥ 65 cohort.

Patient data from 2004 to 2021 was identified from the National Cancer Database using ICD-10 codes specific for the vulva, and ICD-O-3 histology codes for squamous cell carcinoma or premalignant vulvar intraepithelial neoplasia Grade III. GraphPad Prism and IBM SPSS were used to analyze variable frequency with cross analysis. Chi-squared tests, Kaplan-Meier survival curves with log-rank comparison, and Cox proportional hazard regression models were utilized for statistical analysis. For regression models of hazard ratios (HRs) and odds ratios (ORs), the 50-64-year-old cohort was used as a reference variable.

The patient population was 68,153. Mean overall survival decreased as age increased (≤ 49 years old was 184.9 months, 50-64 years old was 152.1 months, 65-74 years old was 107.3 months, and ≥ 75 years old was 57.7 months). The ≥ 75-year-old cohort had a 330% higher risk of mortality when compared to the reference variable (HR 4.3, p < 0.001), followed by the 65-74-year-old cohort (HR 1.96, p < 0.001). The ≥ 75 years old and 65-74-year-old cohorts had the highest likelihood of advanced VSCC (OR 1.91, p < 0.001 and OR 1.37, p < 0.001, respectively).

Patients ≥ 65 years old are significantly more likely to experience worse survival outcomes and higher stage diseases, indicating that a lack of screening protocols may influence VSCC outcomes.

To assess the association of systemic immune-inflammation biomarkers (SIIBs) and other clinical parameters with objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease-specific survival (DSS), and immune-related adverse events (irAEs) in patients with advanced cSCC treated with cemiplimab, and to compare baseline SIIBs levels between early-stage and advanced-stage disease.

A retrospective multicenter cohort of 110 immunocompetent advanced cSCC patients treated with cemiplimab was analysed. ORR was assessed using logistic regression; PFS and OS were evaluated using Cox models, and DSS using cause-specific hazards. ROC analyses assessed biomarker discrimination. Baseline SIIBs (LMR, NLR, SIRI) were compared between early-stage (AJCC I/II, non-ICI cohort, n = 59) and advanced-stage disease. Tumor characteristics, body mass index (BMI), and Charlson comorbidity index were evaluated.

Among 110 patients, 79 (71.8%) achieved an objective response. Baseline LMR showed modest discrimination for ORR (AUC 0.64, 95% CI 0.53-0.75; p = 0.015) but did not retain statistical significance after adjustment for baseline clinical covariates (OR 1.35, 95% CI 0.95-1.91; p = 0.096). Higher BMI was associated with improved PFS (HR 0.94 per kg/m², 95% CI 0.89-1.00; p = 0.035) and showed a borderline association with OS (HR 0.92 per kg/m², 95% CI 0.85-1.00; p = 0.051). AJCC stage IV strongly predicted DSS (HR 14.03, 95% CI 1.80-109.67; p = 0.012). Baseline LMR was higher in early-stage than in advanced-stage disease (Hodges-Lehmann difference 0.43; p = 0.011), whereas NLR did not differ significantly between stage groups; SIRI was modestly higher in advanced-stage disease (p = 0.029).

In immunocompetent patients with advanced cSCC receiving PD-1 inhibition, BMI was prognostic for survival and AJCC stage remained the key driver of cSCC-specific mortality. Baseline LMR showed a modest association with response and differed between early- and advanced-stage disease, whereas other SIIBs were not consistently linked to tumor progression. Prospective validation is warranted.

To compare the efficacy of induction chemotherapy with or without PD-1 inhibitors followed by chemoradiotherapy (CCRT) among patients with human papillomavirus (HPV)-negative locally advanced head and neck squamous cell carcinoma (LA-HNSCC).

We retrospectively reviewed patients with HPV-negative LA-HNSCC who received induction chemotherapy with or without PD-1 inhibitors followed by CCRT between January 2018 and June 2023. Overall survival (OS), disease-free survival (DFS), and treatment-related adverse effects (TRAEs) were compared between the two groups overall and then in one-to-one propensity-score matched (PSM) cohorts.

A total of 289 eligible patients were enrolled, with 120 patients received induction chemotherapy (the IC group), and 169 patients received induction chemotherapy combined with PD-1 inhibitors (the IC-IO group). Median follow-up was 39.3 months (range: 37.5-41.5 months). After PSM, objective response rate (ORR) was not significantly different in the IC-IO group versus the IC group (81.5% vs 74.1%, P = 0.19). The IC-IO group (vs. the IC group) had a superior 2-year OS (84.3% vs. 68.2%, P = 0.002) and DFS (74.1% vs. 56.9%, P = 0.005). G3/4 TRAEs between the two matched groups were comparable both during induction (11.1% vs 11.1%, P = 1.000) or CCRT (29.6% vs 38.9%, P = 0.152) phases. For the IC-IO group, no significant differences in OS (P = 0.68) or DFS (P = 0.29) were observed in the subset with versus without PD-1 inhibitors concurrently with CCRT.

The addition of PD-1 inhibitors to IC significantly improves outcomes with tolerable TRAEs in patients with HPV-negative LA-HNSCC.

Cancer cachexia is a multifactorial syndrome characterized by severe muscle loss, metabolic disturbances, and unintentional weight loss, posing a major challenge in oncology care. Despite advances in palliative and nutritional management, it remains underdiagnosed and undertreated due to organizational and practice-related barriers. This study aims to identify the factors influencing Jordanian healthcare professionals' assessment and management of cancer cachexia.

The awareness, confidence, and perceived barriers of healthcare professionals in cachexia care were assessed using a descriptive cross-sectional method. Oncology professionals, including nurses, nutritionists, and physiotherapists assigned to the largest government oncology hospital in Jordan, provided the data.

Over 80% of participants could not accurately define sarcopenia or undernutrition, highlighting major knowledge gaps. Overall, 81.1% failed to correctly define undernutrition and 65.5% failed to define cancer cachexia, with substantial gaps particularly among nurses. Healthcare professionals also reported low confidence in identifying and managing cachexia, worsened by unclear roles and limited institutional support. Only 6.8% knew who was responsible for identifying cachexia, while 8.1% knew who was responsible for its treatment. Key barriers included time constraints, lack of standardized screening tools, weak multidisciplinary collaboration, and limited access to evidence-based guidelines, with 43.9% reporting cachexia was not an organizational priority.

This study highlights the urgent need for effective institutional guidelines, improved multidisciplinary collaboration, and organized educational programs to assist healthcare professionals in managing cancer cachexia. Enhancing cachexia care with specialized education and standard protocols might dramatically improve patient outcomes and progress cancer care approaches in Jordan.

High-dose chemotherapy with autologous stem cell transplantation (ASCT) is a key consolidative therapy for primary central nervous system lymphoma (PCNSL). However, the optimal regimen for mobilizing haematopoietic stem cells remains undefined in this population, leading to unpredictable failure rates and suboptimal cell yields. We retrospectively analysed data from 142 patients with histologically confirmed PCNSL who underwent stem-cell mobilisation before ASCT. Three mobilisation strategies were compared: high-dose cytarabine (HD-Ara-C)-based mobilisation (n = 64), plerixafor plus G-CSF (n = 60), and cyclophosphamide (CTX, n = 18). Mobilisation success, CD34⁺ cell yield, toxicity, and predictors of collection outcomes were evaluated. Patients in the HD-Ara-C-based mobilisation group achieved a 100% success rate, significantly outperforming CTX (77.8%) and steady-state mobilisation (98.3%) while delivering a markedly superior median CD34⁺ cell yield (20 × 10⁶/kg vs. 12.7 and 10 × 10⁶/kg, p < 0.001). Notably, 79.7% of patients in the HD-Ara-C-based mobilisation group were classified as "very good" mobilisers,with all "poor" mobilisers confined to the other groups. Crucially, we identified and validated the first-day peripheral blood CD34⁺ cell count as a powerful predictor of collection outcome. A threshold of > 31 cells/µL predicted successful collection (> 2 × 10⁶/kg) with an AUC value of 0.94 (98.6% specificity, 78.6% sensitivity). Higher thresholds predicted optimal and high-yield collections. Although grade 4 thrombocytopenia was more common with HD-Ara-C, it was manageable with supportive care. HD-Ara-C-based mobilisation is a highly effective strategy for PCNSL, ensuring universal success and maximizing CD34⁺ cell yields. The first-day CD34⁺ cell count provides a robust, real-time tool for guiding apheresis. HD-Ara-C-based mobilisation should be considered the preferred regimen for fit patients, with steady-state mobilisation as an alternative for selected cases.

Radical or partial nephrectomy followed by adjuvant pembrolizumab is the standard of care for high-risk localized renal cell carcinoma (RCC), yet around 40% of patients relapse within 5 years. We investigated patterns of disease recurrence and the clinical management of RCC patients treated with adjuvant immunotherapy.

We collected patients with high-risk RCC who received adjuvant immunotherapy after radical surgery in our Institution. The primary endpoint was the rate and pattern of disease recurrence. Secondary endpoints were disease-free survival (DFS), overall survival (OS), post-progression survival (OS2) and treatments at recurrence.

From March 2018 to September 2025, 70 patients were included, most received adjuvant pembrolizumab (71%), followed by nivolumab + ipilimumab (16%), and nivolumab monotherapy (13%). 15 patients (21%) experienced recurrence, including 7 (10%) who relapsed on adjuvant treatment. Oligometastatic disease was observed in 10 cases (67%), mainly involving lung (60%), lymph nodes (33%) and renal bed (13%). At recurrence, 9 patients (60%) started first-line therapy, while 5 patients (33%) received loco-regional treatments. After a median follow-up of 30.2 months, 30-month DFS and OS rates were 74% and 94%, respectively, in the overall population. Among patients who progressed, the 24-month OS2 rate was 100% after local therapy alone and 86% with systemic therapy.

High-risk RCC patients treated with adjuvant immunotherapy remain at considerable risk of relapse, frequently with oligometastatic disease. Excellent post-progression outcomes after loco-regional treatment support a multidisciplinary, metastasis-directed approach to recurrence after adjuvant immunotherapy.

Immune checkpoint inhibitor (ICI)-based combination therapy is a standard first-line treatment for metastatic renal cell carcinoma (mRCC), with combinations such as nivolumab plus cabozantinib (Nivo + Cabo) and pembrolizumab plus lenvatinib (Pem + Len) demonstrating favorable oncologic outcomes. However, no direct comparisons between these two regimens have been conducted. This study aimed to compare the safety and oncologic outcomes of Nivo + Cabo and Pem + Len in patients with mRCC.

This retrospective study included 185 patients with mRCC treated with Nivo + Cabo (n = 81) or Pem + Len (n = 104) between January 2018 and June 2025 across multiple institutions. The primary outcome was a comparison of treatment-related adverse events (TrAEs). Oncologic outcomes, including objective response rate (ORR), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were compared using one-to-one propensity score matching.

Any-grade TrAEs occurred in 90% of patients in the Nivo + Cabo group and 92% in the Pem + Len group (p = 0.6). Severe TrAEs (grade ≥ 3) were more frequent in the Pem + Len group (44%) than in the Nivo + Cabo group (30%, p = 0.048). Tyrosine kinase inhibitor dose reduction and treatment discontinuation rates were similar between groups. In the matched cohort (Nivo + Cabo: n = 74; Pem + Len: n = 74), ORRs were comparable (66% vs. 71%, p = 0.6). With a median follow-up of 17 months, no significant differences were observed in PFS (p = 0.4), CSS (p = 0.9), or OS (p = 0.5).

Nivo + Cabo and Pem + Len demonstrated similar oncologic efficacy as first-line treatments for mRCC. However, Pem + Len was associated with more severe TrAEs. Careful toxicity management and shared decision-making are essential when selecting ICI-based combinations.

Smokeless tobacco (SLT), particularly chewing tobacco, is an underrecognized public health concern. Its long-term burden and trends, especially in China, remain incompletely quantified.

Using Global Burden of Disease (GBD) 2021 data, we estimated chewing tobacco-attributable deaths, disability-adjusted life years (DALYs), and age-standardized mortality and DALY rates for lip and oral cavity cancer and esophageal cancer (2000-2021), globally and in China. Analyses were stratified by year, sex, and age. Decomposition, age-period-cohort (APC), and Bayesian age-period-cohort (BAPC) models assessed drivers and project trends.

From 2000 to 2021, chewing tobacco-attributable lip and oral cavity cancer deaths and DALYs nearly doubled globally and in China, with modest rises in age-standardized rates. Esophageal cancer showed slight absolute increases but declining standardized rates. For both cancers, DALYs peaked earlier than deaths. Compared with global patterns, China experienced a steeper increase in age-standardized lip and oral cavity cancer burden, particularly among males, and a larger decline in esophageal cancer burden, especially among females, leading to increasing male predominance. Globally, changes mainly reflected population growth and aging, whereas population growth predominated in China. Projections indicate continued increases in lip and oral cavity cancer burden and further declines in esophageal cancer burden.

Chewing tobacco-attributable lip and oral cavity cancer burden in China has risen markedly and is projected to increase further, particularly among males and working-age populations, whereas esophageal cancer burden continues to decline. Integrated prevention strategies are needed to sustain progress and reduce the growing burden.