Serum prostate-specific antigen (PSA) is widely used for prostate cancer screening. While the genetics of PSA levels have been studied to enhance screening accuracy, the genetic basis of PSA velocity, the rate of PSA change over time, remains unclear. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a large, randomized study with longitudinal PSA data (15,260 cancer-free males, averaging 5.34 samples per subject) and genome-wide genotype data, provides a unique opportunity to estimate PSA velocity heritability. We developed a mixed model to jointly estimate the heritability of PSA levels at age 54 and PSA velocity. To accommodate the large dataset, we implemented 2 efficient computational approaches: a partitioning and meta-analysis strategy using average information restricted maximum likelihood (AI-REML) and a fast restricted Haseman-Elston (REHE) regression method. Simulations showed that both methods yield unbiased estimates of both heritability metrics, with AI-REML providing smaller variability in the estimation of velocity heritability than REHE. Applying AI-REML to PLCO data, we estimated heritability at 0.32 (s.e. = 0.07) for baseline PSA and 0.45 (s.e. = 0.18) for PSA velocity. These findings reveal a substantial genetic contribution to PSA velocity, supporting future genome-wide studies to identify variants affecting PSA dynamics and improve PSA-based screening.

We evaluated how perioperative changes in the prognostic nutritional index (PNI) influence recurrence and survival after hepatectomy for colorectal cancer liver metastases (CRLM). We conducted a retrospective analysis of 108 patients who underwent hepatectomy for CRLM. Preoperative and postoperative PNI levels were compared, and patients were categorized into high (postoperative PNI equal to or higher than preoperative PNI) and low (postoperative PNI lower than preoperative PNI) groups. Statistical analyses included the Kaplan-Meier analysis, log-rank tests, Cox proportional hazards regression models, and Akaike information criterion. The median observation period was 3.3 years. The Kaplan-Meier analysis showed worse overall survival and recurrence-free survival in the low group. Subgroup analysis demonstrated reproducibility regardless of patient background, era of surgery, surgical outcomes, neoadjuvant or adjuvant chemotherapy, and liver metastasis status. Multivariate analysis identified low group assignment and synchronous liver metastasis as independent predictors of recurrence (hazard ratio [HR], 3.788; 95% confidence interval [CI], 2.030-7.621; HR, 3.338; 95% CI, 1.715-6.964, respectively) and survival (HR, 4.484; 95% CI, 1.945-10.334; HR, 2.529; 95% CI, 1.183-5.407, respectively). The Akaike information criterion analysis showed that perioperative shifts in PNI were superior to preoperative or postoperative PNI alone in predicting outcomes. Perioperative shifts in PNI predicted recurrence and prognosis post-hepatectomy for CRLM more accurately compared to using preoperative or postoperative PNI alone.

Cervical lymph node metastasis (CLNM) plays a crucial role in determining the surgical strategy for patients with papillary thyroid carcinoma (PTC). This study aimed to identify predictive factors for CLNM based on ultrasound features and gene mutation characteristics, and to develop a nomogram model for individualized risk prediction. A total of 171 patients with pathologically confirmed PTC who underwent surgery between January 2023 and October 2025 were retrospectively analyzed. Patients were randomly divided into a training set (n = 131) and a validation set (n = 40) at a ratio of 7:3. Clinical characteristics, ultrasound imaging features, and thyroid-related gene mutations were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CLNM, and a nomogram model was subsequently constructed. Model performance was evaluated using receiver operating characteristic curves, calibration analysis with the Hosmer-Lemeshow test, and decision curve analysis. Significant differences were observed between groups in terms of sex, tumor shape, boundary, calcification, and capsule contact (all P < .05). Multivariate logistic regression identified sex (odds ratio [OR] = 2.817), irregular shape (OR = 5.585), obscure boundary (OR = 2.074), calcification (OR = 3.515), and capsule contact (OR = 2.927) as independent predictors of CLNM in PTC (all P < .05). A nomogram was constructed based on these variables. The area under the curve was 0.800 (95% CI: 0.723-0.876) in the training set and 0.775 (95% CI: 0.628-0.922) in the validation set. The model demonstrated good calibration and clinical utility as indicated by the Hosmer-Lemeshow test (P > .05) and decision curve analysis. A nomogram integrating ultrasound features and clinical factors was developed to predict CLNM in patients with PTC, showing favorable predictive performance and potential clinical utility. Future prospective, multicenter studies with larger sample sizes and more comprehensive datasets are needed to further validate and optimize the model, thereby improving its generalizability and supporting individualized clinical decision-making.

This study aimed to investigate the risk factors for perforation during endoscopic snare resection with an elastic band (ESR-EB) resection of gastric submucosal tumors ≤ 10 mm, providing clinical guidance for preventing intraoperative adverse events. A retrospective study was conducted on patients who underwent ESR-EB resection of gastric submucosal tumors ≤ 10 mm at Shenzhen Second People's Hospital from April 2023 to October 2024. Clinical characteristics, tumor location, size, pathological type, resection time, operation time, and perforation rate were analyzed using binary regression analysis to identify risk factors for perforation. A total of 108 patients underwent ESR-EB surgery, with a mean age of 55.83 ± 9.27 years and 30.56% being male. The mean tumor size was 6.07 ± 1.42 mm, with intraluminal growth being the most common (88.89%). Tumors were primarily located in the fundus (72.22%) and body (27.78%) of the stomach. The mean operation and resection times were 21.22 ± 10.37 minutes and 9.02 ± 4.99 minutes, respectively. Gastrointestinal stromal tumors (GISTs) were the most common pathological type (75.93%), followed by leiomyomas (21.30%). Perforation occurred in 73.15% of cases during surgery, all of which were successfully closed endoscopically. Binary regression analysis showed that tumor location and histological type were risk factors for perforation. Tumors in the fundus increased perforation risk (odds ratio = 5.080, 95% confidence interval 1.234-20.923; P = .024). The risk of perforation was significantly reduced in non-GIST pathological types (odds ratio = 0.129,95% confidence interval 0.029-0.565; P = .007). Gender, age, tumor size, growth pattern, operation time, and resection time were not associated with perforation. ESR-EB can completely resect gastric submucosal tumors ≤ 10 mm. Perforation risk is higher when tumors are located in the fundus or are GISTs. Tumor location is a useful preoperative predictor of intraoperative perforation.

Osteoporosis is a major public health problem in aging populations and is increasingly linked to interactions between nutritional status and systemic inflammation. The Prognostic Nutritional Index (PNI) and the Advanced Lung Cancer Inflammation Index (ALI) are established immunonutritional markers in oncology, but their associations with osteoporosis in the general population remain unclear. We examined the cross-sectional associations of PNI and ALI with osteoporosis and compared the consistency of these associations across analytic strategies. We conducted a cross-sectional analysis of adults from the National Health and Nutrition Examination Survey 1999-2018. A total of 18,497 participants with valid dual-energy X-ray absorptiometry-derived bone mineral density data and complete components for PNI and ALI calculation were included. Osteoporosis was defined as a femoral neck or lumbar spine T-score ≤ -2.5. Survey-weighted multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Sensitivity analyses using calibration-based balancing weights and restricted cubic splines were performed. In fully adjusted models, ALI showed a consistent inverse association with prevalent osteoporosis. Participants in the highest ALI quartile had significantly lower odds of osteoporosis than those in the lowest quartile (OR 0.590, 95% CI 0.447-0.778; P < .001), and this association remained significant in sensitivity analyses (OR 0.79, 95% CI 0.64-0.97; P = .027). PNI was inversely associated with osteoporosis in continuous analyses (OR 0.782 per 1-SD increase; P = .011), but this association was attenuated in categorical analyses and not significant in sensitivity analyses. Dose-response analyses suggested an approximately linear inverse relationship for ALI, whereas results for PNI were less consistent. Both PNI and ALI were associated with osteoporosis in US adults, but ALI showed a more consistent inverse association across analytical strategies. As a composite index integrating body mass index, albumin, and the neutrophil-to-lymphocyte ratio, ALI may warrant further evaluation as a practical composite marker associated with bone health. Given the cross-sectional design, these findings should be interpreted as associational rather than causal.

Disclosing a cancer diagnosis, particularly to individuals in family-centric cultures, is a complex process that directly impacts patient-centered care. This study explores the factors that influence attitudes toward truth disclosure of a terminal cancer diagnosis in the diverse population of the United Arab Emirates and compares these findings with practices in other nations and regions. A descriptive cross-sectional study was conducted using an online self-administered questionnaire. The questionnaire comprised 4 sections: 9 questions collected demographic data, 6 questions assessed respondents' perceptions regarding the diagnosis of terminal-stage cancer, 7 questions evaluated their perceptions of its prognosis, and 7 questions focused on their views on truth disclosure in terminal-stage cancer. The questionnaire was developed based on existing literature and expert input. The study targeted healthcare providers, as well as all students (undergraduate or postgraduate), faculty members, and staff at universities in the United Arab Emirates. Multivariate logistic regression models were applied to determine the factors influencing participants' attitudes and perceptions. A total of 495 participants were recruited, with 73.7% being female and 26.3% being male. The majority (45.9%) were aged 18 to 24 years. The average attitude scores were 87.8% for the diagnosis of terminal-stage cancer, 85.8% for its prognosis, and 69.7% for truth disclosure to family. Logistic regression analysis showed that female participants had more positive attitudes toward diagnosis (odds ratio [OR] = 1.85; 95% confidence interval [CI]: 1.1-3.1), while participants from the Middle East and North Africa had less positive attitudes toward both diagnosis (OR = 0.653; 95% CI: 0.48-0.87) and prognosis (OR = 0.652; 95% CI: 0.47-0.86). More positive attitudes toward truth disclosure were observed among participants from South Asia (OR = 1.52; 95% CI: 1.25-1.85) and Southeast Asia/Oceania (OR = 2.1; 95% CI: 1.63-2.70), as well as among nurses (OR = 5.15; 95% CI: 2.64-10.03) and Christian participants (OR = 4; 95% CI: 1.02-15.6), whereas single participants exhibited less positive attitudes (OR = 0.560; 95% CI: 0.38-0.82). These results highlight the complex interaction between cultural and demographic factors in determining perceptions of terminal-stage cancer. They emphasize the value of customized treatments and communication techniques to address different points of view, which will ultimately improve patient support and care in situations involving terminal illness.

The albumin-to-globulin ratio (AGR) has emerged as a novel inflammation-based prognostic marker in various cancers; however, a comprehensive and quantitative assessment of its prognostic role in hepatocellular carcinoma (HCC) is lacking. Therefore, we conducted this meta-analysis to assess the prognostic value of the preoperative AGR in patients with HCC.

We systematically reviewed the literature for studies reporting the prognostic impact of AGR in patients undergoing curative hepatectomy for HCC. Random-effects meta-analyses of overall survival (OS) and recurrence-free survival were performed.

Six studies involving 2107 patients were included in this meta-analysis, with all conducted in Asian populations. Four studies were conducted in China, whereas 2 studies were conducted in Japan. Low pretreatment AGR was significantly correlated with decreased OS (hazard ratio: 1.69, 95% confidence interval: 1.37-2.08, P < .001) and recurrence-free survival (hazard ratio: 1.62, 95% confidence interval: 1.37-1.91, P < .001). Subgroup analyses suggested that a low AGR predicted decreased OS in patients with HCC, regardless of region, sample size, age, and cutoff values.

Low preoperative AGR was significantly associated with poor prognosis of patients with HCC. AGR may serve as a prognostic biomarker, although validation in prospective cohorts is required.

Frailty is a multidimensional geriatric syndrome associated with adverse outcomes in aging populations and cancer patients. Although skin cancer is the most common malignancy in the United States, the prognostic role of frailty among skin cancer survivors remains unclear. This study aimed to examine whether frailty and pre-frailty are independently associated with all-cause mortality among skin cancer survivors. We analyzed data from the National Health Interview Survey 1997-2018, linked with the National Death Index through 2019. Frailty was assessed using a modified Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale, classifying participants as robust (score 0), pre-frail (1-2), or frail (3-5). The analytic sample included 14,411 adults with self-reported skin cancer. The Kaplan-Meier methods were used to estimate survival across frailty categories, and Cox proportional hazards models quantified the association between frailty and all-cause mortality, adjusting for demographic, socioeconomic, and clinical covariates. Subgroup analyses were conducted by age and sex. Among skin cancer survivors, 79.9% were robust, 10.8% were pre-frail, and 9.3% were frail at baseline. During follow-up, 1998 deaths were recorded. Frailty status was strongly associated with mortality in a dose-response manner. In the fully adjusted model, pre-frail survivors had a 38% higher risk of death (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.32-1.45; P < .001), and frail survivors had a 65% higher risk (HR, 1.65; 95% CI, 1.45-1.89; P < .001) compared with robust survivors. Among those aged ≥60 years, both pre-frailty (HR, 1.42; 95% CI, 1.36-1.50) and frailty (HR, 1.62; 95% CI, 1.40-1.88) significantly predicted mortality. In survivors younger than 60 years, frailty more than doubled the mortality risk (HR, 2.20; 95% CI, 1.38-3.50), whereas pre-frailty was not significantly associated with outcomes. Sex-stratified analyses showed consistent associations in women, while estimates in men were less precise due to smaller numbers. Frailty, as assessed by the FRAIL scale, is an independent predictor of all-cause mortality among skin cancer survivors. Incorporating frailty screening into survivorship care may enable early identification of high-risk individuals and inform tailored interventions to improve long-term outcomes.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, characterized by favorable prognosis and low incidence of distant metastasis. However, brain metastasis from PTC is rare, and its development years after the initial diagnosis is even more uncommon. Given the potential clinical implications of late metastasis, there is a need to reconsider follow-up strategies for high-risk PTC patients.

A 54-year-old woman with a history of PTC diagnosed 8 years earlier presented with progressive headaches and mild left-sided hemiparesis. She had previously undergone multiple surgeries and radioiodine therapy after the initial diagnosis and had a history of childhood neck irradiation.

Imaging revealed a brain mass, which was confirmed as isolated brain metastasis from PTC following biopsy after surgical resection. Despite persistently undetectable serum thyroglobulin (Tg) levels and no lymph node metastasis at the time of primary surgery, this patient developed isolated brain metastasis 8 years after initial treatment.

The patient underwent craniotomy to remove the metastatic brain lesion. No adjuvant radiotherapy was given postoperatively.

The patient recovered well after surgery, with mild left-sided hemiparesis (4/5 muscle strength). At the most recent follow-up, no additional distant metastases were detected.

This case highlights the importance of extending the follow-up period for high-risk PTC patients, including those with prior neck irradiation or aggressive tumor features. Late metastasis can occur even in patients with initially favorable prognoses and normal biochemical markers. Imaging-based surveillance is necessary to detect late metastasis early. The findings support extended follow-up strategies to enable timely intervention and improve outcomes in high-risk patients with PTC.

The factors associated with early death in primary hepatopancreatobiliary non-Hodgkin's lymphoma (PHPB-NHL) patients have not been previously investigated. This study aimed to develop and validate a population-based nomogram for early death prediction in PHPB-NHL patients. Data on PHPB-NHL patients diagnosed from 2000 to 2021 were collected from the Surveillance, Epidemiology and End Results database. Patients diagnosed between 2000 and 2015 formed the training cohort, while those from 2016 to 2021 represented the validation cohort. Univariate and multivariate logistic regression analyses identified factors affecting early death, which were used to create a nomogram. The discriminatory ability, calibration, and clinical utility of the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis, respectively. The Surveillance, Epidemiology and End Results database identified 2802 PHPB-NHL patients from 2000 to 2021, with eligible patients divided into a training cohort (1240) and a validation cohort (509). In the training cohort, 29.4% (365/1240) experienced early death. Factors for early death included age, race, primary site, histological type, surgery, radiotherapy, chemotherapy, median household income, and time from diagnosis to treatment. A nomogram based on these factors showed good discrimination (AUC 0.815, 95% CI: 0.789-0.842) and was validated internally (optimism-corrected AUC 0.805, 95% CI: 0.780-0.831). Calibration curves showed strong agreement between predictions and actual outcomes. The validation cohort also showed good discrimination (AUC 0.827, 95% CI: 0.787-0.867) and calibration. Decision curve analysis indicated a positive net benefit. We developed and validated a nomogram to predict early death in PHPB-NHL patients, demonstrating strong predictive accuracy and clinical utility.