Thoracoscopic radical resection for lung cancer is widely performed, but postoperative pulmonary complications (PPCs) remain one of the most common and severe perioperative adverse events, which prolong hospital stay and increase postoperative morbidity. Esketamine exerts anti-inflammatory and lung-protective properties, while its effect on reducing PPCs after thoracoscopic lung cancer surgery still requires further clinical verification. This study aimed to investigate whether perioperative application of esketamine could reduce the incidence of PPCs in patients undergoing thoracoscopic radical resection for lung cancer.

A total of 80 adult patients scheduled for thoracoscopic radical lung cancer surgery were enrolled. The primary outcome was the overall incidence of PPCs on postoperative day 1. Secondary outcomes included the incidence of PPCs on postoperative days 3 and 7, PPC severity score, postoperative nausea and vomiting, postoperative hospital stay, indwelling time of the thoracic drainage tube, 24-hour postoperative resting visual analog pain score, unplanned intensive care unit admission, and postoperative mortality.

The incidence of PPCs on postoperative day 1 was significantly lower in the esketamine group than in the control group (37.5% vs 72.5%, P = .002). No significant between-group differences were observed in the incidence of PPCs on postoperative days 3 and 7 or in any of the other secondary outcomes.

Perioperative esketamine administration can effectively decrease the early postoperative (postoperative day 1) incidence of PPCs in patients undergoing thoracoscopic radical lung cancer surgery, with no obvious impact on other secondary clinical outcomes.

This study evaluates the clinical efficacy of transperineal 3D image registration combined with AI-electromagnetic navigation-guided mpMRI-TRUS fusion biopsy versus transrectal cognitive fusion biopsy for prostate cancer diagnosis. This retrospective cohort study analyzed 283 patients undergoing prostate biopsy at Yongchuan Hospital of Chongqing Medical University (January 2022 to December 2024). Participants were stratified into transrectal cognitive fusion (n = 146) and transperineal AI-navigated fusion (n = 137) groups. Detection rates of clinically significant prostate cancer (csPCa) and complication profiles were compared. Multivariable logistic regression identified independent predictors of csPCa detection. The transperineal AI-navigated fusion group demonstrated a significantly higher csPCa detection rate compared to the transrectal cognitive fusion group (55.5% vs 45.2%, P = .043). Multivariable logistic regression revealed that advanced age (OR = 1.05, 95% CI: 1.01-1.17), PI-RADS score > 3 (OR = 9.4, 95% CI: 3.95-16.74), and transperineal approach (OR = 3.65, 95% CI: 1.22-4.75) independently predicted csPCa detection. The AI-navigated group showed no hematochezia (0% vs 9.6%, P = .003), no sepsis (0% vs 2.1%, P = .246), and a significantly lower urinary tract infection rate (13.9% vs 28.8%, P = .035). However, urinary retention was significantly more frequent in the transperineal group (14.4% vs 7.3%, P = .012), although all cases resolved within 72 hours with conservative management. Transient perineal pain was also more frequent in the transperineal group (24.1% vs 8.9%, P = .017). AI-navigated transperineal fusion biopsy was associated with improved csPCa detection and a lower infectious complication rate compared to transrectal cognitive fusion biopsy, but with a significantly higher incidence of transient, self-limiting urinary retention. These findings support its potential as an effective diagnostic strategy, with the caveat that patients should be counseled regarding post-biopsy voiding function.

Desmoid tumors are classified as borderline malignancies and are characterized by a high rate of local recurrence despite the absence of distant metastasis. Low-dose methotrexate combined with vinblastine, known as the methotrexate and vinblastine (MV) regimen, has been reported as an effective treatment for desmoid-type fibromatosis (DF). At our institution, we adopt a treatment strategy beginning with celecoxib as the first-line therapy, escalating to the MV regimen only in cases showing disease progression. This study evaluates treatment outcomes based on this protocol. At our institution, 10 patients diagnosed with DF between 2003 and 2025 received surgical resection and/or pharmacotherapy. The standard approach involved initiating treatment with oral celecoxib; if no clinical improvement was observed, therapy was escalated to the MV regimen. Treatment response was assessed using Response Evaluation Criteria in Solid Tumors 1.1 criteria. Of the 10 cases, 1 achieved complete response, 5 showed partial response, 2 maintained stable disease, and 2 exhibited progressive disease, yielding a response rate of 60%. Among patients treated with the MV regimen, extended dosing intervals did not lead to tumor progression, and sustained suppression was observed in several cases. No grade 3 or 4 adverse events were reported. Celecoxib and the MV regimen appear to be effective and well-tolerated options for DF. Given its low toxicity and favorable tolerability, celecoxib should be considered the first-line treatment, especially since tumor control was achieved in half of the cases. Although tumor progression occurred in the remaining cases, disease control was subsequently achieved by introducing the MV regimen. These findings support recent trends favoring nonsurgical management and suggest that the celecoxib followed by the MV regimen strategy should be considered a primary therapeutic approach.

DNA methylation is an emerging biomarker for cervical cancer screening. This study aimed to evaluate the diagnostic performance of paired box gene 1/junctional adhesion molecule 3 (JAM3) dual-gene methylation analysis for detecting high-grade cervical intraepithelial neoplasia and cervical cancer, and to explore its potential utility as a triage biomarker for high-risk human papillomavirus positive women.

A systematic search was conducted across 5 databases, including PubMed, for studies on PAX1/JAM3 methylation testing in cervical cancer screening. Following quality assessment via the QUADAS-2 tool, statistical analyses were performed using Meta-Disc 1.4 and Stata 17 software.

Eight studies involving 7494 participants were included in the meta-analysis. For diagnosing cervical intraepithelial neoplasia grade 2 and above the pooled sensitivity was 0.81 (95% CI: 0.73-0.88), specificity was 0.95 (95% CI: 0.94-0.96), and the area under the curve was 0.96. For diagnosing cervical intraepithelial neoplasia grade 3 and above the pooled sensitivity was 0.85 (95% CI: 0.75-0.92), specificity was 0.88 (95% CI: 0.86-0.89), and the area under the curve was 0.90.

PAX1/JAM3 dual-gene methylation testing demonstrates high diagnostic accuracy for detecting high-grade cervical intraepithelial neoplasia and cervical cancer, supporting its potential role as a triage biomarker in high-risk human papillomavirus positive women.

Gastric cancer remains a leading gastrointestinal malignancy with persistently high incidence and poor prognosis. Marital status, an established proxy for social support, has been linked to survival in several solid tumors, yet its impact on gastric-cancer outcomes remains uncertain in large contemporary cohorts. The aim of this study was to quantify the association between marital status and cancer-specific and overall survival in patients with gastric cancer in a large, contemporary, population-based cohort, and to determine whether marital status serves as an an independent prognostic factor for gastric-cancer outcomes. Using the surveillance, epidemiology, and end results database, we identified patients with primary gastric adenocarcinoma diagnosed from 2013 through 2022. Patients were dichotomized as married or unmarried. Baseline characteristics were compared with χ2 tests. To mitigate selection bias, 1:1 propensity-score matching (PSM) was performed. Cancer-specific survival (CSS) and overall survival (OS) were estimated with Kaplan-Meier and log-rank tests. Subgroup analyses and multivariable Cox regression were conducted to determine the independent prognostic value of marital status. A total of 39,013 patients were included (median follow-up 14 months). Before PSM, unmarried patients had significantly worse CSS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.14-1.20, P < .001) and OS (HR 1.20, 95% CI 1.16-1.23, P < .001). After 1:1 PSM (15,256/group), the survival gap narrowed but remained significant (CSS: HR 1.12, P < .001; OS: HR 1.15, P < .001). Subgroup analyses showed unmarried status was consistently associated with poorer CSS and OS across most strata. Multivariable Cox regression confirmed unmarried status as an independent adverse prognostic factor for both CSS (HR 1.17, 95% CI 1.13-1.20, P < .001) and OS (HR 1.19, 95% CI 1.15-1.22, P < .001). In this large population-based cohort, unmarried status was independently associated with worse gastric-cancer outcomes. Marital status is a readily available marker of social and economic support that identifies patients at higher risk of adverse outcomes; these patients may benefit from targeted psychosocial, financial, and logistical support during and after treatment.

To determine the cost-effectiveness of molecular testing for indeterminate (Bethesda III/IV) thyroid nodules in a real-world, single-payer healthcare system.

This retrospective population-based cohort study analyzed fine-needle aspiration biopsy (FNAB) and lobectomy data for thyroid nodules in Manitoba, Canada, during 2023. Microcosting was performed to capture surgical, surveillance, molecular testing, and complication costs in 2023 Canadian dollars. Six molecular tests (Afirma, ThyroSeqV3, ThyroidPrint, ThyroSPEC, ThyGeNEXT/ThyraMIR, and mir-THYpe) were evaluated using site-specific malignancy prevalence (21%) and published test statistics.

The study was performed within a publicly funded healthcare system.

Participants were 18 years and above having undergone FNAB in Manitoba.Intervention or Exposures:Three scenarios were identified Current Care, Molecular Testing, and Reference Standard (diagnostic lobectomy) pathways. The total cost per year were compared among scenarios.

Cost-utility analyses compared Current Care, Molecular Testing, and Reference Standard pathways. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. A $50 000/QALY willingness-to-pay (WTP) threshold was used to interpret ICERs.

Among 1486 FNABs performed, 413 were indeterminate nodules, and 149 patients underwent diagnostic lobectomy. The cost of lobectomy was $7542.69 per patient. All molecular testing strategies improved net QALYs and demonstrated ICERs ranging from $9791.03 to $58 749.94 per QALY compared to Current Care. All tests apart from Afirma were cost-effective at the WTP threshold relative to Current Care. Compared to the Reference Standard, all molecular testing strategies were dominant.

For the investigated Manitoba scenario, molecular testing for indeterminate thyroid nodules can be a cost-effective strategy, possibly reducing unnecessary surgeries while preserving patient outcomes.

This study contributes to the body of evidence suggesting molecular testing is cost-effective and has potential to influence political decisions in health care spending.

Breast cancer incidence varies by race, stage at diagnosis, and molecular subtype. However, these patterns are often obscured in overall estimates, particularly in high-burden settings. This study examined incidence trends overall and by race, stage at diagnosis, and molecular subtype among women in Mississippi.

We used population-based data from the Mississippi Cancer Registry, including Black and White women aged ≥ 18 years diagnosed with primary breast cancer from 2010 to 2019. Age-adjusted incidence rates (IRs) per 100,000 population were standardized to the 2000 United States standard population. Trends were assessed using Joinpoint regression estimating average annual percent changes (AAPCs) and annual percent changes (APCs). Multivariable Poisson regression estimated incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

Among 21,130 women (64.4% White; 35.6% Black), the overall age-adjusted IR was 166.0 per 100,000 with no significant change over time (AAPC = 0.48%; 95% CI: -0.27 to 1.24). Black women had higher incidence than White women (178.0 vs. 159.1). Among White women, incidence increased modestly (AAPC = 0.60%; 95% CI: 0.06-1.13). Trends among Black women were not significant overall (AAPC = 0.36%; 95% CI: -0.25 to 1.04) but increased from 2014 to 2019 (APC = 1.95%; 95% CI: 0.77-4.26) after an initial decline. Localized-stage incidence increased in both groups, while Black women had higher regional- and distant-stage incidence. In adjusted models, Black women had higher incidence of HER2-overexpressing (IRR = 1.55; 95% CI: 1.15-2.10) and triple-negative cancer (IRR = 2.35; 95% CI: 1.74-3.17) than White women.

Overall incidence remained stable, but substantial heterogeneity across subgroups underscores the need for stratified surveillance and equity-focused cancer control strategies in high-burden settings.

Pancreatic cancer (PC) disrupts metabolic and nutritional processes, including glucose homeostasis and albumin levels. Both hyperglycemia and hypoalbuminemia have been linked to poorer outcomes in various cancers, including PC. This study investigates the preoperative glucose-to-albumin ratio (GAR) as a potential prognostic marker of overall survival in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma (PDAC).

This single-center retrospective analysis included patients who underwent curative-intent pancreatectomy for PDAC and adenosquamous carcinoma of the pancreas between 2017 and 2024. GAR was calculated from preoperative laboratory tests. Kaplan-Meier and Cox regression analyses were performed for recurrence-free and overall survival.

A total of 566 patients were included (51% males and 49% females, mean age 68.3); 548 had PDAC and 18 had adenosquamous carcinoma of the pancreas. High GAR was associated with elevated CA 19-9, CEA and BMI (p < 0.0001, p < 0.0001, p = 0.02, respectively), more advanced T staging (p = 0.001), increased tumor size (p = 0.007), and AJCC staging (p = 0.04), as well as perineural invasion (p = 0.01) and lymphovascular invasion (p = 0.008). Kaplan-Meier analysis demonstrated significantly worse overall survival in high GAR patients (26.6 vs. 35.0 months, p = 0.004), while low albumin was associated with significantly worse recurrence-free survival (15.5 vs. 20.7 months, p = 0.04). Cox regression identified high GAR (HR = 1.3, p = 0.04), lower BMI (Body Mass Index) (p = 0.02), higher CA 19-9 (p = 0.006), N staging (p = 0.002), histological tumor grading (p < 0.0001), neoadjuvant chemotherapy (p = 0.002) and perineural invasion (p = 0.03) as independent risk factors for poorer overall survival.

Higher preoperative GAR is associated with more advanced disease at presentation and an adverse prognosis in patients with resected PC.

The generation and maintenance of effective tumor-specific CTL responses require more than antigen recognition. In most settings, TCR engagement must be accompanied by co-stimulatory input, with the B7-1/B7-2-CD28 axis being one of the best-characterized examples. When this second signal is weak or absent, tumor-reactive CD8+ T cells may recognize tumor antigens but fail to expand, survive, or acquire and sustain cytotoxic activity. Tumors take advantage of this vulnerability by reducing co-stimulatory ligand availability, increasing inhibitory checkpoint signaling, and remodeling the tumor microenvironment in ways that further restrict T-cell activation. Depending on the stage and context of dysfunction, this shift may favor anergy-like dysfunction, impaired persistence and apoptotic attrition, or, under persistent antigen exposure and sustained inhibitory signaling, exhaustion-associated dysfunction, thereby promoting immune escape. This review examines how reduced or functionally restricted B7-CD28 co-stimulation impairs CTL activation, intratumoral reactivation, and persistence, and how checkpoint signaling, suppressive immune cells, metabolic stress, and stromal barriers compound this defect within tumors. We also evaluate strategies intended to restore or bypass inadequate co-stimulatory input, distinguishing established checkpoint-based interventions from co-stimulatory agonists, engineered T-cell therapies, multispecific antibodies, and gene-based approaches that remain preclinical or early translational in many settings. We propose that mechanism-matched therapy should be guided by the phase at which the dominant barrier arises-tumor-reactive CD8+ T-cell priming, intratumoral CTL reactivation, or long-term CTL persistence.

Cancer-associated fibroblasts (CAFs) are pivotal stromal component in tumor microenvironment (TME) and participate in regulating tumor development and progression via exosomes (exos) mediated intercommunication. However, the intricate mechanism underlying the exosomal miRNAs from CAFs in gastric cancer (GC) tumorigenesis remains ambiguous. Herein, we found that miR-4435 was highly expressed in both CAFs- derived exos and GC tissues and was associated with TNM stage as well as tumor size in GC patients. Additionally, inhibition of miR-4435 remarkably restricted GC proliferation, migration, and invasion in vitro and in vivo; whereas facilitating ferroptosis in GC cells. Moreover, miR-4435 could bind with the downstream target NDUFA10 mRNA and was shown to silence NDUFA10 expression. Importantly, exosomal miR-4435 derived from CAFs could suppress CD8⁺ T cells effector function, contributing to immune resistance, while knockdown of miR-4435 in CAFs-exo could foster CD8⁺ T cells effector function and enhanced the sensitivity of anti-PD-1 therapy in GC. Collectively, exosomal miR-4435 derived from CAFs suppress ferroptosis and CD8⁺ T cell effector function in GC via mediating NDUFA10. Our results highlight exos-transfered miR-4435 as a potential therapeutic target in GC.