Covalent BTK inhibitors (cBTKis) are the cornerstone of chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL) therapy, yet real-world data on dose modifications and their differential impact on long-term outcomes remain incompletely defined. This study investigated the incidence, timing, and the effectiveness of drug switching in a real-world CLL cohort.

In this 7-year retrospective real-world study, 324 CLL/SLL patients treated at a specialized Shanghai outpatient clinic (April 2018-April 2025; median follow-up, 42 months) were analyzed. Dose modifications were classified as dose interruption (DI) or dose reduction (DR). Their prognostic impact on progression-free (PFS) and overall survival (OS) was assessed by Kaplan-Meier analysis and multivariate Cox regression.

The 42-month PFS rate was 70.2%. Of 324 patients, 229 (70.7%) experienced dose reductions or interruptions; infections were the predominant cause (61.9%). The full-dose (FD) group (n = 90) demonstrated superior 4-year PFS (93% vs. 58%, p < .001) and OS (98% vs. 76%, p = .007). Early modifications (0-3 months) were independent predictors of inferior PFS (hazard ratio [HR], 3.93, p = .008) and OS (HR, 3.29, p = .014). Prolonged DI (>14 days) was associated with inferior PFS (HR, 2.64) and OS (HR, 2.15), whereas DR and short DI (≤14 days) had negligible impact. Early (0-3 months) prolonged DI was devastating (3-year PFS, 41.2%; HR, 3.84, p < .001). cBTKi switching (n = 82; 100% nonprogression-driven) shortened DI (median, 6 vs. 14 days) and was independently associated with superior OS (HR, 0.34, p = .018) and PFS (HR, 0.36, p = .022).

Early prolonged DI is the dominant adverse prognostic factor in cBTKi-treated CLL/SLL. Proactive switching minimizes treatment gaps and improves survival, supporting a timing-aware, DI- versus DR-informed approach to dose management.

Multiple myeloma (MM) is a prevalent hematologic malignancy. A systematic comparison of the temporal trends in MM disease burden between China and the global level is important for optimizing prevention and control strategies. This study describes trends in the age- and sex-specific burden of MM in China from 1990 to 2023, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs); projects sex-specific incidence to 2050; and compares findings globally.

Using the Global Burden of Disease (GBD) 2023 database, we extracted data on MM in China and globally from 1990 to 2023. Joinpoint regression was used to calculate the average annual percentage change (AAPC) and its 95% confidence interval (CI) for trend analysis, with comprehensive comparisons by age and sex. In addition, Bayesian age-period-cohort (BAPC) modeling was used to describe and predict sex-specific trends in MM incidence through 2050, with 95% uncertainty intervals (UIs) reported for GBD estimates and BAPC projections.

From 1990 to 2023, the age-standardized incidence rate (ASIR) of MM increased from 0.30 to 0.94 per 100,000 people in China, and the global ASIR increased from 1.59 to 1.95 per 100,000. In China, the AAPC was 3.70%, well above the global level of 0.65%. Comparable differences were observed in prevalence, mortality, and DALYs. The burden of disease increased substantially with advancing age and was higher in males. The BAPC model suggested that by 2050, the ASIR for females in China may surpass that for males, whereas the global ASIR for both sexes is projected to continue to rise.

The disease burden of MM in China has risen substantially faster than the global average over the past three decades and is expected to continue increasing, particularly among females. Priority public health strategies for prevention and control are essential to address this growing public health issue.

Existing hepatocellular carcinoma (HCC) risk scores specific to chronic hepatitis B (CHB) mostly rely solely on baseline indicators, limiting their applicability in clinical practice. By incorporating dynamic and static indicators, this study aimed to address this limitation by developing a machine learning (ML) model for HCC prediction in patients with CHB and compensated advanced chronic liver disease (cACLD).

ML models were trained to predict HCC in 1 272 patients with CHB and cACLD, who underwent at least 2 measurements from different centres and were further tested with external cohorts (n = 601). The first and last liver stiffness measurements were defined as the baseline and follow-up values, respectively.

A total of 1 873 individuals with CHB and cACLD were included, with 192 patients (10.3%) developing HCC after a median of 30.7 months. Based on LASSO logistic regression, baseline age, baseline albumin concentration, follow-up albumin concentration, follow-up platelet count, and change in the liver stiffness measurement (∆LSM) were selected, with ∆LSM identified as the most important indicator. Developed using XGBoost, the ALPS-HCC score achieved the highest integrated AUROC (0.852), Harrell's C-index (0.852), and F1 score (0.944), and performed significantly better than existing HCC risk scores. Based on these results, our risk stratification performed well in terms of prognosis in the validation cohort, including the identification of low-risk (n = 250; reference), intermediate-risk (n = 91; hazard ratio [HR] = 5.25), and high-risk (n = 41; HR = 24.47) groups.

ALPS-HCC score provides robust predictive power and screening capability for predicting HCC risk in patients with CHB and cACLD.

TrueBeam (TB) and Halcyon (HC) are state-of-the-art linear accelerators (linacs) widely utilized for external beam radiotherapy. As clinical demand increases, expanding treatment capacity through new machine installations or extended operating hours remains costly and resource intensive. Retrospective analyses of treatment delivery performance can help guide machine assignment strategies that optimize machine utilization, reduce patient time alone on the treatment couch, and improve overall departmental throughput.

To introduce a trajectory log-based methodology for assessing treatment delivery efficiency on Halcyon and TrueBeam systems by quantifying gantry speed, MLC speed, and dose-rate utilization, and to integrate these machine-level parameters with beam-on time and modulation factor (MF) to guide treatment machine assignment and patient triaging.

Volumetric modulated arc therapy (VMAT) trajectory logs acquired between February 2025 and February 2026 were collected from fourteen clinical linacs across a main institution and its affiliated regional clinics. The percentages of beam-on time during which the machine operated at ≥95% of its maximum dose rate (max_DR), gantry speed (max_GS), or MLC speed (max_MLC) were quantified. Plans were categorized by procedure type and disease site, and delivery efficiencies were compared using Mann-Whitney U test.

A total of 4347 VMAT plans were included in the study. For stereotactic body radiation therapy (SBRT) plans, Halcyon had a significantly higher max_DR (0.96 ± 0.14 vs. 0.51 ± 0.39 for TrueBeam), suggesting its max dose rate might be a bottleneck for treatment efficiency. For non-SBRT plans, Halcyon demonstrated greater max_GS (0.68 ± 0.32 vs. 0.43 ± 0.22 for TrueBeam) and max_MLC (0.66 ± 0.32 vs. 0.38 ± 0.23 for TrueBeam), which is reflected in its higher MF and faster beam-on time compared to TrueBeam, saving over 50 seconds of on-table time per plan for each patient.

Halcyon demonstrates superior delivery efficiency for non-SBRT plans compared to TrueBeam through higher usage of its maximum MLC speed and gantry speed throughout treatment, especially for pelvis plans. In contrast, TrueBeam has significantly shorter beam-on time for higher-dose treatments (e.g. prostate SBRT), likely due to its higher nominal maximum dose rates at flattening filter-free energies. By linking delivery performance to underlying machine-specific limitations, this work provides a transferable framework for machine efficiency assessment that can be readily implemented at other centers using trajectory log data to guide machine assignment decisions and evaluate the potential impact of future Linac technology advancements.

The recently proposed classification of steatotic liver disease (SLD) comprises metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Long-term cancer risk across these phenotypes remains incompletely characterized, and was investigated in this study.

This longitudinal cohort study included 43,994 adults who underwent health check-ups in 2010-2011. Liver steatosis was diagnosed by ultrasonography. The Fibrosis-4 (FIB-4) and steatosis-associated fibrosis estimator (SAFE) scores were evaluated as predictors of cancer incidence.

Over a median 10.5 years (398,202 person-years), 3,169 cancers occurred (795.8 per 100,000 person-years). Versus no SLD, overall cancer risk was elevated in ALD (incidence rate ratio [IRR], 1.38; 95% confidence interval, 1.08 to 1.79) but not MASLD or MetALD. Hepatocellular carcinoma risk increased across all SLD groups, most strongly in the MetALD and ALD groups, with a more modest association in the MASLD group that was attenuated in sensitivity analyses. ALD was associated with an elevated risk of esophageal cancer (IRR, 5.98) and stomach cancer (IRR, 2.41), and MetALD with an increased risk of stomach cancer (IRR, 1.61). FIB-4 and SAFE showed dose-response associations with cancer that were substantially attenuated after age adjustment, persisting mainly at the highest categories.

Cancer risk differs across MASLD, MetALD, and ALD, with alcohol-related phenotypes carrying the highest burden. Noninvasive fibrosis indices such as FIB-4 and SAFE may help stratify risk-though largely age-related-and could inform risk-based surveillance in SLD.

A dedicated breast PET (BPET) scanner integrated with digital breast tomosynthesis (DBT) enables three-dimensional functional imaging with quantitative information co-registered to high-resolution anatomical images. With the availability of breast cancer specific PET radiotracers, such a scanner has the potential to improve treatment planning in breast cancer. We recently developed a BPET-DBT scanner utilizing an integrated gantry design to generate intrinsically co-registered BPET-DBT images.

This paper presents the scanner design, characterizes its imaging performance, and reports on our initial human imaging experience to demonstrate scanner's clinical readiness.

The PET component is comprised of two detector heads, providing a 20 × 10 × 10 cm³ scanner field-of-view. The detector provides time-of-flight (TOF) measurement and is comprised of 32×32 LYSO arrays of 1.5 × 1.5 × 15 mm³ crystals coupled to multi-anode PMTs. Custom waveform-sampling electronics ensures high spatial and timing resolution with minimal deadtime. The DBT component is a state-of-the-art system which employs 2D x-ray tube and detector motion for improved contrast and resolution. Phantoms appropriate for breast imaging were imaged to assess spatial resolution, image quantitation, count-rate capability, and co-registration accuracy. First human imaging was performed in volunteers with estrogen-receptor-positive (ER+) breast cancer. A five-minute BPET-DBT scan using ¹⁸F-fluoroestradiol was acquired and compared with a whole-body PET scan.

System timing resolution of 425 ps and energy resolution of 16% were measured. Spatial resolution measurements showed an in-plane (parallel to the detector) resolution of 2 mm and demonstrates the ability to resolve 1.6 mm rods in the micro-deluxe hot rod phantom. TOF reconstruction combined with image-based resolution modeling mitigates artifacts typical in scanners with incomplete angular coverage and enables good out-of-plane (orthogonal to detector) discrimination of the 2.4 mm rods. Count-rate measurements confirm low scanner dead-time, with sufficient count-rate capability for clinical use.

We successfully constructed and tested a BPET scanner and integrated it with DBT. BPET scanner performance was characterized, and imaging capabilities relevant for clinical imaging have been highlighted. Images from a patient with ER+ breast cancer show clear tumor delineation and visualization of heterogeneous uptake, as also seen with WB-PET. This approach offers a promising strategy for improved treatment planning and outcomes in breast cancer care.

Conventional ultrasound phantoms typically lack anatomical surface geometry and procedural access constraints, limiting the transferability of acquired skills to clinical practice. The objective of the present work was to develop and describe such a platform for ultrasound-guided thyroid nodule puncture training, including its construction and initial ultrasound appearance. We present a modular, body-mimicking ultrasound phantom platform comprising three components: an anatomically shaped epoxy composite chassis cast from a healthy volunteer and covering the cervical and upper thoracic region, interchangeable gelatin-based inserts representing thyroid (including puncture target lesions) and surrounding tissue structures, and an integrated dual-camera optical feedback system for real-time and post-procedural needle trajectory visualization. Two chassis configurations reflecting different chin and shoulder positions allow deliberate modulation of procedural difficulty. Insert composition can be varied to simulate tissues of differing echogenicity and density, including liquid-filled targets. Under appropriate storage and disinfection conditions, inserts remained usable for up to four weeks in qualitative observation. The optical feedback system supports self-directed learning and structured debriefing. In combination with magnet-based ultrasound needle guidance technology, the platform is intended to support a longitudinal, competency-based training concept with quantifiable performance metrics, enabling systematic documentation of individual learning curves. The presented system is designed to more closely replicate the anatomical and procedural complexity of clinical ultrasound-guided interventions than conventional phantoms and represents a flexible simulation platform for interventional ultrasound education.

Background: Malnutrition is a significant clinical problem in patients with cancer, occurring not only during hospitalization but also throughout the recovery phase. It brings severe health and economic consequences, affecting patients on both physical and psychological levels. The American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) emphasize the critical importance of early detection of nutritional disorders and timely intervention in oncology populations. The aim of this study was to determine the prevalence of malnutrition and factors associated with malnutrition among hospitalized Polish oncology patients and to draw attention to the need for early nutritional assessment in patients with cancer so as to ensure appropriate nutritional care. Methods: A multicenter cross-sectional study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines among adult patients diagnosed with cancer and undergoing oncological treatment. Data collection involved a structured survey questionnaire, anthropometric measurements, and validated screening tools: Mini Nutritional Assessment (MNA), Nutritional Risk Screening Score 2002 (NRS 2002), and Subjective Global Assessment (SGA). Results: The study group comprised 560 patients with a mean age of 55 ± 13.95 years, including 59% women and 41% men. The mean duration of illness was 3.37 years. Advanced-stage cancer was present in 43% of participants, and 66% were undergoing chemotherapy. The mean Body Mass Index (BMI) for the study group was 23.14 kg/m², with a mean MNA score of 16.23 points and a mean NRS 2002 score of 2.39 points. Based on Subjective Global Assessment, moderate malnutrition was identified in 45% of patients, whereas severe malnutrition was confirmed in 27% of the study population. Conclusions: The prevalence of malnutrition among oncology patients is high. Early screening and regular monitoring are essential for the prompt identification of patients at risk, enabling the implementation of appropriate nutritional therapy and the improvement of clinical outcomes.

Purpose: Young adult cancer survivors aged 20-30 years are at increased risk for chronic health conditions, influenced by modifiable lifestyle behaviors. Many do not meet the American Cancer Society's guidelines for physical activity and healthy eating. Guided by Social Cognitive Theory, this qualitative study explored the facilitators and barriers to healthy lifestyle behaviors among a racially and ethnically diverse sample of young adult cancer survivors aged 20-30 years to inform tailored interventions. Methods: Participants were recruited through the Adolescent and Young Adult Oncology Program at Moffitt Cancer Center in Florida, USA. Semi-structured interviews were conducted and analyzed using applied thematic analysis. Transcripts were coded in NVivo 12 Plus and organized into themes reflecting Social Cognitive Theory constructs and intervention preferences. Demographic information was collected via pre-interview surveys. Results: Participants (N = 30) were an average of 26 years (SD = 2.4). Most identified as non-Hispanic (60%), White (60%), unmarried (83%), women (83%), and with annual household income ≥$40,000 (67%). The most common diagnoses were thyroid cancer (20%), lymphoid (17%), and sarcoma (13%). Interviews lasted 30-88 min (M = 52). Five themes emerged: (1) competing demands and time constraints; (2) symptom burden and desire for credible, flexible support; (3) previous habits, self-efficacy, and community building; (4) dual role of social support; and (5) cancer as a catalyst for behavior change. Conclusions: Findings identified facilitators and barriers to physical activity and healthy eating, and intervention preferences among young adult cancer survivors, which can inform the timing, content, and modality of tailored interventions. Implications for Cancer Survivors: Findings can inform tailored, survivor-centered interventions for young adult cancer survivors.

Nutritional deterioration is a common consequence of gastrectomy for gastric cancer and may persist despite standardized perioperative care. However, prospective longitudinal evidence describing the early course of postoperative nutritional recovery remains limited. This study aimed to characterize nutritional recovery trajectories following curative gastrectomy and to evaluate the influence of the extent of gastric resection on postoperative recovery.

A prospective cohort of 239 consecutive patients undergoing curative-intent subtotal or total gastrectomy for gastric adenocarcinoma was followed between January 2022 and December 2025. The longitudinal complete-case analysis included 217 patients with available assessments at all three predefined time points: preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3). Nutritional-immune biomarker trajectories were assessed preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3) using serum albumin, total cholesterol, absolute lymphocyte count, and the Controlling Nutritional Status (CONUT) score. Longitudinal changes were evaluated using linear mixed-effects models with patient-specific random intercepts.

All evaluated nutritional-immune biomarkers changed significantly in an adverse direction after surgery, reaching their most unfavorable values at hospital discharge (all p < 0.001), followed by partial biochemical recovery at three months. Because albumin, lymphocyte count, and CONUT are influenced by the acute inflammatory and metabolic response to surgery, the discharge changes should not be interpreted as direct evidence of acute malnutrition. Nevertheless, none of the evaluated biomarkers returned to its preoperative value. Recovery between discharge and three months represented 65.6% of the initial decline for serum albumin, 50.5% for absolute lymphocyte count, 51.7% for total cholesterol, and 60.9% for the CONUT score. After adjustment for age, sex, neoadjuvant chemotherapy, baseline body mass index, ASA status, pathological T3-T4 stage, and major postoperative morbidity, total gastrectomy was associated with a greater early decline in absolute lymphocyte count at hospital discharge (β = -165.7 cells/mm³; 95% CI, -204.9 to -126.6; p < 0.001). This difference was no longer present at three months (p = 0.955). No significant time-by-gastrectomy interactions were observed for albumin, cholesterol, or corrected CONUT.

Nutritional recovery following gastrectomy is a dynamic and prolonged process characterized by marked early nutritional-inflammatory biomarker changes and incomplete biochemical restoration at three months. Resection extent was not independently associated with persistently less favorable albumin, cholesterol, or corrected CONUT trajectories. The findings describe early biochemical changes and should not be extrapolated to body composition, functional recovery, micronutrient status, quality of life, or long-term survivorship. These findings apply primarily to patients who survived and completed the three-month follow-up.