Gastric cancer remains one of the most common and deadly malignancies worldwide. Trace elements are gaining increasing interest due to their dual roles as both essential nutrients and potential carcinogens. This study aimed to compare trace element concentrations in gastric cancer tissues with healthy controls. A cross-sectional study was conducted analyzing 27 trace elements in gastric cancer tissues from 73 patients and healthy gastric tissues from 99 controls. Tissue samples were collected from archived paraffin blocks and analyzed using appropriate analytical methods. Statistical analyses included Mann-Whitney U test, ROC curve analysis, and Kruskal-Wallis test. Due to demographic differences between groups, Firth's penalized logistic regression adjusted for age and sex was used to determine the independent diagnostic value of elements. P-values were corrected using the False Discovery Rate (FDR). Significant differences in trace element concentrations were observed between gastric cancer patients and controls. Silver, bismuth, cadmium, cobalt, chromium, gallium, potassium, lithium, nickel, lead, thallium, antimony, vanadium and selenium) were elevated in cancerous tissues (p < 0.05). Conversely, aluminium, boron, iron, indium,manganese, zinc, and mercury were found in lower concentrations in tumor tissues (p < 0.05). After adjusting for age and sex, Selenium and Zinc levels remained significantly lower in cancer tissues, while Copper was significantly higher. These associations persisted independently of demographic variables. This study demonstrates significant changes in trace element profiles between gastric cancer and healthy tissues. The diagnostic potential of trace element profiling and stage-specific variations open new avenues for research and clinical applications in gastric cancer management.

Patient-centered care (PCC) improves quality of life, symptom management and healthcare outcomes in oncology. However, integration into routine cancer care remains limited. Digital solutions using patient-reported outcome measures (PROMs) offer a potential mechanism to operationalize PCC. This study explored healthcare professionals' (HCPs) pre-implementation perspectives on using digital PROMs to support PCC in Norwegian oncology outpatient clinics, informing the design and implementation strategies of the European MyPath digital solution.

Semi-structured interviews (n = 29) and three focus groups (n = 16) were conducted with varied HCPs across four Norwegian hospitals. Interviews explored perceptions of PCC, experiences with PROMs, and requirements for digital implementation. Data were analyzed using thematic analysis, combining inductive and deductive coding guided by the TPOM framework.

Four themes emerged: (1) balancing PCC with disease-centered practices, (2) integrating PCC into daily routines, (3) customization and patient acceptance of digital tools, and (4) combining patient-reported data with clinical autonomy. HCPs viewed digital PROMs as promising for facilitating PCC but emphasized that successful implementation requires workflow alignment, adaptable digital solutions, and strong stakeholder engagement. Concerns included patient digital literacy, workload implications, and overreliance on PROMs at the expense of direct patient interaction.

Our findings highlight a tension between HCPs' needs for technical functionality and workflow alignment, and the support required to adapt their practice to fully realize PCC through digital tools. Integrating PCC successfully requires organizational, cultural, and workflow adaptations, alongside active HCP engagement in design and implementation. These changes are essential to reposition PCC as an integral rather than competing component of high-quality cancer care.

A model is developed of disease initiation and progression for asbestos related plaque deposition and mesothelioma based on prior models of wound healing and asbestos transport. The model includes short term processes such as macrophage polarization and immune system response, extending the time frame to that of detectable disease. Model results were in a biologically reasonable range. Cancer development and plaque deposition are shown to be dependent on total exposure (intensity * duration). Plaque deposition was sensitive to many systemic parameters, suggesting that assays could be developed to identify individuals with higher risk. Tumor development was sensitive only to a few parameters describing exposure and T-cell levels, indicating potential for immune system intervention.

The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions.

This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did not receive excisional treatment for cervical intraepithelial lesions between 2009 and 2022 was enrolled. Adverse pregnancy outcomes (preterm delivery and pregnancy loss) in women with and without HIV, untreated or treated for cervical dysplasia, were recorded and analysed. The significance of the obtained results was judged at the 5% level.

The study was conducted at all Academic Model Providing Access to Healthcare-Kenya satellite sites, which offer cervical cancer screening and treatment for cervical dysplasia in western Kenya. The Moi Teaching and Referral Hospital was also included.

A cohort of 488 women aged between 20 years and 49 years, with and without HIV, diagnosed and treated for high-grade cervical intraepithelial neoplasia, and those followed up for low-grade cervical intraepithelial neoplasia between 2009 and 2022, were included.

The study was interested in adverse pregnancy outcomes, particularly pregnancy loss and preterm delivery following cervical excision treatment for high-grade cervical intraepithelial lesions.

After adjustment for confounding factors, excisional treatment involving the uterine cervix-particularly cold knife conisation-was associated with higher odds of adverse pregnancy outcomes (OR 13.1; 95% CI 1.1 to 137.1; p=0.032). A prior history of adverse pregnancy outcomes was also strongly associated with subsequent adverse outcomes after treatment (OR 37.7; 95% CI 13.8 to 102.7; p<0.001). In contrast, maternal HIV infection was not independently associated with adverse pregnancy outcomes after adjustment (p=0.125).

Adverse pregnancy outcomes after excisional treatment of the uterine cervix for high-grade squamous intraepithelial lesions are multifactorial and were associated with cold knife conisation and prior adverse pregnancy outcomes, while maternal HIV infection was not independently associated with adverse outcomes.

Pleural malignancies pose a significant clinical challenge due to their poor prognosis and limited treatment options. Hyperthermic intrathoracic chemotherapy (HITHOC) is an emerging modality that has shown promise in treating primary pleural cancers when used with cytoreductive surgery (CRS), but its efficacy in treating pleural malignancies other than mesothelioma remains underexplored. This review aims to evaluate recent advancements in HITHOC use for nonmesothelioma pleural cancers and provide insights into its potential clinical applications.

A comprehensive Boolean search was conducted using PubMed/Medline and Google Scholar to identify relevant studies on the use of HITHOC for nonmesothelioma pleural cancers. Studies exclusively focused on pleural mesothelioma were excluded. Findings were summarised to address key questions regarding HITHOC's effectiveness, integration with other therapies and obstacles to its broader use.

HITHOC, when combined with CRS, could prolong overall and progression-free survival and reduce complication and mortality rates in patients with advanced pleural cancers. Advances in chemo-immunotherapy, the evolution of minimally invasive techniques and the emergence of precision surgery hold significant promise in the treatment of pleural malignancies.

Given the challenges associated with HITHOC, including protocol variability and technical complexity, future research using larger, multinational datasets is essential to support its broader application and to identify patient-specific characteristics that enhance its efficacy in treating pleural cancers.

5-Aminolevulinic acid (5-ALA), an amino acid precursor of protoporphyrin IX, is used in the photodynamic diagnosis (PDD) of bladder cancer because it emits fluorescence at specific wavelengths. Severe hypotension has been reported in patients undergoing 5-ALA-based PDD. Previous studies have mainly focused on hypotension occurring immediately after 5-ALA administration. Persistent hypotension lasting beyond the day of administration has also been reported, indicating a need for continued postoperative management. However, the risk factors associated with persistent 5-ALA-induced hypotension remain unclear. This retrospective study aimed to identify the risk factors for persistent hypotension following 5-ALA administration. Among 263 patients who received 5-ALA for PDD of bladder cancer at Yamaguchi University Hospital between April 2018 and March 2022, 183 developed hypotension and were included in the analysis. Patients were classified into a persistent hypotension group (n = 30), comprising those with continued hypotension the following day, and a nonpersistent group (n = 153). Baseline demographics and clinical characteristics were comparable between the groups. In contrast, preoperative hemoglobin levels were significantly lower in the persistent group (p < 0.05). Multivariate logistic regression analysis identified preoperative hemoglobin levels as an independent risk factor for persistent hypotension (odds ratio, 0.76; 95% confidence interval, 0.60-0.97). A hemoglobin concentration of 12.9 g/dL was determined as the cutoff value for predicting the incidence of persistent hypotension using receiver-operating characteristic curve analysis. Although further validation is required, these findings suggest that the preoperative hemoglobin level may serve as a potential indicator for risk stratification of persistent hypotension induced by 5-ALA.

Central airway adenoid cystic carcinoma (CAACC) is a rare malignancy lacking a standard treatment approach and often precluding complete resection. This study assessed the surgical outcomes of patients with CAACC treated at a single institution.

We retrospectively reviewed patients who underwent surgical resection for CAACC between September 2013 and August 2021.

Eight patients (mean age: 51.5 years) were included. Tumor locations were bronchus (n = 1), trachea (n = 4), carina and bronchus (n = 2), and carina and trachea (n = 1). Surgical procedures included sleeve lobectomy (n = 1), tracheal resection (n = 4), sleeve pneumonectomy (n = 2), and carinal resection with reconstruction (n = 1). Preoperative radiation and bronchoscopic tumor resection were performed in 1 patient each. One patient died from a postoperative tracheoinnominate artery fistula. Major complications included recurrent laryngeal nerve palsy (n = 3). Adjuvant therapy was provided for positive or uncertain margins. During a median follow-up of 6 years, 2 patients developed recurrence but remained alive at the last follow-up. The 5-year overall survival rate was 72.9%.

Surgical resection with airway reconstruction and adjuvant therapy can offer long-term disease control in CAACC, though life-threatening complications warrant careful consideration.

There is an urgent need for more systematic investigations into how image inspection and primary treatment for low-risk prostate cancer vary by type of medical institution. To investigate disparities in imaging inspections and first-line treatment depending on the type of medical institution for low-risk prostate cancer using the Japan Study Group of Prostate Cancer database.

Data on patients with low-risk prostate cancer diagnosed between 2016 and 2018 from a nationwide database of the Japan Study Group of Prostate Cancer were used. Among these databases, patient and tumor characteristics, image inspections for diagnosis, and first-line treatment at clinics, community hospitals, and university hospitals were compared statistically.

This analysis included patients with low-risk prostate cancer at clinics (n = 89), community hospitals (n = 1259), and university hospitals (n = 671). The three facilities had no significant differences in the performance of computed tomography scans, bone scintigraphy, and magnetic resonance imaging scans. Active surveillance was less performed in clinics and university hospitals, compared with community hospitals. Androgen deprivation therapy was significantly more common, but curative treatments, including radiation and prostatectomy, were less performed in clinics. Curative radiation was significantly more common, but androgen deprivation therapy was less performed in university hospitals.

Our study analyzed data on low-risk prostate cancer obtained from a Japanese multi-institutional registry and showed differences in first-line treatment options by type of medical institution.

Adjuvant immunotherapies have transformed lung cancer management by improving survival and patient-reported quality of life. However, their high acquisition costs and uncertainty around real-world economic value raise concerns regarding health system affordability and long-term sustainability. This study assessed the cost-effectiveness of adjuvant immunotherapies and evaluated their projected budget impact under plausible real-world adoption scenarios.

We systematically reviewed published economic evaluations of adjuvant immunotherapies in lung cancer from 2010 to 2024. Eligible studies included cost-effectiveness and cost-utility analyses comparing immune checkpoint inhibitors with standard chemotherapy or best supportive care. Data on costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and willingness-to-pay (WTP) thresholds were extracted and narratively synthesised. For therapies judged cost-effective, we conducted a five-year (2025-2029) budget impact analysis using ISPOR-consistent methods, with costs standardised to 2024 US dollars. Three adoption scenarios were modelled: a base-case phased adoption (10%-50%), an accelerated uptake scenario (30%-50%), and a restricted uptake scenario (10%-30%), to examine the sensitivity of affordability to alternative implementation pathways.

Thirty-five economic evaluations of adjuvant immunotherapies for lung cancer were included (33 NSCLC and 2 SCLC studies). Frequently evaluated agents were pembrolizumab (n=11), nivolumab (n=8), atezolizumab (n=6), and durvalumab (n=5), alongside emerging agents including icotinib, sintilimab, sugemalimab and camrelizumab. Overall, adjuvant immunotherapies were associated with improved health outcomes compared with standard chemotherapy, with incremental gains of ~0.3-0.5 QALYs in several US/European models and gains of ≥1.0 QALY in selected biomarker-defined population or Chinese cohorts. However, per-patient costs were substantially higher, ranging from modest increases (~US$4,000 with icotinib) to totals >US$230,000-390,000 for PD-1/PD-L1 based regimens and >10-fold higher than standard care in some middle-income settings. ICERs ranged from highly favourable estimates (e.g. icotinib ~US$3,440/QALY; selected pembrolizumab, sintilimab, sugemalimab, squamous-specific nivolumab and CAD strategies within local WTP thresholds) to clearly non-cost-effective values (>US$300,000-600,000/QALY) for broad, unselected use, combination regimens, and several SCLC indications. Fo interventions judged cost-effective, five-year dudget impact estimates for cost-effective options indicated substantial 5-year incremental spending (from low millions up to >US$400 million), while a small subset of regimens were cost-saving or near budget-neutral, underscoring the need for targeted adoption and price negotiation in the adjuvant setting. Under the base-case phased uptake scenario, budget impact increased steadily over time, with high-cost regimens such as pembrolizumab- and durvalumab-based strategies generating the largest cumulative five-year expenditure. Accelerated uptake substantially intensified short-term fiscal pressure, with first-year spending approximately tripling and over half of total five-year costs incurred within the first three years for several therapies. In contrast, restricted uptake reduced cumulative five-year budget impact by approximately one-third to nearly one-half, depending on the agent.

Adjuvant immunotherapies for lung cancer deliver meaningful clinical benefits, but their economic value and affordability are highly context-specific. While several strategies are cost-effective at the individual patient level, health system affordability is strongly influenced by the pace and scale of adoption. Scenario-based budget impact analyses demonstrate that accelerated uptake can impose substantial short-term fiscal pressure, whereas phased or restricted implementation markedly improves affordability without altering cost-effectiveness conclusions. These findings underscore the importance of integrating cost-effectiveness evidence with explicit consideration of budget impact, adoption strategies, and managed entry mechanisms to support sustainable and equitable scale-up of adjuvant immunotherapies in routine clinical practice.

CRD420251127115.

The optimal surgical approach and extent of lymph node dissection for esophagogastric junction (EGJ) cancer remains uncertain. We conduct a nationwide multicenter prospective study in patients with resectable cT2-T4 adenocarcinoma or squamous cell carcinoma with the tumor epicenter located within 2 cm of the EGJ. Patients undergo subtotal or lower esophagectomy with dissection of all regional lymph nodes. Of 1,065 patients screened, 371 are enrolled before surgery. Final analysis shows that proximal perigastric and suprapancreatic nodes exhibit a high therapeutic efficacy index (TEI), strongly supporting their dissection for improved long-term survival. TEIs in middle and lower para-esophageal stations are higher when esophageal involvement exceeds 3 and 2 cm, respectively. Conversely, all other stations, including distal perigastric and paraaortic nodes, have low TEIs, indicating minimal survival impact. Thus, mediastinal node dissection should be tailored to esophageal involvement length. This study is registered at UMIN Clinical Trials Registry (UMIN000013205).