Treatment for childhood acute lymphoblastic leukemia (ALL) can result in hepatotoxicity. Despite being a common complication of ALL therapy, mechanisms and biomarkers of treatment-associated hepatotoxicity (TAH) are not well described.

We conducted lipidomic profiling to identify plasma lipids associated with TAH in children receiving ALL therapy utilizing a nested case-control framework. TAH was defined as (1) transaminitis: ALT/AST ≥ CTCAE grade 3, and/or (2) conjugated hyperbilirubinemia: > 3.0 mg/dL during induction therapy or > 2.0 mg/dL post induction. A total of 90 patients (45 matched pairs) treated at Texas Children's Hospital between 2012 and 2021 were selected for lipidomic profiling, with controls matched to cases based on the availability of samples collected at similar time points in therapy. Lipidomic profiling quantified 1056 lipids, with 751 retained after quality control. Associations with TAH were evaluated using multivariable conditional logistic regression controlling for age, diagnostic BMI z-score, race/ethnicity, and induction intensity.

The cohort was 55% male, 50% Hispanic, with a mean diagnostic age of 5 years. We identified 110 lipids nominally associated with TAH post-sample collection (p < 0.05). Lipid classes phosphatidylcholines (PCs; Holm-p = 5 × 10^-6) and sphingomyelins (SMs; Holm-p = 0.0009) were significantly enriched in cases.

We identified plasma lipid profiles, characterized by elevated PCs and SMs with reduced triglycerides, associated with the incidence of TAH in children with ALL. Similar patterns have been linked to metabolic liver disease in adults and children. These findings suggest lipid dysregulation may contribute to TAH susceptibility and highlight candidate biomarkers for future validation in larger cohorts.

Patients with terminal cancer often have swallowing dysfunction (dysphagia), which is associated with quality of life. Dysphagia has been reported to be associated with cancer treatment, physical decline, or poor eating posture. However, its relationship with activities of daily living (ADLs) and eating posture has rarely been studied. This study examined these associations in patients with terminal cancer.

This cross-sectional observational study included patients admitted to a palliative care unit between November 2018 and April 2024 who underwent rehabilitation. Data included age, sex, swallowing function (Functional Oral Intake Scale [FOIS]), ADLs (Functional Independence Measure [FIM]), eating posture (upright sitting, chair sitting, full gatch-up, high-angle, low-angle), and Palliative Prognostic Index (PPI). Patients were categorized into tube-dependent (FOIS 1-3) and oral intake (FOIS 4-7) groups. Group comparisons used the Mann-Whitney U test. Multivariate logistic regression examined associations between swallowing function, ADLs, eating posture, adjusting for age, sex, PPI, and sleepiness.

Among 201 patients (mean age 82.0 ± 10.8 years), 26.4% were tube-dependent. Swallowing function was significantly associated with mFIM (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.002), cFIM (OR 1.07, 95% CI 1.02-1.12, P = 0.002), total FIM (OR 1.03, 95% CI 1.01-1.05, P < 0.001), and upright sitting (OR 2.92, 95% CI 1.12-7.62, P = 0.029).

Swallowing function in patients with terminal cancer was associated with ADLs and eating posture. The cross-sectional design limits causal inference, and prospective studies are needed.

The use of 3D imaging with navigation bronchoscopy has increased with the introduction of mobile cone-beam CT (mCBCT). Shape-sensing robotic-assisted bronchoscopy (ssRAB) integrated with mCBCT has been introduced to correct for CT to body divergence (CT-BD) during the biopsy of peripheral pulmonary nodules (PPNs).

Prospective observational multicentre study, enrolling patients with a PPN of ≤20 mm suspicious for malignancy, assessing tool-in-lesion (TIL), diagnostic yield, sensitivity for malignancy and incidence of pneumothorax or airway bleeding. Non-malignant index biopsies were followed for 12 months. Descriptive statistics are reported for all variables along with 95% CI for primary endpoints.

155 consecutive patients were enrolled at six centres. Median nodule size was 14.0 mm (IQR 11.0-17.0), with 54.8% of nodules (85/155) in the upper lobes, 25.8% (40/155) with CT bronchus sign present and median distance to the nearest pleural surface of 8.2 mm (IQR 1.8-20.0). TIL was achieved in 154/155 (99.4%, 95% CI 96.5 to 100.0) procedures. A median of two (IQR 1-3) mCBCT spins were performed, with median dose area product of 25.7 Gy · cm² (IQR 11.0-46.7). Diagnostic yield per the American Thoracic Society/American College of Chest Physicians (ATC/ACCP) definition was 89.0% (n=138/155; 95% CI 83.0 to 93.5) and sensitivity for malignancy was 91.5% (95% CI 86.4 to 96.5). No pneumothorax (0%, 95% CI 0.0 to 2.4) and two Nashville Grade three bleeding events were reported (1.3%, 95% CI 0.2 to 4.6).

The first prospective multicentre study of integrated ssRAB and mCBCT for small peripheral nodules resulted in diagnostic outcomes similar to those reported for transthoracic biopsy with a more favourable safety profile.

ClinicalTrials.gov ID: NCT05562895.

The DNA damage response (DDR) is crucial for maintaining genomic stability and preventing cancer development. Base excision repair (BER) and nucleotide excision repair (NER) play key roles in correcting oxidative and bulky DNA lesions, respectively. Alterations in these mechanisms have been implicated in breast and colorectal cancers (CRC), affecting both tumorigenesis and therapeutic responses. We have evaluated BER and NER activities in 85 cancer patients (58 breast cancer, 27 CRC) and 31 healthy controls. We used a comet assay-based approach to assess DNA repair capacity in peripheral blood lymphocytes. At diagnosis, patients exhibited lower BER and NER activities compared to controls, which suggests that impaired DNA repair mechanisms may contribute to cancer development. Following treatment, an overall increase in repair activity was observed, indicating cellular adaptation to therapy-induced DNA damage. This increase was greater in patients who later experienced relapse or metastasis, which suggests a possible link between enhanced repair capacity and treatment resistance. Our results also showed an interplay between BER and NER mechanisms, with their simultaneous activation potentially contributing to treatment resistance by enhancing tumour cell survival. These findings highlight the dual role of BER and NER in cancer progression and therapy outcomes, reinforcing their potential as biomarkers for predicting treatment response. Understanding the regulatory dynamics of these pathways may provide a foundation for improved personalized cancer treatment strategies.

This study aimed to investigate the effects of long-term and habitual physical activity on mortality and long-term care insurance (LTCI) certification among cancer survivors using a population database.

5-year retrospective study.

13 Japanese municipalities participated in the Longevity Improvement & Fair Evidence study.

Among 471 511 participants who underwent health check-ups, 39 435 met the following eligible criteria: documented in the cancer claims database without a suspected diagnosis and participated in a health check-up at least once in a 12-month period, had no missing exercise data and had already been certified for LTCI.

Outcomes were new LTCI certification and all-cause mortality. LTCI certification was assigned by a trained local government official through a systematic process (involving various items-physical function, daily activity function, cognitive function, behavioural disorders, adjustment to social life and daily use of medical services-as well as overall consideration of computer-based and specialist team assessments), and the LTCI severity level correlates with the Barthel index. LTCI certification reflects some impairment in activities of daily living. All-cause mortality was defined based on claims data.

Three physical activity categories, 'exercise and walking', 'exercise or walking' and 'no physical activity', were used. Among survivors aged 65-74 years, the 'no physical activity' group had a higher risk of mortality and LTCI certification than the 'exercise and walking' group (adjusted model HR: 1.72, 95% CI 1.52 to 1.94). Among survivors aged ≥75 years, the low physical activity groups had a higher risk of mortality and LTCI certification than the 'exercise and walking' group (adjusted model: 'exercise or walking', HR: 1.51, 95% CI 1.29 to 1.85; 'no physical activity', HR: 1.66, 95% CI 1.43 to 1.92). The effects of physical activity differed according to cancer type.

Habitual physical activity had positive effects on cancer survivors. These effects differed according to age and cancer type.

Colorectal cancer (CRC) is the fourth most common cancer in the UK and second leading cause of cancer-related deaths. The faecal immunochemical test (FIT) is a non-invasive home-based test used for both symptomatic assessment and population-based screening. However, approximately 30% of screening FIT kits and 10% of symptomatic FIT kits are never returned. Under-served populations, including ethnic minorities, socioeconomically deprived communities and those with mental health conditions, experience particularly low FIT return rates, contributing to health inequalities in CRC outcomes. This systematic review aims to synthesise evidence on the effectiveness and acceptability of interventions to improve FIT returns in both asymptomatic screening and symptomatic populations, with particular focus on under-served communities.

We will conduct a systematic review of qualitative and quantitative evidence. We will search Scopus, MedLine via Ovid, CINAHL via Ebsco and Cochrane Central Register of Controlled Trials from September 2010 onwards, supplemented by reference screening and trial registry searches. Eligible studies will include randomised controlled trials, quasi-experimental studies, observational studies, qualitative studies, mixed-methods studies and implementation studies examining FIT interventions in screening or symptomatic populations. Two reviewers will independently screen search results for eligible studies. Data extraction will capture study characteristics, population demographics, intervention components and outcomes including FIT return rates, acceptability, feasibility and implementation factors. Quantitative data will undergo systematic tabulation and meta-analysis where appropriate, with narrative synthesis for heterogeneous studies. Qualitative data will be analysed using framework-based thematic analysis, mapping findings to both the theoretical domains framework and theoretical framework of acceptability. A mixed-methods synthesis will integrate quantitative and qualitative findings to identify intervention characteristics, implementation strategies and contextual factors associated with improved outcomes across different population groups.

Ethics approval is not required as this systematic review will analyse published studies. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251111663.

To compare the short- and long-term outcomes of patients with colorectal liver metastases (CRLM) who underwent portal vein embolisation followed by liver resection (PVEfLR) with those who underwent other treatment strategies.

Rapid review of the literature retrieved through a systematic search.

Electronic databases PubMed, Embase and Ovid MEDLINE were searched from 1 April 2014 to 31 December 2025.

Studies were included if they involved only patients with CRLM, applied PVEfLR and reported comparative outcomes against other interventions (eg, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), liver transplantation and portal vein ligation). Only randomised controlled trials, cohort and case-control studies published in English were included. Studies that included patients other than those with CRLM were excluded.

Two authors independently screened records, extracted data and assessed quality using the Newcastle-Ottawa Scale. Data were narratively synthesised and presented in summary tables.

14 studies (n=2,022 patients) were included. The overall median survival time for the PVEfLR group was similar to that of the ALPPS group but significantly lower than that of the liver transplantation group (19 vs 41 months, p=0.007). Postoperative complications were significantly lower for PVEfLR than for ALPPS (27% vs 65%, p<0.05) but higher than for liver resection without portal vein embolisation (51% vs 36%, p<0.001). The future liver remnant growth and completion rates for PVEfLR were variable compared with those of other techniques.

PVEfLR is an effective strategy for converting selected patients with initially unresectable CRLM to resectable status, achieving long-term survival comparable to other complex techniques such as ALPPS, although with a different perioperative risk profile. The choice of technique should be individualised based on the patient's anatomy, disease burden and institutional expertise.

Oxaliplatin, a key drug in the treatment of colorectal cancer (CRC), can cause oxaliplatin-induced peripheral neuropathy (OIPN) in a dose-dependent manner. These symptoms can severely affect daily life, and chronic OIPN often limits treatment continuation because of its correlation with the cumulative dose of oxaliplatin. Currently, effective preventive measures are unavailable. However, surgical glove compression therapy may reduce paclitaxel-induced neuropathy, suggesting its potential in preventing OIPN.

This multicentre, randomised, open-label, phase II/III trial evaluates surgical glove compression therapy to investigate the possible preventive effects of OIPN in patients with CRC receiving adjuvant capecitabine plus oxaliplatin chemotherapy. Patients with stage III CRC undergoing curative surgery will be enrolled and randomised into two groups. The intervention group will wear two layers of tight-fitting surgical gloves from 30 min before to 30 min after oxaliplatin infusion, whereas the control group will receive standard care. The primary endpoint is the incidence of grade ≥2 chemotherapy-induced peripheral neuropathy (CIPN) based on the Common Terminology Criteria for Adverse Events criteria. Secondary endpoints include quality of life assessments (Functional Assessment of Cancer Therapy/Gynecological Oncology Group-Neurotoxicity-12 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-item), duration and extent of OIPN as assessed using the Debiopharm Neurologic and Sensory Toxicity Criteria, chemotherapy completion rates, and adverse events. To detect a significant reduction in the incidence of CIPN, 170 patients will be enrolled (36% in the control group vs 15% in the intervention group). The planned case enrolment period is from 1 November 2024 to 31 October 2026.

This trial was approved by the Institutional Review Board of Hiroshima University, Japan (approval no. CRB2024-0008), and has been registered with the Japan Registry of Clinical Trials (jRCTs062240066). The results of this study will be submitted for publication in a peer-reviewed journal and shared with the scientific community at international conferences.

jRCTs062240066.

Therapy-associated thrombosis remains a challenge in the management of patients with acute lymphoblastic leukaemia (ALL). Thrombosis associated with asparaginase-containing chemotherapy complicates patient management strategies, prompting the need for effective prophylaxis. Assessing the relationship between chemotherapy-induced thrombosis and patient outcomes is crucial for optimising ALL management strategies. The aim of this systematic review is to provide a synthesis on whether the development of thrombosis during asparaginase-containing chemotherapy regimens impacts the overall and event-free survival of patients with ALL.

Data sources: to identify relevant studies, a comprehensive search will be conducted on the major electronic databases, including MEDLINE (PubMed), Web of Science (Clarivate), Academic Search Complete (EBSCOhost), clinicaltrial.gov and the Cochrane Central Register of Controlled Trials from inception to 30 January 2026.Inclusion criteria for selecting studies: randomised and non-randomised clinical studies evaluating the impact of asparaginase-containing chemotherapy-associated thrombosis on survival outcomes in patients with ALL will be included. Two reviewers will independently screen the retrieved studies, extract data and assess study quality using a predefined criteria. A narrative synthesis will be undertaken, and if feasible, meta-analyses will be conducted. A subgroup and sensitivity analysis will be performed to explain the sources of heterogeneity. The quality of cumulative evidence will be assessed using the grading of recommendations assessment, development and evaluation tool. The findings from this systematic review will inform evidence-based clinical guidelines for thrombosis risk assessment and management in patients with ALL, potentially improving treatment outcomes and reducing thrombosis-related morbidity.

No ethical approval will be required and the findings of this meta-analysis will be published in a peer-reviewed journal.Trial registration numberCRD42024532665.

ObjectivePancreatic cancer is a deadly disease that may initially present as acute pancreatitis. This study aimed to examine the survival and outcomes of patients with pancreatic cancer presenting with acute pancreatitis.MethodsA retrospective review was conducted of alcohol-abstinent adult patients diagnosed with pancreatic cancer between February 2002 and February 2024 at a single tertiary care center. Patients with and without acute pancreatitis were compared with respect to clinical characteristics, tumor features, management strategies, and outcomes.ResultsA total of 284 patients were diagnosed with pancreatic cancer during the study period, of whom 84 met the inclusion criteria. Among these, 24 presented with acute pancreatitis. Sixty control patients without acute pancreatitis were matched for comparison. There were no significant differences between the groups in terms of demographics or comorbidities. Tumor stage, location, and histological subtype were also comparable. Acute pancreatitis was not associated with improved survival (p = 0.252). Patients in the acute pancreatitis group experienced significantly longer hospital stays (p = 0.044) and had a higher rate of sudden cardiac arrest (p = 0.032).ConclusionThe presence of acute pancreatitis in patients with pancreatic cancer is not associated with earlier diagnosis or improved survival outcomes. Although acute pancreatitis may lead to earlier clinical evaluation, it does not confer a prognostic advantage. Further studies are needed to clarify the clinical significance of acute pancreatitis in pancreatic cancer.