Evidence suggests that 58% of new cervical cancer cases worldwide occur among women living with HIV. However, compared with HIV-negative women, this population has significantly poorer access to healthcare services for cervical cancer screening. There is a need to better understand the factors influencing their uptake of cervical cancer screening within the context of their lives. This study aims to objectively evaluate and synthesize qualitative studies on the facilitators and barriers to cervical cancer screening among women living with HIV.

A systematic search was conducted in four databases-Web of Science, Embase, PubMed, and CINAHL-covering the period from January 2000 to December 2024. The included studies were qualitatively reviewed according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A meta-aggregative approach was used to summarize and categorize the identified facilitators and barriers.

A total of 10 articles were included in the study, identifying 27 facilitators and 79 barriers. These factors were categorized into two main themes and six sub-themes.

Women living with HIV face specific barriers to participating in cervical cancer screening. The findings of this review provide evidence to promote cervical cancer screening in this vulnerable population. Future research should focus on increasing the engagement of women living with HIV in cervical cancer screening to develop new strategies for their long-term participation and to contribute to the elimination of cervical cancer at local and global levels.

identifier [CRD42024498012].

Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer; however, the prognostic role of HPV viral load and its association with the tumor immune microenvironment remain incompletely understood. This study aimed to systematically evaluate the association between HPV viral load and disease progression, prognosis, and tumor immune microenvironment in patients with cervical cancer.

A retrospective cohort of 278 patients with cervical neoplasia was analyzed. HPV viral load was quantified and log₁₀-transformed. Patients were categorized into low- and high-viral load groups using segmented regression. Clinical characteristics, recurrence, metastasis, and survival were compared. Immune parameters (CD3⁺, CD4⁺, CD8⁺, FOXP3⁺ T cells, programmed death-ligand 1 [PD-L1] expression), serum tumor markers (squamous cell carcinoma antigen [SCC], cancer antigen 125 [CA125], CA199, carcinoembryonic antigen [CEA]), Ki67, p16, and sex hormone levels were assessed.

High HPV viral load (log₁₀ ≥5.6) was significantly associated with advanced disease stage (p < 0.001), lymph node metastasis (28.3% vs. 13.5%, p = 0.002), and higher recurrence rates (27.4% vs. 13.0%, p = 0.002). Five-year overall survival (OS) (68.5% vs. 87.3%) and recurrence-free survival (RFS) (59.3% vs. 82.1%) showed a trend toward worse outcomes in the high viral load group, but the differences were not statistically significant (log-rank p = 0.38 and p = 0.068, respectively). Multivariable Cox analysis confirmed high viral load as an independent predictor of recurrence (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.32-3.61, p = 0.002). High viral load correlated with reduced tumor-infiltrating lymphocytes (TILs) (CD3⁺: 12.1% vs. 18.3%, p = 0.001), lower PD-L1 positivity (36.4% vs. 63.2%, p = 0.045), and higher Ki67 expression (58.3% vs. 42.5%, p = 0.003). Combining viral load with serum SCC improved prediction of high-grade lesions (area under the curve [AUC] 0.78 vs. 0.73, p = 0.02) and recurrence (C-index 0.71 vs. 0.65). Machine learning models ranked viral load as the top predictor. Post-treatment viral load decline was significantly associated with lower recurrence risk (odds ratio [OR] 4.12 for slow decline, p = 0.02). In premenopausal women, estradiol levels correlated positively with viral load (ρ = 0.31, p = 0.003) and disease severity. A correlation network revealed a cluster linking high viral load, low immune infiltration, and high proliferation. The prognostic effect of viral load was consistent across HPV types and was more pronounced in advanced-stage patients (interaction p = 0.09).

High HPV viral load is an independent predictor of poor prognosis in cervical cancer, associated with an immunosuppressive tumor microenvironment and enhanced proliferative activity. Incorporating viral load into routine assessment may improve risk stratification and guide personalized treatment strategies, particularly for patients with high viral load who may benefit from immune-enhancing therapies.

Brain metastases (BMs) are a common and prognostically unfavorable complication of non-small cell lung cancer (NSCLC). Although the combination of immune checkpoint inhibitors (ICIs) with radiotherapy has shown potential in the treatment of BMs, there is a lack of comparative studies specifically contrasting whole-brain radiotherapy (WBRT) versus stereotactic radiotherapy (SRT), each combined with immunotherapy. This study aimed to systematically evaluate the efficacy and safety of WBRT plus immunotherapy (WBRT+I) versus SRT plus immunotherapy (SRT+I) in patients with driver-gene-negative NSCLC accompanied by BMs.

This single-center, real-world retrospective cohort study enrolled patients with driver gene-negative NSCLC and BMs who received their first course of intracranial radiotherapy at Chongqing University Cancer Hospital between January 2018 and June 2024. Inverse Probability of Treatment Weighting (IPTW) was applied to balance baseline variables between the WBRT+I and SRT+I groups. Survival outcomes were evaluated using Kaplan-Meier analysis and Cox regression. The primary endpoints were overall survival (OS) and intracranial progression-free survival (iPFS). Secondary endpoints included the intracranial objective response rate (iORR), intracranial disease control rate (iDCR), and safety profile.

In this real-world cohort of 158 patients with driver gene-negative NSCLC with BMs, SRT+I demonstrated superior survival outcomes compared to WBRT+I. After IPTW adjustment, SRT+I was associated with significantly prolonged median overall survival (29.3 vs. 19.9 months, P = 0.034) and intracranial progression-free survival (14.7 vs. 9.4 months, P = 0.038). These advantages remained consistent in the subgroup with ≤4 BMs. Immunotherapy administered after radiotherapy yielded superior survival compared to the reverse sequence. The SRT+I group also achieved a higher intracranial objective response rate (78.6% vs. 61.5%) and disease control rate (95.0% vs. 88.5%), with a lower incidence of documented radiation-induced brain injury (3.75% vs. 10.26%) and no grade ≥3 immune-related adverse events.

In driver-gene-negative NSCLC patients with BMs, SRT+I demonstrates superior survival and intracranial disease control compared to WBRT+I, particularly in those with limited BMs. These findings provide high-level evidence for optimizing individualized clinical strategies.

This study aimed to evaluate the short-term efficacy and safety of neoadjuvant chemoimmunotherapy (NACI) followed by radical radiotherapy (RR) in patients with locally advanced cervical cancer (LACC).

A retrospective analysis was conducted on 60 patients with FIGO 2018 stage IIIA-IVA cervical cancer between June 2022 and July 2024. The experimental group (n=30) received 1-3 cycles of NACI (anti-PD-1/PD-L1 therapy plus platinum-based chemotherapy) followed by RR, which was administered either alone or concurrently with immunotherapy/chemotherapy. The control group (n=30) received RR with or without concurrent chemotherapy. Treatment response was assessed using RECIST 1.1 incorporating gynecological examination.

After NACI, the objective response rate (ORR) was 93.3% in the experimental group, increasing to 100% post-radiotherapy. The complete response (CR) rate was comparable between groups (90.0% vs. 86.7%, P = 1.000). With a median follow-up of 20.5 months, the 2-year progression-free survival (PFS) was significantly higher in the experimental group (82.5% vs. 66.0%; HR = 0.364, P = 0.0303), though overall survival (OS) did not differ significantly. The experimental group had a significantly lower incidence of radiotherapy-related intestinal toxicity (20% vs. 60%, P = 0.0033). All immune-related adverse events were grade 1-2.

For high-risk LACC, NACI followed by RR was associated with a significantly lower incidence of radiotherapy-related intestinal toxicity. A potential PFS benefit was also observed, although its independent effect could not be confirmed in this limited sample. These findings warrant further investigation in larger prospective trials.

Gastric cancer (GC) remains a leading cause of cancer-related death worldwide, and PD-1 monotherapy offers limited clinical benefit due to intrinsic and acquired immune tolerance. PD-1-containing bispecific antibodies (BsAbs) represent an emerging immunotherapeutic strategy to reverse immune suppression, enhance antitumor immunity, and overcome therapy resistance. Here, we present a systematic clinical trial landscape analysis to characterize the global development of PD-1-based BsAbs for GC. We identified 121 interventional clinical trials registered up to April 17, 2026, from the INFORMA database. Total trial numbers grew continuously from 2017 to 2025, with phase II trials constituting the largest segment. The most frequent non-PD-1 cotarget was CTLA-4, followed by VEGF, TIGIT, and LAG3. Most trials combined BsAbs with chemotherapy, focused on stage III/IV GC, and were conducted in the first-line or neoadjuvant setting. Academic institutions sponsored the majority of trials, and 84.30% were performed in China. Further temporal regression revealed annual growth for CTLA-4, VEGF and TIGIT-targeted programs, and correlation analyses indicated divergent co-target preferences across distinct sponsors and trial status and combination therapy. Subgroup comparison identified that combination therapy was more common in China-led trials, whereas monotherapy was preferentially adopted in non-China-led trials. This Perspective delineates a rapidly expanding global pipeline with China as the leading contributor. Our findings support the rational design of PD-1 BsAbs and combination strategies to target immune tolerance in GC, and highlight future priorities including balancing therapeutic efficacy against safety risks, biomarker-driven patient stratification, and international collaboration to optimize immunotherapy.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a contributor to hepatocellular carcinoma. Whether repeated assessment of MASLD provides additional prognostic information for liver cancer risk remains unclear.

Using the UK Biobank, we included 12,111 participants who underwent both baseline and follow-up health screenings. MASLD was defined at each assessment as fatty liver index ≥60 plus at least one cardiometabolic risk criterion. Four trajectory groups were defined: no MASLD → no MASLD, no MASLD → MASLD, MASLD → no MASLD, and MASLD → MASLD. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI).

At baseline, 4,008 participants (33.1%) had MASLD. MASLD at period 1 was associated with a higher risk of incident liver cancer compared with no MASLD (aHR, 2.81; 95% CI, 1.20-6.58). A similar association was observed for MASLD at period 2 (aHR, 2.61; 95% CI, 1.12-6.06). In trajectory analyses, MASLD → no MASLD (aHR, 4.00; 95% CI, 1.01-15.80) and MASLD → MASLD (aHR, 3.51; 95% CI, 1.31-9.44) were associated with higher liver cancer risk than no MASLD → no MASLD.

MASLD at either assessment was associated with higher incident liver cancer risk. Trajectory analyses suggest that persistent MASLD and prior MASLD exposure may both carry prognostic importance.

Within breast screening programs, digital breast tomosynthesis (DBT) can play a key role in the assessment pathway for screen-recalled abnormalities, where women may undergo multiple or additional imaging views, making accurate characterization of mean glandular dose (MGD) particularly important. Breast dosimetry has traditionally been based on the Dance model, with the more recent AAPM/EFOMP TG282 framework offering a more anatomically realistic alternative.

This study aimed to compare MGD estimates derived using the Dance and TG282 methodologies across a large dataset of DBT examinations performed in a breast screening service. In addition, the study compared breast density metrics from the DBT-imaged population with the breast density assumptions of the TG282 model and evaluated the relationship between breast density and MGD estimates.

This retrospective study analyzed 7,142 DBT images acquired between 2022 and 2025 from Siemens and Hologic mammography systems installed at assessment sites within the breast screening program in Queensland, Australia. MGD was estimated for each DBT exposure using the Dance and TG282 methodologies and evaluated as a function of compressed breast thickness (CBT). Statistical comparisons were performed using the Wilcoxon signed-rank test. Results were additionally stratified by vendor model to explore potential system-dependent effects. Volumetric breast density (VBD) was estimated using Volpara, and median values were evaluated as a function of CBT. The relationship between VBD and MGD was assessed within a representative CBT range using Spearman correlation analysis. TG282 MGD estimates were additionally recalculated using exposure-specific VBD values and compared with estimates derived using model-defined median VBD.

Across the full dataset, TG282 yielded MGD values that were, on average, 8.98% lower than those derived using the Dance methodology for craniocaudal (CC) views and 7.91% lower for mediolateral oblique (MLO) views (p < 0.001). The magnitude of difference between MGD estimates showed dependence on CBT and system-specific beam quality. In addition, the study population exhibited higher median VBD values than those assumed by the TG282 reference breast model. The influence of VBD on MGD estimates varied by system, with stronger dependence observed for systems with softer beam quality. Recalculation of TG282 MGD using exposure-specific VBD resulted in slightly lower estimates, further increasing the relative difference compared with Dance-derived values to approximately -10%.

Differences between TG282 and Dance MGD estimates depend on CBT and system beam quality, with TG282 producing lower estimates overall. The higher breast density observed in the DBT assessment population and its system-dependent influence on MGD estimates highlight the importance of accounting for both population breast density characteristics and mammography system mix when comparing DBT MGD estimates across populations.

Bladder cancer (BCa) prognostication is pivotal for tailored clinical interventions. Using machine learning, this study assesses prognostic capabilities of H&E-stained BCa images. From 569 slides across The Cancer Genome Atlas, Sun Yat-sen Memorial Hospital, and Zhongshan City People's Hospital, we extracted 150 histopathological markers each. LASSO regression yielded a pathomic fingerprint, which was further validated. An integrated model, fusing this fingerprint with salient clinicopathological indicators, displayed notable efficacy in both training (C-index: 0.658) and validation cohorts (C-index: 0.590-0.597). Incorporating the fingerprint, age, and N stage, the model excelled in training (C-index: 0.703) and validations (C-index: 0.612-0.646). Decision curve analysis underscored its clinical relevance. Conclusively, our pathomic-clinical framework offers advanced precision in BCa patient prognosis, enhancing clinical decision-making.

Myeloproliferative neoplasms (MPN) are an uncommon but important cause of non-cirrhotic portal hypertension (NCPH) and may present with variceal bleeding rather than overt hematologic abnormalities. Diagnosis may be further delayed when polycythemia vera (PV) is masked by iron deficiency or prior venesection, resulting in non-elevated hemoglobin despite an underlying JAK2-positive neoplasm. We report a rare case of isolated gastric variceal bleeding as the presenting manifestation of presinusoidal NCPH in a patient with early myelofibrosis evolving from iron-deficient PV.

A 57-year-old man presented with intermittent rectal bleeding and melena. His history was notable for prior erythrocytosis managed with recurrent therapeutic venipunctures and superficial thrombophlebitis. Upper endoscopy revealed isolated gastric varices without esophageal varices. Abdominal computed tomography showed massive splenomegaly with dilated portal and splenic veins, a radiologically normal liver, and no portal or splenic vein thrombosis. Laboratory evaluation showed hemoglobin of 13.2 g/dL and normal liver chemistries. The patient underwent transjugular liver biopsy with concurrent hepatic venous pressure gradient (HVPG) measurement, which demonstrated a normal gradient of 5 mmHg, while histopathology revealed focal hepatic extramedullary erythropoiesis without cirrhosis. JAK2 V617F testing was positive. Peripheral blood smear and bone marrow biopsy showed leukoerythroblastosis, absent iron stores, panmyelosis, atypical megakaryocytic clustering, and grade 1-2 reticulin fibrosis, consistent with early myelofibrosis evolving from iron-deficient polycythemia vera.

This case highlights that masked MPN should be considered in patients with non-cirrhotic portal hypertension, massive splenomegaly, or variceal bleeding even when hemoglobin is normal at presentation. Early JAK2 testing and bone marrow evaluation are essential for diagnosis.

Exercise is considered safe for patients with myeloma, but evidence specific to multiple myeloma bone disease (MMBD) is unclear. Scoping review aims: 1) Review the literature on exercise interventions for myeloma patients that included those with MMBD 2) Map reporting of safety, assessment and intervention characteristics 3) Identify bone-related outcomes measuring changes in MMBD 4) Highlight research priorities.

Following the Joanna Briggs Institute framework, a comprehensive search of PubMed, OVID-MEDLINE, and CINAHL between 1946 to October 2025 was conducted.

Twelve studies met inclusion criteria, though none focused exclusively on MMBD patients. Reporting of MMBD characteristics varied; across 346 participants, prevalence ranged from 69-86%. There were 7 exercise-related adverse events, but it was not reported if they occurred in MMBD patients. Most studies used medical clearance, imaging, or standardized tools to assess participants' suitability for exercise. However, procedures varied between studies and haematological considerations were generally not utilised. Patients were commonly excluded if they had spinal instability, spinal cord compression or were at risk of a fracture. Interventions occurred across all disease stages and commonly involved tailored, supervised/ unsupervised aerobic and resistance exercise, led by physiotherapists. However, practitioner experience, exercise modifications for MMBD and bone-related outcomes were infrequently reported, limiting clinical application.

Exercise appears safe for MMBD patients under certain exclusion criteria, but inconsistent reporting of adverse events in MMBD patients, MMBD characteristics, assessments, and exercise adaptations limits clinical translation, highlighting the need for targeted trials with only MMBD patients and bone-specific outcomes.