To determine the predictive performance of the Briganti 2017 and MSKCC nomograms with the addition of Prostate Health Index (PHI) in a Chinese cohort of prostate cancer patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.

This single-center retrospective study included 473 prostate cancer patients who underwent robot-assisted radical prostatectomy with extended pelvic lymph node dissection from Dec. 2021 to Dec. 2025. The two nomograms were validated, and PHI was incorporated as a continuous variable. Model performance was assessed using AUC, calibration plots, and decision curve analysis, with the DeLong test for AUC comparison. This study was registered in the Medical Research Registration and Filing Information System of the National Health Security Information Platform of China (Registration No.: MR-50-25-036796, retrospectively registered).

Lymph node invasion (pN1) was confirmed in 26.0% (123/473) of the cohort. The original Briganti 2017 and MSKCC nomograms had AUCs of 0.69 (95% CI: 0.61-0.79) and 0.71 (95% CI: 0.62-0.78) with satisfactory calibration. PHI incorporation significantly improved discrimination, raising their AUCs to 0.787 (absolute improvement 0.093, P < 0.01) and 0.782 (absolute improvement 0.077, P < 0.01), respectively. Decision curve analysis showed PHI expanded the threshold probability range of positive net benefit from 10% to 30% to 10%-40% for both models.

The Briganti 2017 and MSKCC nomograms showed acceptable predictive performance for lymph node invasion in Chinese prostate cancer patients. PHI enhances their discriminatory ability and clinical utility, supporting its use as a valuable preoperative biomarker for pN1 in prostate cancer.

Childhood myelodysplastic neoplasm (cMDS) is a rare condition with distinct biological and clinical characteristics. To characterize the epidemiological features of cMDS, including incidence, demographics, and underlying etiologies. We also aimed to identify prognostic factors and assess long-term outcomes associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with cMDS.

This nationwide Korean study analyzed 484 patients < 19 years of age diagnosed with cMDS between 2003 and 2021, using data from the Korean National Health Insurance Service database.

Annual incidence ranged from 1.7 to 4.3 per million children, with 7.2% had a prior history of malignancy. A total of 180 patients underwent allo-HSCT for cMDS. The 5-year overall survival (OS) rates were 76.6% in the transplant group and 80.5% in the non-transplant group. Among non-transplanted patients, key prognostic factors included later period of diagnosis (hazard ratio [HR] 0.372, P = 0.012), history of prior malignancy (HR 3.329, P = 0.002), and chemotherapy for cMDS (HR 3.701, P = 0.002). Only CBT was significantly associated with increased mortality in univariate analysis of the transplant group (HR, 3.911; P = 0.008). The 10-year cumulative incidence of leukemia was 20.5%, with a significantly higher rate in the cMDS with increased blasts (cMDS-IB) group (53.3% vs. 19.4%, P = 0.002).

While many patients achieved stable disease control without allo-HSCT, monitoring remains essential due to the risk of leukemic transformation, particularly in therapy-related and cMDS-IB subtypes.

Bladder cancer significantly impacts patients' quality of life, making patient-reported outcomes (PROs) a crucial component of clinical evaluation and care. However, patients' internal standards, values, or conceptualizations may change over time due to diagnosis or treatment experiences-a phenomenon known as response shift -which can threaten the validity of longitudinal PRO assessments and remains underexplored in this population. This study aims to explore response shift in the evaluation of PROs among bladder cancer patients and to identify its underlying mechanisms, using a phenomenological qualitative design.

Semi-structured interviews were conducted between December 2023 and October 2024 in the urological wards of a tertiary-level hospital in China. Purposive sampling was used to recruit 14 patients with bladder cancer. Colaizzi's phenomenological analysis method was used to analyze the data.

Three themes were identified as relevant to response shift effects on PROs of bladder cancer patients: multidimensional preoperative and postoperative stressors as triggering antecedents of response shift; cognitive adjustment strategies constituting response shift mechanisms; two divergent adaptive outcomes after exposure to bladder cancer stress.

Response shift was observed in PROs three months after surgery for bladder cancer. Understanding the mechanisms behind response shift can help healthcare professionals interpret patient feedback more accurately and optimize personalized care strategies.

The current BTS guidelines recommend evaluation of suspicious pulmonary nodules using [¹⁸F]FDG-PET/CT imaging, followed by Herder model risk stratification. However, it is based on limited imaging features, which may limit diagnostic accuracy. This study aims to develop a PET/CT-based deep learning (DL) model for malignancy probability estimation (AITO-PETCT-MP) and compare its performance to the Herder model and clinician performance.

In a single-center retrospective study, we collected 533 indeterminate pulmonary nodules (268 malignant) with a mean diameter of 18.4 mm (SD ± 12.1) in 436 patients. Histopathological malignancy confirmation or a minimum 2-year benign national cancer registry follow-up served as the reference standard. Model diagnostic performance was compared against the Herder model and seven clinicians in a reader study on a test set of 161 nodules (80 malignant).

AITO-PETCT-MP achieved an AUC of 0.78 [95% CI: 0.70-0.85] compared to the Herder model: AUC = 0.73 [0.65-0.80] (non-inferiority: p = 0.005). On average, experienced clinicians achieved an AUC of 0.80 [0.75-0.85]. Stratifying into BTS follow-up categories, the Herder model referred more benign nodules for potential direct treatment (26/81) than AITO-PETCT-MP and clinicians (both 3/81), while AITO-PETCT-MP and clinicians assigned more malignant cases to CT surveillance instead of direct treatment.

AITO-PETCT-MP demonstrated non-inferior performance to the guideline-recommended Herder model, while only using imaging data. Diagnostic performance fell in the performance range of seven clinicians. Differences in BTS follow-up recommendations between the Herder model and clinicians suggest a difference in patient management compared to current clinical practice.

Question How well can an imaging-only deep learning model estimate pulmonary nodule malignancy probability on [¹⁸F]FDG-PET/CT compared to the established Herder model and expert clinicians? Findings The model (AITO-PETCT-MP) performed non-inferior to the Herder model (AUC 0.78 vs 0.73, p = 0.005) and comparably to seven expert readers (AUC 0.74-0.87). Clinical relevance BTS-based follow-up stratification showed the Herder model referred more benign nodules to potential direct treatment than clinicians and AITO-PETCT-MP, while assigning fewer malignant cases to surveillance. This suggests a difference between Herder recommendations and current clinical practice.

To investigate whether cyst shrinkage in intraductal papillary mucinous neoplasm (IPMN) is paradoxically associated with a higher risk of concomitant pancreatic ductal adenocarcinoma (PDAC).

This retrospective cohort included 1103 patients with pathologically or cytologically confirmed branch-duct or mixed-type IPMN followed for ≥ 1 year. Patients were classified by annual cyst size change rate per the 2024 Kyoto guideline thresholds: shrinkage (< 0 mm/year), stable (0 to < 2.5 mm/year), and growth (≥ 2.5 mm/year). The primary outcome was concomitant PDAC, with IPMN-derived carcinoma as a competing event. Multivariable Fine-Gray regression compared shrinkage with a pre-specified merged non-shrinkage reference; cause-specific Cox regression served as sensitivity analysis.

Of 1103 patients (541 men, 562 women; mean age, 67.3 ± 9.8 years), 282 (25.6%) showed shrinkage, 728 (66.0%) remained stable, and 93 (8.4%) showed growth. Concomitant PDAC was most frequent in shrinkage (6/282, 2.1%), followed by stable (8/728, 1.1%), with no events in growth (0/93). IPMN-derived carcinoma was most frequent in growth (9/93, 9.7%). Adjusted for age, sex, initial cyst size, and main pancreatic duct diameter, shrinkage was independently associated with concomitant PDAC (subdistribution hazard ratio 4.46; 95% CI 1.62-12.30; p = 0.004); cause-specific Cox regression yielded a concordant estimate (hazard ratio 4.54; 95% CI 1.52-13.50; p = 0.007).

In this single-center retrospective cohort, cyst shrinkage was associated with an increased incidence of concomitant PDAC, contrary to the prevailing assumption that shrinkage reflects a benign course. Given the modest number of concomitant PDAC events (n = 14), these findings are hypothesis-generating and exploratory; external validation in multicenter prospective cohorts is required before clinical surveillance practice is modified.

Question Cyst shrinkage during intraductal papillary mucinous neoplasm surveillance is considered reassuring, but its association with concomitant pancreatic cancer risk remains unclear. Findings Shrinkage was paradoxically associated with higher concomitant pancreatic cancer risk (subdistribution hazard ratio 4.46); the growth group's 0% rate reflected competing risks from IPMN-derived carcinoma. Clinical relevance Radiologists should not reduce surveillance intensity for shrinking intraductal papillary mucinous neoplasm cysts, as these patients carry an elevated risk of concomitant pancreatic cancer developing independently of the monitored cyst.

The role of primary tumor surgery in patients with de novo metastatic soft tissue sarcoma (STS) is controversial, with a lack of objective selection criteria. This study aimed to identify patients who may benefit from surgery and to evaluate the prognostic value of integrated ¹⁸F-FDG PET/CT metabolic parameters and clinicopathological factors.

Forty patients with de novo metastatic STS undergoing pretreatment ¹⁸F-FDG PET/CT were analyzed. Clinical data and metabolic parameters (maximum standardized uptake value [SUVmax], total metabolic tumor volume, and total lesion glycolysis [TLG]) were collected. Prognostic factors for overall survival (OS) were assessed using Cox regression. Heterogeneity was examined through pre-specified subgroup analyses and formal interaction tests.

Multivariate analysis identified age > 50 years, lactate dehydrogenase (LDH) > 200 U/L, and SUVmax > 10.0 as independently associated with worse OS (all p < 0.05). Significant interactions were observed between surgical treatment and both the Ki67 index and TLG (P for interaction = 0.006 and 0.042, respectively). Surgery was associated with significantly improved OS in patients with low Ki67 (HR = 0.24, 95% CI: 0.06-0.89; p = 0.032) or low TLG (HR = 0.21, 95% CI: 0.04-0.97; p = 0.046), with no significant benefit observed in corresponding high-expression subgroups (all p > 0.05).

The survival benefit of primary tumor surgery in de novo metastatic STS is restricted to patients with less aggressive tumor dbiology, characterized by low proliferative activity (Ki67 ≤ 35%) or low TLG. Integrated assessment of Ki67 and PET/CT parameters, particularly TLG, provides a practical framework for personalized surgical decision-making.

Question Does primary tumor surgery provide a survival benefit for patients with de novo metastatic STS based on PET/CT and clinicopathological markers? Findings Surgery was associated with improved survival only in patients with low Ki67 or low TLG, with significant interaction effects (p = 0.006 and 0.042, respectively). Clinical relevance Surgical selection in metastatic STS should be guided by tumor biology. Integrating Ki67 and TLG provides a practical framework to identify patients most likely to derive a survival benefit from primary tumor resection.

Sinonasal squamous cell carcinoma (SNSCC) is a rare malignancy arising de novo or from inverted papilloma (IP), a benign neoplasm with malignant potential. The molecular drivers of IP-associated SNSCC (IP-SNSCC) remain poorly defined, and no effective therapies are available. Progress is hindered by limited preclinical studies and prospective clinical investigations. We performed multi-omic profiling, including whole-exome, RNA, and mitochondrial DNA sequencing (mtDNA-Seq), of matched normal sinonasal epithelium, IP, and SNSCC samples from 11 patients. Analyses revealed a stepwise transcriptional continuum across histological stages, marked by progressive activation of the cell cycle, extracellular matrix remodeling, and metabolic pathways, with suppression of immune and apoptotic signaling. Shared genomic aberrations were detected in only a subset of paired IP and SNSCC specimens, whereas mtDNA-Seq revealed no overlapping mutations, indicating divergent mitochondrial evolution even in clonally related lesions. Given the need for targeted therapies, we applied PandaOmics, an AI-driven target discovery platform, to genes progressively upregulated during IP-SNSCC development. We first prioritized targets with FDA-approved inhibitors, identifying CDK6, EGFR, HDAC, and SRC/YES1 as repurposing candidates, and nominated AURKA, PLK4, TTK, and CDK1/7 as druggable preclinical targets. Together, this study defines the molecular basis of IP-SNSCC and provides a foundation for future translational investigation.

Exposure to chemotherapy and/or radiotherapy increases the risk of therapy-related myeloid neoplasms (t-MN), a heterogeneous group of disorders currently classified by treatment history rather than molecular features. Although germline predisposition has been suggested in approximately 20% of cases, its prevalence and clinical impact remain insufficiently defined. To address this, we analyzed 100 patients with t-MN by integrating clinical characteristics, prior treatment regimens, and genomic profiling. Somatic and germline variants were identified using targeted next-generation sequencing (NGS; n = 33) or whole-exome sequencing (n = 67). Somatic abnormalities, including cytogenetic and/or molecular alterations, were detected in 89.8% of patients. Germline variants were identified in 32.3% of cases, including mutations in cancer predisposition genes (19.8%) and myeloid disease-related genes (14.6%). Patient stratification by germline landscape and gene category defined two prognostic scenarios and three subgroups with distinct clinical outcomes. Patients harboring germline cancer predisposition variants exhibited were enriched for TP53 mutations, complex karyotypes, and had an adverse prognosis. In contrast, patients with germline myeloid-related variants and those without detectable germline variants showed recurrent mutations in TET2, DNMT3A, SF3B1, SRSF2, RUNX1 and ASXL1, were associated with normal karyotypes, and favorable outcomes. These findings underscore the importance of the germline landscape in t-MN pathogenesis and support its incorporation into disease classification and risk stratification. Notably, chemotherapy exposure was associated with complex karyotypes and poor prognosis in patients with germline cancer predisposition variants, highlighting a subgroup that may benefit from targeted surveillance and preventive strategies.

A custom Genexus myeloid assay (CMA) underwent a technical evaluation for detection of variants from both DNA and RNA in a single assay format. The custom assay was initially verified with commercial DNA and RNA controls containing known myeloid variants. Seventy-five patient specimens with various DNA and RNA variants were selected for replicate testing. The CMA generated consistent data on two Genexus sequencers, with occasional samples failing quality metrics randomly. All 22 control DNA variants were detected, with 95% reported as key. Sensitivity and positive predictive value for clinical variants were 95.60% and 97.60%, rising to 98.63% and 99.65% for allele frequencies ≥5%. FLT3 duplications were consistently detected at lower expected frequencies. Low-level, false-positive key variants were mostly recurrent and filterable. Fusion calling sensitivity was 100% for control and clinical RNA samples, with 97.09% of replicates reporting expected fusions. The CMA reliably detects key DNA and RNA variants in myeloid specimens within 24 hours on the Genexus platform. Variants and fusion transcripts were identified with high sensitivity and minimal nucleic acid input, providing a rapid and precise workflow for reporting clinically relevant myeloid disease variants.