Obesity and low muscle mass (LMM) have been associated with adverse outcomes in cancer population. However, their individual and combined effects on long-term mortality and cardiovascular disease (CVD) outcomes in breast cancer patients are not well characterized.

We conducted a retrospective study of 46,037 women aged 40 years and older with pathologically confirmed breast adenocarcinoma using data from the Cancer Public Library Database. LMM was defined as the lowest quartile of appendicular skeletal muscle mass index (ASMI), estimated by a validated equation. The remaining quartiles were classified as normal muscle mass (NMM). Obesity was defined as BMI ≥ 25 kg/m². Patients were categorized into four groups by muscle mass and obesity status. Multivariable Cox proportional hazards models assessed associations with overall, cancer-specific, and cardiovascular mortality, and incident CVD.

Over a mean follow-up of 4.63 years, 2,286 deaths and 851 incident CVD events were recorded. Compared to NMM, LMM was independently associated with increased overall (adjusted hazard ratio [aHR] 1.27, 95% CI 1.15-1.40), cancer-specific (aHR 1.19, 95% CI 1.08-1.32), and cardiovascular (aHR 1.76, 95% CI 1.10-2.81) mortality. When stratified by muscle-obesity status, the LMM with obesity group had the highest risk of overall (aHR 1.69, 95% CI 1.18-2.42) and cancer (aHR 1.58, 95% CI 1.03-2.43) mortality. LMM without obesity was also associated with increased overall, cancer, and cardiovascular mortality.

LMM was independently associated with increased mortality in breast cancer patients, with risk amplified in those with coexisting obesity.

To comprehensively map the available evidence on the application of Home Enteral Nutrition (HEN) in cancer patients, summarize its current application status, reported effects, and identified challenges, and to identify gaps in the literature to inform future research directions.

This scoping review was conducted following the Arksey and O'Malley framework. A computer-based search was conducted in eight databases (PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang, VIP, and CBM) for relevant studies from their inception to April 16, 2025. The content from 19 included studies was extracted, summarized, and analyzed.

A total of 19 studies were included, comprising 10 randomized controlled trials and 9 quasi-experimental studies. The most frequently studied cancer type was esophageal cancer (n = 11), followed by gastric cancer (n = 4); other cancer types (gastrointestinal, liver, nasopharyngeal, and colorectal) were also represented. The most frequently reported outcome domains were nutritional status (assessed in 18 studies), quality of life (7 studies), complications/adverse events (6 studies), and Chemotherapy-related conditions (5 studies), the included literature frequently reported improvements in these areas among patients receiving HEN.

The current literature suggests that HEN may play a beneficial role in the management of cancer patients, with studies reporting improvements in nutrition, quality of life, and chemotherapy tolerance. However, there are deficiencies in the quality and standardization of current research. Future research should focus on conducting high-quality studies, establishing unified standards, and strengthening personnel training and patient education to generate high-quality evidence and guide the rational application of HEN in cancer treatment.

This study evaluates treatment intensity, tolerability, and survival outcomes in early breast cancer patients with high body surface area (BSA) receiving capped chemotherapy doses.

We retrospectively analyzed 730 patients with early breast cancer who received neoadjuvant or adjuvant chemotherapy with anthracycline/cyclophosphamide and taxane-based regimens at the University Hospital Tübingen between 2014 and 2021. Institutional policy capped dosing at BSA 2.0 m². To identify patients with clinically relevant dose reduction (≥ 5%), we classified those with BSA > 2.1 m² as the high-BSA group. We assessed relative dose intensity (RDI), adverse events leading to treatment modifications, and survival outcomes using Kaplan-Meier analyses and Cox proportional hazards regression.

Among 730 patients, 61 (8.4%) had BSA > 2.1 m². High-BSA patients received significantly lower median RDI (83.9% vs. 92.6%, p < 0.001). Consistent with reduced dose intensity, treatment tolerability was good: blood and lymphatic system disorders (8.2% vs. 24.5%, p = 0.006) and gastrointestinal disorders (0.0% vs. 11.1%, p = 0.002) occurred less frequently, and fewer patients required subsequent dose reductions (37.7% vs. 58.3%, p = 0.008). Despite this favorable tolerability profile, 5-year overall survival (85.5% vs. 94.3%, p = 0.015) and disease-free survival (74.3% vs. 91.0%, p = 0.008) were inferior in the high-BSA group. This association persisted in multivariate analysis (OS: HR 3.25; DFS: HR 2.17), though obesity-related effects could not be separated due to collinearity.

In this cohort with consistent dose capping at BSA 2.0 m², patients with high BSA represent an at-risk population with reduced chemotherapy intensity, inferior survival, but good treatment tolerability. Lower rates of blood and lymphatic system disorders and gastrointestinal disorders and fewer dose reductions suggest these patients may have tolerated full weight-based doses. While the contributions of obesity-related prognostic factors and potential underdosing could not be separated, these findings support ASCO guideline recommendations against routine dose capping in curative settings.

In April 2012, the American Society of Clinical Oncology joined the Choosing Wisely (CW) initiative to reduce the use of low-value oncology services. Neurokinin-1 receptor antagonists (NK1-RAs) are a class of expensive antiemetic drugs and are not recommended for patients who receive low to moderate risk emetogenic anticancer agents.

To identify patient factors and costs associated with NK1-RAs prophylactic use in a real- world setting post-Choosing Wisely among patients with breast cancer.

Using Optum's de-identified Clinformatics^® Data Mart Database (2013 to 2018), a retrospective cohort study was conducted for women aged 18 years and older with breast cancer who initiated a low/minimal/moderate emetogenic chemotherapy (index date) and received prophylactic antiemetics 2 weeks prior to the index date through the day after index (N = 18,515). Patients with no claims for antiemetics or who had negative costs were excluded from the costs analysis (n = 12,068). All US Food and Drug Administration-approved NK1-RAs were included. A multivariable logistic regression model was used to assess the association between patient demographic and socioeconomic characteristics, health system and environmental factors, and NK1-RA use, with results presented as adjusted odds ratios (AORs) and 95% CIs. A generalized linear model with gamma distribution and log link and two-part model were used to model mean third-party and out-of-pocket antiemetic-specific costs per patient, respectively, controlling for baseline patient characteristics.

Out of 18,515 women included, 7.7% (n = 1,429) received NK1-RAs. As compared with women aged 75 years and older, those aged 50-64 and 65-74 years had 1.96 (95% Cl = 1.50-2.57) and 1.39 (95% Cl = 1.19-1.63) times higher odds to receive NK1-RAs, respectively. Black women (AOR: 1.35; 95% Cl = 1.12-1.63), intravenous low-emetogenic chemotherapy (AOR: 3.94; 95% Cl = 3.16-4.91), enrolled in Medicare low-income subsidy (AOR: 1.49; 95% Cl = 1.08-2.07), had higher odds of receiving prophylactic NK1-RAs as compared with White patients, intravenous moderate emetic risk chemotherapy, and commercial insurance, respectively. In the adjusted analysis for costs, the mean total third-party payer antiemetic-specific costs for women who received steroids only, first-generation serotonin-receptor antagonists (5HT3-RAs) with or without steroids, or second-generation 5HT3-RAs with or without steroids were found to be significantly lower by 97.8% (P < 0.001), 95.0% (P < 0.001), and 42.1% (P = 0.023), respectively, when compared with those who received NK1-RAs.

Variability in the potential overuse of NK1-RAs was driven by certain patient- (age, race and ethnicity), clinical- (emetic risk), and health care- (insurance, health plan type) related factors. Furthermore, the mean total costs reimbursed by payers were significantly higher for those who received NK1-RAs as compared with other antiemetics, except for those who received both first- and second-generation 5HT3-RAs with or without steroids. Guideline-concordant use of NK1-RAs could result in significant cost-avoidance for patients and payers.

In a weighted logrank test, such as the Harrington-Fleming test and the Tarone-Ware test, predetermined weights are used to emphasize early, middle, or late differences in survival distributions to maximize the test's power. The optimal weight function under an alternative, which depends on the true hazard functions of the groups being compared, has been derived. However, that optimal weight function cannot be directly used to construct an optimal test since the resulting test does not properly control the type I error rate. We further show that the power of a weighted logrank test with proper type I error control has an upper bound that cannot be achieved. Based on the theory, we propose a weighted logrank test that self-adaptively determines an "optimal" weight function. The new test is more powerful than existing standard and weighted logrank tests while maintaining proper type I error rates by tuning a parameter. We demonstrate through extensive simulation studies that the proposed test is both powerful and highly robust in a wide range of scenarios. The method is illustrated with data from several clinical trials in lung cancer.

Definitions of prostate specific antigen progression for men with prostate cancer on androgen deprivation therapy (ADT) are mainly derived from randomised trials, and their applicability to the clinical practice remains uncertain. This study aimed to assess how different PSA-based definitions of progressions while on ADT affect estimates of progression, treatment initiation, and outcomes in men with prostate cancer.

Using data from the Prostate Cancer database of Sweden with extended treatments and endpoints data (PCBase Xtend), we identified 3718 men who initiated ADT between 2009 and 2022 and who had longitudinal PSA and treatment data. PSA progression was defined according to four modified guideline-based definitions ranging from the European Association of Urology (EAU) that has the most stringent criteria for progression to our previously used and less stringent definition (PCBase). We analysed cumulative incidence of PSA progression, treatment for castration resistant prostate cancer before and after PSA progression, and prostate cancer-specific mortality, accounting for competing risks.

ADT was prescribed as the primary treatment in 52% of included men. The number of men with PSA progression ranged by definition from 1047 men (28%, EAU) to 2378 men (64%, PCBase) at 10 years after initiation of ADT. Earlier progression was observed with less stringent criteria, with a difference in median time to progression of 3 months (PCBase vs EAU). Despite variation in incidence proportion of PSA progression, the proportion of men treated within 5 years after progression was similar (45-52%), as was prostate cancer-specific mortality (26-27%) across definitions.

While definitions of PSA progression significantly impacted estimated incidence proportion of disease progression, they had limited influence on treatment initiation and long-term mortality. These findings suggest that in the clinical practice, decisions are guided by factors other than formal progression criteria. PSA-based definitions can be useful in observational studies if supported by sensitivity analyses.

The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconstruction accuracy. We evaluated long-term surgical and oncologic outcomes of limb salvage procedures using 3D-printed cutting guides, with updated follow-up from our previously published case series and the addition of new cases focusing on margin status, bony union, and local recurrence.

We retrospectively reviewed 9 patients from our surgical database who underwent limb salvage surgery for long bone sarcoma using patient-specific 3D-printed cutting guides. This included extended follow-up of 6 previously reported cases and 3 new patients. Clinicopathologic, surgical, and radiographic data were collected and analyzed.

All 9 patients (100%) achieved negative surgical margins (mean, 7.7 mm) with no local recurrences at a mean follow-up of 4.1 years (range, 0.5-11.6 years). Bony union was achieved at 16 of 18 (89%) osteotomy sites, comparing favorably to reported intercalary allograft nonunion rates of 6% to 43%. Two patients (22%) required revision to modular oncology devices due to nonunion. At most recent follow-up, no local recurrences were observed, while 7 grafts (78%) remained. Eight patients (89%) are continuously disease free, and 1 (11%) is alive with metastatic disease.

This expanded case series demonstrates excellent long-term oncologic and surgical outcomes using 3D-printed cutting guides for long bone sarcoma resection. Patient-specific guides achieved 100% negative margins with durable graft retention and no local recurrences at 4.1-year follow-up, supporting their continued use in complex limb salvage procedures.

Endocan (endothelial cell-specific molecule-1) is a soluble dermatan sulfate proteoglycan of the extracellular matrix released into the circulation by vascular endothelial cells and involved in vascular processes in which endothelial cell activation occurs. In this study, we aimed to evaluate serum and urinary endocan levels in children with hemolytic uremic syndrome (HUS) during the acute disease and follow-up period, compared with controls, and to evaluate associated clinical and laboratory parameters.

Children were evaluated in three groups: HUS patients in the active stage (Group 1, HUS-active stage, n=15), HUS patients followed until the resolution of active disease (Group 2, HUS-follow-up, n=10) and healthy controls (Group 3, n=15). Clinical parameters and renal outcomes were compared between the groups based on serum and urinary endocan levels.

The pairwise group comparisons of the urinary endocan levels (median; Q1-Q3) revealed statistically significant differences between Group 1 (2148; 1592-3068 ng/gCr) and Group 2 (1274; 733-1565 ng/gCr), and between Group 1 and Group 3 (954; 517-1966 ng/gCr) (P0.05). The serum endocan level showed no statistically significant difference between the groups (p>0.05). When all groups were evaluated together, urinary endocan level showed positive correlations with white blood cell counts (r= 0.63, P.

Febrile neutropenia is a common cause of hospital admissions among pediatric cancer patients. To optimize personalized approaches for hospitalization and antibiotic treatment, risk stratification has been proposed. This study aimed to explore the impact of clinical and laboratory parameters on risk stratification for patient discharge.

This prospective study included pediatric lymphoma and solid tumor patients who were hospitalized due to febrile neutropenia between June 2018 and June 2019. Patient characteristics, primary oncological diagnosis and disease status, comorbid conditions, time elapsed after the last course of chemotherapy, use of granulocyte-colony stimulating factor (G-CSF) prophylaxis, presence of port catheter, infection type, fever values/duration, physical examination findings, and duration of neutropenia were collected. Laboratory investigations including complete blood counts, acute phase reactants at the onset of the episode, culture results were also recorded.

The study examined 142 febrile neutropenic episodes from 88 consecutive patients. The median age of the study group was 6.8 years, with 19.3% of cases being lymphoma and 80.7% having solid tumors. The median hospital stay was 7 days. Factors associated with longer hospitalization periods included a lymphoma diagnosis, presence of comorbid conditions, bone marrow involvement, and febrile neutropenic period during hospitalization. Patients presenting with fever ≥ 39 °C at admission, poor general appearance, hypotension, prolonged capillary filling time, and severe infection signs had longer hospital stays. In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells/mm3, platelet count ≤ 50,000/mm3, and prolonged neutropenia delayed discharge time. Patients with microbiologically defined infections, especially those with positive catheter cultures, also had delayed discharge.

The diagnosis of lymphoma, poor general condition at admission, presence of microbiologically defined infection, thrombocytopenia, delayed recovery of absolute neutrophil counts, and prolonged fever duration were significant factors in determining the treatment duration and predicting discharge time.

A high coverage rate of cervical cancer screening is necessary to prevent cervical cancer. Women who have not been tested in the last 10 years are considered as long-term non-attenders from the screening program. A recent report from the Regional Cancer Centers in Sweden addressed geographic disparities in the 10-year coverage rate among 33-62-year-old women residing in Sweden in 2023, and compared the results with those in a previous report from 2020. The analytic method employed is referred to as geomapping, based on geo-coded data to 5984 neighborhoods (Statistics Sweden's Demographic Statistics Areas [DeSO]). Individual data on HPV/Pap testing in the previous 10-year period, age, and residential address (used for the geo-coding) were retrieved from the National Cervical Screening Registry. Neighborhood-level data on economic standard, proportion of non-Western immigrants, and geographic location (urban/semi-urban/rural) were assessed, based on data from Statistics Sweden, for estimation of neighborhood-level associations. The overall 10-year coverage rate decreased from 91.9% in 2020 to 91.1% in 2023. We identified 147 out of the 5984 neighborhoods as showing statistical evidence for a pronouncedly lower 10-year coverage rate than the overall average of 91.1 %. Furthermore, we found a decreasing 10-year coverage rate with lower economic standard, as well as with increasing proportion of non-Western immigrants. After adjustments for these two neighborhood-level covariates, we found that rural geographical location was associated with lower 10-year coverage rate. The results demonstrate that geomapping can provide a rational basis for targeting population-level interventions to improve screening. Specifically, it is rational to allocate extra resources, if available, towards the 147 identified neighborhoods with a pronouncedly lower 10-year coverage rate.