The efficacy of durvalumab consolidation therapy after chemoradiotherapy (PACIFIC regimen) for patients with epidermal growth factor receptor (EGFR) mutation-positive locally advanced unresectable non-small cell lung cancer (NSCLC) remains unclear. Additionally, data on failure patterns, including in-field recurrence (IFR) and out-of-field recurrence (OFR), are limited.

In this retrospective study, 83 patients with locally advanced unresectable NSCLC treated with the PACIFIC regimen were analyzed. Of them, 10 patients had tumors harboring EGFR mutations. Progression-free survival (PFS), overall survival (OS), and the cumulative incidences of IFR and OFR were evaluated.

The median follow-up time was 26.6 months. The 2-year PFS rate was 23% [95% confidence interval (CI)=7-78%] in the EGFR mutation-positive group and 53% (95%CI=42-66%) in the EGFR mutation-negative group (p=0.15). The 2-year cumulative incidence of OFR was significantly higher in the EGFR mutation-positive group (77%, 95% CI=49-100%) than in the EGFR mutation-negative group (26%, 95%CI=16-37%) (hazard ratio=2.90, 95%CI=1.29-6.51, p=0.01). On exploratory multivariate analysis, EGFR mutation positivity, Eastern Cooperative Oncology Group performance status 2-4, and PD-L1 expression <1% were significantly associated with OFR. No significant differences in IFR, OS, and adverse events were observed between the groups.

Although IFR and safety profiles were comparable between the two groups, EGFR mutation positivity was associated with a higher incidence of OFR. These exploratory findings highlight the limitations of durvalumab consolidation and support the shift toward alternative systemic strategies, such as osimertinib, in patients with EGFR mutation-positive locally advanced unresectable NSCLC.

Biopsy of suspicious microcalcifications (MC) detected in breast cancer screening yields benign results in the majority of cases, resulting in a substantial number of avoidable interventions. While magnetic resonance imaging (MRI) demonstrates high accuracy for invasive breast cancer, its diagnostic value for precancerous lesions remains uncertain - particularly in average-risk screening populations. This study aimed to assess the diagnostic performance of an abbreviated breast MRI reading protocol in a screening-like cohort.

In this prospective single-center study, 58 women (mean age 58±24 years) with 59 suspicious MC on full-field digital mammography (FFDM) were included. A total of 68 lesions underwent histopathological verification. MRI datasets were independently assessed by four radiologists (5-15 years of experience), blinded to mammographic findings, using a standardized abbreviated protocol including maximum intensity projection (MIP), early post-contrast subtraction, and native images.

Among 59 microcalcification lesions, 21 were malignant and 38 benign. Sensitivity ranged from 74% to 83%, specificity from 58% to 83%, positive predictive value from 56% to 75%, negative predictive value from 83% to 86%, and accuracy from 68% to 81%. No invasive carcinomas were missed by any reader. False-negative findings were exclusively ductal carcinoma in situ (DCIS). Mean reading time ranged from 1 min 42 sec to 3 min 26 s. MIP-only evaluation demonstrated markedly lower sensitivity (48-52%) despite higher specificity (83-94%). Interreader agreement for the final recall decision was moderate (Fleiss' κ=0.47), with pairwise Cohen's κ values ranging from 0.40 to 0.53.

Abbreviated breast MRI is a feasible and time-efficient approach with consistent diagnostic performance across readers for evaluating suspicious MC, further evaluation as screening tool is needed. MIP-only evaluation, does not appear to provide sufficient diagnostic reliability.

This study aimed to evaluate the association between clinicopathological features, iron status, and prognosis in patients undergoing gastrectomy for gastric cancer.

We retrospectively analyzed 634 patients who underwent gastrectomy between 2014 and 2023. Anemia was defined by World Health Organization criteria (Hb <12.0 g/dl in women, <13.0 g/dl in men). Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards models.

Preoperative anemia was present in 61.8% of patients. The 5-year overall survival rate was significantly lower in patients with anemia (62.0% vs. 78.0%; p=0.001) and those receiving blood transfusion (44.7% vs. 73.9%; p<0.001). Multivariate analysis identified stage, age, and comorbidities as independent prognostic factors. Although anemia was not an independent factor considering the entire cohort, stage-stratified analysis revealed that in patients with stage I/II disease, the 5-year overall survival rate was significantly lower in the group with anemia (83.0% vs. 93.8%; p=0.024). Hemoglobin levels were significantly positively correlated with serum iron (r=0.554) and albumin (r=0.555) levels.

Preoperative anemia is highly prevalent and significantly associated with poor long-term survival, particularly in stage I/II gastric cancer. As a modifiable risk factor reflecting physiological reserve, preoperative optimization of the hemoglobin level may improve outcomes in this population.

This study aimed to identify clinical predictors associated with early discontinuation of eribulin therapy in patients with unresectable or recurrent breast cancer.

We retrospectively reviewed data for 63 patients with breast cancer starting eribulin therapy between August 2011 and December 2022 at a single institution. Patients with missing data for hormone receptor/human epidermal growth factor receptor 2 (HER2) status or baseline hematological parameters were excluded. Data were collected on demographics, tumor subtype, comorbidities, concomitant medications, and baseline complete blood count. The primary outcome was time to treatment discontinuation for any reason. Cox proportional hazards models were used to identify predictors of discontinuation, stratified by reason: progressive disease (PD) or adverse events (AE).

The median age was 62 years; 69.8% were hormone receptor-positive and 15.9% HER2-positive. During follow-up, 61 out of 63 patients (96.8%) discontinued treatment. Discontinuation was due to PD in 69.8%, AE in 17.5%, and other causes in 9.5%. Considering all reasons, multivariate analysis identified a neutrophil-to-lymphocyte ratio (NLR) ≥3.5 [hazard ratio (HR)=1.97, p=0.020] as an independent predictor of discontinuation. Multivariate analysis identified dyslipidemia (HR=3.59, p=0.009) as independent predictors of PD-related discontinuation, whilst antidepressant use (HR=0.22, p=0.049) was associated with a lower risk of discontinuation. Univariate analysis showed that oral glucocorticoid use was associated with a higher risk of AE-related discontinuation (HR=4.79, p=0.013).

High NLR and dyslipidemia were associated with early discontinuation of eribulin therapy. These findings highlight the need for individualized treatment strategies based on baseline risk factors.

Risk stratification after curative resection remains challenging in stage II-III colorectal cancer (CRC). The cancer inflammation prognostic index (CIPI) has been proposed as a novel prognostic marker; however, whether high-risk stage II disease, as defined by CIPI, has outcomes comparable to those of stage III CRC remains unclear, particularly in patients with normal carbohydrate antigen 19-9 (CA19-9) levels.

We retrospectively analyzed 654 patients with pathological stage II-III CRC and normal preoperative CA19-9 who underwent curative resection between 2008 and 2018. Patients were stratified using a validated CIPI cutoff (56.9). Disease-free (DFS) and overall (OS) survival were evaluated using Kaplan-Meier analysis and Cox proportional hazards models.

A high CIPI was significantly associated with poor DFS and OS (both log-rank p<0.01). In multivariate analysis, CIPI ≥56.9 independently predicted worse DFS (hazard ratio=1.91, 95% confidence interval=1.25-2.91; p<0.01) and OS (hazard ratio=2.57, 95% confidence interval=1.42-4.64; p<0.01). Among patients with stage II disease, those with a high CIPI demonstrated DFS and OS comparable to those with stage III CRC (DFS: p=0.31; OS: p=0.49).

CIPI identifies biologically high-risk stage II CRC with long-term outcomes comparable to stage III disease among patients with normal CA19-9 levels, supporting its role as a complementary prognostic tool beyond conventional pathological staging.

Postoperative complications can interfere with the continuation and completion of adjuvant chemotherapy (ACT) in stage III colorectal cancer. However, simple indicators for predicting treatment completion after severe postoperative complications remain unclear. This study evaluated whether total lymphocyte count (TLC) at ACT initiation predicts ACT completion and explored the association between ACT completion and recurrence-free survival.

This retrospective multicenter study included 61 patients with pathological stage III colorectal cancer who developed severe postoperative complications, defined as Clavien-Dindo grade III-IV, and received ACT. The primary endpoint was ACT completion. Recurrence-free survival was evaluated as a secondary oncological outcome. Clinical factors, complication-related factors, treatment-related factors, and laboratory parameters at ACT initiation were compared according to completion status.

Among the 61 patients, 47 completed ACT and 14 did not. TLC at ACT initiation was significantly higher in the completion group. The area under the receiver operating characteristic curve of TLC for predicting ACT completion was 0.739. In multivariable logistic regression analysis, high TLC remained significantly associated with ACT completion [odds ratio 7.75, 95% confidence interval (CI)=1.90-31.63, p=0.004]. ACT completion was also associated with favorable recurrence-free survival (hazard ratio=0.387, 95%CI=0.155-0.968, p=0.042).

TLC at ACT initiation may serve as a practical marker for predicting ACT completion in patients with stage III CRC who develop severe postoperative complications. ACT completion was associated with favorable recurrence-free survival and may reflect both adequate treatment exposure and postoperative recovery sufficient to tolerate ACT.

Multiple measures of health and wellness have worsened for rural communities in the last two decades. Few studies have sought to characterize the rural-urban difference in 5-year cancer survival data in a nationwide sample over that time.

We analyzed cause-specific five-year survival data for prostate, breast, colorectal, pancreatic, lung, and liver cancers diagnosed from 2000-2016 among rural and non-rural populations using the Surveillance, Epidemiology, and End Results Database. We explored the CDC Wonder Database for drug related mortality in rural and non-rural populations. Ordinary least squares regression assessed temporal survival trends, and analysis of covariance compared the statistical significance in annual change in survival between groups.

We created a cohort of 2.96 million individuals, of whom 93% were from urban areas and 7% were from rural areas, and observed significant differences in demographics between groups within each cancer type. Five-year survival improved over time for all cancers except prostate; however, gains were consistently inferior for rural populations. Rural-urban differences in survival were present at year 2000 and widened by 2016 for breast (1.8% to 2.9%), colorectal (2.1% to 3.0%), pancreatic (0.2% to 4.2%), lung (2.5% to 8.7%) and liver cancer (2.1% to 14.0%) and there were significant differences in the rate of change in cancer mortality in all cancers (p<0.05) except for prostate cancer (p=0.57). We also found significant worsening (p<0.0001) of drug related mortality disparities between rural and urban populations from the years 1999 to 2015.

From 2000 to 2016, rural-urban disparities in cancer survival widened for five of six major cancers during the same period in which national drug overdose rates increased in rural populations.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. Matrix metalloproteinase-2 (MMP-2) plays an important role in extracellular matrix remodeling and HCC progression. This study investigated the associations of two functional MMP-2 promoter polymorphisms, rs243865 and rs2285053, with HCC susceptibility in a Taiwanese population and explored their potential interactions with environmental risk factors.

A hospital-based case-control study was conducted at China Medical University Hospital (Taichung, Taiwan), involving 298 HCC patients and 889 age- and sex-matched cancer-free controls recruited in Taiwan. MMP-2 rs243865 and rs2285053 genotypes were determined utilizing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Stratified analyses were used to explore their potential interactions between MMP-2 genotypes and environmental factors including sex, smoking and alcohol drinking status.

No significant association was observed between HCC susceptibility and either rs243865 (CT+TT versus CC: odds ratio (OR)=1.20, 95% confidence interval (CI)=0.87-1.66, p=0.2944] or rs2285053 (CT+TT versus CC: OR=1.12, 95% CI=0.86-1.46, p=0.4219). Similarly, allelic analyses revealed no significant effects. Interestingly, stratified analyses demonstrated significant gene-environment interactions for rs243865. Male carriers of the TT genotype exhibited an increased HCC risk (OR=3.24, 95% CI=1.12-9.37, p=0.0488). Among smokers, the TT genotype was associated with a markedly elevated risk (OR=6.46, 95% CI=1.65-25.29, p=0.0055), while alcohol drinkers carrying the TT genotype showed the highest susceptibility (OR=9.69, 95% CI=1.99-47.13, p=0.0022). No significant association was found for rs2285053 genotype in any genetic variant and subgroup.

Although MMP-2 rs243865 and rs2285053 do not independently determine HCC susceptibility, rs243865 T allele may serve as a genetic biomarker for identifying Taiwanese males, smokers, and alcohol drinkers at elevated risk of HCC. These findings highlight the importance of gene-environment interactions in hepatocarcinogenesis and support the incorporation of genetic information into personalized HCC risk assessment and prediction strategies.

Chemotherapy administered near death is a recognized quality indicator of end-of-life cancer care intensity. However, simple clinical signals to prompt treatment reassessment and coordinate planned end-of-life care remain unclear in advanced gastric cancer. This study evaluated the interval from last chemotherapy to death and explored factors associated with near-end-of-life chemotherapy and failure to transition to a planned end-of-life care setting.

This single-center retrospective study included 53 patients with advanced or recurrent gastric cancer who had complete data regarding final chemotherapy, mortality, and concurrent laboratory findings. The primary endpoint was chemotherapy administration within 30 days of death. A planned end-of-life care setting was defined as a scheduled transition to a palliative care unit, institutional care, or home-based care with visiting nursing support.

The median interval from last chemotherapy to death was 67 days, with 15 patients (28.3%) receiving chemotherapy within 30 days of death. Serum albumin at final chemotherapy was significantly lower in these patients compared to those treated >30 days before death (2.5 vs. 3.2 g/dl, p<0.001), with an optimal cutoff of 2.9 g/dl. Patients receiving chemotherapy ≤30 days before death were less likely to transition to a planned end-of-life care setting (60.0% vs. 91.4%, p=0.015) and more likely to experience emergency hospitalization or sudden clinical deterioration (46.7% vs. 11.4%, p=0.010). Furthermore, albumin ≤2.9 g/dl and C-reactive protein (CRP) >1.0 mg/dl were associated with failure to transition to a planned care setting.

Low serum albumin at final chemotherapy may serve as a practical clinical trigger for reassessing treatment continuation and facilitating timely end-of-life care planning in advanced or recurrent gastric cancer.

Immune checkpoint inhibitor-based combination therapies are standard treatment options for unresectable hepatocellular carcinoma (HCC). However, conventional endpoints such as objective response rate, progression-free survival, and overall survival may not fully capture response dynamics, including depth of response (DpR), time to response, and duration of response. This study descriptively evaluated response dynamics in patients with unresectable HCC treated with durvalumab plus tremelimumab or atezolizumab plus bevacizumab.

This retrospective single-center study included 148 patients with unresectable HCC who received durvalumab-tremelimumab (n=53) or atezolizumab-bevacizumab (n=95). A reduction of ≥50% in target lesion diameter was defined as DpR50. Because of baseline imbalances and differences in observation period, the analysis was only descriptive and hypothesis-generating.

Fifty-three patients received durvalumab-tremelimumab and 95 received atezolizumab-bevacizumab. The overall response rate was 35.8% for the durvalumab-tremelimumab group and 27.4% for the atezolizumab-bevacizumab group, whereas the disease control rates were 54.7% and 71.6%, respectively. DpR50 was observed in 26.4% and 11.6% of patients, respectively. The median times to response were 2.3 and 3.3 months, and the median durations of response were 22.3 and 10.0 months, respectively. Durable response lasting ≥6 months occurred in 24.5% and 15.8% of all treated patients, respectively. The median PFS was 5.2 and 7.0 months, and median OS was 17.0 and 22.0 months, respectively.

Therapy with durvalumab-tremelimumab was associated with deeper and more durable tumor shrinkage in selected responders, whereas atezolizumab-bevacizumab provided broader disease control mainly through stable disease. These findings should be interpreted as hypothesis-generating.