Robot-assisted minimally invasive esophagectomy (RAMIE) has swiftly gained global acceptance for the management of esophageal cancer; however, the associated learning curve may negatively impact patient outcomes. This study aimed to evaluate differences in surgical outcomes between the initial and subsequent periods and to assess the impact of accumulated experience in RAMIE in clinical practice.

We retrospectively reviewed 130 consecutive patients who underwent RAMIE at our institution. The initial period comprised the first 20 procedures performed by each of three surgeons (n=60), and the remaining procedures constituted the later period (n=70). Operative and postoperative outcomes were compared between the two periods, and factors associated with major postoperative complications were evaluated using logistic regression analysis.

Operative performance demonstrated significant improvement in the later period. Total, thoracic, and robotic operative times were significantly shorter (all p<0.001), and the number of thoracic dissected lymph nodes (LNs) was significantly higher (p=0.02). Thoracic blood loss exhibited a decreasing trend (p=0.07). Clinical outcomes also improved, with a significantly lower overall complication rate (p=0.04), reduced severity of postoperative complications (p=0.02), and a lower incidence of major complications (p=0.005) during the later period. No mortality was recorded, and the length of postoperative hospital stay did not differ significantly between the two periods. Multivariate analysis identified the later period as an independent factor associated with a reduced risk of major complications (odds ratio=0.30; 95% confidence interval=0.12-0.75; p=0.01).

Accumulated experience with RAMIE is correlated with improved operative time, enhanced LN dissection, and a reduction in postoperative complications, thereby supporting its continued safe and effective implementation following the initial learning curve.

A substantial proportion of patients with cancer experience clinically relevant psycho-oncological distress. In addition to clinic-based screening, mobile approaches are receiving increasing attention for standardized assessment. However, evidence in patients with musculoskeletal sarcoma remains limited.

Forty-five patients with sarcoma underwent smartphone-based distress screening using a cancer-specific questionnaire (QSC-R10) at two time points (T1 and T2). At T1, patients also completed the System Usability Scale (SUS) and additional acceptability items.

Mean QSC-R10 scores decreased significantly from T1 to T2 (p=0.034). Patients with recurrent disease showed significantly higher distress at follow-up (p=0.012). Usability was high (SUS: 83.78±12.68), and overall acceptance was high.

Smartphone-based distress screening is feasible and well accepted in patients with musculoskeletal sarcoma and may improve the identification of psycho-oncological needs through repeated, real-world assessments.

Several studies have reported the clinical value of prognostic markers in patients with hepatocellular carcinoma (HCC). However, no study has examined the clinical significance of the Cirrhosis Outcome Risk Estimator (CORE) risk score on outcomes. This study aimed to investigate the impact of CORE risk score on survival in patients undergoing hepatectomy for HCC.

This single-center retrospective study included 639 patients who underwent hepatectomy for HCC between January 2004 and December 2023. Clinical parameters were compared between the low (≤2.4) and high (>2.4) CORE score groups. Multivariate analyses were performed to assess the impact of the CORE risk score on outcomes.

Patients in the high CORE score group had significantly worse 5-year overall (58.9% vs. 80.4%; p<0.001) and recurrence-free (32.9% vs. 52.5%; p<0.001) survival rates than the low CORE score group. Multivariable analyses indicated high CORE risk score as an independent prognostic factor for poor overall [hazard ratio (HR)=1.84; 95% confidence interval (CI)=1.38-2.43; p<0.001] and recurrence-free (HR=1.38; 95%CI=1.09-1.75; p=0.007) survival.

The CORE risk score, an easily accessible screening test, may be a reliable predictor of survival in patients undergoing hepatectomy for HCC.

The development of radiation techniques has demonstrated that stereotactic body radiation therapy (SBRT) effectively achieves good local control and long-term pain palliation for metastatic bone tumors. This study evaluated the efficacy and safety of SBRT for metastatic bone tumors in clinical practice.

Fifty-five patients with 64 metastatic bone tumors treated at the University of Osaka Hospital from July 2014 to March 2022 were retrospectively analyzed. Local failure (LF) rates were estimated using competing risk analysis, and overall survival (OS) rates using the Kaplan-Meier method. Pain response rates were assessed as complete response, partial response, and pain progression based on the patient's chief complaint at three months, six months, and the last follow-up. Treatment response was determined using the Spine Response Assessment in Neuro-Oncology criteria.

The most common primary site was the prostate (n=18), and the spine was the most prevalent radiation site (n=45). Dose prescription was performed at a planning target volume of D_95%, with a median dose fraction of 35 Gy in five fractions. The median follow-up duration was 25.8 months (range=1.9-60.5 months), and the 2-year LF and OS rates were 3.4% and 72.4%, respectively. The pain response rate three months post-SBRT was 93.8%. Grade 2 and 3 toxicities occurred in 4.7% (three cases) and 1.6% (one case), respectively.

SBRT for metastatic bone tumors achieved low LF rates with low toxicity and favorable pain response and is an effective treatment option in clinical practice.

Neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) is recommended for patients with resectable pancreatic ductal adenocarcinoma (PDAC) in Japan. However, its real-world feasibility, the impact of treatment-related toxicity, and the influence of relative dose intensity (RDI) on outcomes remain unclear. This study evaluated the safety and efficacy of NAC-GS for resectable PDAC.

We retrospectively reviewed 117 patients with resectable PDAC who underwent treatment between January 2017 and December 2024. Outcomes were compared between patients treated with NAC-GS and those who underwent upfront surgery (UFS). Propensity score matching was performed among patients who underwent curative resection to adjust for baseline characteristics. Recurrence-free survival (RFS), overall survival (OS), recurrence patterns, adverse events, and the association between RDI and outcomes were analyzed.

The study included 46 patients in the NAC-GS group and 71 in the UFS group. Resection rates did not differ significantly between the groups. Although grade ≥3 adverse events occurred frequently in the NAC-GS group, no patient became ineligible for surgery because of treatment-related toxicity. After propensity score matching, 32 pairs were analyzed. The NAC-GS group had significantly longer RFS and OS than the UFS group. The 5-year RFS rates were 57.2% and 26.0%, respectively, and the 5-year OS rates were 60.2% and 37.2%, respectively. NAC-GS was also associated with a lower early recurrence rate. In the NAC-GS group, an RDI <70% tended to be associated with poorer survival.

NAC-GS was feasible and was associated with improved long-term outcomes and reduced early recurrence in patients with resectable PDAC. Maintaining adequate RDI may be important for maximizing its therapeutic benefit.

This study evaluated the clinical significance of baseline lymphocyte-to-monocyte ratio (LMR) and its early dynamic changes as an on-treatment biomarker in patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (Ate/Bev), with stratification by alpha-fetoprotein (AFP) status.

We retrospectively reviewed 108 patients with advanced HCC treated with first-line Ate/Bev. Baseline LMR and LMR at six weeks (LMR 6w) were calculated. Patients were classified into high/low groups (cutoff: 3.69) and dynamic change groups [increased (Up) vs. decreased (Down)]. Overall survival (OS) and objective response rate (ORR) were assessed according to baseline AFP levels (cutoff: 20 ng/ml).

High baseline LMR significantly correlated with longer OS (median not reached vs. 17.3 months, p<0.001). Notably, patients with increased LMR at six weeks (Up group) demonstrated significantly superior OS compared to the Down group (33.6 vs. 18.9 months, p=0.018) and a higher ORR (46.0% vs. 26.0%, p=0.037). The High+Up cohort achieved the most favorable prognosis. In stratified analyses, these prognostic and predictive values of early LMR dynamics were prominently observed in AFP-negative patients (p<0.05), but were attenuated in AFP-positive individuals.

Early dynamic increase in LMR serves as a powerful, cost-effective on-treatment biomarker for Ate/Bev therapy in advanced HCC. Integrating systemic immune dynamics with tumor biology provides superior risk stratification, particularly for AFP-negative patients.

Esophageal squamous cell carcinoma (ESCC) exhibits substantial heterogeneity in its tumor immune microenvironment (TIME). We aimed to establish an integrated spatial immune phenotyping framework incorporating immune infiltration, spatial distribution, and suppressive-effector immune balance.

A total of 139 patients with surgically resected ESCC were retrospectively analyzed, including a discovery cohort (n=89) and an external validation cohort (n=50). Whole-slide histopathological evaluation and immunohistochemistry were used to assess spatial immune-cell infiltration. Tumors were classified according to total tumor-infiltrating lymphocyte (TIL) level, the intratumoral-to-stromal TIL ratio, and stromal suppressive-to-effector immune balance. TCGA-ESCA transcriptomic data were analyzed to characterize the identified phenotypes.

Stromal TILs significantly exceeded intratumoral TILs (p<0.001). Increased intratumoral immune infiltration and enrichment of suppressive immune-cell populations were associated with aggressive clinicopathological features. Four immune phenotypes were identified: immune-cold, immune-excluded, CD8-effector infiltrated, and suppressive-infiltrated. The suppressive-infiltrated phenotype showed the poorest overall survival in both the discovery (p=0.010) and validation cohorts (p=0.008). In the pooled cohort, Type IV status remained independently associated with worse overall survival after adjustment for major clinicopathological factors [hazard ratio (HR)=2.64, 95% confidence interval (CI)=1.20-5.79, p=0.015]. Adding Type IV status improved prognostic performance (C-index: 0.650 to 0.673; likelihood-ratio test, p=0.018). Transcriptomic analyses demonstrated increased immune checkpoint activity, T-cell exhaustion, and stromal activation signatures in the suppressive-infiltrated phenotype (all p<0.05).

Integrated assessment of immune infiltration, spatial distribution, and suppressive-effector balance identified clinically distinct immune phenotypes in ESCC. The suppressive-infiltrated phenotype represents a high-risk immune microenvironmental subgroup independently associated with poor survival.

While thermal ablation has emerged as a less invasive alternative for colorectal liver metastases (CRLM), evidence directly comparing repeat hepatectomy and ablation after prior resection remains limited. This study aimed to compare survival and short-term outcomes between the two strategies using propensity-adjusted analyses with multiple imputation.

A total of 150 patients with recurrent CRLM after initial resection who underwent repeat hepatectomy (n=94) or ablation (n=56) were retrospectively enrolled. Outcomes included overall survival (OS), local tumor progression-free survival (LTPFS), distant progression-free survival (DPFS), and perioperative outcomes. Propensity score matching (PSM) was applied, and Inverse probability of treatment weighting (IPTW) was additionally used as a sensitivity analysis. Estimates were pooled across imputed datasets.

In pooled PSM analyses, ablation showed comparable OS to repeat hepatectomy [hazard ratio (HR)=1.330, p=0.370] and comparable DPFS (HR=1.310, p=0.299). However, ablation was associated with significantly worse LTPFS (HR=4.540, p=0.004). For short-term outcomes, ablation resulted in shorter hospital stay (4.6 versus 15.5 days, p<0.001) and lower incidence of Clavien-Dindo grade ≥IIIa complications (0% versus 19.5%, p=0.033). These findings were consistent in IPTW analyses.

Repeat hepatectomy and ablation for intrahepatic recurrence after resection of colorectal metastases showed comparable OS, with a trade-off between superior local control and reduced perioperative burden. When both options are feasible, ablation may represent a reasonable alternative to repeat hepatectomy for patients prioritizing lower treatment burden.

Quantitative post-therapy single-photon emission computed tomography/computed tomography (SPECT/CT) may offer valuable insights for response assessment during peptide receptor radionuclide therapy (PRRT), but lesion-level evidence for liver metastases from neuroendocrine tumors (NETs) remains limited. This study assessed lesion-level longitudinal changes in practical quantitative indices, including kBq/ml max and maximum standardized uptake value (SUVmax), during ¹⁷⁷Lu-DOTATATE PRRT and their association with CT-based volumetric change.

This retrospective single-center study included 12 patients with NETs (51 liver metastases) treated with ¹⁷⁷Lu-DOTATATE PRRT. Quantitative SPECT/CT was performed the day after each cycle. SUVmax and kBq/ml max were measured for each lesion, and tumor volume was assessed using the CT component. Baseline (post-cycle 1) and final-cycle values were recorded. Lesions were classified as non-progressive (shrinkage/disappearance/stable) or progressive based on CT volumetric change. Spearman's rank correlation, the Wilcoxon signed-rank test, and the Mann-Whitney U-test were used.

Eleven patients completed four cycles and one discontinued after three cycles. Lesion volume, kBq/ml max, and SUVmax significantly decreased from baseline to final evaluation (all p<0.01). Of 51 lesions, 39 were non-progressive and 12 were progressive. Percentage reductions in kBq/ml max and SUVmax were strongly correlated with volumetric shrinkage (ρ=0.757 and 0.734). Non-progressive lesions showed greater reductions in both indices than progressive lesions (both p<0.01). Baseline kBq/ml max and SUVmax were higher in non-progressive lesions (p=0.029 and 0.030).

In this exploratory lesion-level analysis for NET liver metastases, post-therapy quantitative SPECT/CT metrics (kBq/ml max and SUVmax) were associated with CT-based volumetric change during ¹⁷⁷Lu-DOTATATE PRRT.

To evaluate whether tumor-bed boost irradiation improves local control outcomes in women aged 50 years or younger with invasive ductal carcinoma (IDC) and widely negative margins after breast-conserving surgery (BCS), and to clarify its clinical value within a modern, risk-adapted radiotherapy strategy.

This retrospective single-center study included 318 female patients aged ≤50 years with IDC and negative surgical margins (>5 mm) who underwent BCS followed by whole-breast irradiation (WBI) at Tohoku University Hospital between 2008 and 2022. Patients treated before 2016 did not receive boost irradiation, whereas those treated thereafter received a 10 Gy tumor-bed boost. Survival estimates were calculated using the Kaplan-Meier method from the first date of radiotherapy.

Among the 318 eligible patients, 110 received boost irradiation and 208 did not. Luminal disease was the predominant subtype in both groups (87/110 in the boost group and 159/208 in the non-boost group), whereas triple-negative disease was uncommon (11/110 and 18/208, respectively). After a median follow-up of 95.5 months, the 7-year ipsilateral breast tumor recurrence (IBTR) rates were 1.2% and 0% (log-rank p=0.859), while the 7-year overall survival (OS) rates were 97.9% in the non-boost group and 96.6% in the boost group (log-rank p=0.616), respectively. There were no significant differences in IBTR or OS between groups.

In female patients aged ≤50 years with IDC and widely negative surgical margins following BCS, the addition of a 10 Gy tumor-bed boost did not demonstrate a significant improvement in IBTR or OS. These findings suggest that routine boost irradiation may not be necessary in carefully selected low-risk patients and support a risk-adapted approach to postoperative radiotherapy.