Identifying pathogenic germline variants in men with metastatic prostate cancer is important for therapeutic options and for identifying relatives who may have a high cancer risk. To keep genetic testing costs manageable, it is important to identify which patients should be selected for testing. In this study, we compared expected costs and number of identified pathogenic variants in two scenarios: offering genetic testing to all men with metastatic prostate cancer versus testing only those with additional risk factors linked to a higher likelihood of carrying a pathogenic variant. Costs were evaluated with a mainstream genetic testing pathway, where testing is discussed by a non-genetic healthcare professional. Using Dutch national incidence data, predefined healthcare cost frameworks, and a hypothetical assumption for the acceptance rate of patients, we modelled total costs for the Netherlands and number of identified pathogenic variants for each approach. The costs of genetic testing and post-test counselling decreased threefold when applying selection criteria, compared to the scenario where all metastatic prostate cancer patients are eligible. However, applying selection criteria would result in missing 41% clinically relevant pathogenic germline variants that would otherwise be identified. This implies that, at national level, a discussion should be started regarding willingness to pay for identifying pathogenic germline variants.

The importance of routine symptom screening in pediatric oncology is increasingly being recognized. The Pediatric Oncology Group of Ontario (POGO) is therefore committed to facilitating its implementation province-wide. The objective was to establish common symptom screening practices in Ontario, Canada, by determining baseline implementation characteristics including initial enrollment cohorts, symptom screening frequency and screening duration.  METHODS: POGO's Guidelines and Implementation Program convened an in-person focus group of site representatives, methodologists and a patient advocate. The focus group aimed to establish initial minimum characteristics of the symptom screening and management program: which patient cohorts to include, symptom screening reminder frequency and symptom screening duration. The nominal group technique and simple voting procedures were used.

Using the nominal group technique with two rounds of voting, focus group members identified newly diagnosed or relapsed pediatric outpatients receiving ambulatory chemotherapy as the initial target cohort. Simple voting procedures determined that the initial minimum symptom screening frequency will be once weekly and that symptom screening will extend for 3 months. At 3 months, patients or families can opt to continue or stop.

We convened a focus group to establish provincial minimum characteristics of a symptom screening and management program in pediatric oncology. The program will include outpatients who are newly diagnosed or relapsed receiving ambulatory chemotherapy. Symptom screening reminders will be sent weekly for 3 months. These efforts should improve quality of life of pediatric patients with cancer at the population level.

To explore self-advocacy in male patients with liver cancer, identify heterogeneous subgroups, and examine their relationship with fear of progression, family resilience, and cognitive emotion regulation to a reference for individualized precise nursing intervention.

Two hundred seven male patients with liver cancer completed the general information questionnaire, Fear of Progression Questionnaire-Short Form, Family Hardiness Index, Cognitive Emotion Regulation Questionnaire-Short, and Self-Advocacy in Cancer Survivorship between August 2024 and June 2025. Latent profile analysis was used to classify self-advocacy, and multiple logistic regression was used to analyze the factors of influence for each subgroup.

Patients were divided into three subgroups based on their levels of self-advocacy: the "balanced-low interaction group" (25.60%), the "comprehensive-multidimensional strengths group" (55.56%), and the "imbalanced-low decision-high interaction group" (18.84%). The multivariate logistic regression analysis showed that place of residence, fear of progression, and cognitive emotion regulation were all associated with self-advocacy (P < 0.05). However, family resilience did not show a statistically significant association in this study (P > 0.05).

Self-advocacy in male patients with liver cancer is heterogeneous and presents in three distinct categories. The patient's place of residence, fear of progression, and cognitive emotion regulation are key factors influencing their self-advocacy model. This suggests that clinical practice should pay attention to the patients' psychosocial characteristics and implement targeted support and guidance to enhance self-advocacy and adaptive coping.

Robotic colorectal surgery is increasingly complex, expanding from pelvic to multiquadrant procedures. Reports on the impact of institutional robotic platform transition remain limited. This study evaluated the challenges and effects of transitioning from the da Vinci Si (dV Si) to the da Vinci X/Xi (dV X/Xi) platform. A prospective observational cohort with historical comparison describing an institutional experience that included consecutive elective robotic colorectal cancer resections performed in 2023 (dV Si) and 2024 (dV X/Xi). The primary endpoint was the learning curve for console time. Secondary outcomes included total operative time, port placement time, length of stay (LOS), ileus, anastomotic leakage, severe complications (Clavien-Dindo ≥ 3), reoperation, and 30-day mortality. An institutional learning curve for the surgical team was constructed and evaluated using the cumulative sum (CUSUM) test. A total of 121 procedures were analyzed (dV Si: n = 49; dV X/Xi: n = 72). Procedural profile shifted significantly (p = 0.002), with increased multiquadrant resections in the dV X/Xi group. Console time was longer in dV X/Xi group (p = 0.05), while total operative time and LOS were similar in the two groups. Postoperative outcomes were comparable. Parenteral nutrition was less frequently required in the dV X/Xi group (p = 0.02). CUSUM analysis showed a console learning plateau at 48 cases.We describe a real-world experience of robotic platform transition, demonstrating that it enabled an expanded range of procedures without compromising short-term outcomes.

To report the clinical, functional and oncological outcome in patients with spinal OBL/OO (osteoblastoma/osteoid osteoma) using Enneking and WBB staging system treated at a single center.

This is a retrospective observational study in which the hospital records of 20 patients with OBL and 11 patients with OO were reviewed with a minimum follow-up period of 24 months. Besides demographic information, presenting symptoms, radiological findings and operative details, the outcome measures reported were: neurological (ASIA) and non-neurological complications, patient-reported outcome score (visual analogue scale) and local recurrence after surgery.

The mean age at presentation was 20.2 ± 9.2 years and 17.3 ± 6.8 years, respectively for the OBL and OO patient groups, with a male predilection in either tumor. Localized pain was the most common presenting symptom. Neurological deficit at presentation was noted in 8/20 OBL patients, whereas all patients with OO were neurologically intact. Both the tumors predominantly involved posterior elements (27/31 patients) with no intradural involvement. Five patients (all with OO) underwent only decompression/curettage; 26/31 patients underwent decompression with instrumentation. 4 patients underwent Enneking inappropriate resection, with one patient having local tumor recurrence. Significant improvement in pre-existing neurological status and VAS scores was noted at final follow-up.

Surgical treatment of OBL and OO is associated with a favourable clinical, radiological and oncological outcome. While anatomical constraints don't allow wide excisions, combined Enneking and WBB staging facilitates surgical planning and helps in doing anatomically feasible resections with structural stability.

Liver cancer remains a leading cause of cancer-related mortality due to drug resistance and limited treatment options. There is an urgent need to explore therapeutic strategies to improve outcomes. This pilot study presents a protocol for assessing the potential effects and underlying mechanisms of the combination of sorafenib and gemcitabine in liver cancer. The liver cancer cell line HepG2 was used, and a non-obese diabetic/severe combined immunodeficient (NOD/SCID) mouse xenograft model was established. Key procedural steps are demonstrated including: (1) HepG2 cell culture and drug treatment; (2) MTT assay setup, incubation, and absorbance reading; (3) protein extraction, SDS-PAGE, transfer, and immunoblotting for ERK and p-ERK; (4) subcutaneous xenograft establishment in NOD/SCID mice; (5) tumor measurement and volume calculation; and (6) VEGF immunohistochemistry on tumor sections. Critical steps, troubleshooting tips, and equipment specifications are provided. The combination of sorafenib (3 µmol/L) and gemcitabine (10 µmol/L) achieved an inhibition rate of 71.23% ± 6.76% at 72 h, with a q-value of 1.35, suggesting a synergistic effect at this specific dose pair under the conditions tested. Compared with the control group, the combination treatment was associated with reduced p-ERK expression, decreased tumor volume, and qualitatively lower VEGF immunostaining. These data show a correlative association between reduced p-ERK expression and the observed anti-proliferative effect, without establishing causality. In HepG2 cells and a NOD/SCID mouse xenograft model, the combination of sorafenib and gemcitabine shows preliminary evidence of anti-proliferative potential and is associated with reduced VEGF expression; however, this finding does not constitute direct evidence of anti-angiogenic activity, as microvessel density or functional vascular analyses were not performed. This reproducible protocol provides a useful framework for evaluating drug combinations in HCC models and can be adapted for other targeted therapy-chemotherapy regimens, though further mechanistic and dose-validation studies are required before any clinical implications can be drawn.

Short-term associations of omega-3 polyunsaturated fatty acids (PUFA)-enriched oral nutritional supplementation (ONS) with hematological, nutritional, and immune-inflammatory outcomes were evaluated in a retrospective cohort of 87 malnourished or nutritionally at-risk patients with gastrointestinal (GI) cancer. During a 3-week observation period, 46 patients received omega-3 PUFA-enriched ONS plus dietary counseling, whereas 41 received dietary counseling alone. The groups differed at baseline in tumor site, body-weight status, and recent weight loss, whereas oncological treatment category and supportive treatment did not differ statistically. Unadjusted change analyses showed a smaller decline in neutrophil (NE) count in the ONS group (P for Δ = 0.007), whereas between-group differences in white blood cell (WBC) and platelet (PLT) changes were not statistically significant. The larger reductions in the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in the control group coincided with greater declines in NE and PLT and were therefore not interpreted as evidence of an anti-inflammatory benefit. In linear regression models adjusted for the corresponding baseline value, tumor site, and weight-loss status, ONS receipt was associated with higher week-3 body weight (adjusted difference, 1.49 kg; 95% CI, 0.58-2.39; P = 0.002), body mass index (BMI) (0.51 kg/m²; 95% CI, 0.19-1.02; P = 0.002), WBC (1.08 × 10⁹/L; 95% CI, 0.24-1.92; P = 0.012), and NE count (0.97 × 10⁹/L; 95% CI, 0.30-1.64; P = 0.005). Adjusted NLR was also higher in the ONS group (adjusted difference, 0.60; 95% CI, 0.07-1.13; P = 0.028), whereas PLT, C-reactive protein (CRP), PLR, SII, albumin (ALB), and prognostic nutritional index (PNI) did not differ significantly. Thus, receipt of omega-3 PUFA-enriched ONS was associated with a potential myeloprotective effect and more favorable short-term weight outcomes, but not with a consistent reduction in systemic inflammation.

Gastric cardia adenocarcinoma is biologically distinct from distal disease, but deployable molecular markers remain scarce. We investigated whether explainable deep learning applied to public transcriptomes could nominate diagnostic and survival-associated candidates. We developed and externally evaluated an explainable transcriptome-based classifier. The Asian Cancer Research Group SuperSeries GSE66229 (300 tumors and 100 patient-matched non-tumor tissues) underwent robust multi-array average preprocessing and quality control. An attention-based deep neural network was evaluated by stratified fivefold cross-validation for tumor-versus-non-tumor classification. Inputs were restricted before training to genes available in all cohorts and ordered identically; no missing model inputs were imputed. Shapley additive explanations nominated 20 genes, and univariable Cox models evaluated overall survival associations. External testing without refitting used GSE29272 and The Cancer Genome Atlas stomach adenocarcinoma cohort. Pathway analyses provided biological context. Cross-validated receiver operating characteristic and precision-recall areas under the curve were both 1.00. External values were 0.85/0.93 for cardia and 0.50/0.67 for non-cardia in GSE29272, and 0.78/0.80 and 0.71/0.50, respectively, in The Cancer Genome Atlas cohort. Six genes showed nominal survival associations in GSE66229. None replicated statistically in the strict external cardia subset; LVRN and WISP2 were nominally concordant in the full stomach adenocarcinoma cohort, but neither survived six-test correction. Enrichment implicated immune and lipid-related processes. Explainable deep learning prioritized candidates with stronger external performance in cardia-versus-non-tumor contrasts. These exploratory diagnostic and survival findings require clinically adjusted, prospective validation before clinical use.

Psychological prehabilitation aims to prepare patients for cancer treatment, yet psychological readiness is under-specified and distress during and after treatment is common. A patient-informed account of readiness is needed to guide readiness-focused, proactive psychological support in cancer care.

To examine patients' experiences of psychological readiness for cancer surgery across the prehabilitation-treatment pathway.

We used a longitudinal qualitative design. Ten adults enroled in a tertiary cancer prehabilitation service for major elective surgery completed semi-structured interviews before surgery (T1) and after surgery (T2). We analysed data using Reflexive Thematic Analysis with an inductive, semantic approach, and compared change and stability across time points using a longitudinal analytic matrix.

Participants described psychological readiness as developing a future-focused "mindset to have surgery", comprising three interrelated elements that were stable from T1 to T2: confidence, motivation, and contained anxiety, that is, anxiety that remained expected and manageable rather than absent or overwhelming. Three processes shaped this mindset. Reliable and complete information from professionals and credible peers supported clearer and more concrete expectations, increased confidence, and helped keep anxiety manageable. Participants preferred candid information about plausible difficulties over reassurance that downplayed them. Reciprocal support from family, peers, and professionals strengthened motivation and reduced loneliness. Readiness could be held back when participants found it difficult to tell loved ones about their diagnosis. Agency developed through drawing on personal resources and taking controllable steps, including making progress visible through prehabilitation activity and staff encouragement.

These findings identify provisional, patient-informed targets for psychological preparation within multimodal prehabilitation. They provide a foundation to operationalise and measure readiness and, following work on transferability, co-production and feasibility, to test whether readiness-focused support in prehabilitation is associated with post-operative adjustment.

The ratio of red blood cell distribution width (RDW) to serum albumin (RAR) combines hematologic and nutritional information from routine blood tests and has shown potential value for prognostication in several diseases. This study aimed to evaluate the prognostic significance of preoperative RAR in patients with gastric cancer undergoing curative gastrectomy and to explore whether RAR could provide additional prognostic information beyond conventional indicators such as TNM stage.

This study evaluated the prognostic value of preoperative RAR in patients with gastric cancer undergoing curative resection. Specifically, we aimed to (i) determine the association between RAR and clinicopathological characteristics, (ii) assess its predictive value for overall survival (OS) and disease-free survival (DFS), and (iii) evaluate the complementary prognostic value of RAR beyond conventional indicators such as TNM stage and other markers.

This is a retrospective cohort study including 6988 patients with gastric cancer who underwent curative resection at a tertiary cancer center between July 2011 and December 2022. We explored associations between preoperative RAR and a range of clinicopathological characteristics. Overall survival was estimated by the Kaplan-Meier method, and Cox proportional hazards models were used to assess factors influencing prognosis. The discriminative ability of RAR was evaluated using time-dependent ROC analysis.

An elevated baseline RAR was associated with older age, larger tumor dimensions, higher TNM classification, lymphatic spread, deeper tumor invasion, and the presence of vascular and perineural invasion, with poorer overall survival (OS) and disease-free survival (DFS). Time-dependent receiver operating characteristic analyses indicated that RAR consistently achieved higher discriminative performance than neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) across follow-up. However, the absolute AUC values remained modest, indicating that RAR alone has limited predictive capacity.

RAR may facilitate postoperative risk stratification as an accessible prognostic marker.