Nasopharyngeal carcinoma (NPC) is a multifactorial malignancy often diagnosed at an advanced stage due to nonspecific early symptoms. Accurate prognostic stratification is essential for individualized therapy but remains challenging because of biological and clinical heterogeneity. This study aimed to develop and validate a gene expression-based prognostic signature for locally advanced NPC.

This retrospective biomarker investigation combined transcriptomic profiling and survival analyses. A prognostic model was constructed using LASSO-Cox regression in the discovery cohort (N = 99) from the multicenter, randomized phase III trial NPC-0501, and validated in independent cohorts (N = 133) from Queen Elizabeth Hospital (QEH), Hong Kong, and Sun Yat-sen University Cancer Center (SYS), Guangzhou, using different profiling methods. Mechanisms underlying the signature were explored using single-cell RNA-seq (scRNA-seq) data. The primary outcome was 3-year progression-free survival (PFS), with 5-year overall survival (OS) as a secondary end point. Performance was evaluated using hazard ratios (HRs) and survival probabilities (SP).

A 5-gene signature (SPP1, IL18BP, PALMD, WDR35, and SOCS6) predicted 3-year PFS in the NPC-0501 cohort (HR, 0.046 [95% CI, 0.011 to 0.190]; P < .001), separating high-risk from low-risk patients (SP, 42.9% v 96.0%; P < .0001). It predicted survival in both validation cohorts, with associations with 5-year OS in QEH (SP, 72.7% v 100%; P < .001) and 3-year PFS in SYS (SP, 70.5% v 93.2%; P = .0059). It outperformed a published metastasis-related model. Single-cell analyses showed SPP1 enrichment in M2 macrophages, linking high risk with an immunosuppressive tumor microenvironment.

A robust five-gene signature was established and validated for prognostic stratification of locally advanced NPC. Reproducibility across transcriptomic platforms and biological relevance support clinical application to guide personalized treatment.

The Shield test is a blood-based assay that uses multimodal analysis of cell-free DNA (cfDNA) to enable noninvasive colorectal cancer (CRC) detection. The aim of this study was to assess the diagnostic performance of the cfDNA test for CRC and advanced precancerous lesions (APLs) and evaluate its potential clinical utility, particularly in early-stage disease.

In this prospective, multicenter study, 451 patients with histologically confirmed CRC or APLs were enrolled across eight institutions. Blood samples collected before treatment were analyzed using the cfDNA test (Shield, Guardant Health, United States). We assessed the sensitivity of the test for different CRC stages and APLs. In addition, we examined the correlation between test positivity and clinicopathologic factors in stage I and T1 CRC.

The test showed 87.9% sensitivity for CRC overall, with stage-specific sensitivities of 71.2% for stage I and 97.4% for stages II-IV. Sensitivity for APLs was 37.0%. In stage I CRC, test positivity was significantly associated with tumor depth (T2: 88.6% v T1: 59.7%, P < .01). Among 70 patients with T1 CRC, the test detected all to have lymph node metastasis (LNM; 100% sensitivity). Compared with guideline-based pathologic criteria, the cfDNA test achieved higher specificity for LNM prediction (38.7% v 11.3%), thereby potentially reducing the frequency of unnecessary radical surgery from 78.6% to 54.3%.

This cfDNA blood-based test shows a robust diagnostic performance in CRC detection. It may improve risk stratification and support more tailored clinical decision making, particularly in the management of T1 CRC.

Recurrent cancers are not captured in a standardized way by US tumor registries, making it difficult to conduct research on risk factors for cancer recurrence. We developed rule-based algorithms to be used with electronic health data to identify recurrent cases of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL).

Incident DLBCL and FL cases (2000-2018) were identified in tumor registry data at two health plan study sites. We captured pharmacy and procedure codes to indicate first-line treatment initiation. Recurrent cases were defined as those who completed first-line treatment followed by ≥6 months with no treatment-related codes, but who later restarted treatment. The baseline algorithm was built using a claims-based database from Fallon Health (FH; Massachusetts) and tested using electronic health records and claims data at Henry Ford Health (Michigan). Results were validated by chart review at Henry Ford, and measures of validity calculated overall and by subtype. The algorithm was subsequently revised to reduce the false-positive rate.

FH identified 137 DLBCL and 88 FL eligible cases; 42 patients met the baseline algorithm-defined criteria for recurrent disease. Henry Ford identified 246 DLBCL and 146 FL cases. The baseline algorithm identified 115 recurrent cases with a 54% false-positive rate; the revised algorithm (R2D-non-Hodgkin lymphoma [NHL]) identified 60 recurrent cases, with a 10% false-positive rate. Following chart review, the R2D-NHL algorithm had a sensitivity of 74%, specificity of 90%, negative predictive value of 83%, and positive predictive value of 83%. Measures varied slightly between subtypes.

We developed a rule-based algorithm that can be applied to electronic health data for population-based research requiring the identification of recurrence for two common but dissimilar NHL subtypes.

Germ cell tumors (GCTs) are the most common malignancies among young men. In Latin America and the Caribbean, including Chile, population-based data remain limited; however, mortality is consistently reported to be higher than that in other regions. This study aimed to describe the clinical characteristics and survival outcomes of a cohort of Chilean patients with GCT and to assess the performance of established prognostic factors.

A retrospective cohort analysis was conducted among patients with GCT treated at two Chilean institutions. Clinical characteristics, recurrence, and survival outcomes were analyzed according to the stage and histological subtype. Established prognostic factors for stage I disease were evaluated for their association with recurrence-free survival.

In total, 628 patients were included in this study. The 5-year overall survival (OS) rate was 98.8% (95% CI, 91.8 to 99.8) for stage I seminoma and 98.0% (95% CI, 92.0 to 99.5) for stage I nonseminomatous disease. Patients with advanced-stage disease had inferior outcomes compared with the International Germ Cell Cancer Collaborative Group reference cohorts. In stage I seminoma, lymphovascular invasion (LVI) and preorchiectomy β-human chorionic gonadotropin levels are associated with relapse. The Harrell C-index was 0.76 (95% CI, 0.6 to 0.9). No evidence of an association was found between internationally recognized risk factors and relapse in the stage I nonseminomatous cohort.

The outcomes for stage I GCT in Chile are consistent with the global experience; however, survival in advanced-stage disease remains suboptimal. These findings highlight structural challenges, including a lack of centralized care. Strengthening referral pathways, consolidating specialized management, and expanding national registries are critical steps for improving outcomes.

The number of cancer survivors from low- and middle-income countries is rising, but most research has been conducted in high-income countries. Although studies have characterized the detection and treatment of cervical cancer in Botswana, survivorship care is a severely understudied area. We assessed short- and long-term survivorship visit adherence and factors associated with adherence in patients treated for cervical cancer in Botswana.

Between 2015 and 2022, females with cervical cancer were prospectively enrolled in an observational cohort study. Based on recommendations in the Botswana National Cervical Cancer Guidelines, adherence was defined as completion of a clinical visit biannually (every 6 months) during short-term survivorship care (0-2 years after treatment) and annually for long-term survivorship care (3-5 years after treatment). Generalized estimating equations (adjusted odds ratio [aOR]) were used to evaluate factors associated with short- and long-term adherence.

This cohort included 857 females treated with definitive- or curative-intent surgery- or radiation-based treatment, with a median age of 47.7 years (IQR, 41.6-58.2 years) and 68.6% living with HIV. On multivariable analysis of short-term care (n = 772), patients who traveled ≥100 km to the treatment facility (aOR, 0.35; P < .001), had advanced-stage (III and IV) cervical cancer (aOR, 0.69; P = .007), and were undergoing care during the COVID-19 pandemic (aOR, 0.72; P = .005) were less likely to be adherent. Results were similar for long-term care.

Adherence to recommended survivorship visits in Botswana is suboptimal. Strategies to help survivors, particularly those living farther away from treatment facilities and with advanced disease, are needed to improve adherence and reduce cervical cancer mortality.

Breast cancer (BC) is the most commonly diagnosed malignancy among women worldwide and the leading cause of cancer-related death in this population in Argentina. Despite its burden, Argentina lacks comprehensive epidemiologic data. In low- and middle-income countries (LMICs), acknowledging existing disparities and delays in treatment is essential for implementing cost-effective policies that optimize outcomes and reduce relapse and mortality.

This retrospective, observational study analyzed 786 women with operable BC treated between 2017 and 2022 in two Buenos Aires institutions. Patients were stratified by health coverage: private prepaid health insurance (PPHI, n = 557) and social security (SS, n = 229). Four quality indicators were assessed: stage at diagnosis, time from anomaly detection to pathologic diagnosis and treatment initiation, and adherence to multimodal therapy. In addition, the impact on eligibility for adjuvant cyclin-dependent kinase inhibitors (CDK4/6i) was evaluated in the hormone receptor-positive/human epidermal growth factor receptor 2-negative subgroup.

Patients with PPHI were significantly more likely to be diagnosed at earlier stages (stage I: 56.7% v 37.1%, P < .05) and to meet WHO benchmarks for timely diagnosis (<60 days) and treatment (<90 days). Median time to diagnosis and treatment was notably shorter in the PPHI group (30.5 v 61 days and 76 v 126 days, respectively; P < .05). CDK4/6i eligibility was higher among SS patients, suggesting more advanced disease and increased treatment cost burden.

Disparities between Argentina's health subsystems significantly affect the BC stage at diagnosis and treatment timelines, influencing therapeutic pathways and associated costs. These findings highlight the need for targeted, system-level interventions. While further research is needed to confirm their long-term impact, such efforts may contribute to more equitable care and improved outcomes in LMICs.

Childhood cancer has high cure rates; however, data on long-term socioeconomic challenges faced by survivors, particularly in low- and middle-income countries, are limited. We aimed to identify issues related to educational disruption, employment, and financial hardship among childhood cancer survivors.

We conducted a cross-sectional study of survivors enrolled in the Childhood Cancer Survivorship Program at a tertiary cancer center in India (December 2020-March 2025). Eligible survivors were aged 21 years and younger at diagnosis and had completed therapy. Clinical and sociodemographic data were abstracted from records and structured proforma. Logistic regression with forward stepwise modeling was used to identify predictors of educational, financial, and employment challenges.

We included 1,098 survivors. The median age was 16 years at evaluation, and 74.7% were male. Among those diagnosed at age 5-21 years (n = 764), 85% reported educational disruption (median 1.75 years). Relocation from the hometown for therapy (odds ratio [OR], 1.8; P = .01) and job loss within the family (OR, 2.1; P = .01) independently predicted educational disruption, whereas maternal education until or above high school was associated with lower odds of educational disruption (OR, 0.29; P = .001). Catastrophic health expenditure occurred in 91.3%. Younger age at diagnosis (OR, 1.03; P = .003) and relocation (OR, 1.61; P = .001) independently predicted higher treatment costs, ≥$3,385 US Dollars. Cancer-related employment difficulties affected 30.2% of working-age survivors, with older age at diagnosis (OR, 1.15; P < .001) and longer time since treatment completion (OR, 1.08; P = .02) being independent predictors.

For Indian childhood cancer survivors, cure carries hidden costs of disrupted education, financial strain, and workplace barriers. Survivorship care in resource-constrained settings should integrate school reintegration, financial protection, and vocational support.

Cystoscopy, biopsy, and urine cytology are gold standards for the diagnosis and surveillance of bladder carcinoma. Bladder washings, obtained via cystoscopy or by catheterization, are common in routine cytology practice, whereas voided urine is evaluated less frequently. The aim of this study was to perform a comparative cytologic assessment of voided urine and bladder washing specimens in patients with bladder carcinoma.

In this prospective study, second-morning voided urine and bladder washing samples were obtained from 75 patients with histologically confirmed bladder carcinoma over a 3-year period. Samples were re-evaluated cytologically according to the Paris system.

Bladder washing cytology showed higher sensitivity (81 vs. 62%) and the correlation coefficient (0.617 vs. 0.487), compared to voided urine cytology.

While bladder washing cytology showed superior diagnostic performance with a higher area under the curve and sensitivity in this cohort, voided urine cytology remains a valuable non-invasive alternative despite its lower sensitivity.

The aim of this study was to determine whether adenomyosis is an independent prognostic factor in cervical cancer using integrated survival analysis and machine-learning models.

This retrospective cohort study included 131 patients with early-stage cervical cancer treated surgically between 2008 and 2020. Patients were stratified by the presence (n=28) or absence (n=103) of adenomyosis based on final histopathology. Kaplan-Meier curves and log-rank tests assessed overall survival. Independent prognostic factors were identified through multivariate Cox regression and logistic regression analyses, supplemented by machine-learning decision tree modeling to evaluate variable importance and model performance.

Women with adenomyosis had no significant differences in tumor size, histology, depth of stromal invasion, lymphovascular space invasion, parametrial involvement, lymph node metastasis, or International Federation of Gynecology and Obstetrics 2018 stage. Kaplan-Meier analysis demonstrated shorter overall survival in the adenomyosis group (median overall survival 31.3 vs. 64.8 months, log-rank p=0.045). Multivariate Cox regression identified age, tumor size, International Federation of Gynecology and Obstetrics stage III, histologic grade, lymphovascular space invasion, parametrial infiltration, and vaginal involvement as independent determinants of overall survival (all p<0.05). Adenomyosis status did not retain prognostic significance after adjustment (HR 0.91, p=0.818). Decision tree models corroborated these findings, with International Federation of Gynecology and Obstetrics stage and tumor size emerging as the most influential predictors of survival and recurrence.

Although adenomyosis was associated with shorter overall survival in univariate analysis, it did not function as an independent prognostic factor after adjustment for established clinicopathological variables in both multivariate Cox regression and machine-learning decision tree models. These findings indicate that prognostic stratification in cervical cancer should remain guided by tumor burden, stage, and histopathological risk factors.

This article analyzed the impact of Law No. 12,732/2012 on breast cancer care in São Paulo State (Brazil) between 2013 and 2024, as well as the role of external oversight.

This qualitative-quantitative study used 58,892 records from the São Paulo Oncocenter Foundation database and cases judged by the São Paulo State Court of Accounts.

The analysis revealed significant and persistent delays in diagnosis (31.3-66.8%) and treatment initiation (38-72%) across all Regional Health Directorates, although delays fluctuated over time, no consistent trend toward reduced delays was observed between the 2013-2024 period. The São Paulo State Court of Accounts, as an external oversight mechanism, focused on formal analyses rather than results-oriented evaluations, particularly regarding the identified delays.

Our findings led us to conclude that the 60-day Law has had a limited impact in ensuring timely access to breast cancer diagnosis and treatment in the state, as delays have remained high and have not consistently improved over time. It is recommended that external control strategically strengthen this public policy by inducing managerial accountability and ensuring the right to access and comprehensive care.