Compared to medulloblastoma (MB), atypical teratoid rhabdoid tumor (AT/RT) is characterized by a lower incidence, younger age at onset, and a poorer prognosis. Preoperative clinical and neuroimaging differentiation between these tumors remains challenging. This study aimed to evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in distinguishing AT/RT from MB in children.

We retrospectively included 32 patients with AT/RT and 82 patients with MB confirmed by surgery and pathology in our hospital between 2010 and 2023. We analyzed the clinical data, preoperative MRI characteristics, and apparent diffusion coefficient (ADC) values of these patients to evaluate their diagnostic value.

The overall survival time of AT/RT patients was significantly shorter than that of MB patients (P < 0.001), with a higher mortality rate (81.4% vs. 35.5%, P = 0.007). Significant differences were found between AT/RT and MB in T2WI signal, off-midline growth, supratentorial ventriculomegaly, cystic degeneration, hemorrhage, peritumoral edema, tumor boundary clarity, and metastasis/dissemination (P < 0.05). No significant differences were observed in gender, age, lesion size, T1WI signal, or enhancement pattern (P > 0.05). The mean ADC value differed significantly between the two groups (P < 0.001), with an optimal cut-off value of 0.622 × 10⁻³ mm²/s.

MRI features, including more cystic degeneration, hemorrhage, supratentorial ventriculomegaly, and peritumoral edema, combined with a lower ADC value may provide reliable information to differentiate AT/RT from MB in children.

Basal cell carcinoma (BCC) is characterized by slow growth and a low malignant potential. Recently, active surveillance (AS) has gained attention as an alternative management option for BCC patients. This study aimed to explore the experiences of patients and their proxies with AS.

An interview study was conducted involving 15 patients who previously chose AS for one or more BCC and 12 accompanying proxies. Patients from two hospitals (Radboud University Medical Center, Nijmegen, the Netherlands, and University Hospital Ghent, Belgium) were included.

Five themes emerged: reasons for choosing AS, experiences during AS, reasons for continuation or discontinuation, needs and barriers, and proxies' experiences. Overall, the experience with AS was positive, with minimal impact on daily life. Negative experiences included the follow-up burden and BCC symptoms. Patient's needs included clear communication about the nature of BCC and proactive discussion of AS by the healthcare provider. Impact on the proxies was limited, but they played a valuable supportive role in decision-making and follow-up.

The experiences of patients and proxies indicate that AS is a valuable option for BCC, particularly for older patients and/or patients experiencing cumulative treatment burden. The need for dermatologists to proactively discuss AS was highlighted.

Automated urinalysis offers rapid and efficient evaluation of urine sediment; however, most systems do not routinely report epithelial cell atypia. This study aimed to evaluate the clinical relevance of the atypical cell (Atyp.C) parameter generated by the Sysmex UF-4000 analyzer as an early indicator of suspected urothelial carcinoma.

A prospective study was conducted using the UF-4000 analyzer to detect Atyp.C in urine specimens from high-risk patients. Atyp.C results were collected simultaneously for all samples. Specimens with positive Atyp.C findings underwent urinary tract cytology, which was independently reviewed by board-certified cytopathologists and categorized into four diagnostic groups. Statistical analyses were performed using IBM SPSS version 21.

Among 332 specimens, 20 samples (6.02%) showed Atyp.C values > 0.0/μL. The mean Atyp.C value was 0.6/μL (95% CI 0.064-1.135) in males and 1.20/μL (95% CI 0.608- 1.791) in females, with no significant difference between sexes (p = 0.2549). Of the 20 Atyp.C-positive samples, 5 (25%) demonstrated abnormal cytology, including 2 cases of atypical urothelial cells, 1 case suspicious for high-grade malignancy, and 2 cases of confirmed high-grade urothelial carcinoma. Atyp.C values were significantly higher in abnormal compared with benign cytology (p < 0.01).

The Atyp.C parameter may have potential as an adjunctive screening marker for urothelial abnormalities; however, further validation studies are required.

Oxaliplatin-based chemotherapy is the standard adjuvant treatment for stage III colon cancer, but oral fluoropyrimidines remain widely used for patients unsuitable for combination therapy. Real-world data comparing these strategies are limited.

We conducted a retrospective cohort study of patients with stage III colon cancer who received adjuvant chemotherapy at Kaohsiung Veterans General Hospital (2017-2021). Using a 12-month landmark design, we compared disease-free survival (DFS) between patients receiving FOLFOX (IV-Only) versus oral fluoropyrimidines (PO-Only). The primary analysis used overlap-weighted restricted mean survival time (RMST) differences to quantify absolute treatment effects. Cox proportional hazards regression provided complementary hazard ratio estimates.

Of 157 patients included, 58 (36.9%) received FOLFOX and 99 (63.1%) received oral fluoropyrimidines. During median follow-up of 36 months, 22 DFS events occurred. The 3-year DFS was 93.1% versus 76.5% for IV-Only and PO-Only groups, respectively. The primary analysis showed that patients receiving FOLFOX had 4.0 additional months of disease-free time over 48 months (RMST difference: 4.0 months; 95% CI, 0.6-7.9; p = 0.014) and 2.4 months over 36 months (RMST difference: 2.4 months; 95% CI, 0.2-4.7; p = 0.024). The hazard ratio from overlap-weighted Cox regression with covariate adjustment was 0.37 (95% CI 0.09-1.45; p = 0.154), directionally consistent with the RMST findings but not reaching statistical significance. Hazard ratio estimates were directionally consistent across sensitivity analyses but varied in statistical significance, likely reflecting limited power: unadjusted (HR 0.23; p = 0.019), stabilized weighting with covariates (HR 0.19; p = 0.046), and multivariable adjustment (HR 0.44; p = 0.249).

In this real-world cohort, oral fluoropyrimidines were associated with 4.0 fewer months of disease-free time compared with FOLFOX at 48 months among patients for whom both treatment options were appropriate. As a single-center study with limited events, these findings should be confirmed in larger multicenter cohorts. The combination of RMST with overlap weighting provides an interpretable framework for comparative effectiveness questions where treatment selection is strong.

Genetic predisposition to hereditary breast and ovarian cancer and Lynch syndrome increases the risk of developing cancer, including epithelial ovarian cancer (EOC). Depending on the pathogenic variant, (e.g., BRCA1 or PMS2) the risk of developing EOC ranges from approximately 3%-60%. To reduce this risk, many individuals are offered risk-reducing salpingo-oophorectomy (RRSO), a procedure in which fallopian tubes and ovaries are removed. Some centers have dedicated programs that provide targeted care for individuals at risk of gynecologic cancers, such as the Hereditary Gynecology Clinic in Winnipeg, Manitoba. To better understand how individuals across a spectrum of risk values for developing EOC interpret their personal risk and make decisions regarding RRSO, we conducted a convergent mixed-methods study involving an online survey and virtual interview. Sixty-three surveys and twenty interviews were completed. Participants viewed objective risk information as a starting point, to which 'experiential knowledge' and perceived control were applied and integrated into their personal subjective risk assessment. Perceived risk was intertwined with cancer worry, and individuals made decisions regarding RRSO based on factors such as perceived risk, control, family planning, hormonal impacts, and recovery. Importantly, healthcare providers exerted both direct and indirect influences on the decision-making process.

[¹⁸F]FDG PET/CT-derived metabolic tumor volume (MTV) is a strong prognostic biomarker in patients undergoing liver transplantation (LT) for non-resectable colorectal liver metastases (nCRLM). This study aimed to evaluate whether MTV-based survival outcomes after LT for nCRLM differ between males and females. Patients who underwent LT for nCRLM between 2006 and 2022 were included (n = 45). Baseline characteristics were compared using the Mann-Whitney U test and Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and survival after relapse (SAR) were estimated using Kaplan-Meier analysis with the log-rank test. Cox regression analyses including sex, dichotomized MTV, and an interaction term between sex and MTV were performed. Female patients had significantly shorter OS compared with male patients (median 58 vs. 92 months, p = 0.047). Low MTV was associated with significantly longer OS, DFS and SAR in both sexes. Among patients with high MTV, females had significantly shorter OS than males (median 25 vs. 59 months, p < 0.001). Females had more non-pulmonary recurrences than males (p = 0.006) and shorter median SAR than males (17 vs. 46 months, p < 0.001) with high MTV. A significant interaction between sex and MTV was observed, indicating a particularly adverse prognostic impact of high MTV in female patients.

Air pollution exposure has been associated with increased lung cancer risk globally. However, evidence linking fine particulate matter with an aerodynamic diameter of ≤2.5 micrometers (PM_2.5) to adenocarcinoma, the most common histological subtype of lung cancer, using the real-world data remains limited in Southeast Asia populations where air pollution levels are rising. This study aimed to investigate the association between average daily PM_2.5 exposure and lung adenocarcinoma incidence in upper northern Thailand.

A population-based study was conducted across eight upper northern provinces (103 districts) of Thailand. Daily PM_2.5 exposure data were linked with lung adenocarcinoma incidence rates obtained from population-based cancer registries during 2013-2017 using patients' residential areas at the district level. Generalized estimating equations were employed to estimate adjusted incidence rate ratios (IRRs), adjusting for individual-level characteristics (gender and age <65 years) and geographical-level characteristics (urbanization and smoking prevalence).

Among 12,484 lung cancer cases, cell type was identified in 5,465 cases, of which 3,318 (60.7%) were lung adenocarcinoma, with a median age of 64 years (IQR: 57-71). A significant positive association was observed between 10 μg/m³ increment in average daily PM_2.5 exposure and lung adenocarcinoma incidence (adjusted IRR = 1.022, p = 0.013). Additional significant associations were found for female (aIRR = 1.126, p < 0.001), age <65 years (aIRR = 1.105, p < 0.001), and smoking prevalence in the patient's residing district (aIRR = 0.991, p = 0.001).

This finding highlights PM_2.5 as an important environmental risk factor for lung adenocarcinoma in the region, regardless of smoking prevalence. Our findings support the need for targeted air pollution control policies to reduce incidence of related cancers.

Lymph node metastasis is the most prevalent form of spread in thyroid cancer, with surgical intervention and prophylactic cervical lymph node dissection being the standard treatments. However, there remains a lack of effective methods for predicting lymph node metastasis in clinical practice. The study enrolled patients who were admitted to the Department of Thyroid and Neck Oncology at Tianjin Medical University Cancer Hospital between October 2021 and March 2022, as well as from February to April 2024. Variables collected included basic patient information, laboratory tests, and pathological data. Additionally, we focused on investigating the impact of emotional problems on lymph node metastasis. Subsequently, variable selection was performed using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. A nomogram was then constructed for predicting lymph node metastasis, with model performance assessed using calibration curves, decision curves and other methods. In this study, a total of 484 cases were ultimately included, and the variables were screened using LASSO regression. Subsequently, nine variables were utilized to construct a nomogram. For model training purposes, 85% of the data was randomly selected as the training set and the prediction efficiency was verified using ROC curve analysis. The AUC index for both the training set (0.8045) and verification set (0.8146) were obtained along with calibration curve and decision curve plots. This study developed a nomogram to predict lymph node metastasis in papillary thyroid cancer. This model demonstrates exceptional discrimination and calibration, providing invaluable assistance for clinical decision-making processes.

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening-rather than actual costs-remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions. Optimizing cervical cancer prevention requires attention not only to initial screening uptake but also to completion of the full screening continuum, including timely follow-up after abnormal results. Recent policy developments-including the US Supreme Court affirmation of the ACA preventive services mandate, elimination of cost-sharing for patient navigation beginning in 2026, expansion of coverage for diagnostic follow-up starting in 2027 for insured individuals, and endorsement of self-collected human papillomavirus testing-create an unprecedented opportunity to reduce financial and logistic barriers to completion of cervical cancer screening. However, realizing the population-level and equity benefits of these advances will require deliberate implementation strategies that emphasize transparent communication about patient out-of-pocket costs, integration of navigation services, and follow-up pathways. See related article by Isaacson et al., p. 1158.

Chemoprevention for gastric cancer remains underdeveloped despite a well-defined premalignant window and a substantial burden in high-risk populations. Two phase IIa trials conducted in Puerto Rico and Honduras evaluated curcuminoids and eflornithine in patients with gastric premalignant conditions. Curcuminoids reduced IL1β, whereas eflornithine showed a possible delayed reduction in pH2AX-defined DNA damage. Both agents were generally well tolerated, although hearing-related adverse events were more frequent in eflornithine. Together, these studies support the feasibility of mechanism-based chemoprevention for gastric cancer while highlighting key challenges in patient selection, surrogate endpoint validation, long-term safety, and, critically, the demonstration of durable cancer prevention beyond short-term biomarker modulation. See related article by Morgan et al., p. 391 See related article by Gonzalez-Pons et al., p. 403.