BMC Cancer

PurposeCancer cachexia is a life-threatening complication of advanced malignancies, driven by anorexia and profound systemic metabolic reprogramming. Insulin action in skeletal muscle is markedly impaired in patients with cancer and may contribute directly to cachexia pathogenesis. However, the interplay between reduced nutrient intake and cancer-associated metabolic rewiring in cachexia remains poorly defined. Clarifying this relationship is essential for identifying the fundamental drivers of cachexia and for developing effective therapeutic strategies. MethodsWe assessed metabolic rewiring by glucose tolerance test and isotopic tracers to determine muscle insulin-stimulated glucose uptake in male cachectic and non-cachectic C26- and KPC-tumor-bearing, as well as mice towards C26 cachectic mice. ResultsCachectic C26-tumor-bearing mice displayed reduced body weight, lean, and fat mass, and food intake (-20%, -15%, -75%, -40%, respectively). Cachectic C26- and KPC-tumor mice showed improved glucose tolerance compared to non-cachectic mice, correlating inversely with tumor size. Ex vivo insulin-stimulated glucose uptake was elevated in soleus (+78%) and extensor digitorum longus (+35%) muscle from cachectic C26-cancer mice compared to non-cachectic and control mice. This increase was associated with enhanced AKT signaling. This was phenocopied in pair-fed non-tumor-bearing mice to match the food intake of cachectic mice, where glucose tolerance, insulin-stimulated glucose uptake ex vivo, and AKT signaling were all enhanced by food restriction. ConclusionsOur findings suggest that enhanced skeletal muscle insulin responsiveness in cachectic tumor-bearing mice is due to anorexia-induced adaptations, highlighting AKT signaling as a key node connecting nutrient status to muscle glucose metabolism in cancer cachexia. HighlightsO_LIC26 and KPC cancer-induced weight loss (cachexia) increases glucose tolerance in mice C_LIO_LIInsulin responsiveness is increased in cachectic, but not in non-cachectic, tumor-bearing mice. C_LIO_LILowered food intake drives elevated muscle insulin responsiveness in cachectic mice C_LI

Background: Rectal cancer (RC) is traditionally grouped within colorectal cancer (CRC), despite growing evidence of distinct epidemiologic features. However, global comparative assessments of lifetime risks of RC relative to CRC remain limited. We aimed to estimate lifetime risks of developing and dying from RC and CRC worldwide and to examine geographic, socioeconomic, and temporal variations in the proportional contribution of RC within CRC. Methods: Age-specific incidence and mortality estimates for RC and CRC across 185 countries were obtained from GLOBOCAN 2022, together with population and all-cause mortality data from the United Nations. Lifetime risks of incidence (LRI) and mortality (LRM) were calculated using the adjusted-for-multiple-primaries (AMP) method by sex, country, region, and Human Development Index (HDI). The RC-to-CRC lifetime risk ratio quantified the proportional contribution of RC. Temporal trends were assessed in 42 countries using Cancer Incidence in Five Continents Plus (CI5plus) data and average annual percent change (AAPC). Results: In 2022, the global lifetime risk of developing RC was 1.61% and dying from RC was 0.95%, accounting for approximately 35% of the corresponding CRC lifetime burden (4.61% and 2.68%). Absolute lifetime risks of both RC and CRC increased with HDI. In contrast, the proportional contribution of RC varied markedly, peaking at 41%-43% in Central and South-Eastern Asia but falling below 20% in the Caribbean and Central America, and showed a negative association with HDI. The LRI/LRM ratio increased with socioeconomic development. Temporal analyses showed increasing LRI trends in 17 of 42 countries for CRC versus 9 for RC, while declines occurred in 14 countries for RC and 11 for CRC. Conclusions: RC constitutes a substantial yet epidemiologically distinct component of the global CRC burden. Its proportional contribution varies across regions and does not parallel absolute risk patterns, supporting the need for subsite-specific surveillance and prevention strategies.

Background: The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on nutrition for cancer patients provides evidence based dietary recommendations that is routinely deployed by dieticians in oncology settings. Although these can be culturally adapted, they do not adequately address inter individual variability in treatment related gastrointestinal symptoms and appetite, issues that increase malnutrition risk in cancer patients. Ayurveda, on the other hand, lacks nutrient based guidelines but offers a well grounded dietary framework to assess digestive function and personalise diets. This study investigated the feasibility of combining the two approaches in a clinical setting. Methods: Consenting adult cancer patients diagnosed with any type and stage of cancer were recruited. At baseline, digestive strength, dietary intake, quality and frequency and Patient Generated Subjective Global Assessment (PGSGA) score were recorded. Based on this, personalised meal plans (MPs) that combine nutrient guidelines from ESPEN and traditional food concepts to support digestive strength were provided to participants. Follow ups ranged from 4 weeks to 6 months, at which digestive strength and PGSGA was noted. To evaluate against a benchmark, meal plans were theoretically constructed using Ayurveda concepts (traditional MP) or ESPEN guidelines (Standard MP) alone. Results: Data is presented for 33 participants, of which 52% had weak digestive strength. Baseline intake averaged 879 kcal/day, well below the recommended 1400 to 1600 kcal/ day level. Traditional MPs improved energy intake but were protein insufficient, aspects that were addressed in the standard MPs. Diet quantity (1417 kcal/day), quality and frequency improved on the integrated MP, with 3 patients achieving optimal digestive strength. Personalised counselling reduced malnutrition risk, as reported by PGSGA score. Conclusion: Customising dietary advice by overlaying nutrient guidelines with Ayurveda dietary concepts is feasible. The evaluation of digestive strength holds promise for personalising nutrition therapy. Trial Registration: CTRI/2023/07/055657

BackgroundPancreatic ductal adenocarcinoma is one of the most aggressive and lethal malignancies of the gastrointestinal tract. The poor prognosis is largely attributed to late-stage diagnosis, pronounced tumor heterogeneity, and limited therapeutic efficacy. These challenges underscore the urgent need for the identification of robust molecular biomarkers and novel therapeutic targets. MethodsGene expression data from a total of 146 pancreatic tissue samples, comprising 72 normal and 74 tumor specimens obtained from the Pan-Cancer Atlas(TCGA) were analyzed. Differential gene expression analysis was conducted using the DESeq2 package, followed by functional enrichment analysis based on GO and KEGG. A classification model was developed using the XGBoost algorithm and evaluated through 500 bootstrapping iterations and 5-fold cross-validation to ensure robustness and generalizability. Model interpretability was assessed using SHAP (SHapley Additive exPlanations) values to identify genes with the highest predictive contribution. ResultsA comprehensive transcriptomic analysis revealed significant dysregulation of multiple genes between normal and tumor pancreatic tissues. Genes such as GJB3, S100A2, MSLN, and SLC2A1 were notably overexpressed, whereas DEFA6, APOB, and RBP2 exhibited marked downregulation, indicative of impaired exocrine function and aberrant epithelial reprogramming. The XGBoost classification model achieved an average area under the curve (AUC) of 0.9868 and an overall accuracy of 98.6%. SHAP (SHapley Additive exPlanations) analysis identified GJB3, LINC02086, and TSPAN1 as key predictive features. Six genes were concurrently identified as differentially expressed and highly influential within the model, supporting their potential utility as robust biomarkers for pancreatic tumor characterization. ConclusionsPancreatic ductal adenocarcinoma is marked by extensive transcriptomic reprogramming. The integration of differential gene expression analysis with interpretable machine learning enabled the identification of a molecular signature with potential diagnostic and therapeutic relevance.

PurposePancreatic ductal adenocarcinoma (PDAC) is characterized by a nutrient-deprived and hypoxic tumor microenvironment (TME) that imposes severe metabolic stress on cancer cells. Under these conditions, tumor cells frequently activate the integrated stress response (ISR) to adapt to TME and develop resistance to therapies. However, how TME components support tumor adaptation to mitochondrial metabolic stress remains incompletely understood. Here, we aimed to identify key metabolite involved in ISR adaptation under oxidative phosphorylation (OXPHOS) inhibition and to elucidate the metabolic symbiosis between cancer-associated fibroblasts (CAFs) and PDAC cells. MethodsWe integrated transcriptomic and metabolomic analyses with functional assays. ISR activation was evaluated by assessing the phosphorylation of eIF2 (p-eIF2) following treatment with carboxyamidotriazole orotate (CTO), an Complex I inhibitor. Metabolomic profiling was used to identify metabolites involved in ISR activation alleviation. Mouse models were used to assess therapeutic responses following depletion of the identified metabolite under CTO treatment. Genetic perturbation of Slc38a4 was performed to assess its functional role in tumor cell adaptation to metabolic stress. ResultsWe identified asparagine (ASN) as a critical metabolite supplied by CAFs to PDAC cells under OXPHOS inhibition. A minimum level of ASN is required for PDAC cells to execute ISR downstream adaptation. ASN depletion significantly enhanced the anti-tumor efficacy of OXPHOS inhibition both in vitro and in vivo. SLC38A4 emerged as a potential mediator of this interaction. SLC38A4 expression was associated with c-Myc, and its loss increased the sensitivity of PDAC cells to CTO-induced metabolic stress. ConclusionOur findings reveal a CAF-tumor metabolic crosstalk in which stromal-derived ASN supports PDAC cell adaptation to mitochondrial metabolic stress. Adaptive outcome of ISR signaling depends on the availability of key metabolic substrates such as ASN. When extracellular ASN supply is limited, the ATF4-dependent adaptive program collapses, converting ISR from a pro-survival response into a therapeutic vulnerability. SLC38A4 may function as a key mediator of this metabolic coupling and represents a potential target for enhancing the efficacy of OXPHOS inhibition in PDAC.

BackgroundDespite extensive characterization of key oncogenic drivers, pancreatic ductal adenocarcinoma (PDAC) continues to exhibit profound molecular heterogeneity and inconsistent responses to standard therapies, including gemcitabine. The role of pathway-level alterations, particularly in the context of age at onset and therapeutic exposure, remains insufficiently defined. MethodsIn this study, we leveraged a conversational artificial intelligence framework (AI-HOPE-TP53 and AI-HOPE-PI3K) to enable precision oncology, driven interrogation of clinical and genomic data from 184 PDAC tumors, stratified by age at diagnosis and gemcitabine exposure. Using AI-enabled cohort construction and pathway-centric analyses, we evaluated alterations in TP53 and PI3K signaling networks, with findings validated through conventional statistical methods. ResultsTP53 pathway analysis revealed a significantly higher frequency of TP53 mutations in early-onset compared to late-onset PDAC among gemcitabine-treated patients (86.7% vs. 57.1%, p = 0.04), with a similar trend observed between treated and untreated early-onset cases (86.7% vs. 40%, p = 0.07). Notably, in late-onset PDAC patients not treated with gemcitabine, absence of TP53 pathway alterations was associated with improved overall survival (p = 0.011). Complementary analyses of the PI3K pathway demonstrated a higher prevalence of pathway alterations in late-onset gemcitabine-treated tumors compared to untreated counterparts (13.2% vs. 2.7%, p = 0.02). Importantly, among late-onset patients not receiving gemcitabine, those without PI3K pathway alterations exhibited significantly improved overall survival (p < 0.0001). ConclusionTogether, these findings identify distinct TP53 and PI3K pathway dependencies that are modulated by both age-of-onset and treatment exposure in PDAC. This work highlights the utility of conversational artificial intelligence in enabling rapid, integrative, and hypothesis-generating analyses within a precision oncology framework, supporting the identification of clinically relevant molecular stratification strategies for this aggressive disease.

BackgroundQuality-of-life (QoL) assessment is essential in breast cancer care, yet limited evidence describes how interrelated QoL domains change during pharmacotherapy. This study aimed to evaluate correlations among functional and symptom scales using the EORTC QLQ-C30 and QLQ-BR23, highlighting their ability to reveal multidimensional QoL patterns. MethodsA prospective observational study was conducted in two second-referral hospitals in Indonesia, enrolling 106 female breast cancer patients. QoL was assessed before and after pharmacotherapy using QLQ-C30 and QLQ-BR23. Changes in scores ({Delta}) were computed, and interdomain relationships were analyzed using Spearmans rho. ResultsPhysical functioning correlated with role functioning ({rho} = 0.55, p <0.001), emotial functioning ({rho} = 0.33, p <0.001), and social functioning ({rho} = 0.31, p = 0.002). Role and social functioning were likewise correlated ({rho} = 0.32, p = 0.001), indicating that improvements across functional domains tended to occur in parallel. Symptom scales showed strong positive clustering, including fatigue with pain ({rho} = 0.37, p <0.001), insomnia ({rho} = 0.35, p <0.001), and systemic side effects ({rho} = 0.48, p <0.001). Functional and symptom domains generally exhibited inverse relationships: physical functioning negatively correlated with fatigue ({rho} = -0.40), pain ({rho} = -0.43), both p <0.001, and systemic side effects ({rho} = -0.26; p = 0.01). ConclusionThe QLQ-C30 and QLQ-BR23 instruments effectively captured structured, clinically meaningful interdependencies. Functional improvements consistently aligned with symptom reductions, revealing coherent functional-symptom clustering. These findings underscore the sensitivity of QoL instruments to detect multidimensional patient-reported changes during breast cancer pharmacotherapy.

Purpose In resource-limited settings, locally advanced rectal cancer (LARC) often presents at advanced stages. Long-course chemoradiotherapy (LCCRT) remains a cornerstone of neoadjuvant therapy, yet outcome data from such settings remain limited. This study assessed tumor resectability, pathologic response, and factors associated with resectability following neoadjuvant LCCRT at Ethiopias largest tertiary oncology center. Methods A retrospective cohort study was conducted among patients with stage II-III rectal adenocarcinoma (cT3-4 and/or cN+) who completed neoadjuvant LCCRT at Tikur Anbessa Specialized Hospital between 2018 and 2023. Tumor resectability was determined by multidisciplinary team (MDT) assessment. Multivariable logistic regression was used to identify factors associated with post-LCCRT resectability, adjusting for initial T stage, circumferential resection margin (CRM) status, histologic subtype, radiotherapy technique, and neoadjuvant regimen. Results Among 58 eligible patients (median age 45 years; 62% male), 62% had cT4 tumors, 53% had cN2 disease, and 84.5% had involved CRM. The median diagnosis-to-LCCRT interval was 64 weeks (interquartile range [IQR], 37-82). After LCCRT, 27 patients (46.6%) were deemed resectable by MDT assessment; 19 patients (32.8%) ultimately underwent curative-intent surgery (median interval from LCCRT to surgery, 10 weeks; IQR, 7-15). Initial cT3 stage was associated with higher odds of resectability (adjusted odds ratio [AOR], 6.2; 95% CI, 1.06-36.37), whereas receipt of total neoadjuvant therapy was associated with lower odds (AOR, 0.10; 95% CI, 0.02-0.49). No pathologic complete responses were observed. Conclusion In this cohort characterized by advanced disease at presentation and treatment delays, neoadjuvant LCCRT resulted in low resectability and limited pathologic response. To enhance curative potential, concerted efforts are needed to expedite the timely initiation of radiotherapy, optimize multidisciplinary team assessment, and increase surgical capacity.

Background and ObjectivesIntramedullary spinal cord tumors (IMSCTs) are rare, and the extent of surgical resection may influence overall survival (OS). Gross total resection (GTR) may offer superior outcomes compared to subtotal resection (STR) or biopsy. Our study seeks to quantify the benefits of resection extent on OS in patients with spinal gliomas (SGs). MethodsA systematic review was conducted using the following databases: Scopus, Embase, and PubMed. Studies reporting OS in patients who underwent GTR, STR, or biopsy for low- or high-grade SG. We used a random-effects model to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs); this was performed separately for low-grade (WHO grade I-II) and high-grade (III-IV) SGs. Subgroup analysis was performed for radiotherapy. I2 statistic and Cochrans Q tests evaluated study heterogeneity, Eggers and funnel plot asymmetry tests assessed publication bias, and Risk Of Bias In Non-randomized Studies of Exposure (ROBINS-E) evaluated individual study bias. ResultsIn a pooled analysis of 5 studies, GTR was not associated with improvement in OS compared to STR or biopsy in high grade SGs (HR=0.48, 95% CI: 0.19 -1.26). However, low-grade SGs revealed significant benefit in overall survival with GTR (HR=0.27, 95% CI: 0.15-0.46). Patients treated with radiotherapy were associated with worse outcomes following GTR in low-grade SGs (HR=1.48, 95% CI: 1.30-1.69) but no survival differences in high-grade SGs (HR=1.21, 95% CI: 0.52-2.83). ROBINS-E determined only 1 study with high risk of bias. ConclusionGTR for intramedullary spinal gliomas may not confer a significant benefit in overall survival for high-grade lesions but may provide benefit in lower grades. Radiotherapy confers a worse survival in lower-grade tumors, potentially due to their infiltrative nature. Future studies should stratify outcomes based on tumor biology, as well as follow functional outcomes overtime.

BackgroundFamily history of cancer is a well-established risk factor for several malignancies, including colorectal, breast, and ovarian cancers. Estimating the prevalence of familial cancer history is essential for identifying high-risk populations and guiding targeted prevention strategies. ObjectiveThis study aimed to estimate the prevalence of family history of colorectal, breast, and ovarian cancer among residents of Derna City, Libya. MethodsA cross-sectional survey was conducted among 300 participants aged 17-45 years, selected using stratified random sampling. Data were collected through structured questionnaires covering sociodemographic characteristics and family history of cancer. Descriptive statistical analyses were performed to estimate prevalence rates. ResultsThe mean age of participants was 24.65 {+/-} 4.70 years, with the majority under 25 years of age (67.3%). Females constituted 79.9% of the sample, and most participants had a university-level education (93.5%). A family history of breast cancer was reported by 30.0% of participants, followed by colorectal cancer (23.3%) and ovarian cancer (13.3%). These findings indicate a substantial proportion of individuals with potential genetic susceptibility to these cancers within the study population. ConclusionA notable prevalence of family history of colorectal, breast, and ovarian cancers was observed in Derna City. These results underscore the importance of incorporating family history assessment into routine healthcare practice and strengthening genetic counseling, screening, and public awareness programs. Targeted prevention strategies may help reduce the burden of hereditary cancers in this region.

BackgroundPancreatic cancer is a leading cause of cancer mortality, and early recognition is challenging. To achieve early diagnosis using symptoms alone, we examined patterns across different stages using network analysis to derive clinically useful insights. MethodsSymptom variables from a de-identified dataset of 50,000 pancreatic cancer patients were analyzed. Stratification by stage was done, followed by bootstrap resampling to address imbalances across strata. Symptom networks were then constructed with nodes representing symptoms and edges representing conditional dependencies estimated via an Ising-style neighborhood selection approach implemented through L1-regularized logistic regression. Strength, betweenness, and closeness centrality indices were then calculated, and their stability was analyzed using the case-dropping bootstrap. Network comparison tests were done, and difference networks were analyzed. Spring-layout algorithm was used for visualization, with node size being the predictability (pseudo-R{superscript 2}), and the edge weight being the mean partial correlation magnitude. ResultsOn average, symptoms were present in about one out of four patients (M = 0.26). Weight loss and abdominal discomfort were the most prevalent of the symptoms, followed by jaundice and back pain. Network structures became sparser across stages with a decreasing number of edges and centrality indices. Jaundice emerged as the dominant hub in Stage I, but shared dominance with Weight Loss in Stage II. Node predictability (pseudo-R2) was effectively zero across all disease stages. ConclusionOur network analysis of pancreatic cancer symptomatology across stages revealed distinct patterns that may improve understanding of its clinical presentation and support earlier recognition.

The Receptor for Advanced Glycation End-products (RAGE) has been implicated in driving cancer growth, aggression, and metastasis through the fueling of chronic inflammation in the tumor microenvironment. This systematic review and meta-analysis summarize and analyze current clinical and preclinical data to provide insight into the relationship between RAGE and cancer, cancer grade, metastasis, patient survival, and cellular processes. A multi-database search was performed to identify original clinical and preclinical research studies examining RAGE expression in cancer. After screening and review, 53 clinical and 233 preclinical studies were included. Associations of RAGE with clinical cancer outcomes were estimated using odds ratio (OR) and associated 95% confidence intervals (CI). The meta-analysis found that RAGE expression was highly correlated with cancerous tissue when compared to controls; high-grade tumors; regional lymph node invasion; and was somewhat negatively associated with patient survival. In addition, meta-analysis estimates of preclinical studies found positive associations between RAGE expression/activation and cancer growth, metastatic potential, evasion of apoptosis, and activated NF-{kappa}B expression. This systematic review and meta-analysis is the first comprehensive study through which both preclinical and clinical research in all available cancer types are assessed for correlations with RAGE expression and activation, demonstrating that RAGE does indeed play a significant role in cancer progression and that further research is warranted.

BackgroundLeptomeningeal disease (LMD) is a serious complication of metastatic breast cancer (MBC) with poor survival. This single-institution retrospective study compares overall survival (OS) among MBC patients with LMD based on CSF parameters (glucose, protein, and WBC count) MethodologyMBC patients who were diagnosed with LMD between 2010-2023 at Wilmot Cancer Institute were screened for eligibility. Only those with available data on CSF glucose, protein, and WBC count were included. OS was assessed via the Kaplan-Meier method and compared using the log-rank test. Cox models were used for multivariate analysis. ResultsOut of 69 patients with MBC LMD, 28 had CSF data and were included in the final analysis. The CSF cytology-positive cohort had significantly lower glucose levels vs the CSF cytology-negative cohort [median (IQR) 40 (18-58) vs 64 (53-92) mg/dl, p=0.006]. Median CSF WBC count was significantly higher in the CSF cytology positive cohort vs the CSF cytology negative cohort [median (IQR) 13 (6-44) vs. 2(2-4)cells/mm3, p=0.001]. When stratified by CSF cytology results and CSF glucose levels, the CSF cytology negative, glucose-low group was associated with the worst OS, while the CSF cytology negative, normal/high glucose group was associated with the best OS(p=0.03) in an unadjusted analysis. Multivariate analysis confirmed that low CSF glucose was independently associated with poorer survival [HR 4.64 (1.71, 13.2)]. Neither CSF protein levels nor CSF WBC counts were significantly associated with OS in unadjusted and multivariate analyses. ConclusionLow CSF glucose was associated with worse OS than normal/high CSF glucose. There was insufficient evidence to suggest that CSF protein or CSF WBC counts were associated with OS.

Triple-negative breast cancer (TNBC) is an aggressive subtype that lacks effective targeted therapies. This study aimed to identify robust prognostic biomarkers by integrating network biology with machine learning (ML) approaches. TNBC expression cohorts were analysed to identify differentially expressed genes (DEGs) and crucial gene clusters via limma and Weighted Gene Co-expression Network Analysis (WGCNA). In results, 579 DEGs were identified, and network analysis revealed two TNBC-associated modules. Overlapping determined 208 genes enriched in cell-cycle and mitotic-regulation pathways. To identify candidate biomarkers, protein-protein interaction (PPI) networks and ML feature selection techniques, including support vector machine with recursive feature elimination module (SVM-RFE) and least absolute shrinkage and selection operator (LASSO) regression, were performed. The Kaplan-Meier (KM) analysis revealed AASS and CCNA2 were favourable prognostic markers, whereas CXCL8, SPP1, and CCNB1 were poor prognostic markers. Multi-level validation and immune-subtype analysis were carried out, revealing AASS as a novel TNBC-associated metabolic tumour suppressor.

The TGIF1 transcription factor gene is present on chromosome 18, which is subject to whole chromosome copy number reduction in colon cancer. Despite this, TGIF1 expression is significantly higher in cancer than in normal. In mice complete deletion of Tgif1 reduced tumor burden in an Apc mutant model of intestinal cancer. Here we show that reducing TGIF1 expression in a human colon cancer cell line slows proliferation and reduces growth of orthotopic xenografts. To ask if additional genes with copy number loss are more highly expressed in tumors we identified chromosomal regions subject to copy number reductions from ten TCGA cancer datasets. Within these regions a small proportion of genes, generally less than 10%, are expressed at higher levels in the tumor than in corresponding normal samples. Enrichment analysis using a set of 435 genes that have copy number reduction and increased expression identified mitosis as the most enriched gene set and FOXM1 and E2F family transcription factors as potential regulators. For mitotic genes, the average expression increase in tumor compared to normal is independent of copy number. In contrast, while DepMap common essential genes are generally more highly expressed in cancer than normal tissue, the relative increase in expression tracks well with copy number. Similarly, expression differences for gene sets such as S-phase, rRNA processing and DNA repair show increased expression in cancer versus normal, but changes also track with copy number. Thus, genes with increased expression despite copy number reduction may represent the output of key pro-tumorigenic transcriptional programs and could be potential therapeutic targets.

Background: The tumor suppressor gene TP53 and the oncogene KRAS are among the most frequently altered core drivers in human malignancies. Although they cooperatively regulate critical biological processes, the prognostic impact of their co alterations remains poorly defined and exhibits striking inconsistency across different cancer types. Methods: We comprehensively analyzed genomic and clinical data from multi-cancer cohorts sourced from the cBioPortal database and The Cancer Genome Atlas (TCGA). Genetic alterations, including sequence variations and copy number alterations (CNAs), were classified for TP53 and KRAS. Patients were stratified into four subgroups based on individual or combined alteration status. Survival analyses were performed using Kaplan-Meier methods. Integrated multi-omics analyses were conducted to assess the relationship between genetic alterations and mRNA/protein expression, and to characterize co-occurring genetic events and their prognostic implications. Results: Patients harboring concurrent TP53 and KRAS alterations exhibited significantly shorter overall survival in pancreatic cancer, colorectal cancer, and ampullary carcinoma, but surprisingly demonstrated the longest survival in gastric cancer. Distinct KRAS mutation subtype distributions were observed across cancer types: G12D/G12V predominated in pancreatic and colorectal cancers, G12C in non small cell lung cancer, and G13D in gastric cancer, with copy number alterations representing a substantial proportion of KRAS alterations in gastric and lung cancers. Multi-omics analysis revealed a lack of concordance between genetic alterations and mRNA/protein expression, indicating that mutation status alone does not reliably reflect downstream molecular changes. Concurrent genetic events displayed striking cancer-type specificity: CDKN2A alterations frequently co-occurred with TP53/KRAS double alterations in pancreatic cancer and were associated with worse prognosis, whereas APC mutations co-occurred in colorectal cancer and correlated with improved survival. Integrated analysis further demonstrated that KRASaltered/TP53altered patients were highly enriched in pancreatic, colorectal, and lung cancers, each exhibiting unique background genomic landscapes. Conclusions: The prognostic significance of TP53 and KRAS alterations is profoundly cancer-type specific, driven by differences in mutation subtype distribution, copy number alteration patterns, co-occurring genetic events, and the discordance between genotype and functional expression. These findings challenge the simplistic view of dual-gene alterations as universal markers of poor prognosis and underscore the necessity of incorporating cancer-specific molecular contexts into prognostic models and precision oncology strategies.

BackgroundPrecision oncology is predominantly focused on nuclear genomic alterations, while mitochondrial DNA (mtDNA) variation remains largely excluded from routine pharmacogenomic testing. However, mitochondria regulate oxidative phosphorylation (OXPHOS), reactive oxygen species (ROS) production, apoptosis, and metabolic reprogramming pathways central to chemotherapy response. Methods468 Complete mitochondrial genomes from Kenyan individuals representing diverse ethnolinguistic groups were analyzed. Seven variants associated with effect on cancer treatment were identified. These include; m.310T>C(D-loop), m.10398A>G (MT-ND3), m.13708G>A (MT-ND5), m.16189T>C, m.13928G>C, m9055G>A and m.16519T>C (D-loop). Allele frequencies and distribution were assessed. ResultsThe coding-region variants (m.10398A>G and m.13708G>A) occur in Complex I subunits and are associated with altered oxidative phosphorylation efficiency and ROS production. The control-region variants (m.16189T>C and m.16519T>C) influence mtDNA replication and copy number. These variants have been implicated in differential response to chemotherapeutic agents including platinum-based therapies and anthracyclines. m.13928G>C sits in the MT-CYB gene and could possibly affect mitochondrial respiratory function; this variant could influence how tumors respond to therapies that rely on apoptosis or ROS generation.m.9055G>A is a MT-ATP6 variant classified as benign in mitochondrial disease but may represent a marker of haplogroup background rather than a direct cancer driver. While m.310T>C itself does not encode a protein, its location in the regulatory D-loop influences mitochondrial function, which can affect how tumor cells respond to chemotherapies that rely on mitochondrial-mediated apoptosis or oxidative stress. ConclusionPharmacogenomics relevant mitochondrial variants are present in the Kenyan population. With the rise of cancer burden in Kenya there is a need carry out more studies to understand the impact of these variations on cancer treatment. This can inform the integration of mtDNA analysis into precision oncology strategies in African populations.

This study aimed to evaluate the prognostic value of quantitative analysis of {superscript 1}F-FDG positron emission tomography (PET)/computed tomography (CT) metabolic parameters in patients with pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemotherapy (NACT). A retrospective analysis was conducted on the clinical and imaging data of 44 patients with pathologically confirmed PDAC who received NACT. All patients completed standard chemotherapy regimens and underwent {superscript 1}F-FDG PET/CT examinations within 2 weeks before and after chemotherapy. Multiple metabolic parameters of lesions were extracted, their percentage changes were calculated, and the optimal cut-off values for each parameter were determined. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were applied to explore the prognostic value of the metabolic parameters, and the prognostic stratification performance of PET Response Criteria in Solid Tumors (PERCIST) 1.0 was compared with that of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. PERCIST 1.0 demonstrated significantly superior prognostic stratification compared with RECIST 1.1. A peak standardized uptake value corrected for lean body mass (SULpeak2) > 3.07 and a percentage change in SULpeak between pre- and post-treatment scans ({Delta}SULpeak%) [&le;] 37.66% were identified as independent risk factors for poor prognosis. Furthermore, SUL-related parameters exhibited markedly better predictive efficacy than traditional metabolic parameters such as the standardized uptake value and metabolic tumor volume. Quantitative analysis of {superscript 1}F-FDG PET/CT metabolic parameters can effectively predict prognosis in PDAC after NACT, and PERCIST 1.0 is a more optimal criterion for efficacy and prognostic assessment. A post-NACT SULpeak > 3.07 and {Delta}SULpeak% [&le;] 37.66% were core independent indicators for predicting poor prognosis in these patients.

IntroductionColorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide, despite advances in conventional oncological therapies. In recent years, various studies have made advances in integrative oncology, such as investigating the use of Chinese Herbal Medicine (CHM) as a complementary therapy alongside conventional oncological therapies to alleviate treatment-related adverse effects, improve quality of life, and potentially enhance therapeutic outcomes. Despite this, clinical practice in this area remains highly heterogeneous, with limited standardized guidelines on key areas of concern such as (1) optimal intervention, (2) recommended stage and duration of intervention, (3) safety considerations, and (4) possible herb-drug interactions. Hence, this study aims to establish expert consensus on the usage of CHM as a complementary therapy in the management of CRC, to support safe, consistent, and evidence-informed clinical practice. Methods and AnalysisWe will employ a modified Delphi technique to achieve consensus amongst a panel of international experts in various fields related to integrative oncology. Prior to the study, a list of questionnaire items was developed based on a systematic review of existing clinical practice guidelines on CRC. An international panel will be invited based on established international profile in integrative oncology research and clinical practice, and by peer referral. Two rounds of Delphi will be conducted using anonymous online questionnaires. Consensus will be considered reached if at least 50% of the panel strongly agree/disagree that an item should be included or excluded while strong consensus will be set at 76%. Items which achieve strong consensus after Round 1 will be removed, before being sent out for Round 2 with a summary of Round 1 responses for a final consensus. Ethics and DisseminationEthics approval has been obtained from the Institutional Review Board of Nanyang Technological University (IRB-2025-1222). Our findings will be disseminated through peer-reviewed publications and conference presentations. Strengths and limitations of this studyO_LIThis study will develop an expert consensus which aims to guide future integration of Chinese Herbal Medicine (CHM) as a complementary therapy into colorectal cancer (CRC) management. C_LIO_LIKey concerns in areas such as determining the (1) optimal intervention, (2) recommended stage and duration of intervention, (3) safety considerations, and (4) possible herb-drug interactions, thereby laying the groundwork for potential future incorporation of CHM into CRC treatment protocols alongside conventional oncology approaches has been identified, thus limiting implementation in clinical practice. C_LIO_LIDesigning a study e-guide, followed by the consensus rounds study online will facilitate participants responses and the dissemination of information from previous rounds. C_LI

BackgroundMetastasis significantly contributes to cancer-related mortality and therapeutic failure. Cancer cells acquire metastatic potential by losing epithelial characteristics and gaining mesenchymal properties through the epithelial-mesenchymal transition (EMT). Differential poly(A) site (PAS) usage, known as alternative polyadenylation (APA), generates mRNA isoforms differing in coding sequence, subcellular localization, stability, or translation efficiency. In cancer, 3'UTR shortening increases expression of proto-oncogenes by escaping miRNA-mediated repression. High expression of CPSF73, which cleaves mRNA precursors at PASs, is associated with unfavorable prognoses in cancer patients. However, the role of APA in regulating EMT remains poorly understood. MethodsIn this study, to investigate the role of APA in EMT, we employed JTE-607, a small-molecule inhibitor of CPSF73 activity, to examine the impact of catalytic inhibition of CPSF73 on proliferation and EMT in MDA-MB-231, MCF7, A549, and HepG2 cancer cells. To identify differential usage of PASs, global profiling of APA changes, and differential gene expression analysis were performed in MDA-MB-231 cells. Additionally, antisense oligonucleotides were used to block the use of a specific PAS whose APA change may be a driver of EMT reversal. ResultsOur findings showed that catalytic inhibition of CPSF73 not only attenuates cancer cell proliferation but also moves the cells away from the mesenchymal state across all four cell lines tested. Global profiling of APA changes following CPSF73 inhibition revealed widespread 3'UTR lengthening and suppression of intronic PASs in MDA-MB-231 cells. APA shifts were observed in key EMT-related genes, accompanied by decreased expression of corresponding proteins across all four cell lines. We used antisense morpholino oligonucleotides to block the proximal PAS of AKT2, shifting the balance of AKT2 mRNA isoforms toward the long isoform. This shift caused EMT reversal, marked by reduced AKT2 protein expression, changes in EMT-related markers, and impaired invasion by MDA-MB-231 cells. ConclusionTogether, these findings identify APA-mediated 3UTR lengthening, with functional consequences in EMT-related genes, as a coordinated mechanism leading to an attenuated EMT phenotype, highlighting a significant connection between APA and the EMT process. Interfering with these APA changes may offer a promising therapeutic strategy to suppress metastasis, with potential efficacy across multiple pathways. Statement of SignificanceOur findings highlight APA-mediated 3 UTR lengthening as a coordinated mechanism that promotes EMT reversal and support CPSF73 inhibition or APA-targeting strategies as potential therapeutic approaches to suppress metastasis across multiple pathways.