Cancer Letters

Background Complex gastrointestinal (GI) oncologic surgeries carry substantial perioperative risk, and nationwide outcomes in low- and middle-income countries (LMICs) are underreported. This study aimed to evaluate national trends in surgical volume, in-hospital mortality, and intensive care unit (ICU) utilization for major GI cancer surgery in Brazils Unified Health System (SUS) over a 14-year period. Methods A population-based analysis was performed using national administrative databases to identify all adult patients undergoing colectomy, gastrectomy, pancreatic resection or esophagectomy for cancer in the SUS from 2010-2023. Annual rates were age-standardized according to the WHO standard population. Temporal trends were assessed using Poisson regression to estimate average annual percent change (AAPC) with 95% confidence intervals (CIs). Results A total of 179,337 hospital admissions were analyzed (median age 63 years; 48% female). Colectomies accounted for 72% of cases, followed by gastrectomies (19%), pancreatic resections (5%), and esophagectomies (3%). Although crude surgical volume increased, population-adjusted rates declined overall (AAPC -2.09%; 95% CI -2.58 to -1.59), mainly due to reductions in gastrectomies and esophagectomies. Median hospital stay decreased from 9 to 7 days (AAPC -1.93%; 95% CI -2.79 to -1.06). Overall in-hospital mortality declined from 8.1% to 5.7% (AAPC -2.88%; 95% CI -4.15 to -1.59). ICU utilization rose from 37% to 43% of admissions (AAPC +1.31%; 95% CI 0.91 to 1.71). Conclusion Over 14 years, in-hospital mortality and length of stay for major gastrointestinal cancer surgery declined within Brazils universal public health system. These temporal trends occurred alongside expansion of accredited oncology services and increased ICU utilization, although causal relationships cannot be established from administrative data. These findings should be interpreted as hypothesis-generating and highlight the need for more granular hospital-level data in LMIC settings.

PURPOSE: Cancer outcomes in sub-Saharan Africa are driven by delayed diagnosis and treatment initiation. We evaluated the magnitude and determinants of diagnostic and treatment delays among cancer patients in Kinshasa, Democratic Republic of the Congo (DRC). METHODS: We conducted a hospital-based cross-sectional study of 460 adults with confirmed cancer at Nganda Hospital Center in Kinshasa, DRC. Two outcomes were assessed: delay from symptom onset to diagnosis and delay from diagnosis to treatment initiation. Log-normal regression models were fitted for each outcome to estimate adjusted geometric mean ratios (aGMRs) and 95% confidence intervals (CIs). Covariates included demographic, socioeconomic, clinical, behavioral, and stigma-related factors. RESULTS: The median age was 55 years, and 76.2% of participants were women. Overall, 55.0% of participants experienced symptom-to-diagnosis delays >6 months, and 49.4% experienced diagnosis-to-treatment delays >3 months. Older age was associated with longer diagnostic delay (aGMR 1.55, 95% CI 1.03-2.31) and treatment delay (1.51, 1.07-2.14). Unemployment was strongly associated with both diagnostic delay (1.68, 1.15-2.47) and treatment delay (2.27, 1.54-3.33), as was hepatitis B co-infection (1.88, 1.06-3.34 and 2.42, 1.15-5.11, respectively). Longer diagnostic delay was additionally associated with informal trading (1.99, 1.21-3.28), taxi or motorbike transport (1.92, 1.25-2.94), and smoking history (2.25, 1.03-4.91), while high cancer-stereotype stigma was associated with longer treatment delay (1.56, 1.04-2.34). CONCLUSION: Substantial delays exist across the DRC cancer care continuum, driven by socioeconomic vulnerability, transport barriers, hepatitis B co-infection, and cancer-related stigma. These findings highlight the need for integrated interventions to improve timely diagnosis and treatment initiation, including strengthening financial protection, decentralizing cancer services, and reducing stigma in cancer care.

Background: Immune-oncology has revolutionized cancer treatment, but some patients fail to benefit due to primary resistance and tumour-immune evasion. Extracellular vesicles (EVs) are secreted by both tumour and immune cells and mediate communication between cancer cells and the immune system. Our study used proteomic profiling of circulating EVs collected from NSCLC patients treated with immune checkpoint inhibitors (ICI) to identify predictive biomarkers of response as well as immune evasion mechanisms related to treatment resistance. Methods: EVs were isolated from plasma collected prior to ICI treatment using peptide-affinity purification and high-throughput proteomics was performed using Proximal Extension Assay. Differentially expressed EV proteins between durable (DR) and non-durable responders (NDR) were identified and evaluated using Cox proportional hazards regression, survival analysis, sex-stratified analysis, as well as pathway and network analysis. Results: Proteomics analysis identified 116 differentially expressed EV proteins between DR and NDR. NDR was characterized by enrichment of inflammatory, angiogenic, and immune-suppressive EV proteins, such as IL1RL1, TFRC, IL6ST, galectins, TNF superfamily death receptors, chemokines, and PCSK9. Pathway analysis revealed enrichment of angiogenesis, chemotaxis, ECM remodeling, and neutrophil degranulation associated with poor progression-free survival (PFS). In contrast, DR to ICI treatment was associated with EV proteins related to T- and B-cell activation and adaptive immunity. Sex-related differences in abundance and association with PFS was observed for certain EV proteins, including IL1RL1 and TFRC. A six protein EV model (IL1RL1, TFRC, ERI1, CCN5, IGFBPL1, and TNFRSF13C) demonstrated good prognostic performance for identifying NDR (AUC = 0.907) and stratified patients into three discrete risk groups. Conclusions: High-plex EV proteomics revealed biologically coherent tumour-immune signaling programs that are associated with ICI treatment resistance. Profiling circulating EVs may improve our understanding of EV-mediated immune evasion mechanisms and identify protein signatures that reflect the tumour immune microenvironment and predict response to immune checkpoint blockade.

Background: Non-invasive diagnosis, reliable recurrence surveillance remain critical unmet needs in gliomas. Glioma induces profound systemic immune alterations despite its anatomical confinement to the central nervous system. Circulating immune cells, particularly monocytes, are key mediators of tumor-host crosstalk and may retain tumor-induced transcriptional imprints. However, their potential clinical utility as blood-based biomarkers for detection and monitoring, remain largely unexplored. Methods and findings: In this study, we performed integrated single-cell RNA sequencing of blood immune cells and demonstrated that circulating CD14+ monocytes are significantly expanded in glioma patients, exhibiting features of differentiation arrest and increased transcriptional plasticity. These cells harbor glioma-specific molecular signatures distinct from those observed in healthy controls and patients with other tumors. Leveraging these findings, we developed an ensemble machine learning diagnostic model based on transcriptomic profiles of circulating CD14+ monocytes (training cohort, n=107), which achieved a mean area under the receiver operating characteristic curve (AUC) of 0.971 during cross-validation. In an independent cohort of 567 participants, the model maintained high diagnostic accuracy, yielding an AUC of 0.877 for distinguishing glioma from controls and other tumors. And it achieved a recurrence detection AUC of 0.969 in 51 postoperative samples. Moreover, in a prospective follow-up study involving 30 glioma patients, lower model-derived scores of postoperation were significantly associated with prolonged progression-free survival (log-rank test, P=0.043), supporting its prognostic utility. Conclusion: We demonstrate circulating CD14+ monocytes undergo glioma-specific transcriptional reprogramming, generating systemic tumor-associated signal captured via transcriptomic profiling. This blood-based diagnostic model provides non-invasive, scalable approach for glioma detection, recurrence surveillance, outcome prediction.

Importance: While gut dysbiosis is known to impair response to immune checkpoint inhibitors (ICIs), the relative clinical impact of antibiotic timing (pre- vs. post-ICI initiation) remains unclear. Objective: To evaluate whether antibiotic timing differentially influences overall survival (OS) in a large, multi-institutional pan-cancer cohort. Design, Setting, and Participants: This retrospective cohort study utilized deidentified electronic health record data from six academic medical centers within the University of California Health system. We included 21,108 adults with any malignancy who received PD-1, PD-L1, or CTLA-4 inhibitors between January 2014 and December 2024. Exposures: Antibiotic exposure windows were categorized as pre-only (-60 to -1 days), post-only (+1 to +60 days), both windows, or none. Main Outcomes and Measures: The primary outcome was overall survival (OS) calculated from the first ICI dose. Multivariable Cox proportional hazards models adjusted for demographics, tumor type, line of therapy, and baseline health indicators (albumin, NLR, and recent hospitalization). Results: Among 21,108 patients, 17.3% had pre-only exposure, 13.3% had post-only exposure, and 60.6% had no exposure. In the multivariable model, post-only exposure (HR, 1.27; 95% CI, 1.20-1.35) and combined pre- and post- exposure (HR, 1.31; 95% CI, 1.23-1.40) were significantly associated with higher mortality. Pre-only exposure was not significantly associated with OS (HR, 1.04; 95% CI, 0.99-1.10). Subgroup analyses by tumor type showed consistent trends across major malignancies, including head and neck (Post HR, 1.46) and renal cell carcinoma (Post HR, 1.26). Conclusions and Relevance: In contrast to some smaller studies, this large-scale analysis indicates that antibiotic exposure after ICI initiation carries a greater risk than exposure prior to treatment. These findings highlight the need for rigorous antibiotic stewardship strategies specifically during the early phases of immunotherapy treatment.

Background: Reirradiation (reRT) is increasingly offered following progression in diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG), though optimal patient selection remains a challenge. This study evaluated clinical outcomes after reRT in a contemporary cohort of patients with DIPG/DMG. Methods: Patients <26 years old with DMG/DIPG treated with radiation therapy between 2011-2025 were retrospectively reviewed. Primary endpoints included overall survival (OS2) and progression-free survival (PFS2), measured from first progression, and change in neurologic symptoms after reRT. Survival was estimated using Kaplan Meier methods, with Cox proportional hazards modeling for prognostic factors. Results: Fifty eight patients were included; 37 (63.8%) underwent reRT. Tumors were predominantly pontine (74.1%). ReRT was associated with improvement in motor function (51.4% vs. 9.5%, p=0.002), cranial nerve function (29.7% vs. 4.8%, p=0.044), and gait ataxia (35.1% vs. 9.5%, p=0.059). Median OS2 and PFS2 were improved with reRT (OS2: 9.67 vs. 2.57 months, p<0.001; PFS2: 5.63 vs. 1.57 months, p<0.001). OS2 was independently associated with reRT (HR 0.27, p<0.0001), pontine location (HR 2.94, p=0.004), and steroid use at progression (HR 4.12, p=0.001). PFS2 was independently associated with reRT (HR 0.23, p < .0001) and distant pattern of failure (HR 2.83, p=.037). Among reRT patients, non-pontine location was associated with improved OS2 (p=0.02), and local failure was associated with improved PFS2 (p=0.003). Conclusion: ReRT was associated with neurologic improvement and prolonged survival. Patients with non-pontine tumors or local-only failure might derive the greatest benefit. Prospective studies are warranted to define optimal dose/fractionation and refine patient selection.

Abstract Background Cancer is an increasing public health challenge in Kenya, particularly in rural and underserved regions where surveillance systems and diagnostic capacity remain limited. Kilifi County, located along the Kenyan coast, lacks a population-based cancer registry, and data on the local cancer burden is not available. This study aimed to characterize the demographic distribution of patients, cancer burden in the county, and management of cancer cases diagnosed at Kilifi County Referral Hospital (KCRH) over ten years. Methods This retrospective study analyzed the patterns of cancer in Kilifi County using patient records from KCRH during the study period (January 1, 2014, to January 1, 2024). Results A total of 101 patients with cancer were identified, 58% female, with a mean age of 54 years. Most patients were from Kilifi North (47%), with a high proportion reporting no formal occupation (41%) or farming (26%). Esophageal and cervical cancers were the most common (18% each), followed by breast and prostate cancers (5% each), with other malignancies occurring infrequently. Histopathology was the primary diagnostic modality (88%). Staging data were incomplete in 70% of cases; among documented cases, the majority presented with advanced disease (21% stage IV). Due to limited local treatment capacity, approximately half of the patients were referred to tertiary centers for chemotherapy, radiotherapy, or surgery. At data cut-off, 43% had died, 25% were on treatment, and 29% were lost to follow-up, with only 2% completing treatment or under follow-up. Conclusions This study demonstrates a substantial cancer burden in Kilifi County and highlights critical gaps in diagnostic capacity, staging, and continuity of care. Strengthening cancer surveillance systems, expanding diagnostic and treatment infrastructure, and establishing a population-based cancer registry are essential to improving cancer outcomes and advancing equitable care in rural Kenya

Background: The development of personalised mRNA cancer vaccines holds considerable promise for oncology, yet a significant translational gap persists between neoantigen identification and the selection of therapeutically impactful targets. Current approaches predominantly prioritise human leukocyte antigen (HLA) binding affinity and immunogenicity, often overlooking the systems-level biological context of the target. This can inadvertently favour immunogenic but biologically peripheral peptides that exert limited influence on tumour signalling networks, thereby constraining vaccine efficacy. Furthermore, mRNA therapeutics must satisfy additional design requirements, including favourable codon usage and favourable secondary-structure stability, which directly affect in vivo translation and half-life. A unified computational framework that integrates neoantigen discovery with network biology is therefore critically needed. Results: Here, we present PimRNA, a Priority index (Pi)-centric computational medicine framework that bridges this gap by unifying neoantigen identification, mRNA sequence optimisation, and gene interaction network analysis. First, high-confidence tumour-specific HLA class I and II neoantigenic peptides are identified from paired tumour-normal genomic and tumour transcriptomic data using NeoDisc. Second, the coding sequences of these peptides are optimised for stability and translational efficiency with LinearDesign, yielding a core set of neoantigen-encoding mRNAs. Third, a random walk with restart algorithm is applied to a knowledgebase of gene interactions to identify peripheral genes exhibiting significant network connectivity to core genes, generating a gene-predictor matrix in which each gene is assigned an affinity score reflecting its network proximity to immunogenic neoantigens. These scores are consolidated into a single, unified priority rating (0-5) for each gene, followed by subnetwork analysis that reveals therapeutically relevant gene modules. Application of PimRNA to breast cancer and melanoma datasets demonstrates that it successfully selects high-confidence immunogenic neoantigen candidates embedded within biologically meaningful tumour-specific networks. Conclusion: PimRNA provides a systems biology foundation for mRNA vaccine design, moving beyond isolated immunogenicity to prioritise targets that are both highly presented and central to tumour-relevant biological networks. This framework offers a generalisable strategy for the rational discovery and prioritisation of mRNA therapeutics, significantly advancing the field of computational medicine towards personalised cancer vaccines.

Background: The use of immune checkpoint inhibitors (ICIs) in the treatment of cancer has rapidly expanded over the last decade. However, there are several knowledge gaps in understanding how tumor cells evade the immune system. There is paucity of data in HPV negative oral cancer, particularly of the gingivobuccal region. Understanding the mechanism of immune system evasion in this cancer is vital for improving patient outcomes. Methods: We characterized the baseline immune milieu of oral cancer using immunohistochemistry (IHC) on whole tumor sections from 124 cases. Tumors were classified as hot or cold and further stratified into high-risk and low-risk groups. High-risk patients included those with lymph node metastasis at diagnosis/recurrence or distant metastasis within 2 years of treatment completion. Patients without these features were categorized as low risk. Validation by RNA-Seq and Joint Enrichment Analysis of Oncogenic and Immunologic Pathways was carried out in a subset of 46 cases. Results: Hot high-risk tumors (by IHC) were distinguished by elevated PD-L1 expression and reduced NK-cell, PD1, and CTLA-4 expression. There was no difference in the expression levels of CD3+, CD8+, granzyme, or perforin compared to hot low-risk tumors, findings that align with the definition of hot tumors. RNA-Seq revealed a gene signature associated with exhausted T-cells in hot high-risk tumors. Gene and pathway analyses identified differential upregulation of isoform-specific TOX, TCF, CXCR, RUNX, IRF, BRD and BCL6 genes, implicating immune cell exhaustion and tumor aggressiveness. Significantly downregulated genes included PDCD1, HAVCR2, ZAP70, and STAT, indicative of a disabled immune microenvironment. These findings support that a state of immune exhaustion in HHR tumors is driven by progenitor exhausted T-cells and terminally exhausted T-cells; independent of PD1-TIM3. Conclusion: These findings suggest that combining TOX/TCF/BCL6 inhibitors with immune checkpoint inhibitors in the adjuvant setting might benefit patients with hot high-risk tumors. Given the results, testing for a targeted exhaustion-related gene panel at diagnosis is recommended for oral cancers to stratify tumors as high-risk or low-risk. Larger validation studies and clinical trials are now warranted.

While prostate cancer (PC) is defined as immunologically cold, limiting the efficacy of immune checkpoint inhibitors, therapeutic vaccination targeting tumor-associated antigens represents an attractive strategy to promote disease control in low volume metastatic patients. The UV1 cancer vaccine is based on immunization with tripeptide fragments from human telomerase reverse transcriptase (hTERT) and a phase II clinical trial demonstrated induction of robust T cell response in men with de novo metastatic castration-sensitive prostate cancer (mCSPC). Comparison with long-term survival data of non-metastatic CSPC patients as reference showed that despite metastatic disease at diagnosis, UV1-treated patients who mounted an early vaccine-induced immune response achieved progression-free and overall survival comparable to non-metastatic patients. We examined biological determinants of clinical benefit following UV1 vaccination including tumor transcriptome and T cell receptor (TCR) profiling from circulating and tissue resident T-cells of the 22 men enrolled. Analysis of diagnostic and post-UV1 treatment biopsies revealed that low baseline exhaustion of T cells and higher CD8+ T cell abundance are associated with early immune response to the vaccine and longer survival. Moreover, we identified specific TCR motifs relative to early responders, that can indicate potential benefit from UV1 vaccination. These findings indicate that baseline intratumoral T cell exhaustion state and repertoire shape responsiveness to hTERT vaccination and long-term outcome. Overall, our study underlines how baseline immune profiling may be used as a companion biomarker to predict mCSPC patients most likely to benefit from therapeutic vaccination.

Importance Prognostic tools beyond staging are needed to guide treatment and counseling in head and neck squamous cell carcinoma (HNSCC). Objective To develop and externally validate a machine learning model predicting survival in advanced HNSCC using routinely collected clinical and biomarker data. Design, Setting, and Participants Retrospective, multi-institutional cohort study including 2,385 patients with stage III-IV HNSCC diagnosed from 2012-2022 in the University of California Health Data Warehouse (UCHDW). Patients were randomly split into training (n = 1,908) and test (n = 477) sets. Partial external validation used 7,749 patients from the Surveillance, Epidemiology, and End Results (SEER) registry (2010-2020). Exposures Demographic, tumor, treatment, comorbidity, and biomarker variables recorded at or before diagnosis. Main Outcomes and Measures The primary outcome was all-cause mortality within 70 months. Cox proportional hazards models included all predictors. Discrimination was assessed with Harrell's concordance index (C-index), calibration with predicted vs observed survival, and stratification with Kaplan-Meier curves. A Random Survival Forest (RSF) was trained for benchmarking and interpretability using Shapley Additive exPlanations (SHAP). Results Among 2,385 patients in UCHDW (median age, 63 years; 29.0% mortality), the Cox model achieved a C-index of 0.735 in the internal test set. Risk quartiles showed clear separation on Kaplan-Meier curves (log-rank p < 0.0001). In the SEER cohort (n = 7,749), where only demographic, staging, subsite, and treatment variables were available, the reduced Cox model achieved a C-index of 0.688, with calibration showing modest underestimation of survival in high-risk groups. Age, T stage, Charlson Comorbidity Index, neutrophil-to-lymphocyte ratio, and platelet count were among the strongest predictors, while surgery was associated with improved survival. The RSF achieved a C-index of 0.758 internally, with SHAP highlighting nonlinear effects of albumin, BMI, and inflammatory markers. Conclusions and Relevance A machine learning model using routine clinical and biomarker data demonstrated good prognostic performance in advanced HNSCC, with partial external validation. Such approaches may support individualized survival estimates, risk stratification, and treatment discussions, but broader validation is required before clinical adoption.

Background: CD8+ tumor-infiltrating lymphocytes (TILs) are established prognostic markers in colorectal cancer, yet the clinical significance of CD103+CD8+ tissue-resident memory-like (TRM-like) T cells in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (NACRT) remains unknown. Methods: We quantified CD8+ and CD103+CD8+ T-cell densities in stromal and intratumoral compartments of post-NACRT resection specimens from 40 LARC patients using Cu-Cyto, a deep learning-based imaging cytometry platform. Associations with survival, pathological response, and adjuvant chemotherapy (AC) were examined. Treatment-induced T-cell dynamics were assessed in paired pretreatment biopsies and post-NACRT resections (n = 9). Results: High stromal CD103+CD8+ density independently predicted better 5-year RFS (67.4% vs. 12.1%, p < 0.001) and OS (80.0% vs. 26.6%, p = 0.016); intratumoral density showed no prognostic significance. Pathological response correlated with stromal CD8+ but not CD103+CD8+ density. Paired analysis revealed a selective non-expansion of the CD103+ subset: stromal CD8+ T cells increased significantly after NACRT while CD103+CD8+ density remained unchanged. AC may preferentially benefit patients with low stromal CD103+CD8+ density. Conclusions: Stromal CD103+CD8+ T-cell density is a robust independent prognostic biomarker in rectal cancer after NACRT that appears to reflect pre-existing rather than treatment-induced immunity. Given its stability across NACRT, pretreatment biopsy assessment may provide equivalent prognostic information, with potential implications for patient stratification before treatment initiation.

Background: The rising prices of cancer medicines have intensified concerns about treatment access and health system sustainability particularly in low- and middle-income settings. Systematic facility level evidence on what medicines is actually available, at what prices, and at what cost to patients remains scarce, constraining evidence-based policy reform. Methods: Using adapted WHO/Health action international methodology, we conducted a cross-sectional survey of 52 cancer medicines across five therapeutic classes at five health facilities in Kisumu County, Kenya. Availability was measured as the proportion of facilities stocking each medicine. Affordability was assessed using days' wages required for the lowest-paid government worker to purchase standard treatment regimens, calculated per one chemotherapy cycle and maximum possible cycles. Results: Overall medicine availability was 48.1%, with marked inter-facility variation. Affordability analysis revealed severe financial barriers. The breast cancer AC regimen required 19.6-47.4 days' wages per full course; cervical cancer cisplatin, 19.8-49.2 days' wages; colorectal FOLFOX, 80.0-303.6 days' wages; and prostate docetaxel reached 437 days' wages at the highest-cost facility. The Social Health Authority's (SHA) KES 550,000 annual ceiling adequately covered cytotoxic regimens for common cancers at competitive prices but was exceeded by 24-116% for HER2-positive breast cancer requiring trastuzumab, with further strain for recurrent cervical and metastatic prostate cancers. Conclusions: Cancer medicines in Kisumu County are inconsistently available and highly variable in price resulting in inequitable access. We call for urgent retail price markup regulation, expanded pooled procurement through KEMSA, inclusion of priority targeted therapies on the Kenya Essential Medicines List, and SHA benefit packages redesigned around full-course regimen costs.

Background: Severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are major dose-limiting toxicities of chimeric antigen receptor (CAR) T-cell therapy. Existing pre-infusion biomarkers offer modest discrimination, motivating non-invasive alternatives. Methods: We prospectively enrolled 26 patients with relapsed/refractory large B-cell lymphoma receiving axicabtagene ciloleucel. Pre-infusion (day -1) exhaled breath samples were analyzed by gas chromatography-mass spectrometry for 40 volatile organic compounds (VOCs). Candidates with univariate AUC > 0.65 for severe (grade >=2) CRS or ICANS were carried forward to sensitivity-maximization-at-given-specificity with LASSO regularization (SMAGS-LASSO), which selected separate panels for each outcome. Model performance was assessed by leave-one-out cross-validation with permutation p-values and Harrell bootstrap optimism correction. Results: The 4-VOC CRS panel (heptanal, benzaldehyde, 2-butanone, ethylbenzene) achieved LOOCV AUC 82.5% (80% sensitivity at 88% specificity) and the 3-VOC ICANS panel (nonanal, allyl methyl sulfide, levomenthol) achieved AUC 86.3% (67% sensitivity at 86% specificity). By tertile, severe CRS occurred in 8/9 (89%) high-risk versus 2/9 (22%) low-risk patients (Cox HR 6.82, 95% CI 1.41-32.9, p=0.017) and severe ICANS occurred in 8/9 (89%) versus 2/9 (22%) (HR 8.28, 95% CI 1.73-39.6, p=0.008). Each 1-SD score increase corresponded to a 3.80-fold higher hazard of severe CRS (p<0.001) and 4.36-fold higher hazard of severe ICANS (p<0.001). In head-to-head comparison, the 3-VOC ICANS panel outperformed the modified Endothelial Activation and Stress Index (mEASIX) (delta-AUC +0.36, DeLong 1-sided p=0.008). The 4-VOC CRS panel had numerically higher AUC than mEASIX (delta-AUC +0.19, p=0.150). Conclusions: Pre-infusion exhaled breath VOC panels stratify CAR T-cell recipients by severity and timing of severe CRS and ICANS, providing a non-invasive complement to existing serum biomarkers. Multi-institutional validation is warranted.

Curative-intent immunochemotherapy fails in ~30% of patients with large B-cell lymphoma (LBCL), yet no validated molecular tool enables early identification of high-risk individuals to guide treatment intensification. Using shallow whole genome sequencing (sWGS) of plasma cell-free DNA from 190 LBCL patients, we developed and validated the ACT score (Aberrations, fragment Composition, Terminal motifs), a composite classifier integrating genomic and fragmentomic features from a single post-cycle-1 sample. ACT-positive patients had worse 2-year outcomes versus ACT-negative patients: time-to-progression 29% vs. 83% (HR 4.4, 95% CI 1.9 - 10.0; P = 1.5 x 10 - 4) and overall survival 47% vs. 93% (HR 8.7, 95% CI 3.0 - 25.4; P = 1.8 x 10-6). ACT score was independently prognostic of the International Prognostic Index, and their combination identified the highest-risk patients. Unlike mutation-based approaches, this assay requires neither tumor tissue, germline control nor a baseline plasma sample. Built on open-source tools and sWGS, the ACT score offers a feasible scalable strategy for early risk stratification in aggressive LBCL.

Objective: To identify Dickkopf-1 (DKK1) as a prognostically relevant candidate in head and neck squamous cell carcinoma and to evaluate whether DKK1 and cytoskeleton-associated protein 4 (CKAP4) expression is associated with cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: DKK1 was screened using the Human Protein Atlas Pathology Atlas. Immunohistochemical expression of DKK1 and CKAP4 was examined in 54 patients with primary TSCC (cT1-4N0) treated surgically between 2015 and 2020. Nine cases were excluded because of insufficient tissue blocks or inadequate staining quality, leaving 45 evaluable cases. Associations with delayed cervical lymph node metastasis were assessed together with conventional clinicopathological factors, including infiltrative growth pattern (INF) and pathological depth of invasion (pDOI). Results: In public database analysis, high DKK1 expression was associated with poorer overall survival in head and neck squamous cell carcinoma. In the TSCC cohort, pDOI [&ge;]5 mm and INF pattern c were significantly associated with cervical lymph node metastasis. Positive DKK1 and CKAP4 expression were also significantly associated with cervical lymph node metastasis. Furthermore, combined DKK1/CKAP4 positivity, when incorporated with INF and pDOI, provided additional risk stratification, and cases with all 3 factors showed a markedly increased likelihood of cervical lymph node metastasis. Conclusions: Expression of DKK1 and CKAP4 was associated with cervical lymph node metastasis in TSCC. Combined assessment of DKK1/CKAP4 expression with INF and pDOI may improve pathological risk stratification and may help identify patients who require closer neck evaluation and postoperative management.

Background: Extent of resection remains central to meningioma management, yet Simpson grading is subjective and may not reflect measurable postoperative residual disease. We compared surgeon-reported Simpson grade, report-derived radiological grading, and residual tumour volumetry across a multicentre cohort. Methods: We performed a retrospective study across two tertiary neurosciences centres comprising four hospitals, including patients undergoing primary cranial meningioma resection from 2006 to 2025. Postoperative magnetic resonance imaging (MRI) reports were harmonised using weakly supervised natural language processing based on term frequency-inverse document frequency (TF-IDF) and a linear support vector machine classifier. Residual tumour volume was segmented from contrast-enhanced postoperative MRI and log-transformed. Concordance between Simpson and radiological gross-total/subtotal resection classification was assessed using absolute agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Cox models assessed recurrence-free survival, with bootstrap validation and anatomical and scan-timing sensitivity analyses. Results: Among 912 patients, recurrence or residual progression occurred in 281. Surgical-radiological agreement was substantial but imperfect (absolute agreement 74%; PABAK 0.61), with lower agreement in skull-base and parafalcine-parasagittal tumours. In adjusted models, recurrence hazard increased with Simpson grade (hazard ratio 1.54, 95% confidence interval 1.37-1.72), radiological grade (1.92, 1.68-2.20), and log-transformed residual volume (1.20, 1.16-1.24; all p<0.0005). Optimism corrected concordance increased from Simpson grade to radiological grade and log-volumetry (0.692, 0.733, and 0.748), with this ranking preserved across sensitivity analyses. Conclusions: Imaging-based postoperative residual disease measures outperformed Simpson grade. TF-IDF-assisted report-derived grading provides a scalable bridge to volumetry, while quantitative residual volume offers the strongest prognostic representation.

The choroid is critical for maintaining vision and implicated in several ocular diseases, being the sole source of nutrients and waste removal for the outer retina. Genetic discovery can help elucidate the pathways through which choroidal features influence disease risk. Our meta-analysis of genome-wide association studies (n= 78,682 participants) identified 30 genomic regions, including 20 novel loci, associated with choroidal thickness. Findings suggest inflammatory and vascular processes drive choroidal thickness, with overlapping mechanisms shared with refractive error. Genome-wide independently significant SNPs accounted for 18.7% of the genetic variance in choroidal thickness. Mendelian randomisation analyses showed a causal effect of age-related macular degeneration on choroidal thickness, and suggest a bidirectional causal effect between choroidal thickness and primary angle-closure glaucoma. These findings provide insight into the shared genetic architecture and biological pathways linking choroidal thickness and related diseases.

Biological aging is heterogeneous across organ systems, yet whether CT-derived abdominal aging provides prognostic value beyond routine clinical data and whether organ decomposition adds beyond a unified estimate remains untested. We developed and evaluated organ-specific and ensemble biological age models from radiomic features across five abdominal organs in 68,675 CT scans from 32,883 subjects, evaluated on alignment with chronological age of healthy subjects (nested cross validation: MAE=3.68 years, R^2=0.90). In sequential analyses restricted to adults aged 20-60 years which is the stratum of strongest BAG-disease association, ensemble biological age gaps provided incremental prognostic value beyond demographic covariates for all-cause disease and mortality (Delta C-index=0.141, 0.051) and beyond routine blood biomarkers (Delta C-index=0.048), confirming CT-derived aging captures structural information beyond laboratory markers. Organ-specific biological age added incremental prognostic value beyond ensemble selectively for focal diseases: cardiovascular (aorta, Delta C-index=0.091) and hepato-pancreatic (pancreas, Delta C-index=0.096). These findings establish a hierarchical organization of CT-derived biological aging, positioning routine CT as a source that adds prognostic value to existing clinical biomarkers.

Background: Frontotemporal dementia (FTD) lacks widely accessible disease-specific biomarkers. Optical coherence tomography (OCT) and OCT angiography (OCTA) may provide non-invasive measures of retinal changes associated with neurodegeneration. We conducted a systematic review and meta-analysis evaluating retinal biomarkers in FTD compared with Alzheimer disease (AD) and controls. Methods: A systematic search of PubMed and Embase was conducted through April 25, 2026 according to PRISMA guidelines. Studies evaluating OCT/OCTA biomarkers in FTD with comparator groups were included. Inverse weighted random-effects models, publication bias assessments, and meta-regressions were performed. Results: Ten studies involving 139 individuals with FTD, 87 with AD, 29 with mild cognitive impairment, 14 with TDP-43 proteinopathy, 5 with tauopathy, and 255 controls were included in the systematic review; five studies were eligible for meta-analysis. Compared with AD, individuals with FTD demonstrated significantly thinner retinal nerve fiber layer (RNFL) thickness (SMD = -0.61, 95% CI -0.98, -0.24). Compared with controls, individuals with FTD exhibited significantly thinner ganglion cell layer-inner plexiform layer (GCL-IPL) thickness (SMD = -0.55, 95% CI -1.02, -0.08), whereas pooled analyses across multiple retinal biomarkers were non-significant (SMD = -0.19, 95% CI -0.52, 0.14). RNFL thickness correlated negatively with female % in FTD and positively with age in both AD and controls. Conclusions: Individuals with FTD exhibit lower RNFL thickness than AD and lower GCL-IPL thickness than controls, suggesting retinal alterations may reflect neurodegeneration. However, larger longitudinal studies with standardized OCT/OCTA protocols are needed to determine the diagnostic and prognostic utility of retinal biomarkers in FTD