Frontiers in Oncology

Background: Cutaneous squamous cell carcinoma (cSCC) accounts for a significant proportion of skin malignancies in India, yet data on patterns of failure, particularly for extremity and truncal primaries remain scarce. We audited a decade of surgically treated cSCC at a tertiary cancer center to characterize failure patterns and associated risk factors. Methods: This retrospective study included 161 patients with histopathologically confirmed cSCC treated surgically between January 2013 and December 2023, comprising 127 upfront/residual and 34 recurrent presentations. Primary sites were extremities (64%), head and neck (26%) and torso (10%). 21 patients had Marjolin's ulcer. Outcomes included local, regional and distant failure, recurrence-free survival and overall survival. Brigham and Women's Hospital (BWH) staging was applied to assess prognostic utility. Statistical analysis was done using Kaplan-Meier and competing-risk methods. Results: Median follow-up was 2.4 years. Regional recurrence was the predominant failure pattern seen in 26 patients, local recurrence was seen in 14 patients and distant metastasis in 13. The 3-year cumulative incidences of local, regional and distant failure were 11%, 19% and 8.4% respectively. Rates of regional recurrence were substantially higher than Western series. Extremity primaries accounted for 19/26 regional recurrences. BWH T2b disease showed the highest regional failure rate (27.6%), exceeding T3 (17.8%) and T2a (6%) with perineural invasion significantly associated with regional failure in T2b/T3 tumors (p<0.001). Median time to regional metastasis was 8.4 months. At 3 years, overall survival was 77% and progression-free survival was 64%. Conclusion: Regional recurrence is the dominant mode of failure in this cohort, at rates higher than most published series, with extremity primaries and BWH T2b staging identifying particularly high-risk subgroups. These findings highlight the need for a comprehensive staging system encompassing non head and neck cSCC and support prospective evaluation of elective nodal staging and adjuvant radiotherapy in high-risk patients, alongside intensified surveillance.

Background Lymph node status and molecular subtype are among the most established prognostic factors in breast cancer. However, the extent to which their prognostic effects vary across different tumor size categories and clinical subgroups remains incompletely understood. We investigated the interplay between nodal status, molecular subtype, and tumor size in a large real world breast cancer cohort and developed a prognostic nomogram for individualized survival prediction. Methods A total of 12,225 women with invasive breast cancer from the Shiraz Breast Cancer Registry were analyzed. Patients were stratified according to tumor size, lymph node status, and molecular subtype. Overall survival (OS) and disease free survival (DFS) were evaluated using Kaplan Meier analyses and subgroup comparisons. Logistic regression was performed to identify predictors of lymph node involvement, while Cox regression was used to determine independent prognostic factors. A nomogram was subsequently developed and internally validated for prediction of 3-year and 5-year OS. Results Of 12,225 patients, 41.7% had lymph node positive disease. Across nearly all tumor size categories and molecular subtypes, nodal involvement was associated with significantly worse OS and DFS. Notably, the survival disadvantage associated with nodal positivity was more pronounced among patients with larger tumors and among those with HER2 positive and triple negative breast cancer (TNBC). Although TNBC demonstrated the lowest rate of lymph node involvement among molecular subtypes (adjusted OR 0.54, 95% CI 0.46-0.63), it appeared to show one of the largest survival gaps between node positive and node negative disease. In the overall cohort, survival outcomes generally ranked from best to worst as Luminal A, Luminal B, HER2 positive, and TNBC. However, survival differences among molecular subtypes were not consistently observed across all tumor size and nodal status subgroups. When significant differences were present, Luminal A and Luminal B tumors consistently showed superior outcomes compared with HER2 positive and TNBC tumors. Multivariable analysis identified lymph node status, tumor size, molecular subtype, lymphovascular invasion, tumor necrosis, type of surgery, radiotherapy, hormone therapy, and adjuvant chemotherapy as independent prognostic factors. A nomogram integrating clinicopathological and treatment variables demonstrated good predictive performance, with time dependent AUCs of 0.749 and 0.751 for 3 year and 5 year OS, respectively, and showed good calibration. Conclusions The prognostic impact of lymph node status is not uniform across breast cancer subgroups and appears particularly pronounced in larger tumors and biologically aggressive subtypes. Despite a lower likelihood of nodal involvement, TNBC showed substantial outcome deterioration when nodal metastasis was present. These findings highlight the importance of jointly considering nodal status, molecular subtype, and tumor burden in prognostic assessment.

Objective -- To analyze the incidence dynamics of uveal melanoma (UM) in Irkutsk Oblast over the period 2023 -- 2025, assess the structure of newly diagnosed cases by territory and stage, and compare the outcomes of anticancer care with those of other constituent entities of the Russian Federation that lead in registered prevalence of malignant neoplasms (MN) of the eye and adnexa. Materials and Methods. Data from the cancer registry of the Irkutsk Regional Oncology Dispensary (IROD) for 2023 -- 2025 and information from the state reference book "The State of Cancer Care for the Population of Russia in 2025" (P.A. Herzen Moscow Oncology Research Institute) were used. The analysis included cases of MN of the eye and adnexa (ICD - 10 code C69) of uveal localization. Incidence rates per 100,000 population, stage distribution, proportion of morphological verification, mortality, and the cohort of patients under follow-up were calculated. Results. Over three years, 112 new cases of UM were registered in Irkutsk Oblast (37, 36, and 39, respectively), corresponding to a crude incidence rate of approximately 1.6 per 100,000 population per year. In 2025, the region ranked 3rd in the Russian Federation for the number of newly registered patients with MN of the eye (45 individuals) and 1st for the registered prevalence rate (15.6 per 100,000). The highest proportion of stage I disease (58.3 %) and one of the lowest mortality rates (1.9 %) were observed. Conclusions. Irkutsk Oblast is characterized by a consistently high incidence of UM, accompanied by a favorable stage distribution and low mortality, reflecting both the biological and geographic features of the region and an adequate level of organization of ophthalmic oncology care.

Background. Sentinel lymph node biopsy (SLNB) is an essential component of axillary staging in breast cancer. Fluorescence-guided mapping with indocyanine green (ICG) enables real-time visualization of lymphatic drainage; however, the parameters of fluorescence-signal recording require standardization. Objective. To assess the technical feasibility and clinical applicability of SLNB with ICG under near-infrared (NIR) imaging guidance in patients with breast cancer. Materials and Methods. This prospective single-center study included 30 patients who underwent ICG-guided SLNB between 2023 and 2025. In 24 patients, ICG mapping was combined with technetium-99m radioisotope navigation; in 6 patients, ICG guidance alone was used. The protocol comprised periareolar ICG injection, standardized imaging conditions, and fluorescence-index recording. Results. The protocol was completed in all 30 patients. Fluorescent visualization of the lymphatic pathway and/or the sentinel lymph node (SLN) was achieved in every case, and no ICG-related adverse reactions were recorded. The mean fluorescence index was 213.0 +/- 24.7, the median was 206.0 [192.5-237.2], and the min-max was 180-255. Conclusion. SLNB with ICG under NIR imaging guidance demonstrated technical feasibility in a prospective single-center cohort. Quantitative fluorescence-index recording may serve as a component of standardizing intraoperative fluorescence guidance. Keywords: breast cancer; sentinel lymph node biopsy; indocyanine green; near-infrared imaging; fluorescence lymphography; fluorescence index; axillary staging.

Abstract Aim: Low chemotherapy response is a major risk factor for early mortality in cancer patients; it is one of the biggest challenges in cancer treatment. Main aim of this study is to identify chemotherapy non-responder, prognostic significance of pre-chemotherapy baseline variables in survival, distinguish most effective anti-cancer drug classes and formulation. Methods: In this multi-center retrospective cohort (n=2459) patients deceased with NSCLC and received anti-cancer drugs were included for analyses. To identify chemotherapy non-responder, patient population was divided into three sub-groups based on chemotherapy prescription frequency [1-15] as group-A, [16-30] as group-B, and [[&ge;]31] as group-C. Multivariate analysis was performed to identify risk of 1-year mortality in these groups. To prognose chemotherapy response in resected and unresected NSCLC patients, 0-7 days pre-chemotherapy white blood cell (WBC) count total five-ranges were compared as per overall survival in abnormal Vs normal WBC counts. Results: Post-stratification in group-A there were (n=1289) patients, in group-B (n=648) patients, and in group-C (n=522) patients. In group-A (n=301) patients 23% were found to have no new metastasis post-diagnosis significantly less p-value (0.004) compared to Group-B (n=125) 19.3%, and group-C (n=110) 19.2% patients p-value (0.008). Metastasis during chemotherapy was found significantly less in 20% patients of group-A, compared to (33%) in group-B, and (43%) in group-C p-value (<0.001). Post-chemotherapy initiation OS in group-A patients were significantly less 9 months (95% CI 9.3 - 9.6) compared to group-B 19 months (95% CI 17.7 - 20.2) and group-C 36.6 months (95% CI 34.6 - 38.5) patients p-value (<0.0001). Despite of low new metastasis and post chemo metastasis, group-A patients survived significantly less based on these outcomes group-A patients were considered as chemotherapy non-responder. Males and NSCLC stage III/IV patients were at higher risk; clinical benefits are corelated to surgery and radiotherapy for chemotherapy non-responder. Leukocytosis in both resected/unresected NSCLC group-A (13%) patients were found to be bad prognostic factor of survival in unresected group-B (5%) patients. Oral formulation of receptor tyrosine kinase inhibitors (RTKI) was effective in non-responders. Conclusion: Stratification of patient population based on chemotherapy prescriptions could be a useful method to find chemotherapy response in retrospective analysis. Patients with pre-chemotherapy leukocytosis should be closely monitored prior to selection of chemotherapy dose and formulation.

Abstract Background Prostate cancer (PCa) diagnosis remains challenged by the limited specificity of prostate-specific antigen (PSA) testing, which cannot reliably distinguish malignancy from benign prostatic hyperplasia (BPH). MicroRNAs (miRNAs) are emerging candidates for liquid biopsy-based diagnostics, but most studies assess expression in isolation within a single compartment (biological source - Tissue, blood, serum, urine etc.), overlooking both compartment-specific behavior and the coordinated relationships among miRNAs. Methods We profiled four candidate miRNAs --- miR-19b-3p, miR-21-5p, miR-101-3p and miR-375-3p, across four biological compartments (prostate tumor tissue, urine, serum, and blood) in 179 patients undergoing prostate biopsy for clinical suspicion of PCa (104 PCa, 75 BPH) using qRT-PCR. Urinary exosomal RNA was isolated with a commercial exosome isolation kit so from here onwards this compartment will be referred to as urine. Differential expression was quantified using Cohen's d; inter-miRNA coordination was assessed via Spearman correlation and differential correlation ({delta} r) analysis; and a compartment-level network rewiring score was derived as the sum of {delta} r| across miRNA pairs. Cross-compartment structural alignment was evaluated by comparing correlation patterns at the population level. Diagnostic models combining PSA, age, and urinary exosomal-miRNA features were evaluated using Logistic Regression, Elastic Net Logistic Regression and Naive Bayes classifiers under leave-one-out cross-validation (LOOCV). Results Effect sizes were largest and most consistent in urine, with miR-101-3p showing the strongest separation between PCa and BPH (d = -1.01), followed by miR-21-5p (d {approx}-0.72$) and miR-19b-3p (d {approx}-0.64). Two markers (miR-19b-3p, miR-375-3p) showed directional reversals across compartments, indicating that disease-associated signals are compartment-specific rather than uniformly conserved. In tumor tissue, PCa was associated with substantial reorganization of inter-miRNA coordination (network rewiring score = 2.46), including the emergence of a strong miR-21-5p--miR-375-3p co-regulatory axis ({delta} r = +0.87$) and decoupling of the miR-21-5p--miR-19b-3p relationship ({delta}r = -0.64$). Urine showed a structurally distinct coordination pattern (rewiring score = 1.77), dominated by a miR-101-3p--miR-19b-3p axis (r = +0.56) absent from tissue; cross-compartment comparison showed concordance in only 1 of 5 miRNA pairs, indicating that urine's architecture is largely independent of tissue's. For diagnostic translation, the conventional PSA cutoff (4 ng/mL) achieved 100% sensitivity but only 23.5% specificity. In urine, miR-101-3p performs better than other miRNAs, with AUC of 0.77 (95% CI: 0.62--0.90). Adding PSA and age to the urinary miR-101-3p further improved discrimination to an AUC of 0.91 (95% CI: 0.82--0.99), with 70% specificity at 92% sensitivity; this pattern was consistent across Elastic Net and Logistic Regression classifiers. Expanding the model to include all urinary miRNAs, age, and pair-derived coordination features did not improve on this result (AUC = 0.88), indicating that population-level coordination changes did not translate into additional individual-level diagnostic value in this cohort. Conclusions miRNA signals in extracellular compartments do not represent direct surrogates of tumor-level molecular architecture; each compartment harbors a distinct, transformed coordination structure reflecting its biological context. While these coordination-level changes are mechanistically informative, the most direct translational gain in this study came from a parsimonious model combining PSA, age with a single urinary marker, miR-101-3p, which improved AUC from 0.77 to 0.91, with specificity 70.5% at 90% sensitivity criteria. This combination represents a promising, interpretable candidate for reducing unnecessary prostate biopsies, pending validation in larger, independent cohorts. Keywords: MicroRNA, Compartment-Specific Biomarkers, Urinary Exosomes, Differential Correlation, Liquid Biopsy, Machine learning, PSA, Early diagnosis

Abstract Background: The lack of effective biomarkers and therapeutic targets to overcome radioresistance in cervical cancer remains a major clinical challenge. Tumor necrosis factor receptor-associated factor 6 (TRAF6), an E3 ubiquitin ligase pivotal in immune and inflammatory signaling, has been implicated in various malignancies. However, its role in radioresistance in cervical cancer remains unclear. Methods: TRAF6 expression was evaluated in cervical cancer tissues from 162 patients who underwent postoperative radiotherapy at our institution and in 304 cases from the TCGA-CESC cohort. The prognostic significance of TRAF6 was assessed using Kaplan-Meier and Cox regression analyses. A nomogram integrating TRAF6 expression with clinicopathological factors was constructed to predict overall survival (OS) and progression-free survival (PFS). The functional role of TRAF6 in malignant phenotypes and radiosensitivity was investigated using shRNA-mediated knockdown in HeLa and C33A cervical cancer cells. Immune cell infiltration patterns associated with TRAF6 expression were analyzed using ssGSEA and xCELL algorithms based on TCGA data. Results: TRAF6 expression was significantly elevated in cervical cancer tissues compared with adjacent normal tissues (70.99% vs. control, P < 0.001) and was higher in radioresistant than in radiosensitive patients (P < 0.001). High TRAF6 expression was associated with shorter OS (HR = 18.73, P = 0.004) and PFS (HR = 8.44, P < 0.001) and was identified as an independent risk factor for radiotherapy resistance (OR = 8.44, P < 0.001). The TRAF6-integrated nomogram demonstrated good predictive accuracy for OS (C-index = 0.7351) and PFS (C-index = 0.7444). TRAF6 knockdown in cervical cancer cells significantly suppressed proliferation, migration, and invasion, while substantially enhancing radiosensitivity of tumor cells. Functional enrichment analysis revealed that TRAF6-related genes were enriched in autophagy, mitophagy, and HPV infection pathways. Immune cell infiltration analysis showed that TRAF6 expression correlated with distinct immune cell profiles, characterized by enrichment of activated dendritic cells, M1 macrophages, and regulatory T cells, alongside depletion of cytotoxic effectors such as CD8+ T cells and {gamma}{delta} T cells. Conclusions: TRAF6 could be a prognostic biomarker associated with poor outcomes and indicator of radiotherapy resistance in cervical cancer, TRAF6 represents a potential therapeutic target for overcoming radioresistance in cervical cancer.

Introduction: This study aimed to provide population level survival trends during the era in which new systemic therapies transformed treatment guidelines for metastatic cancer, as well as insights on the real world use of these treatments and associated survival. Methods: Adults diagnosed with synchronous metastatic solid cancer in 2008 until 2022 (22 cancer types) were identified from the Netherlands Cancer Registry. Median overall survival (OS) was assessed by five year diagnostic period. For 2018 until 2022, systemic therapy use in any treatment line was analyzed and survival percentiles within treatment and cancer types were estimated with Kaplan Meier survival analyses. Results: Median OS in the overall cohort (n=280,419 patients) improved from 6 to 8 months between the period 2008 until 2012 and 2018 until 2022. Among patients diagnosed in 2018 until 2022, 15% received immunotherapy, 15% targeted therapy, 29% chemotherapy and/or traditional hormone therapy only, and 39% no systemic therapy. In some cancer types, a relatively large proportion of treated patients had longterm survival (e.g., immunotherapy in melanoma: p50 = 67 months). Other cancer types had a smaller subset of treated patients (p10 and p25) with substantially better outcomes than the median (e.g., targeted therapy in NSCLC: p50 = 22 months, p10 = 96 months). Conclusion: Population level survival for patients with synchronous metastatic solid cancer has modestly improved over time. The marked survival heterogeneity within cancer and treatment types highlights both the potential and uncertainty associated with (novel) treatments. Improved prediction of treatment effects and clear communication regarding survival expectation remain critical. Presenting multiple survival scenarios over median survival alone can support decision making.

T2, an N4-aryl-substituted thiosemicarbazone, has previously been shown to exert cytotoxic and anti-invasive effects in triple-negative breast cancer (TNBC) and to increase expression of the metastasis suppressor N-myc downstream-regulated gene 1 (NDRG1). Given the role of NDRG1 in regulating epithelial-mesenchymal transition (EMT) and WNT/{beta}-catenin signaling, we investigated the contribution of this pathway to the anti-invasive activity of T2. The effects of T2 on WNT/{beta}-catenin signaling and associated microRNAs (miR-182-5p and miR-200c) were evaluated in 4T1 cells. In vivo activity was assessed using a fully immunocompetent intraductal 4T1 mouse model that recapitulates the progression from ductal carcinoma in situ (DCIS) to invasive ductal carcinoma (IDC). Tumor progression, invasion, NDRG1 expression, and WNT/{beta}-catenin pathway components were analyzed. T2 reduced WNT/{beta}-catenin signaling and modulated the expression of miR-182-5p and miR-200c in vitro. In the MIND model, T2 decreased the frequency of invasive lesions and reduced {beta}-catenin, ZEB1, and c-Myc expression while increasing NDRG1 levels. {beta}-catenin localization differed between lesion types, showing predominantly membrane-associated staining in DCIS lesions and a diffuse cytoplasmic distribution in invasive foci. These findings identify WNT/{beta}-catenin signaling and NDRG1-associated pathways as potential mediators of the anti-invasive effects of T2 in TNBC. The reduction in invasive progression observed in the MIND model supports further investigation of this compound in preclinical models of TNBC.

Purpose/Objective There is paucity of data reporting outcomes of breast cancers with initial internal mammary nodal involvement and no visceral metastases, treated with curative hypofractionated radiotherapy . We report the outcomes from a tertiary centre alongside spatial patterns of recurrences in the above group Material/Methods For this retrospective cross-sectional study, consecutive patients contoured as per the ESTRO 2013 guidelines, treated between 2016-2022 were eligible if their diagnostic imaging demonstrated involvement of the internal mammary nodes. Radiotherapy (40 Gy/15#/3 weeks) was delivered to the residual breast / thoracic wall, SCF region corresponding to the ESTRO lymph node level 4 and internal mammary chain nodes. Residual IMN/ level 4 nodes received a boost of 10Gy/5#. Spatial mapping of sites of recurrence at the local site and three nodal sites (axilla, SCF and IMN) was performed using deformable image registration. Sites of recurrence at the local site and three nodal levels were contoured separately. Volumetric intersection of the recurrent gross tumour volume (GTV_recurrence) with treated clinical target volume (CTV) was calculated. Actuarial overall (OS), disease free survival (DFS) & cumulative incidence of local (LR), regional (RR) and loco-regional recurrence(LRR) were calculated using Kaplan Meier method. Univariate comparison of outcomes with or without residual disease was performed using the log rank test. Results The median age of the 61 eligible women was 49 years. 77% received neoadjuvant chemotherapy and the rest adjuvant chemotherapy. 82% patients had a mastectomy. Axillary lymph node dissection was done in 96.7%. Boosts to residual IMN and SCF nodes were delivered to 21(34.4%) and 2 (3.3%) respectively. Median follow up was 3.6 years. Out of the 61 patients, 42 patients were disease free with an estimated 3 year disease free survival of 75% (95% CI 64, 88%). Spatial mapping of locoregional recurrence was possible in all but 1 patient with local (only) recurrence who was lost to follow-up after mammogram only. Among the patients with loco regional recurrence 1 had recurrence in local site + SCF +axilla, 3 had recurrence in the SCF+axilla, 2 in the SCF+IMN and 1 in the axilla+SCF+IMN. Only one patient had isolated axillary recurrence or isolated SCF recurrence. There were no IMN only recurrences. Among the 8 patients with nodal recurrence, a total of 27 individual GTV_recurrence were identified in the axilla(n=11), SCF(n=11) and IMN (n=5). IMN recurrences showed complete or partial overlap with CTV. SCF recurrences were a mix with predominantly in-field recurrences while axillary recurrences occurred outside the treated volume.Four (6.6%) patients had Grade 2 lymphoedema as documented late side effect. Conclusion Aggressive treatment of IMN disease with adjuvant radiation is effective with good locoregional control. Systemic recurrences are common and may benefit from intensification strategies.

Background: Patients aged [&le;]50 years with early-stage HR+/HER2- breast cancer are considered to have an aggressive disease biology and are treated with chemotherapy. However, a subset may still experience favourable outcomes without chemotherapy. Commercially available prognostic tests help guide such treatment decisions, but most are developed and validated predominantly in Western populations, with an underrepresentation of Asian patients. In this study, we explore the prognostic value of CanAssist Breast (CAB), a proteomic prognostic test, in optimal treatment management of patients aged [&le;]50 years. Methods: This study includes a previously published retrospective cohort. The performance of CAB was evaluated using Kaplan-Meier analysis, with 5-year Distant recurrence-free interval (DRFI) from diagnosis as the endpoint; the study also used multivariate analysis to evaluate the independent prognostic value of CAB. Results: In the retrospective cohort, CAB identified 70% as low-risk (LR) and 30% as high-risk (HR) with DRFI of 93.1% (P<0.0001); further classification showed 64% LR and 36% HR in the Asian and 75% LR and 25% HR in the Caucasian subgroup. In patients with N0 disease, CAB identified 85% as LR and 15% as HR. In N+ patients, CAB identified 49% as LR. All CAB LR patients have an acceptable DRFI of >90% at 5 years from diagnosis. Conclusions: Based on the results presented, CAB adds prognostic value for patients [&le;]50 years and can be used as a treatment guidance tool for these patients.

AbstractAutophagy and Toll-like receptor (TLR) signaling are both implicated in cancer progression, but whether they act as tumor suppressors or promoters remains unclear. To explore this relationship, we investigated the role of autophagy downstream of therapeutic TLR activation in oral squamous cell carcinoma (OSCC). Using the FDA- approved TLR agonists Bacillus Calmette-Guerin (TLR2/4) and imiquimod (TLR7), we assessed their effects in vitro on SCC-4 cells and in vivo in a chemically induced OSCC hamster model. Both agents, alone or in combination with each other or with Monophosphoryl Lipid-A induced robust autophagy, as measured by LC3B staining in vitro and flow cytometry in vivo. Autophagy induction correlated with reduced tumor volume and prolonged survival, with outcomes comparable to cisplatin, the current standard chemotherapeutic, but with less treatment-associated morbidity and mortality. Autophagy was also associated with cisplatin antitumor effects. Notably, imiquimod produced the most pronounced and sustained autophagic and antitumor effects. To our knowledge, this is the first study to directly link the therapeutic efficacy of TLR agonists in OSCC to autophagy modulation, providing both mechanistic and translational insights into their potential as immunotherapeutic agents.

Background: For patients with metastatic gastrointestinal cancers, chemotherapy resistance is a common phenomenon that, if known in advance, would allow for individualized treatment decisions. This study aimed to test the feasibility of developing a deep learning computer vision system that uses laparoscopy images depicting peritoneal surface metastases (i.e., capturing the in-vivo optical appearance of metastases as a summary of their molecular makeup) to predict whether a patient is resistant to standard chemotherapy. Methods: The retrospective observational feasibility study included 35 adult patients who underwent staging laparoscopy for non-colon gastrointestinal adenocarcinoma with biopsy-confirmed peritoneal surface metastases and who underwent chemotherapy as their only treatment modality. Chemotherapy resistance was determined based on each patient's observed cancer-specific survival after controlling for confounders. Results: Of 35 patients, 17 were assigned to the chemotherapy sensitive group and 18 to the chemotherapy resistant group. The study cohort provided 1010 laparoscopy image patches of 101 biopsy-confirmed metastases. A densely connected convolutional neural network with cross-validation provided the best results for correctly predicting chemotherapy resistance at the patient level (accuracy 0.80 (95%CI 0.63-0.92), sensitivity 0.72, specificity 0.88, AUC-ROC 0.78). Saliency maps demonstrated the system's trustworthiness. Conclusion: In this study, a prototype surgical computer vision system designed to determine chemotherapy resistance from operative images of peritoneal surface metastases demonstrated its technical feasibility. Further development and validation in a multi-institutional clinical study are pending.

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas. An obstacle to treating MPNSTs is a lack of effective systemic therapies. Although over 70% of human MPNSTs have lost or inactivated the epigenome regulator polycomb repressive complex 2 (PRC2), its activity and contribution to canine PNST progression remain unclear. This study compared canine peripheral nerve sheath tumors (PNSTs) and human MPNSTs across biological and clinical features, including PRC2 activity. Immunohistochemical analysis was performed for a human tissue microarray of 54 neurofibromas and 139 MPNSTs, and 63 canine PNSTs for H3K27me3, a repressive histone mark deposited by intact PRC2, and H3K27ac, which increases globally upon H3K27me3 loss. To understand the genomic alterations present in canine PNSTs, we analyzed tumor mutation burden, copy number alteration, and transcriptomes of eight canine PNST/normal pairs. The results suggested that H3K27me3 loss and associated gain of H3K27ac epigenetically drive human and canine tumors. These findings warrant further studies to evaluate whether these epigenetic deregulations alter similar gene signatures across species.

Cell confluency is a major determinant of cell-cell communication, protein interactions, access to nutrients, and signalling dynamics, thereby significantly impacting biological outcomes. Lung cancer cells like A549 are widely used as screening models for scientific studies wherein their growth in vitro progress from non-confluent to confluent growth. In this study, we investigated the transcriptomic adaptations associated with the transition of A549 cells from baseline non-confluent to confluent growth. Comparative transcriptomic analysis between confluent and cells at baseline identified 815 upregulated and 671 downregulated transcripts. Pathway enrichment analysis of deregulated transcripts in confluent cells revealed enhanced cholesterol and sterol biosynthetic pathways, along with suppression of chromosomal segregation and mitotic pathways. At confluency, an increased expression of glucose transporters (SLC2, SLC60, and SL37 families) and glycolytic pathways, and a decrease in amino acid transporters (SLC1, SLC7, SLC38, and SLC36) and amino acid metabolic pathways is observed. A reduced one-carbon metabolic signature (SHMT2, DHFR, and MTHFD2) and enhanced fatty acid precursor synthesis (HMGCLL1, ALDH6A1, and AASS) were also observed at confluency. 1H NMR profiling of culture media revealed higher glucose and glutamine utilisation with lactate accumulation during culture maturation. Collectively, the data suggest transcriptome-level rewiring in A549 cells with preferential biosynthesis of lipids and sterols at confluency and underscore the importance of considering culture maturity in cancer biology, metabolism, and therapeutic studies.

Background and Objectives: Robotic-assisted natural orifice specimen extraction surgery (NOSES) is a minimally invasive approach for mid-rectal cancer, but it is technically complex and lacks a standardized operational framework. This study aimed to propose and preliminarily validate a structured modular robotic NOSES II surgical procedure for mid-rectal cancer. Methods: This was a retrospective observational study that consecutively enrolled 11 patients with mid-rectal cancer who underwent modular robotic NOSES-II surgery at our center between December 2024 and August 2025. All procedures were performed by the same surgical team strictly following the predefined six-module structured surgical protocol. Perioperative indicators, pathological outcomes, and patient-reported outcomes (PROs) at 4 to 8 months postoperatively were collected. Key techniques were analyzed via high-definition surgical videos. Results: All 11 procedures were completed successfully without conversion to open surgery. The mean operative time was 299.6 plus or minus 54.2 minutes, and the mean intraoperative blood loss was 94.1 plus or minus50.6 mL. The mean number of harvested lymph nodes was 17.4 plus or minus 8.4, with a 100% R0 resection rate. No severe complications (Clavien-Dindo grade [&ge;] III) occurred. The mean postoperative hospital stay was 8.2 plus or minus 1.5 days. Postoperative PROs indicated good defecatory function, urinary function, and overall quality of life. Conclusions: Preliminary findings demonstrate that the structured modular robotic NOSES-II procedure is safe and feasible for the treatment of mid-rectal cancer. This modular protocol provides a clear and reproducible technical framework for this complex procedure, and it is expected to achieve favorable functional preservation while ensuring oncological radicality.

PurposeThere is an urgent need for improved prognostic tools and biological understanding of chemoradiation resistance in head and neck squamous cell carcinoma (HNSCC). This study established a preclinical imaging dataset aimed at identifying prognostic imaging features from 18F-FDG micro-PET/CT scans in HNSCC mouse models. MethodsThree orthotopic murine models were utilized: two human papillomavirus (HPV)-negative (MOC1, MOC2) and one HPV-positive (MLM1). When tumor volume exceeded 50 mm3, chemoradiation was initiated using cisplatin (5 mg/kg) and image-guided radiation therapy (8 Gy) on days 0 and 7. 18F-FDG micro-PET/CT imaging was performed on day 14. Tumors were manually segmented on PET/CT, and quantitative image features including tumor volume, SUVmean, and SUVmax were extracted. Treatment response was evaluated by relative tumor size on day 11 compared to day 0. Tumor growth and survival were compared across models using multiple-effects model and log-rank. Imaging feature associations were evaluated by Mann-Whitney U tests. Associations between survival, SUVmax, and tumor volume were assessed using Cox proportional hazards modeling and Kaplan-Meier analysis with log-rank testing. ResultsA total of 121 mice were treated and imaged. Significant differences in tumor growth and survival were observed among the three models (p < 0.01 for pairwise growth comparisons; p < 0.0001 for survival). Day 11 treatment response groups demonstrated significantly different growth trajectories following chemoradiation (p < 0.0001). SUVmax was significantly associated with survival (p = 0.0009), whereas SUVmean was not significant (p = 0.13). PET tumor volume demonstrated the strongest association with survival (p < 0.0001). A multivariate Cox proportional hazards model incorporating SUVmax and tumor volume significantly stratified survival risk (p < 0.0001). ConclusionOverall, these findings demonstrate that 18F-FDG PET/CT-derived metrics, particularly SUVmax and tumor volume, are robust predictors of chemoradiation response in orthotopic murine models of HNSCC.

The therapeutic landscape for hepatocellular carcinoma (HCC) is evolving rapidly, necessitating scalable approaches to synthesize the expanding scientific literature. We characterized thematic shifts in HCC treatment and prognosis research by conducting a retrospective bibliometric analysis of influential publications from 2023 and 2024. Using the OpenAlex database, we identified the 50 most highly cited papers from each year based on eighteen-month post-publication citation counts. Large language models were deployed to extract, normalize, and classify concepts from unstructured text into canonical topics and parent themes, enabling quantitative year-over-year frequency comparisons. Analysis of these 100 papers revealed a distinct maturation in research focus. Although broad categories like general immunotherapy remained prevalent, their relative frequency declined in favor of specific dual immune checkpoint regimens, notably CTLA-4 inhibition and the durvalumab plus tremelimumab combination. Concurrently, parent themes related to radiomics, imaging, and health systems exhibited significant growth in the 2024 cohort. These findings demonstrate a thematic transition in high-impact HCC research from foundational immuno-oncology toward optimized combination therapies and precision diagnostics. Furthermore, this study highlights the utility of artificial intelligence-driven bibliometrics for objectively tracking dynamic conceptual shifts in oncology. A web interface for exploring the data is available at https://pri.pepkio.com/.

Background: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by the absence of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression. It is associated with limited targeted treatment options, early relapse, and a high propensity for visceral metastasis. Data describing metastatic patterns and treatment characteristics of TNBC in Nigeria remain limited. Methods: This retrospective descriptive cohort study included 869 patients with TNBC managed at the Medserve-LUTH Cancer Center, Lagos University Teaching Hospital, Nigeria between June 2019 and June 2024. Demographic, clinicopathologic, metastatic, and treatment-related data were extracted from electronic medical records. Descriptive statistics were used to summarize patient characteristics, metastatic patterns, and treatment profiles. Associations between metastatic disease and selected clinicopathologic and treatment variables were explored using Pearsons chi-square test. Complete-case analysis was applied throughout. Results: The mean age at presentation was 52.09 {+/-} 12.26 years. Most patients were married (79.1%), postmenopausal (64.3%), and of Yoruba ethnicity (56.8%). Advanced disease predominated, with Stage III and Stage IV disease accounting for 42.9% and 35.6% of cases, respectively. Invasive ductal carcinoma was the most common histologic subtype (77.0%), while Grade II tumours constituted 51.3% of graded cases. Surgery was performed in 73.1% of patients, predominantly mastectomy (70.9% of surgical procedures). Chemotherapy was administered to 83.2% of patients, most commonly anthracycline-based regimens (41.8%), while radiotherapy was delivered to 63.5% of patients, with hypofractionated schedules of 42-43 Gy in 15-16 fractions accounting for 47.2% of radiotherapy courses. Metastatic disease was documented in 32.9% of evaluable patients. Lung metastasis was the most frequent site (62.5%), followed by bone (46.3%), regional lymph node invasion (38.5%), liver (23.0%), and brain (22.6%). Tumour grade and histologic subtype were not significantly associated with metastatic disease, whereas radiotherapy exposure demonstrated a significant association with metastatic status ({chi}{superscript 2} = 10.35, p = 0.001). Conclusion: TNBC in this Nigerian cohort was characterized by advanced-stage presentation, invasive ductal predominance, extensive use of multimodality treatment, and substantial visceral metastatic burden. Lung metastasis was the most common metastatic site. These findings provide contemporary real-world data on TNBC in Nigeria and highlight the continuing need for earlier diagnosis, timely referral, and sustained investment in comprehensive cancer care services.

Background: Objective assessment of tumor burden in patients with solid tumors remains inexact. Furthermore, while mutation-based liquid biopsies are specific, they are limited by tumor heterogeneity and the requirement for detectable clonal mutations. Cell-free DNA (cfDNA) concentration, a cost-effective substrate for mutation-focused liquid biopsy, has shown promise as a "molecular tumor burden" biomarker. Methods: We analyzed cfDNA concentration from 1000 unique cancer patients using standardized protocols. Demographics, AJCC stage, clinical anatomic tumor burden and oncologic outcome variables were collected. Associations were assessed with non-parametric tests. Multivariable linear regression and Cox proportional hazards models were used to identify independent predictors and survival associations. Results: CfDNA concentration varied broadly (median 6.25 ng/mL; range 0.5-1132.9). Anatomic tumor burden, including tumor number (rho=0.25, p<0.0001) and largest tumor diameter (rho=0.25, p<0.0001), correlated significantly with cfDNA, especially in stage IV disease. Primary tumor site influenced cfDNA levels, with liver/bile duct cancers having higher cfDNA than other sites (median 13.5 vs 6.1 ng/mL, p<0.0001). Multivariable analysis confirmed overall tumor burden and hepatic tumor location (primary or metastatic) as principal drivers of cfDNA. Critically, cfDNA concentration was an independent predictor of shorter PFS (p=0.001) and DSS (p<0.0001), demonstrating increased value in advanced disease settings, irrespective of treatment intent. Conclusions: CfDNA concentration is a robust, biologically integrated biomarker that provides an objective measure of total systemic tumor burden and prognosis in a large, pan-cancer cohort. By capturing disease activity irrespective of mutational status, it offers a valuable adjunct to targeted profiling, particularly in heterogeneous or advanced malignancies. Although these findings require prospective clinical validation, cfDNA concentration may eventually augment patient selection for aggressive versus palliative interventions, especially in advanced disease.