Current Oncology

Background: Circulating tumor DNA is a promising biomarker for molecular residual disease and recurrence surveillance in biliary tract cancers. We evaluated the association between postoperative tumor-informed ctDNA and recurrence-free survival (RFS) and assessed the performance of initial and longitudinal ctDNA surveillance. Methods: We performed a single-institution retrospective cohort study of 51 patients with resected non-metastatic biliary tract cancers who underwent postoperative ctDNA testing. Kaplan–Meier, log-rank, univariable Cox regression, and limited multivariable Cox regression analyses were used to evaluate associations between ctDNA status and RFS. A 3-month landmark sensitivity analysis was performed to address time-related bias. Results: Twenty-five patients (49.0%) developed recurrence. Recurrence occurred in 18 of 20 patients (90.0%) with postoperative ctDNA positivity compared with 7 of 31 patients (22.6%) without ctDNA positivity. Median RFS was 10.8 versus 47.4 months, respectively. Postoperative ctDNA positivity was associated with shorter RFS (HR, 7.85; 95% CI, 3.03–20.29; p < 0.001). In a pre-specified multivariable Cox model adjusting for stage III/IV disease and CA 19-9 > 37 U/mL, postoperative ctDNA positivity remained associated with shorter RFS (adjusted HR, 5.09; 95% CI, 1.82–14.26; p = 0.002). Longitudinal ctDNA surveillance demonstrated a sensitivity of 72.0%, specificity of 92.3%, PPV of 90.0%, and NPV of 77.4% for recurrence. Median lead time to recurrence was 69.5 days. In a 3-month landmark cohort of 37 evaluable patients, postoperative ctDNA positivity was associated with shorter subsequent RFS after exploratory adjustment for stage and CA 19-9 (adjusted HR, 6.45; 95% CI, 1.47–28.34; p = 0.014). Conclusions: Postoperative ctDNA positivity was associated with recurrence and shorter RFS. Longitudinal ctDNA surveillance improved recurrence detection and frequently preceded clinically documented recurrence.

Background/Objectives: The prognostic significance of pre-existing diabetes mellitus (DM) in surgically treated oral cavity cancer remains uncertain. We evaluated the association between recorded pre-existing DM and 5-year overall survival. Methods: Adults with a first recorded oral cavity cancer diagnosis who underwent cancer-directed surgery within 6 months were identified in the TriNetX Research Network. The recorded DM was defined by ICD-10-CM codes E08–E13 before cancer diagnosis. Survival was evaluated from cancer diagnosis and, in a complementary analysis addressing guarantee-time bias, from the first qualifying surgery. Multivariable Cox regression and 1:1 propensity score matching were applied. Results: The diagnosis-indexed cohort included 2304 patients with recorded DM and 25,195 without recorded DM. DM was not associated with mortality in the unmatched analysis (HR 1.05, 95% CI 0.953–1.146), after multivariable adjustment (adjusted HR 1.081, 95% CI 0.977–1.196), or after matching (2242 patients per group; HR 0.997, 95% CI 0.878–1.131). In the surgery-indexed matched analysis (2298 patients per group), recorded DM was associated with a lower observed mortality hazard (HR 0.83, 95% CI 0.734–0.934). An E11-only sensitivity analysis yielded consistent findings. Conclusions: Recorded pre-existing DM was not associated with inferior 5-year overall survival. DM alone should not justify withholding or delaying surgery in otherwise appropriate candidates, although metabolic and systemic comorbidities should be optimized. The lower surgery-indexed mortality hazard likely reflects selection and residual confounding and should not be interpreted as a protective effect of DM.

Background: Although outcomes following autologous breast reconstruction (ABR) have been evaluated across body mass index (BMI) cohorts, patient-reported outcomes remain understudied. This study aimed to compare 1-year BREAST-Q scores and complication rates across BMI cohorts following ABR. Methods: All female patients ≥ 18 years who underwent ABR from January 2010 to December 2024 were included. Patients were stratified into three BMI cohorts: <21, 21–25, and >25–30. The primary outcome was 1-year BREAST-Q scores, and secondary outcomes included postoperative complications. Results: A total of 2366 patients were included: 263 with BMI < 21, 936 with BMI 21–25, and 1167 with BMI > 25–30. DIEP flap was the predominant flap (72%), followed by TRAM flaps (13%). At 1-year, patients with BMI < 21 demonstrated higher Physical Well-being: Chest scores (85 vs. 76 vs. 76; p = 0.007) and Physical Well-being: Abdomen scores (76 vs. 70 vs. 69; p < 0.001). Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being did not differ significantly across cohorts (p > 0.05). Mastectomy skin flap necrosis rates were lowest in the BMI < 21 cohort (5.7%; p = 0.029), and 30-day readmission rates were lowest in the BMI 21–25 cohort (5.0%; p = 0.033). All other complications were comparable across groups. Conclusions: Physical well-being scores at 1 year favored lower-BMI patients, while breast satisfaction, psychosocial well-being, and sexual well-being were equivalent across cohorts. These findings may inform preoperative counseling regarding physical recovery expectations in higher-BMI patients, while suggesting BMI in this range is not a primary driver of patient-reported satisfaction.