Search Results (34,274)

This review examines the clinical and practical implications of embedding molecular profiles directly into the 2023 FIGO staging system for endometrial carcinoma, in the context of the 2025 ESGO/ESTRO/ESP guidelines. The primary purpose is to navigate a central conflict in modern oncology: how to deliver increasingly personalized care while maintaining a globally accessible, equitable, and standardized cancer classification system. The 2023 FIGO update represents a paradigm shift from the traditional dualistic model (Type I versus Type II) by allowing molecular findings to redefine stage itself. While this integration offers clear benefits, it introduces significant challenges. First, the system depends on advanced molecular testing, creating a “rich-poor” divide where patients in resource-limited settings are systematically overtreated because testing is unavailable. Second, stage becomes unstable, changing with sequential histologic and molecular re-review, which causes confusion for patients and clinicians. Third, the system lumps prognostically distinct histotypes (Serous, Clear Cell, Carcinosarcoma, and Grade 3 Endometrioid) into a single aggressive stage, obscuring meaningful differences in survival. Fourth, it relies on subjective parameters such as “substantial” lymphovascular space invasion, for which no standardized definition exists, leading to high inter-observer variability. After analyzing these controversies, the review proposes a pragmatic solution: decouple anatomical staging from molecular risk stratification. Staging should remain a purely anatomical, universally applicable descriptor of tumor extent, while molecular and histologic data are used separately within a dynamic risk assessment model, as suggested by the European guidelines. This dual-track approach preserves global comparability, reduces inequity, and maintains diagnostic stability, while still enabling personalized treatment where advanced diagnostics are available. Full article

Background/Objectives: Prognostic stratification of stage I endometrioid-type endometrial cancer remains imperfect when based on clinicopathological variables alone. This retrospective study evaluated immunohistochemical markers reflecting stress adaptation, inflammatory signaling, autophagy regulation, and apoptotic balance, and developed an exploratory Endometrioid Immunohistochemical Prognostic Score (EIPS) based on SIRT1, HMGB1, Bcl-2, and Caspase-3 expression. Methods: Using surgical specimens from 139 patients with stage I endometrioid-type endometrial cancer, EIPS was calculated by assigning one point for high SIRT1, high HMGB1, high Caspase-3, and low Bcl-2 expression. Associations with overall survival and model discrimination were evaluated using Kaplan–Meier analysis, Cox regression, ridge-penalized multivariable modeling, and ROC/AUC analysis. Results: During a median follow-up of 1577 days, 12 deaths occurred. High SIRT1, HMGB1, and Caspase-3 expression were associated with poorer overall survival, while low Bcl-2 was retained as a biologically plausible adverse component. EIPS stratified patients into ordered low-, intermediate-, and high-risk groups with increasing event rates and showed higher apparent mortality discrimination than the predefined LVSI/grade-based clinicopathologic grouping (AUC = 0.857 vs. 0.756). IE-EIPS provided a modest additional apparent improvement in discrimination (AUC = 0.876). Conclusions: EIPS may offer prognostic stratification in stage I endometrioid-type endometrial cancer by integrating biologically complementary immunohistochemical markers. Full article

Background/Objectives: Idiopathic Carpal Tunnel Syndrome (CTS) can be an early manifestation of systemic amyloidosis, particularly transthyretin cardiac amyloidosis (ATTR-CA). The primary purpose of this retrospective case series was to describe the presence of amyloid deposits in tenosynovial tissue and explore potential cardiac involvement in patients undergoing carpal tunnel release surgery. Methods: From a cohort of 54 patients diagnosed with bilateral idiopathic CTS with surgical indication, 12 patients were selected for tenosynovial tissue samples, which were subsequently evaluated using Congo red staining and proteomic confirmation via mass spectrometry. Before the procedure, patients underwent a clinical assessment of medical history, electrocardiogram, and cardiac scintigraphy with Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD). Transthoracic echocardiogram and cardiac magnetic resonance were subsequently performed in all patients with positive scintigraphy, while a subset of scintigraphy-negative patients underwent an echocardiogram. Results: Congo red staining identified amyloid deposits in 3 of the 12 patients (25%). Proteomic analysis confirmed ATTR amyloidosis deposits in 2 of these patients (17%). One of these 2 patients presented Perugini grade 3 uptake on cardiac scintigraphy, suspicious for ATTR-CA. Complete concordance across histology, proteomics, and cardiac imaging was observed in only 1 patient (8.3%). Three discordances were noted: one case of tenosynovial ATTR without evident cardiac disease, one patient with a discordant Congo red result likely reflecting low amyloid burden or tissue heterogeneity, and one with imaging findings suspicious for ATTR-CA despite a negative tenosynovial biopsy. Conclusions: Tenosynovial biopsy obtained during CTS surgery can reveal early amyloid deposition, which may precede overt cardiac involvement. The variability observed across findings underscores the need for a multimodal diagnostic approach that integrates histological, proteomic, and imaging data, thereby mitigating the risk of amyloidosis misclassification. Full article

The universal operator-growth hypothesis (OGH) states that, in a closed chaotic system, the Lanczos coefficients grow linearly, $b_n\simeq \alpha n$. We ask how this structure is modified when the system is coupled to a Markovian environment, so that the generator becomes non-Hermitian. Applying the Arnoldi recursion to the vectorized Lindbladian in the infinite-temperature Wightman inner product, we organize the resulting pair of growth rates ${\alpha }_{\mathbb{C}}\equiv {\alpha }_R+i{\alpha }_I$—defined as effective slopes of the sub-diagonal and diagonal Arnoldi coefficients over a pre-registered fit window—around two statements whose logical status we delimit precisely. First, whenever the dissipator acts as $\mathcal{D}=-2\gamma \widehat{G}$ with $\widehat{G}$, a Hermitian grading (all dephasing-type baths), the diagonal obeys the identity $\mathrm{Re}{a}_n=-2\gamma {⟨\widehat{G}⟩}_n$: the imaginary rate measures how fast the growing operator accumulates weight in the dissipation channels. Second, we prove a conditional parity theorem: if the Hamiltonian, jump operators, and seeds can be made simultaneously real in some basis (an antiunitary condition), then $b_n$ is even, and $\mathrm{Re}{a}_n$ is odd in $\gamma$ exactly, so ${\alpha }_R$ is renormalized only at $O\left({\gamma }^2\right)$, and ${\alpha }_I=2{\kappa }_0\gamma$ follows from closed-system data alone. We exhibit a one-qubit Lindbladian that satisfies the often-assumed generator symmetry ${\mathcal{G}}^{†}\left(\gamma \right)=-\mathcal{G}(-\gamma )$ yet violates parity ($b_1=|1-\gamma |$), showing that the extra condition is essential; all models studied here satisfy it bit-exactly. For large-q SYK, these ingredients predict ${\alpha }_{\mathbb{C}}=J^{(-)}2i(q-2)\gamma$, whose imaginary part is fixed solely by the interaction range; the first ladder step is exact, and the multi-step increments approach $q-2$ with system size ($1.92\pm 0.04$ at $N=12$, $q=4$). Under a common fit protocol, the closed-system rates saturate by $N=10$ (${\alpha }_R\left(0\right)\to 0.437$, $2{\kappa }_0\to 0.224$). The imaginary rate is not an independent observable at leading order—its content is its sign, which resolves how the growing operator meets its environment (opposite for spin chains and SYK). Full article

Background/Objectives: Movement- and arts-based experiences are frequently promoted as developmentally appropriate contexts for supporting cognition in early childhood, but effects may differ across executive-function domains, pedagogical formats and study contexts. Methods: This PRISMA 2020 systematic review and meta-analysis was registered in PROSPERO (CRD420261363924). PubMed/MEDLINE, Web of Science, Scopus, ERIC, PSICODOC, CINAHL and SPORTDiscus were searched from inception through April 2026. One immediate-post effect per Study ID and core domain was retained. Random-effects models used restricted maximum likelihood with Hartung–Knapp adjustment. Study-level risk of bias was assessed with RoB 2 or ROBINS-I, missing-evidence risk with ROB-ME and certainty with GRADE. Intervention content, pedagogical format and embedded cognitive demands were also coded descriptively. Results: The review included 130 reports representing 125 unique studies. Fifteen Study IDs contributed 29 core effects: 10 for inhibition (n = 675), 10 for working memory (n = 697) and nine for cognitive flexibility (n = 642). Twelve core programmes were primarily structured, and three used guided-play/structured-hybrid formats; no free/unstructured-play intervention entered the meta-analysis. Mean effects favoured the intervention for inhibition (Hedges’ g = 0.52, 95% CI 0.15 to 0.90), working memory (g = 0.42, 95% CI 0.09 to 0.75) and cognitive flexibility (g = 0.60, 95% CI 0.22 to 0.98). Heterogeneity was substantial, and all 95% prediction intervals crossed the null. Estimates remained favourable after excluding Serious risk-of-bias judgments. Age-exclusion and ICC-sensitivity analyses retained positive effects; a worst-case exclusion of unadjusted class- or cluster-assigned studies reduced precision for inhibition and working memory. SMD-specific modified-precision regressions did not indicate small-study associations for inhibition (p = 0.529) or working memory (p = 0.619); cognitive flexibility was not formally tested because k = 9. ROB-ME indicated some concerns, and GRADE certainty was low for all three domains. Conclusions: Favourable average effects should not be attributed to movement or arts participation per se. Pedagogical structure and embedded cognitive demands may influence outcomes, but substantial inconsistency, unit-of-analysis uncertainty and low certainty preclude identification of a superior model. Funding: There was no external funding. Full article

Gut-derived indole metabolites are implicated in the gut–kidney axis, but the factors controlling the intestinal conversion of indole-3-acetic acid (IAA) to skatole remain incompletely defined. We developed a deterministic, hypothesis-generating framework that represents this conversion as a finite-pool allocation process governed by $\mathrm{pH}$-dependent ecological permissiveness, terminal-conversion capacity, precursor availability, spatial progression, and competing loss. The model separates the available-pool scale from a dimensionless integrated conversion exposure, $\Psi$. Across 5400 loss-free scenarios spanning 10 pH profiles and graded metabolic and host-associated constraints, the distal endpoint normalized to the available pool followed the analytically derived relationship $1-\exp \left(-\Psi \right)$. Thus, distinct combinations of mechanistically relevant parameters produced the same normalized distal endpoint, demonstrating that this endpoint alone cannot uniquely identify the underlying mechanism. Competing loss further separated absolute, total-pool-normalized, and conditional outputs, showing that mechanistic interpretation depends on endpoint normalization. Analytical and numerical checks supported internal consistency. The framework was not fitted to biological data, and concentration values were used only as technical scaling references. This biologically unvalidated model generates experimentally testable hypotheses regarding the roles of $\mathrm{pH}$, terminal-conversion capacity, precursor availability, and competing loss in intestinal IAA-to-skatole metabolism; it is not intended to provide physiological or clinical predictions. Full article

Background/Objectives: Primary biliary neuroendocrine tumors (PBilNETs) are exceptionally rare biliary tract neoplasms that are frequently misdiagnosed preoperatively as cholangiocarcinoma because of overlapping clinical and radiological findings. This systematic review aimed to summarize overall evidence regarding presentation, diagnostic evaluation, surgical management, and outcomes of PBilNETs. Methods: A systematic search of PubMed, Scopus, and Embase databases was performed according to PRISMA guidelines for studies published between January 2000 and December 2025. Studies including adult patients with histologically confirmed and surgically treated PBilNETs were eligible. Data regarding demographics, symptoms, imaging findings, surgical treatment, histopathology, immunohistochemistry, and outcomes were extracted and analyzed. Results: Fifty-eight studies involving 79 patients met the inclusion criteria. Median age at diagnosis was 49 years, with female predominance. Obstructive jaundice, abdominal pain, and pruritus were the most common presenting symptoms. Most tumors originated from the hilar or extrahepatic bile ducts. Preoperative diagnosis was challenging, as most lesions were initially considered cholangiocarcinomas. Surgical resection was the main therapeutic approach and included bile duct excision with biliary reconstruction, pancreaticoduodenectomy, or hepatic resection according to tumor location. Histopathological analysis demonstrated predominantly well- or moderately differentiated neuroendocrine neoplasms with frequent chromogranin A and synaptophysin positivity. Favorable long-term outcomes were reported, with high postoperative survival and limited recurrence during follow-up. Conclusions: PBilNETs remain diagnostically challenging because of their rarity and nonspecific presentation; however, they appear to exhibit a less aggressive biological behavior than conventional biliary adenocarcinomas. Surgical resection remains the cornerstone of treatment, while further multicenter studies are required to optimize diagnostic and therapeutic strategies. The findings also support an individualized multidisciplinary approach integrating clinical presentation, advanced imaging, histopathological grading, and immunohistochemical profiling to optimize personalized management of these rare tumors. Full article

Background: While live-cell therapies face significant translational hurdles, cell-free secretomes derived from fetal progenitor cells offer a unique, scalable approach natively programmed for scarless tissue repair. Methods: This GLP-compliant study evaluated the therapeutic efficacy spectrum of an off-the-shelf, clinical-grade, intratracheal lyophilized FE002-Lu lung fibroblast conditioned medium (LFCM) across five controlled Wistar rat models of induced lung injury: bleomycin (5 mg/kg), asbestos (100 µg/rat), hyperoxia (100% oxygen exposure), silica (30 mg/rat), and lipopolysaccharide (LPS, 4 mg/kg). Following lung injury induction and symptom onset, symptomatic rats were randomized to receive intratracheal LFCM (low, mid, or high dose) or a vehicle control every 4 days for 28 days. Results: The intervention demonstrated an exceptional safety profile, maintaining 100% survival with no severe procedural toxicity across all cohorts. Across all study arms, LFCM effectively attenuated pulmonary inflammation, reducing pro-inflammatory markers (IL-1β, IL-6, TNF-α, and CINC-1) in bronchoalveolar lavage fluid. Concurrently, high LFCM doses consistently elevated the anti-inflammatory cytokine IL-10. Within the lung tissue, mid- and high doses significantly reduced key pro-fibrotic drivers, including TGF-β1, TIMP-1, WISP-1, and hydroxyproline. Treatments consistently decreased α-SMA expression and pro-fibrotic gene mRNA levels, mitigating pulmonary myofibroblast activation. This correlated with reduced Ashcroft scores and collagen deposition, thereby preserving lung architecture. Notably, the FE002-Lu LFCM treatment exerted a biphasic regulation of extracellular matrix turnover: it elevated Cathepsin-D and MMP-12 in the bleomycin arm to actively clear newly deposited fibrotic debris, while reducing these markers in the hyperoxia and LPS arms to prevent acute collateral degradation of the native lung matrix. In both particulate models (asbestos and silica), the LFCM mid-dose established an optimal therapeutic threshold, avoiding the localized secretome saturation and pro-fibrotic exacerbation occasionally observed at higher doses. Conclusions: Lyophilized FE002-Lu LFCM acts as a potent, pleiotropic biologic that effectively resolves acute pulmonary inflammation and arrests progressive fibrotic remodeling across multiple distinct in vivo models. By overcoming the cold-chain and delivery limitations inherent to pulmonary live-cell therapies, this stable, cell-free secretome represents a highly scalable, “off-the-shelf” candidate poised for non-invasive, aerosolized clinical translation. Full article

Clinical practice guidelines require expert synthesis that large language models (LLMs) might partly automate, yet their ability to reproduce clinically actionable recommendations is poorly quantified. We evaluate an LLM (Claude Sonnet 4.6) against the 103 recommendations of the Spanish enhanced-recovery guideline Vía RICA 2026, grouped in 17 bundles. The model used the panel’s own closed corpus (617 documents) in a multilingual retrieval-augmented generation pipeline. Concordance was assessed twice: by optimal 1:1 bipartite matching (Hungarian) on cosine similarity, and by an LLM-as-a-judge clinical adjudicator (Claude Haiku 4.5) validated against a three-clinician panel (Fleiss’ κ = 0.538). The two schemes bracket a micro F₁ of 0.61–0.69 and reveal four findings: (i) a systematic granularity bias, producing 1–8 recommendations per bundle regardless of ground-truth size; (ii) failure of cosine similarity to discriminate within narrow clinical domains; (iii) high reference-concordance precision (0.70–0.81) despite low exhaustiveness; and (iv) no transfer of the GRADE fields, evidence level agreeing no better than chance and strength systematically downgraded. An eight-fold larger retrieval budget left it intact. A corpus audit found 25 documents that formulate recommendations; excluding them lowers judged micro F₁ to 0.602. The results delimit the current utility of generative AI for guideline development. Full article

Plastic waste management remains a major challenge, and the mechanical recycling of polyethylene (PE) is complicated by the coexistence of HDPE, LDPE, and LLDPE grades that are difficult to separate. This review critically examines the miscibility, apparent miscibility, compatibility, and crystallization behavior of PE blends, with an emphasis on linear viscoelastic rheology and thermal analysis. Rheological criteria, including additivity, Cole–Cole, time–temperature superposition, Han, and van Gurp–Palmen analyses, were evaluated, together with DSC and successive self-nucleation and annealing. Most studies indicate that HDPE/LDPE blends are melt-immiscible. HDPE/LLDPE blends more frequently exhibit apparent melt miscibility when LLDPE has low short-chain branching, typically below 15 branches per 1000 carbon atoms, and relatively low molar mass; increasing molar mass generally promotes immiscibility. LDPE/LLDPE behavior is less systematic and depends on branch content and distribution, molar mass, and catalyst-controlled molecular architecture. Crystallization does not necessarily mirror melt miscibility. HDPE/LLDPE co-crystallization is generally favored at high HDPE contents but strongly depends on branching, comonomer type, and cooling conditions, while LDPE/LLDPE may co-crystallize despite apparent melt immiscibility. These trends provide practical guidelines for designing recycled PE blends with more predictable processing and properties. Full article

Background: The rotator cable is thought to contribute to load transmission and preservation of shoulder function in rotator cuff tears; however, its detectability on arthroscopy and magnetic resonance imaging (MRI), agreement between these modalities, and clinical relevance remain incompletely defined. This study evaluated rotator cable visibility on arthroscopy and MRI, factors associated with arthroscopic cable visibility, and its relationship with preoperative active shoulder motion. Methods: This retrospective cross-sectional study included 128 patients who underwent shoulder arthroscopy for supraspinatus tears between January 2019 and February 2023. Arthroscopic video recordings were reviewed for rotator cable visibility. Standardized preoperative MRI review was available in 58 patients. Agreement between MRI and arthroscopic visualization was assessed using Cohen’s kappa and percentage agreement measures. Multivariable binary logistic regression was performed to identify factors independently associated with arthroscopic cable non-visibility. Results: The rotator cable was visible arthroscopically in 79 of 128 patients (61.7%) and on MRI in 38 of 58 patients (65.5%). Overall agreement between MRI and arthroscopy was 67.2% (95% CI, 53.7–79.0%), with a Cohen’s kappa of 0.315 (95% CI, 0.090–0.540; p = 0.011), indicating fair agreement. Positive and negative percent agreement were 78.8% and 52.0%, respectively. Although increasing age was associated with cable non-visibility in univariable analysis, this association did not remain statistically significant after multivariable adjustment. Higher Lafosse grade was independently associated with cable non-visibility in the overall cohort (adjusted OR, 1.43 per grade; 95% CI, 1.04–1.97; p = 0.028), whereas increasing tear size was independently associated with cable non-visibility among patients with full-thickness tears (adjusted OR, 2.78 per category; 95% CI, 1.19–6.52; p = 0.019). The unadjusted association between massive tear size and reduced MRI cable visibility did not remain significant after false discovery rate adjustment (q = 0.276). No statistically significant associations were detected between cable visibility or MRI-measured cable dimensions and preoperative active abduction or forward elevation. Conclusions: MRI and arthroscopy demonstrated fair agreement in the assessment of rotator cable visibility. After multivariable adjustment, cable non-visibility was more closely associated with tear-related characteristics than with patient age. No statistically significant associations were detected between cable characteristics and the assessed preoperative range-of-motion measures; however, smaller or moderate associations cannot be excluded, particularly within the MRI subgroup. Rotator cable visibility should primarily be interpreted as a marker of detectability and tear morphology rather than as a direct surrogate for structural integrity or shoulder function. Full article

Background: Inverted-bearing reverse total shoulder arthroplasty (rTSA), using a polyethylene glenosphere with a metal humeral liner, may reduce polyethylene wear, osteolysis, and scapular notching. This study evaluated long-term survivorship, complications, radiographic findings, and clinical outcomes of a large-glenosphere inverted-bearing rTSA design. Methods: A retrospective single-surgeon cohort included 394 primary rTSAs (363 patients; mean age 73.8 ± 8.5 years) performed between 2006 and 2018 using the same implant system. Clinical follow-up was available for 123 patients at a mean of 9.4 years. Outcomes included ASES, Oxford Shoulder Score (OSS), Subjective Shoulder Value (SSV), and pain VAS. Radiographs obtained at ≥8 years were assessed for scapular notching, glenoid loosening, and humeral osteolysis/stress shielding. Kaplan–Meier survival analysis was performed. Results: Thirty of the 257 rTSAs with revision follow-up (11.7%) underwent revision, most commonly for glenoid loosening or instability. Among patients with long-term radiographs, scapular notching occurred in 8.3% of all-polyethylene glenospheres and was limited to grade 1. Humeral osteolysis/stress shielding was present in 36%, although no humeral components were revised for loosening. Median final follow-up PROMs were ASES 75.8, OSS 42, SSV 78, and pain VAS 1. Conclusions: Large-glenosphere inverted-bearing rTSA demonstrated satisfactory long-term outcomes, low notching rates, and acceptable survivorship. The favourable notching profile should be interpreted in the context of the larger eccentric glenosphere design, which precludes attribution of this finding to bearing material alone. Full article

Cardiac surgery-associated acute kidney injury (CS-AKI) increases short- and long-term mortality, progression to chronic kidney disease (CKD), and healthcare costs. Its pathogenesis is multifactorial—combining renal hypoperfusion, impaired oxygen delivery, hemodilution, inflammation, ischemia–reperfusion injury, and nephrotoxin exposure—so no single intervention confers universal protection. This narrative review appraises fourteen perioperative prevention strategies, grading each by study design, reproducibility, and concordance with contemporary guidelines. The strongest actionable evidence supports the preservation of renal oxygen delivery during cardiopulmonary bypass through goal-directed perfusion, perioperative amino acid infusion, and biomarker-guided Kidney Disease: Improving Global Outcomes (KDIGO) care bundles. Remote ischemic preconditioning, pulsatile flow, minimally invasive extracorporeal circulation, dexmedetomidine, N-acetylcysteine, levosimendan, hemoadsorption with the oXiris membrane, and natriuretic peptides show variable or subgroup-dependent signals limited by heterogeneous trial design and acute kidney injury (AKI) definitions. Prevention of CS-AKI is, therefore, best conceived as a multimodal, patient-centered process integrating preoperative risk stratification, intraoperative oxygen delivery optimization, patient blood management (PBM), and postoperative nephrotoxin avoidance and surveillance. Full article

Background: In-office dental bleaching is a common aesthetic procedure, and different application methods may influence laboratory and clinical outcomes. Objectives: This systematic review and meta-analysis evaluated the effects of applicator brush use compared with conventional application without a brush during in-office hydrogen peroxide bleaching. Methods: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023491451). Electronic searches were conducted in PubMed, Cochrane Library, LILACS, and OpenGrey for studies published until April 2026. Clinical and in vitro studies comparing bleaching gel application with and without an applicator brush were included. Outcomes included hydrogen peroxide concentration in the pulp chamber, bleaching gel consumption, color change, and tooth sensitivity. Risk of bias was assessed using RoB 2 for the randomized clinical trial and the Sarkis-Onofre tool for in vitro studies. Meta-analyses were performed using RevMan, and certainty of evidence was assessed using the GRADE approach. Results: Of 10,260 records identified, four studies met the eligibility criteria, including one randomized clinical trial and three in vitro studies. Quantitative synthesis was based exclusively on the three in vitro studies. The randomized clinical trial showed low risk of bias, whereas the in vitro studies presented methodological limitations. Meta-analyses showed no statistically significant differences between applicator brush and conventional application methods for hydrogen peroxide concentration in the pulp chamber or bleaching gel consumption, although pooled estimates showed a tendency toward lower values with applicator brush use. No significant differences were observed in color change outcomes assessed by ΔEab, ΔE00, or ΔWID (p > 0.05). Heterogeneity ranged from 0% to 99%, and the certainty of evidence for all outcomes was rated as very low. Conclusions: Based on predominantly laboratory evidence of very low certainty, applicator brush use may be associated with lower hydrogen peroxide concentration in the pulp chamber and reduced bleaching gel consumption; however, these findings should be interpreted cautiously, and the clinical relevance of this application method remains uncertain. Full article

Background: Sarcopenia, systemic inflammation, and malnutrition are established poor prognostic factors in renal cell carcinoma (RCC). This study investigated the utility of a novel preoperative score combining psoas muscle density (PMD)—an imaging-based indicator of muscle quality—and the albumin–bilirubin (ALBI) grade—a blood-based biomarker of liver reserve and systemic nutritional status—for predicting disease-free survival (DFS) and overall survival (OS) in patients undergoing curative surgery for RCC. Methods: This retrospective observational study included 274 patients with non-metastatic RCC treated with radical or partial nephrectomy. Preoperative computed tomography was utilized to measure PMD, defining “low PMD” as a value below the sex-specific median (males: 47.75 Hounsfield Units [HU]; females: 46.25 HU). “Worsened ALBI” was defined as an ALBI grade ≥ 2. Patients were stratified into three risk categories: Score 0 (both normal, n = 122), Score 1 (either abnormal, n = 114), and Score 2 (both abnormal, n = 38). Results: Kaplan–Meier analysis revealed a highly significant, stepwise decline in both DFS and OS as the risk score increased (log–rank p < 0.001 and p = 0.004, respectively). Multivariate Cox regression identified the combined risk score as a robust, independent prognostic factor for DFS (Score 1: HR 1.93, 95% CI 1.11–3.37, p = 0.020; Score 2: HR 3.58, 95% CI 1.82–7.02, p < 0.001). Furthermore, after adjusting for age and comorbidities, the score remained an independent predictor of poor OS (Score 1: HR 2.35, 95% CI 1.08–5.13, p = 0.032; Score 2: HR 3.01, 95% CI 1.16–7.82, p = 0.024). The combined model synergistically enhanced risk stratification accuracy compared to evaluating either factor independently. Conclusions: The concurrent presence of preoperative low PMD and a worsened ALBI grade is a powerful, independent predictor of poor prognosis in localized RCC. Derived solely from routine preoperative imaging and laboratory tests, this straightforward scoring system effectively captures the structural and immunometabolic dimensions of cancer cachexia and host vulnerability. This tool can significantly aid in personalizing postoperative surveillance strategies and identifying high-risk patients who may warrant closer postoperative surveillance or who might be considered as high-risk candidates for adjuvant therapy discussions. Full article