Search Results (2,473)

Background/Objectives: Mortality among patients receiving maintenance hemodialysis remains high, and biomarkers that allow early risk stratification are needed. Serum albumin reflects nutritional status and systemic inflammation and has been associated with adverse outcomes; however, its long-term prognostic significance remains incompletely defined. This study examined the association between baseline serum albumin and long-term (up to 10-year) all-cause mortality in a large hemodialysis cohort. Methods: This retrospective cohort study included adult patients undergoing maintenance hemodialysis between 2015 and 2025 at a tertiary nephrology center. Individuals with at least three months of stable dialysis and available baseline serum albumin measurements were included. Patients were categorized into two groups according to baseline serum albumin levels (<3.5 g/dL and ≥3.5 g/dL). The primary outcome was long-term (up to 10-year) all-cause mortality, while secondary outcomes included emergency department visits, hospital admissions, cardiovascular events, and infection-related hospitalizations. Survival was assessed using Kaplan–Meier analysis, and predictors of mortality were evaluated using Cox proportional hazards regression. The median follow-up duration was 54 months (interquartile range: 28–92), with a maximum follow-up of 10 years. Results: A total of 412 patients were analyzed, of whom 40.8% had serum albumin levels < 3.5 g/dL. During follow-up, 233 deaths occurred. Lower albumin levels were associated with significantly higher mortality (76.2% vs. 43.4%, p < 0.001), increased healthcare utilization, and a greater incidence of cardiovascular and infectious complications. In multivariate analysis, albumin < 3.5 g/dL remained an independent predictor of mortality (hazard ratio 1.84, 95% confidence interval 1.42–2.38; p < 0.001). Receiver operating characteristic analysis identified 3.4 g/dL as the optimal cutoff for mortality prediction (area under the curve 0.72). Conclusions: Baseline serum albumin is an independent predictor of long-term (up to 10-year) mortality and adverse clinical outcomes in patients receiving maintenance hemodialysis. Although albumin is not a causal determinant, its association with survival likely reflects underlying nutritional and inflammatory burden. Prospective multicenter studies are warranted to validate albumin-based risk stratification and to evaluate the prognostic value of longitudinal changes in serum albumin over time. Full article

Background: Stenotrophomonas maltophilia is an intrinsically multidrug-resistant, biofilm- forming, non-fermenter increasingly implicated in hospital-acquired infections. Evidence from non-cystic fibrosis populations, especially in the Middle East, remains sparse. Methods: We conducted a retrospective observational cohort study at a tertiary academic center (Al-Khobar, Saudi Arabia) spanning 1 May 2001–30 April 2023. Hospitalized adults (≥18 years) with culture-confirmed, clinically diagnosed S. maltophilia infection and ≥72 h of antibiotic therapy were included. The primary outcome was all-cause mortality (14-day, 30-day, 1-year). Secondary outcomes were clinical response, microbiological eradication, and infection recurrence. Predictors of 30-day mortality were assessed using multivariable logistic regression; 14-day mortality was analyzed by Kaplan–Meier/log-rank according to susceptibility-guided versus alternative therapy. Results: Of 539 patients with positive cultures, 436 met the inclusion criteria. Mean age was 60.5 ± 19.3 years; 62.2% were male. Most infections were hospital-acquired (92.9%); pneumonia composed 64.7% and bloodstream infection 15.4%. Polymicrobial growth occurred in 55.5% (predominantly Gram-negative co-isolation). Susceptibility was 95.1% to trimethoprim–sulfamethoxazole, 76.4% to levofloxacin, and 43.6% to ceftazidime. Mortality at 14 days, 30 days, and 1 year was 22.8%, 37.9%, and 57.2%, respectively. On multivariable modelling, intensive care unit (ICU) admission, leukocytosis, neutrophilia, anemia, and thrombocytopenia independently predicted 30-day mortality. Susceptibility-guided therapy was associated with improved 14-day survival (log-rank p = 0.033). Conclusions: In this large, long-running non-cystic fibrosis cohort, host acuity and early alignment of treatment to susceptibility data were dominant drivers of outcome. High polymicrobial burden and limited reliably active agents underscore the need for meticulous stewardship, robust infection prevention, and cautious interpretation of S. maltophilia antimicrobial susceptibility testing. Full article

Background/Objectives: Breast cancer is the most common cancer among women worldwide. Surgical treatments include breast-conserving therapy (BCT) and mastectomy, often followed by reconstruction, but the impact of reconstruction on locoregional recurrence (LRR) remains unclear. This study evaluated LRR, survival, and risk factors following primary breast reconstruction performed simultaneously with mastectomy compared with mastectomy without reconstruction. Methods: This population-based, retrospective cohort included 2475 women with breast cancer treated between 2004 and 2018 at the Tumor Center and Caritas St. Josef Hospital in Regensburg, Germany. Patients were grouped into not primarily reconstructed, primary autologous reconstruction, primary allogeneic reconstruction, and primary combined reconstruction. Overall survival (OS), recurrence-free survival (RFS), and cumulative recurrence rates (CRR) were assessed using Kaplan–Meier methods and Cox proportional hazards models adjusted for age, nodal status, tumor biology, and adjuvant therapies. Results: Of 14,046 eligible cases, 2475 met inclusion criteria: no primary reconstruction (87%), autologous reconstruction (3.1%), allogeneic reconstruction (9.0%), and combined reconstruction (0.4%). Patients undergoing reconstruction were younger and more likely to receive chemotherapy. The 5-year OS was 71.8% without primary reconstruction, 82.1% after autologous reconstruction, and 90.0% after allogeneic reconstruction. Allogeneic reconstruction was associated with improved OS (HR 0.570, p = 0.015) and RFS (HR 0.669, p = 0.039), whereas autologous reconstruction was associated with higher hazards of LRR and distant metastases compared to no primary reconstruction. Conclusions: The 5-year cumulative LRR was 5.2%, 13.5%, and 4.8%, respectively. Immediate allogeneic reconstruction after mastectomy was therefore associated with favorable survival and recurrence outcomes, while autologous reconstruction was linked to higher LRR and distant metastasis rates in this cohort. The retrospective design, small autologous subgroup, and absence of detailed lifestyle and metabolic data are important limitations of these findings. These associations likely reflect differences in tumor stage, biology, and unmeasured risk factors, and should be interpreted as hypothesis generating. Prospective multicenter studies with detailed risk profiling are needed to clarify the oncologic safety of different reconstructive strategies. Full article

Background/Objectives: Glioblastoma (GBM) exhibits heterogeneous, nonlinear invasion patterns that challenge conventional modeling and radiomic prediction. Most deep learning approaches describe the morphology but rarely capture the dynamical stability of tumor evolution. We propose an AI framework that approximates a latent attractor landscape of GBM morphodynamics—stable basins in a continuous manifold that are consistent with reproducible morphologic regimes. Methods: Multimodal MRI scans from BraTS 2020 (n = 494) were standardized and embedded with a 3D autoencoder to obtain 128-D latent representations. Unsupervised clustering identified latent basins (“attractors”). A neural ordinary differential equation (neural-ODE) approximated latent dynamics. All dynamics were inferred from cross-sectional population variability rather than longitudinal follow-up, serving as a proof-of-concept approximation of morphologic continuity. Voxel-level perturbation quantified local morphodynamic sensitivity, and proof-of-concept control was explored by adding small inputs to the neural-ODE using both a deterministic controller and a reinforcement learning agent based on soft actor–critic (SAC). Survival analyses (Kaplan–Meier, log-rank, ridge-regularized Cox) assessed associations with outcomes. Results: The learned latent manifold was smooth and clinically organized. Three dominant attractor basins were identified with significant survival stratification (χ² = 31.8, p = 1.3 × 10⁻⁷) in the static model. Dynamic attractor basins derived from neural-ODE endpoints showed modest and non-significant survival differences, confirming that these dynamic labels primarily encode the morphodynamic structure rather than fixed prognostic strata. Dynamic basins inferred from neural-ODE flows were not independently prognostic, indicating that the inferred morphodynamic field captures geometric organization rather than additional clinical risk information. The latent stability index showed a weak but borderline significant negative association with survival (ρ = −0.13 [−0.26, −0.01]; p = 0.0499). In multivariable Cox models, age remained the dominant covariate (HR = 1.30 [1.16–1.45]; p = 5 × 10⁻⁶), with overall C-indices of 0.61–0.64. Voxel-level sensitivity maps highlighted enhancing rims and peri-necrotic interfaces as influential regions. In simulation, deterministic control redirected trajectories toward lower-risk basins (≈57% success; ≈96% terminal distance reduction), while a soft actor–critic (SAC) agent produced smoother trajectories and modest additional reductions in terminal distance, albeit without matching the deterministic controller’s success rate. The learned attractor classes were internally consistent and clinically distinct. Conclusions: Learning a latent attractor landscape links generative AI, dynamical systems theory, and clinical outcomes in GBM. Although limited by the cross-sectional nature of BraTS and modest prognostic gains beyond age, these results provide a mechanistic, controllable framework for tumor morphology in which inferred dynamic attractor-like flows describe latent organization rather than a clinically predictive temporal model, motivating prospective radiogenomic validation and adaptive therapy studies. Full article

Background: A subset of patients with T1-T2 oesophageal cancer are not candidates for surgery or chemotherapy and have a poor prognosis due to limited treatment options. This study evaluated the combination of external beam radiotherapy (EBRT) and endo-oesophageal brachytherapy (EBT) as a curative treatment in these patients, with cause-specific survival (CSS) and local recurrence-free survival (LRFS) as the primary endpoints. Methods: This was a single-centre retrospective analysis of 11 patients with T1-T2 oesophageal cancer treated between 2005 and 2024 with combined EBRT and EBT schedules. Clinical data, treatment schedules, outcomes, and complications were obtained from patient medical records and follow-up documentation. Descriptive statistics and Kaplan–Meier survival analysis were used. Results: The median follow-up was 22 months (2–61 months). CSS rates were 79.5% at 2 years, 66% at 3 years, and 30% at 5 years. LRFS rates were 74.1%, 59%, and 39%, respectively. One severe toxicity (grade ≥ 3) was observed. The most frequent mild toxicities were oesophageal mucositis (18.2%) and ulceration (18.2%). Conclusions: EBT in combination with EBRT seems to be a feasible and well-tolerated treatment with curative intent for inoperable T1-T2 oesophageal cancer patients, offering favourable survival outcomes in a population with limited therapeutic alternatives. Full article

Background/Objectives: Stemness has been proposed as a unifying driver of invasion, treatment resistance, and relapse in oral squamous cell carcinoma (OSCC). We synthesized two complementary evidence streams to determine whether higher stemness predicts poorer survival in OSCC: (i) computational stemness signatures derived from transcriptomic/epigenetic data and (ii) tissue cancer stem cell (CSC) immunophenotypes by immunohistochemistry (IHC). Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Embase, Scopus, and SciELO. Adults with histologically confirmed OSCC were eligible. Primary outcome was overall survival (OS); disease-specific survival (DSS) and recurrence-free survival (RFS) were secondary. Two parallel meta-analyses pooled effects within domains; random-effects restricted maximum likelihood (REML) models were applied. Results: Of 785 records, 11 studies met criteria. For computational signatures (k = 6), higher stemness was associated with poorer OS (pooled HR 2.24, 95% CI 1.61–3.12; I² ≈ 49%). Sensitivity excluding the single unadjusted Kaplan–Meier (KM)-derived estimate yielded a similar effect (HR 2.13, 95% CI 1.56–2.89). For CSC-IHC (main analysis, k = 2), CSC-positive profiles predicted worse OS (pooled HR 2.01, 95% CI 1.42–2.84; I² ≈ 0%); results were robust to excluding an internally inconsistent study (single-study HR 2.078). An exploratory sensitivity analysis, including a 1-year HR (different time horizon), increased heterogeneity and was not considered definitive. A functional meta-synthesis converged on epithelial–mesenchymal transition/extracellular matrix remodeling, hypoxia/glycolysis, redox/ferroptosis resistance, and ribosome/rRNA biogenesis, supporting biological plausibility across modalities. Conclusions: Across computational and IHC evidence, stemness consistently portends inferior OS in OSCC, offering a biologically anchored framework for risk stratification and testable therapeutic hypotheses. Full article

Background/Objectives: Preoperative prognostic assessment is essential for optimizing treatment strategies in pancreatic ductal adenocarcinoma (PDAC). This study aimed to evaluate and compare the prognostic value of the Heidelberg Pancreatic Prognostic (HELPP) score and the C-reactive protein–albumin–lymphocyte (CALLY) index in patients with resectable PDAC. Methods: We retrospectively analyzed clinical and laboratory data of 109 patients with resectable PDAC who underwent curative-intent surgery and adjuvant therapy. Patients were stratified based on preoperative HELPP and CALLY scores. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan–Meier analysis, while independent prognostic factors were determined through multivariate Cox regression. Results: Kaplan–Meier survival analyses demonstrated that a HELPP score > 3 and a low CALLY index (≤1.029) were significantly associated with worse OS and DFS (log-rank p < 0.05). In multivariate analysis, the HELPP score was identified as an independent predictor of survival, whereas the CALLY index, although associated with survival in univariate analysis, did not reach statistical significance. In ROC analysis, both models exhibited acceptable discrimination, with the HELPP score achieving superior AUC values in predicting 1-year OS compared to the CALLY index. Conclusions: The HELPP score demonstrated independent prognostic value in multivariate analysis and may serve as a robust preoperative tool in resectable PDAC. The CALLY index, although not independently significant in multivariate analysis, showed strong prognostic separation in Kaplan–Meier survival analyses and may still aid in preoperative risk stratification, particularly where access to comprehensive scoring systems is limited. Full article

Objective: To investigate long-term prognosis and impact factors in children with vasovagal syncope (VVS) receiving metoprolol therapy. Method: This retrospective study included children with VVS who underwent metoprolol therapy at the Pediatric Syncope Unit of Peking University First Hospital between January 2012 and November 2023. Baseline demographic data, pre-treatment indices, including head-up tilt test (HUTT) and 24 h Holter monitoring, were collected. All participants received standardized metoprolol therapy for a minimum duration of one month. Follow-up was conducted between June and July 2025, with syncope recurrence as the primary endpoint. Multivariable Cox proportional hazards regression analysis was performed to identify independent impact factors of prognosis and to construct a Prognostic Risk Score (PRS) model. The model’s performance was rigorously validated through receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), and Bootstrap resampling (1000 iterations). Furthermore, children were stratified into high- and low-risk groups based on median PRS values. Kaplan–Meier survival analysis was then performed to assess the model’s discriminative efficacy. Result: This study included 97 children diagnosed with VVS. The median duration of metoprolol therapy was 2.5 months (interquartile range [IQR]: 2.0–3.0 months), with a median follow-up period of 59 months (IQR: 25.5–72 months). During follow-up, syncope recurrence was observed in 37 patients, while 60 patients remained symptom-free. COX regression analysis showed that time-domain indices of heart rate variability (HRV), including the standard deviation of all NN intervals (SDNN) and the triangular index (TR), as well as the frequency-domain index of HRV very low frequency (VLF), were relative factors of the long-term prognosis in children with VVS treated with metoprolol. Based on the above three identified factors, the PRS model was calculated as: PRS = 0.03 × SDNN − 0.02 × VLF − 0.1 × TR. ROC showed that the area under the curve (AUC) for discriminative power related to long-term prognosis was 0.808 (p < 0.01). The cumulative recurrence rate of symptoms in the high-risk score group was significantly higher than that in the low-risk score group (p < 0.01). The DCA curve demonstrated the clinical applicability of the model. Bootstrap internal verification indicated high stability, with the bias-corrected and accelerated (Bca) confidence interval (CI) of the C index ranging from 0.71 to 0.89. Conclusions: After metoprolol treatment, 38.1% of children with VVS experienced syncope recurrence during a median follow-up period of 59 months. Baseline HRV index, SDNN, TR, and VLF were identified as factors associated with the long-term prognosis of children with VVS treated with metoprolol. The PRS model based on the above indices demonstrated good value in linking to the individual long-term prognosis. Full article

Background and Aims: Gastric cancer remains a major health burden in East Asia. Gastrectomy is a primary treatment, yet postoperative malnutrition—particularly inadequate protein intake—adversely affects outcomes. This study assessed the association between achieving ≥70% of the recommended protein intake one year after gastrectomy and three-year survival. Methods: In this prospective, single-center, observational study, 69 patients with newly diagnosed gastric cancer who underwent gastrectomy between January 2021 and August 2023 were enrolled. Four patients who died within one year postoperatively were excluded, leaving 65 patients for analysis. Protein intake achievement rate (PIAR) at 12 months was calculated based on a recommended intake of 1.2 g/kg/day, and patients were stratified as PIAR ≥ 70% or <70%. Overall survival was analyzed using time-to-event methods, with a median follow-up of 2.1 years. Results: Among the 65 patients (median age 62 years, IQR 56–68; 56.9% male), 75.4% underwent subtotal gastrectomy. At 12 months, 7 patients (10.8%) failed to achieve a PIAR ≥ 70%. Compared with patients achieving adequate protein intake, those with inadequate intake more frequently underwent total gastrectomy (71.4% vs. 19.0%, p = 0.008) and had advanced-stage disease (Stage III–IV: 85.7% vs. 39.7%, p = 0.039). Kaplan–Meier analysis demonstrated significantly lower survival in the inadequate protein group, with a hazard ratio of 13.02 (95% CI 2.53–66.93); the wide confidence interval reflects the small number of patients with inadequate intake (n = 7). Conclusions: Failure to achieve ≥70% of recommended protein intake one year after gastrectomy is a strong independent predictor of mortality, associated with a 13-fold higher risk of death. Nutritional monitoring and early intervention are crucial, particularly for patients with total gastrectomy or advanced disease. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) presents limited therapeutic options for advanced disease, and sorafenib therapy is hampered by significant interpatient heterogeneity in response. This necessitates biomarker-guided strategies to personalize treatment. This study investigated the long noncoding RNAs UCA1 and MALAT1 as pharmacogenomic biomarkers for personalizing sorafenib therapy in advanced HCC. Methods: In a prospective cohort of 154 HCC patients receiving first-line sorafenib (400 mg twice daily), serum lncRNA levels were quantified by RT-qPCR at baseline, Week 4, and Week 12. Expression levels were correlated with treatment response (mRECIST), time-to-progression (TTP), and overall survival (OS). Statistical analyses included Kaplan–Meier estimates, Cox proportional hazards models, and ROC curve analysis. Results: High baseline expression of UCA1 (77.9% of patients) and MALAT1 (73.4%) was associated with aggressive disease. High UCA1 correlated with reduced 12-month survival (60.8% vs. 73.5%, p = 0.026) and shorter median Time-to-Progression (TTP) (18.0 vs. 21.9 weeks, p = 0.002). High MALAT1 was associated with significantly shorter median TTP (18.0 vs. 25.2 weeks, p = 0.003). In multivariable analysis, both lncRNAs were independent prognostic factors for shorter TTP (UCA1: HR = 1.52, p = 0.014; MALAT1: HR = 1.61, p = 0.006). Serial monitoring revealed that a ≥10% rise in either lncRNA by Week 4 predicted a five-fold higher progression risk by Week 12 (52% vs. 10%, p < 0.001), providing a median lead time of 7.0 weeks before radiological confirmation of progression. Conclusions: These findings demonstrate that UCA1 and MALAT1 enable early identification of sorafenib resistance. Baseline stratification and serial monitoring can provide early detection of treatment resistance, informing clinical decision-making and supporting their potential utility for personalizing therapy in advanced HCC. Full article

Background/Objectives: New-onset atrial fibrillation (NOAF) frequently develops in patients with chronic coronary syndrome (CCS) and is associated with adverse cardiovascular outcomes. The C-reactive protein–to–albumin ratio (CAR) reflects systemic inflammation, whereas left atrial diameter (LAD) indicates structural cardiac remodeling. Their combined predictive role for NOAF in CCS remains uncertain. This study evaluated the predictive value of combined CAR and LAD for NOAF in CCS patients. Methods: We retrospectively analyzed 2431 CCS patients treated at the Third Affiliated Hospital of Sun Yat-sen University between 2012 and 2019. The primary endpoint was NOAF occurrence during follow-up. Receiver operating characteristic (ROC) analysis determined exploratory cutoff values for CAR (0.0429) and LAD (33.96 mm). Patients were categorized into four groups: Group 1 (low CAR–low LAD), Group 2 (high CAR–low LAD), Group 3 (low CAR–high LAD), and Group 4 (high CAR–high LAD). Cox proportional hazards, Kaplan-Meier, and subgroup analyses were conducted to evaluate associations with NOAF risk. Results: During a median follow-up of 4.96 years, 93 NOAF events were identified. Compared with the Group 1, patients with higher CAR and LAD showed significantly elevated NOAF risk (HR = 2.67, 95%CI 1.99–3.57, p < 0.001). The combined CAR–LAD model demonstrated superior predictive accuracy (AUC = 0.731, 95% CI = 0.654–0.765; p < 0.001) and consistent effects across most subgroups. Decision curve analysis confirmed greater net clinical benefit for the combined model. Conclusions: The integration of CAR and LAD serves as a simple, non-invasive, and effective tool for predicting NOAF in CCS patients. This dual-marker model facilitates early identification of high-risk individuals and support personalized preventive strategies in clinical practice. Full article

Background: Durvalumab combined with gemcitabine–cisplatin (GC) has become the standard first-line treatment for advanced biliary tract cancer (BTC) following the TOPAZ-1 trial. However, real-world effectiveness, safety, and prognostic determinants, particularly in underrepresented populations, remain insufficiently defined. The aim of this study was to evaluate the real-world outcomes of first-line durvalumab plus chemotherapy and identify independent prognostic factors in patients with advanced BTC. Methods: This multicenter retrospective cohort study included patients with unresectable or metastatic BTC treated with first-line durvalumab plus chemotherapy across 21 tertiary oncology centers in Türkiye. Clinical characteristics, laboratory parameters, biomarker data, and treatment details were collected. The primary endpoint was overall survival (OS), while secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards regression models. Results: A total of 78 patients were analyzed; 53.8% were male, and the median age was 62 years. Primary tumor sites were intrahepatic (55.1%), extrahepatic (30.8%), and gallbladder (14.1%). After a median follow-up of 12.58 months, median OS was 11.59 months and median PFS was 6.80 months. The ORR was 50.6%, including complete and partial responses in 2.7% and 47.9% of patients, respectively. Treatment-related adverse events occurred in 97.4% of patients, with grade 3–4 events in 37.2%. Immune-related adverse events were observed in 19.2%, including one case of grade 3 pneumonitis. No patient permanently discontinued durvalumab due to toxicity, and no durvalumab-related mortality occurred. In multivariable analysis, ECOG performance status 2 (HR 3.43; 95% CI 1.33–8.80) and ALBI grade 2–3 (HR 2.54; 95% CI 1.24–5.19) independently predicted worse OS, while ECOG performance status 2 also predicted shorter PFS (HR 5.91; 95% CI 2.30–15.17). Conclusions: In this multicenter real-world Turkish cohort, first-line durvalumab plus chemotherapy showed effectiveness and tolerability comparable to clinical trial data. Baseline ECOG performance status and ALBI grade were independent prognostic factors, supporting their use for risk stratification in advanced biliary tract cancer. Full article

Background/Objectives: Tumor size is not included in the TNM staging system for colon cancer, and its prognostic significance remains controversial. We aimed to evaluate the impact of tumor size on recurrence-free survival (RFS) and overall survival (OS) in patients with stage T3N1 colon cancer. Methods: We retrospectively analyzed 336 patients with pathologically confirmed pT3N1 colon cancer who underwent curative resection between January 2015 and January 2025 at our tertiary institution. Clinicopathological features, adjuvant chemotherapy details, and survival outcomes were collected. Tumor size was measured pathologically, and a cutoff was determined by receiver operating characteristic (ROC) analysis. Kaplan–Meier and Cox regression analyses were performed to identify prognostic factors. Results: The optimal cutoff for tumor size predicting recurrence was 4 cm. Patients with tumors ≥ 4 cm had significantly lower 5-year RFS compared to those with smaller tumors (65.1% vs. 80.3%, p = 0.007). In multivariate analysis, tumor size ≥ 4 cm (HR: 2.014, 95% CI: 1.093–3.714, p = 0.025), ECOG performance status ≥ 2 (p = 0.005), positive resection margin (p = 0.011), and failure to complete adjuvant chemotherapy (p = 0.007) were identified as independent adverse prognostic factors for RFS. Tumor size was not independently associated with OS (p = 0.46). Adjuvant chemotherapy significantly improved both RFS (p < 0.001) and OS (p < 0.001). Conclusions: In patients with stage T3N1 colon cancer, tumor size ≥ 4 cm is an independent adverse prognostic factor for RFS. Incorporating tumor size into risk stratification, alongside TNM staging and treatment completion status, may improve prognostic assessment and guide clinical decision-making. Full article

Background: Tumors of the pineal region account for less than 1% of supratentorial neoplasms in adults and represent a distinct neuro-oncological challenge. Their management requires a multidisciplinary and multimodal approach. Traditionally, direct surgical resection was considered the primary treatment modality. Recent advances in minimally invasive techniques and onco-radiotherapy have paved the way for safer and more personalized treatment strategies, in line with the principles of precision medicine. This study aims to present our institutional approach, which relies on a combination of endoscopic and radiotherapy-based techniques. Methods: A retrospective, single-center clinical study was conducted involving 28 adult patients who underwent endoscopic third ventriculostomy and biopsy of a pineal region tumor between January 2014 and March 2025. Descriptive statistics, permutation tests with bootstrap-derived confidence intervals, Fisher’s exact test, and Kaplan–Meier survival analysis were applied for data evaluation. Results: Endoscopic intervention resulted in clinical improvement in 78% of cases. A significant increase in performance status was observed in the postoperative period (<0.001) compared to preoperative results. Radiotherapy contributed to either tumor regression or disease stabilization. Conclusions: Based on our findings, the combination of endoscopic intervention and personalized radiotherapy represents a safe and effective treatment strategy, offering a compelling alternative to direct surgical resection, which is reserved as a second-line treatment. Full article

Background/Objectives: This study aimed to evaluate the prognostic effects of tumor spread through air spaces (STAS) and other clinical and pathological risk factors on disease-free survival (DFS) in patients with non-small cell lung cancer (NSCLC) who underwent curative lobectomy and had tumors measuring 4 cm or less. Methods: NSCLC patients who underwent surgery between March 2015 and May 2024 and had at least 12 months of follow-up were retrospectively analyzed. Patients with tumors measuring 4 cm or less who underwent R0 resection, lobectomy, and STAS assessment on intraoperative frozen sections were included in the study. Clinicopathological features of all patients were restaged according to the 9th edition of the TNM staging system. The Kaplan–Meier method, log-rank test, and univariate Cox regression analysis were used to determine the factors affecting DFS. Results: 88 patients were included in the study. The median age of the patients was 61 years, 77.3% were male, and 72.7% had adenocarcinoma histology. According to TNM 9, 23.9% of the cases were staged T1b, 18.2% T1c, and 58.0% T2a. STAS positivity was detected in 45 patients (51.1%). The rates of lymphovascular invasion (LVI) (40.0% vs. 18.6%; p = 0.028) and visceral pleural invasion (VPI) (57.8% vs. 27.9%; p = 0.005) were significantly higher in the STAS-positive group than in the STAS-negative group. Recurrence was observed in a total of 31 patients (35.2%) during a median follow-up period of 68.1 months. In Kaplan–Meier analysis, the median DFS was not reached for the entire cohort. The estimated median DFS in STAS-positive patients was 52.7 months, while the median was not reached in the STAS-negative group (p = 0.001). The median DFS was 52.3 months in those with lymph node positivity, while the median was not reached in those with lymph node negativity (p = 0.031). According to TNM 9, the difference in DFS between stage IA/IB and stage IIAB groups was not statistically significant (p = 0.080). In univariate Cox analysis, STAS positivity (HR = 3.79; 95% CI: 1.69–8.51; p = 0.001), lymph node positivity (HR = 2.58; 95% CI: 1.05–6.31; p = 0.038) and VPI (HR = 2.28; 95% CI: 1.07–4.86; p = 0.032) were found to be significant prognostic factors adversely affecting DFS. Age, gender, histological type, tumor location, T stage, LVI, perineural invasion (PNI), and adjuvant chemotherapy had no significant effect on DFS. Conclusions: STAS is a strong negative prognostic indicator for recurrence in patients with operated NSCLC with tumor size ≤ 4 cm. It is believed that STAS should be integrated into risk-based staging and adjuvant treatment decision-making processes in early-stage NSCLC, particularly when evaluated in conjunction with VPI and lymph node positivity. Full article