Search Results (1,926)

Background/Objectives: Whole-blood fatty acid composition provides an objective biomarker of fatty acid status, but its relationships with nutritional characteristics and subsequent quality-of-life (QoL) changes among cancer survivors remain incompletely understood. We aimed to identify whole-blood fatty acid phenotypes and examine their associations with nutritional characteristics, cross-sectional QoL profiles, and subsequent QoL changes in an overlapping longitudinal subcohort. Methods: In this cohort study, the 2023 baseline investigation included 3175 community-dwelling adult cancer survivors with whole-blood fatty acid profiles and paired questionnaires. After excluding participants with substantial missing QoL data, implausible fatty acid measurements, or missing age, sex, or cancer type, 3009 participants comprised the baseline analytical sample. Among these, 423 overlapped with an independent longitudinal cohort contributing QoL data from June 2021 and June 2024, and 398 had complete covariate data for the core adjusted longitudinal analyses. Whole-blood fatty acid phenotypes were identified using principal component analysis and unsupervised clustering. Nutritional characteristics were assessed using habitual dietary intake, Diet Balance Index 2022 scores, and nutrition literacy measures. QoL was assessed using the EORTC QLQ-C30. Multivariable models examined cross-sectional QoL and annualised QoL changes. An open-source phenotype assignment tool was developed to support reproducible classification in future cohorts. Results: Among 3009 baseline participants (mean [SD] age, 64.9 [7.0] years; 2397 women [79.7%]), five whole-blood fatty acid phenotypes were identified. Phenotypes 2 and 3 were rarely observed in the available general-population reference sample and appeared enriched among survivors. Phenotype 2, a high-SFA/low-PUFA phenotype accompanied by higher red meat intake and greater DBI-22 excess scores for red meat and related animal foods, was associated with statistically significant worsening across multiple QoL domains over 12 months despite relatively favourable baseline QoL. Compared with the general-population-mapped reference pool (Phenotypes 1, 4, and 5), Phenotype 2 showed annualised declines in summary score (−4.66 [95% CI, −8.14 to −1.19]) and role functioning (−5.35 [−9.88 to −0.83]), and worsening pain (8.28 [2.58 to 13.98]), dyspnoea (6.83 [0.16 to 13.50]), and constipation (14.10 [7.30 to 20.90]). Prebaseline annualised QoL changes over the preceding 24 months did not differ significantly across phenotypes. Conclusions: Whole-blood fatty acid profiling identified distinct nutritional-metabolic phenotypes among community-dwelling cancer survivors. The high-SFA/low-PUFA phenotype, accompanied by higher red meat intake and greater DBI-22 excess scores for red meat and related animal foods, was associated with worsening across multiple QoL domains over the subsequent 12 months despite relatively favourable baseline QoL. These findings highlight whole-blood fatty acid phenotyping as a potentially informative framework for characterising nutritional-metabolic heterogeneity and subsequent QoL vulnerability among cancer survivors. The open-source phenotype assignment tool may facilitate reproducible phenotype assignment and external validation in future cohorts. Full article

Background/Objectives: The emotional impact of a cancer diagnosis may become particularly salient during survivorship, as survivors continue to face fears and concerns related to recurrence. Fear of cancer recurrence (FCR) is one of the most prevalent psychological challenges and significant unmet need among women with female cancer. The aim of this study was to assess the presence of FCR in predominantly breast cancer survivors, and to examine its relationship with certain demographic, clinical, and psychosocial factors. Methods: This cross-sectional study was conducted with a convenience sample of 120 women with a history of breast or gynecological cancer who were recruited over a two-month period through several cancer support associations across Croatia. Data were collected in person using a questionnaire comprising sociodemographic and clinical variables, as well as four self-reported instruments: the Fear of Cancer Recurrence Inventory–Short Form, Impact of Event Scale, Cancer Behavior Inventory–Brief Version, and Multidimensional Scale of Perceived Social Support. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient and hierarchical regression analysis. Results: In the final sample of 110 women, FCR levels were moderate, with 66.4% of participants reporting clinically significant levels. FCR was positively associated with chemotherapy (r = 0.22, p < 0.05), intrusive thoughts (r = 0.56, p < 0.01) and avoidance tendencies (r = 0.39, p < 0.01), and negatively associated with age (r = −0.26, p < 0.01) and self-efficacy for coping (r = −0.41, p < 0.01). In the final regression model, intrusive thoughts, coping self-efficacy, and chemotherapy were the only variables independently associated with fear of cancer recurrence. Conclusions: These findings indicate the presence of FCR in the period after primary treatment, particularly among breast cancer survivors, and highlight cognitive processing of cancer-related experiences and self-efficacy as potentially relevant areas for further research. Full article

Background: Post-surgical breast cancer (BC) survivors frequently experience clusters of persistent post-treatment physical and psychological symptoms, which can negatively affect their quality of life (QoL). Mind–body interventions such as Qigong may offer potential benefit, but evidence in oncology remains limited. Methods: We conducted a single-arm pilot feasibility study at the AMICO clinic (IRCCS-CROB, Southern Italy) to evaluate the feasibility, acceptability, safety, and exploratory pre–post symptoms associated with an 8-week Qigong programme in post-surgical BC patients. Fourteen women (aged 42–73 years; stage I–III) who reported symptom burden and emotional sensitivity attended weekly one-hour classes and were encouraged to practise at home. Feasibility outcomes included adherence, completion of post-intervention assessment, adverse events, and participant acceptability. Symptom severity was assessed at baseline and post-intervention using a 0–5 study-specific symptom questionnaire score. For the secondary descriptive prevalence analysis, scores ≥ 3 were classified as indicating moderate-to-severe symptom burden. Results: All 14 participants completed the post-intervention assessment, overall intervention adherence was 92%, and no adverse events were reported. In the secondary descriptive analysis, the prevalence of moderate-to-severe pain and mood changes decreased from 64.3% to 35.7%, fatigue from 57.1% to 28.6%, anxiety from 85.7% to 42.9%, and sleep disturbances from 35.7% to 14.3%. Hot flushes decreased from 64.3% to 42.9%. Despite the heterogeneity of individual symptom trajectories, most participants reported meaningful improvements in overall well-being. Conclusions: The 8-week programme was feasible, well tolerated, and acceptable in this small real-world cohort. Symptom burden decreased during the intervention period; however, because of the uncontrolled study design and small sample size, these changes cannot be attributed specifically to Qigong. Larger controlled studies are required to estimate treatment effects and identify potential moderators of response. Full article

Background: The dynamic advancement of pediatric hemato-oncology and intensified therapeutic protocols have significantly increased survival rates while simultaneously highlighting the challenge of long-term treatment complications. Within the cohort of adolescent and young adult (AYA) survivors, delayed neurocognitive deficits, often manifesting as the chemobrain phenotype, and psychosocial disorders constitute a particularly substantial burden. Contemporary neurogastroenterological evidence indicates a fundamental role of persistent dysbiosis and gut–brain axis dysfunction in the pathogenesis of these alterations. This review aims to critically synthesize translational evidence elucidating the impact of iatrogenic gut microbiota damage and modifiable dietary patterns on the development of long-term neurocognitive sequelae in survivors of early childhood cancer. Methods: A systematized narrative review was conducted in accordance with the SANRA guidelines by integrating data from in vivo models and observational studies. A comprehensive literature search across the PubMed, Embase, Cochrane Central, Scopus, and Web of Science databases up to June 2026 was performed utilizing the Population, Exposure, and Outcomes (PEO) framework. Results: Oncological therapies, including myeloablative conditioning and broad-spectrum antibiotic therapy, induce a microbial scar phenomenon characterized by the depletion of commensal Firmicutes in favor of resistant pathobionts. The subsequent decline in the synthesis of neuroprotective short-chain fatty acids (SCFAs) alongside the pathological activation of the kynurenine pathway disrupts central nervous system homeostasis. Translocation of lipopolysaccharides (LPSs) across the compromised intestinal barrier generates systemic inflammation recognized as inflammaging, which, in turn, stimulates neurotoxic microglial hyperreactivity. This pathophysiological cascade is accelerated by a pro-inflammatory Western diet, whereas anti-inflammatory interventions such as the MIND diet and postbiotics demonstrate measurable restorative potential. Conclusions: The pathophysiology of delayed neurotoxicity is largely a consequence of systemic neuroinflammation driven by intestinal dysbiosis. Implementing individualized dietary and microbiome-targeted strategies into survivorship care protocols constitutes a crucial direction for clinical prophylaxis. Validating their clinical efficacy in the AYA population necessitates prospective randomized controlled trials integrated with shotgun metagenomic sequencing. Full article

Background: Treatment-related peripheral neuropathies are disabling long-term complications of modern cancer therapy. Chemotherapy-induced peripheral neuropathy (CIPN) and radiation-induced peripheral neuropathy (RIPN) can lead to pain, motor deficits, and sensory loss, substantially impairing quality of life in cancer survivors. Surgical decompression has been proposed as a potential therapeutic option in cases of superimposed focal nerve compression due to treatment-related tissue changes, but evidence remains limited. This systematic review aims to evaluate the indications, surgical techniques, and outcomes of microsurgical decompression for cancer treatment-related peripheral neuropathies. Methods: A systematic search was performed in PubMed and Embase up to July 2026. Studies were screened by two independent researchers, and included when reporting outcomes of surgical intervention for chemotherapy-induced or radiation-induced peripheral neuropathy. Data on patient demographics, oncologic diagnosis, surgical indication, technique, and postoperative subjective and functional outcomes were extracted and presented in tables. Results: Fourteen studies met inclusion criteria describing 95 patients and 120 treated nerves. In CIPN, all surgically treated patients experienced pain relief and improvement in two-point discrimination, without reported deterioration. In RIPN, 88.5% of patients improved in pain, 58.8% in sensory function, and 44.4% in motor strength. Neurolysis combined with vascularized flap reconstruction was associated with better outcomes when compared with neurolysis alone. No major surgical complications were reported. Overall evidence quality was low, with small sample sizes and high heterogeneity among methodologies. Conclusions: Microsurgical decompression with or without vascularized flap reconstruction may provide meaningful pain relief and partial functional recovery in selected patients with treatment-related peripheral compression neuropathies refractory to conservative management. Nevertheless, current evidence is restricted to small retrospective series and case reports. Full article

Objective: This study assessed the prevalence of fear of cancer recurrence (FCR) and its clinical, treatment-related, and psychological correlates in breast cancer survivors without active disease. Materials and Methods: This cross-sectional study included 200 breast cancer survivors after curative treatment. FCR was assessed using the Fear of Cancer Recurrence Inventory–Short Form (FCRI-SF), with scores ≥ 13 indicating clinically significant FCR. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Depression (HADS-D) scores ≥ 8 indicated clinically significant symptoms. Associations with FCR were analyzed using logistic regression, with HADS-A and HADS-D evaluated in separate multivariable models because of their potential overlap. Results: The mean age was 55.6 ± 9.5 years; clinically significant FCR, anxiety, and depression occurred in 38.0%, 32.5%, and 38.0%, respectively. In univariable analysis, younger age, stage III disease, mastectomy, chemotherapy history, and high HADS-A and HADS-D were associated with FCR. In the HADS-A model, chemotherapy history (adjusted OR: 5.841; p = 0.006) and high HADS-A (adjusted OR: 7.828; p < 0.001) were independently associated with FCR, whereas increasing age was protective (adjusted OR: 0.855; p < 0.001). In the HADS-D model, mastectomy (adjusted OR: 6.265; p = 0.002), chemotherapy history (adjusted OR: 6.941; p = 0.001), and high HADS-D (adjusted OR: 14.343; p < 0.001) were independently associated with FCR, whereas increasing age was protective (adjusted OR: 0.836; p < 0.001). Conclusions: FCR is a major psychosocial concern among breast cancer survivors, particularly in younger patients, those with chemotherapy history, and those with greater psychological symptom burden. The association with mastectomy should also be considered, particularly in patients with depressive symptoms. Full article

Background: Survival after early breast cancer has improved to the point where reproductive health is no longer a peripheral concern in young survivors but a routine one. This review synthesizes current evidence on oncologic safety, obstetric and neonatal outcomes, fertility preservation, breastfeeding, and psychosocial survivorship to develop a counseling framework that clinicians can apply in practice. Methods: This narrative review was informed by a structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library covering studies published from January 2000 to July 2026, with greater analytic weight given to studies published from 2010 onward to ensure the synthesis reflects contemporary treatment standards. Relevant evidence was identified and narratively synthesized according to the clinical and reproductive aspects of pregnancy after breast cancer. No formal risk-of-bias assessment or quantitative synthesis was undertaken. Results: On the currently available evidence, pregnancy after breast cancer is not associated with an increased risk of recurrence. This holds in hormone receptor-positive disease and in BRCA1/2 carriers, and it is supported prospectively by the POSITIVE trial, whose preplanned update at a median follow-up of 71 months found a five-year incidence of breast cancer-free interval events of 12.3% against 13.2% in matched external controls. Obstetric and neonatal risks are higher than in the general obstetric population, although the pooled effect sizes are small to moderate: odds ratios are approximately 1.14 for cesarean delivery, 1.45 for preterm birth, 1.50 for low birth weight, and 1.16 for small-for-gestational-age birth. The excess concentrates in pregnancies conceived within the first one to two years after diagnosis and attenuates thereafter. Fertility preservation techniques appear both effective and oncologically safe. Fertility-related distress, by contrast, is common and does not reliably resolve once treatment ends. Conclusions: Oncologic risk alone is not a reason to advise against pregnancy after breast cancer. Early oncofertility referral, multidisciplinary planning, and risk-adapted obstetric surveillance remain the priorities. Because the evidence base is predominantly observational, these conclusions describe what the current data show rather than establishing safety definitively. Full article

Glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RAs) (including medications that contain GLP-1 and other RAs), hereafter referred to as GLP-1 medicines, have significantly advanced the management of metabolic disease and weight management. Obesity is highly prevalent among cancer survivors at the time of diagnosis, and cancer treatments are associated with subsequent changes in weight, either gain or loss. Research has shown that obesity can adversely affect cancer treatment outcomes and survivorship, leading researchers to investigate the potential integration of GLP-1 medicines into oncology care. There is growing interest in understanding the effects of GLP-1 medicines on weight loss and cancer-related outcomes among individuals with obesity who are taking anticancer therapies, as well as individuals treated for cancer in the past who are long-term survivors. This review examines the literature to characterize what is known about GLP-1 medicine use among cancer survivors. The current literature, though limited and largely retrospective, suggests that GLP-1 medicines may contribute to weight loss among cancer survivors, with outcomes varying by cancer stage and type of anticancer therapy. It is important for healthcare providers to consider the potential negative impact of these GLP-1 medications on their patients, especially those with cancer cachexia or sarcopenic obesity, as well as those undergoing anticancer treatments that often lead to weight loss. While there is preclinical evidence suggesting that there are weight-loss independent effects that may be beneficial to individuals with cancer, use of GLP-1 medicines in patients of normal weight for reasons other than treatment of type 2 diabetes should be initiated with caution. On the positive side, these agents may help mitigate therapy-related toxicities, such as cardiotoxicity, with the potential to enhance survivorship outcomes. Unfortunately, there is a notable lack of well-designed randomized controlled trials evaluating the effects of GLP-1 medicines on weight loss, clinical endpoints, and cancer-related outcomes. Advancing the field requires a focus on elucidating the interactions between GLP-1 medicines and anticancer therapies, particularly their impact on treatment efficacy, nutritional status, and overall patient outcomes, both during treatment and in the long term. Full article

Background: Worldwide, around 400,000 children are diagnosed with cancer every year. Understanding survivors’ social and stigma-related experiences may help address their needs and improve their outcomes. Objectives: To explore the social and stigma-related experiences, coping strategies, and support needs of pediatric cancer survivors in Newfoundland and Labrador, a province of Canada. Methods: This is a qualitative, cross-sectional study focusing on retrospective participant experiences. Eligibility criteria included being diagnosed with cancer before the age of 18 and being diagnosed or treated in the province. Extensive recruitment activities were employed. Data collection occurred through semi-structured virtual interviews and completion of a sociodemographic survey. Participant interviews were transcribed verbatim, and themes were identified iteratively through inductive thematic analysis. Descriptive statistics were used to define the participants’ sociodemographic characteristics. Results: Seven participants were recruited. Thematic analysis identified five major themes: (i) isolation and being treated differently; (ii) support received, coping mechanisms, and support needs; (iii) resilience and interest to give back; (iv) workplace and disability related experiences; and (v) additional impacts of cancer. Our results showed that participants received substantial social support in various ways but inadequate professional mental health support. School was a significant setting for cancer-related stigmatization. Discrimination in the workplace was rare and was disability-related rather than cancer-related. Conclusions: Our results show that there are significant issues to address, such as stigma and isolation experienced by pediatric cancer survivors as well as the need to improve the psychosocial support programs offered to them. Our results also show that the participants had distinct lived experiences compared to adult-onset cancer populations. Overall, the findings presented are expected to inform further studies and healthcare-education policies to help address these issues and improve the experiences of pediatric cancer survivors. Full article

Background: Physical exercise is a vital component of cancer rehabilitation, with demonstrated improvements in cancer health-related outcomes, relapse rates, mortality and overall survival, yet global participation remains low. In Singapore, uptake of community cancer rehabilitation is limited despite high prevalence of treatment-related impairments. Methods: A cross-sectional study was conducted among adults (≥21 years) enrolled in the Singapore Cancer Society Rehabilitation Center between December 2021 and March 2023. Clinical data was collected from medical records and assessments included the Distress Thermometer (DT), Brief Illness Perception Questionnaire (Brief IPQ), and modified Bandura’s Exercise Self-Efficacy (ESE) scale. Adequate exercise was defined as ≥150 min/week of moderate intensity aerobic exercise and ≥2 days/week of resistance training. Regression analyses were performed to identify factors associated with meeting recommended moderate-intensity aerobic exercise levels. Results: The median age of our study cohort was 60.0 (IQR: 51.0–66.3) years. Of 132 analyzed participants, only 29.5% met recommended aerobic exercise levels and 9.1% met resistance training level recommendations. The median duration of moderate intensity aerobic exercise per week was 85.0 (30.0–180.0) minutes. The three most common cancer diagnoses amongst the participants were breast (53.8%), gastrointestinal (11.4%) and gynecological (7.6%) cancers. Clinically significant distress (DT ≥ 5) was present in 40.9% of patients. Multivariate regression analyses revealed that having lower ESE was the only significant psychosocial factor associated with a lower likelihood of meeting recommended aerobic exercise activity levels (OR = 0.856; 95% CI = 0.787–0.931; p < 0.001). Conclusions: Our study found a low prevalence of meeting recommended physical activity levels amongst our cohort of Asian cancer survivors enrolled in a community rehabilitation program in Singapore. Reinforcing the need for future longitudinal studies involving Asian cancer survivors to explore additional factors associated with physical inactivity and whether behavioral interventions targeting ESE will improve physical activity participation. Full article

Postoperative atrial fibrillation (POAF) after cardiac surgery is often managed as a transient inpatient arrhythmia, yet recurrent or silent atrial fibrillation (AF) after discharge may identify persistent atrial vulnerability. This issue is particularly relevant in cancer survivors, whose thrombotic and bleeding risks vary according to cancer activity, treatment exposure, thrombocytopenia, frailty and planned procedures. For this narrative review, PubMed/MEDLINE and Scopus were searched from inception to 16 June 2026, with Google Scholar used for supplementary citation tracking. A total of 50 publications were included in the final narrative synthesis. Direct evidence at the intersection of cancer, cardiac surgery, POAF and digital monitoring remains limited. Accordingly, the proposed “Digital Cancer-POAF Survivorship Pathway” is presented as a conceptual, hypothesis-generating framework, rather than a validated clinical algorithm. Its distinctive contribution is to connect cancer-state phenotyping and treatment-specific arrhythmic risk with post-discharge rhythm surveillance, electrocardiogram (ECG) confirmation, multidisciplinary interpretation, data governance and outcomes for prospective validation. Digital monitoring may increase AF detection; however, whether it reduces stroke, bleeding, readmission, or healthcare utilisation in this population is unknown. Neither a low detected AF burden nor the absence of AF during finite monitoring has been validated as an independent basis for anticoagulation decisions. Full article

Background/Objectives: Liver metastasis develops in approximately 50% of patients with colorectal cancer. Invasion of the biliary tract from colorectal liver metastasis (CRLM) is rarely reported. Preoperative diagnosis remains elusive, prohibiting optimal surgical management. The objective of this systematic review was to summarize the clinical, radiological, pathological, and treatment characteristics of ibCRLM and describe the reported outcomes. Methods: A systematic literature search of the Medline, Embase, Web of Science, CENTRAL, and CINAHL databases was undertaken for studies reporting clinical outcomes of patients with ibCRLM, up to May 2026. An individual patient data analysis approach was utilized. Results: Thirty-eight case reports and 10 case-series, incorporating 228 patients with biliary involvement from CRLM, were identified. Mean age was 62.4 ± 10.9 years, with a male-to-female ratio of 3.2:1. The majority of metastatic lesions were metachronous in 71.1% and solitary in 59.1% of patients. Surgical treatment was implemented in 89.2% of patients. Major hepatectomy was the most common procedure, being performed in 46.2% of patients, followed by minor hepatectomy in 38.7% and pancreatoduodenectomy in 4.3%. After a median follow-up of 52.5 months (range 2–164 months), the survival rate was 60.5%. Non-survivors were found to have significantly more synchronous CRLM (50% versus 0, p = 0.008), while a single patient did not receive any curative-intent treatment and died 20 days following CRLM presentation. Conclusions: IbCRLM is a distinct clinicopathological presentation of CRLM with characteristic radiological and pathological features. The available evidence suggests that selected patients may achieve favorable long-term outcomes following complete surgical resection, although these findings should be interpreted with caution given the limitations of the available literature. Full article

Background: To better understand the complexity of sexual dysfunction, we aim to construct multi-factorial explanatory models of sexual dysfunction using data from participants enrolled in the Danish cross-sectional Study of latE effects for those liviNg through cErvical CAncer (SENECA). Methods: In a nationwide survey, patient-reported outcomes (PRO) were collected from 2002 cervical cancer survivors treated with surgery and/or radio(chemo)therapy between 2005–2020 and a reference cohort consisting of 7853 women without a history of cancer. PROs in the EORTC C30/CX24 questionnaires were analysed. Bayesian Network models were developed for sexual activity and dyspareunia in reference and cancer survivor cohorts, resulting in four explanatory models. The reference cohort served as a structural prior for the cancer models. Sexual activity models included participants with complete data (6706 reference, 1694 cancer), while dyspareunia models included those reporting sexual activity in the past four weeks (4521 reference, 996 cancer). Results: Respondents were stratified by treatment received: (1) reference group (n = 7853), (2) surgery alone (n = 1285), (3) radio(chemo)therapy (RCT) with/without prior surgery (n = 951). Sexual inactivity was reported by 28%, 29% and 49% of reference, surgery and RCT groups respectively, and dyspareunia by 23%, 39% and 54%. Sexual activity was associated with age, treatment modality and social functioning. Social functioning was associated with cognitive and role functioning, global QoL, and financial difficulties, all of which were associated strongly with fatigue. Dyspareunia was associated with vaginal functioning and soreness. The strong associations observed in the cancer survivor cohort between fatigue and functional outcomes/QoL/sexual activity were absent in the reference cohort. Conclusions: Sexual inactivity and dyspareunia were more common in cervical cancer patients, particularly in those treated with RCT compared with the reference cohort. Differences in explanatory factors between cancer and reference cohorts highlight the need for cancer-specific approaches to sexual rehabilitation. Full article

Background and objectives: Melanoma survivors may develop additional primary malignancies, but data from Eastern European hospital cohorts are scarce. We aimed to estimate the observed incidence of second primary cancers (SPCs) within a Romanian referral-centre cohort, identify associated factors, and explore the association of SPC occurrence with overall survival. Methods: We conducted a retrospective, hospital-based cohort study of 394 patients with histopathologically confirmed cutaneous melanoma followed at two referral centres in Cluj-Napoca. Additional malignancies were counted as new primaries only when clinical and/or histopathological documentation distinguished them from recurrence or metastasis. Incidence density was expressed per 1000 person-years. Multivariable logistic regression assessed age, sex, residence, and Breslow thickness. Fixed-covariate Cox and Kaplan–Meier analyses were considered exploratory because of immortal-time and competing-risk limitations. Results: Over 1848 person-years, 79 patients (20.1%) developed at least one SPC (131 events; observed incidence 70.9/1000 person-years), most frequently cutaneous (53.6/1000 person-years). SPC occurrence increased with age (Cochran–Armitage Z = 5.63, p < 0.001); the Kaplan–Meier complement estimate reached 20.7% at five years. Age independently predicted SPC (OR 1.86 per decade, p < 0.001), whereas greater Breslow thickness was inversely associated (OR 0.86, p = 0.008). Actinic keratosis showed a strong unadjusted association (OR 6.64, p < 0.001) but was not included in the adjusted model. The fixed-status Cox model showed lower mortality among patients with an SPC (HR 0.36, p < 0.001), a finding vulnerable to detection and immortal-time bias. Conclusions: SPCs were frequent in this hospital cohort and predominantly cutaneous. Older age was an independent predictor, while actinic keratosis was a strong unadjusted marker. Prospective, population-based validation is needed before surveillance intensity is individualised. Full article

Background/Objectives: Total en bloc spondylectomy (TES) remains one of the most invasive and selectively used procedures in spine oncology. Its role has become more selective in the modern era of stereotactic body radiotherapy, separation surgery, targeted systemic therapy, immunotherapy, and multidisciplinary cancer care. This study evaluated long-term survival, imaging-defined systemic disease burden, operative morbidity, patient-reported outcomes, and frailty-related variables after TES in a rare single-center cohort, with the goal of identifying selection-relevant survival and treatment-burden signals rather than developing a validated decision algorithm. Methods: We performed a retrospective single-center cohort study of consecutive adults who underwent TES for spinal tumors between 2011 and 2022. Of the 36 screened patients, 30 had sufficient clinical and survival data for analysis; patients without reliable survival or last-contact data were not included. Contrast-enhanced CT and PET-CT were reviewed for extraspinal metastases, lymphadenopathy, pleural effusion, and soft-tissue extension. Survival was analyzed using Kaplan–Meier methods, log-rank testing, and exploratory univariate Cox regression. Patient-reported outcomes included the Oswestry Disability Index (ODI) and SF-36 when available; frailty was summarized with the modified frailty index-5 (mFI-5) when component data were present. Results: The cohort included 13 men and 17 women with a mean age of 54.8 ± 15.2 years. At final follow-up, 18 patients had died, and 12 were alive. Five-year overall survival was approximately 76% in the full cohort. Extraspinal metastases were present in 72.2% of deceased patients compared with 8.3% of survivors and showed the clearest exploratory association with increased mortality (HR 3.46, 95% CI 1.23–9.78; p = 0.019). Metastatic disease demonstrated inferior survival compared with primary bone or soft-tissue tumors. Perioperative blood loss and transfusion burden were substantial but were not associated with survival in univariate analysis. ODI and SF-36 data were available only in small subsets and were therefore interpreted as descriptive signals of treatment burden. Conclusions: TES remains relevant in modern spine oncology, but only as an increasingly selective intervention. In this rare cohort, systemic disease burden, particularly extraspinal metastases, was the clearest selection-relevant survival signal, while blood loss, transfusion requirements, complications, and limited patient-reported outcomes illustrated substantial treatment burden. These findings do not establish a validated selection algorithm but support a contemporary decision threshold that integrates tumor biology, systemic disease status, anticipated margins, physiologic reserve, operative morbidity, and patient goals. Full article