Search Results (784)

Background/Objectives: Perioperative chemoimmunotherapy has become an important curative-intent strategy for selected patients with resectable non-small cell lung cancer (NSCLC). However, most pivotal trials evaluate neoadjuvant therapy, surgery, and postoperative immune checkpoint inhibitor (ICI) treatment as an integrated regimen. Whether continued postoperative immunotherapy provides independent incremental benefit for all patients after effective neoadjuvant chemoimmunotherapy and complete resection remains unresolved. This review focuses on the adjuvant-phase dilemma and discusses how postoperative treatment may be refined according to response and residual risk. Methods: We performed a narrative review of major neoadjuvant and perioperative chemoimmunotherapy trials, indirect comparative analyses, pathological-response studies, circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) evidence, immune biomarker studies, and emerging data in driver-positive and real-world populations. Particular attention was given to evidence informing postoperative continuation, de-escalation, or intensification after neoadjuvant chemoimmunotherapy. Results: Current phase III perioperative trials demonstrate clinically meaningful activity but do not isolate the independent contribution of the adjuvant ICI phase. Pathological response provides the most accessible postoperative risk signal: pathologic complete response identifies the deepest-response group, major pathologic response represents an intermediate state, and non-major pathologic response or persistent nodal disease suggests higher relapse risk. ctDNA-based MRD offers dynamic risk refinement and may help identify patients with residual systemic disease, although prospective validation is required before it can guide routine treatment omission or escalation. Programmed death-ligand 1 (PD-L1), tumor mutational burden, tertiary lymphoid structures, B-cell signatures, radiomics, and pathomics may provide complementary information but are not sufficient as standalone decision tools. Driver-positive disease requires molecularly stratified perioperative strategies rather than unselected extrapolation from epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)-negative trials. Conclusions: The key question in resectable NSCLC is shifting from whether perioperative immunotherapy is active to which patients truly require postoperative immunotherapy. Future trials should prospectively test response-guided strategies integrating pathological response, ctDNA-based MRD, immune contexture, baseline risk, and treatment feasibility. Full article

The fatigue failure (F/F) test is an important method for evaluating hair strength. In this study, we evaluate commercial European hair after up to four bleaches. F/F-data were directly fitted using a two-parameter cumulative Weibull distribution (CWD) function, described by lifetime index (λ) and shape factor (β). Fibre samples taken from treated tresses (T) exhibited stable F/F behaviour across multiple treatments, while treated single fibres (S) showed early breakage if treated more than twice. We attribute this effect mainly to the liquor ratio during treatment. In this context, we suggest a strategy to estimate a treatment-related apparent decay constant for λ. The constant for T-samples was determined as k_n = 0.095. This is consistent with DSC results in the literature for the denaturation enthalpy. This may indicate an important role for intermediate filaments in fatigue failure. To possibly establish a link with hair breakage during combing, we investigated the properties of the hazard function for T-samples based on β = 0.92. The model calculations indicate that early failure risks are low but increase exponentially with repeated bleaches. The correspondence with the literature results leads to the hypothesis of a relationship between F/F and combing tests. Full article

Background/Objectives: Clinical outcomes with immune checkpoint inhibitors (ICIs), such as nivolumab, vary among patients with metastatic non-small cell lung cancer (NSCLC). The Lung Immune Prognostic Index (LIPI) may help stratify prognosis. This study evaluated the prognostic significance of LIPI in patients receiving second- or third-line nivolumab and developed a nomogram for individualized survival estimation. Methods: This single-center retrospective study included 142 patients with metastatic NSCLC who received second- or third-line nivolumab between February 2022 and December 2024, after progression on platinum-based chemotherapy. LIPI was calculated from baseline values obtained within 14 days before nivolumab initiation, based on a derived neutrophil-to-lymphocyte ratio (dNLR) > 3 and lactate dehydrogenase (LDH) > 225 U/L (institutional upper limit of normal), classifying patients as good-, intermediate-, or poor-risk (0, 1, or 2 factors, respectively). Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method; independent prognostic factors were assessed by multivariable Cox regression, and a prognostic nomogram combining ECOG performance status, serum albumin, and LIPI was developed and internally validated. Results: By LIPI, 34.5%, 45.1%, and 20.4% of patients were at good, intermediate, and poor risk, respectively. Objective response and disease control rates were 29.6% and 55.6%. Median OS and PFS were 19.3/8.0/3.1 and 8.6/3.1/2.5 months across good, intermediate, and poor LIPI groups (log-rank p < 0.001). In multivariable analysis, ECOG 2 (hazard ratio [HR], 4.94), albumin per 1 g/dL (HR 0.27), and poor versus good LIPI (HR 3.74) were independently associated with OS. A nomogram combining these three factors showed acceptable discrimination (optimism-corrected Harrell C-statistic 0.742). Conclusions: LIPI was independently associated with prognosis in this cohort. Combining LIPI with ECOG and albumin may aid individualized risk assessment, pending external validation. Full article

Background: Host-related factors such as skeletal muscle and adipose tissue characteristics are increasingly recognized as determinants of outcome in advanced non-small cell lung cancer (aNSCLC). However, the prognostic relevance of integrated body composition phenotypes in patients receiving first-line immunotherapy-based treatment remains unclear. Methods: We retrospectively analyzed patients with aNSCLC treated with first-line immune checkpoint inhibitors (ICI) alone or combined with chemotherapy (ICI–CT) between October 2018 and December 2023 at LMU University Hospital. AI-derived CT biomarkers included skeletal muscle volume index (SMVI), skeletal muscle density (SMD), visceral adipose volume index (VAVI), and subcutaneous adipose volume index (SAVI), normalized for height. Individual body composition parameters were analyzed as standardized continuous variables. For exploratory phenotype analyses, SMVI and VAVI were categorized using cohort-specific sex-stratified median values. An integrated body composition phenotype was defined as “high-muscle/low-visceral-adiposity” (high SMVI/low VAVI) or “low-muscle/high-visceral-adiposity” (low SMVI/high VAVI), with patients not meeting either definition classified as having an intermediate phenotype. Multivariable Cox regression adjusted for age, sex, treatment modality, and metastatic burden evaluated associations with progression-free survival (PFS) and overall survival (OS). Results: Of 116 screened patients, 103 with evaluable baseline CT imaging were included. The cohort predominantly comprised ever-smokers (81.6%) and patients with adenocarcinoma (62.1%). Higher SMD (per one standard deviation increase) was associated with improved overall survival (HR 0.72, 95% CI 0.52–1.00; p = 0.047), and higher VAVI was associated with a higher risk of death (HR 1.29, 95% CI 1.00–1.65; p = 0.048). Neither SMD nor VAVI was significantly associated with PFS, and SMVI and SAVI were not significantly associated with OS or PFS. In the exploratory integrated phenotype analysis, median OS was 29.5 months in the high-muscle/low-visceral-adiposity group, 16.2 months in the intermediate group, and 19.3 months in the low-muscle/high-visceral-adiposity group; however, the overall Kaplan–Meier comparison was not statistically significant (log-rank p = 0.385). Conclusions: AI-derived CT body composition assessment may provide complementary prognostic information in patients with aNSCLC receiving first-line immunotherapy-based treatment. Higher skeletal muscle density was associated with a lower risk of death, whereas higher visceral adiposity was associated with a higher risk of death. The exploratory integrated phenotype analysis did not demonstrate a consistent risk gradient across phenotype categories. These findings require validation in larger prospective cohorts before clinical implementation. Full article

Background/Objectives: Periodontal and peri-implant diseases are influenced by several risk factors, including smoking. While cigarette smoking (CS) is a well-established risk factor, the impact of heated tobacco products (HTPs), electronic cigarettes (E-Cigs), and waterpipe (WS) remains less clear. This systematic review aimed to update the current evidence evaluating the clinical, radiographical, and inflammatory biomarkers of periodontal and peri-implant status among different untreated adult users of inhaled tobacco and nicotine products. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Cochrane Library was performed for studies published between April 2022 and December 2025. Data were extracted and synthesized qualitatively according to the study protocol (PROSPERO: CRD420261284851). Studies were qualitatively assessed using the Risk-of-Bias in Nonrandomized-I. Results: Thirty-one studies including 3106 subjects were analyzed. CS consistently showed the worst periodontal and peri-implant status, with higher plaque indices, probing depth (PD), clinical attachment level (CAL), marginal bone loss (MBL) and more missing teeth. WS showed parameters comparable to CS and worse than non-smokers, with particularly high plaque accumulation and probing depth, as well as a pro-inflammatory biomarker profile. E-Cigs and HTPs generally exhibited intermediate status; E-Cigs showed increased PD and CAL compared with non-smokers, with elevated bleeding on probing despite a lower gingival index, whereas MBL was notably higher, showing the highest overall values among all smoking categories, exceeding CS. HTPs presented slightly less harmful outcomes than other smokers, but the evidence was limited. Biomarker analysis indicated elevated pro-inflammatory and tissue-destructive markers, particularly in CS and WS. Conclusions: Smoking negatively affects periodontal and peri-implant status, with CS exhibiting the worst impact. E-Cigs and HTPs appear less harmful but are not risk-free. Longitudinal studies are warranted to define long-term effects, particularly on peri-implant status, for which robust evidence was restricted to CS. Full article

Background: Immune checkpoint inhibitors have improved outcomes in metastatic clear-cell renal cell carcinoma (mRCC), yet clinically applicable tissue biomarkers remain limited. Growth differentiation factor-15 (GDF-15) promotes tumour immune evasion and has emerged as a potential therapeutic target in immuno-oncology. We evaluated the prognostic significance of tumour GDF-15 expression in patients with intermediate-risk clear-cell mRCC treated with second-line nivolumab. Methods: Forty-six patients with intermediate-risk clear-cell mRCC who received nivolumab after one line of tyrosine kinase inhibitor therapy were retrospectively evaluated. Tumour GDF-15 expression was assessed by immunohistochemistry and classified as low (0–1+) or high (2–3+). Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the development of cancer-associated cachexia were compared between expression groups. Results: High tumour GDF-15 expression was observed in 23 patients (50%). ORR was significantly higher in the low-expression group than in the high-expression group (57% vs. 26%, p = 0.036). Low tumour GDF-15 expression was associated with significantly longer PFS (24.5 vs. 7.5 months; HR 0.38, 95% CI 0.18–0.80; p = 0.009) and OS (28.6 vs. 12.6 months; HR 0.43, 95% CI 0.19–0.98; p = 0.041). The association with OS remained significant after adjustment for age. The frequency of cancer-associated cachexia did not differ according to tumour GDF-15 expression (43% vs. 35%, p = 0.546). Conclusions: Low tumour GDF-15 expression was associated with better objective response and longer progression-free and overall survival in patients with intermediate-risk metastatic clear-cell renal cell carcinoma treated with second-line nivolumab, with the association with overall survival remaining significant after adjustment for age. Tumour GDF-15 represents a promising tissue biomarker for prognostic risk stratification and warrants validation in larger prospective studies. Full article

Background/Objectives: Human metapneumovirus (hMPV) is a leading cause of acute respiratory tract infections in children, but comorbidities and mixed infections have confounded most previous studies. This study aimed to develop an early prediction model for severe respiratory illness in children with isolated hMPV infection. Methods: This retrospective study enrolled 540 children with isolated hMPV infection (without comorbidities or mixed infections) hospitalised between February 2022 and January 2024. Severe respiratory illness was defined according to British Thoracic Society guidelines. Multivariable logistic regression analysis was performed to identify predictors and develop a nomogram, with model performance evaluated by AUC, Hosmer–Lemeshow test, and bootstrap validation. Results: Six independent predictors were identified: male sex (protective factor, OR = 0.500), elevated neutrophil count (OR = 1.114), decreased lymphocyte count (OR = 0.829), decreased prealbumin level (OR = 0.992), crackles (OR = 1.858), and wheezes (OR = 3.734). The nomogram achieved an AUC of 0.743 (95% CI: 0.690–0.796) and demonstrated good calibration performance (Hosmer–Lemeshow p = 0.139, Brier score = 0.136). Risk stratification classified patients into low-risk (<10%), intermediate-risk (10–30%), and high-risk (>30%) groups, with severe illness rates of 5.1%, 16.7%, and 46.0%, respectively (p < 0.001). Conclusions: The nomogram incorporating six early-admission indicators may serve as a practical tool for early risk stratification in hospitalised children with isolated hMPV infection. Full article

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of irreversible visual impairment, and AREDS2-based nutritional supplementation is recommended for clinically eligible patients to reduce the risk of disease progression. However, successful implementation depends on regular supplement use and sustained adherence. This study investigated demographic, socioeconomic, clinical, and physician-related factors associated with regular AREDS2 supplement use and evaluated medication adherence, physician counseling, and patient-reported barriers among clinically eligible patients with AMD. Methods: In this single-center cross-sectional study, 389 patients with intermediate AMD or advanced AMD in one eye who fulfilled the indications for AREDS2 supplementation were enrolled. Participants reporting occasional supplement use were excluded. A structured interviewer-administered questionnaire was used to collect demographic, socioeconomic, and clinical data, together with information on physician recommendation, medication adherence, patient knowledge, and perceived barriers to supplementation. Factors associated with regular AREDS2 supplement use were evaluated using univariable and multivariable logistic regression analyses, whereas adherence patterns and patient-reported barriers were analyzed descriptively. Results: Of the 389 participants, 273 (70.2%) reported regular AREDS2 supplement use, whereas 116 (29.8%) were non-users. Multivariable analysis showed that younger age, educational attainment, and physician recommendation were independently associated with regular supplement use (adjusted OR for physician recommendation, 5.38; 95% CI, 2.68–10.81; p < 0.001). Among regular users, 53.5% met the study-defined criteria for good medication adherence. The most frequently reported barriers among non-users were financial burden, limited supplement availability, polypharmacy, and insufficient knowledge regarding AREDS2 supplementation. Conclusions: Regular AREDS2 supplement use among clinically eligible patients with AMD was associated with demographic, educational, and physician-related factors, whereas long-term adherence remained suboptimal despite substantial uptake. These findings emphasize the importance of effective physician counseling, structured patient education, and interventions addressing socioeconomic barriers to improve the real-world implementation of evidence-based nutritional supplementation in AMD. Full article

Sulfamethoxazole (SMX), a persistent sulfonamide antibiotic widespread in aquatic environments, resists conventional water treatment degradation. This work developed a NaOAc/Fe³⁺/O₃ homogeneous ozonation system for SMX abatement. Four comparative reaction groups confirmed significant synergism between trace Fe³⁺ and sodium acetate. Under optimized near-neutral conditions, 96.19% SMX was removed within 30 min with k_obs = 0.107 min⁻¹, outperforming sole O₃, O₃/NaOAc and O₃/Fe³⁺ by 11.0%, 31.0% and 21.9% respectively. Single-factor tests revealed excess Fe³⁺ or acetate suppressed catalytic activity, while alkaline conditions accelerated degradation yet aggravated iron precipitation. Radical quenching and p-CBA probing indicated that acetate coordination did not increase bulk ·OH exposure, while the stronger TEMP-derived TEMPO response after acetate addition was consistent with enhanced ¹O₂-associated oxidation, suggesting that acetate altered the relative contributions of ozone-derived oxidation pathways. Post acetate background deduction, the ternary system achieved higher TOC/COD elimination. Twelve SMX intermediates were identified via LC-MS, with three ring-opening degradation pathways proposed. QSAR toxicity evaluation indicated that most intermediates possessed lower bioconcentration and developmental risks than raw SMX. Overall, the results indicate that weak acetate ligands can alter iron-mediated ozone oxidation pathways, providing a low-dose and economical strategy for antibiotic wastewater treatment. Full article

Background and Objectives: Tobacco smoking is associated with an increased risk of depression and anxiety symptoms, but it remains unclear whether this relationship differs according to the type of nicotine product used. The increasing popularity of heated tobacco products has created a need to better understand their association with mental health, particularly in comparison with combustible cigarettes. Therefore, this study aimed to compare the prevalence of depression and anxiety symptoms among combustible cigarette (CC) users, heated tobacco product (HTP) users, and non-smokers. Materials and Methods: A cross-sectional study was conducted among 497 adults. Participants were classified into three groups according to their tobacco-use status: combustible cigarette smokers, heated tobacco users, and non-smokers. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7). Group differences were evaluated using hierarchical linear regression analyses adjusted for sociodemographic, health, and lifestyle factors. Results: Tobacco-use group significantly improved the model fit for PHQ-9 (ΔR² = 0.0575, p < 0.001) and GAD-7 (ΔR² = 0.0764, p < 0.001). In non-smokers, scores of depression were 3.48 lower than in CC users and 1.42 lower than in the HTP users’ group. In HTP users, these scores were 2.06 lower than in the CC users’ group. Anxiety scores were 3.71 lower in non-smokers than in CC users, and 1.29 lower than in the HTP users’ group. In the HTP users’ group, this score was 2.42 lower than in the CC users’ group. HC3 robust standard errors with 5000-sample BCa bootstrap confidence intervals and reduced-adjustment sensitivity analyses confirmed the primary pattern. Conclusions: Our study results showed that combustible cigarette users had the highest adjusted depression and anxiety scores, HTP users had intermediate scores, and non-smokers had the lowest. In both tobacco-using groups, greater product-specific nicotine dependence was associated with higher PHQ-9 and GAD-7 scores. Further interdisciplinary studies incorporating biomarkers of nicotine exposure, HPA axis function, inflammation, and oxidative stress are needed to clarify whether the observed differences reflect the characteristics of individuals who choose specific tobacco products or are partly attributable to product-specific effects. Full article

The corrosion behavior of N80 steel in a simulated coalbed–methane environment was investigated in a high-temperature, high-pressure autoclave. Uniform corrosion and maximum pit depth were quantified by weight-loss measurements and ultra-depth-of-field three-dimensional microscopy, respectively, while SEM, EDS, and XRD were used to characterize the morphology, elemental composition, and crystalline phases of the surface corrosion products. A one-factor-at-a-time design was applied at a constant total pressure of 10 MPa to evaluate the effects of nominal CO₂ partial pressure (0.10–1.00 MPa), nominal O₂ partial pressure (0–0.40 MPa), Cl⁻ concentration (3–187 g/L), and temperature (40–75 °C). Increasing the nominal CO₂ partial pressure raised the uniform corrosion rate from 0.712 to 0.930 mm/a but reduced the maximum pitting corrosion rate from 1.691 to 0.280 mm/a, while FeCO₃-containing surface coverage increased. Increasing the nominal O₂ partial pressure intensified both corrosion modes; at 0.40 MPa, the uniform and maximum pitting corrosion rates reached 1.446 and 2.202 mm/a, respectively, and the corrosion-product layer exhibited extensive cracking and spallation. Increasing the Cl⁻ concentration reduced the uniform corrosion rate from 1.078 to 0.839 mm/a but increased the maximum pitting corrosion rate from 0.474 to 1.807 mm/a, indicating a shift in the principal damage risk from average metal loss to localized penetration. The uniform corrosion rate reached a maximum of 1.516 mm/a at 60 °C, whereas the maximum pitting corrosion rate increased continuously to 2.202 mm/a at 75 °C. XRD identified Fe, FeCO₃, Fe₂O₃, Fe₃O₄, and FeOOH. The persistent Fe substrate reflections, interpreted together with the SEM observations, revealed spatially heterogeneous corrosion-product coverage. These results show that the protective contribution of FeCO₃-containing products depends on their surface coverage and visible integrity rather than on phase presence alone. The findings support stringent oxygen-ingress control, targeted pitting protection in high-salinity environments, and enhanced corrosion surveillance of intermediate- and high-temperature well sections. Full article

Background/Objectives: Most cases of non-small cell lung cancer (NSCLC) are diagnosed at advanced stages, where prognosis remains poor. Machine learning (ML) offers new opportunities for patient stratification. This study aimed to identify distinct subgroups of patients with advanced-stage NSCLC using unsupervised ML techniques and to evaluate their association with survival outcomes and biomarker expression. Methods: 400 patients with advanced-stage NSCLC were analyzed using the k-prototypes algorithm. Clinical, demographic, and analytical variables, including smoking history and comorbidities, were incorporated. Identified clusters were compared in terms of molecular biomarkers and overall survival. A multivariable Cox proportional hazards model was performed to assess the association between cluster membership and overall survival. Results: Five patient profiles were identified. Cluster F, characterized by a predominance of women, relatively low smoking exposure, and a higher frequency of epidermal growth factor receptor (EGFR) mutations, showed the most favorable survival profile. Cluster S comprised mainly male heavy smokers with poorer performance status and high metastatic burden, whereas Cluster Y consisted predominantly of younger men without comorbidities but with frequent M1c disease. Clusters E and O showed intermediate outcomes and were characterized by older age with pleural effusion and by an older predominantly male smoking profile, respectively. In the multivariable Cox model, compared with Cluster F, a higher risk of death was observed for Cluster S (HR 1.62, 95% CI 1.01–2.60; p = 0.045) and Cluster Y (HR 1.55, 95% CI 1.09–2.21; p = 0.015), although the association for Cluster S should be interpreted cautiously. Differences in molecular biomarker distribution were also observed across clusters, particularly for EGFR mutations and programmed death-ligand 1 (PD-L1) expression. Conclusions: In this single-centre retrospective pilot study, unsupervised ML identified distinct patient profiles associated with differences in survival outcomes and molecular characteristics. These findings support the potential of data-driven approaches to characterize heterogeneity in advanced-stage NSCLC, although external validation is required before clinical application. Full article

Cancer-associated thrombosis (CAT) is defined as venous or arterial thrombotic events occurring in patients with active malignancy or during anticancer treatment, most commonly presenting as venous thromboembolism and representing a leading cause of morbidity and mortality in oncology. Hormone-sensitive malignancies, including breast, ovarian, and endometrial cancers, are characterized by a complex interaction among tumor biology, endocrine signaling, inflammation, endothelial dysfunction, and coagulation activation. In these malignancies, venous thromboembolism (VTE) risk is influenced not only by intrinsic tumor-related mechanisms but also by patient-specific factors and anticancer therapies, particularly endocrine treatments, chemotherapy, targeted agents, and extensive surgical procedures. Breast cancer is generally associated with an intermediate thrombotic risk, although endocrine therapy—especially tamoxifen—significantly increases VTE incidence. Ovarian cancer represents one of the most thrombogenic solid tumors because of elevated tissue factor expression, inflammatory activation, advanced-stage presentation, and aggressive multimodal treatment strategies. Endometrial cancer exhibits a strong association with obesity, metabolic syndrome, prolonged estrogen exposure, and perioperative thrombotic complications. Emerging evidence highlights the role of immune-thrombosis, extracellular vesicles, inflammatory cytokines, and sex-specific coagulation pathways in cancer-associated hypercoagulability. Current guidelines increasingly support individualized thromboprophylaxis based on tumor biology, patient-specific risk factors, and bleeding risk assessment. This review summarizes the biological mechanisms linking hormones and thrombosis in breast and gynecologic cancers, discusses current evidence regarding VTE risk factors and treatment-related thrombotic complications, and explores modern approaches to biomarkers, risk stratification, and personalized thromboprophylaxis. Full article

Background: Adolescent pregnancy is a public health problem in Latin America, with a higher prevalence in rural areas. This population faces barriers to accessing education and healthcare services, increasing the risk of maternal and neonatal complications. Methods: This study employed a cross-sectional analytical design and included 72 adolescents aged 12 to 17 years in Lonya Grande. The associations between structural and intermediate social determinants of health and the prevalence of adolescent pregnancy were assessed. Results: Among the structural determinants, extreme poverty (PR: 2.48; 95% CI: 1.23–5.03; p = 0.004), type of public health insurance (PR: 3.05; 95% CI: 1.21–7.72; p = 0.005), and parental educational level were associated with a higher prevalence of adolescent pregnancy. After adjustment, having public health insurance (aPR: 0.49; 95% CI: 0.36–0.66; p < 0.001) and having parents who had completed primary school (aPR: 1.67; 95% CI: 1.15–2.42; p = 0.01) were associated with a higher prevalence of adolescent pregnancy. Among the intermediate determinants, alcohol consumption (PR: 2.77; 95% CI: 1.85–4.16; p < 0.001), knowledge about contraceptives (PR: 0.21; 95% CI: 0.03–0.85; p = 0.04), and being 17 years old (PR: 4.44; 95% CI: 1.48–13.39; p = 0.01) were associated with adolescent pregnancy. In the adjusted model, adolescents aged 15 years (aPR: 3.15; 95% CI: 1.04–9.52; p = 0.04) maintained a higher prevalence compared with those aged 14 years. Conclusions: An association was found between structural and intermediate social determinants of health and adolescent pregnancy in rural settings. These findings suggest the need for additional studies to better understand interventions targeting these associated factors. Full article

Background/Objectives: Outcomes after perioperative FLOT for gastric and gastroesophageal junction adenocarcinoma remain variable, even among patients treated with curative intent. Although postoperative pathological findings are central to risk assessment, they do not fully capture patient-related factors that may influence recovery, treatment completion, and survival. This multicenter study evaluated routinely available clinical, laboratory, and pathological variables and assessed whether integrating these variables could improve postoperative prognostic stratification. Methods: We retrospectively analyzed 173 patients with locally advanced gastric or gastroesophageal junction adenocarcinoma treated with perioperative FLOT across seven oncology centers in Türkiye. Overall survival (OS) was the primary endpoint. Baseline inflammatory/nutritional status, pretreatment carcinoembryonic antigen (CEA), postoperative nodal status, and comorbidity burden were assessed. An exploratory modified FLOT Prognostic Score (mFPS) was constructed by assigning one point each for high inflammatory/nutritional risk, elevated CEA, ypN-positive disease, and age-adjusted Charlson Comorbidity Index ≥ 5. Results: At a median follow-up of 39.7 months, median OS was 41.4 months, with estimated 2-year and 5-year OS rates of 69% and 44%, respectively. Surgery was performed in 164 patients, and 83 patients completed planned adjuvant chemotherapy. In multivariable analysis, ypN-positive disease, higher comorbidity burden, and high inflammatory/nutritional risk were independently associated with shorter OS. Among the 126 patients with complete data available for all score components, the mFPS stratified patients into groups with significantly different outcomes: median overall survival was not reached in the low-risk group, compared with 56.1 months in the intermediate-risk group and 18.7 months in the high-risk group. Conclusions: Survival after perioperative FLOT was not determined by residual disease burden alone. Integrating postoperative nodal status with baseline host-related factors may help identify patients at increased risk of adverse outcomes following curative-intent treatment. The proposed score should be considered exploratory and requires external validation before clinical application. Full article