Search Results (209)

Introduction and Aims: Androgen deprivation therapy (ADT) with systemic anti-cancer treatment (SACT) ± palliative radiotherapy (pRT) is the current standard of care for Oligo-metastatic hormone-sensitive prostate cancer (o-mHSPC). Cytoreductive radical prostatectomy (cRP) has gained interest in this group of patients, with potential benefits including reduced tumour burden and a lower risk of local events from disease progression. In this review, we compare both survival outcomes and local event rates between cRP and upfront ADT ± SACT. Methods: All randomised trials and observational studies comparing cRP with standard treatment (ST), which we defined as ADT ± SACT for o-mHSPC, were included in the review. The study protocol was registered in PROSPERO (CRD42024516586), and the review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases searched included Embase, Medline, Cochrane Library, PubMed, and Web of Science. A risk of bias assessment was performed for the included studies as recommended by the Cochrane Handbook of Systematic Reviews and Interventions. The primary outcome measures were Overall Survival (OS), Cancer-Specific Survival (CSS), Progression-free Survival (PFS), Castrate-resistant Prostate Cancer-free Survival (CRPC-FS), and local complication rates. The secondary outcome measures were complication rates and functional outcomes post-cRP. Results: A total of 5130 studies were identified for this review (5119 by database searching and 11 through manual searching). Eight studies were included in the review, comprising 611 patients. cRP was identified to have superior OS (HR: 0.56 (95% CI: 0.34–0.92), I² = 0%, p = 0.02 (very low certainty)) and CSS (HR: 0.27 (95% CI: 0.15–0.47), I² = 0%, p < 0.0001 (very low certainty)). The PFS (HR: 0.67 (95% CI: 0.34–1.33), I² = 58%, p = 0.25 (very low certainty)) and CRPC-FS (HR: 0.67 (95% CI: 0.32–1.43), I² = 57%, p = 0.30 (very low certainty)) were similar between the two groups. The rates of local events were significantly lower in patients undergoing cRP (RR 0.27 (95% CI: 0.13–0.59), I² = 17%, p = 0.001 (low certainty)). The rates of Clavien–Dindo (CD) grade 3 or higher complications ranged from 0% to 13.1%. Additionally, the reported continence rates ranged from 81.5% to 91.3%. The review is limited by the lack of a uniform definition for o-mHSPC and the predominance of low-quality, heterogeneous studies. Despite mitigation strategies, the overall certainty of evidence remains very low per GRADE assessment. Conclusion: cRP significantly reduces local event rates compared with ST and offers comparable PFS and CFPC-FS, with superior OS and CSS in the cRP arm compared to the ST arm in patients with o-mHSPC. However, there is a paucity of high-quality literature on this subject. Ongoing randomised controlled trials may soon clarify the role of cRP in the context of o-mHSPC concerning survival benefits. Full article

Female cancers such as breast and gynaecological cancers contribute to a significant global health burden and are a leading cause of fatality among women. With current treatment options often limited by resistance to cytotoxic drugs, side effects and lack of specificity to the cancer, there is a pressing need for alternative treatments. Recent research has highlighted the promising role of non-coding RNAs (ncRNA) in regulating these issues and providing more targeted approaches to suppressing key cancer pathways. This review explores the involvement of the various types of non-coding RNAs in regulating key oncogenic pathways, namely, the MAPK, PI3K/Akt/mTOR, Wnt/β-catenin and p53 pathways, in a range of female cancers such as breast, cervical, ovarian and endometrial cancers. Evidence from a multitude of studies suggests that non-coding RNAs function as double-edged swords, serving as both oncogenes and tumour suppressors, depending on their expression and cellular interactions. By mapping and investigating these regulatory interactions, this review demonstrates the complexity and dual functionality of ncRNAs in cancer. Understanding these complex mechanisms is essential for the development of new and effective ncRNA-based diagnostic methods and targeted therapies in female cancer treatment. Full article

Background/Objectives: Romania remains a tuberculosis (TB) hotspot in the European Union, yet host-derived factors of poor outcomes are poorly characterised. We quantified circulating pro-inflammatory cytokines and examined their interplay with behavioural risk factors, the nutritional status, and the clinical course in adults hospitalised with pulmonary TB. We analysed 80 adults with microbiologically confirmed pulmonary TB and 40 respiratory symptom controls; four TB patients (5%) died during hospitalisation, all within 10 days of admission. Methods: A retrospective analytical case–control study was conducted at the Constanța regional TB referral centre (October 2020—October 2023). Patients with smear- or culture-confirmed TB were frequency-matched by sex, 10-year age band, and BMI class to culture-negative respiratory controls at a 2:1 ratio. The patients’ serum interferon-γ (IFN-γ), interleukin-1α (IL-1α), interleukin-1β (IL-1β), and tumour-necrosis-factor-α (TNF-α) were quantified within 24 h of admission; the neutrophil/lymphocyte ratio (NLR) was extracted from full blood counts. Independent predictors of in-hospital mortality were identified by multivariable logistic regression; factors associated with the length of stay (LOS) were modelled with quasi-Poisson regression. Results: The median TNF-α (24.1 pg mL⁻¹ vs. 16.2 pg mL⁻¹; p = 0.009) and IL-1β (5.34 pg mL⁻¹ vs. 3.67 pg mL⁻¹; p = 0.008) were significantly higher in the TB cases than in controls. TNF-α was strongly correlated with IL-1β (ρ = 0.80; p < 0.001), while NLR showed weak concordance with multiplex cytokine patterns. Among the patients with TB, four early deaths (5%) exhibited a tripling of TNF-α (71.4 pg mL⁻¹) and a doubling of NLR (7.8) compared with the survivors. Each 10 pg mL⁻¹ rise in TNF-α independently increased the odds of in-hospital death by 1.8-fold (95% CI 1.1–3.0; p = 0.02). The LOS (median 29 days) was unrelated to the smoking, alcohol, or comorbidity load, but varied across BMI strata: underweight, 27 days; normal weight, 30 days; overweight, 23 days (Kruskal–Wallis p = 0.03). In a multivariable analysis, under-nutrition (BMI < 18.5 kg m⁻²) prolonged the LOS by 19% (IRR 1.19; 95% CI 1.05–1.34; p = 0.004) independently of the disease severity. Conclusions: A hyper-TNF-α/IL-1β systemic signature correlates with early mortality in Romanian pulmonary TB, while under-nutrition is the dominant modifiable determinant of prolonged hospitalisation. Admission algorithms that pair rapid TNF-α testing with systematic nutritional assessment could enable targeted host-directed therapy trials and optimise bed utilisation in high-burden settings. Full article

Background: Assessment of the peritoneal cancer burden is crucial for determining the optimal treatment in advanced ovarian cancer (AOC). Effective non-invasive methods to predict tumour load remain limited. This study aimed to assess the applicability of 2-[¹⁸F]FDG PET/CT volumetric parameters, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) for predicting the surgical peritoneal cancer index (PCI) in AOC before primary treatment. Methods: Patients with high-grade serous or undifferentiated AOC who underwent surgical PCI evaluation and 2-[¹⁸F]FDG PET/CT between 01/2013 and 12/2018 were included. MTV and TLG were calculated using thresholds of 40% and 50% (MTV40, MTV50, TLG40, and TLG50). Correlations between the peritoneal carcinomatosis MTV (car_MTV) and TLG (car_TLG) were analysed. The capacity of volumetric parameters to estimate PCIs above or below 14 and 20 was assessed for the whole abdominal cavity and in per-quadrant analysis, specifically for upper-abdomen areas 1, 2, and 3 (MTV40_1, 2, 3 and TLG40_1, 2, 3). Results: MTV40, MTV50, TLG40, and TLG50 significantly correlated with the PCI in the final study population (n = 45). MTV40 showed a Pearson coefficient of 0.41 (p = 0.003). MTV3_40 (AUC 0.79) and TLG3_40 (AUC 0.81) presented the highest AUCs for predicting a PCI above or below 14. The volumetric parameters allowed the prediction of a PCI greater or less than 20, with an AUC of 0.77 for MTV40_1 and 0.78 for TLG40_1. Conclusions: 2-[¹⁸F]FDG PET/CT MTV and TLG correlate significantly with the surgical PCI when assessing peritoneal carcinomatosis or quadrant-specific disease. This approach offers a reliable non-invasive method for evaluating tumour burden in AOC. Full article

Cancer remains a leading global health burden, profoundly affecting patient survival and quality of life. Current treatments—including chemotherapy, radiotherapy, immunotherapy, and surgery—are often limited by toxicity or insufficient specificity. Conventional chemotherapy, for instance, indiscriminately attacks rapidly dividing cells, causing severe side effects. In contrast, peptide-based therapeutics offer a paradigm shift, combining high tumour-targeting precision with minimal off-target effects. Their low immunogenicity, multi-pathway modulation capabilities, and adaptability for diagnostics and therapy make them ideal candidates for advancing oncology care. Innovative peptide platforms now enable three transformative applications: (1) precision molecular diagnostics (e.g., ¹⁸F-PSMA-1007 for prostate cancer detection), (2) targeted therapies (e.g., BT5528 and SAR408701 targeting tumour-specific antigens), and (3) theranostic systems (e.g., RAYZ-8009 and ¹⁷⁷Lu-FAP-2286 integrating imaging and radiotherapy). Despite their promise, peptides face challenges like metabolic instability and short half-lives. Recent advances in structural engineering (e.g., cyclization and D-amino acid incorporation) and delivery systems (e.g., nanoparticles and PEGylation) have significantly enhanced their clinical potential. This review highlights peptide-based agents in development, showcasing their ability to improve early cancer detection, reduce metastasis, and enhance therapeutic efficacy with fewer adverse effects. Examples like CLP002 underscore their role in personalised medicine. By overcoming current limitations, peptide drugs are poised to redefine cancer management, offering safer, more effective alternatives to conventional therapies. Their integration into clinical practice could mark a critical milestone in achieving precision oncology. Full article

Angioimmunoblastic T-cell lymphoma (AITL) is a rare and aggressive subtype of non-Hodgkin lymphoma, the monitoring of which is largely restricted to radiological methods. Diagnosis relies on identifying characteristic clinicopathological features, supported by the detection of recurrent somatic mutations in RHOA, TET2, IDH2 and DNMT3A. The characteristic molecular profile of AITL and the high levels of circulating tumour DNA (ctDNA) measurable in AITL before treatment makes this an attractive lymphoma subtype in which to further investigate the role of ctDNA monitoring. The detection of somatic mutations in pre-treatment AITL-containing tissue samples was compared to those detected in pre-treatment ctDNA samples in a cohort of 12 patients. Changes in ctDNA somatic mutation burden over time were then correlated with radiological response. All six paired pre-treatment ctDNA and tissue samples had variants in common. All (8/8) previously ctDNA-detectable IDH2 and RHOA variants were undetectable in ctDNA samples at the time of end-of-treatment complete metabolic response (CMR). In comparison, the majority of both previously ctDNA-detectable DNMT3A variants (3/4) and TET2 variants (6/11) were detectable in ctDNA samples at the time of end-of-treatment CMR. These observations suggest that IDH2/RHOA variants may be more reliable markers of measurable residual disease in AITL than DNMT3A/TET2 variants. Full article

Background: Basal cell carcinoma (BCC) is the most common skin cancer worldwide, with a multifactorial aetiology involving environmental and intrinsic factors. A small subset of patients develops high-frequency BCC (HF-BCC), defined as ≥9 BCCs within 3 years. Objective: To analyse demographic, clinical, and histopathological features of non-syndromic HF-BCC in a Belgian cohort, compared with low-burden BCC patients and healthy controls. Methods: A retrospective cohort study was conducted at Erasme Hospital (Brussels) using data from the EUSCAP platform. Clinical, behavioural, and histopathological data were collected and statistically analysed. Results: Of 783 patients, 16 with HF-BCC were identified. For comparison, 32 patients with 1–2 BCCs and 117 patients without BCC were selected. HF-BCC patients showed distinct characteristics, including a higher proportion of superficial BCCs (68.3% vs. 50%, p = 0.01) and fewer nodular subtypes (43.2% vs. 63.5%, p = 0.01). Their tumours were less frequently located on the nose and ears compared with patients having 1–2 BCCs. HF-BCC was associated with a personal history of squamous cell carcinoma (SCC) and actinic keratosis (AK). Conclusions: HF-BCC patients display distinct anatomical, histopathological and clinical characteristics, with a predominance of superficial BCC and an association with a personal history of SCC and AK. They show a lower frequency of tumours on the nose and ears, with a stronger tendency for localisation on the trunk and extremities. Identifying risk factors and genetic markers may contribute to improved early detection strategies, preventive measures, and the development of targeted therapies. Full article

Although immunotherapy has led to a breakthrough in the treatment of NSCLC, fast disease progression in some patients remains problematic. Great efforts are being made to identify the mechanisms of immune resistance and to establish new predictive and prognostic biomarkers. The aim of this study was to evaluate the association between PD-L1 expression, genetic alterations, and prognosis in patients diagnosed with metastatic NSCLC. PD-L1 expression and genetic profiling using NGS were assessed in 50 patients with advanced NSCLC who were negative for EGFR mutations. According to this study results, positive PD-L1 expression was detected in 62% of cases, whereas high TMB was detected in 34% of cases. Targetable mutations were detected in 33.4% of cases. The TP53 mutation was more likely to be found in tumours with higher PD-L1 and TMB levels (median 45 vs. 0, p = 0.005; median 10 vs. 4.5, p = 0.008, respectively). Meanwhile, STK11 mutation was associated with lower PD-L1 and higher TMB levels (median 0 vs. 17.5, p = 0.019; median 11.5 vs. 6, p = 0.047). Fast disease progression was observed in 22.2% of cases when immunotherapy alone or combined with chemotherapy was administered, with the most frequently detected TP53 (87.5%), STK11 (37.5%), and KEAP1 (37.5%) mutations in this part of the population. Progressive disease was more likely to be found in patients with KEAP1 mutation than in those with wild-type KEAP1 (75% vs. 18.8%, p = 0.02). To conclude, significant associations were found between PD-L1, TMB statuses and mutations in STK11 and TP53. Fast disease progression was established in 1/5 of the entire population treated with immunotherapy or chemo-immunotherapy. TP53, STK11, and KEAP1 mutations were most frequently detected in patients with fast disease progression. The KEAP1 mutation was associated with progressive disease in patients with advanced NSCLC. Our results suggest that a specific genetic profile could serve as a predictor of fast progression in a selected group of patients. Full article

Background: Colorectal liver metastases (CRLM) occur in up to 50% of colorectal cancer with a significant impact on patient survival, of whom only 20–30% will be considered suitable for surgical treatment. Despite the progress in systemic therapies, palliative chemotherapy alone results in a 5-year overall survival (OS) < 10%. Recently, liver transplantation (LT) has been reconsidered as an option and demonstrates improved survival in highly selected patients. This study assessed the impact of implementing a standardised patient selection protocol (LITORALE) on post-transplant outcomes for unresectable CRLM (uCRLM) at a high-volume single centre. Methods: This is a prospective observational study including all consecutive patients transplanted for uCRLM at our institution between July 2015 and September 2024. This prospective observational study evaluated the impact of the LITORALE protocol on post-transplant outcomes in uCRLM patients at a single centre. Patients who underwent LT between July 2015 and September 2024 were grouped into pre-LITORALE (2015–2021) and LITORALE (post-2021) cohorts. Recipient profiles, transplant variables, and post-transplant outcomes were compared. Results: Twenty-one patients were included (eight pre-LITORALE, thirteen LITORALE). The LITORALE group had a lower median number of lesions (4 vs. 17.5, p = 0.004), a smaller major lesion size (3 cm vs. 5.5 cm, p = 0.082), and a significantly lower tumour burden score (6.32 vs. 18.02, p = 0.002). Similar to recent major clinical trials, one- and three-years OS were 100% and 83%, respectively, after protocol introduction; recurrence patterns were significantly different, with reduced multi-site recurrences (7.7% vs. 50%, p = 0.048) and a higher incidence of lung-only recurrences in the LITORALE group (50% vs. 0%, p = 0.033). Conclusions: The introduction of the LITORALE protocol significantly influenced patient selection and recurrence patterns in LT for uCRLM. Although the limited number of patients and the short study timespan highlight the need for future validation, these preliminary results support the adoption of structured, multidisciplinary criteria to optimise oncologic outcomes. Full article

Background/Objectives: Patients with inflammatory bowel disease (IBD) are at an increased risk of various cancers; such as colorectal cancer; skin cancer; bile duct cancer; or lymphoma; with IBD itself not being the sole cause. Inappropriate or ineffective IBD therapy with a continuous inflammatory burden within the gut leads to an increased risk of malignancy. Our study aimed to investigate the risk of malignancy in our patient cohort; focusing on concomitant therapy; disease duration; and inflammatory burden. Methods: A total of 333 consecutive adult patients with IBD (Crohn’s disease; ulcerative colitis; and IBD unclassified) were included in this study. Data from patients were collected retrospectively using patient charts. The patients were treated in the gastroenterological outpatient clinic of the University Hospital of Augsburg; Germany; between 1 January 2014 and 31 December 2018. Results: The study group included 333 patients; 32 (9.61%) of whom suffered from malignancy (any form). Men (n = 21; 65.62%) tended to develop malignancy more often than women (n = 11; 34.38%, p = 0.051). It was also observed that the probability of developing cancer was 2.40 times higher in male patients than in female patients in our cohort. However, this trend was non-significant (HR = 2.412; p = 0.075). Furthermore; the probability of developing cancer increased with the increasing age at the time of the first diagnosis of IBD (HR = 1.088; p < 0.025). A total of 20 patients (6.00%) received their cancer diagnosis after being diagnosed with IBD. The majority of those patients had skin (n = 6; 30.00%) or colon cancer (n = 5; 25.00%). Other diseases such as CML; NHL; HL; HCC; liver sarcoma; prostate cancer; breast cancer; seminoma; thyroid cancer (a second cancer in one of the patients); or CUP syndrome/lung cancer were diagnosed in single patients. Patients with IBD and colon cancer (n = 5; 25.00%) shared some of the known risk factors for tumour development; such as a long-lasting IBD (n = 5; 100.00%), diagnosis at a young age (under 30; n = 3; 60.00%), and the coexistence of PSC (n = 1; 20.00%). The cancer prevalence rate was relatively low in our cohort despite the use of diverse biologics and immunosuppressive drugs. Faecal calprotectin was confirmed as a relevant tool for inflammation monitoring in this cohort. Conclusions: In our study cohort; we could show a low prevalence rate of malignancy in IBD. There were more malignancies in men and in patients who were diagnosed with IBD at later ages. It can be observed that the prevalence rate of cancer was relatively low despite the use of diverse biologics and immunosuppressive drugs; which is the major conclusion of this study. Additionally; the known correlation between elevated levels of faecal calprotectin and gut inflammation was confirmed through our statistical analysis. The use of calprotectin as a non-invasive screening tool for gut inflammation is advised. Full article

Background/Objectives: Surgical pathology of tubo-ovarian and peritoneal cancer carries a well-recognised diagnostic workload, partly due to the large amount of non-primary tumour-related tissue requiring assessment for the presence of metastatic disease. The lymph nodes and omentum are almost universally included in such resection cases and contribute considerably to this burden, principally due to volume rather than task complexity. To date, artificial intelligence (AI)-based studies have reported good success rates in identifying nodal spread in other malignancies, but the development of such time-saving assistive digital solutions has been neglected in ovarian cancer. This study aimed to detect the presence or absence of metastatic ovarian carcinoma in the lymph nodes and omentum. Methods: We used attention-based multiple-instance learning (ABMIL) with a vision-transformer foundation model to classify whole-slide images (WSIs) as either containing ovarian carcinoma metastases or not. Training and validation were conducted with a total of 855 WSIs of surgical resection specimens collected from 404 patients at Leeds Teaching Hospitals NHS Trust. Results: Ensembled classification from hold-out testing reached an AUROC of 0.998 (0.985–1.0) and a balanced accuracy of 100% (100.0–100.0%) in the lymph node set, and an AUROC of 0.963 (0.911–0.999) and a balanced accuracy of 98.0% (94.8–100.0%) in the omentum set. Conclusions: This model shows great potential in the identification of ovarian carcinoma nodal and omental metastases, and could provide clinical utility through its ability to pre-screen WSIs prior to histopathologist review. In turn, this could offer significant time-saving benefits and streamline clinical diagnostic workflows, helping to address the chronic staffing shortages in histopathology. Full article

Background/Objectives: Vascular anomalies represent a complex group of conditions including vascular malformations and haemangiomas. Haemangiomas are benign tumours that have an endothelial origin. In contrast, vascular malformations are characterized by the abnormal dilation of vessels without proliferation. Depending on the extension of the disease, there is a higher risk of life-threatening haemorrhages that may occur during simple dental procedures. The aim of this case report is to present the interdisciplinary treatment for patients with venous malformation and to discuss the possible dental management of these patients. Methods: A 66-year-old male patient with an extensive venous malformation of the head and neck was referred for a tooth extraction. The venous malformation involved lips, buccal mucosa, tongue, and floor of the oral cavity. Its proximity to the tooth requiring extraction was associated with a high risk of severe bleeding. Results: Prior to the treatment, CBCT and CT scans were performed to confirm the extensions of the lesion and visualise its margins. Considering the possible risks related with venous malformation, the procedure consisted of tooth removal in a hospital setting with control over severe bleeding complications. Conclusions: The presence of an extensive vascular malformation in the head and neck region is burdened with a higher risk of haemorrhages during simple dental procedures. The radiological and clinical planning enables the choice of an accurate treatment strategy to avoid possible difficulties. In cases where such complications cannot be avoided, it is important to perform the treatment in a hospital setting with the cooperation of maxillofacial surgeons. Full article

Background/Objectives: Laryngeal cancer (LC), predominantly squamous cell carcinoma (SCC), represents a considerable health burden worldwide. Tumour subsite heterogeneity (supraglottic, glottic, subglottic) influences clinical behavior and outcomes. This review synthesizes current knowledge on epidemiology, risk factors, diagnostics, histological variants, biomarkers, treatment modalities, and survival. Results: This narrative review synthesizes current literature on the epidemiology, risk factors, diagnosis, histological variants, biomarkers, and prognosis of LC. The review highlights the critical influence of tumour sites (supraglottic, glottic, subglottic) on metastatic patterns and survival. Key risk factors of LC include tobacco and alcohol use, human papillomavirus (HPV) infection, and occupational exposures. The diagnostic process encompasses clinical examination, endoscopy, biopsy, and imaging. Several biomarkers that aid in diagnosis, treatment plan determination, and prognosis prediction have been established. These biomarkers include long noncoding RNAs, cell cycle regulators, apoptosis regulators, oncogenes, tumour suppressor genes, growth factor pathway components, angiogenic factors, structural proteins, sex hormone receptors, and immunological markers. Current treatment modalities range from organ-preserving surgery and radiotherapy to combined chemoradiotherapy and total laryngectomy. Finally, survival data are presented and stratified by stage and subsite. Conclusions: The review underscores the need for a multidisciplinary approach to LC management, integrating clinical, pathological, and molecular information to optimize patient outcomes. Full article

Background: Dedifferentiated liposarcoma (DDLPS) is a rare, aggressive tumour with poor survival outcomes in advanced settings. This study assessed the incidence/prevalence, treatment patterns, survival, healthcare resource utilization (HCRU), and costs for DDLPS patients in Ontario, Canada. Methods: A retrospective cohort study was conducted among DDLPS patients between 2010 and 2022 using administrative databases. Overall survival, all-cause HCRU, and costs (2023 Canadian dollars, CAD) were compared based on advanced disease and resection status. Results: The overall incidence and cumulative prevalence of DDLPS was 0.465 and 1.995 per 100,000 people, respectively. Of all 611 DDLPS cases (64.3% male, median age [IQR]: 67 [57–76] years), 40.3% and 61.0% had advanced and unresected disease, respectively. The median overall survival (mOS) was 69 months [IQR = 15–151] for the entire cohort, but this was significantly lower for advanced and unresected disease (p < 0.0001). Among patients receiving systemic treatments (N = 117), 81.2% were prescribed doxorubicin as first-line treatment. All-cause healthcare costs (2023 CAD) amounted to CAD 34,448 per person-year (PPY), with inpatient hospitalizations being the highest cost driver at CAD 14,522 PPY and 0.8 inpatient hospitalization PPY for all years. Advanced disease had higher HCRU and costs. Conclusions: This is the first comprehensive real-world evidence study that quantifies the high mortality and cost burden associated with DDLPS in Canada. Full article

Background/Objectives: Patients with haematological malignancies less frequently receive specialist palliative care, although they may have unmet needs for symptom control and alleviating psychosocial and existential burdens. The ‘Surprise’ Question, ‘Would you be surprised if this patient died in the next 12 months?’, helps physicians to identify patients who may benefit from palliative care. We tested the influencing factors of the feasibility of the ‘Surprise’ Question in haemato-oncology outpatients. Methods: We performed a prospective cohort study comparing patients with solid tumours and haematological malignancies. All the patients in the haemato-oncology outpatient clinics of a German university hospital were screened by haemato-oncologists using the ‘Surprise’ Question. Results: A survival analysis was performed on 672 patients (76% with haematological malignancies) at 3 and 12 months. Within one year, 110 patients (16%) died. Of these, 30/52 (58%) were patients with solid tumours, but only 12/53 (23%) patients with haematological malignancies were identified in advance by the ‘Surprise’ Question, which reflects ambiguous test sensitivity. A substantial part of the haematology patients in their last year of life were not identified (77%). The match between the survival estimates and actual outcomes was fair (Cohen’s kappa 0.37). The proximity from prediction to event and the estimating physician rather than patient characteristics influenced the accuracy of the instrument. Conclusions: For the first time, the feasibility of the ‘Surprise’ Question in haematology outpatients was proven. Factors that would improve haemato-oncologists’ clinical intuition should be further explored to facilitate timely conversations about issues important to patients nearing the end of life. Full article