Search Results (200)

Background and Objective: Diagnosis of TFE3-rearranged RCC (tRCC) requires a pathologist’s expertise and a high index of suspicion. The objectives of this study were to determine the rate of misclassification of RCC in the adolescent and young adult (AYA) patient population, identify any clinically significant impact associated with misclassification, and compare oncologic outcomes between patients with tRCC vs. other RCC subtypes. Methods: All patients < 50 years who underwent renal surgery and were diagnosed with renal cell carcinoma at a single institution from 2004 to 2019 were identified retrospectively. Pathology specimens were reviewed by a genitourinary pathologist. Changes in a pathologic diagnosis were denoted as “misclassified.” Clinical and oncologic data were analyzed comparing misclassified and non-misclassified groups as well as tRCC and other RCC diagnoses. A survival analysis was used to compare oncologic outcomes. Results: In total, 169 patients were identified, and 20/169 (11.8%) patients were misclassified after pathologic review, with 50% (n = 84) of this cohort < 40 years of age at diagnosis. There were significant differences between misclassified and non-misclassified groups with respect to race (p = 0.002), Appalachian county status (p = 0.035), and initial RCC subtype (p = 0.004). There were no significant differences in clinical or oncologic outcomes between tRCC and other RCC groups. There were no significant differences in time to death or recurrence in misclassified vs. non-misclassified patients (p = 0.83 and 0.68, respectively) or between patients with tRCC and other RCC subtypes (p = 0.45 and 0.062, respectively). Conclusions: >10% of patients with RCC were misclassified on the original pathologic diagnosis; however, there was no significant impact on oncologic outcomes. This identifies diagnostic blind spots for tRCC diagnosis in a young cohort. Perhaps reflex IHC or molecular testing could be of importance upfront for the AYA population with renal masses. Full article

HER2DX is a 27-gene genomic assay generating three complementary scores: a pCR score predicting the likelihood of achieving pathological complete response (pCR, defined as absence of residual invasive disease after neoadjuvant therapy), a Risk score estimating long-term recurrence risk, and an ERBB2 mRNA score quantifying HER2 transcriptional activation. Together, these scores may guide treatment escalation or de-escalation strategies in routine practice. We performed a single-center observational study at 12 de Octubre University Hospital (Madrid, Spain), including patients with early-stage HER2-positive breast cancer who underwent HER2DX testing (2023–2025), and analyzed clinicopathologic features, treatment decisions, and pathological outcomes. Forty-five patients were included (median age 57 years). Stage II accounted for 71.1% of cases; 66.7% were hormone receptor-positive, and 31.3% were node-positive. HER2DX modified clinical management in 51.1% of patients. The pCR score changed the initial strategy (neoadjuvant therapy versus upfront surgery) in 17.8% of cases and, independently, favored de-escalation to taxane plus dual HER2 blockade, with 90% of high-score tumors achieving a pathological complete response. The Risk score informed chemotherapy backbone selection within stage II disease. The ERBB2 score correlated with HER2 immunohistochemical intensity. In this exploratory real-world cohort, HER2DX provided biologically distinct information beyond traditional immunohistochemistry and was associated with modifications in multidisciplinary treatment decision-making in early-stage HER2-positive breast cancer, warranting prospective validation in larger cohorts. Full article

The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Full article

Background/Objectives: A considerable number of patients with malignant spinal cord compression (MSCC) and a longer expected lifespan do not receive upfront surgery but radiation therapy alone. These patients were suggested to benefit from radiation programs with total doses > 30 Gy in terms of better local progression-free survival (LPFS). A previous study compared such regimens, namely 15 × 2.633 Gy over three weeks (34 patients, prospective cohort) and 20 × 2.0 Gy over four weeks (239 patients, control), using a propensity score-adjusted approach. Both regimens were associated with similar rates of overall survival (OS) and LPFS. However, follow-up was limited to 12 months. For long-term survivors, a longer period of follow-up would be desirable. Therefore, the present study was initiated. Methods: Retrospective collection of additional data enabled us to provide OS- and LPFS-rates at 36 months following radiation therapy. Results: In the prospective cohort, 36-month rates of OS and LPFS were 27.0% and 89.7%, respectively. After application of the propensity score-adjusted Cox regression model, 36-month OS-rates (HR 1.454; 95% CI 0.748–2.828; p = 0.270) and LPFS-rates (HR 0.311; 95% CI 0.041–2.352; p = 0.258) appeared not considerably different. Late radiation myelopathy and pathologic vertebral fractures were not identified. Conclusions: The results of the current study suggest that the role of 15 × 2.633 Gy should be further investigated in selected patients with MSCC, particularly when considering its shorter overall treatment time in comparison to 20 × 2.0 Gy. Overall, our findings are hypothesis-generating rather than confirmatory. Full article

Objective: This study aimed to investigate the impact of elevated CRP on survival outcomes in small renal masses (SRM). Methods: This was a multi-institutional retrospective analysis of SRM (≤3 cm) managed surgically. The cohort was divided into elevated CRP (≥0.5 mg/dL) vs. non-elevated CRP groups (<0.5). The primary outcome was all-cause mortality (ACM). The secondary outcomes were non-cancer (NCM) and cancer-specific mortality (CSM). Cox-regression analysis was used to elucidate predictive factors for mortality outcomes. Kaplan–Meier Analysis (KMA) was performed to analyze 10-year overall (OS), cancer-specific (CSS) and non-cancer-specific survival (NCS). Results: A total of 1001 patients were analyzed (309 non-elevated CRP/692 elevated CRP; median follow-up 70 months). Elevated CRP was an independent predictor for ACM (HR = 2.60, p < 0.001) NCM (HR = 2.90, p = 0.002), and CSM (HR = 1.20, p = 0.011). KMA comparing elevated vs. non-elevated groups revealed greater 10-year OS (p < 0.001) and NCS (p < 0.001) for non-elevated CRP, but no significant difference in 10-year CSS (p = 0.295). A total of 83 deaths were observed in elevated CRP (71 NCM/12 CSM—all clear-cell histology). The sensitivity/specificity of elevated CRP was 0.87/0.33, 0.75/0.81, and 0.90/0.33 for ACM, CSM, and NCM. By utilizing CRP for a decision-making algorithm prioritizing biopsy in CRP elevation and offering surveillance in benign or indolent histology, surgery may be avoided in 218 patients, in whom there were 38 fatalities, all NCM. Conclusions: Elevated CRP was an independent predictor of survival outcomes in SRM ≤ 3 cm. From a competing mortality standpoint, patients with elevated CRP had significantly worsened NCM compared to CSM. In such patients, upfront oncologic risk stratification through biopsy may be considered, and indolent/low-grade neoplasms should be strongly considered for non-surgical management. Full article

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal gastrointestinal cancers, and reliable preoperative predictors of aggressive tumor biology are essential for optimizing treatment strategies, particularly in resectable PDAC (RPDAC). This retrospective study evaluated the diagnostic accuracy of dynamic computed tomography (CT) for detecting extrapancreatic extension, peripancreatic plexus (PL), serosal (S), and retroperitoneal (RP) invasion, and assessed its prognostic significance. Methods: Ninety-four patients who underwent curative-intent upfront surgery for resectable PDAC between 2007 and 2020 were included. Dynamic CT was reviewed using standardized window settings (WL 35/WW 350) to identify soft-tissue projections extending beyond the pancreatic contour. Results: Pathological S, RP, and PL invasion occurred in 29.8%, 56.3%, and 17.0% of patients, respectively. Dynamic CT demonstrated accuracies of 73.4%, 76.6%, and 87.2% for S, RP, and PL invasion, respectively. Notably, patients with PL-positive CT findings had significantly poorer disease-specific survival (DSS) than those with PL-negative, with 3- and 5-year DSS rates of 37% and 0% versus 61% and 53% (p < 0.001). Multivariate analysis confirmed preoperative PL invasion as the only independent predictor of poor prognosis. Conclusions: Dynamic CT provides reasonable diagnostic performance for assessing extrapancreatic invasion. In addition, CT-identified PL invasion reflects aggressive tumor behavior and may justify consideration of neoadjuvant therapy, even in anatomically resectable disease. Full article

Background and Objectives: The role of neoadjuvant or perioperative treatment in anatomically resectable pancreatic ductal adenocarcinoma (PDAC) remains intensely debated, in part because prior evidence syntheses have often pooled resectable and borderline-resectable disease. We aim to evaluate the efficacy and safety of neoadjuvant or perioperative treatment versus upfront surgery in trial-defined resectable PDAC using randomized evidence only. Materials and Methods: We performed a systematic review and meta-analysis of parallel-group randomized controlled trials comparing neoadjuvant therapy with upfront surgery in adults with resectable PDAC. PubMed, CENTRAL, Scopus, and Clarivate Web of Science were searched from inception until 30 November 2025. Mixed resectable- and borderline-resectable trials were included only when outcomes for the resectable subgroup were extractable. The primary outcome was overall survival (OS), analyzed on an intention-to-treat basis. Secondary outcomes included time-to-disease-event (TTDE) endpoints, resection rate, R0 resection, pathological node-negative (pN0) status, postoperative morbidity and mortality, and grade ≥3 adverse events. The review protocol was prospectively registered in PROSPERO (CRD420251243805). Results: Eight randomized controlled trials enrolling 1395 patients, including 1184 patients with resectable PDAC, met the eligibility criteria. Overall survival was available for six trials (seven comparisons totaling 1066 randomized patients) and was not significantly different between neoadjuvant treatment and upfront surgery (HR 0.80, 95% CI 0.59–1.08). TTDE was likewise not significantly different between strategies (HR 0.80, 95% CI 0.58–1.11). Neoadjuvant treatment reduced the likelihood of proceeding to resection (RR 0.90, 95% CI 0.85–0.95), while R0 resection and pN0 rates were numerically but not significantly higher among the resected patients. Postoperative morbidity and mortality were comparable between groups. Exploratory analyses suggested favorable survival estimates in trials with higher neoadjuvant treatment deliverability and completion. Conclusions: In trial-defined resectable PDAC, current randomized evidence does not demonstrate a universal survival advantage for neoadjuvant treatment over upfront surgery. Exploratory trial-level analyses suggested that higher neoadjuvant treatment deliverability and completion were associated with more favorable survival estimates. These findings support a selective, individualized rather than routine use of preoperative strategies in resectable PDAC. Full article

Background and Objectives: Sinonasal carcinomas are heterogeneous malignancies often associated with poor prognosis because of the locally advanced stage at presentation and high recurrence rates. Easily accessible prognostic biomarkers are therefore of increasing clinical interest. Systemic inflammatory blood markers have shown prognostic value in several solid tumors, but their role in sinonasal carcinomas remains unclear. Materials and Methods: A scoping review was performed according to PRISMA-ScR recommendations. The PubMed/MEDLINE, Scopus, and Embase databases were searched from inception to March 2026. Original English-language studies evaluating preoperative or pre-treatment inflammatory blood biomarkers in sinonasal malignant tumors were included. Results: Six retrospective single-center studies met the inclusion criteria, comprising 1049 patients. All studies evaluated biomarkers before treatment initiation in cohorts managed primarily with upfront surgery. The neutrophil-to-lymphocyte ratio (NLR) was the most frequently investigated biomarker and the one most commonly associated with adverse oncologic outcomes, including poorer survival, advanced stage, and increased recurrence risk. Additional biomarkers included the platelet-to-lymphocyte ratio, advanced lung cancer inflammation index (ALI), systemic immune-inflammation index (SII), and other composite scores. Preliminary evidence suggests that ALI and SII may provide additional prognostic information beyond isolated inflammatory ratios, although current evidence remains limited. Conclusions: Preoperative inflammatory blood biomarkers, particularly NLR, appear to be promising, low-cost, and widely accessible prognostic tools for risk stratification in sinonasal carcinomas. However, current evidence is limited by retrospective study design, heterogeneous cohorts, and non-standardized cut-off values. Prospective multicenter studies are needed before routine clinical implementation can be recommended. Full article

Background: Stage III non-small cell lung cancer (NSCLC) represents a clinically and biologically heterogeneous disease group, posing challenges in treatment standardization. Objective: This study aimed to evaluate survival outcomes and prognostic factors in patients with pathological stage III NSCLC undergoing upfront surgery in a real-world setting. Methods: Patients treated between January 2009 and December 2023 were retrospectively analyzed. All patients underwent anatomical resection with systematic mediastinal lymph node dissection and achieved complete (R0) resection. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method, and prognostic factors were evaluated using Cox proportional hazards regression. Nomograms were developed for individualized survival prediction. Results: A total of 390 patients were included, with a median follow-up of 35 months. The median OS was 47 months, and the median RFS was 30 months. Multivariable analysis identified age, PET-detected mediastinal nodal involvement, tumor location, postoperative complications, pathological nodal status, adjuvant chemotherapy, and adjuvant radiotherapy as independent predictors of OS (p = 0.001, p = 0.029, p = 0.006, p =0.002, p = 0.009, and 0.004, respectively), while adjuvant chemotherapy was associated with improved survival (p = 0.010). For RFS, pathological N2b disease, stage IIIB, tumor location, and adenocarcinoma histology were independent predictors (p = 0.001, p = 0.016, p = 0.029, and p = 0.027, respectively). The OS nomogram demonstrated moderate discriminative ability, whereas the RFS model showed limited predictive performance. Conclusions: These findings highlight the substantial heterogeneity of stage III NSCLC and emphasize the importance of individualized, multidisciplinary treatment strategies beyond conventional staging systems. Full article

Background: Persistent lymph node metastases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer indicate poor response to treatment. This study evaluated the long-term prognosis of patients with residual nodal disease following neoadjuvant RCT and total mesorectal excision (TME) in comparison with patients who underwent upfront TME without adjuvant radiotherapy. Methods: Consecutive patients with rectal adenocarcinoma and histopathologically confirmed lymph node metastases after TME were identified from the prospectively maintained database of the colorectal unit at Dresden-Friedrichstadt General Hospital. Patients with distant metastases, in-hospital mortality, or postoperative radiotherapy were excluded. The two groups were comprehensively compared regarding patient-, tumor-, and treatment-related characteristics. Cumulative local recurrence, time to recurrence, cancer-specific survival, and overall survival were analyzed using the Kaplan–Meier method. Results: Between 1996 and 2021, 155 eligible patients were identified, including 101 patients in the RCT group and 54 in the upfront surgery group. Baseline characteristics were largely comparable, except for a higher median age (70.5 vs. 64 years, p < 0.001) and a higher proportion of lymphovascular invasion (36.0% vs. 15.2%, p = 0.004) in the upfront surgery group. Ten-year local recurrence rates were similar between groups (21.0% [95% CI: 10.4–31.6] vs. 20.8% [95% CI: 8.5–33.1], p = 0.609). No significant differences were observed in time to recurrence or cancer-specific survival. Overall survival was lower in the upfront surgery group, most likely reflecting the substantially higher age of these patients. Conclusions: Despite more intensive treatment, patients with a persistent ypN-positive category have outcomes no better than untreated patients with node-positive disease after TME, indicating a biologically high-risk subgroup. Non-response is therefore a sign of a negative selection. These patients may lose the opportunity for optimal local tumor control during prolonged neoadjuvant treatment, underscoring the urgent need for reliable predictive markers to identify non-responders and guide individualized treatment strategies. Full article

Background/Objectives: Sentinel lymph node biopsy is central to axillary staging in breast cancer, but conventional mapping often relies on radioisotopes and/or blue dye. Indocyanine green fluorescence has emerged as an alternative, although evidence for its use as a sole tracer in routine practice remains limited. This study evaluated the technical feasibility, lymph node yield, nodal metastasis detection, and short-term clinical outcomes of indocyanine green used as the only tracer for axillary staging in a consecutive single-centre cohort. Methods: This retrospective observational cohort study included 260 patients with histologically confirmed breast cancer who underwent axillary surgery at University Hospital Kaspela between 2024 and 2025 under an institutional protocol using indocyanine green as the sole tracer. Indocyanine green-guided mapping was attempted in all patients. For node-focused statistical analyses, a predefined complete-case–cohort of 230 patients was used. Descriptive analyses assessed axillary procedure distribution, lymph node yield, nodal metastasis, and postoperative outcomes. Exploratory multivariable logistic regression was performed to evaluate predictors of nodal metastasis. Results: Mapping was successful in 259/260 patients (99.6%). In the complete-case–cohort, sentinel lymph node biopsy was performed in 166/230 patients (72.2%), targeted axillary dissection in 4/230 (1.7%), and axillary lymph node dissection in 60/230 (26.1%). Median overall lymph node yield was 4 (IQR 3–7), but this pooled value reflected heterogeneous axillary procedures and should not be interpreted as sentinel node yield alone. In the clinically node-negative upfront SLNB subgroup, median lymph node yield was 4 (IQR 2.75–5), and nodal metastasis was identified in 22/112 patients (19.6%). Overall, nodal metastasis was identified in 58/230 patients (25.2%), with a median of 2 metastatic nodes (IQR 1–3) among nodal-positive cases. Reoperation for axillary lymph node dissection occurred in 14/230 patients (6.1%). In exploratory multivariable analysis, suspicious biopsied-positive nodes (OR 12.85, 95% CI 3.98–41.52), suspicious non-biopsied nodes (OR 15.58, 95% CI 3.44–70.59), and neoadjuvant therapy (OR 0.31, 95% CI 0.11–0.87) were associated with nodal metastasis; these findings should be interpreted cautiously given the expected clinical relationship between preoperative nodal suspicion and nodal positivity, and the limited number of nodal-positive events. Conclusions: Indocyanine green used as a sole tracer demonstrated high technical feasibility within a heterogeneous real-world axillary staging workflow in this single-centre cohort. These findings should be interpreted as implementation-focused feasibility data rather than formal diagnostic validation, given the retrospective design, heterogeneous case mix, and absence of an internal comparator. Full article

Background: The optimal role of induction chemotherapy (IC) in the management of oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study compared oncologic outcomes between IC followed by surgery and concurrent chemoradiotherapy (CCRT) and upfront surgery followed by adjuvant CCRT. Methods: We retrospectively analyzed 98 patients with OCSCC treated between 2011 and 2017. Overall survival (OS), cancer-specific survival (CSS), and local control (LC) were evaluated using Kaplan–Meier survival analysis and Cox proportional hazards models to identify prognostic factors. Results: Fifty patients received IC and 48 underwent upfront surgery. With a median follow-up of 77.8 months, no significant differences in OS, CSS, or LC were observed between treatment groups (OS: HR 1.31, p = 0.415; CSS: HR 1.36, p = 0.421; LC: HR 1.29, p = 0.475). Positive surgical margins independently predicted inferior OS, CSS, and LC, while extracapsular spread was independently associated with inferior CSS. Although tumor downstaging was frequently observed after IC, it did not translate into survival benefit. Conclusions: IC followed by surgery was associated with no statistically significant differences in oncologic outcomes compared with upfront surgery followed by adjuvant CCRT. Prognosis was primarily determined by pathological risk factors rather than treatment sequence. Full article

Background: Neoadjuvant therapy (NAT) is increasingly investigated in operable pancreatic ductal adenocarcinoma (PDAC), yet its role in strictly resectable disease remains controversial. Randomized trials have been conducted both in borderline resectable and resectable PDAC and have demonstrated survival advantages, while evidence in strictly resectable tumors remains poor. We conducted an umbrella review of systematic reviews and meta-analyses (SRMAs) to comprehensively evaluate the highest level of available evidence on NAT versus upfront surgery in operable PDAC. Methods: We performed an umbrella review of completed SRMAs assessing neoadjuvant chemotherapy (NAC) and/or chemoradiotherapy (NACRT) in resectable and borderline resectable PDAC. MEDLINE/PubMed, Embase, and Cochrane Library were searched from inception through November 2025. Eligible SRMAs reported at least one clinical outcome, including overall survival (OS), disease-free/event-free survival (DFS/EFS), resection rate, R0 resection, nodal status, or perioperative outcomes. Methodological quality was appraised using AMSTAR-2 and ROBIS tools. Overlap among SRMAs was quantified using the Corrected Covered Area (CCA), and RCT-only evidence was prioritized for causal inference. Evidence credibility was graded using an Ioannidis-style classification framework. Results: Thirty-four SRMAs published between 2010 and 2025 were included. In strictly resectable PDAC, RCT-only meta-analyses showed no definitive OS benefit for NAT compared with upfront surgery (pooled HR approximately 0.85, 95% CI 0.68–1.05), although a significant improvement in EFS was observed (HR approximately 0.77, 95% CI 0.65–0.90). Trial sequential analyses suggested insufficient information size for conclusive OS benefit in resectable disease. Conversely, in pooled resectable and borderline resectable populations, NAT significantly improved OS (HR approximately 0.66, 95% CI 0.52–0.85), with subgroup analyses indicating that the survival advantage was primarily driven by borderline resectable tumors. NAT consistently increased R0 resection and node-negative (pN0) rates and reduced non-curative explorations. However, neoadjuvant strategies were associated with treatment-related attrition and, in some analyses, lower overall resection rates. Comparative evidence suggested improved pathological outcomes with chemoradiotherapy versus chemotherapy alone, without a consistent survival advantage. Conclusions: Current high-level evidence supports NAT as the preferred strategy for borderline resectable PDAC, demonstrating consistent survival and pathological benefits. In strictly resectable disease, NAT improves disease-control endpoints and pathological surrogates, but a definitive OS advantage has not been consistently demonstrated in RCT-only syntheses. This should not be interpreted as evidence of equivalence between NAT and a surgery-first strategy, given the heterogeneity, limited power, and therapeutic-era effects of the available literature. Treatment decisions in resectable PDAC should therefore be individualized, balancing potential oncologic benefits against attrition risk. Future adequately powered randomized trials employing contemporary multi-agent regimens are needed to clarify the survival impact of NAT in strictly resectable disease. Full article

Background: Non-Wilms renal tumours (NWRTs) are rare paediatric malignancies and account for a small but clinically significant proportion of childhood renal cancers. Due to their low incidence and biological heterogeneity, outcome data are limited, and management is largely extrapolated from international collaborative protocols. No national data describing the incidence and outcomes of NWRTs in children in the Republic of Ireland (ROI) have previously been published. Objective: To determine the incidence, treatment strategies, and survival outcomes of NWRTs in children in the ROI. Methods: A retrospective cohort study was conducted of all children under 16 years of age with histologically confirmed renal tumours diagnosed and treated at Children’s Health Ireland (CHI) at Crumlin between January 2005 and December 2025. As CHI Crumlin is the single national paediatric oncology centre in the ROI, this cohort represents national case ascertainment for the study period. A total of 143 paediatric renal tumours were identified; Wilms tumours (n = 118) were excluded, leaving 25 children (17.48%) with NWRTs for analysis. No cases of bilateral renal tumours were identified. Histological subtypes included renal cell carcinoma (RCC), clear cell sarcoma of the kidney (CCSK), congenital mesoblastic nephroma (CMN), malignant rhabdoid tumour of the kidney (MRTK), and anaplastic sarcoma of the kidney. Demographic characteristics, treatment strategies, and survival outcomes were analysed. Results: Twenty-five children with NWRTs were identified: CCSK (n = 9), RCC (n = 7), CMN (n = 6), MRTK (n = 2), and anaplastic sarcoma of the kidney (n = 1). At a median follow-up of 107.9 months (range 4.5–181.3 months), overall survival for the cohort was 76%. Overall survival by histology was 100% for CMN, CCSK and anaplastic sarcoma, 43% for RCC, and 0% for MRTK. Treatment strategies varied by histology, with 68% undergoing upfront surgery, 32% receiving neoadjuvant chemotherapy, 60% receiving adjuvant systemic therapy, and 44% receiving radiotherapy. Tumour recurrence occurred in 4/25 patients (16%), confined to the RCC (3) and CMN (1) subgroups. Seven Event-Free Survival events were observed, comprising three RCC relapses and one RCC progression, one CMN relapse, and two MRTK progression-related deaths. No recurrences occurred in CCSK. Conclusions: NWRTs comprised 17.5% of all paediatric renal tumours diagnosed nationally during the study period and demonstrated marked heterogeneity in outcomes according to histological subtype. CMN showed excellent survival with six out of seven requiring surgery alone, whereas MRTK remained associated with dismal outcomes despite multimodal therapy. These national data support histology-driven, risk-adapted management and highlight the importance of continued international collaboration to improve outcomes in NWRTs. Full article

Objectives: This study aimed to compare the results obtained by endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) with the pathologic staging of the operative specimen in patients with lower and middle rectal cancer not treated with neoadjuvant therapy and undergoing surgery. Methods: From 2011 to 2022, all the consecutive patients with lower/middle rectal cancer who underwent surgery-first treatment were evaluated. The results of diagnostic examinations and the definitive pathological examination were considered and compared. Results: One hundred and one patients were enrolled in the study. The mean age was 72.5 (SD ± 9.7) years. F:M = 1:2. Mean distance from the anal orifice was 87 (SD ± 9.7) mm. Mean tumoral cranio-caudal extension was 35 (SD ± 12.5) mm. According to the T-stage, the κ coefficient showed a fair concordance between MRI and Pathology (κ = 0.294) and moderate between ERUS and Pathology (κ = 0.534). According to the N-stage, MRI was related to a lower concordance (κ = 0.138) than ERUS (κ = 0.337) with Pathology. Comparing ERUS with MRI, κ was higher in staging T (κ = 0.410), showing a moderate agreement. Stage N was related to a fair agreement between the two imaging methods (κ = 0.237). Conclusions: MRI and ERUS have similar results in performing the TN staging in patients with lower and middle rectal cancer who did not undergo neoadjuvant chemoradiotherapy. ERUS might be a valid option for staging patients who cannot have the possibility to perform an MRI. Full article