Cancer Management and Research最新文献

{"title":"Multidisciplinary Palliative Care and Its Impact on Symptom Burden and Quality of Life in Advanced Cancer Patients in Ethiopia: A Pre-Post Quasi-Experimental Study.","authors":"Atalay Mulu Fentie, Edom Seife, Sachiko Ozawa, Teferi Gedif Fenta","doi":"10.2147/CMAR.S624631","DOIUrl":"10.2147/CMAR.S624631","url":null,"abstract":"<p><strong>Purpose: </strong>This study implemented a multidisciplinary team (MDT) palliative care and assessed its impact on symptom burden and health-related quality of life (HRQoL) among patients with advanced-stage cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>This non-randomized pre-post quasi-experimental study (without a concurrent control group) enrolled 192 adult patients with cancer. The intervention was the introduction of MDT palliative care delivered by palliative-care-trained healthcare professionals. Outcomes were assessed before and after MDT implementation using the African Palliative Outcome Scale (APCA POS), EQ-5D-5L (Ethiopian value set) with EQ-VAS, and EORTC QLQ-C15-PAL. Within-patient changes were evaluated in the matched alive cohort (n=167) using paired-sample t-tests, with effect sizes quantified using Cohen's d. Factors associated with changes in HRQoL were examined using ANCOVA-of-change linear regression.</p><p><strong>Results: </strong>All APCA POS domains, except social/communication, improved significantly, and the overall patient score decreased by 3.71 points (Cohen's d = -0.662, <i>p</i><0.001). The EQ-5D-5L utility index score increased by 0. 0.286 (Cohen's d=0.668, <i>p</i><0.001). The EORTC global HRQoL increased by 14.62 points (Cohen's d = 0.909, <i>p</i><0.001), exceeding the conventional 10-point minimal clinically important difference. In the multivariable model, each one-level reduction in patient-rated pain severity was associated with a 4.22-point gain in HRQoL (<i>p</i><0.001), and approximately 31.2% of marginal HRQoL improvement was associated with concurrent pain reduction. Patients with a poor performance status (ECOG 2-4) showed greater HRQoL improvement than those with a better performance status (β = 2.81, <i>p</i>=0.031).</p><p><strong>Conclusion: </strong>MDT palliative care was associated with clinically meaningful improvements in symptom burden and HRQoL, with the largest gains observed in patients with the greatest symptom burden at baseline. To maximize the population-level impact, ensuring the integration of MDT palliative care into Ethiopia's national cancer and palliative care strategies is recommended.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"624631"},"PeriodicalIF":2.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Factors in Upper Gastrointestinal Neuroendocrine Carcinoma: A Retrospective Cohort Study of Clinicopathological Features and Survival Outcomes.","authors":"Erdoğan Şeyran, Azer Gökmen","doi":"10.2147/CMAR.S618644","DOIUrl":"10.2147/CMAR.S618644","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal neuroendocrine carcinoma (NEC) is a rare and highly aggressive malignancy with limited prognostic data. This study aimed to evaluate clinicopathological characteristics and to identify clinically relevant prognostic factors, with a particular focus on simple and readily available inflammatory and nutritional biomarkers that may support routine risk stratification.</p><p><strong>Methods: </strong>In this retrospective cohort study, 54 patients with histologically confirmed esophageal or gastric NEC were analyzed. Clinical, pathological, laboratory, treatment, and survival data were collected. Overall survival (OS) was assessed using Kaplan-Meier analysis. Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.</p><p><strong>Results: </strong>The median OS was 17.9 months. On univariate analysis, metastatic disease, elevated LDH, elevated neutrophil-to-lymphocyte ratio (NLR), hypoalbuminemia, surgical resection, and adjuvant chemotherapy were significantly associated with OS. In multivariate analysis, hypoalbuminemia remained the only independent predictor of worse survival (HR 2.876, 95% CI 1.116-7.414; p = 0.029).</p><p><strong>Conclusion: </strong>Hypoalbuminemia emerged as a potential independent prognostic factor in this cohort and may serve as a simple and readily available marker of poor outcome. Albumin, LDH, and NLR may provide additional prognostic information in patients with upper gastrointestinal neuroendocrine carcinoma. However, these findings should be considered exploratory and require validation in larger prospective multicenter studies.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"618644"},"PeriodicalIF":2.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticancer Activity and Cell Mechanism of a Novel Flavonoid Derivative from <i>Chrysanthemum × morifolium</i> (Ramat). Hemsl Leaves Against the MCF-7 Breast Cancer Line in vitro.","authors":"Imas Maesaroh, Muhaimin Muhaimin, Rizky Abdulah, Melisa Intan Barliana","doi":"10.2147/CMAR.S618125","DOIUrl":"10.2147/CMAR.S618125","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer has the highest number of cases and deaths in women. Cell cycle dysregulation and decreased cell apoptosis are among the causes of cancer cell growth. An ideal anticancer drug has selective toxicity, meaning it can kill cancer cells without damaging normal tissue cells. Several cultivars of <i>Chrysanthemum morifolium</i> leaves (CML) contain the main active compounds, such as flavonoids, as active ingredients of drugs that have potential as anticancer agents.</p><p><strong>Purpose: </strong>The main objective of this study was to investigate the potential anticancer effects of a compound extracted from CML.</p><p><strong>Methods: </strong>Chromatographic isolation of compounds using different separation techniques, including extraction, separation, and purification; characterization using ultraviolet (UV), infrared (IR), nuclear magnetic resonance (NMR), and mass spectroscopy; and evaluation of anticancer activity in vitro (WST-8 assay), cell mechanism: cell cycle inhibition, and apoptosis activity (flow cytometry), and analysis of the <i>ESR1</i> gene expression (RT-qPCR).</p><p><strong>Results: </strong>Bioactive components found in the ethyl acetate extract of CML were acaetin (<b>1</b>), 3,5,5'-Trihydroxy-4'-methoxy flavone (<b>2</b>), and kaempferide-7-O-glycoside (<b>3</b>). The lowest percentage of cell viability was shown in isolate (<b>2</b>) with an IC₅₀ value of 49.37 and 225.045 ppm in MCF-7 and HEK-293 cells. Isolate <b>2</b> at a concentration of 1 × IC₅₀ caused a significant increase in the G2/M phase (50.73 ± 4.13%), indicating G2/M arrest. Meanwhile, in the apoptosis assay, the same treatment increased early apoptosis of up to 38.87 ± 11.43%. Isolate <b>2</b> CML showed increased <i>ESR1</i> gene expression at a dose of 1 × IC₅₀ of 1.34 ± 0.13 and at a dose of ½ × IC₅₀ of 1.01 ± 0.14.</p><p><strong>Conclusion: </strong>Isolate <b>2</b> CML showed selective potential as an anticancer agent through G2/M cell cycle inhibition, early apoptosis, and suppression of <i>ESR1</i> gene expression.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"618125"},"PeriodicalIF":2.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonal Seborrheic Keratosis with Adjacent Bowen's Disease in a Non-Sun-Exposed Patient: Collision or Transformation?","authors":"Zhi Wang, Sen Mao, Haibo Xiao, Qian Zhao","doi":"10.2147/CMAR.S602855","DOIUrl":"10.2147/CMAR.S602855","url":null,"abstract":"<p><p>We report a case of clonal seborrheic keratosis (CPSK) adjacent to Bowen's disease (BD) in a 29‑year‑old male with no history of chronic sun exposure. The lesion presented as a brown, flat papule on the right side of the back. Histopathologically, the CPSK component featured well‑demarcated intraepidermal nests of basaloid keratinocytes, consistent with the Borst‑Jadassohn phenomenon. Adjacent areas showed full‑thickness epidermal atypia, nuclear pleomorphism, and numerous mitotic figures, including atypical forms, characteristic of BD. No clear transitional zone was identified between the two components. These findings align most closely with a collision tumor-coincidental coexistence of two independent neoplasms-rather than true malignant transformation of CPSK into BD. This case underscores the need for careful histologic evaluation to distinguish collision from transformation, particularly in the absence of chronic ultraviolet exposure.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"602855"},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment Prognostic Nutritional Index Predicts Progression-Free Survival in BCLC Stage C Hepatocellular Carcinoma Treated with Sorafenib.","authors":"Umut Aydın, Mustafa Dikilitaş, İpek Balıkçı Çiçek, Ömer Arif Pamuk, Zehra Sadak Öcal, Yurdagül Danacı, Elanaz Alizade","doi":"10.2147/CMAR.S621105","DOIUrl":"10.2147/CMAR.S621105","url":null,"abstract":"<p><strong>Background: </strong>Systemic inflammation and nutritional status are key determinants of tumor progression in advanced hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic significance of inflammation and nutrition based indices in patients with BCLC stage C HCC treated with sorafenib.</p><p><strong>Methods: </strong>This retrospective cohort study included 109 patients with Barcelona Clinic Liver Cancer (BCLC) stage C HCC who received sorafenib as first line systemic therapy. A complete-case approach was used for multivariate Cox regression analysis. Progression-free survival (PFS) was defined according to RECIST version 1.1. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to assess prognostic factors.</p><p><strong>Results: </strong>In Kaplan-Meier and univariate Cox analyses, several inflammation- and nutrition-based indices, including NLR, PLR, SII, mGPS, PI, and ALBI grade, were significantly associated with PFS. Although the total cohort included 109 patients, the final multivariate Cox regression model for PNI included 78 complete-case patients. In this model, low prognostic nutritional index (PNI) (HR: 2.36, 95% CI: 1.14-4.87, p=0.020) and prior local ablative treatment (HR: 0.45, 95% CI: 0.24-0.83, p=0.011) remained independently associated with PFS.</p><p><strong>Conclusion: </strong>Pretreatment low PNI was independently associated with shorter progression-free survival in patients with BCLC stage C HCC treated with sorafenib. Other inflammation and nutrition-based indices were associated with PFS in univariate analyses but did not retain independent prognostic significance after adjustment. PNI may serve as a simple prognostic marker for risk stratification in real-world settings, although external validation is required.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"621105"},"PeriodicalIF":2.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Expression of BTN3A3 Acts as an Independent Predictive Factor of Better Prognosis in Patients with Sarcomas.","authors":"Fengrui Liu, Sen Zhao","doi":"10.2147/CMAR.S555381","DOIUrl":"10.2147/CMAR.S555381","url":null,"abstract":"<p><strong>Background: </strong>Butyrophilin subfamily 3 member A3 (BTN3A3) may be used as a prognostic biomarker for various malignancies. However, there is little evidence on the role of BTN3A3 in sarcomas.</p><p><strong>Methods: </strong>Using data from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), we detected BTN3A3 in normal and sarcomas tissues. Then we further evaluated clinical relevance, prognostic significance, genetic alternations, DNA methylation, co-expression gene and correlations with immune infiltration of BTN3A3.</p><p><strong>Results: </strong>The results showed that BTN3A3 expression was higher in sarcoma tissues than in normal tissues. The expression of BTN3A3 was regulated by methylation and miRNA. Higher BTN3A3 expression was associated with a better prognosis of sarcomas than lower BTN3A3 expression. GSEA revealed that the JAK-STAT signaling pathway, cytokine-cytokine receptor interaction, NK cell-mediated cytotoxicity, T cell receptor signaling pathway, cell adhesion, and Toll-like receptor signaling were differentially enriched in patients with elevated BTN3A3 expression. The BTN3A3 expression were found to be positively correlated with immune infiltration, immune checkpoints. In the multivariate analysis, high BTN3A3 expression was found to be an independent risk factor for overall survival.</p><p><strong>Conclusion: </strong>In conclusion, increased BTN3A3 expression is a significant predictor of better prognosis in patients with sarcomas.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"555381"},"PeriodicalIF":2.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"lncRNA HOTAIR in Cancer: Recent Advances and Critical Perspectives on Molecular Mechanisms.","authors":"Zidian Hu, Bo Yan","doi":"10.2147/CMAR.S602523","DOIUrl":"10.2147/CMAR.S602523","url":null,"abstract":"<p><p>The long non-coding RNA (lncRNA) HOTAIR (HOX transcript antisense RNA) has emerged as an important regulatory molecule that plays a critical role in tumor initiation and progression. With advances in tumor molecular biology, HOTAIR has become a research focus owing to its high expression in multiple malignancies and its profound impact on key biological behaviors such as tumor cell proliferation, migration, invasion, and drug resistance. This review critically synthesizes recent advances, with a focus on mechanistic controversies, context-dependent functions, and the integration of epigenetic, non-coding RNA, and signaling network mechanisms. Current studies indicate that HOTAIR regulates diverse cellular functions and drives tumor progression mainly through epigenetic modification, modulation of key signaling pathways, and complex interactions with microRNAs (miRNAs). However, its precise molecular mechanisms have not yet been fully elucidated, and translation into clinical practice remains challenging. This review summarizes recent progress on HOTAIR in cancer, systematically outlines its multifaceted molecular mechanisms and functions, and discusses its potential as a diagnostic biomarker and therapeutic target, with the aim of providing a theoretical basis and research directions for precision diagnosis and treatment in oncology.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"602523"},"PeriodicalIF":2.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"microRNA-139-3p Inhibits Malignant Behaviors of Laryngeal Cancer Cells via the KDM5B/SOX2 Axis and the Wnt/β-Catenin Pathway [Retraction].","authors":"","doi":"10.2147/CMAR.S638585","DOIUrl":"https://doi.org/10.2147/CMAR.S638585","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.2147/CMAR.S268871.].</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"638585"},"PeriodicalIF":2.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytotoxic Effect of <i>Halimeda macroloba</i> Crude Extract on Cervical Cancer Spheroid Cells via p-mTOR/mTOR, Apoptosis, and Ferroptosis Pathways.","authors":"Kesara Nittayaboon, Kittinun Leetanaporn, Kankamol Kerdkumthong, Jaruwan Mayakun, Raphatphorn Navakanitworakul","doi":"10.2147/CMAR.S611650","DOIUrl":"10.2147/CMAR.S611650","url":null,"abstract":"<p><strong>Background: </strong>Because of the limited efficacy of existing therapeutic strategies and the emergence of treatment resistance, cervical cancer remains a major global health burden. Recently, marine-derived natural compounds have attracted attention as potential sources of novel anticancer agents. We aimed to investigate the cytotoxic effects of crude <i>Halimeda macroloba</i> extract on cervical cancer spheroid cells and to explore its underlying molecular mechanisms.</p><p><strong>Methods: </strong>Three-dimensional spheroid cultures of SiHa cervical cancer cells were treated with varying concentrations of <i>H. macroloba</i> extract, followed by assessment of migration, cell viability, caspase activity, and protein expression profiles using liquid chromatography-tandem mass spectrometry, with selected findings validated by Western blotting.</p><p><strong>Results: </strong>Treatment with <i>H. macroloba</i> extract significantly reduced spheroid migration and decreased cell viability in a dose-dependent manner, accompanied by increased caspase activity. Proteomic analysis demonstrated altered expression of proteins associated with mitochondrial function, apoptosis-related pathways, and oxidative stress-related processes. Mechanistic studies further revealed downregulation of phosphorylated mTOR (p-mTOR) and total mTOR, together with increased expression of pro-apoptotic markers.</p><p><strong>Conclusion: </strong>The <i>H. macroloba</i> crude extract exerts anticancer effects in cervical cancer spheroids, primarily through apoptosis-associated mechanisms and modulation of the mTOR signaling pathway, supporting its potential for further investigation as a marine-derived bioactive compound.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"611650"},"PeriodicalIF":2.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-IMvigor011 Era: CtDNA-Guided Postoperative Adjuvant Treatment Stratification in Muscle-Invasive Bladder Cancer.","authors":"Jie Sui, Yunfan Chen, Yu Jiang, Qiyu He, Xiping Guo","doi":"10.2147/CMAR.S609903","DOIUrl":"10.2147/CMAR.S609903","url":null,"abstract":"<p><p>Muscle-invasive bladder cancer (MIBC) remains characterized by substantial postoperative heterogeneity after radical cystectomy, and conventional pathology and imaging incompletely identify patients with biologically active residual disease. Circulating tumor DNA (ctDNA) has emerged as the most clinically advanced liquid-biopsy marker of molecular residual disease (MRD) in this setting because it can detect recurrence before radiographic progression and, more importantly, can now inform postoperative treatment selection. The Phase III IMvigor011 trial provided the first prospective randomized evidence that ctDNA-guided adjuvant atezolizumab improves disease-free and overall survival in patients who become ctDNA-positive after cystectomy, thereby establishing molecular relapse as an actionable postoperative state rather than a merely prognostic observation. By contrast, the favorable outcomes observed in persistently ctDNA-negative patients support surveillance-based de-escalation but do not yet constitute randomized proof that adjuvant therapy can be safely omitted. In this review, we examine how the field evolved from early prognostic studies to biomarker-directed intervention, synthesize the distinct clinical logics of escalation and de-escalation, and analyze the remaining barriers to implementation, including assay selection, sampling kinetics, false-negative risk, clonal hematopoiesis of indeterminate potential (CHIP) interference, pre-analytical control, and economic feasibility. We also discuss how emerging data from TOMBOLA, MODERN, and complementary plasma/urine multi-analyte approaches may determine whether ctDNA-guided management matures from selective escalation into a broader risk-adapted postoperative strategy. The central challenge in the post-IMvigor011 era is therefore no longer whether ctDNA is clinically relevant, but how to integrate it rigorously, reproducibly, and contextually into contemporary perioperative MIBC care.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"18 ","pages":"609903"},"PeriodicalIF":2.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}