Cancers最新文献

{"title":"Effect of Jaw Exercise on Mouth Opening and Trismus in Head and Neck Cancer Patients Undergoing Radiotherapy: A Randomised Controlled Trial.","authors":"Tharmentheran Pitchaimuthu, Mohamad Yunus Mohd Razif, Khairiyiah Sidek, Syed Nabil","doi":"10.3390/cancers18193215","DOIUrl":"10.3390/cancers18193215","url":null,"abstract":"<p><p><b>Background/Objectives</b>: We aimed to assess the efficacy of a simple intervention by comparing changes in mouth opening and trismus status among HNC patients during radiotherapy treatment. It also explored its effect on the patient's mandibular function impairment. <b>Methods</b>: This is a Randomised Controlled Trial in which subjects were divided into groups undergoing jaw exercise with a wooden tongue depressor versus a basic jaw exercise group. The primary outcome of this study was changes in maximal mouth opening (MMO)/maximal interincisal distance (MID) measured at baseline (before treatment), at the 10th and 20th week after initiation of radiotherapy. The secondary outcome included trismus prevalence and mandibular functionality, which were assessed in relation to trismus severity and the effectiveness of the intervention. <b>Results</b>: A total of 38 subjects were recruited, comprising 19 (50.0%) in the control group and 19 (50.0%) in the intervention group. There were 22 (57.9%) males and 16 (42.1%) females. Overall, the mean age of the patients was 52.5 years (22 to 74 years). Our clinical assessment showed no statistically significant differences (<i>p</i> = 0.835) in mouth opening among the groups, with an overall median of 0mm (IQR 7.0). <b>Conclusions</b>: Mouth opening did not worsen from baseline to 20 weeks after initiation of radiotherapy, and the addition of wooden tongue depressors did not confer a statistically significant benefit over basic jaw exercise alone. <b>Trial Registration</b>: ISRCTN96737564, registered on 26 August 2026, retrospectively registered.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Invasion and Survival in Extremity Leiomyosarcoma: An Exploratory Single-Center Cohort Study from the Oxford Sarcoma Service.","authors":"Seva N S Gill, Tanjot S Kurala, Serkan Bayram, Jennifer M Brown, Muhammad Riaz, Muhammad A Siddiqi, Thomas D A Cosker","doi":"10.3390/cancers18193212","DOIUrl":"10.3390/cancers18193212","url":null,"abstract":"<p><strong>Background/objectives: </strong>Extremity leiomyosarcoma is an uncommon soft tissue sarcoma with a more favorable prognosis than other anatomical subtypes. Risk stratification currently rests on tumor grade, size, and metastatic status. Vascular invasion is an established predictor of metastasis in mixed soft tissue sarcoma cohorts but has seldom been formally examined in extremity leiomyosarcoma. We assessed its prognostic value in a single-center cohort.</p><p><strong>Methods: </strong>We retrospectively studied 62 adults who underwent resection of primary localized extremity leiomyosarcoma at a tertiary sarcoma center between January 2015 and February 2025. Vascular invasion was reported contemporaneously at original diagnostic reporting by specialist sarcoma histopathologists. Overall (OS), disease-specific (DSS), local recurrence-free (LRFS), and metastasis-free (MFS) survival were estimated by the Kaplan-Meier method and compared using log-rank tests. Death from another cause was treated as a competing event for disease-specific death and distant metastasis in a sensitivity analysis. Multivariable Cox models were refitted using Firth's penalized likelihood, with discrimination corrected for optimism by bootstrapping.</p><p><strong>Results: </strong>Median follow-up was 59.5 months. Five-year OS, DSS, and MFS were 71.0%, 80.2%, and 74.6%. Vascular invasion was reported in 11 of 62 patients (17.7%) and was associated with inferior OS (<i>p</i> = 0.002), DSS (<i>p</i> < 0.001), and MFS (<i>p</i> < 0.001), but not LRFS (<i>p</i> = 0.631). Adjusted for grade, it was associated with inferior OS (HR 3.89, 95% CI 1.35-11.26), DSS (HR 5.48, 95% CI 1.46-20.58), and MFS (HR 5.63, 95% CI 1.69-18.80). The association persisted on separate adjustment for tumor size, depth, and neoadjuvant radiotherapy.</p><p><strong>Conclusions: </strong>Vascular invasion was associated with inferior survival in localized extremity leiomyosarcoma. With 17 deaths and 14 metastatic events, these are exploratory estimates, but they support documenting vascular invasion explicitly, as present or absent, in routine histopathological reporting so that its role can be evaluated at scale.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CABOPRE: Evaluating Perioperative Cabozantinib's Efficacy and Biomarkers for Cytoreductive Nephrectomy in Advanced Renal Cell Carcinoma.","authors":"Guillermo de Velasco, Teresa Alonso-Gordoa, Juan Francisco Rodríguez-Moreno, Ignacio Duran, Lucía Carril Ajuria, Pablo Álvarez Ballesteros, Enrique González-Billalabeitia, José I Domínguez, Ana García-Casas, Enrique Pérez-Navarro, Sara Sánchez-Redondo, Javier Molina-Cerrillo, Felix Guerrero-Ramos, Ray Manneh Kopp, Cecilia Marinas, Jesús M Paramio, Héctor Peinado, Daniel Castellano, Marta Dueñas","doi":"10.3390/cancers18193216","DOIUrl":"10.3390/cancers18193216","url":null,"abstract":"<p><strong>Background/objectives: </strong>Despite advances in metastatic renal cell carcinoma (mRCC), long-term survival is poor and biomarkers are lacking. Optimal integration of cytoreductive nephrectomy (CN) in the current era remains controversial. CABOPRE, the first phase II trial assessing perioperative cabozantinib in mRCC patients eligible for CN, aimed to determine its effects in this setting, integrating tumor outcomes with molecular profiling.</p><p><strong>Methods: </strong>CABOPRE (NCT06377722) is a multicentre, single-arm, phase II study conducted in Spanish academic hospitals. Patients with resectable metastatic clear cell RCC (ccRCC) eligible for post-treatment CN received perioperative cabozantinib (60 mg/day for 12 weeks; <i>n</i> = 18). The primary endpoint was the objective response rate (ORR) at 12 weeks assessed by RECIST v1.1. Exploratory analyses included longitudinal plasma miRNA and spatial transcriptomic profiling to identify candidate biomarkers. The trial closed early because of slow accrual, after enrolling 18 of 50 planned patients and without completing the 26-patient first stage of the Simon two-stage design; the planned interim analysis was therefore never performed.</p><p><strong>Results: </strong>Because the two-stage design was not completed, the primary endpoint could not be formally evaluated against the prespecified decision rule. Among 15 evaluable patients, the objective response rate was 26.7% (95% CI, 7.8-55.1), with stable disease in 10 (66.7%) and progressive disease in 1 (6.7%). Cabozantinib demonstrated a manageable safety profile (Grade 1-2 adverse events). In exploratory biomarker analyses, <i>miR-126-3p</i> upregulation and <i>VEGFA/CCND1</i> downregulation were associated with tumor shrinkage, and the adhesion molecules <i>ITGAV</i> and <i>ICAM1</i> were upregulated in these patients. Because no direct vascular measurements were performed, these changes are described as treatment-associated and hypothesis-generating rather than as predictors of response or evidence of vascular normalization.</p><p><strong>Conclusions: </strong>The observed response rate was close to the 25% null rate, and the prespecified efficacy rule could not be applied. CABOPRE provides preliminary evidence that perioperative cabozantinib is active and represents a viable backbone for neoadjuvant combination strategies in selected patients with potentially resectable mRCC. The identified molecular heterogeneity and stromal-immune signatures provide a biological rationale for the prospective evaluation of cabozantinib-IO combinations in this setting.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Marrow Adipocytes in Multiple Myeloma: Emerging Immunometabolic Interactions and Implications for Immunotherapy.","authors":"Adriana Roque, Artur Paiva, Raquel Seiça, Catarina Geraldes","doi":"10.3390/cancers18193213","DOIUrl":"10.3390/cancers18193213","url":null,"abstract":"<p><p>Immunotherapy has revolutionized the treatment of multiple myeloma (MM), but durable immune control remains limited, increasing interest in how the bone marrow (BM) microenvironment influences antitumor immunity. BM adipocytes (BMAds) are increasingly recognized as metabolically active components of the BM. This review summarizes the current evidence linking BMAds to myeloma cell survival and immune cell function, particularly T cell activity. It also discusses their potential relevance to monoclonal antibodies, bispecific antibodies, and chimeric antigen receptor (CAR) T-cell therapy. Preclinical studies have shown that myeloma-associated BMAds undergo lipid depletion and acquire inflammatory and senescence-associated secretory features. BM lipid exposure is associated with impaired CD8⁺ T-cell metabolic fitness, whereas leptin receptor activation suppresses invariant natural killer T-cell anti-myeloma activity. Evidence concerning conventional natural killer cells and other immune compartments remains limited. Available clinical evidence is predominantly cross-sectional and therefore does not establish a direct role for BMAds in resistance to current immunotherapies or clarify whether they influence therapeutic target availability or function as clinically relevant bystander targets. Patient- and treatment-related factors, including aging and obesity, may further reshape the adipocytic-stromal and immune landscape of the marrow, potentially modifying local responses to immunotherapy. Future studies combining patient-derived multicellular models with spatial and longitudinal approaches should determine how BMAd-associated metabolic, inflammatory, and adipokine signaling affect immune control and treatment outcomes in MM and whether these processes can be therapeutically modulated.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worsening of Oral Health Parameters After Head and Neck Radiotherapy-Findings from a Multidisciplinary Head and Neck Tumor Board: A Prospective Observational Study.","authors":"Cosimo Rupe, Gioele Gioco, Benedetta Corraro, Anna Schiavelli, Silvia Longo, Francesco Pastore, Mariangela Massaccesi, Maria Antonietta Gambacorta, Francesco Miccichè, Raffaella Castagnola, Jacopo Galli, Stefano Settimi, Luca Raffaelli, Alessandra Cassano, Massimo Cordaro, Carlo Lajolo","doi":"10.3390/cancers18193211","DOIUrl":"10.3390/cancers18193211","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate (a) changes in caries experience, (b) changes in periodontal status, and (c) the need for dental extractions in a cohort of patients treated with radiotherapy (RT) and chemoradiotherapy (RTCT) for head and neck cancer (HNC).</p><p><strong>Methods: </strong>This prospective cohort study was approved by the local Ethics Committee (Ref. 22858/18) and registered at ClinicalTrials.gov (ID: NCT04009161). The study population consisted of patients with HNC who, prior to RT, underwent a dental examination followed by the elimination of oral foci of infection and were then enrolled in a follow-up program. The primary outcome was oral health worsening, defined as the onset of severe periodontitis and/or a DMFt score ≥ 13. Oral cavity RT dose was obtained contouring the 'buccal mucosa' organ at risk (OAR).</p><p><strong>Results: </strong>In total, 113 patients were included (median follow-up: 44.77 months). The sample mainly included oral, oropharyngeal, nasopharyngeal and laryngeal cancers (89/113, 78.8%). Salivary glands, hypopharynx and other sites accounted for a minority of the cases (24/113, 21.2%). Seventeen patients (34.7%) experienced worsening of oral health status over time, which was associated with smoking (OR = 4.7, 95% CI: 1.27-17.37; <i>p</i> = 0.02). The DMFt index increased (difference: 4.08; 95% CI: 1.60-6.56; <i>p</i> = 0.001), and this increase was associated with smoking (β = 2.05, 95% CI: 0.27-3.83; <i>p</i> = 0.02). Although worsening of periodontitis stage was not statistically significant (<i>p</i> = 0.35), localized deterioration was observed, with an increase in sites with PPD ≥ 5 mm (<i>p</i> = 0.02). Forty-nine patients (43.4%) experienced tooth loss. Mean tooth loss was 2.12 teeth per patient (<i>p</i> = 0.05), primarily due to caries (48.5%) and periodontitis (48.1%). Independent risk factors for tooth loss were age (<i>p</i> = 0.025) and an RT dose > 60 Gy to the 'buccal mucosa' OAR (<i>p</i> = 0.023).</p><p><strong>Conclusions: </strong>Patients treated with RT experienced significant deterioration in dental and periodontal health, and oral cavity dosimetric parameters might be associated with tooth loss, although this association requires confirmation in further studies.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Neoplasms with Sebaceous Differentiation: A Comprehensive Update on Clinical, Histopathological and Molecular Classification.","authors":"Katharina Wiedemeyer, Ingrid Ferreira, David J Adams, Thomas Brenn","doi":"10.3390/cancers18193209","DOIUrl":"10.3390/cancers18193209","url":null,"abstract":"<p><p>Cutaneous sebaceous neoplasms are rare adnexal tumours differentiated towards sebaceous glands, spanning a biological spectrum from benign (sebaceous adenoma, sebaceoma, nevus sebaceus) to outright malignant (sebaceous carcinoma). Most tumours are sporadic and solitary, with a predilection for the head and neck of elderly adults, but a clinically important subset is observed in the setting of Lynch syndrome/Muir-Torre syndrome. Recent large-scale genomic and transcriptomic studies have provided insights into the pathogenesis of these unique neoplasms, revealing a genetically heterogeneous landscape shaped by mismatch repair deficiency, UV damage, and abnormalities in several other key signalling pathways. The inclusion of nevus sebaceus within the sebaceous tumour family in the WHO 5th Edition of Skin Tumours reflects a conceptual shift, recognising nevus sebaceus as a clonal, mutation-driven neoplasm and a precursor lesion for secondary tumour development.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Molecular Landscape of the Senescence-EMT Interplay: Deciphering Tumour Plasticity Through Molecular Signatures and Multi-Omic Profiling.","authors":"Eva M Verdugo-Sivianes, Carmen Campos-Silva, José Luis García-Márquez, Elena Aguado-Domínguez","doi":"10.3390/cancers18193204","DOIUrl":"10.3390/cancers18193204","url":null,"abstract":"<p><p>Therapy-induced senescence (TIS) is a common response to anticancer treatments, characterised by stable cell cycle arrest and the acquisition of a complex senescence-associated secretory phenotype (SASP). Initially regarded as a beneficial mechanism that limits tumour growth, growing evidence indicates that TIS is a highly dynamic and heterogeneous process with context-dependent effects that can either suppress or promote tumour progression. The SASP is a central mediator of tumour plasticity, linking TIS to epithelial-to-mesenchymal transition (EMT), cancer stemness, microenvironmental remodelling, therapeutic resistance, and metastatic dissemination. These findings highlight the therapeutic potential of senotherapeutic approaches, including senolytic and senomorphic agents, as key components of one-two-punch therapeutic strategies to selectively eliminate or modulate persistent senescent cells and improve treatment outcomes. Recent advances in multi-omics technologies, artificial intelligence, and liquid biopsy are further transforming the study of senescence by enabling comprehensive molecular characterisation, biomarker discovery, patient stratification, and real-time monitoring of tumour evolution. Collectively, current evidence supports a paradigm shift in which senescence should be considered a dynamic regulator of tumour plasticity and a promising target for precision oncology strategies.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Prognostic Modelling with the CALLY Index and Interim PET/CT in Hodgkin Lymphoma.","authors":"Hasan Göze, İsmail Eren Polat, Nermin Bal, İsa Yalçınkaya, Gokhan Burul, Büşra Tuğçe Tonyalı, Tahir Alper Cinli, İstemi Serin","doi":"10.3390/cancers18193205","DOIUrl":"10.3390/cancers18193205","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Interim ¹⁸F-FDG PET/CT is the most powerful prognostic tool in Hodgkin lymphoma but is only available after 2 cycles and does not guide initial treatment. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel composite index of inflammation, nutrition, and immunity, measurable at diagnosis, but has not been studied in Hodgkin lymphoma (HL). We tested whether baseline CALLY could predict interim PET response and survival and whether combining the two provides additional information over either alone. <b>Methods</b>: A retrospective study of 180 consecutive patients with newly diagnosed Hodgkin lymphoma at a single center was performed. CALLY was defined as albumin (g/L) × lymphocytes (×109/L)/CRP (mg/L). Interim PET after two cycles was scored using the Deauville scale (4-5 positive). The endpoints were progression-free survival (PFS) and overall survival (OS). <b>Results</b>: Median follow-up was 30.5 months, 32 patients had a PFS event, and 16 died. Interim PET was positive in 31/163 patients (19.0%). Baseline CALLY was lower in PET-positive patients compared with PET-negative patients (median 1.16 vs. 3.34; <i>p</i> = 0.022; area under the curve 0.635, modest discrimination). Interim PET positivity (29.8% vs. 13.0%; OR 2.84, 95% CI 1.26-6.42), 24-month PFS (66.9% vs. 89.8%; <i>p</i> = 0.001) and OS (84.8% vs. 95.5%; <i>p</i> = 0.022) were reduced below a Youden-derived threshold of 1.5. CALLY was not independently prognostic after adjustment for interim PET (PFS hazard ratio [HR] 1.86, 95% CI 0.79-4.37; <i>p</i> = 0.157). A three-tier exploratory model combining both factors separated 24-month PFS into 94.5% (<i>n</i> = 87), 79.6% (n = 53), and 41.2% (n = 17) (<i>p</i> < 0.001; high- vs. low-risk HR 9.48, 95% CI 3.59-25.04), although the intermediate tier was not statistically different from the low-risk tier. <b>Conclusions</b>: In this cohort, baseline CALLY provides a low-cost pre-treatment correlate of early metabolic response and outcome, with numerically greater discrimination than the International Prognostic Score. Its prognostic signal seems largely mediated through the interim PET response, and therefore it should complement, not replace, interim response assessment. Discrimination was modest, and the integrated model is exploratory and requires prospective multicenter validation in contemporary protocols before clinical use.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive Radical Prostatectomy in Oligometastatic Prostate Cancer and the Role of the Robotic Platform: A Narrative Review.","authors":"Juan Gomez Rivas, Pedro Gabriel Silva, Helena Margot Flôres Soares da Silva, Luís Severo, Luís Campos Pinheiro, Isabel Galante Romo, Enrique Redondo-González, Claudia González-Santander, Jesús Moreno Sierra","doi":"10.3390/cancers18193207","DOIUrl":"10.3390/cancers18193207","url":null,"abstract":"<p><p><b>Background</b>: Oligometastatic prostate cancer (OMPC) comprises biologically and clinically distinct states with a limited number of detectable metastases. Improved systemic therapy and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) have intensified interest in treating the primary tumor. <b>Methods</b>: In this narrative review we searched PubMed/MEDLINE from inception to 1 July 2026, reviewed current guidelines, and searched ClinicalTrials.gov, the ISRCTN registry and the EU Clinical Trials Register for ongoing surgical studies, prioritizing randomized trials, prospective studies, PSMA PET-staged cohorts, systematic reviews, guidelines, and studies of perioperative, functional and patient-reported outcomes. <b>Results</b>: Registry and institutional data generated the hypothesis that cytoreductive prostatectomy improves outcomes but are vulnerable to selection bias; prospective and PSMA PET-staged cohorts established feasibility. The phase II trial by Dai and colleagues supported radical treatment of the primary tumor but combined surgery and radiotherapy. RAMPP provided the first prostatectomy-specific randomized signal, with lower 5-year cancer-specific mortality after radical prostatectomy plus best systemic therapy than after systemic therapy alone (13% versus 23%; hazard ratio 0.39, 95% confidence interval 0.16-0.98), but accrual ended early, clinical progression was similar, overall survival was not significantly improved, systemic therapy predated contemporary intensification, and major surgery-related complications occurred in 14%. A randomized phase II trial with a predominantly surgical local-therapy arm found no progression-free or overall survival benefit, so randomized evidence is mixed. All randomized evidence concerns radical prostatectomy or local treatment irrespective of surgical approach; no trial has tested a robot-specific oncologic effect. Guidelines recommend prostate radiotherapy for selected low-volume de novo metastatic disease and restrict surgery to clinical trials. <b>Conclusions</b>: Cytoreductive prostatectomy, delivered mostly as robot-assisted radical prostatectomy (RARP), is feasible and may improve local control while providing complete pathology, but it remains investigational; the robotic approach is the surgical platform, not a modality with distinct oncologic efficacy. Appropriate use requires expert-center surgery, modern staging, guideline-concordant systemic therapy, multidisciplinary selection, transparent counseling and, preferably, trial participation. Future trials must establish whether prostatectomy adds meaningful benefit beyond modern systemic therapy, prostate radiotherapy and metastasis-directed treatment, while measuring morbidity, continence and quality of life.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decade-Stratified Malignancy Risk in Hysteroscopic Polypectomy: A Multicenter Registry Analysis of 9269 Procedures.","authors":"Rina Tamir Yaniv, Tamar Tzur, Hila Goldstein, Gadi Ben-Shitrit, Gabi Haran","doi":"10.3390/cancers18193206","DOIUrl":"10.3390/cancers18193206","url":null,"abstract":"<p><strong>Background: </strong>Malignancy risk in hysteroscopic polypectomy specimens rises with age and postmenopausal status, but decade-stratified absolute rates from large, unselected cohorts remain scarce, limiting the quantitative basis for pre-procedural risk counseling.</p><p><strong>Objective: </strong>To estimate decade-specific absolute malignancy rates and to determine how the documented procedural indication modifies that risk.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study with SNOMED-coded histology. All hysteroscopic polypectomies at five Assuta Medical Center sites from January 2019 to April 2026 with a linked histology result constituted the analytic cohort (<i>n</i> = 9269; 75.1% of a base cohort of 12,339). The primary outcome was histologically confirmed endometrial malignancy, defined by SNOMED morphology and topography coding. Multivariable logistic regression adjusted for weight category, hospital site, and calendar year.</p><p><strong>Results: </strong>The overall malignancy rate was 1.63% (151/9269), increasing monotonically: 0.45% (under 50 years), 1.25% (50-59), 3.79% (60-69), and 4.58% (70 or older). Adjusted odds ratios versus the reference group were 2.02 (95% CI, 1.13-3.60), 5.77 (95% CI, 3.39-9.83), and 8.03 (95% CI, 4.51-14.30). Across all age groups, procedures with a documented postmenopausal bleeding (PMB) indication carried an overall malignancy rate of 6.32% (29/459; adjusted OR, 3.04; 95% CI, 1.96-4.72 versus incidental polyp finding); among women aged 70 or older with a documented PMB indication, the rate was 8/61 (13.1%; 95% CI, 6.8-23.8%). Procedures coded with a non-PMB uterine bleeding indication were not associated with excess malignancy risk (0.36%). Weight over 80 kg was an independent predictor of endometrial malignancy (adjusted OR, 3.05; 95% CI, 1.92-4.84). Age group and the documented PMB indication were entered as independent covariates in a single multivariable model; no significant age-by-PMB interaction was detected (likelihood ratio test <i>p</i> = 0.667).</p><p><strong>Conclusions: </strong>Malignancy risk rises more than tenfold from the youngest to the oldest age group. Procedures with a documented PMB indication were associated with substantially higher risk than other indications, while non-PMB bleeding was not associated with excess risk in this cohort. Age and documented procedural indication may be the most clinically useful predictors for stratifying histological examination decisions.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}