Cancers最新文献

{"title":"Computational Drug Repurposing Across the Multiple Myeloma Spectrum: From MGUS to MM.","authors":"Kyriaki Savva, Marilena M Bourdakou, Dimitris Stellas, Jerome Zoidakis, George M Spyrou","doi":"10.3390/cancers17183045","DOIUrl":"10.3390/cancers17183045","url":null,"abstract":"<p><strong>Background/objectives: </strong>Multiple myeloma (MM) is a challenging, B cell malignancy characterised by the uncontrolled proliferation of plasma cells within the bone marrow. Despite significant advances in treatment options nowadays, MM remains an incurable malignancy, with the majority of patients succumbing to the disease. MM develops from a pre-malignant state known as monoclonal gammopathy of unknown significance (MGUS), which then has the potential to evolve either into smouldering (asymptomatic) multiple myeloma (SMM) or into MM. Since novel drug discovery takes years to reach the clinic, drug repurposing, which concerns the detection of existing drugs for a novel disease, can be applied.</p><p><strong>Methods: </strong>To address this critical and still unmet medical need, we present a comprehensive signature-based drug-repurposing approach using all the publicly available bulk transcriptomics datasets on mGUS, sMM, and MM.</p><p><strong>Results: </strong>Our study included an in-house scoring scheme approach enabling further filtering and prioritisation, resulting in 25 candidate repurposed drugs for mGUS, 23 for sMM, and 66 for MM. The corresponding gene targets and the related functional terms have been analysed, providing extra information for stage-specific underlying mechanisms in myeloma. Lastly, enabled by a specific computational workflow, we propose drug combinations between our top candidate repurposed drugs and FDA-approved drugs for MM.</p><p><strong>Conclusions: </strong>Together, these results deliver a stage-specific, transparent resource for MM drug repurposing and combination design, intended to accelerate translation toward earlier disease intervention and improved patient outcomes.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172958","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":"Latest Advancements and Future Directions in Prostate Cancer Surgery: Reducing Invasiveness and Expanding Indications.","authors":"Valerio Santarelli, Roberta Corvino, Giulio Bevilacqua, Stefano Salciccia, Giovanni Di Lascio, Francesco Del Giudice, Giovanni Battista Di Pierro, Giorgio Franco, Simone Crivellaro, Alessandro Sciarra","doi":"10.3390/cancers17183053","DOIUrl":"10.3390/cancers17183053","url":null,"abstract":"<p><p>For more than 20 years, after the introduction of the first robotic system, research on prostate cancer (PCa) surgery has mainly focused on evaluating outcomes of Robotic-Assisted Radical Prostatectomy (RARP). In the last few years, however, a new generation of innovative techniques, surgical approaches, and expanded indications have emerged. The Single Port (SP) robotic system was the first real hardware innovation in robotic surgery, and has already demonstrated advantages in terms of shorter length of stay, better cosmetic results and reduced postoperative pain. Artificial Intelligence (AI)-powered algorithms are being proposed as reliable tools for surgical assistance, aiding in standardization and mass implementation of robotic training. New surgical indications are emerging on the basis of patient and tumor characteristics. The extensive adoption of PCa screening and the precision of diagnostic tools have increased the rate of PCa diagnoses in a localized stage. Partial prostatectomy, despite needing further validation, has emerged as a safe and minimally invasive treatment option for confined tumors, able to minimize the side effects of prostate surgery. For locally advanced PCa, radioguided surgery has not only enhanced the oncological effectiveness of lymphadenectomy by enabling the precise identification and extraction of pathological lymph nodes, but has also contributed to minimizing the side effects associated with unnecessarily extensive dissections. Finally, in light of the increased efficacy of modern systemic therapies and the longer life expectancy, RP is currently being evaluated for primary tumor management in the metastatic phase. Despite the novelty of the aforementioned treatment options, they are already set to shape the future evolution of PCa management and international guidelines.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173823","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":"Clinicopathological Features and Outcomes of Endoscopic Submucosal Dissection for Early Gastric Lymphoepithelioma-like Carcinoma.","authors":"Young Eun Oh, Tae-Se Kim, Yo Han Jeon, Soomin Ahn, Kyoung-Mee Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim","doi":"10.3390/cancers17183050","DOIUrl":"10.3390/cancers17183050","url":null,"abstract":"<p><strong>Background/objectives: </strong>The curability of endoscopic submucosal dissection (ESD) for early gastric lymphoepithelioma-like carcinoma (LELC) remains unclear, as this rare histological subtype is not well represented in current guidelines. We aimed to evaluate the clinicopathological features and outcomes of early gastric LELC following ESD.</p><p><strong>Methods: </strong>We retrospectively compared 51 patients with early gastric LELC and 8243 patients with well- or moderately differentiated (WD or MD) tubular adenocarcinoma who underwent ESD.</p><p><strong>Results: </strong>LELC was more frequently located in the proximal stomach than WD/MD adenocarcinoma (52.9% vs. 10.3%). The deep submucosal invasion rate was significantly higher in LELC (77.3% vs. 9.5%), whereas the lymphatic invasion rate was comparable between the two groups (5.7% vs. 9.2%). No LELC cases were diagnosed preoperatively using forceps biopsy. Despite the comparable en bloc with R0 and complete resection rates, the curative resection rate of LELC was significantly lower than that of WD/MD adenocarcinoma, primarily due to deep submucosal invasion. Post-ESD bleeding was more frequent in LELC (11.3% vs. 2.7%). During a mean follow-up of 38.1 months, no extra-gastric recurrence was observed in patients who did not undergo additional surgery, and no lymph node metastasis was detected among the 23 patients who underwent gastrectomy. No gastric cancer-specific deaths occurred in the study population during follow-up.</p><p><strong>Conclusions: </strong>Considering these favorable long-term outcomes despite a low curative resection rate, early gastric LELC fulfilling the conventional curative criteria of current guidelines can be regarded as having been curatively treated by ESD, particularly in patients with high surgical morbidity.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173968","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":"A Preliminary Study on Deep Learning-Based Plan Quality Prediction in Gamma Knife Radiosurgery for Brain Metastases.","authors":"Runyu Jiang, Yuan Shao, Yingzi Liu, Chih-Wei Chang, Aubrey Zhang, Malvern Madondo, Mohammadamin Moradi, Aranee Sivananthan, Mark C Korpics, Xiaofeng Yang, Zhen Tian","doi":"10.3390/cancers17183056","DOIUrl":"10.3390/cancers17183056","url":null,"abstract":"<p><strong>Background/objectives: </strong>GK plan quality is strongly affected by lesion size and shape, and the same evaluation metrics may not be directly comparable across patients with different anatomies. This study proposes a deep learning-based method to predict achievable, clinically acceptable plan quality from patient-specific geometry.</p><p><strong>Methods: </strong>A hierarchically densely connected U-Net (HD-U-Net) was trained at the lesion level to predict 3D dose distributions for the estimation of plan quality metrics, including coverage, selectivity, gradient index (GI), and conformity index at a 50% prescription dose (CI50). To improve the prediction accuracy of plan quality metrics, Dice similarity coefficient losses for the 100% and 50% isodose lines were incorporated with conventional mean squared error (MSE) loss.</p><p><strong>Results: </strong>Ten-fold cross-validation on 463 brain metastases (BMs) from 175 patients showed that our method achieved smaller mean absolute errors across all four metrics than the HD-U-Net baseline trained with MSE loss. Improvements were pronounced in all metrics for small metastases, and were observed primarily in GI and CI50 for medium and large lesions. Paired Wilcoxon signed-rank tests confirmed the statistical significance of these improvements (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>The proposed method outperformed the baseline model in capturing overall trends, improving per-lesion accuracy, and enhancing robustness to dataset variability. It can serve as a pre-planning tool to guide planners in constraint setting and priority tuning, a post-planning quality control tool to identify subpar plans that could be substantially improved, and as a foundation for developing deep reinforcement learning-based automated planning of GK treatments for brain metastases.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173556","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":"Cervical Cancer Treatment and Fertility: What We Know and What We Do.","authors":"Nassir Habib, Salwa Idoubba, Francoise Futcher, Emilio Pieri, Giorgia Schettini, Matteo Giorgi, Ramon Rovira Negre, Centini Gabriele","doi":"10.3390/cancers17183057","DOIUrl":"10.3390/cancers17183057","url":null,"abstract":"<p><p>Cervical cancer is a major health issue worldwide, with approximately 660,000 new cases a year, particularly in women of reproductive age (47.4 ± 12.8 years at diagnosis). Current advances in screening and immunization have shifted cervical cancer diagnoses to earlier stages; as a result, fertility preservation is an essential component of building a treatment plan. <i>Objectives:</i> This systematic review aims to synthesize the existing techniques for fertility preservation with a focus on early-stage cervical cancer (cancer stage IA1-IB1). We will describe the different surgical and medical approaches for the treatment of cervical cancer, followed by an analysis of their oncologic safety and the associated reproductive risks and outcomes. <i>Methods:</i> A descriptive synthesis of the strategies for surgical management, including conization, radical trachelectomy, neoadjuvant chemotherapy (NACT), and radiotherapy, was completed. Fertility and successful pregnancy rely on patient selection, prognostic variables, and obstetric outcomes. The use of transposition of the ovaries and cryopreservation in the context of gonadotoxic treatment plans also requires investigation. <i>Results:</i> For patients meeting conservative eligibility criteria, conservative surgery for tumors up to 2 cm has been considered a safe oncological management strategy, although evidence remains limited. Pregnancy rate after conization ranged from 36 to 55% and 10 to 38% after radical trachelectomy. Ovarian function can be successfully preserved in >60% of laparoscopic transposition cases but resulted in a less than 15% chance of natural conception; the need for assistive reproductive techniques was often required. <i>Conclusions:</i> Fertility-preserving management of cervical cancer is safe and feasible in carefully selected patients, with oncologic outcomes comparable to more radical management. Continued innovation and randomized control trials in treatment paths and oncologic and fertility outcomes will benefit the field.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173911","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":"CRAFITY and AFP/PIVKA-II Kinetics Predict Prognosis in Hepatocellular Carcinoma on Immunotherapy.","authors":"Shou-Wu Lee, Yi-Jie Huang, Ying-Cheng Lin, Hsin-Ju Tsai, Chia-Chang Chen, Chung-Hsin Chang, Teng-Yu Lee, Yen-Chun Peng","doi":"10.3390/cancers17183058","DOIUrl":"10.3390/cancers17183058","url":null,"abstract":"<p><strong>Background: </strong>The CRAFITY score, integrating baseline C-reactive protein (CRP) and alpha-fetoprotein (AFP), has been validated as a prognostic biomarker in hepatocellular carcinoma (HCC) treated with immunotherapy, but many patients present with non-elevated AFP, limiting its accuracy. This study evaluated a composite model incorporating the CRAFITY score with AFP/PIVKA-II kinetic changes.</p><p><strong>Methods: </strong>We retrospectively enrolled 69 patients with unresectable HCC (BCLC stage B/C) receiving immunotherapy between September 2021 and June 2023. Baseline CRP, AFP, and PIVKA-II, as well as 4-week changes, were recorded. The CRAFITY-100 RULE combined CRAFITY (0-2) with AFP/PIVKA-II kinetics (0-3), yielding three risk levels (I-III). Clinical outcomes included objective response (OR) and overall survival (OS).</p><p><strong>Results: </strong>Of the cohort, 10 (14.5%), 29 (42%), and 30 (43.5%) patients had CRAFITY scores 0, 1, and 2, respectively, but this score did not clearly stratify OS (median 24, 12, and 15 months; <i>p</i> = 0.267). In contrast, the CRAFITY-100 RULE classified 5 (7.3%), 35 (50.7%), and 29 (42%) patients into levels I-III, respectively, with significantly different survival (median OS 24, 15, and 7 months; <i>p</i> = 0.048). OR rates were lowest at level III (17%). Time-dependent ROC analysis confirmed superior discrimination of CRAFITY-100 RULE over CRAFITY scores at 6 months (AUROC 0.673 vs. 0.604) and 12 months (0.732 vs. 0.656).</p><p><strong>Conclusions: </strong>The CRAFITY-100 RULE provided clearer stratification and higher discrimination. This simple model integrating baseline and dynamic biomarkers may assist clinical decision-making in unresectable HCC treated with immunotherapy.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173643","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 Prognostic Value of a Nomogram Model Based on Tumor Immune Markers and Clinical Factors for Adult Primary Glioma.","authors":"Junpeng Wen, Ziling Zhang, Yan Zhao, Yingzi Liu, Jiangwei Yuan, Yuxiang Wang, Juan Li","doi":"10.3390/cancers17183043","DOIUrl":"10.3390/cancers17183043","url":null,"abstract":"<p><p><b>Objective</b><b>:</b> This study aimed to identify the factors associated with overall survival (OS) in adult patients with primary gliomas, construct a nomogram prediction model, and evaluate its predictive performance. <b>Methods:</b> Clinical data were retrospectively collected from adult patients newly diagnosed with gliomas who underwent surgical treatment in the Department of Neurosurgery of the Fourth Hospital of Hebei Medical University, between January 2019 and December 2023. External validation was conducted using data from the China Glioma Genome Atlas (CGGA) database. Data analysis and visualization were performed using SPSS 26.0 and R software (Version 4.4.1). <b>Results:</b> A total of 257 adult patients were included in this study. Multivariate Cox regression analysis identified age, Karnofsky Performance Status (KPS) score, tumor diameter, WHO grade, and postoperative radiotherapy and chemotherapy, as well as the expression of ATRX, IDH1, and Ki-67, as independent prognostic factors. These factors were incorporated into a nomogram for predicting 1-year, 2-year, and 3-year survival rates. The model demonstrated excellent discrimination, calibration, and clinical utility in both internal and external validations. <b>Conclusions:</b> The nomogram model incorporating clinical factors (age, WHO grade), treatment (radiotherapy, chemotherapy), and tumor markers (ATRX, IDH1, Ki-67) has good predictive efficacy and may serve as a practical and effective alternative to molecular testing for prediction of survival in adult patients with primary glioma.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173945","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":"Immature Teratoma of the Ovary-A Narrative Review.","authors":"Giuseppe Marino, Serena Negri, Filippo Testa, Jasmine Corti, Daniela Giuliani, Daniele Lugotti, Tommaso Grassi, Marta Jaconi, Alessandra Casiraghi, Cristina Maria Bonazzi, Robert Fruscio","doi":"10.3390/cancers17183041","DOIUrl":"10.3390/cancers17183041","url":null,"abstract":"<p><p>Immature teratoma of the ovary is a rare condition primarily affecting young women and constitutes a significant proportion of ovarian cancer cases in adolescents and young adults. It is commonly diagnosed at stage I, though advanced-stage disease is not infrequent. Accurate diagnosis and a fertility-sparing approach are central to the management of this condition, as many affected women retain, or have yet to develop, a desire for childbearing. However, due to the rarity of this disease, management is often guided by retrospective data derived from subanalyses of studies on malignant ovarian germ cell tumors, which can complicate the treatment of these patients once diagnosed. The aim of this review is to summarize the current evidence on immature teratoma of the ovary, considering it as a distinct clinical and pathological entity.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173539","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":"Clinicopathological Factors Affecting Prognosis in Patients with Advanced Cervical Cancer Undergoing Concurrent Chemoradiation Therapy.","authors":"Maitreyee Parulekar, Min Kyung Kim, Joseph J Noh, Dong Hoon Suh, Kidong Kim, Yong Beom Kim, Jae Hong No","doi":"10.3390/cancers17183042","DOIUrl":"10.3390/cancers17183042","url":null,"abstract":"<p><strong>Background: </strong>Concurrent chemoradiation therapy (CCRT) is the standard treatment for patients with locally advanced cervical cancer (LACC), including those with parametrial or lymphatic metastasis. However, therapeutic outcomes vary, and prognostic factors remain inadequately defined.</p><p><strong>Methods: </strong>We conducted a retrospective study involving 128 patients with cervical cancer who received definitive CCRT between 2003 and 2022 at Seoul National University Bundang Hospital. We evaluated clinicopathological variables, including age, height, body weight, histologic type, tumor size, human papillomavirus (HPV) type, squamous cell carcinoma (SCC) antigen levels, and involvement of the parametrium, lower vagina, and lymph nodes. Survival outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazards models.</p><p><strong>Results: </strong>Stage IIIC1r, according to the 2018 FIGO staging system, was the most common disease stage among the study population. Para-aortic lymph node metastasis was significantly associated with increased recurrence risk (odds ratio [OR] = 5.892; 95% confidence interval [CI]: 2.030-17.097; <i>p</i> = 0.001) and was linked to poorer progression-free survival (PFS, <i>p</i> = 0.001), overall survival (OS, <i>p</i> = 0.014), and treatment-free interval (TFI, <i>p</i> = 0.001). Obesity (body mass index ≥ 25 kg/m²) was also associated with higher recurrence risk (OR = 2.737; 95% CI: 1.093-6.855; <i>p</i> = 0.032) and reduced PFS (<i>p</i> = 0.0089).</p><p><strong>Conclusions: </strong>Para-aortic lymph node metastasis and obesity are significant prognostic factors in patients undergoing definitive CCRT for LACC. These findings highlight the need for risk-adapted treatment strategies and potential incorporation of adjunctive therapies to improve clinical outcomes in high-risk patient subgroups.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173937","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":"Long-Term Survival After Thyroidectomy for Thyroid Cancer: A Propensity-Matched TriNetX Study with Specialty-Stratified Analyses.","authors":"Ci-Wen Luo, Meng-Hao Chang, Lan Lin, Frank Cheau-Feng Lin, Shih-Wei Chen, Yu-Hsiang Kuan, Pei-Chi Tsai, Ji-Kuen Yu, Stella Chin-Shaw Tsai","doi":"10.3390/cancers17183051","DOIUrl":"10.3390/cancers17183051","url":null,"abstract":"<p><strong>Background/objectives: </strong>Whether thyroidectomy confers a long-term survival advantage over non-surgical management in real-world practice remains uncertain. We primarily evaluated the association between surgery and all-cause mortality in thyroid cancer; specialty-stratified outcomes were prespecified as secondary, exploratory analyses.</p><p><strong>Methods: </strong>Using the TriNetX US Collaborative Network (2008-2024), we identified adults with thyroid cancer and created 1:1 propensity score-matched cohorts of patients who did or did not undergo thyroidectomy, balancing demographics, comorbidities, medications, and laboratory variables. Overall survival was assessed with Kaplan-Meier curves and Cox proportional hazard models. Among the surgical patients, we performed exploratory analyses stratified by operating specialty (otolaryngology-head and neck surgery (reference) vs. general/endocrine surgery and other/unknown, reported descriptively).</p><p><strong>Results: </strong>After matching, 49,219 patients were included per cohort. Thyroidectomy was associated with lower long-term mortality versus non-surgical care (adjusted HR 0.685, 95% CI 0.652-0.721). Among the surgical patients, secondary, exploratory specialty-stratified analyses suggested differences: compared with otolaryngology-head and neck surgery (ENT-HNS; reference), general/endocrine surgery (GS/ES) had a lower adjusted hazard of death (aHR 0.561, 95% CI 0.481-0.654), whereas other/unknown specialties had a higher adjusted hazard (aHR 1.583, 95% CI 1.302-1.924). These patterns are hypothesis-generating and may reflect residual confounding, including the tumor stage and histology, referral pathways, and surgeon or center experience.</p><p><strong>Conclusions: </strong>In a large, propensity-matched real-world cohort, surgery was linked to improved long-term survival regarding thyroid cancer. Observed specialty-related variation should be interpreted cautiously, and prospective studies incorporating tumor-level variables and provider/center characteristics are needed. Emphasis should remain on timely surgery within multidisciplinary care pathways.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 18","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173950","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}