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We validated an 18-gene classifier (GC) initially developed to predict local/regional recurrence after mastectomy in estimating distant metastasis risk. The 18-gene scoring algorithm defines scores as: <21, low risk; ≥21, high risk. Six hundred eighty-three patients with primary operable breast cancer and fresh frozen tumor tissues available were included. The primary outcome was the 5-year probability of freedom from distant metastasis (DMFP). Two external datasets were used to test the predictive accuracy of 18-GC. The 5-year rates of DMFP for patients classified as low-risk (n = 146, 21.7%) and high-risk (n = 537, 78.6%) were 96.2% (95% CI, 91.1%-98.8%) and 80.9% (74.6%-81.9%), respectively (median follow-up interval, 71.8 months). The 5-year rates of DMFP of the low-risk group in stage I (n = 62, 35.6%), stage II (n = 66, 20.1%), and stage III (n = 18, 10.3%) were 100%, 94.2% (78.5%-98.5%), and 90.9% (50.8%-98.7%), respectively. Multivariate analysis revealed that 18-GC is an independent prognostic factor of distant metastasis (adjusted hazard ratio, 5.1; 95% CI, 1.8-14.1; p = 0.0017) for scores of ≥21. External validation showed that the 5-year rate of DMFP in the low- and high-risk patients was 94.1% (82.9%-100%) and 80.3% (70.7%-89.9%, p = 0.06) in a Singapore dataset, and 89.5% (81.9%-94.1%) and 73.6% (67.2%-79.0%, p = 0.0039) in the GEO-GSE20685 dataset, respectively. In conclusion, 18-GC is a viable prognostic biomarker for breast cancer to estimate distant metastasis risk.

Angiomatoid fibrous histiocytoma is a rare soft tissue tumor of low-grade malignancy. We present the case of a 32-year-old man who complained of soreness and numbness over his left arm and hand over the previous 2 months and of having a palpable mass over his left upper back for 4 years. Magnetic resonance imaging (MRI) showed an intramuscular soft tissue mass in the left scapular region. The tumor mass was seen to have multiple cystic components with fluid-fluid levels. Histological examination showed multiple cystic spaces filled with blood lakes and hemosiderin deposits in the solid part of the tumor. After the initial surgery, the patient had local recurrences over 2.5 years. The immunohistochemical study at the second surgery showed that the recurrent tumor was strongly positive for the histiocytic marker CD68, and the myoid trait desmin. Histological diagnosis was compatible with angiomatoid fibrous histiocytoma.

Adult T‐cell leukemia/lymphoma (ATLL) is a distinct type of peripheral T‐cell lymphoma (PTCL) driven by human T‐lymphotropic virus type I (HTLV‐1)–infected T cells, but diagnosis can be confounded by histological overlap with non‐ATLL PTCL. While molecular testing is the diagnostic gold standard in endemic areas, HTLV‐1/2 serology is often used as a surrogate in nonendemic settings, yet its accuracy and limitations remain unclear. We retrospectively analyzed 881 PTCL cases over 25 years at two tertiary referral hospitals in Taiwan, where HTLV‐1 is nonendemic. Serology was available in 48.2% of cases. Molecular confirmation was performed using HBZ in situ hybridization and tax quantitative polymerase chain reaction. Among the 44 seropositive PTCL patients with tissue available, 37 were diagnosed and molecularly confirmed as ATLL. Of the seven initially diagnosed as non‐ATLL PTCL, three were reclassified as ATLL, while four showed no molecular evidence, including three likely false seropositives with borderline signal‐to‐cutoff (S/CO) values in serology assay and T follicular helper cell phenotype. In seropositive PTCL, clinicopathologic interpretation without molecular testing yielded 100% positive predictive value, 93% sensitivity, and 93% accuracy, compared with 91% positive predictive value by serology alone. In addition, retrospective molecular screening in 59 PTCL without prior serologic data revealed one case of ATLL that had initially been overlooked. In conclusion, our findings support routine HTLV‐1/2 serologic testing in all newly diagnosed PTCLs. However, interpretation should be guided by clinicopathological correlation and serology index values. Borderline index results warrant molecular confirmation.

Splenectomy has been suggested to have an impact on immunological function, and subsequent development of cancer has been recognized as a possible adverse effect of splenectomy. This study evaluated the possible association between splenectomy and malignancy in Taiwan. A cohort study consisted of including 2,603 patients with nontraumatic and 2,295 patients with traumatic splenectomy, and then randomly frequency matched with 4 participants without splenectomy. The Cox proportional hazard regression analysis was conducted to estimate the influence of splenectomy on cancer risk. Both nontraumatic and traumatic splenectomy had a significantly higher risk for overall cancer development (adjusted hazard ratios are 2.64 and 1.29 for nontraumatic and traumatic reasons, respectively). After adjusting for age, sex, and comorbidities, patients with splenectomy were associated with significantly higher risks for developing certain gastrointestinal tract cancers, other head and neck cancers, and hematological malignancies, and the phenomenon is more prominent in nontraumatic splenectomy group. This nationwide population-based study found that people with splenectomy have higher risks of developing overall cancer, as well as certain site-specific cancers, especially for patients with nontraumatic reasons. •Subsequent cancer risks were higher in both nontraumatic and traumatic splenectomy patients.•Associated with higher risks for GI, head and neck, hematological, and bladder cancer.•Follow-up years showed various patterns among diverse cancers.

Resistance training plays a key role in enhancing muscular performance; however, the effects of different combinations of loading intensity and velocity loss (VL) thresholds on muscle oxygen saturation (SmO2) dynamics during exercise remain insufficiently understood. This study aimed to investigate the influence of intensity (60% vs. 80% one-repetition maximum [1RM]) and VL (20% vs. 40%) on SmO2 responses during the back squat exercise. Eighteen resistance-trained males (age: 20.06 ± 1.63 years; height: 176.78 ± 6.45 cm; body mass: 70.26 ± 9.56 kg) performed four back squat protocols - 60%1RM-VL20% (60-20), 60%1RM-VL40% (60-40), 80%1RM-VL20% (80-20), and 80%1RM-VL40% (80-40) - using a repeated-measures, counterbalanced design. Each protocol comprised three sets with 5-minute inter-set rest periods. SmO2 of the vastus lateralis was continuously monitored to determine changes in its magnitude and slope during exercise and recovery phases. Results revealed no significant differences were observed in the magnitude of SmO2 decline across conditions, with values ranging from 47.28% to 57.67% across all sets (p > .05). The SmO2 decline slope was significantly steeper (more negative) in the 80-20 condition (-1.71 to -2.04 %·s-1) compared to both 60-20 (-0.80 to -1.13 %·s-1) and 60-40 (-0.53 to -1.00 %·s-1) across all sets (p < .001). No significant differences were observed in SmO2 recovery slope during rest (range: 0.36-0.61 %·s-1; p > .05). The present study demonstrated that combining 60% 1RM with a 40% VL% threshold elicited the slowest SmO2 decline rate, potentially delaying fatigue onset and allowing greater repetition volume. Although both training intensity and velocity loss thresholds influenced muscle oxygenation dynamics, the rate of SmO2 desaturation was particularly sensitive to changes in VL% thresholds under the 80% 1RM. These findings underscore the importance of integrating training intensity, VL% magnitude, and oxygenation dynamics when designing individualized resistance training protocols.

Background Metachronous liver metastasis (MLM) occurs in 20–40% of colorectal cancer (CRC) patients following surgical treatment. The aim of the present study was to determine the risk factors affecting the development of MLM in CRC patients following curative resection. Methods A total of 1,356 patients who underwent curative intent resection for CRC were retrospectively studied. Of these patients, those who with 30 days postoperative mortality ( n  = 23), incomplete medical record ( n  = 32), synchronous liver metastasis ( n  = 148) and UICC stage IV ( n  = 54) were excluded, and finally 1,099 patients were analyzed, including 977 patients without liver metastasis and 122 patients with MLM-only. Clinical and pathological records for each patient were reviewed from medical charts. The clinicopathologic characteristics of 1,099 patients were investigated. Results The median timing of developing MLM was 13 months with a range of 4 to 79 months. Univariate analysis identified that preoperative serum carcinoembryonic antigen (CEA) level, depth of invasion, lymph nodes metastasis, vascular invasion, and perineural invasion were significantly correlated with the development of MLM (all P  < 0.05). Meanwhile, a multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) level > 5 ng/ml (Odds Ratio [OR] = 1.591; 95% Confidence Interval [CI], 1.065–2.377; P  = 0.024), tumor depth (OR = 2.294; 95% CI, 1.103–4.768; P  = 0.026), positive lymph node metastasis (OR = 2.004; 95% CI, 1.324–3.031; P  = 0.001) and positive vascular invasion (OR = 1.872; 95% CI, 1.225–2.861; P  = 0.004) were independent prognostic factors contributing to the occurrence of MLM. Conclusions The present study demonstrates that preoperative serum CEA level, tumor depth, lymph node metastasis, and positive vascular invasion could affect the occurrence of MLM in CRC patients following curative resection, and thus could help to define these high-risk patients who would benefit from enhanced surveillance and therapeutic program(s).

BackgroundEven with significant advances in surgical techniques and treatment, salvage chemotherapy remains the major treatment strategy for patients with unresectable or metastatic gastric cancer (GC). Practical and technical advances have simplified safe and convenient use of supplemental home parenteral nutrition (HPN). We aimed to clarify the role of HPN in patients with incurable GC undergoing salvage chemotherapy.MethodsWe enrolled 25 patients with GC with a nutritional risk index (NRI) of ≦ 97.5 undergoing HPN. Their nutritional status, laboratory data, and quality of life (QoL) were analyzed using the Research and Treatment of Cancer quality of life questionnaire-C30 before and after HPN administration at 0.5, 1, 2, and 3 months. We enrolled 25 patients with an NRI of > 97.5 not undergoing HPN as the control group.ResultsTotal protein (P = 0.008), prealbumin (P < 0.001), and total cholesterol (P = 0.023) levels improved significantly after 0.5 months of HPN administration. The study group also demonstrated a marked improvement in nitrogen balance (P = 0.004) and prealbumin levels (P < 0.012) after 1 month. Gains in body weight after 1 month and body mass index after 2 months of HPN administration remained comparable with those of the control group. Global QoL scores were maintained and comparable with those of the control group.ConclusionsSupplemental HPN therapy for malnourished patients with unresectable or metastatic GC undergoing salvage chemotherapy is feasible and revealed marked improvement in nutritional status. Early HPN intervention should be considered an important part of palliative treatment for advanced GC.

To evaluate the relationship between the use of zolpidem and subsequent cancer risk in Taiwanese patients. We used data from the National Health Insurance system of Taiwan to investigate whether use of zolpidem was related to cancer risk. For the study cohort, we identified 14,950 patients who had received a first prescription for zolpidem from January 1, 1998, through December 31, 2000. For each zolpidem user, we selected randomly 4 comparison patients without a history of using zolpidem who were frequency-matched by sex, age, and year of the index date. Incidence rates of all cancers and selected site-specific cancers were measured by the end of 2009, and related hazard ratios (HRs) and 95% confidence intervals (CIs) of the cancer were measured as well. The risk of developing any cancer was greater in patients using zolpidem than in nonusers (HR, 1.68; 95% CI, 1.55-1.82). The stratified analysis showed that the overall HR for high-dosage zolpidem (≥300 mg/y) was 2.38. The site-specific cancer risk was the highest for oral cancer (HR, 2.36; 95% CI, 1.57-3.56), followed by kidney cancer, esophageal cancer, breast cancer, liver cancer, lung cancer, and bladder cancer (HR, 1.60; 95% CI, 1.06-2.41). Men were at higher risk than women. This population-based study revealed some unexpected findings, suggesting that the use of zolpidem may be associated with an increased risk of subsequent cancer. Further large-scale and in-depth investigations in this area are warranted.

Background The aim of this study was to determine influence of prognostic factors in addition to UICC staging systems, on cancer-specific and overall survival rates for patients with colorectal cancer (CRC) undergoing surgical treatment. Methods Between January 1996 and December 2006, a total of 1367 CRC patients who underwent surgical treatment in Kaohsiung Medical University Hospital were analyzed. We retrospectively investigated clinicopathologic features of these patients. All patients were followed up intensively, and their outcomes were investigated completely. Results Of 1367 CRC patients, there were seven hundred and fifty-seven males (55.4%) and 610 (44.6%) females. The median follow-up period was 60 months (range, 3–132 months). A multivariate analysis identified that low serum albumin level ( P = 0.011), advanced UICC stage ( P < 0.001), and high carcinoembryonic antigen (CEA) level ( P < 0.001) were independent prognostic factors of cancer-specific survival. Meanwhile, a multivariate analysis showed age over 65 years ( P < 0.001), advanced UICC stage ( P < 0.001), and high CEA level ( P < 0.001) were independent prognostic factors of overall survival. Furthermore, combination of UICC stage, serum CEA and albumin levels as predictors of cancer-specific survival showed that the poorer the prognostic factors involved, the poorer the cancer-specific survival rate. Likewise, combination of UICC stage, age and serum CEA level as predictors of overall survival showed that the poorer the prognostic factors involved, the poorer the overall survival rate. Of these prognostic factors, preoperative serum CEA level was the only significant prognostic factor for patients with stage II and III CRCs in both cancer-specific and overall survival categories. Conclusion Preoperative serum albumin level, CEA level and age could prominently affect postoperative outcome of CRC patients undergoing surgical treatment. In addition to conventional UICC staging system, it might be imperative to take these additional characteristics of factors into account in CRC patients prior to surgical treatment.

Controversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer. This paper explores the possible association between the use of oral ALN in osteoporosis patients and subsequent cancer risk using the National Health Insurance (NHI) system database of Taiwan with a Cox proportional-hazard regression analysis. The exposure cohort contained 5,624 osteoporosis patients used ALN and randomly frequency-matched by age and gender of 3 osteoporosis patients without any kind of anti-osteoporosis drugs in the same period. For a dose ≥ 1.0 g/year, the risk of developing overall cancer was significantly higher (hazard ratio: 1.69, 95% confidence ratio: 1.39-2.04) than in osteoporosis patients without any anti-osteoporosis drugs. The risks for developing liver, lung, and prostate cancers and lymphoma were also significantly higher than in the control group. This population-based retrospective cohort study did not find a relationship between ALN use and either esophageal or breast cancer, but unexpectedly discovered that use of ALN with dose ≥ 1.0 g/year significantly increased risks of overall cancer incidence, as well as liver, lung, and prostate cancers and lymphoma. Further large population-based unbiased studies to enforce our findings are required before any confirmatory conclusion can be made.