Background: Pancreatic cancer is most often diagnosed at an advanced stage because it develops silently, and its early symptoms are vague and nonspecific. Grouping patients by their primary symptom clusters could provide valuable prognostic insights, enabling more accurate predictions of the stage at diagnosis, the likelihood of surgical resection, and expected survival. Methods: Single-center retrospective cohort study of 164 adults with histologically confirmed pancreatic adenocarcinoma. Patients were grouped by primary symptom cluster: obstructive (jaundice/dark urine/pruritus/steatorrhea), systemic (anorexia, fatigue, weight loss, or dyspnea/neurologic), pain-predominant (abdominal/back/epigastric pain or acute pancreatitis), or control (asymptomatic/incidental). Results: The study included 164 patients with a median age of 69 years (range 57– 81); 56.7% were male. At diagnosis, the overall stage distribution was as follows: stage I, 11%; stage II, 15.9%; stage III, 24.4%; and stage IV, 48.8%. Patients in the obstructive, systemic, and pain-predominant groups were more likely to present with advanced disease than those in the control group (p< 0.05). Among the symptomatic groups, the systemic cluster had a higher proportion of advanced-stage cases compared with both the obstructive and pain-predominant groups (p< 0.05). In contrast, no difference was found between the obstructive and pain-predominant groups (p> 0.05). In Cox proportional hazards analysis, symptom cluster category, stage at diagnosis, surgical resection status, treatment rate, treatment type, and localization were identified as independent predictors of overall survival (p< 0.05). Median survival was longest in the control group (37.6 months), followed by the obstructive (16.0 months), pain-predominant (11.8 months), and systemic (7.8 months) groups, with all between-group comparisons reaching significance (p< 0.05). Conclusion: Presenting symptom clusters are strongly associated with disease stage, surgical resectability, and survival outcomes in pancreatic cancer. Early recognition of high-risk symptom profiles may improve surgical opportunities and outcomes.

Immune checkpoint inhibitors such as nivolumab have brought meaningful benefits to patients with advanced non-small cell lung cancer (NSCLC), yet many patients still experience limited responses. Vitamin D is a key modulator of immune function, and deficiency is common in individuals with cancer. Given its potential role in shaping immunotherapy response, we retrospectively assessed whether baseline vitamin D levels were associated with clinical outcomes in advanced NSCLC patients treated with nivolumab. We retrospectively analyzed patients with stage IV NSCLC treated with nivolumab across multiple centers, predominantly as second-line therapy. Prior to nivolumab initiation, all patients were confirmed to be negative for common driver mutations, including EGFR, ALK, ROS1, and other actionable genomic alterations. Baseline serum 25-hydroxyvitamin D levels were measured prior to nivolumab initiation, and patients were categorized as having severe deficiency (< 10 ng/mL), deficiency (10–20 ng/mL), or sufficient levels (≥ 20 ng/mL). The presence of liver metastases was recorded at baseline. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Multivariable Cox proportional hazards models adjusted for age, sex, ECOG performance status, liver metastasis, and other metastatic sites were used to evaluate the independent prognostic value of vitamin D status. Objective response rates (ORR) were assessed in patients with available radiologic data. A total of 890 patients were screened, and after excluding those with missing baseline vitamin D data, 305 patients were included in the analysis. The median age was 64 years (range 34–85), and 68% of patients were male. Vitamin D levels were < 10 ng/mL in 30%, 10–20 ng/mL in 44%, and ≥ 20 ng/mL in 26% of patients. Patients with severe vitamin D deficiency were numerically older (median age 65 vs. 63 years) and had higher rates of ECOG PS ≥ 2 (15.1% vs. 7.5%) and squamous histology (37.6% vs. 27.5%), though these differences were not statistically significant (p > 0.05 for all). Liver metastases were present in 54 patients (17.7%), and the distribution was similar across vitamin D groups (p = 0.92). Median PFS was shortest in patients with severe vitamin D deficiency (3.4 months), intermediate in the 10–20 ng/mL group (5.2 months), and longest in patients with sufficient levels (8.1 months). Median OS ranged from 8.6 months in the < 10 ng/mL group to 15.8 months in the ≥ 20 ng/mL group. Patients with liver metastases had significantly shorter OS compared to those without (median OS 9.8 vs. 13.6 months, HR 1.48, p = 0.006). Vitamin D deficiency was associated with significantly worse PFS and OS on univariate analysis. In multivariable analysis, vitamin D levels < 20 ng/mL remained independently associated with poorer OS. ORR was numerically higher in patients with sufficient vitamin D levels (30% vs. 14%). Lower baseline vitamin D levels were associated with inferior clinical outcomes in advanced NSCLC patients treated with nivolumab. Patients with vitamin D levels ≥ 20 ng/mL demonstrated longer PFS and OS and a trend toward higher response rates. These findings support a prognostic role for vitamin D status in immunotherapy-treated NSCLC; however, prospective studies are required to determine whether vitamin D optimization can causally enhance immunotherapy efficacy.

Background: Risk stratification is one of the most critical parameters guiding treatment decisions in nonmetastatic prostate cancer. Although it is well established that high risk (HR) and very high risk (VHR) groups diverge prognostically, the real-world impact of this distinction in non-surgically managed patient populations has been less extensively evaluated. Methods: In this retrospective study, 81 patients with nonmetastatic prostate cancer were analyzed (HR: n=24; VHR: n=57). All patients received androgen deprivation therapy (ADT), and 65.4% additionally underwent radiotherapy (RT). Clinical and pathological characteristics, early PSA responses, overall survival (OS), and disease-free survival (DFS) were compared between HR and VHR groups. Results: At diagnosis, VHR patients presented with higher PSA values, worse Gleason scores, and more advanced stages. Although PSA responses at three and six months were similar between groups, long-term outcomes were significantly inferior in the VHR cohort. Median OS for the entire cohort was 72.1 months in VHR patients versus 97.1 months in HR patients (p=0.039). Among those receiving RT, the difference was preserved (HR: 104.5 months vs VHR: 75.1 months; p=0.032). Median DFS was 23.3 months in the VHR group and 44.5 months in the HR group (p=0.026). During follow-up, recurrence/metastasis occurred in 54.4% of VHR patients compared with 16.7% of HR patients (p=0.002). Conclusion: Our findings show that the VHR classification maintains strong prognostic value even in non-surgically managed patients, underscoring its role as a biologically distinct and aggressive disease entity. Standard RT+ADT seems insufficient in this subgroup. The study supports exploring intensified treatment strategies, such as prolonged ADT, brachytherapy boost, pelvic nodal RT, and, where appropriate, novel androgen receptor signaling inhibitors or chemotherapy.

Objective: This study aimed to investigate the prognostic value of the preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinicopathological parameters for predicting survival outcomes in patients undergoing curative-intent gastrectomy for gastric adenocarcinoma. Methods: This retrospective cohort study analyzed data from 304 patients with histopathologically confirmed gastric adenocarcinoma who underwent curative-intent gastrectomy with standardized D1+ or D2 lymphadenectomy. The MHR was calculated using preoperative monocyte counts and HDL cholesterol levels. Patients were dichotomized based on the optimal MHR cutoff determined via receiver operating characteristic curve analysis with the Youden index. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were assessed using Kaplan–Meier analysis and compared with log-rank tests. Results: ROC analysis determined an optimal MHR cutoff of ≥11.02 (AUC: 0.654; 95% CI: 0.59–0.718), yielding sensitivities and specificities of 62.6% and 62.4%, respectively. Patients with an elevated MHR (≥11.02) had worse 5-year OS (51.4 vs. 72.2%; p < 0.001) and PFS (65.2 vs. 80.5%; p = 0.003). In the multivariate Cox regression model, elevated MHR emerged as an independent predictor of disease progression (HR: 1.93; 95% CI: 1.17–3.18; p = 0.010), while parameters such as signet ring cell histology, lymphovascular invasion, and perineural invasion were significant in univariate analyses but not in the adjusted multivariate model. Conclusions: MHR should not be regarded as a definitive predictor in isolation but rather as a cost-effective, readily obtainable adjunct within a broader preoperative risk assessment framework. Integration with other inflammation-based and clinicopathological factors may enhance predictive performance and clinical applicability.

Nivolumab is currently widely used in the treatment of lung cancer. Studies have been conducted using flat doses of 240 mg and 3 mg/kg. In fact, studies involving a small number of patients have begun to explore low-dose immunotherapies. The literature on the optimal dose of immunotherapy, the use of weight based, or fixed doses is very recent and has become a one of the subject of ongoing research. This multicenter study included 716 patients with NSCLC. Patients receiving standard doses of 3 mg/kg and 240 mg of nivolumab were divided into subgroups based on their weight. Patients weighing 80 kg have already received a flat dose. However, patients weighing < 80 kg who received a flat dose were considered to be receiving high-dose therapy. Conversely, patients weighing more than 80 kg who received a flat dose were maintained on a low dose. Therefore, overall survival, progression-free survival, and toxicity were examined according to weight-based usage. The median progression free survival (PFS) for those receiving a 3 mg/kg dose was 6 months, whereas it was 9.8 months for those receiving a flat dose (p < 0.001). The median (metastatic overall survival) OS for those receiving a 3 mg/kg dose was 12 months, whereas it was 14 months for those receiving a 240 mg dose (p = 0.03). This study was based on real-world data. Therefore, our results may be instructive regarding the nivolumab dose, which is a commonly used treatment for NSCLC patients. Our results suggest that a flat dose may be preferred in all groups and as a subgroup, especially in patients weighing < 80 kg.

Aims: We aimed to assess how well the ESGO risk classification predicts disease free and overall survival in patients treated for endometrial carcinoma (EC) at our center. Methods: We conducted a single-center retrospective analysis of 61 patients with EC who underwent surgery between 2015 and 2023. Patient demographics, clinicopathological characteristics, treatment modalities and survival outcomes were analyzed. Patients were stratified according to the ESGO risk groups (low, intermediate, high). Survival analysis was performed using Kaplan-Meier curves with Log-rank tests, and Cox proportional hazards regression models were used to identify independent prognostic factors. Results: The median age at diagnosis was 57 years (range: 35-106). The most common histological subtype was endometrioid (73.8%). According to the ESGO classification, 36.1% of patients were low-risk, 45.9% intermediate-risk, and 18.0% high risk. Recurrence occurred in 9 patients (14.8%), with the liver being the most common site (6.6%). In univariate analysis, age at diagnosis, T stage, adjuvant CT, and ESGO risk classification were significant predictors for DFS. For OS, age and ESGO classification were significant. In the multivariate analysis, only age at diagnosis (HR: 1.138, 95% CI: 1.040-1.246, p=0.005 for DFS; HR: 1.148, 95% CI: 1.046-1.260, p=0.004 for OS) and ESGO risk classification (HR: 5.223, 95% CI: 1.788 15.256, p=0.003 for DFS; HR: 4.742, 95% CI: 1.600-14.060, p=0.005 for OS) remained independent prognostic factors. Kaplan–Meier analysis showed that patients in the high-risk ESGO group had shorter disease-free and overall survival than those in the other groups (p