Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. National Institute for Health and Care Research.

Background: Treatment of inflammatory bowel diseases with biological therapies has significantly increased, with ever increasing numbers of patients receiving such treatment at the time of surgery. This study evaluates the perioperative safety of three commonly used biologics—Infliximab, Vedolizumab, or Ustekinumab—in patients undergoing intestinal surgery for IBDs. Materials and Methods: In this systematic review a comprehensive search was conducted in Scopus, Medline and PubMed up to January 2025 by two independent reviewers, and a total of 34 articles (retrospective studies in the majority of them) reporting total surgical complications of patients treated with these three agents, in comparison to a control group, were included. Relative risks were aggregated using the Mantel-Haenszel method, and the I² statistic was used to assess between-study heterogeneity. Subgroup analyses were conducted for particular complications, and direct comparisons among the biological agents were made. Results: In the primary analysis, INFL was not linked to a statistically significant rise in overall postoperative complications when compared to controls (RR = 1.13, 95% CI: 0.90–1.42, p = 0.31). VDLZ exhibited a non-significant inclination towards increased complications (RR = 1.26, 95% CI: 0.94–1.67, p = 0.12), although it was linked to a notably higher risk of postoperative ileus compared to INFL (RR = 2.29, 95% CI: 1.59–3.29, p < 0.00001). USTK also did not show significant differences from controls overall (RR = 0.55, 95% CI: 0.20–1.57, p = 0.26), though it was associated with a considerably lower risk of SSIs (RR = 0.35, 95% CI: 0.17–0.73, p = 0.005). There were no significant distinctions between the biological agents regarding SSIs or anastomotic leakage, although many comparisons faced challenges due to high heterogeneity and low event rates. Conclusions: USTK demonstrated the most favorable safety profile, while VDLZ was associated with higher rates of ileus and inflammatory complications. However, prospective studies are warranted.

Background/Objectives Ki‑67 is widely used as an immunohistochemical marker of tumor proliferation in hormone receptor–positive (HR‑positive), HER2‑negative breast cancer, but its inter-pretation is limited by variability and uncertain concordance with genomic assays. The Oncotype DX® Recurrence Score (RS) is a validated multigene assay with established prognostic and predictive utility. This study evaluated the relationship between Ki‑67 and RS in clinical practice. Methods We retrospectively analyzed women in Greece with early‑stage estrogen receptor–positive, HER2‑negative breast cancer without distant metastasis (pM0) who under-went Oncotype DX testing between 2020 and 2023. Eligible patients were node nega-tive or postmenopausal with node positive disease. RS was categorized as low (0–25) or high (>25). Ki‑67 was assessed using binary (< 20% vs ≥20%) and three‑tier (≤5%, >5%–< 30%, ≥30%) classifications. Associations were analyzed using correlation, con-cordance, and nonparametric methods. Results Among 2,967 patients, the median RS was 16, with similar distributions across nodal subgroups. Ki‑67 and RS demonstrated a moderate positive correlation as continuous variables (r = 0.42, p < 0.001). After stratification, associations with RS were observed only in tumors with high Ki‑67 expression, whereas no correlation was detected in low or intermediate groups. RS distributions differed significantly across Ki‑67 strata. Overall concordance between Ki‑67‑based proliferation categories and RS‑based ge-nomic risk was 56.2%, with discordant cases in both directions. Conclusions Ki‑67 shows a moderate association with Oncotype DX RS, but substantial discordance indicates it should not substitute genomic testing in HR‑positive/HER2‑negative early breast cancer.

Background/Objectives: Ki-67 is widely used as an immunohistochemical marker of tumor proliferation in hormone receptor-positive (HR-positive), HER2-negative breast cancer, but its interpretation is limited by variability and uncertain concordance with genomic assays. The Oncotype DX^® Recurrence Score (RS) is a validated multigene assay with established prognostic and predictive utility. This study evaluated the relationship between Ki-67 and RS in clinical practice. Methods: We retrospectively analyzed women in Greece with early-stage estrogen receptor-positive, HER2-negative breast cancer without distant metastasis (pM0) who underwent Oncotype DX testing between 2020 and 2023. Eligible patients were node-negative or postmenopausal with node-positive disease. RS was categorized as low (0–25) or high (>25). Ki-67 was assessed using binary (5–<30%, ≥30%) classifications. Associations were analyzed using correlation, concordance, and non-parametric methods. Results: Among 2967 patients, the median RS was 16, with similar distributions across nodal subgroups. Ki-67 and RS demonstrated a modest positive correlation as continuous variables (R = 0.30, p < 0.001). After stratification, associations with RS were observed only in tumors with high Ki-67 expression, whereas no correlation was detected in low or intermediate groups. RS distributions differed significantly across Ki-67 strata. Overall concordance between Ki-67-based proliferation categories and RS-based genomic risk was 56.2%, with discordant cases in both directions. Conclusions: Ki-67 shows a modest association with Oncotype DX RS, but substantial discordance indicates Ki-67 should not substitute genomic testing in HR-positive/HER2-negative early breast cancer.

Background: Breast cancer and gynecological malignancies, including cervical, ovarian, and endometrial cancers, remain leading causes of cancer incidence and mortality among women worldwide. This study investigated hereditary predisposition rates in women diagnosed with breast or gynecological cancer, focusing on the effect of age on pathogenic/likely pathogenic (P/LP) variant detection. We sought to determine whether younger age at diagnosis should be used as a criterion for patient selection for genetic testing. Methods: A total of 9084 consecutive females with breast cancer or gynecological tumors underwent NGS-based genetic testing (53 cancer-relevant genes) at Genekor laboratory from 2020-2026. Multivariable logistic regression evaluated factors associated with P/LP variant detection, adjusting for tumor type and family history. Results: Overall P/LP prevalence was approximately 20% (one in five patients), with tumor-specific rates of 19.24% in breast cancer, 27.59% in ovarian cancer, and 26.67% in endometrial cancer. P/LP prevalence declined significantly with age from 24.37% in patients <40 years to 15.90% in those ≥70 years, while VUS remained stable (40-43%). P/LP patients had earlier diagnosis (median 45 vs 46 years, p<0.001), driven predominantly by high-risk genes (13.87% in <40y vs 7.11% in ≥70y). BRCA1 showed stronger age enrichment than BRCA2 (8.14% vs 3.16% in <40y; median diagnosis 43 vs 45 years). Age remained independently associated with P/LP detection in multivariable analysis, with an 18% reduction in odds per 10-year increase for any P/LP (OR 0.82, 95% CI 0.78-0.86) and a stronger 28% reduction for high-risk variants (OR 0.72, 95% CI 0.67-0.78). Family history also independently predicted P/LP detection (OR 1.40, 95% CI 1.19-1.66). Conclusions: While younger patients have a higher prevalence of high-risk variants, clinically actionable findings were identified across all age groups, including patients ≥70 years These findings indicate that focusing on age to determine eligibility for genetic testing is insufficient. Expanding testing accessibility to individuals regardless of their age at diagnosis may enhance the identification of genetic cancer risk and optimize patient management.

In breast cancer, current knowledge of the associations between clinicopathologic characteristics, genetic changes, and subtype-specific patterns remain unclear. This research investigated how pathological and clinical variables affect the actionability of NGS-based tumor molecular data. Materials and methods: 227 breast cancer patients referred to Genekor’s laboratory for tumor molecular profile analysis were included in the study. Pathology records, available in all cases, were used to assess critical clinicopathological features including HER2, ER, PR, Ki67, grade, metastatic site, and age. A 1021 gene NGS-based multigene panel was utilized to assess tumors’ biology alongside tumor mutational burden (TMB) and microsatellite instability (MSI) Results: Comprehensive genomic profiling revealed that 95.6% of the patients harbored at least one oncogenic or likely oncogenic alteration, highlighting the high diagnostic yield of NGS-based testing. Distinct subtype-specific patterns were observed: HR+/HER2-tumors were enriched for PIK3CA and ESR1 gene alterations, while Triple Negative Breast Cancer (TNBC) was dominated by TP53 alterations. Clinically actionable alterations were most common in HR+/HER2-tumors (~60% on-label), whereas TNBC more often harbored off-label or trial-associated targets. The inclusion of tumor-agnostic biomarkers (TMB/MSI) increased on-label actionability up to 64.5% in ER−/PR+ tumors. primarily driven by TMB-high cases. Median TMB values were low, and age was the only independent predictor. Furthermore, the presence of actionable alterations was significantly higher in metastatic tumors, and TP53 alterations were associated with aggressive tumor characteristics.Conclusions: Comprehensive NGS-based genomic profiling identifies clinically actionable alterations in over half of breast cancer patients, with substantial variability across molecular subtypes. The HR+/HER2-subtype demonstrates the highest prevalence of on-label actionable biomarkers. These findings support the routine implementation of comprehensive genomic profiling, especially in metastatic HER2-negative breast cancer, to guide precision oncology strategies and enable enrollment in biomarker-driven clinical trials.