Background: Large language models (LLMs) such as GPT-4 are being evaluated for their use as supportive tools in oncological treatment planning. However, in pancreatic cancer, current studies are confined to predefined question–answer formats, while studies specifically investigating real-world scenarios that benchmark LLM performance against multidisciplinary tumor board (MDT) decisions are lacking. Methods: This prospective comparative analysis evaluated treatment and diagnostic recommendations for patients with newly diagnosed or suspected pancreatic cancer between an MDT and GPT-4. Using MDT referrals, clinical data were entered into a clinical data matrix and submitted to GPT-4 for therapeutic and diagnostic recommendations. Outputs were assessed before and after additional prompting with 41 high-ranking abstracts relevant to pancreatic cancer care. The primary endpoint was the concordance of recommendations between the MDT and GPT-4 before and after literature-based prompting. Results: Between September 1, 2024 and March 31, 2025, 45 patients were enrolled. The overall concordance rate between the MDT and GPT-4 was 73.3% (κ = 0.64, p < 0.0001) and did not improve following literature prompting. Discordance most often occurred in complex clinical scenarios. Concordance was highest in cases of metastatic disease (90.0%) and in neoadjuvant settings (90.0%) while it was lowest in patients requiring additional diagnostic workup (50.0%). Conclusions: GPT-4 demonstrated substantial agreement with MDT recommendations in patients with newly diagnosed or suspected pancreatic cancer. However, specific abstract prompting did not enhance the rate of concordance and GPT-4’s limitations in individualized or complex contexts underscore the need for a cautious future integration into oncologic workflows.

Background: TROP2 (TACSTD2) is a therapeutic target of antibody–drug conjugates and is broadly expressed in epithelial malignancies. Data on TROP2 protein expression in large, clinically annotated prostate cancer cohorts, particularly in recurrent disease, remain limited. Methods: TROP2 immunohistochemistry was performed on a prostate cancer tissue microarray comprising 17,747 primary radical prostatectomy specimens and 258 recurrent prostate cancer samples. TROP2 staining data were compared with clinicopathological parameters, biochemical recurrence and ERG status. Results: Among 12,807 interpretable primary prostate cancers, TROP2 staining was detectable in all cases and considered strong in 94.5%, moderate in 3.5%, and weak in 2.0%. Reduced TROP2 was statistically associated with high pT stage (p = 0.0011) and high Gleason grade (p < 0.0001), but absolute differences were small. Reduced TROP2 expression levels were unrelated to PSA recurrence in the entire cohort (p = 0.0787) but statistically linked to early PSA recurrence in ERG positive cancers (p = 0.0165). In four different scenarios of multivariate analyses, reduced TROP2 expression did not show an unequivocal independent prognostic role. As compared to primary tumors, TROP2 was markedly reduced among 250 evaluable recurrent cancers (strong 57.6%, moderate 31.6%, weak 8.4%, negative 2.4%; p < 0.0001 vs. primary cancers). Reduced TROP2 was also significantly more frequent in recurrent cancers than in the subgroup of high-grade primary tumors (Gleason ≥ 4+4; strong 57.6% vs. 90.2%; p < 0.0001). Conclusions: TROP2 is consistently expressed at high levels in primary prostate cancer but often reduced in recurrent disease. While uniform expression in primary tumors supports TROP2 as a therapeutic target in prostate cancer, reduced expression in many recurrent cancers highlights the potential need for TROP2 expression measurement as a predictive test in this subgroup.

Venous congestion and small bowel edema after venous reconstruction during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) may compromise anastomotic safety. A two-stage approach with delayed gastrointestinal reconstruction may offer a protective strategy. We refer to this concept as the TARP procedure (Two-stage Anastomotic Reconstruction after Pancreatectomy). This retrospective single-center study analyzed all consecutive patients who underwent TARP between February 2023 and February 2025. Tumor resection and venous reconstruction were completed in an initial operation, followed by deferred reconstruction within 24-72 h. Baseline characteristics and perioperative outcomes were analyzed descriptively. Nine patients underwent TARP during the study period. The median age was 72 years and the primary indication for a two-stage reconstruction was small bowel edema due to venous congestion. Median operation time was 401 min, median ICU stay 9 days, and median hospital stay 28 days. No patient developed an anastomotic leak or clinically relevant postoperative pancreatic fistula. Six patients (66.7%) experienced Clavien-Dindo grade ≥ IIIb complications. One patient (11.1%) died within 30 days. Two-stage PD with delayed reconstruction appears to be a feasible approach in selected patients with intraoperative risk factors such as bowel edema or instability. Avoiding anastomosis under unfavorable conditions may reduce early morbidity.

Background/Objectives: Annexin A4 (ANXA4) is one of twelve members of the annexin superfamily that bind membrane phospholipids in a calcium-dependent manner, and which are involved in several processes related to the membrane. Methods: To learn more about the role of ANXA4 in cancer, the ANXA4 expression was analyzed by immunohistochemistry (IHC) on tissue microarrays (TMAs) containing 17,654 tumors and precursor lesions from 148 tumor types. Results: ANXA4 immunostaining was found in 10,858 (83.4%) of 13,017 analyzable tumors, and was considered weak in 10.1%, moderate in 16.6%, and strong in 61.8% of cases. Of 148 tumor categories, 144 showed ANXA4 staining in at least one case and 133 included at least one case with strong staining. Among tumor entities with at least 10 evaluable samples, strong ANXA4 staining in >50.0% of cases was seen in 56 of 120 entities, while absence of staining in >50.0% of cases was seen in 13. Clinically important tumor entities where ANXA4 staining was always positive (>99.5%) included gallbladder adenocarcinoma, cholangiocarcinoma, pancreatic/ampullary, various subtypes of salivary gland tumors, papillary renal cell carcinoma, urothelial carcinoma, squamous and basal cell carcinoma of the skin, and epithelioid mesothelioma. A reduced ANXA4 expression was linked to features of cancer aggressiveness in breast cancer, clear cell renal cell carcinoma, urothelial carcinoma, pancreatic ductal adenocarcinoma, hepatocellular carcinoma, colorectal adenocarcinoma, and follicular thyroid carcinoma. Conclusions: It is concluded that ANXA4 is abundantly expressed in human malignancies and that a reduced expression may be linked to unfavorable disease characteristics in many important tumor entities.