Background: Mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) colorectal tumors constitute 5% of metastatic colorectal cancer(mCRC). Immunotherapy is a new standard, but it is difficult to provide for all patients. 5-Flurouracil-based treatment with anti-EGFRs (cetuximab and panitumumab) in RAS/BRAF-wild or anti-VEGF (bevacizumab) is used in mCRC. Data is limited for the efficacy of anti-VEGF or anti-EGFRs in dMMR/MSI-H mCRC due to the small number of cases in the colorectal cancer population in trials. Aims: To evaluate prognostic factors in dMMR/MSI-H mCRC and compare progression-free survival time of patients receiving anti-VEGF and anti-EGFR combined with first-line 5FU-based therapy. Methods: Patients with metastatic dMMR/MSI-H colorectal cancer diagnosed between January 2015 and January 2023 were included in this cohort study. Progression-free survival times of patients treated with first-line therapy were compared. Prognostic factors associated with overall survival were investigated. Results: A total of 132 patients were included. Mutation rates were 35.6% (n:47) for RAS and 12.1% (n: 16) for BRAF (. Median progression-free survival (PFS) was 10.9 (95% CI: 9.2–12.6) months. Median overall survival (OS) was 44 months (95% CI: 26.23–63.03). 82 (62.1%) patients had primary tumor resection (PTR), 26 (19.7%) had PTR and metastasectomy. A total of 17 (12.8%) de novo mCRC patients had maximal cytoreductive surgery (MCS). A total of 14 (10.6%) patients had subsequent immunotherapy (IO). In multivariate analysis, RAS/BRAF mutation status, MCS, and subsequent IO are defined as prognostic factors for OS (p < 0.01, p: 0.022, and p: 0.005, respectively). No statistically significant difference (PFS, OS) was found in patients receiving first-line anti-VEGF or anti-EGFR therapy. Conclusions: dMMR/MSI-H mCRC is an entity with different tumor biology. We consider that dMMR/MSI-H mCRC patients with BRAF wild, MCS and subsequent IO have better outcomes with 1st line 5FU-based treatment with anti-VEGF/anti-EGFRs.

Introduction. Although approximately 75% of the digestive system’s length and almost 90% of its surface area consists of the small intestine, small bowel tumors are rare. In this study, we aimed to compare the clinical, pathological and prognostic features of small bowel tumors. Material and methods. 107 patients diagnosed with small bowel tumor were evaluated retrospectively. Their clinical and pathological features were examined. The effects of the evaluated parameters on survival were analyzed, and overall survival rates were determined. Results. Of the 107 patients diagnosed with small bowel malignancy included in the study, 44 (41%) were diagnosed with adenocarcinoma, 27 (25%) were diagnosed with GIST, 22 (20.6%) were diagnosed with NHL, and 14 (13.1%) were diagnosed with NET. Distant metastases were more common at diagnosis in adenocarcinoma patients [22 patients (50%)] than in GIST [5 patients (18.5%)] and NHL patients [3 patients (13.6%)] (p = 0.011, p = 0.006, respectively). The median OS in the adenocarcinoma group was 1.1 (min–max = 0.7–1.6) years, in the NET group it was 8.8 (min–max = 3.5–14.2) years, in the NHL group it was 10.7 (min–max = 1.9–19.6) years, but in the GIST group the median OS was could not be reached. OS differences between adenocarcinoma and other groups were statistically significant (p < 0.001). Conclusions. The overall survival of adenocarcinoma was significantly lower than other small bowel tumor subgroups. Keywords: small bowel tumors GIST NHL NET adenocarcinoma

Anthracyclines can induce endothelial and microvascular injury that precedes measurable myocardial dysfunction. However, reliable early markers of such injury are lacking. Nailfold capillaroscopy (NFC) is a noninvasive imaging technique that visualizes microcirculatory alterations. This pilot prospective study aimed to explore post-treatment NFC findings after anthracycline-based chemotherapy and their association with subclinical changes in left ventricular ejection fraction (LVEF) in patients with breast cancer. Twenty-six patients with breast cancer scheduled for four cycles of neoadjuvant doxorubicin/cyclophosphamide (AC) were prospectively enrolled. All patients underwent baseline and post-chemotherapy echocardiography and post-treatment NFC assessment. Capillaroscopic abnormalities (tortuosity, crossing capillaries, extravasation, hemorrhage, dilated capillaries, giant capillaries, and neoangiogenesis) were recorded to generate a composite NFC score (0-7). Early cardiotoxicity was defined as ≥ 10% reduction in LVEF or LVEF < 53%. Correlations between change in ejection fraction (ΔEF) and NFC score were analyzed using Spearman's test. Exploratory ROC analysis was performed using any EF decline as a sensitive pilot endpoint, and an additional sensitivity analysis was performed using a more conservative threshold of ΔEF ≥ 3%. The mean age was 51.8 ± 11.2 years. Baseline and post-AC LVEF were 60.1 ± 2.2% and 58.4 ± 2.6%, respectively (ΔEF = -1.73 ± 2.15%). No clinical cardiotoxicity was observed. The mean composite NFC score was 3.15 ± 0.73. Higher NFC scores showed a negative correlation with ΔEF that did not reach statistical significance (Spearman ρ = -0.36, 95% CI: -0.67 to 0.00, p = 0.072). Exploratory ROC analysis using any EF decline as a sensitive pilot outcome yielded an AUC of 0.78 (95% CI: 0.57-0.95), with an optimal cutoff of NFC ≥ 4. In a sensitivity analysis using ΔEF ≥ 3%, the findings remained directionally consistent (AUC 0.79; optimal cutoff NFC ≥ 4). Post-treatment NFC abnormalities were frequently observed after anthracycline-based chemotherapy and showed an exploratory association with modest subclinical declines in left ventricular ejection fraction. As a prospective pilot study integrating NFC with paired echocardiographic assessment in a homogeneous anthracycline-treated breast cancer cohort, this work provides early hypothesis-generating evidence for a potential microvascular imaging approach in cardio-oncology. Given the absence of baseline NFC assessment and the non-significant primary correlation, these findings should be interpreted cautiously rather than as evidence of anthracycline-induced microvascular injury. Larger longitudinal studies are warranted to clarify the potential role of NFC in cardio-oncology.