BACKGROUND/AIM:In advanced renal cell carcinoma (RCC), immune checkpoint inhibitor (ICI) combinations (ICI-ICI) and ICI plus tyrosine kinase inhibitor (TKI) combinations (ICI-TKI) are standard first-line therapies. However, real-world data directly comparing these approaches remain limited. This study aimed to compare treatment outcomes between ICI-ICI and ICI-TKI therapies. PATIENTS AND METHODS:We retrospectively analyzed 58 patients who received first-line ICI-ICI therapy (ipilimumab plus nivolumab) or ICI-TKI therapy (pembrolizumab plus axitinib, avelumab plus axitinib, nivolumab plus cabozantinib, or pembrolizumab plus lenvatinib) for advanced RCC at Nagasaki University Hospital (March 2018 to June 2024). Primary endpoints were progression-free survival (PFS), overall survival, and objective response rate (ORR). Safety profiles were also evaluated. RESULTS:We included 36 patients in the ICI-ICI group and 22 in the ICI-TKI group. The median follow-up was 17.5 months. The median age of patients in the ICI-TKI group was significantly older than that in the ICI-ICI group (74 vs. 66 years, p<0.001). The median PFS was 30 months in the ICI-ICI group and 25 months in the ICI-TKI group. The median overall survival was 51 months in the ICI-ICI group and 49 months in the ICI-TKI group, with no significant difference observed for either endpoint. The ORR was also similar between the groups. Notably, two complete responses occurred in the ICI-ICI group. The treatment discontinuation rate due to grade ≥3 adverse events was not significantly different between the ICI-ICI and ICI-TKI groups (30.6% vs. 40.9%). CONCLUSION:Across all International Metastatic RCC Database Consortium risk groups, PFS, OS, and ORR showed no significant differences between ICI-ICI and ICI-TKI therapies. Treatment selection should consider patient-specific factors. Validation through larger prospective studies is warranted.
BACKGROUND:Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with pulmonary involvement is a rare, indolent lymphoma with no standard treatment approaches. METHODS:To clarify patient characteristics, treatment, and prognosis of pulmonary MALT lymphoma in the modern era, a multi-institutional observational study of patients diagnosed between 2013 and 2022 was conducted. A modified Ann Arbor system was used for the analysis. RESULTS:Among 186 eligible patients, 131 (70%) had stage IE/IIE disease, whereas 55 (30%) had stage IV disease. No patient had stage III disease. With a median follow-up of 57 months, the 4-year overall survival (OS) rates for the stage IE, IIE, and IV groups were 96%, 92%, and 90%, respectively. The stage IIE and IV groups had similar progression-free survival (PFS) that was significantly worse than that of the stage IE group (p < .001). In stage IE/IIE patients, no differences were found in OS (p = .89) or PFS (p = .90) among the first-line treatment groups. In stage IV patients, the stomach was the most common synchronous extranodal site of involvement (36%). There were no differences in OS among the first-line treatment groups (p = .64). CONCLUSIONS:The OS of patients with MALT lymphoma with pulmonary involvement was favorable regardless of first-line treatment modality, including watchful waiting. The short PFS in the stage IIE and IV groups indicates that these groups are candidates for therapeutic development.
The Sequential Organ Failure Assessment (SOFA)-2 score was developed to better reflect contemporary critical care practice by incorporating modern organ support modalities and updated thresholds based on recent data. However, the generalizability of this framework to intensive care unit (ICU) populations beyond the development cohort, particularly across organ support subgroups and major disease categories, remains uncertain. We aimed to evaluate the external validity of SOFA-2 using the OneICU database, a large Japanese critical care database with comprehensive domain-level data. Adult ICU stays between February 2013 and August 2025 were included and classified into two cohorts: those with complete SOFA-1 and SOFA-2 component data on the day of ICU admission, and those with complete SOFA-2 data on that day. Discriminatory performance for ICU mortality was evaluated using the area under the receiver operating characteristic curve (AUROC) and compared between SOFA-1 and SOFA-2 using the DeLong test. Subgroup analyses were performed by major organ support device use and across disease categories. Among 152,883 eligible ICU stays, 67,116 had complete SOFA-1 and SOFA-2 data, and 121,443 had complete SOFA-2 data. SOFA-2 showed a slightly higher AUROC for ICU mortality than SOFA-1 (0.859 vs. 0.853; p < 0.001), although the absolute difference was small. Across subgroups defined by mechanical circulatory support use, SOFA-2 showed higher discrimination than SOFA-1. Discrimination was similar in other device-defined subgroups and in patients readmitted to the ICU. SOFA-2 also demonstrated good discrimination across major diagnostic groups. SOFA-2 showed similar discrimination for ICU mortality compared with SOFA-1 and maintained broadly comparable performance across clinically relevant subgroups, supporting its applicability for early severity assessment in heterogeneous ICU populations.
Snakebite envenomation remains a substantial public health burden in the Philippines, particularly in the Eastern Visayas, where the Samar cobra (Naja samarensis) is endemic. In rural communities without trained snake handlers or formal relocation services, residents may install perimeter barriers against venomous snakes. We report three incidents of N. samarensis entrapment on a residential fishnet fence in Barangay Pangasugan, Baybay City, Leyte, between July 2025 and March 2026. All three snakes died of entanglement; no human envenomation occurred, in part because no resident attempted removal. The fishnet had been installed with the explicit intent of trapping, not merely deterring, snakes, a strategy carrying substantial risk of secondary envenomation. These observations reflect not resident negligence but a structural gap in community-level snakebite prevention. We argue for locally led snake rescuer training, structured education, environmental risk reduction, and improved antivenom positioning, integrated with the WHO 2030 snakebite roadmap.
