BACKGROUND:Tumor spread through air spaces (STAS) has been proposed as a histopathological marker of aggressive tumor biology in adenocarcinoma of the lung (ADCL). Its independent prognostic significance and clinical implications regarding surgical strategy remain controversial. This study evaluated clinicopathological correlates and the prognostic impact of STAS in a homogeneous cohort of resected ADCL. METHODS:We retrospectively analyzed 100 patients with primary ADCL resected between 2009 and 2018. STAS was classified as absent, low (1-4 clusters), or high (≥5) by an experienced pathologist. Associations between STAS and clinical, surgical, and pathological variables were tested with univariate analyses and multivariable logistic regression. Overall survival (OS) was evaluated using Kaplan-Meier and Cox regression. RESULTS:STAS was present in 46% of tumors and was significantly associated with a higher pathological N category (pN0-pN3; p = 0.005), more advanced UICC stage (p = 0.049), lymphovascular invasion (LVI; p = 0.008), and perineural invasion (PnI; p = 0.012). In univariate survival analysis, patients with STAS had shorter OS than patients without STAS (p = 0.047). After limited resection, OS did not differ (p = 0.864), whereas after radical anatomical resection, patients with STAS showed reduced OS (p = 0.034). In multivariable Cox regression analysis, STAS did not retain independent prognostic significance. CONCLUSIONS:STAS is frequent in resected ADCL and correlates with adverse pathological features and reduced OS in univariate models. In multivariate analysis, STAS did not emerge as an independent prognostic factor. These findings support the interpretation of STAS as a marker of aggressive tumor biology rather than an independent determinant of prognosis or surgical decision-making.
Neratinib, a pan-HER tyrosine kinase inhibitor, is approved in Europe as extended adjuvant therapy for HR+/HER2+ early breast cancer (EBC) in patients who have completed trastuzumab-based therapy ≤ 1 year ago. In this population, the ExteNET trial for patients with HR+/HER2+ EBC demonstrated a clinical benefit for neratinib vs. placebo, including significantly improved 5-year invasive disease-free survival (iDFS) (iDFS; Δ5.1%, HR 0.58, 95% CI 0.41-0.82). Neratinib-associated diarrhoea was the most common adverse event (39% Grade 3 without mandatory prophylaxis). Real-world data are essential for informing the management of diarrhoea and understanding patterns within its approved indications. NERLYFE is a European, prospective, observational post-authorization safety study (PASS) conducted in routine clinical practice across Austria, Czech Republic, Germany, and the United Kingdom. Patients with HR+/HER2+ EBC were scheduled to receive neratinib as extended adjuvant therapy for up to 12 months in accordance with the EU SmPC. The primary objective is to describe the incidence of permanent treatment discontinuation due to diarrhoea during the first 3 months (mo) of neratinib treatment (core phase). Secondary objectives include describing the pattern of diarrhoea and maintenance of neratinib treatment. At data cut-off on 31 December 2024, 113 patients received at least one dose of neratinib and were observed for at least 3 months. Results of this pre-planned interim analysis are reported. Baseline characteristics were median age 55 years, 86% ECOG PS 0, 79% high risk of recurrence (AJCC stage > I or N+ or non-pCR after neoadjuvant treatment). Overall, 56%, 28% and 11% of patients received adjuvant/post-neoadjuvant trastuzumab monotherapy, trastuzumab-emtansine (T-DM1), and trastuzumab/pertuzumab, respectively, with 5% of patients receiving other anti-HER2 therapy. The initial dose of neratinib was 240 mg/day for 61% of patients and < 240 mg/day for 39%; 63% of patients received anti-diarrhoeal prophylaxis at least once. Fourteen percent of patients permanently discontinued neratinib due to diarrhoea within the first 3 mo of neratinib treatment, primarily within the first 2 mo of treatment. The diarrhoea-related neratinib discontinuation rate was lower in patients who received anti-diarrhoeal prophylaxis vs. those who did not (10% vs. 21%) and in those who started below vs. at 240 mg/day (12% vs. 15%). Any grade diarrhoea occurred in 88% of patients (20% Grade 3): 86% and 91% in the prophylaxis/non-prophylaxis groups respectively, and 82% vs. 91% in the below vs. at 240 mg/day group. No Grade 4 or 5 event was reported. Median time to first diarrhoea was within the first 7 days. Among patients receiving prophylaxis, the median cumulative duration of Grade ≥3 diarrhoea was 6.5 days versus 13 days without prophylaxis. Corrective treatment was used in 66% of patients. Treatment-emergent adverse events (TEAEs) other than diarrhoea were reported in 55% of patients, mostly Grade 1-2 gastrointestinal events. Three patients experienced serious TEAEs, including one diarrhoea event. Anti-diarrhoeal prophylaxis was associated with a reduction in the incidence of diarrhoea occurrence (any grade), rate of neratinib discontinuation, and duration of Grade ≥3 diarrhoea. The overall safety profile of neratinib was consistent with the EU SmPC. These real-world findings support the benefit of anti-diarrhoeal prophylaxis and the use of neratinib in HR+/HER2+ early breast cancer patients in the current treatment landscape. D. Baerens, A. Waqas, G. Dagmar, A. Jegannathen, T. Sarkodie, P. Seropian, V. Bjelic-Radisic, M. Elnaggar, P. Staib, B. Lex, N. Harbeck, C. Jackisch, M. Schmidt, J. Suissa, A. Zkik, O. Dialla, R. Bartsch. A real-world prospective observational multi-national study in adult patients with breast cancer treated with extended adjuvant neratinib: interim results from the NERLYFE study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-11-21.
Intracranial artery dissection (IADS) is an uncommon cause of acute ischemic stroke (AIS). In hyperacute settings, stenting is constrained by the need for intensive antiplatelet therapy. This study evaluated the antithrombogenic hydrophilic polymer–coated pEGASUS-HPC self-expanding stent for IADS-related AIS. This multicenter retrospective cohort study across seven stroke centers included consecutive patients with AIS and occlusion or severe flow-limiting stenosis caused by symptomatic IADS, who were treated with the pEGASUS-HPC. The outcomes were technical and angiographic success (device opening; mTICI score ≥2b when reperfusion was targeted), peri-procedural complications, mRS score, and follow-up patency. In 36 treated patients (mean age 62.0 ± 19.6 years; 63.9
Background The study investigated the acceptance of traditional Chinese medicine (TCM) in (pre-)obese people with the psychosocial atherogenic lipopathic metabolic syndrome (PSALMS) in German-speaking Europe, particularly in people with skeletal pain. Aim To Investigate the influence of pain on TCM preference in (pre-)obese people. Patients and methods A retrospective subgroup analysis of the BARBQTCM (Bariatric Basic Questionnaire for Traditional Chinese Medicine) cross-sectional study collected 496 anonymous questionnaires from the German SANA clinic in Offenbach. Two cohorts, with and without skeletal pain, were compared. Anthropometric data, the use of conventional and complementary therapies, and TCM acceptance for PSALMS complaints were recorded. In addition, the willingness to visit TCM outpatient clinics and to spend money on TCM was examined. Results The cohort consisted mainly of women (73.2%) and had a median age of 45 years and a median BMI of 43.1 kg/m(2). Almost all respondents used conservative (98.5%) and almost a third complementary (29.6%) weight-loss therapies. Two-fifths reported skeletal pain (39.7%). Acceptance of TCM therapies was significantly higher in the pain cohort than in the control group (all p < 0.001). The pain cohort was significantly more likely to visit a TCM outpatient clinic and spend more money on TCM (all p < 0.001). Experience with complementary medicine was the only positive influencing factor on TCM acceptance (RR: 2.84 [95% CI: 1.82-4.41]; p < 0.001). Conclusion TCM therapies can be integrated into multimodal treatment concepts if there is evidence-based proof of effectiveness for (pre-)obesity and skeletal pain, as acceptance in the affected cohort has been impressively demonstrated.
