With advances in surgical treatment for gastric cancer and improvements in long-term prognosis, increasing attention has been directed toward late nutritional complications. This retrospective study focused on body composition as an indicator of nutritional status, aiming to elucidate mid- to long-term changes following minimally invasive gastrectomy (MIG). A total of 102 3-year cancer survivors who underwent curative laparoscopic or robotic gastrectomy were included. Body composition indices, including subcutaneous fat, visceral fat, and skeletal muscle, were calculated using multidetector computed tomography images. All indices decreased relative to preoperative levels and remained lower during long-term postoperative follow-up. The reduction was more pronounced during the mid-term period. Although the body fat indices demonstrated a slight trend toward recovery, skeletal muscle showed persistently reduced levels in the long term. Multiple regression analysis revealed that only total gastrectomy (MITG) was identified as an independent predictor of reductions in all indices (all P < 0.01). When stratified by the extent of gastrectomy, the postoperative values of all indices were lower in the MITG group than in the distal gastrectomy group. To address late nutritional complications following MIG, particular attention should be paid to the mid-postoperative period, when nutritional status reaches its lowest point, as well as to patients undergoing MITG.
Fasting-mimicking diet (FMD) exerts antitumor effects in multiple cancer types, but the role of neural regulation remains unclear. Here, we investigated the involvement of peripheral and central nervous systems in FMD-mediated suppression of colorectal cancer using a murine MC38 tumor model. Cyclic FMD treatment significantly inhibited tumor growth. Three-dimensional imaging revealed abundant neural fibers within colorectal tumor tissues. To assess the contribution of distinct neural pathways, enteric denervation, vagotomy, sympathetic denervation, and sensory nerve ablation were performed. Enteric denervation markedly attenuated the antitumor effect of FMD, whereas vagal, sympathetic, and sensory denervation had limited impact. In addition, c-Fos immunofluorescence demonstrated region-specific central neural responses to FMD, including increased neuronal activation in the arcuate nucleus and insular cortex and altered activity in the rostral ventrolateral medulla. These findings suggest that neural signaling contributes to the antitumor effects of FMD and implicate enteric nerves in this response. Our study highlights the potential involvement of both peripheral and central neural pathways in the regulation of colorectal cancer progression during dietary intervention.
Purpose: Acute Myeloid Leukemia (AML) is a highly aggressive hematological malignancy driven by mutations in early hematopoietic cells, leading to uncontrolled myeloid cell proliferation. The development of efficacious and less toxic therapies remains a critical challenge.Methods: Herein, we evaluated the anti-leukemic potential of a 70% tocotrienol-enriched fraction (TEF), a vitamin E isoform, using different AML models.Results: TEF demonstrated selective cytotoxicity against AML cells, evidenced by low IC50 values and significant induction of apoptosis in AML cell lines and primary AML patient samples, with minimal impact on nonmalignant cells. Mechanistic studies revealed that the TEF treatment disrupted mitochondrial function, leading to reduced mitochondrial membrane potential and ROS generation in AML cells. This triggered the intrinsic apoptotic pathway, as indicated by decreased BCL2 and increased active caspase-3 levels. In a 3D bone marrow niche co-culture system, the treatment with TEF effectively diminished AML cell populations (OCI-AML3 and primary AML cells) while preserving mesenchymal stromal cells and endothelial cells. Importantly, administration of TEF reduced AML burden in leukemic mice.Conclusions: These comprehensive results suggest that the 70% tocotrienol-enriched fraction holds significant promise as a selective anti-neoplastic agent for AML, capable of targeting leukemic cells even within the protective bone marrow microenvironment.
Women with breast cancer experience body composition and dietary changes, which may lead to reduced muscle strength (MS) and muscle mass. This study aimed to analyze the relationship between MS and dietary protein intake in this population. A cross-sectional study was conducted with women aged over 20 years diagnosed within ≤12 months. Sociodemographic, behavioral, clinical, and anthropometric data were collected. MS was assessed based on handgrip strength. Food intake was estimated using a food frequency questionnaire. Adjusted binary logistic regression was performed (p < 0.05). The sample comprised 149 women (mean age: 55.6 ± 11.2 years). Most participants self-identified as black or brown (67.1%), had invasive lobular carcinoma (66.4%), and were overweight (35.6%), while 28.2% exhibited low grip strength. The group with low MS had higher intakes of carbohydrates, plant protein, and magnesium as well as lower intakes of total fat, total protein, and animal protein (p < 0.05 for all). Each additional gram/day of animal protein was associated with a 7% reduction in the likelihood of having low muscle strength (β = -0.042; OR = 0.93; 95% CI: 0.921-0.977; p = 0.035). Animal protein intake was inversely associated with low muscle strength in women with breast cancer.
Although anamorelin improves appetite and body composition in cancer cachexia, early discontinuation is common. We aimed to evaluate predictors of 12-week treatment completion and longitudinal changes among patients who completed treatment. This single-center, retrospective study included patients with advanced gastrointestinal cancer who received anamorelin for cachexia (July 2021-March 2025). Baseline factors were compared between continuation and discontinuation groups, and predictors were assessed using multivariable logistic regression. Of 89 eligible patients, 36 (40.4%) completed 12 wk of treatment. In multivariable analyses, Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥1 (OR, 0.39; 95% CI, 0.15-0.98; p = 0.048) and neutrophil-to-lymphocyte ratio (NLR) ≥3.0 (OR, 0.35; 95% CI, 0.12-0.95; p = 0.047) were associated with lower treatment completion. In another model, NLR ≥3.0 remained significantly associated with lower treatment completion, while concurrent systemic anticancer therapy at anamorelin initiation showed a nonsignificant association with treatment completion (OR, 4.42; 95% CI, 0.92-43.07; p = 0.064). In the continuation group, nutritional status, body composition, handgrip strength, and anorexia-related symptoms improved, whereas NLR increased. Impaired ECOG PS and elevated NLR were associated with failure to complete 12-week anamorelin treatment. Earlier initiation of anamorelin before performance status declines and systemic inflammation progresses may support treatment completion.
Weight loss is a common symptom in patients with esophageal cancer and can negatively impact survival outcomes. This meta-analysis aimed to systematically evaluate the relationship between weight loss and survival outcomes in individuals diagnosed with esophageal cancer. We conducted a comprehensive search of PubMed, Embase, and Web of Science for studies reporting the association between weight loss and overall survival or progression-free survival in patients with esophageal cancer. Pooled adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using a random-effects model. Eleven studies involving 3,566 esophageal cancer patients were included. The pooled results indicated that weight loss was significantly associated with poorer overall survival (HR 1.68; 95% CI 1.49-1.90) and progression-free survival (HR 1.61; 95% CI 1.39-1.86). Subgroup analyses revealed a numerically higher HR for overall survival in patients aged 60 years or younger, those assessed for weight loss during treatment, patients with a follow-up duration exceeding 36 months, and individuals diagnosed with squamous cell carcinoma. Weight loss was significantly associated with poorer overall survival in patients with esophageal cancer. Regarding progression-free survival, a preliminary pooled analysis based on only two studies suggested a potential association; however, this finding requires confirmation in future research.
In gastric cancer (GC) patients, malnutrition is associated with a worse prognosis. Decreases in body mass index (BMI) can reflect malnutrition. Here, we determined whether preoperative time-dependent changes (Δ/day) in BMI provide better prognostic insights than single point-in-time measurements of BMI. A single-center retrospective analysis of 140 GC patients was performed. BMI was measured at both the initial surgical visit and then again at the time of hospitalization for surgery. ΔBMI/day was determined. Associations with time to surgery, intraoperative blood loss, tumor stage, and survival were determined. ΔBMI/day was strongly associated with time to surgery (P = 0.001), magnitude of intraoperative blood loss, tumor stage, progression-free survival (PFS), and overall survival (OS) (all Ps <0.001). In multivariable Cox analyses adjusted for age, sex, Eastern Cooperative Oncology Group Performance Status, pathological stage, surgical approach, blood loss, time-to-surgery, and static BMI measurements, large ΔBMI/day was associated with worse PFS (hazard ratio 2.81, 95% confidence interval 1.07-7.42, P = 0.037) whereas static measurements of BMI at the time of the initial visit or surgery were not independently associated with PFS. ΔBMI/day was not independently associated with OS. In conclusion, preoperative changes in BMI/day provide better prognostic insights, particularly for PFS, compared to measurements of BMI at a single point in time.
Background: Liver regeneration is essential after hepatectomy, but it is frequently impaired in patients with hepatocellular carcinoma (HCC) due to cirrhosis, metabolic dysfunction, sarcopenia, malnutrition, aging, and systemic inflammation. Post-hepatectomy liver failure remains a major clinical challenge. Objective: This review summarizes metabolic mechanisms underlying liver regeneration and explores metabolic vulnerabilities in patients with HCC, along with emerging therapeutic strategies to enhance regenerative capacity. Methods: A narrative review of current literature was conducted focusing on hepatic regenerative biology, metabolic reprogramming, and clinical metabolic interventions relevant to perioperative liver care. Results: Liver regeneration is regulated not only by growth factor signaling but also by coordinated metabolic reprogramming, including energy metabolism, lipid oxidation, amino acid homeostasis, mitochondrial function, and inter-organ crosstalk. Patients with HCC often exhibit impaired regenerative metabolism. Emerging interventions include nutritional optimization, branched-chain amino acid supplementation, L-carnitine administration, exercise-based prehabilitation, and modulation of the gut-liver axis. L-carnitine is highlighted as a mitochondrial modulator with potential benefits for hepatic function and muscle preservation. Conclusion: Targeting metabolic pathways represents a promising strategy to enhance liver regeneration. Integrating metabolic biomarkers and personalized interventions may improve perioperative outcomes in HCC patients undergoing hepatectomy.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for acute leukemia; however, the first year after transplantation is associated with an increased risk of morbidity and mortality. This study aimed to evaluate changes in nutritional intake and body composition during the first 100 days following allo-HSCT and to examine their associations with one-year all-cause mortality. In this single-center prospective study, 152 adults scheduled to undergo allo-HSCT were assessed at baseline and on days +30 and +100 after transplantation. Assessments included anthropometric and body-composition measurements, dietary intake evaluation, and nutritional risk screening using the Nutritional Risk Screening 2002 (NRS-2002) tool. The prevalence of nutritional risk increased from 8.6% at baseline to 69.1% on day +30. In the primary analysis, a greater decline in fat-free mass (FFM) was associated with an increased risk of death within one year after transplantation (adjusted HR = 1.04 per 1-kg loss). However, this association was no longer observed in the landmark sensitivity analysis. During the first 100 days following allo-HSCT, nutritional status and body composition deteriorated markedly. A greater decline in FFM was associated with higher one-year mortality in the primary analysis; however, this association was attenuated and was no longer statistically significant in the landmark sensitivity analysis.
Background:Juvenile myelomonocytic leukemia (JMML) rarely manifests with extramedullary involvement beyond spleen, liver, or skin; testicular infiltration at diagnosis is unreported. We describe a Novel Case of bilateral testicular leukemic infiltration as the initial presentation of NRAS-mutant JMML in a toddler, with rapid remission following azacitidine bridging and haploidentical HSCT. Case presentation:A 2-year-old boy presented with pallor, abdominal distension, and bilateral scrotal swelling. Labs: leukocytosis (58 × 10⁹/L, monocytes 12.8 × 10⁹/L), anemia (Hb 8.2 g/dL), HbF 22%. BM confirmed JMML with NRAS p.G12D (VAF 42%). No pathogenic variants were detected in KRAS, PTPN11, CBL, or NF1. Conventional cytogenetic analysis demonstrated a normal male karyotype (46,XY). US: testes enlarged (18.8/18.2 mL) with hypoechoic infiltration. Azacitidine (75 mg/m²/d × 5, 2 cycles) reduced counts and size. Paternal haplo-HSCT (Flu-Treo-TT conditioning, PTCy) engrafted D + 18; testes normal at 6 weeks, molecular remission (NRAS-) at 3 months. Conclusions:This novel case underscores the efficacy of azacitidine and haploidentical HSCT for NRAS-mutant JMML with testicular involvement. Routine genital examination and ultrasound are recommended for male patients.
BACKGROUND:Sarcopenia is increasingly recognized as a prognostic factor in oncology; however, most studies have focused on static baseline muscle mass in heterogeneous populations. Whether dynamic skeletal muscle loss during systemic therapy carries independent prognostic value, particularly in clinically stable patients with controlled disease, remains unclear. We investigated the prognostic relevance of three-dimensional volumetric muscle assessment in advanced urothelial carcinoma (UC) patients who achieved disease control with first-line platinum-based chemotherapy and subsequently received maintenance therapy. METHODS:This multicenter retrospective study included 82 patients with unresectable or metastatic UC across 10 institutions. Psoas muscle volume (PMV) was quantified using three-dimensional computed tomography (CT) reconstruction. The relative percentage change in PMV during induction chemotherapy (ΔPMV) was calculated as: (PMV at pre-maintenance - PMV at baseline)/PMV at baseline × 100. A predefined PMV loss ≥ 5% (defined as ΔPMV ≤ -5%) was considered clinically significant. Baseline cross-sectional muscle indices, including skeletal muscle index (SMI), total psoas index (TPI), and paraspinal muscle index (PMI), as well as inflammatory and nutritional markers, were evaluated. Overall survival (OS) was analyzed using multivariable Cox regression. RESULTS:During a median follow-up of 19 months, 35 deaths occurred. Baseline cross-sectional muscle indices (SMI, TPI, and PMI) were not associated with OS. In contrast, patients with PMV loss ≥ 5% (ΔPMV ≤ -5%) had significantly shorter OS. In multivariable analysis adjusting for clinical, inflammatory, and nutritional factors, PMV loss ≥ 5% remained independently associated with worse OS (HR 2.14, 95% CI 1.02-4.50, p = 0.044). Dynamic volumetric muscle decline may reflect clinically meaningful physiologic vulnerability despite tumor control. CONCLUSIONS:Dynamic loss of PMV during systemic therapy is a strong independent prognostic marker in advanced UC patients with controlled disease, whereas static baseline muscle indices lack prognostic significance. These findings highlight the clinical importance of preserving skeletal muscle mass during systemic therapy and support further investigation of targeted nutritional or supportive interventions.
Blinatumomab, a CD3/CD19 bispecific T-cell engager, improves outcomes in adult B-cell acute lymphoblastic leukemia (B-ALL), but CD19-negative relapse is an important mode of treatment failure. We report a 69-year-old woman with Philadelphia chromosome-negative B-ALL who achieved hematological complete remission after hyper-CVAD induction therapy but remained measurable residual disease (MRD)-positive. Blinatumomab was administered after one cycle of high-dose methotrexate/cytarabine, resulting in MRD negativity after one cycle. However, blinatumomab was discontinued after one cycle at the patient's request, and hematological relapse occurred three months after MRD conversion. Relapsed blasts showed selective loss of CD19 expression, whereas cytoplasmic CD22 expression was retained. G-banding showed an apparent cytogenetic shift from a diagnostic hyperdiploid abnormal karyotype to a normal karyotype at first relapse. Inotuzumab ozogamicin induced a second hematological remission with MRD negativity, although disease control was not durable. This case highlights the importance of repeat immunophenotypic and cytogenetic assessment at relapse after blinatumomab treatment.
Breast cancer remains a major global health challenge, and increasing evidence suggests that high red meat intake may contribute to its burden. However, the magnitude and long-term trends of red meat-attributable breast cancer across major economies remain unclear. This study quantified the breast cancer burden attributable to high red meat intake from 1990 to 2021 and projected trends to 2040 across G20 countries using Global Burden of Disease (GBD) 2021 data. Using GBD 2021 estimates, we assessed red meat-attributable breast cancer burden based on the Comparative Risk Assessment (CRA) framework. Temporal trends were evaluated using estimated annual percentage change (EAPC), and age-period-cohort (APC) and Bayesian APC (BAPC) models were applied to identify cohort patterns and generate projections through 2040. We found a substantial global increase in age-standardized incidence (ASIR), rising from 3.9 to 6.7 per 100,000 between 1990 and 2021. The United States, China, and Japan together contributed nearly 45% of G20-attributable Disability-Adjusted Life Years (DALYs). Trends varied markedly by development level: high Socio-demographic Index (SDI) countries showed declining or stable burdens, whereas low- and middle-SDI countries experienced pronounced increases. Younger cohorts (particularly ages 30-49) exhibited the highest APC-derived risks, indicating a shift toward earlier-onset burden. BAPC projections suggest that red meat-attributable DALYs will continue to rise and may increase by approximately 30%-50% by 2040 if no further interventions are implemented. High red meat intake is a significant and growing contributor to breast cancer burden, with particularly rapid increases in low- and middle-SDI settings and among younger cohorts. Strengthening dietary risk reduction strategies and targeted prevention efforts in G20 countries is essential to mitigate the projected rise in burden over the coming decades.
CD19 directed immunotherapy with monoclonal antibodies and chimeric antigen receptor T (CAR-T) cell therapy has shown treatment efficacy in the relapsed/refractory setting for non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL). However, the CD19 directed bispecific T-cell engager, blinatumomab, is currently only approved in B-cell acute lymphoblastic leukemia (ALL) and has largely not been investigated in other clinical contexts for CLL. We report a case of a patient who presented with both Philadelphia chromosome positive (pH+) ALL and CLL who achieved measurable residual disease (MRD) negative remission for both diseases with blinatumomab.
Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is rare and presents major diagnostic and therapeutic challenges. We report the case of a man in his late 40s with small lymphocytic leukemia, initially managed conservatively, who presented after four years with progressive left facial numbness, diplopia, and left oculomotor nerve palsy without B symptoms or raised intracranial pressure. He had high-risk disease biology with TP53 mutation and unmutated IGHV status. Positron emission tomography-computed tomography showed mildly FDG-avid systemic lymphadenopathy but intensely avid thickened spinal nerve roots, while magnetic resonance imaging demonstrated enhancement of the bilateral oculomotor nerves, left optic nerve, and extradural tissue at the cervical level. Cerebrospinal fluid analysis showed elevated protein and 34% abnormal B-lymphoid cells with a CLL phenotype. Biopsy of the involved nerve/root tissue confirmed direct CNS and nerve-root infiltration by CLL rather than Richter transformation. The patient was treated with acalabrutinib, venetoclax, obinutuzumab, and intrathecal chemotherapy. He showed rapid neurological improvement, with early symptom resolution, progressive cerebrospinal fluid clearance, and near-complete radiologic response, followed by complete metabolic response on follow-up PET-CT. This case highlights that CNS involvement may occur even in treatment-naïve or early-stage CLL and may not correlate with systemic disease burden. It also supports the clinical activity of novel triplet CNS-penetrant targeted agents, in achieving durable remission in rare CNS manifestations of high-risk CLL.
The associations between dietary factors, whole and refined grains, and colorectal cancer (CRC) remain unclear, particularly in Middle Eastern populations. This multicenter, population-based case-control study assessed the associations between whole and refined grain intake and CRC risk in adults across three provinces in Iran. A total of 402 CRC patients and 825 controls were included. CRC was confirmed by colonoscopy, and dietary intake was assessed using a validated food-frequency questionnaire. Individuals in the highest tertile of whole-grain consumption had a 52% lower risk of CRC compared with those in the lowest tertile (OR: 0.48; 95% CI: 0.32-0.74), whereas individuals in the highest tertile of refined grain intake had 2.62 times higher odds of CRC (OR: 2.62; 95% CI: 1.62-4.24). Dose-response analyses indicated a non-linear inverse association for whole grains, with the greatest risk reduction observed between 50 and 100 g/day. Substitution analyses showed that replacing refined grains with whole grains was associated with a modest reduction in CRC risk (OR: 0.91; 95% CI: 0.85-0.97). These findings suggest that higher whole-grain intake significantly reduces CRC risk, whereas refined-grain consumption substantially increases it, supporting dietary strategies that promote whole-grain intake for CRC prevention.
Indicators of a poorer food environment, such as low food environment index scores, food deserts, and food swamps, have been linked to increased mortality and decreased survival among colorectal cancer (CRC) cases. This retrospective study of 47,807 primary CRC cases from the Kentucky Cancer Registry (KCR) database diagnosed between January 1995 and December 2021 used Cox-proportional-hazard (Cox-PH) regression models to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for CRC-specific mortality and all-cause mortality associated with residential fast-food exposures. Residential fast-food exposures were not associated with CRC-specific mortality. However, residing within 0.5-mile of a fast-food outlet was associated with a 7% higher hazard of all-cause mortality (aHR: 1.07; 95% CI: 1.02-1.11; P-for trend: 0.001) compared with those living more than 3 miles away. Similar associations for all-cause mortality were observed for higher fast-food coverage (aHR: 1.05; 95% CI: 1.02-1.07; P-value: 0.001) and fast-food density (aHR: 1.05; 95% CI: 1.02-1.07; P-value: 0.001) within a mile radius. Residential fast-food exposures, such as closer proximity, higher fast-food coverage and greater fast-food density, may contribute to a modest increase in all-cause mortality among individuals diagnosed with CRC. These findings underscore the potential role of neighborhood food environments in the survival of CRC patients.
Hodgkin's lymphoma is a malignancy of lymphoid tissue with a generally favorable prognosis; however, symptomatic initial presentation with pericardial involvement is rare and presents significant diagnostic and therapeutic challenges. We report the case of a previously healthy 17-year-old male who presented with a four-month history of progressive cough and exertional dyspnea, along with a newly noticed right supraclavicular mass, without systemic B symptoms. Transthoracic echocardiography demonstrated a mild pericardial effusion, and subsequent PET-CT imaging revealed findings consistent with advanced disease. An excisional biopsy of the lymph node confirmed the diagnosis of nodular sclerosis classical Hodgkin lymphoma, and the patient was staged as Stage IV due to both pulmonary and pericardial involvement. Initial cytoreductive treatment with COP (Cyclophosphamide, Vincristine, Prednisone) was administered, followed by standard ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) chemotherapy. This case illustrates the importance of including lymphoproliferative disorders in the differential diagnosis of pericardial effusion. Furthermore, it emphasizes the importance of early imaging, histopathological confirmation, and a multidisciplinary approach in guiding appropriate treatment strategies. As this can help prevent severe complications and enhance the patient's prognosis.
Managing acute leukemia during pregnancy poses clinical challenges requiring a balance between maternal treatment and fetal preservation. From 2019 to 2024, 22 pregnant women were diagnosed with acute leukemia, including 7 acute lymphoblastic leukemia, 15 cases of acute myeloid leukemia, of which 1 was acute promyelocytic leukemia. Diagnosis occurred in the first, second, and third trimesters in 5, 10, and 7 patients, respectively. Nine patients elected pregnancy termination, one had a spontaneous abortion, one had intrauterine fetal demise, and three experienced concurrent maternal and fetal death. Eight patients delivered via elective cesarean section, including one twin pregnancy, resulting in 9 live births. Four neonates (including one twin pregnancy) were exposed to in utero chemotherapy, with no observed congenital anomalies. Chemotherapy was administered to 11 patients, including 3 during pregnancy, all achieving temporary disease control. These findings provide real-world data to inform the management of acute leukemia during pregnancy.
