Radical cystectomy (RC) is the standard care for muscle-invasive or very high-risk non-muscle-invasive bladder cancer (BC), but optimal management for bladder preservation remains uncertain. In this multicentre, open-label, phase 2 trial, patients with cT1-3 N0 M0 muscle-invasive BC received radiation therapy (RT; 41.4 Gy to the small pelvis and 16.2 Gy to the whole bladder) and atezolizumab (1200 mg) every 3 wk. The primary endpoint was progression-free survival (PFS) at 3 yr. Key secondary endpoints included the clinical complete response (cCR) rate at 24 wk, overall survival (OS), and the bladder-intact recurrence-free rate (BIRFR). From 2019 to 2021, 41 of the 45 patients enrolled received treatment. The median age was 71 yr and most patients (73%) had T2 tumours. At 24 wk, 84% achieved cCR. The 3-yr PFS rate was 70% (95% confidence interval [CI] 54-81%), with the lower limit of the 95% CI exceeding the prespecified threshold of 45%. The 3-yr OS rate was 91% and the 3-yr BIRFR was 89%. Grade ≥3 adverse events occurred in 55% of patients, but no treatment-related deaths were observed. Limitations include the single-arm design and cohort size. Bladder preservation therapy with atezolizumab and RT showed favourable treatment effects with manageable toxicity for patients unfit for or refusing RC.

Objective: To evaluate the progression of systemic atrioventricular valve regurgitation (sAVVR) after the insertion of a systemic-to-pulmonary artery (SP) shunt. Methods: This multicenter, retrospective study (2009-2024) enrolled patients undergoing primary SP shunt and divided them into biventricular (BiV) and univentricular (UniV) groups. The primary outcome was the change in sAVVR grade between preoperative and second-stage repair. Secondary outcomes included changes in systemic atrioventricular valve annulus diameter (sAVVD), systemic ventricular diastolic diameter (sVDd), and bilateral pulmonary artery (PA) sizes. Subgroup analyses were performed for UniV by the presence of common atrioventricular valve and ventricle morphology. Results: Eighty-six patients in the BiV group and 105 patients in the UniV were included. Progression of sAVVR in both cohorts was observed (P < .05). Moderate or severe sAVVR developed more in UniV (BiV: from 0% to 4.7% vs UniV: from 8.1% to 21.9%, P < .05) with more sAVV intervention (BiV 1.2% vs UniV 16.2%, P < .05). The BiV group showed increased sAVVD, sVDd, and PA sizes (P < .05). In UniV, sAVVD and PA sizes increased, but sVDd change was not significant (P = .058). Among UniV, preoperative mild or greater sAVVR was more common in patients with common atrioventricular valve ((72.7%) or a dominant right ventricle (70.7%). Multivariable logistic regression identified heterotaxy as a risk factor for sAVVR progression (odds ratio, 1.42; 95% CI, 1.20-1.69; P < .05), with greater sAVVD and sVDd enlargement in patients with heterotaxy. Conclusions: SP was associated with sAVVR progression in both BiV and UniV; however, clinically significant sAVVR was uncommon in BiV. Heterotaxy independently predicted sAVVR progression, likely due to greater AV valve and ventricular dilatation.

BACKGROUND:Several studies have suggested that naldemedine may reduce opioid-induced constipation (OIC) as well as opioid-induced nausea and vomiting (OINV). This study aimed to investigate prophylactic effects of naldemedine on OINV in patients initiating regular, oral, strong opioids for cancer pain. METHODS:In this preplanned secondary analysis of a multicenter, double-blind, randomized, placebo-controlled trial investigating the preventive effects of naldemedine on OIC, eligible patients were randomized in a 1:1 ratio to receive either naldemedine 0.2 mg or placebo once daily for 14 days. The primary endpoint was the complete response (CR) rate, defined as the proportion of patients with no vomiting episodes and no use of rescue antiemetics within the first three days of opioid initiation. The secondary endpoint was the nausea and vomiting score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL). RESULTS:Of the 103 patients, 48 and 47 patients in each group started protocol treatment, respectively. The CR rate was significantly higher in the naldemedine group than in the placebo group (81.3% vs 38.3%, P < .001). Nausea and vomiting scores on the QLQ-C15-PAL at weeks 1 and 2 were significantly better in the naldemedine group (means 7.1 and 6.4) versus placebo (means 44.6 and 35.3; both P < .001). Within the total effect of naldemedine on the QLQ-C15-PAL nausea and vomiting scores at week 2, the proportion mediated through OIC reduction was 21.9%. CONCLUSIONS:Naldemedine may have intrinsic antiemetic potency to prevent both OIC and OINV. TRIAL REGISTRATION:https://jrct.niph.go.jp/ (Japan Registry of Clinical Trials) Identifier: jRCTs031200397.

Intravesical Bacillus Calmette-Guerin (BCG) administration is the most effective immunotherapy for bladder cancer, but live BCG bacteria may cause serious adverse events and are limited to local administration. Here, we report the formulation of a less toxic treatment using trehalose 6,6′-dimycolate (TDM), a predominant BCG cell wall glycolipid, that activates innate immunity and carries an adjuvant effect. We previously established hydrophilic cationic liposomes incorporating TDM (Lip-TDM) and found that local administration of Lip-TDM exerts antitumor effects on subcutaneously inoculated tumors by inducing CD8+ T cell activation via dendritic cell maturation. Here, we further demonstrate that intraperitoneal administration of Lip-TDM exerts antitumor effects in an N-butyl-N-(4-hydroxybutyl) nitrosamine-induced, orthotopic bladder carcinogenesis mouse model. The incidence of bladder cancer in the Lip-TDM treated group was significantly lower compared to the Lip-CON treated group (60.8

Nanomedicine has advanced rapidly as engineered nanoparticles have become increasingly capable of improving drug stability, targeting, controlled release, and biocompatibility. However, nanoparticle clinical utility relies on both delivery efficiency and how they are metabolized, retained, and cleared. This review examines the major biological pathways governing nanoparticle clearance and discusses how engineering parameters can be tuned to influence bioaccumulation, metabolism, excretion, and therapeutic performance with a wide range of available materials. This article is a narrative review of the recent and foundational literature on medically relevant nanoparticles, including lipid-based, polymeric, biopolymer, inorganic, polylactide, and bile-derived systems. All relevant translational, biochemical, chemical, and clinical literature from PubMed was searched from January 1971 to January 2026 to obtain a representative sample of work before information extraction. Nanoparticle clearance is governed by interconnected molecular and organ-level processes that vary according to composition, size, surface chemistry, and route of administration. Surface modifications with PEGylation, zwitterionic coatings, cholesterol, proteins, or responsive linkers can prolong circulation, alter immune recognition, and direct organ-specific handling. While rapid clearance remains desirable for many systemically acting drugs, prolonged intracellular or intratumoral retention may improve outcomes, particularly in boron neutron capture therapy and other activation-dependent treatments. Nanoparticle clearance should be regarded as a context-dependent design parameter rather than a universal limitation. Rational control of clearance kinetics may improve both safety and therapeutic effectiveness in next-generation engineered drug delivery systems.

Background Combination immunotherapy is widely used as first-line treatment for metastatic renal cell carcinoma (mRCC), but pretreatment prognostic stratification remains insufficiently established.Aims To evaluate the performance of various prognostic scores in the first-line treatment of metastatic renal cell carcinoma (mRCC) with combination immunotherapy.Methods and Results We retrospectively analyzed 145 patients who started first-line combination immunotherapy at six institutions from December 2015 to February 2025. We calculated IMDC, LIPI, RMH, PMHI, GRIm, C-PLAN, mGPS, and Meet-URO scores and performed survival (PFS, OS) and ROC analyses (PD, ORR). Survival analyses also evaluated the prognostic ability of each score by concordance index. At a median follow-up period of 28.8 months, the median progression-free survival (PFS) was 35.1 months and the median overall survival (OS) was not reached. Kaplan-Meier analysis showed significant differences for all scores except between IMDC and C-PLAN (PFS) and IMDC and mGPS (OS). Among these, PMHI and RMH demonstrated superior results in the C-index. ROC analysis showed no score had prognostic value for PD or ORR.Conclusion PMHI and RMH may be useful prognostic scores for survival outcomes in mRCC patients treated with immunotherapy. However, their ability to predict treatment efficacy (ORR and PD) is limited and further research is needed.

Abstract Pretreatment immune profiles associated with immune-related adverse events (irAEs) may inform individualized management strategies, including enhanced monitoring and early toxicity intervention, in patients with metastatic renal cell carcinoma (mRCC) treated with nivolumab plus ipilimumab. In this cohort (n = 51), we analyzed pretreatment peripheral blood parameters and whole-blood transcriptomic profiles. Higher lymphocyte and monocyte counts (odds ratios [ORs] 14.36 and 9.90, respectively) were significantly associated with an increased risk of irAEs, whereas higher neutrophil counts and C-reactive protein levels (ORs 0.08 and 0.27, respectively) were associated with a decreased risk. To characterize immune pathways associated with irAE development, we performed whole-blood transcriptomic analyses. Gene set enrichment analysis revealed upregulation of lymphocyte- and humoral immunity-related pathways and downregulation of neutrophil- and inflammatory-related pathways in patients who developed irAEs. CIBERSORTx demonstrated reduced neutrophil fractions and increased proportions of CD8⁺ T cells and activated memory CD4⁺ T cells, indicating an adaptive immune-dominant profile. Exploratory analysis identified five candidate genes (ANAPC1, CDK4, MCM6, GRAP2, and BST2) that may contribute to the immune features associated with irAE development. Collectively, these findings suggest that irAE development is associated with a distinct systemic immune profile characterized by enhanced lymphocyte-related and reduced neutrophil-related immune activity.

Background:Dense spontaneous echo contrast (SEC) and sludge in the left atrial appendage (LAA) complicate differentiation between sludge and thrombi during transoesophageal echocardiography (TOE). We prospectively evaluated the feasibility, safety, and efficacy of dobutamine to reduce sludge and improve thrombus detection in patients with atrial fibrillation (AF). Methods and results:This was an open-label, single-arm, single-center clinical study. A total of 20 patients with LAA sludge on TOE received intravenous dobutamine infusion, starting at 5 μg/kg/min and increasing to 10 and 20 μg/kg/min at 3-min intervals until sludge resolution. SEC grade and thrombus presence were reassessed at the maximum dose. All patients had LAA sludge at baseline, which improved to SEC grade 2 in 5% of patients, grade 1 in 75%, and completely resolved in 20%. Peak dobutamine doses were 5 μg/kg/min in one patient, 10 μg/kg/min in six patients, and 20 μg/kg/min in 13 patients. Dobutamine significantly increased LAA emptying velocity (median: 13.8 to 18.7 cm/s, P < 0.001), emptying fraction (12.8% to 28.9%, P < 0.001), medial and lateral LAA wall velocities (6.6 to 8.4 cm/s, P = 0.012; 5.8 to 7.3 cm/s, P = 0.007, respectively), and left ventricular (LV) ejection fraction (51.8% to 60.0%, P < 0.001). Median heart rate increased from 78 to 89 bpm, while median systolic blood pressure briefly dropped from 116 to 105 mmHg before recovering to 123 mmHg three minutes post-infusion. No severe adverse events or hemodynamic instability occurred. Conclusion:By enhancing LAA and LV function, dobutamine infusion during TOE reduces sludge and facilitates LAA thrombus exclusion in patients with AF.

Clear cell renal cell carcinoma (ccRCC) frequently exhibits dysregulated lipid metabolism yet the contribution of polyunsaturated fatty acid (PUFA) elongation to malignant phenotypes remains incompletely defined. Because PUFA-elongation enzymes ELOVL2 and ELOVL5 are highly expressed in ccRCC, we investigated the clinical and functional significance of their co-overexpression. Using TCGA-KIRC data and clinical ccRCC specimens, we assessed ELOVL2/ELOVL5 expression and associations with clinicopathological features and survival. Functional studies using siRNA-mediated knockdown in renal cancer cell lines demonstrated that dual knockdown markedly suppressed proliferation, invasion, and invadopodia formation. Transcriptomic profiling and pathway analyses indicated that dual knockdown downregulated actin filament-related processes and identified LIMK1 as a candidate mediator. LIMK1 knockdown phenocopied the effects on proliferation, invasion, and invadopodia. These findings link PUFA-elongation programs to LIMK1-associated cytoskeletal remodeling in ccRCC and suggest that the ELOVL2/ELOVL5-LIMK1 axis may represent a therapeutic vulnerability.

Clear cell renal cell carcinoma (ccRCC) exhibits unique metabolic reprogramming characterized by disrupted iron homeostasis, primarily due to inactivation of the von Hippel-Lindau (VHL) tumor suppressor gene. This iron dysregulation creates a therapeutic opportunity through ferroptosis, an iron-dependent form of regulated cell death. However, the specific mechanisms enabling ccRCC cells to evade ferroptosis in high-iron microenvironments remain poorly understood, limiting targeted therapy development. In this study, we identified DANGER (inositol 1,4,5-trisphosphate receptor interacting protein, ITPRIP) as an oncoprotein specifically overexpressed in ccRCC. DANGER establishes a cytoprotective axis by promoting nuclear factor erythroid 2-related factor 2 (NRF2) nuclear translocation, leading to ferritin heavy chain 1 (FTH1) upregulation. The DANGER/NRF2/FTH1 signaling cascade enhances iron storage, reduces cytotoxic labile iron pools, and suppresses lethal lipid peroxidation, conferring robust ferroptosis resistance. Under high-iron stress, ccRCC cells collectively upregulate the pro-ferroptotic enzyme 5-lipoxygenase (ALOX5) alongside this protective axis, creating a ferroptosis pre-conditioning state that elevates the ferroptosis initiation threshold. Translationally, we discovered that deferasirox (DFX), a clinically approved iron chelator, functions as a direct DANGER inhibitor that disrupts this protective axis, resensitizes cells to ferroptosis, and suppresses tumor proliferation and migration. This work establishes DANGER-mediated iron homeostasis as a core mechanism of ferroptosis resistance in ccRCC and validates DFX as a mechanistically grounded therapeutic strategy.

BACKGROUND/AIM:Balloon-occluded infusion of fragmented gelatin particles of transarterial embolization (BOIG-TAE) is a chemotherapy-free technique combining selective balloon occlusion with gelatin particle embolization. PATIENTS AND METHODS:This prospective, single-arm study (June 2022-June 2025) enrolled patients with hypervascular hepatic metastases refractory or intolerant to standard systemic therapy, with safety as the primary endpoint and preliminary efficacy and hepatic function as secondary endpoints. Adverse events were evaluated using Society of Interventional Radiology (SIR) criteria. Tumor response was independently assessed two months after treatment using modified Response Evaluation Criteria in Solid Tumors (mRECIST) and hepatic function was monitored using Child-Pugh and albumin-bilirubin (ALBI) scores. RESULTS:Six patients were enrolled (median age, 77 years; 4 male patients). One patient experienced transient abdominal pain lasting one week (SIR grade C); no other major complications occurred. Transient elevations in aspartate aminotransferase and alanine aminotransferase occurred in all patients and resolved within one month. No biliary or renal complications were recorded. The objective response rate at two months was 66.7% (4/6) and Child-Pugh and ALBI scores remained stable during follow-up. CONCLUSION:BOIG-TAE may be feasible and generally well tolerated in selected patients, with potential for short-term tumor control while preserving hepatic function.

PURPOSE:Bladder preservation therapy in combination with atezolizumab and radiation therapy trial, which was a multicenter, open-label, single-arm phase 2 study, showed a promisingly high interim clinical complete response (cCR) rate of 84.4% (38/45). In the present study, we aimed to identify potential tissue biomarkers for achieving cCR using bladder preservation therapy in combination with atezolizumab and radiation therapy. METHODS AND MATERIALS:We used tumor tissue samples of the bladder and blood samples collected from patients at baseline to analyze the tumor immune microenvironment at baseline using an integrated approach of immunophenotyping, genomic, and tumor-infiltrating lymphocyte (TIL) profiling. RESULTS:Immune phenotype analysis revealed that cCR rates of patients with the desert phenotype were as similarly high as patients with excluded/inflamed phenotypes (73.3% [11/15] vs 93.3% [14/15], P = .33) despite lower programmed death-ligand 1 expression levels in the desert phenotype. Genomic and TIL profiling then revealed that increased CD8+ and CD204+ TIL infiltration, high CD8:forkhead box protein P3 ratios in the stroma of the excluded/inflamed phenotypes, and gene alterations, such as CDK12, GNAS, NOTCH2, and AR1D1A, were associated with a high cCR rate (93.3%). Furthermore, the characteristics of these dual TILs, CD8-forkhead box protein P3 ratios, and gene alterations (especially FGFR3) bifurcated the desert phenotype into 2 subgroups with different cCR rates (100% [11/11] and 0% [0/4]). CONCLUSIONS:These potential subgroups, defined by combined molecular subclass and immune phenotype, could lead to the identification of good responders to atezolizumab plus radiation therapy for invasive bladder cancer. However, given the small cohort size and limited number of tumor samples, these findings should be viewed as hypothesis-generating and require further validation in larger studies.

Squalene, a natural triterpene with antioxidant, anti-inflammatory, and immunostimulatory properties, holds promise for cancer therapy. Here, we examined a previously developed, diethylene glycol derivative of squalene (SQ-diEG) and investigated its in vivo anti-carcinogenic effects in bladder cancer. C57BL/6 mice were treated with 0.025% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) to induce bladder cancer, with SQ-diEG or PBS (control) administered orally from Week 0. SQ-diEG significantly reduced bladder cancer incidence to 3.7% after 8 weeks, compared to 21.4% in controls (p = 0.025). Transcriptomic analysis indicated that SQ-diEG may exert anti-carcinogenic effects by reducing ROS-mediated DNA damage, enhancing the immune microenvironment, and modulating cholesterol biosynthesis via SQLE downregulation. In vitro, SQ-diEG inhibited proliferation and induced apoptosis in bladder cancer cell lines. This study is the first to demonstrate that SQ-diEG significantly reduces bladder cancer in a BBN mouse model, highlighting potential for therapeutic development. Further research is needed to elucidate the mechanisms and long-term efficacy of SQ-diEG.

Objective : Recent preclinical and retrospective clinical evidence shows that androgen receptor (AR)-mediated signals have significant roles in development of non-muscle invasive bladder cancer (NMIBC). Here, we conducted a single-center, phase I study to assess the feasibility and efficacy of enzalutamide in patients having recurrent NMIBC with marker tumors. Patients with NMIBC who cannot achieve complete transurethral resection (TUR) or with recurrence within a year after the TUR, were enrolled. The patients were administered oral enzalutamide at 160 mg dose, once daily for four weeks. Clinical response at the end of the treatment was evaluated using cystoscopy. Results : Of the six patients enrolled, two experienced multiple recurrences. All the patients received the planned administration of enzalutamide. Enzalutamide was tolerable and all patients were able to complete the planed treatment, although four patients experienced mild treatment-related adverse events (AEs), but AEs with grade 2 or more were not observed. As for efficacy, three patients showed no change while the remaining three showed disease progression. Immunohistochemical analysis did not showed the strong staining of AR in the latest tumors. This is the first clinical study on enzalutamide treatment for NMIBC patients. In this study, four weeks of enzalutamide administration was well tolerated, however showed no clinical response for non-strong staining of AR.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of taxane-based chemotherapy in breast cancer patients. Previous findings suggest that compression therapy may be a safe and effective preventive strategy against CIPN. However, patient-reported comfort and usability aspects of such therapy remain underexplored. This sub-analysis aimed to evaluate patient-reported discomfort and pressure associated with compression therapy and explore potential usability barriers to compliance. This sub-analysis of a Phase I single-arm, open-label trial focused on patient-reported outcomes related to the subjective experience of compression therapy using double-layered surgical gloves and stockings during taxane administration. Parameters such as discomfort, pressure, pain, and itch in hands and feet were collected via questionnaires from 10 patients receiving neoadjuvant or adjuvant chemotherapy. Post hoc univariable analyses were conducted to explore potential factors associated with discomfort scores. Most patients reported minimal discomfort (mean hand discomfort score: 1.8; mean foot discomfort score: 2.2) and no pain in hands or feet during therapy. Mean perceived pressure scores were generally rated as “slight” to “mild,” though higher in calves (3.0) than toes (2.6) or fingertips (2.8). No statistically significant associations were identified between discomfort scores and other reported factors, though a positive trend between pain and discomfort was observed. Free-text responses highlighted that application and removal of double-layer compression garments posed greater challenges than physical discomfort itself. Compression therapy using standard gloves and stockings appears tolerable and feasible for CIPN prevention. However, ease of application rather than discomfort may be the primary barrier to patient compliance. Future designs should prioritize usability and fit to ensure sustained adherence, especially in clinical settings. jRCTs032210221, registered on 4 August 2021.

Aims:We previously reported that telomerase activator Centella asiatica (CA) can normalize the crypt structure of human colonic organoids in an ulcerative colitis (UC) model. Therefore, we aimed to evaluate the safety and efficacy of CA for UC in a clinical trial. Methods and Results:Ten patients with mild UC were recruited. Patients received 500 mg of oral CA extract tablets once daily for 12 weeks. Safety and efficacy were monitored based on clinical manifestations, biomarkers, endoscopic findings, histopathological findings, and telomere length. Among 10 patients, one patient withdrew due to the relapse of UC. No adverse events were identified during the medication in the remaining nine patients. One patient showed a Partial Mayo Score (pMayo) decrease from 1 to 0, while the remaining eight pMayo scores remained at 0 before and after treatment. CRP, ESR, and leucine-rich alpha 2 glycoprotein (LRG) levels remained unchanged throughout treatment. Two patients showed endoscopic improvement. The other two patients showed histological improvement. Among five patients, relative telomere length of the rectum remained unchanged by treatment. Conclusion:CA is safe for patients with UC. Longer treatment durations and larger participant pools are required to assess CA efficacy on histological healing in the future.

Background To investigate variations in diagnostic performance of photodynamic diagnosis (PDD) according to surgical experience. Methods Data were extracted from patients having pT1 or lower primary tumors that underwent PDD-assisted transurethral resection of bladder tumors (TURBT) with orally 5-amibolevulinic acid at our institute. Surgical experience was categorized by urological experience (first-year and second-year) and PDD experience (<10, 10-19, and ≥20 cases). Sensitivity, specificity, and accuracy rates were calculated based on PDD or white light (WL) findings and pathologic diagnosis. The bladder neck, trigone, and prostatic urethra were defined as areas with a high probability of tangential effect. Results A total of 108 patients and 343 specimens were extracted. The second-year surgeons had significantly higher accuracy rates than first-year surgeons (81.5% vs. 69.0%, p=0.013), while PDD experience did not significantly affect accuracy rates (76.5, 75.5, and 69.0%). In addition, the accuracy rate was also significantly lower in tangential effect areas (59.6% vs. 80.8%). Multivariate analysis identified urological experience as a significant factor improving accuracy rate (odds ratio [OR] 2.14) while tangential effects substantially reduced accuracy rate (OR 0.37). Notably, combining both PDD and WL resulted in a sensitivity exceeding 94%, even in first-year urology residents and tangential effect areas. Conclusions Urological experience had a greater impact on diagnostic performance of PDD compared to PDD experience. The combination of PDD and WL findings may improve sensitivity and reduce the possibility of missed diagnoses for less experienced urology residents.

Kaplan–Meier curves by treatment. The red line represents the ICI–ICI group, and the blue line represents the ICI–TKI group.

Background To identify the prognosis of Japanese patients with collecting duct carcinoma (CDC). Methods We used a hospital-based cancer registry data in Japan to extract CDC cases that were diagnosed in 2013, histologically confirmed, and determined the first course of treatment. We further investigated treatment modalities and estimated overall survival (OS) by the Kaplan-Meier method. Results A total of 61 CDC patients were identified. The 5-year OS rates for all CDC patients in Japan at 2013 were 23.6% (95% CI: 15.0-37.4), with a median OS of 14 months (95% CI: 12-24). The 5-year OS rate for CDC patients at stages I, III, and IV were 53.0% (95% CI: 29.9-94.0), 35.7% (95% CI: 19.8-64.4), and 3.4% (95% CI: 0.5-23.7), respectively. Noteworthy, the 1-year OS for stage IV patients was 27.6% (95% CI: 0.5-23.7) and the median OS was only 5 months (95% CI: 4-12). We further examined the OS for advanced disease according to treatment modalities. The median OS for chemotherapy alone was significantly shorter than surgery alone (4 months [95% CI: 4-4] vs. 15 months [95% CI: 13-68]; p<0.001). Conclusions Japanese CDC patients face poor prognoses similar to Western countries, especially in advanced cases that receive only chemotherapy. Surgery appears necessary for advanced disease.

Patient characteristics of the ICI–ICI group.