Circulating prostate-specific antigen (PSA) discriminates poorly in the diagnostic gray zone (3.0-9.99 ng/mL), where ~75% of biopsies yield no clinically significant prostate cancer (PCa). We evaluated whether urinary creatine riboside (CR), a tumor-derived metabolite excreted through the prostatic urethra, complements PSA for gray-zone detection and independently predicts prostate-cancer-specific mortality (PCSM). In the NCI-Maryland PCa Case-Control Study (951 cases, 962 controls; 47.6% African American men; median follow-up 11.5 years), urinary CR was quantified by UPLC-MS/MS. Within the PSA gray zone (n = 668), urinary CR was complementary to PSA, with markedly higher single-marker discrimination than PSA (AUC 0.93, 95% CI 0.88-0.98 vs 0.77, 0.66-0.89) and additive when combined (ΔAUC +0.17, p < 0.001; 91.4% sensitivity at 80% specificity). After adjustment for 11 clinical and sociodemographic covariates, urinary CR independently predicted PCSM complementary to PSA (Fine-Gray SHR 1.72, 1.35-2.19 for CR; 1.35, 1.08-1.68 for PSA; Harrell's C 0.85 for CR + PSA vs 0.77 for PSA alone), with strongest signal in African American men (SHR 2.43, 1.57-3.75 for CR). We conclude that urinary CR is a candidate non-invasive biomarker complementary to PSA - improving gray-zone triage and predicting PCSM; prospective validation in biopsy-referred cohorts is warranted. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of the National Cancer Institute, National Institutes of Health gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. Individual-level data from the NCI-Maryland Prostate Cancer Case-Control Study are not publicly deposited due to participant privacy protections governing this NIH intramural research cohort. Intramural Research Program of the U.S. National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research, grant ZIA BC 011492 National Center for Advancing Translational Sciences, ZIC TR000547

Introduction:Lung cancer in never-smokers is a growing, biologically distinct entity lacking non-invasive markers. Established urinary markers-creatine riboside (CR) and N-acetylneuraminic acid (NANA)-report tumor-intrinsic metabolism, not carcinogen processing. We investigated 27-nor-5β-cholestane-3α,7α,12α,24R,25S-pentol glucuronide (CPG), a bile-acid glucuronide linked to aryl-hydrocarbon-receptor (AhR)/CYP xenobiotic metabolism. Methods:Urinary CPG was quantified by UPLC-tandem mass spectrometry in an exploratory (NCI-Maryland; n=846) and validation (Colorado; n=505) cohort of non-small-cell lung cancer cases and frequency-matched controls. Associations with case status, smoking stratum, survival, and discrimination were assessed, using tumor RNA sequencing (n=83) and gene-set enrichment analysis (GSEA). Results:Urinary CPG was higher in cases than controls in both cohorts (P<0.0001). In never-smokers, cases exceeded smoking-matched controls (P<0.001 and P<0.0001), indicating elevation independent of tobacco exposure. After mutual adjustment for CR and NANA, CPG remained independently associated with case status (exploratory OR 1.58, 95% CI 1.15-2.16; validation OR 3.92, 95% CI 2.47- 6.29), with a modest gain in discrimination. High CPG identified never-smokers with worse survival in both cohorts (P<0.001 and P=0.04), remaining significant after multivariable adjustment only in the exploratory cohort. GSEA showed AhR/CYP xenobiotic and Nrf2 oxidative-stress enrichment in high-CPG tumors; the CPG aglycone carried disease-specific 24R,25S stereochemistry. Conclusions:Urinary CPG was associated with NSCLC in two retrospective case-control cohorts, including in a smoking-matched never-smoker comparison. High CPG also identified never-smokers with worse survival, remaining independently prognostic after adjustment in the exploratory cohort. Tumor expression does not establish tissue of origin. Prospective validation against CR and NANA is required.

Aims:Δ133p53α is a naturally occurring isoform of the human p53 protein that inhibits p53-mediated cellular senescence. We previously reported that transgenic expression of this senescence-inhibitory p53 isoform counteracts aging-associated pathological changes in progeria model mice (heterozygous Lmna G609G/+ ). The anti-aging effect of Δ133p53α was attributed in part to reduced levels of the proinflammatory cytokine IL-6. This study aims to comprehensively profile Δ133p53α-induced changes in cytokines and chemokines. Methods:A Luminex-based multiplex quantitative assay was performed using mouse serum samples from transgenic Δ133p53α-expressing Lmna G609G/+ mice and non-expressing controls. Quantitative RT-PCR and RNA in situ hybridization assays were used to assess Cxcl10 expression in mouse tissues. In addition, gene expression datasets from human tissues were analyzed. Results:We confirmed Δ133p53α-mediated repression of serum IL-6 levels. We also found that Δ133p53α reduced serum levels of CXCL1, IL-1α, and CXCL10. We further characterized CXCL10, which has not previously been associated with progeria in mice or humans. Consistent with reduced serum CXCL10 levels, both young (15-week-old) and old (10-month-old) Δ133p53α-expressing Lmna G609G/+ mice showed reduced Cxcl10 expression in the liver, spleen, and brain, major organs that produce CXCL10, compared with age-matched non-expressing controls. In naturally aged wild-type mice (2 years old), transgenic Δ133p53α expression also significantly repressed Cxcl10 expression in the spleen and brain. An inverse association between CXCL10 and Δ133p53α levels was observed in human spleen tissues, suggesting physiological relevance to human aging. Conclusion:CXCL10, a proinflammatory chemokine elevated in both accelerated and natural aging, is a potential target of the anti-inflammatory activity of Δ133p53α.

Abstract Background Building on evidence linking urinary glyphosate to chronic liver disease (CLD) and hepatocellular carcinoma (HCC), we developed urinary pesticide profiling integrated with machine learning risk prediction (MLRP) to stratify risk in high-exposure populations.Methods We conducted a case-control study within the Thailand Initiative in Genomics and Expression Research for Liver Cancer (TIGER-LC; 2011-2016; n=593): 228 CLD, 116 HCC, and 249 controls. Eight urinary pesticides were quantified by LC-MS/MS (pendimethalin, oxadiazon, metsulfuron-methyl, butachlor, 2,4-dichlorophenoxyacetic acid [2,4-D], cypermethrin, flocoumafen, bromadiolone). A composite Pesticide Load Score (PLS), with and without glyphosate, estimated burden. Two predictive models were developed: a logistic-regression Pesticide-Informed Liver Cancer Risk Score (PILCRS) and an Extreme Gradient Boosting (XGBoost) classifier that incorporated age, sex, alcohol use, occupation, and PLS. Internal validity used 1,000 bootstrap resamples with optimism-corrected calibration.Findings Predicted CLD probability increased from 30% in the lowest PLS quartile to over 70% in the highest, and HCC from 10% to 40% (p<0ꞏ0001). Relative estimates were consistent; the highest versus lowest quartile yielded odds ratios of 2ꞏ84 (95% CI 1ꞏ66-4ꞏ91) for CLD and 4ꞏ76 (2ꞏ30- 10ꞏ29) for HCC. Cypermethrin remained independently associated. After optimism correction, both models demonstrated strong discrimination and calibration.Interpretation This framework establishes a scalable, exposure-informed tool for liver disease prediction. Findings underscore pesticide burden as a modifiable risk factor and align with Sustainable Development Goal 3ꞏ9 and WHO-FAO priorities in low- and middle-income countries (LMICs). External validation is essential. Citation Format: Daxeshkumar P. Patel, Christopher Loffredo, Majda Haznadar, Mohammed Khan, Amelia Parker, Benjarath Pupacdi, Siritida Rabibhadana, Panida Navasumrit, Nirush Lertprasertsuke, Anon Chotirosniramit, Chawalit Pairojkul, Vor Luvira, Ake Pugkhem, Wattana Sukeepaisarnjaroen, Teerapat Ungtrakul, Thaniya Sricharunrat, Kannika Phornphutkul, Frank J. Gonzalez, Anuradha Budhu, Chulabhorn Mahidol, Xin Wei Wang, Mathuros Ruchirawat, Curtis C. Harris, TIGER-LC Consortium.. Urinary pesticide biomarkers and liver disease risk in Thailand: A machine-learning-based risk-prediction model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2443.

Abstract Hutchinson-Gilford progeria syndrome (HGPS), a premature aging disorder caused by a de novo LMNA G608G mutation, is characterized by the accumulation of DNA damage and persistent inflammation, which drive accelerated aging and lead to severe clinical manifestations, including skin atrophy, alopecia, and progressive deterioration of the aortic wall due to loss of vascular smooth muscle cells, resulting in severely shortened lifespan. Mouse models of HGPS recapitulate these pathological aging phenotypes, including cardiovascular defects, increased cellular senescence, DNA damage accumulation, systemic inflammation, and shortened lifespan.The human p53 isoform Δ133p53α, which lacks the N-terminal 133 amino acids, is a naturally occurring truncated variant with distinct biological functions. In HGPS patient-derived fibroblasts, Δ133p53α suppresses cellular senescence, reduces pro-inflammatory IL-6 production, limits DNA-damage accumulation, and extends replicative lifespan. These findings suggest that Δ133p53α selectively attenuates p53-mediated cell-cycle arrest and senescence while preserving DNA-repair functions.Here, in a heterozygous HGPS mouse model, we show that transgenic expression of Δ133p53α reproduces these in vitro-observed effects across multiple organs in vivo and extends median lifespan by approximately 10% (387 vs. 358 days, P = 0.0235). In the aorta and skin, Δ133p53α mitigates progeria-associated pathological changes and preserves tissue integrity. Δ133p53α also mitigates spinal kyphosis characteristic of the HGPS mouse phenotype. RNA-sequencing analysis suggests that Δ133p53α promotes mitochondrial function and metabolic fitness. The effects of Δ133p53α in naturally aging mice are under investigation. Our human expression database analysis shows an age-associated downregulation of Δ133p53α in multiple human tissues, including aorta and skin.This study suggests not only a Δ133p53α-based therapeutic approach for HGPS but also broader interventions for preventing or delaying aging. Citation Format: Leo Yamada, Huaitian Liu, Natalia Von Muhlinen, Curtis C. Harris, Izumi Horikawa, . Senescence-inhibitory Δ133p53α mitigates accelerated ageing in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 6001.

ABSTRACT Background Biochemical recurrence (BCR) occurs in 20–40% of men after radical prostatectomy. Existing postoperative recurrence risk tools based on PSA and pathology are clinically useful but show only moderate and variable discrimination, highlighting the need for biomarkers that improve risk stratification and consequent treatment decisions. We hypothesized that the prostate microenvironment, including both the tumor and non-cancerous adjacent tissue, may contain prognostic features associated with adverse postoperative PSA outcomes. Methods We assembled a cohort of matched tumor-adjacent benign and tumor prostate tissue from 243 men across three institutions to establish a discovery cohort (n=123; 43 postoperative PSA events, 35%) and validation cohort (n=120; 46 events, 38%). For primary binary analyses, a postoperative PSA event included BCR, defined as two consecutive postoperative PSA values ≥0.2 ng/mL, or PSA persistence. We performed RNA sequencing of matched tumor-adjacent benign and tumor tissues, quantified immune signatures, and developed an integrated model combining the adjacent-tissue B-cell signature, preoperative PSA, and radical prostatectomy Gleason score (“BRIGADE”). CAPRA-S-adjusted Cox analyses excluding recurrence-time-0 cases evaluated time to BCR, and CD19 multiplex immunofluorescence provided tissue-level confirmation (n=10). Results In prostatectomy specimens, tumors from patients without a postoperative PSA event were enriched for B-cell transcriptional programs, whereas tumors from event-positive patients showed elevated proliferation signatures. B-cell-related transcriptional programs were correlated between tumor and adjacent tissue. Tumor-adjacent benign B-cell scores were higher in no-event cases and discriminated postoperative PSA-event status in PCBN discovery (AUC 0.63) and BM validation (AUC 0.81) cohorts, outperforming numerous other immune-related signatures. In CAPRA-S-adjusted Cox sensitivity analyses excluding recurrence-time-0 cases, higher adjacent-tissue B-cell activity was associated with reduced recurrence risk in PCBN (HR 0.42, 95% CI 0.19–0.94; BH-adjusted p=0.035) and BM (HR 0.54, 95% CI 0.30–0.95; BH-adjusted p=0.034). Tissue-based validation showed that CD19⁺ B-cell density in adjacent benign tissue was higher in no-event than event-positive patients (median 0.1145 vs 0.0471; p=0.008). BRIGADE achieved an AUC of 0.68 in cross-validation and 0.83 in independent validation, compared to AUCs of 0.54–0.63 and 0.44–0.78 for the tested clinical predictors, respectively. At the fixed classification threshold, the validation-cohort odds ratio for BRIGADE was 2.75. The adjacent B-cell score remained associated with lower odds of a postoperative PSA event after adjustment for PSA and Gleason score. Conclusions B-cell infiltration in tumor-adjacent benign prostate tissue may complement existing clinicopathologic models for stratifying adverse postoperative PSA outcomes and subsequent BCR after radical prostatectomy. The transcriptomic signal was recapitulated by CD19-based tissue staining, supporting further development of a pathology-based assay.

Background:Five-year survival from lung cancer exceeds 60% at stage I-II but falls below 10% once metastasis occurs. Low-dose CT (LDCT) screening reduces mortality in heavy smokers but carries a false-positive rate of approximately 29% and is restricted to smoking-based eligibility, leaving most cases undetected. We aimed to develop and independently validate an interpretable machine-learning urinary metabolite risk index (uLCI) for non-invasive lung cancer detection. Methods:Four urinary metabolites-creatine riboside (CR), N-acetylneuraminic acid (NANA), 27-nor-5β-cholestane-3α,7α,12α,24R,25S-pentol (CP), and cortisol sulfate (CS)-and three clinical variables (age, race, smoking) were integrated by Lasso-regularised logistic regression into a uLCI score. The model was developed under 10-fold cross-validation in the NCI-Maryland (NCI-MD) cohort (n=845; 470 controls, 375 cases, stages I-IV) and applied without refitting to the independent Colorado Lung Cancer Cohort (n=488; 211 controls, 277 cases). Analyses were prespecified; reporting followed TRIPOD+AI. Findings:uLCI achieved an area under the curve (AUC) of 0·906 (95% CI 0·887-0·926) in NCI-MD and 0·748 (0·701-0·793) in the independent Colorado cohort. Scores rose monotonically across stages in both cohorts (Spearman ρ=0·69 and 0·45; both p<0·0001). Stage-specific discrimination was preserved from stage I to IV (NCI-MD 0·900-0·927; Colorado 0·722-0·843). Net reclassification improvement over clinical variables was 1·24 (1·14-1·36) and 0·74 (0·56-0·90). uLCI tertiles stratified post-resection survival in stage I-II disease (adjusted hazard ratio 2·03, 1·26-3·27). Interpretation:uLCI is an independently validated, interpretable urinary risk index that detects lung cancer across all stages, with monotonic stage progression and post-resection prognostic value. Its false-positive rate compares favourably with published estimates for LDCT and cell-free-DNA assays, supporting prospective head-to-head evaluation as a non-invasive triage tool, including in screening-ineligible populations.

Research on progeria not only contributes to treatments for the disease but also enhances our understanding of physiological ageing1. Mouse models of progeria recapitulate pathological ageing phenotypes seen in patients, including cardiovascular defects, increased cellular senescence, systemic inflammation, DNA damage accumulation, and shortened lifespan2. In cultured cells from Hutchinson-Gilford progeria syndrome (HGPS) patients, the human p53 isoform Δ133p53α was previously shown to inhibit p53-mediated cellular senescence, proinflammatory IL-6 production, and DNA damage accumulation, and to extend cellular replicative lifespan3. Here we show that, in a heterozygous HGPS mouse model4, transgenic expression of Δ133p53α reproduces these in vitro-observed effects across multiple organs in vivo and extends median lifespan by 11% (387 versus 349 days, P = 0.0379). In the aorta and skin, Δ133p53α abrogates progeria-characteristic pathological changes and preserves tissue integrity. Our data further suggest that Δ133p53α may promote a broad spectrum of ageing-counteracting mechanisms, including bone homeostasis, metabolic fitness, antioxidant defense, youthful epigenome, and tissue stemness. Together with the anti-inflammatory and tissue-preserving effects of Δ133p53α in naturally aged mice and its age-associated downregulation in human tissues, this study suggests that Δ133p53α-based therapeutic strategies may be applicable not only to HGPS but also as broader interventions for preventing or delaying ageing.

Lung cancer is one of the most frequently diagnosed cancers in the US. African-American (AA) men are more likely to develop lung cancer with higher incidence and mortality rates than European-American (EA) men. Herein, we report high-confidence alternative splicing (AS) events from high-throughput, high-depth total RNA sequencing of lung tumors and non-tumor adjacent tissues (NATs) in two independent cohorts of patients with adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC). We identified novel AS biomarkers with notable differential percent spliced in (PSI) values between lung tumors and NATs enriched in the AA and EA populations, which were associated with oncogenic signaling pathways. We also uncovered tumor subtype- and population-specific AS events associated with cell surface proteins and cancer driver genes. We highlighted significant AS events in SYNE2 specific to LUAD in both populations, as well as those in CD44 from EAs and TMBIM6 from AAs specific to LUAD. Here, we also present the validation of cancer signatures based on direct high-throughput reverse transcription-PCR. Our large survey of lung tumors presents a rich data resource that may help to understand molecular subtypes of lung tumor between AAs and EAs and reveal new therapeutic vulnerabilities that potentially advance health equity.

Sample sizes of Sites 1-4 across ten experiments

Supplementary Figure from Accounting for EGFR Mutations in Epidemiologic Analyses of Non–Small Cell Lung Cancers: Examples Based on the International Lung Cancer Consortium Data

Artificial intelligence applications in biomedicine face major challenges from data privacy requirements. To address this issue for clinically annotated tissue proteomic data, we developed a federated deep learning approach (ProCanFDL), training local models on simulated sites containing data from a pan-cancer cohort (n = 1,260) and 29 cohorts held behind private firewalls (n = 6,265), representing 19,930 replicate data-independent acquisition mass spectrometry runs. Local parameter updates were aggregated to build the global model, achieving a 43% performance gain on the hold-out test set (n = 625) in 14 cancer subtyping tasks compared with local models and matching centralized model performance. The approach's generalizability was demonstrated by retraining the global model with data from two external, data-independent acquisition mass spectrometry cohorts (n = 55) and eight acquired by tandem mass tag proteomics (n = 832). ProCanFDL presents a solution for internationally collaborative machine learning initiatives using proteomic data, for example, for discovering predictive biomarkers or treatment targets while maintaining data privacy. SIGNIFICANCE:A federated deep learning approach applied to human proteomic data, acquired using two distinct proteomic technologies from 40 tumor cohorts across eight countries, enabled accurate cancer histopathologic subtyping while preserving data privacy. This approach will enable the privacy-compliant development of large-scale proteomic artificial intelligence models, including foundation models, across institutions globally.

Distribution of cancer subtypes across Sites 2-4 and Experiments 1-10

Cell type enrichment analysis of top SHAP-ranked proteins across cancer subtypes

Despite lung cancer affecting all races and ethnicities, disparities are observed in incidence and mortality rates among different ethnic groups in the United States. Non-Hispanic African Americans had a high incidence rate of lung cancer at 55.8 per 100 000 people, as well as the highest death rate at 37.2 per 100 000 people from 2016 to 2020. While previous genome-wide association studies (GWAS) have identified over 45 susceptibility risk loci that influence lung cancer development, few GWAS have investigated the etiology of lung cancer in African Americans. To address this gap in knowledge, we conducted GWAS of lung cancer focused on studying African Americans, comprising 2267 lung cancer cases and 4264 controls. We identified three loci associated with lung cancer, one with lung adenocarcinoma, and four with lung squamous cell carcinoma in this population at the genomic-wide significance level. Among them, three novel loci were identified near VWF at 12p13.31 for overall lung cancer and GACAT3 at 2p24.3 and LMAN1L at 15q24.1 for lung squamous cell carcinoma. In addition, we confirmed previously reported risk loci with known or new lead variants near CHRNA5 at 15q25.1 and CYP2A6 at 19q13.2 associated with lung cancer and TRIP13 at 5p15.33 and ERC1 at 12p13.33 associated with lung squamous cell carcinoma. Further multi-step functional analyses shed light on biological mechanisms underlying these associations of lung cancer in this population. Our study highlights the importance of ancestry-specific studies for the potential alleviation of lung cancer burden in African Americans.

Per class AUROC for models using ProCan Compendium

Δ133p53α is a naturally occurring isoform of the tumor suppressor protein p53. Δ133p53α functions as a physiological dominant-negative inhibitor of the full-length p53 protein (commonly referred to as p53). Δ133p53α preferentially inhibits p53-mediated cellular senescence, while it does not inhibit, or may even promote, p53-mediated DNA repair. Owing to this selective inhibitory activity that preserves genome stability, Δ133p53α represents a promising target for enhancement in the prevention and treatment of diseases associated with increased senescence of normal cells. These diseases include Alzheimer’s and other neurodegenerative diseases, premature aging diseases such as Hutchinson-Gilford progeria syndrome (HGPS), and idiopathic pulmonary fibrosis (IPF). Current cell-based therapies, which are limited by increased cellular senescence, may also benefit from Δ133p53α-mediated improvements. As an initial application of Δ133p53α in improving therapeutic cells, we here introduce Δ133p53α-armored chimeric antigen receptor (CAR)-T cells. Based on our previous and ongoing studies using various types of senescent human cells in vitro, we also discuss the importance of further exploring the therapeutic potentials of Δ133p53α, with particular focus on HGPS and IPF. The development of mouse models facilitates in vivo evaluation of the therapeutic effects of Δ133p53α, potentially leading to future clinical applications.

Cohort details of ProCan Compendium