Context.—:Tumor budding (TB) is associated with nodal metastasis and worse outcomes in oral squamous cell carcinoma. However, there is a need for standardization of its assessment. Objective.—:To perform TB scoring using 2-tiered and 3-tiered systems, with and without pancytokeratin (CK) immunohistochemistry, and assess relationship with outcome parameters. Design.—:Tumor buds were scored by using 2-tiered (low: <5; high: ≥5) and 3-tiered (low: 0-4; intermediate: 5-9; high: ≥10) systems on hematoxylin-eosin- and CK-stained sections. Results.—:TB was evaluated in 400 oral squamous cell carcinomas, which were predominantly gingivobuccal (242; 61%), had aggressive worst patterns of invasion (WPOI) (WPOI-4: 59%; WPOI-5: 27%), and were late stage (298; 75%). Two-year disease-free survival (DFS) was 56.3%, and 2-year overall survival (OS) was 58.7%. Using 3-tiered scoring, 220 cases (55%) had low, 101 (25%) had intermediate, and 79 (20%) had high TB. With 2-tiered scoring, 220 cases (55%) had low and 180 (45%) had high TB. Greater concordance was seen between hematoxylin-eosin- and CK-stained sections with 2-tiered scoring: 14% were up-scored versus 25% with 3-tiered scoring. Cases with high and intermediate TB had significantly shorter DFS and OS. TB on CK-stained sections scored by both systems was an independent predictor of nodal metastasis. With all 4 scoring models, high TB was an independent predictor of recurrence. All 4 models showed similar predictive values for OS and DFS. Conclusions.—:TB is a significant predictor of nodal metastasis and recurrence, irrespective of site and stage. Three-tiered scoring does not show improved prediction of outcomes over 2-tiered scoring.

PURPOSE:Mucoepidermoid carcinoma (MEC) is the most common malignant histology encountered in salivary glands. Due to the rarity of salivary gland malignancies and more than 20 different histological types, there is a need to analyse clinicopathological risk factors of each histology separately, with emphasis on long-term outcomes. METHODS:Retrospective cohort study from a tertiary care centre conducted from 2014 to 2024 on all histologically confirmed MEC that underwent upfront surgery. RESULTS:244 MEC [major salivary gland (MASG)-153, minor salivary gland (MISG)-91] were available for analysis. The median follow-up was 39 months. Location in MISG, higher T category and female sex were independent prognostic variables for survival on multivariate analysis (MVA) of the entire cohort. The impact of tumour location persisted following matched-pair analysis controlling for tumour stage, grade and margin status (OS: HR:5.3, 95% CI: 2.1 to 12.9; DFS: HR: 2.7, 95% CI: 1.2 to 5.8). The predominant pattern of failure for tumour located in MISG was distant metastasis, whereas in MASG, loco-regional failure was commonly encountered. In terms of tumour grade, low-grade and high-grade had the best and worst outcomes for both MASG and MISG. However, survival curves for intermediate-grade tumours clustered with low-grade tumours in MASG and with high-grade tumours in MISG. CONCLUSION:Tumour location demonstrated a pronounced impact on MEC outcomes following treatment, independent of AJCC staging and histological grade.

Adrenocortical carcinoma is a rare and clinically heterogeneous malignancy, often posing difficulty in accurate prognostication. Existing clinicopathological scoring systems, the Weiss, AFIP/Wieneke, and Lin-Weiss-Bisceglia (LWB) criteria, are constrained by their age/subtype-specific applicability and are not suitable for evaluating the rare myxoid and sarcomatoid morphologies or needle biopsies. The Reticulin Algorithm (RA) is a simplified approach for the histopathological assessment of adrenocortical neoplasms, but its prognostic utility requires further validation. We evaluated the prognostic performance of RA and its pediatric-adaptation (pRA) in 157 adrenocortical neoplasms, comprising 140 resection specimens and 17 needle biopsies from 118 adult and 39 pediatric patients, representing all histomorphological subtypes. Among adult tumors, the RA demonstrated diagnostic accuracy exceeding 90%, comparable to the Weiss system but with higher specificity and a markedly superior positive likelihood ratio, highlighting its stronger prognostic value. Its greatest impact was observed in oncocytic tumors, where it outperformed the LWB criteria and correctly reclassified most lesions previously designated as having uncertain malignant potential. In pediatric cases, RA’s performance was comparable to the AFIP/Wieneke criteria. Notably, pRA further improved predictive precision. All myxoid and sarcomatoid tumors were appropriately classified using the algorithm. RA application to needle biopsies showed complete concordance with clinical outcomes. Survival analyses confirmed significant stratification between RA-defined benign and malignant groups. In this large single-center study, RA demonstrated broad applicability and prognostic utility across age groups, histologic subtypes, and specimen types, supporting its potential role in risk stratification of adrenocortical neoplasms.

Introduction Frailty assessment has proved useful for evaluating the ability to withstand cancer treatments, but it remains understudied in low- and middle-income countries, where the average life expectancy is about two decades lower than in higher-income countries. This study aimed to establish frailty cutoffs to guide treatment decisions by determining optimal G8 (Geriatric 8) and SCOPE-C (SCreening of the Older Person with Cancer) scores to predict postoperative outcomes in older Indian adults with head and neck cancer. Materials and methods In a tertiary care cancer facility in North India, patients ≥60 years with primary head and neck cancers undergoing curative surgery were included. This prospective observational study took place from January 2024 to March 2025. Pre-surgical frailty assessment was done by G8 and SCOPE-C. The main outcomes were major surgical complications and 30-day readmission. Results Of 115 patients included (mean age 66.9 years; 79.1% male), 22.6% developed major complications and 7.8% required readmission. On multivariable analysis, lower G8 (odds ratio [OR] 0.77, p = 0.007) and flap use (OR 3.21, p = 0.048) predicted major complications, while G8 alone predicted readmissions (OR 0.52, p = 0.001). Receiver operating characteristic analysis identified G8 cutoffs of ≤13 score for predicting complications (area under the curve [AUC] 0.636) and ≤ 11 for readmissions (AUC 0.839). Patients with G8 ≤ 11 had higher readmission rates (17% vs 1.5%; p = 0.003), and G8 ≤ 13 had more major complications (28.8% vs 11.9%; p = 0.04). Discussion Compared to the SCOPE-C screening tool, the G8 demonstrated statistically significant predictive value for both major surgical complications and readmissions; however, its low AUC indicates limited sensitivity and guarded clinical usefulness in predicting major postoperative complications.

India’s medical education system is undergoing rapid expansion, yet notable variations in teaching quality, assessment methods, and institutional accountability continue to affect student outcomes. The National Exit Test (NExT), mandated under the National Medical Commission Act, 2019, and detailed in the 2023 Gazette notification, is designed to create a unified, competency-based national assessment that simultaneously functions as the MBBS exit exam, licensure examination, and postgraduate (PG) eligibility-cum-ranking test. Despite a clear regulatory mandate, its rollout has been repeatedly delayed. This editorial outlines why the implementation of NExT is urgently needed, how it addresses the shortcomings of existing university and PG entrance examinations, and how it benefits students, medical colleges, and the broader health system. A phased, student-centred implementation strategy is proposed to ensure a smooth transition and build confidence among stakeholders.

Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla with heterogeneous clinical manifestations. Pheochromocytoma crisis is an uncommon but life-threatening presentation frequently complicated by cardiovascular collapse and multi-organ dysfunction. A 30-year-old male presented with undifferentiated shock, metabolic acidosis, acute heart failure, and renal failure. He was later diagnosed with pheochromocytoma-induced cardiogenic shock, likely worsened by inappropriate β-blocker therapy without prior α-blockade. Management required advanced critical care support, mechanical ventilation, renal replacement therapy, staged endocrine optimization, and definitive adrenalectomy. This case highlights the importance of maintaining a high index of suspicion for pheochromocytoma in patients with unexplained cardiogenic shock and labile hemodynamics, particularly when preceded by episodic headaches and inappropriate β-blocker exposure. Early imaging and multidisciplinary management are crucial for optimal outcomes.

6107 Background: Long-term survivors of oral cavity cancer (OCC) often experience persistent physical, functional, and psychosocial impairments despite disease control. Return to work (RTW) reflects real-world functional recovery and social reintegration. We evaluated whether health-related quality of life (QOL) differs between OCC survivors who returned to work and those who did not. Methods: This prospective cohort study included OCC survivors ≤65 years who underwent definitive surgery between 2016 and 2023 and were disease-free for ≥2 years. Health-related QOL was assessed using EORTC QLQ-C30, EORTC QLQ-HN43, and UW-QOL questionnaires. QOL domains were compared between survivors who returned to work and those who did not. Results: Three hundred OCC survivors were evaluated at a median of 28.5 months after treatment. Survivors who returned to work demonstrated significantly higher global health status and superior physical, role, emotional, cognitive, and social functioning on EORTC QLQ-C30 compared with non-working survivors (all p<0.0001). Non-working survivors had substantially greater head-and-neck–specific symptom burden on EORTC QLQ-HN43, including swallowing difficulty, speech problems, shoulder dysfunction, pain, dry mouth, body-image disturbance, social eating limitations, and fear of progression (all p<0.0001). UW-QOL confirmed significantly worse pain, activity, recreation, swallowing, chewing, speech, shoulder function, mood, anxiety, and overall health-related QOL in survivors who did not return to work (all p<0.0001). Conclusions: Return to work is strongly associated with superior multidimensional quality of life in oral cavity cancer survivors. Survivors who do not resume work experience profound physical, functional, and psychosocial impairment, highlighting the need for rehabilitation-centered survivorship care to restore meaningful functional recovery beyond oncologic cure. Quality of life scores for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 43 (EORTC QLQ HN 43). EORTC QLQ HN 43 Total patients (Overall population ) Returned to work at the time of survey (Mean + SD) Did not return to work at the time of survey (Mean + SD) P Value Pain in the mouth 34.2 + 15.8 10.3+ 13.2 33.2 + 13.5 p<0.0001 Swallowing issue 10.8 + 12.5 7.8 + 8.7 25.5 + 16.9 p<0.0001 Problems with teeth 17.8 + 19.2 14.1 + 17.2 35.7 + 18.6 p<0.0001 Dry mouth and sticky saliva 23.4 + 21.9 19.5 + 19.1 42.8 + 24.3 p<0.0001 Problems with senses 18.1 + 18.9 14.2 + 16.6 36.9 + 18.0 p<0.0001 Speech issues 15.9 + 18.8 11.6 + 15.4 44.9 + 17.2 p<0.0001 Body image issues 18.0 + 19.7 12.5 + 15.2 41.3 + 20.1 p<0.0001 Social eating issues 17.0 + 19.9 12.0 + 15.7 47.1 + 22.5 p<0.0001 Sexuality problem 18.1 + 22.7 12.2 + 17.6 46.4 + 18.3 p<0.0001 Problems with shoulder 18.6 + 22.0 12.9 + 17.9 46.4 + 18.3 p<0.0001 Skin Problems 13.5 + 18.5 9.0 + 14.7 35.7 + 19.4 p<0.0001

Purpose Anaplastic thyroid carcinoma (ATC) exhibits limited responsiveness to immunotherapy. The current study characterises the immune cell repertoire in ATC compared with differentiated thyroid carcinoma (DTC) and thyroid follicular nodular disease (TFND) and evaluates IFN-γ and TGF-β mRNA expression. Methods Cytotoxic T lymphocytes (CTLs), regulatory T cells (TREGs), natural killer cells (NK), B lymphocytes and myeloid-derived suppressor cells (MDSCs) were analysed by multicolour flow cytometry in prospectively collected ATC, DTC and TFND tissues. IFN-γ and TGF-β mRNA expression was quantified using RT-PCR. Results ATC demonstrated significantly higher MDSC infiltration than DTC or TFND. CTLs were elevated in ATC relative to DTC, while TREGs, NK and B-cells were lower. IFN-γ and TGF-β expression did not differ significantly although IFN-γ expression was higher in DTC and ATC than in TFND. Conclusion ATC microenvironment is rich in immunosuppressive MDSCs. These findings support MDSC-focused immunomodulation as a promising adjunct therapy in ATC.

Introduction: The splenic tuberculous involvement is common than other intra-abdominal solid organs such as the liver, pancreas, and kidney. The aim of this article is to present and share a review of the English-language literature on splenic tuberculosis (TB) to gain a better understanding of etiopathogenesis, epidemiological features, and diagnostic methods and provide guidelines for its management and to present our experience of six cases. Methods: The systematic search of the literature was performed on PubMed and Medline from 1950 to 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Fifty-two manuscripts were included in this systematic review. All resulting titles, abstract, and full text, whenever available, were read and kept for reference. Conclusion: Direct histopathological demonstration is the best diagnostic modality. Fine-needle aspiration cytology is the study of choice and polymerase chain reaction assay increases its sensitivity. The standard short course antitubercular therapy for 6 months is recommended for isolated splenic TB, and for widespread disease, 12-month therapy is recommended. Surgery is reserved for failure of medical therapy and complications such as abscess formation.

Thyroid lesions, both benign and malignant, are common worldwide. Although conventional open thyroidectomy remains effective, the visible cervical scar is a cosmetic concern, particularly for younger patients. Endoscopic thyroidectomy techniques such as the Axillo-Breast Approach (ABA) and Bilateral Axillo-Breast Approach (BABA) were developed to overcome this limitation. This study aimed to compare these two approaches with respect to postoperative health-related quality of life (QOL). In this randomized controlled trial, 64 adult patients (> 18 years) with Bethesda category III or lower cytology and thyroid gland volume < 40 mL were randomized to undergo endoscopic hemithyroidectomy via either ABA or BABA. The primary outcome was postoperative QOL assessed using the Short Form-36 (SF-36) questionnaire and a thyroid-specific questionnaire at 2, 6, and 12 weeks after surgery. Secondary outcomes included postoperative complications, duration of hospital stay, pain scores, conversion to open surgery, and ease of performing the procedure. At 6 weeks, significantly higher scores were observed in the ABA group for Vitality (p = 0.045) and Social Function (p = 0.027), whereas no significant differences were identified in the remaining SF-36 domains. At 2 weeks, ABA showed a trend toward higher general health and vitality scores. On thyroid-specific assessment at 2 weeks, ABA was associated with significantly less neck and chest numbness (p = 0.0028) and better neck mobility (p = 0.004) compared to BABA; these differences resolved by 6–12 weeks. Minor complications such as subcutaneous emphysema and ecchymosis were self-limiting. Pain scores, operative difficulty, and hospital stay were similar between groups. Both ABA and BABA endoscopic hemithyroidectomy techniques were safe. No statistically significant differences were observed in most quality-of-life outcomes between the two approaches. ABA provided a short-term advantage in reducing early postoperative neck numbness and movement restriction, although these differences resolved during follow-up.

OBJECTIVES:To compare the incidence of pharyngocutaneous fistula and pharyngeal closure time between barbed and conventional polyglactin sutures after total laryngectomy. METHODS:A single-blinded, randomized clinical trial was conducted from February 2023 to October 2024 at a tertiary academic center. Participants included adults with advanced laryngeal or hypopharyngeal carcinoma undergoing primary total laryngectomy with primary pharyngeal closure. Salvage laryngectomies and patients requiring patch pharyngoplasty were excluded. Patients were randomized 1:1 to pharyngeal closure with either a continuous 3-0 polyglycolic acid barbed suture or a continuous 3-0 polyglactin (Vicryl) suture. The primary outcome was the incidence of pharyngocutaneous fistula. The secondary outcome was pharyngeal closure time. RESULTS:Sixty patients were randomized (median age, 59.7 years; 95% men). Pharyngocutaneous fistula occurred in 5 of 30 patients (16.7%) in the Vicryl group and in none of the 30 patients in the barbed suture group; this difference did not reach statistical significance. Median pharyngeal closure time was shorter in the barbed suture group (15 min) compared with the Vicryl group (25 min). CONCLUSION:In this randomised pilot clinical trial, the use of barbed sutures was associated with shorter pharyngeal closure time and a numerically lower fistula rate. These findings suggest potential technical advantages of barbed sutures, although larger, adequately powered trials are required to confirm an effect on pharyngocutaneous fistula incidence. TRIAL REGISTRATION:Clinical Trials Registry-India Identifier: CTRI/2023/06/054351. LEVEL OF EVIDENCE:Level 2.

Intraparotid lymph node (PLN) recurrence from oral cavity squamous cell carcinoma (OCSCC) is uncommon and inadequately characterised, with limited literature regarding its frequency, predictors, and prognostic implications. A retrospective analysis was conducted on consecutive patients with OCSCC who underwent upfront surgery at a tertiary care centre from 2022 to 2024. Patients with clinical or radiological evidence of PLN recurrence were identified. A site-matched cohort of 100 consecutive patients with OCSCC treated surgically during the same time frame, and patients with non-PLN recurrences served as controls. Among 939 surgically treated OCSCC patients, 22 (2.34

A retained wooden foreign body in the naso-orbital region is rare and poses significant diagnostic challenges. We report a case of a young male presenting with an alleged history of trauma followed by pain and visual disturbance. Clinical examination and detailed radiologic evaluation led to the diagnosis of retained foreign body in the naso-orbital complex. The foreign body was successfully removed via a tailored surgical approach with multidisciplinary involvement. Wooden foreign bodies carry a high risk of infection being organic nature, necessitating prompt removal and adequate antimicrobial therapy. This case highlights the importance of considering retained organic foreign bodies in atypical presentations, recognising radiological pitfalls and adopting an appropriate surgical strategy to ensure complete removal without complications.

INTRODUCTION AND OBJECTIVE:Heterogeneity in locally advanced (LA) Non-Small Cell Lung Cancer (NSCLC) group necessitates a multi-disciplinary approach to its management. Surgery is the standard of care treatment if resectable; otherwise, concurrent chemo-radiation (CCRT) is preferred. This audit aims to analyse various treatment strategies in real-world settings and their resultant outcomes. MATERIALS AND METHODS:Medical records of patients presented to the lung cancer clinic at our centre from January 2014 to December 2018 were retrieved. Cases with stage III NSCLC were included in this retrospective analysis. Demographic and clinical data, treatments offered with associated outcomes and side effects were analysed. The progression-free survival (PFS), and overall survival (OS) were computed using Kaplan-Meier survival curves. Cox proportional hazard model (univariate and multivariate) was used to assess factors affecting PFS and OS. RESULTS:A total of 396 patients of LA NSCLC were eligible for descriptive demography; 53% of them were >60 years of age and male-to-female ratio was 4:1. The proportion of squamous cell carcinoma and adenocarcinoma were 55.8% and 31.3%, respectively. Survival analysis was limited to 310 patients who received any form of cancer treatment. Following multi-disciplinary discussions, the intent of treatment was decided to be curative in 240 of them. Upfront surgical resection was performed in 28 patients (11.6%) with 22 receiving adjuvant chemotherapy. Pre-operative chemotherapy followed by surgery was offered to 20 patients (8.3%). The majority of patients taken for definitive chemo-radiation (CTRT) were treated by induction chemotherapy followed by concurrent CTRT (46 patients = 19.2%). Sequential CTRT (SCRT) was opted for 30 patients (12.5%). Concurrent CTRT (CCRT) was received by only 12 patients (5%). Neoadjuvant chemotherapy (NACT-including preoperative and induction chemotherapy before definitive radiotherapy or CTRT) was administered to 200 patients (83.3%). Of these, 104 patients (43.3%) of NACT were not amenable to curative local treatment later on due to poor performance status (PS), comorbidities, poor cardiopulmonary reserve or logistic issues. The median follow-up was 30.7 months. Survival was assessed by intention to treat analysis. The median PFS and median OS of the curative intent group were 11.9 months (95%CI = 8.99-14.81), and 30.7 months (95%CI = 24.42-36.98), respectively. Upfront resectable patients had longer survival when compared to NACT followed by surgery. Survival outcomes for NACT followed by CCRT were superior to CCRT or SCRT. Both median OS and PFS were found to be superior with surgery plus adjuvant therapy in comparison to definitive CTRT. Long-term survival outcomes were also better with surgical resection. No significant differences in survival outcomes were observed between CCRT and SCRT approaches, likely due to the limited number of patients in the CCRT group. Overall adherence to treatment protocols was 56.7% and adherence to chemotherapy protocols was 50.4%. PS and reception of intended treatment were significant prognostic factors in multivariate analysis for survival. The median PFS and OS of the patients treated with palliative intent were 6.5 months (95% CI: 4.2-12.7), and 9.1 months (95% CI: 3.1-15.7), respectively. CONCLUSION:Whenever feasible, curative intent treatment should be offered to fit LA-NSCLC patients. Although stage-wise comparison was not performed, it was seen that survival is longer when tumour is resectable. Homogenous treatment protocols and well-equipped cancer facilities must be in place to avoid deviations from standard recommendations.

Introduction: Incidental adrenal masses are found in up to 7% of all patients undergoing abdominal imaging. Data from the American College of Surgeons National Surgical Quality Improvement Program suggests that over 95% adrenalectomies are performed by general surgeons. To assess outcomes when surgeries are performed by urologists, we reviewed our database of adrenalectomies performed in the past 17 years. Methods: In this study, we reviewed our database of patients who underwent adrenalectomies between 2008 and 2024 in the department of urology. Clinical parameters were recorded for all patients, including their demographic profile, metabolic and radiological parameters, operative details, and complications. Outcomes were reported, and data for minimally invasive surgery were compared with those for open surgery (OS). Results: During the study period, 320 patients underwent 383 adrenalectomies, including 275 patients (85.9%) who had functional tumors, 69% of which were pheochromocytomas, 15.6% Cushing’s syndrome, and 11.2% Conn’s syndrome. Sixty-three patients had bilateral surgeries. Over 80% (260) patients had laparoscopic surgeries, and an additional 12 were robot-assisted. Six were converted to OS. The mean operative time (122.1 ± 58.3 min vs. 194.1 ± 76.4 min), median blood loss (100 mL vs. 350 mL), and median duration of hospital stay (3 vs. 5 days) were shorter for the minimally invasive approach. The overall complication rate was 6.5%. Conclusions: Adrenalectomy, including bilateral synchronous surgery, is a safe procedure that can be performed by urologists with excellent outcomes.

BACKGROUND:Extranodal extension (ENE) is an important adverse prognostic indicator for head and neck cancers. However, ENE needs further risk stratification in terms of optimum cutoff for the extent of ENE and interaction with clinicopathological risk factors. METHODS:Retrospective single-center study on patients with treatment-naïve head and neck cancer with final histology indicating ENE. RESULTS:Pathological ENE was observed in 122 patients (12.4%). With the 2 mm cutoff separating Mi-ENE and Ma-ENE, no difference was observed in overall survival (OS) and disease-free survival (DFS) for unmatched (OS: 40.9% vs. 33.6%, p = 0.7; DFS: 34.05% vs. 26.12%, p = 0.5) as well as propensity score-matched cohort (OS: HR 1.08, p = 0.82; DFS: HR 0.95, p = 0.89). Receiver-operator curve (ROC) analysis showed the highest area under the curve with a 4 mm cutoff for the extent of ENE (AUC: 0.52). On assessing the impact of adjuvant chemoradiation (CRT) on Ma-ENE and Mi-ENE, only Ma-ENE showed OS (HR: 0.42, 95% CI: 0.18-0.9) and DFS (HR: 0.33, 95% CI: 0.15-0.70) benefit with CRT, which was statistically significant. The revised 4 mm cutoff was predictive of therapeutic benefit with adjuvant CRT (HR: 0.27, 95% CI: 0.1-0.73). Clinicopathological factors with statistically significant interaction with ENE in worsening OS and DFS were tumor location in tongue/floor of mouth (OS), T3/T4 category (OS), depth of invasion greater than 10 mm (OS), ≥ 5 nodes with metastasis (OS), and male sex (DFS). CONCLUSION:The standard 2 mm cutoff for the extent of ENE failed to reveal sufficient hazard discrimination for OS/DFS. Instead, the 4 mm cutoff determined on ROC analysis was found to have the best predictive ability for DFS.

OBJECTIVES:There are notable regional differences in the incidence and mortality of prostate cancer (PCa), whose underlying causes are arguably complex and multifactorial. In this review, we analysed the epidemiology, clinical characteristics, efficacy and safety of therapeutic drugs, prevalence of treatment and testing, and trends in PCa survival in Asian Urological Association member countries. METHODS:To investigate regional differences in incidence, mortality, and survival, we used the latest data from the GLOBOCAN 2022 edition, CONCORD-3 study data, and the International Monetary Fund database. RESULTS:Asian men tend to present with more aggressive forms of PCa than their Caucasian counterparts. Paradoxically, survival outcomes are often better in Asian populations despite their more aggressive disease profiles. According to the GLOBOCAN 2022 data, PCa incidence is the highest in North America, Oceania, and Europe, but the lowest in incidence and mortality in Asian countries, despite varying significantly across these countries. Many developing Asian countries continue to experience rising mortality rates from PCa, largely due to limited access to PCa screening and disparities in healthcare infrastructure. While PCa treatments demonstrate comparable effectiveness in Asian populations to that in global trials, access to these therapies remains highly variable across the Asia-Pacific region, highlighting the need for access to improved healthcare policies and systems. In developing Asian nations, the 5-year survival rate (5Y-SR) is shown to be positively correlated with gross domestic product (GDP) per capita, suggesting that economic factors play a key determinant in PCa outcomes in these regions. CONCLUSIONS:Our analysis reveals stark disparities between developed and developing Asian countries, particularly in mortality-to-incidence ratios, prostate-specific antigen screening coverage, access to novel therapeutics, and reimbursement policies. Despite medical advances, economic status and health policy infrastructure remain key determinants of PCa outcomes in Asia. Moreover, our analysis of 5Y-SR relative to GDP per capita underscores the colossal impact of the latter on PCa prognosis.

CONTEXT.—:Salivary gland (SG) neoplasms (SGNs) display considerable immunophenotypic diversity. A significant proportion of SG carcinomas develop metastases, with increased diagnostic difficulty at metastatic sites. Transcriptional repressor GATA binding 1 (TRPS1), a novel immunohistochemical marker for breast cancer, has been found to stain certain SGNs. OBJECTIVE.—:To investigate TRPS1 and SRY-related HMG-box 10 (SOX10) immunoexpression in various SGNs and non-SG carcinomas, head and neck paragangliomas, and head and neck mucosal melanomas. DESIGN.—:TRPS1 immunoreactivity score (IRS) was determined as negative or low, intermediate, or high positive; SOX10 was reported as negative or positive. RESULTS.—:One hundred forty-eight SGNs, 5 breast carcinomas, 105 nonbreast-non-SG carcinomas, including 33 head and neck squamous cell carcinomas (HNSCCs), 6 head and neck paragangliomas, and 6 head and neck mucosal melanomas, were assessed for TRPS1. All 23 benign SGNs showed TRPS1 positivity, with the majority having high-positive IRS (17 of 23 cases; 74%). Among 125 SG carcinomas, 115 of 125 (92%) were TRPS1 positive, with high-positive IRS in 94 of 125 (75%), intermediate-positive IRS in 15 of 125 (12%), and low-positive IRS in 6 of 125 (5%). Among nonbreast-non-SG carcinomas, HNSCC, lung, thyroid, kidney, and ovarian carcinomas showed frequent TRPS1 staining. Nearly half of HNSCCs had high (11 of 18; 33%) or intermediate (4 of 18; 12%) positive IRS. Mean IRS in SG carcinomas was significantly higher than that in nonbreast-non-SG carcinomas (P < .001). None of the TRPS1-positive nonbreast-non-SG carcinomas expressed SOX10. CONCLUSIONS.—:TRPS1 is positive in most benign and malignant SGNs. Its expression in several nonbreast-non-SG carcinomas indicates that it lacks specificity for breast and SG carcinomas, even if considering only high-positive IRS. Addition of SOX10 can increase the discriminatory utility of TRPS1.