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Background: The increasing incidence, rapidly evolving classification, rarity and heterogeneity of neuroendocrine neoplasms (NENs) pose challenges to NEN registration including difficulty in distinguishing neuroendocrine carcinoma (NEC) and neuroendocrine tumours (NETs). Thus, in Italy a higher NEC incidence was reported. Focusing on gastroenteropancreatic (GEP) NEN, we aimed to review GEP NEN, and in particular cases of neuroendocrine carcinoma, not otherwise specified (NOS) and estimate the incidence of NEN, NET and NEC of the GEP.MethodsWe launched a pilot study examining cases of neuroendocrine carcinomas NOS (ICD-O3 code 8246) of GEP incidents in the years 2012-2020. Cancer registries (CRs) reviewed information included in the pathology report regarding differentiation and tumour cells proliferation to decide whether to confirm the case as neuroendocrine carcinoma NOS or register it as NET or NEC. After the review, we estimated the GEP NEN, NET and NEC incidence.

Results: Nine CRs contributed to the pilot study. After review, in all CRs, only 31% of GEP NOS neuroendocrine carcinomas were confirmed; 50% were recoded as NETs, and approximately 17% of cases were non-NENs. The IR of GEP NENs was 2.99/100,000, and the incidence of NETs was higher than that of NECs.

Conclusion: After the review, the incidence of GEP NEN, NET and NEC in the eight Italian CRs involved was comparable to that reported in other European countries.

Impact: Our results confirmed that heterogeneity of cancer registries in the registration of NEN requires collaborative work to define and promote a standard definition to be extended to all Italian registries.

Evidence from randomized trials regarding adjuvant chemotherapy and its impact on survival in older patients with resected breast cancer is limited. This study evaluates the current evidence on the use of adjuvant chemotherapy and its effects on overall mortality and breast cancer-specific mortality in older patients. A systematic review and meta-analysis were conducted on the impact of adjuvant chemotherapy in elderly patients with HER2-negative breast cancer. Searches in PubMed, Embase, and The Cochrane Library up to May 2024 included terms such as "breast cancer," "adjuvant," "chemotherapy," "elderly," and "HER2-negative." Eligible studies involved women aged 65 years or older with HER2-negative breast cancer, comparing those receiving adjuvant chemotherapy versus those who did not. Excluded were studies on neoadjuvant therapy, HER2-positive disease, or non-English publications. The primary outcome was overall mortality. Among 2345 articles, 35 studies met the inclusion criteria, comprising 376,900 patients. Adjuvant chemotherapy significantly reduced overall mortality (hazard ratio [HR] = 0.73; 95% CI: 0.68-0.78) and breast cancer-specific mortality (HR = 0.81; 95% CI: 0.73-0.9), with the most pronounced benefit in triple-negative breast cancer (HR = 0.63; 95% CI: 0.60-0.67). Adjuvant chemotherapy reduces overall mortality and breast cancer-specific mortality in older patients, particularly those with triple-negative breast cancer. However, the evidence is predominantly based on retrospective or observational studies, highlighting inherent limitations. Comprehensive geriatric evaluations are crucial for patient selection, and dedicated clinical trials focused on older populations are urgently needed.

Purpose: This study aimed to validate a CT-based radiomics signature for predicting Kirsten rat sarcoma (KRAS) mutation status in lung adenocarcinoma (LADC).

Materials and methods: A total of 815 LADC patients were included. Radiomics features were extracted from non-contrast-enhanced CT (NECT) and contrast-enhanced CT (CECT) images using Pyradiomics. CT-based radiomics were combined with clinical features to distinguish KRAS mutation status. Four feature selection methods and four deep learning classifiers were employed. Data was split into 70% training and 30% test sets, with SMOTE addressing imbalance in the training set. Model performance was evaluated using AUC, accuracy, precision, F1 score, and recall.

Results: The analysis revealed that 10.4% of patients showed KRAS mutations. The study extracted 1061 radiomics features and combined them with 17 clinical features. After feature selection, two signatures were constructed using top 10, 20, and 50 features. The best performance was achieved using Multilayer Perceptron with 20 features. CECT, it showed 66% precision, 76% recall, 69% F1-score, 84% accuracy, and AUC of 93.3% and 87.4% for train and test sets, respectively. For NECT, accuracy was 85% and 82%, with AUC of 90.7% and 87.6% for train and test sets, respectively.

Conclusions: CT-based radiomics signature is a noninvasive method that can predict KRAS mutation status of LADC when mutational profiling is unavailable.

Purpose: Professional quality of life (QoL) is crucial for healthcare workers as it affects performance at work and interaction with patients, but little is known about stressors influencing radiation oncology professionals. The present study aims to explore the professional QoL of radiation oncologists (ROs) and radiation therapists (RTTs) in an Italian radiotherapy department and to report data about the possible impact of personality factors, such as alexithymia and empathy.

Material and methods: Participants filled out three validated questionnaires measuring the professional QoL, alexithymia, and empathy: (i) Professional Quality of Life Scale (ProQOL); (ii) Toronto Alexithymia Scale (TAS-20); (iii) Interpersonal Reactivity Index (IRI). Correlation, regression analyses and non-parametric tests were run.

Results: A total of 48 professionals completed the survey (66.7% ROs, 33.3% RTTs). Considering the ProQOL dimensions, moderate levels of risk for burnout (BO) and secondary traumatic stress (STS) were found. BO was found to be predictive by TAS-20 total score (β=.37, p=.010), while STS resulted to be predictive by TAS-20 total score (β=.54, p <.001) and IRI Empathic Concern subscale (β=.45, p <.001). No significant differences were found between ROs and RTTs for all the considered variables, except for TAS-20 total score (p=.032), higher for RTTs.

Conclusions: Results showed no evidence of high risk of burnout and no intrinsic differences regarding the professional QoL between ROs and RTTs. Findings suggest a significant role of alexithymia and empathy predicting professional QoL. These results underscore the importance of promoting a positive work environment and emotional competencies to prevent high stress levels.

Introduction: In the literature, the data about the factors related to the choice of the setting at patient's first palliative care admission visit are scanty. In fact it seems that the choice between home or hospice care is mainly based on the opinions and needs of patients, families and physicians. This study aims to address the association between the clinical factors detected at the first palliative visit in advanced cancer patients and the choice of palliative care setting (i.e., hospice or home care).

Methods: This is a monocentric, prospective cohort study. A total of 1811 consecutive patients with advanced cancer, admitted to the VIDAS Palliative Care service (hospice/ home care), Milan, Italy in 2018-2020 were included.

Results: In the univariate analysis, several clinical comorbidities and physiological deficits were associated with hospice admittance; while patients with more severe symptoms of anxiety, asthenia, depression, and pain were associated with home care admittance. In the multivariate logistic analysis, six clinical factors were associated with the risk of hospice admission: anxiety (OR 0.16), brain metastases (OR 1.67), severe sleep-wake rhythm upset (OR 1.79), bone/vertebral fractures (OR 2.12), intestinal occlusion or sub-occlusion (OR 2.16), and cachexia (OR 2.25). The multivariate cluster analysis confirmed the link observed with the previous statistical analyses.

Conclusion: The results of this analysis showed that some clinical factors were closely related to the chosen palliative care setting and should be taken into consideration a priori to deciding the most appropriate place of care.

Objectives: Concurrence of pregnancy and cancer diagnosis is increasingly frequent in Italy. The study aimed to compare women with pregnancy-associated cancers (PACs) to those of childbearing age, focusing on fertility, induced abortion, and miscarriage.

Methods: The population-based study included women aged 15-49 years, both with and without PAC, who were residents in the area covered by the 19 participating Cancer Registries between 2003 and 2015 and identified by individual deterministic linkage with the Hospital Discharge Database.

Results: Overall, 2,218,139 obstetrics hospitalizations occurred, covering delivery (75%), induced abortion (14%), and miscarriage (11%). Among 2409 women with PAC, 69% gave birth, 16% had an induced abortion and 15% a miscarriage. Compared with the reference population, the fertility rate in women with PACs was steadily lower (mean values 25.7/1000 vs 37.7/1000), while induced abortion (from 359/1000 - SRR 1.99, 95%CI 1.32-3.00 - in 2003 to 147/1000 - SRR 1.11, 95%CI 0.59-2.09 - in 2015) and miscarriage ratios exhibited a decreasing trend.

Conclusion: These results are consistent with international literature and are probably due to advancements in diagnostic and therapeutic opportunities. This is the first Italian population-based study analysing fertility and pregnancy outcomes among women with PAC based on a reliable information on cancer diagnosis.

This article analyses the integration of artificial intelligence (AI) in health pastoral care, emphasizing the synergy between technology and spirituality. This paper discusses possible AI applications, highlighting the importance of ethical implementation that respects human interactions. Ethical issues like privacy and empathy are examined, as well as the potential of AI in facilitating collaboration between healthcare professionals and pastoral workers. Finally, it calls for a debate on the responsible use of AI in care contexts.

The Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) is Italy's first cooperative oncology research group, evolving to conduct academic clinical trials since 1985. With 167 publications and collaborations with national and international partners, GOIRC has significantly impacted clinical practices. The group emphasizes training and has developed robust internal standard operative procedures (SOPs) to enhance data quality. GOIRC is poised to tackle future challenges in translational research, focusing on innovative trial designs, precision medicine, and leveraging different laboratory resources across its 42 units.

O-linked-N-acetylglucosaminylation (O-GlcNAcylation), one of the protein post-translational modifications, is the process of adding O-linked-β-D-N-acetylglucosaminylation (O-GlcNAc) to serine and threonine residues of proteins. O-GlcNAcylation regulates various fundamental cell biological processes, including gene transcription, signal transduction, and cellular metabolism. The role of dysregulated O-GlcNAcylation in tumorigenesis has been recognized, but its role in cancer therapy tolerance has not been elucidated. Therefore, this paper provides the latest evidence on the role of O-GlcNAcylation in cancer therapy responsiveness to understand the impact of O-GlcNAcylation on cancer therapy outcomes, as well as analyzing several possible mechanisms by which O-GlcNAcylation dysregulation affects cancer therapy efficacy, and discusses the possibility of O-GlcNAcylation as a cancer therapy sensitizer.

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care. Here, the essential requirements to treat ovarian cancer patients are described. Ovarian cancer patients continue to have low cure rates with wide variation in treatment and care in Europe and beyond. They require complex treatment that should be carried out in specialised ovarian/gynaecological cancer centres by professionals with the appropriate expertise interacting in a multidisciplinary team. Such centralisation is still not well established in many European countries. A patient-centred pathway from diagnosis through treatment to survivorship, managed in dedicated centres, is key to achieving optimal care and a successful clinical outcome.