Orbital metastases are rare in patients with breast cancer. However, medical management of orbital metastases is limited by the inability of treatment options to penetrate the blood-brain barrier. In patients with triple negative breast cancer (TNBC), these treatment options are further limited. Sacituzumab govitecan, an antibody-drug conjugate, has emerged as a promising agent for metastatic TNBC. However, to date, patients with central nervous system (CNS) disease have been excluded from corresponding clinical trials, making the efficacy of sacituzumab govitecan in patients with orbital metastases unclear.
Case
A 61-year-old female was initially diagnosed with a left breast hormone receptor positive invasive ductal carcinoma, receiving neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and docetaxel and a partial mastectomy. Several years later, the patient presented with a cough and was subsequently diagnosed with metastatic triple negative breast cancer with hepatic, osseous, and right supraclavicular and thoracic nodal metastases. Concurrently, the patient noted floaters in her vision, later found to be consistent with orbital metastases. The patient received radiation therapy to both eyes and was started on Sacituzumab govitecan. Following cycle 1, the ophthalmic exam showed a dramatic decrease in the size of choroidal metastases.
Conclusion
This case report documents the first case of orbital metastases successfully treated with radiation therapy and sacituzumab govitecan. As such, this case highlights the importance of sacituzumab govitecan as a potentially effective option for TNBC patients with CNS disease. Further studies and real-world data are needed to investigate the efficacy of combined radiotherapy and sacituzumab govitecan toward ocular metastases.
{"title":"Triple Negative Breast Cancer With Choroidal Metastasis Responsive to Sacituzumab Govitecan and Radiation Therapy","authors":"Nellie Nafissi, Aditya Mahadevan, Elaine Chiao, Nejina Rijal, Ritesh Parajuli","doi":"10.1002/cnr2.70462","DOIUrl":"10.1002/cnr2.70462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Orbital metastases are rare in patients with breast cancer. However, medical management of orbital metastases is limited by the inability of treatment options to penetrate the blood-brain barrier. In patients with triple negative breast cancer (TNBC), these treatment options are further limited. Sacituzumab govitecan, an antibody-drug conjugate, has emerged as a promising agent for metastatic TNBC. However, to date, patients with central nervous system (CNS) disease have been excluded from corresponding clinical trials, making the efficacy of sacituzumab govitecan in patients with orbital metastases unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>A 61-year-old female was initially diagnosed with a left breast hormone receptor positive invasive ductal carcinoma, receiving neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and docetaxel and a partial mastectomy. Several years later, the patient presented with a cough and was subsequently diagnosed with metastatic triple negative breast cancer with hepatic, osseous, and right supraclavicular and thoracic nodal metastases. Concurrently, the patient noted floaters in her vision, later found to be consistent with orbital metastases. The patient received radiation therapy to both eyes and was started on Sacituzumab govitecan. Following cycle 1, the ophthalmic exam showed a dramatic decrease in the size of choroidal metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case report documents the first case of orbital metastases successfully treated with radiation therapy and sacituzumab govitecan. As such, this case highlights the importance of sacituzumab govitecan as a potentially effective option for TNBC patients with CNS disease. Further studies and real-world data are needed to investigate the efficacy of combined radiotherapy and sacituzumab govitecan toward ocular metastases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil (5-FU)/levo-leucovorin (Levo-LV) therapy is recommended as the standard of care for unresectable locally advanced (UR-LA) and metastatic pancreatic cancer after failure of gemcitabine-containing regimens. Although the concomitant administration of nal-IRI and Levo-LV benefits from a reduced hospital stay, nal-IRI is usually administered after Levo-LV owing to insufficient data on compatibility reactions. This study aimed to compare the safety and efficacy of the sequential and concomitant administration of nal-IRI and Levo-LV.
Methods
Data of patients with UR-LA or metastatic pancreatic cancer who received nal-IRI plus 5-FU/Levo-LV between 2020 and 2023 at Shizuoka Cancer Center were retrospectively collected. Patients were classified into the sequential administration group (Group S) and concomitant administration group (Group C) to compare adverse events, infusion time, and survival. Univariate and multivariate analyses were performed to identify independent prognostic factors in each group.
Results
A total of 94 patients were included (44 in Group S and 50 in Group C). There was no significant difference in the incidence of Grade 3 or higher adverse events between the two groups. The median total infusion times for nal-IRI plus 5-FU/Levo-LV in Groups S and C were 271 and 149 min, respectively (p < 0.001). Overall survival estimates were 5.6 months (95% confidence interval [CI] 3.78–8.57) in Group S and 8.4 months (95% CI 6.77–10.3) in Group C (unstratified HR 0.65, 95% CI 0.42–1.02; p = 0.058). In the multivariate analysis for PFS and OS, the method of administration was not identified as an independent prognostic factor. Concomitant administration of Levo-LV with nal-IRI may not increase adverse events or impact efficacy while reducing infusion time.
Conclusion
Concomitant administration of Levo-LV with nal-IRI may not increase adverse events or impact efficacy compared to sequential administration.
背景：纳米脂体伊立替康（nal-IRI）加5-氟尿嘧啶(5-FU)/左旋亚叶酸钙（lev - lv）治疗被推荐为吉西他滨治疗失败后不可切除的局部晚期（UR-LA）和转移性胰腺癌的标准治疗。虽然同时使用nal-IRI和左左- lv可减少住院时间，但由于相容性反应数据不足，通常在左左- lv之后使用nal-IRI。本研究旨在比较nal-IRI和lev - lv序贯和同时给药的安全性和有效性。方法：回顾性收集2020年至2023年在静冈癌症中心接受nal-IRI + 5-FU/ lev - lv治疗的UR-LA或转移性胰腺癌患者的资料。将患者分为序贯给药组（S组）和伴随给药组（C组），比较不良事件、输注时间和生存期。进行单因素和多因素分析，以确定每组的独立预后因素。结果：共纳入94例患者（S组44例，C组50例）。两组患者3级及以上不良事件的发生率无显著差异。S组和C组nal-IRI加5-FU/左旋- lv的中位总输注时间分别为271 min和149 min (p)。结论：与序贯给药相比，左旋- lv与nal-IRI同时给药可能不会增加不良事件或影响疗效。
{"title":"Safety and Efficacy of Concomitant Administration of Nanoliposomal Irinotecan + 5-Fluorouracil/Levo-Leucovorin for Pancreatic Cancer","authors":"Akane Wakabayashi, Rei Tanaka, Yurie Fukumuro, Keita Mori, Junya Sato, Hiroshi Ishikawa, Michihiro Shino, Takeshi Kawakami","doi":"10.1002/cnr2.70485","DOIUrl":"10.1002/cnr2.70485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil (5-FU)/<i>levo</i>-leucovorin (<i>Levo</i>-LV) therapy is recommended as the standard of care for unresectable locally advanced (UR-LA) and metastatic pancreatic cancer after failure of gemcitabine-containing regimens. Although the concomitant administration of nal-IRI and <i>Levo</i>-LV benefits from a reduced hospital stay, nal-IRI is usually administered after <i>Levo</i>-LV owing to insufficient data on compatibility reactions. This study aimed to compare the safety and efficacy of the sequential and concomitant administration of nal-IRI and <i>Levo</i>-LV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of patients with UR-LA or metastatic pancreatic cancer who received nal-IRI plus 5-FU/Levo-LV between 2020 and 2023 at Shizuoka Cancer Center were retrospectively collected. Patients were classified into the sequential administration group (Group S) and concomitant administration group (Group C) to compare adverse events, infusion time, and survival. Univariate and multivariate analyses were performed to identify independent prognostic factors in each group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 94 patients were included (44 in Group S and 50 in Group C). There was no significant difference in the incidence of Grade 3 or higher adverse events between the two groups. The median total infusion times for nal-IRI plus 5-FU/Levo-LV in Groups S and C were 271 and 149 min, respectively (<i>p</i> < 0.001). Overall survival estimates were 5.6 months (95% confidence interval [CI] 3.78–8.57) in Group S and 8.4 months (95% CI 6.77–10.3) in Group C (unstratified HR 0.65, 95% CI 0.42–1.02; <i>p</i> = 0.058). In the multivariate analysis for PFS and OS, the method of administration was not identified as an independent prognostic factor. Concomitant administration of <i>Levo</i>-LV with nal-IRI may not increase adverse events or impact efficacy while reducing infusion time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Concomitant administration of <i>Levo</i>-LV with nal-IRI may not increase adverse events or impact efficacy compared to sequential administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cnr2.70485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minlian Nong, Weifeng Wei, Naijian Li, Yunxiang Zeng, Jinlin Wang
Background
Primary mediastinal malignant melanoma (PMMM) presenting with pleural effusion as the initial manifestation is exceedingly rare, presenting significant diagnostic and therapeutic challenges. This article reports a case of PMMM that initially manifested as pleural effusion and includes a review of the relevant literature.
Case
The patient was admitted with pleural effusion and an anterior mediastinal mass. A pleural biopsy and fine-needle aspiration of the mediastinal mass led to a pathological diagnosis of malignant melanoma. Ultimately, based on clinical findings, a final diagnosis of PMMM was established. The patient subsequently developed pleural hemorrhage; although hemostasis was achieved through thoracoscopy, his condition stabilized only temporarily. He ultimately succumbed to lung infection and multiple organ failure.
Conclusion
PMMM presenting with pleural effusion lacks distinct clinical features, highlighting the importance of pathological diagnosis. Pleural hemorrhage associated with pleural metastasis may be a characteristic feature, and the prognosis for such cases is poor. Enhanced recognition and early intervention are essential to improve outcomes.
{"title":"Primary Mediastinal Malignant Melanoma Presenting With Pleural Effusion: A Case Report","authors":"Minlian Nong, Weifeng Wei, Naijian Li, Yunxiang Zeng, Jinlin Wang","doi":"10.1002/cnr2.70484","DOIUrl":"10.1002/cnr2.70484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Primary mediastinal malignant melanoma (PMMM) presenting with pleural effusion as the initial manifestation is exceedingly rare, presenting significant diagnostic and therapeutic challenges. This article reports a case of PMMM that initially manifested as pleural effusion and includes a review of the relevant literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>The patient was admitted with pleural effusion and an anterior mediastinal mass. A pleural biopsy and fine-needle aspiration of the mediastinal mass led to a pathological diagnosis of malignant melanoma. Ultimately, based on clinical findings, a final diagnosis of PMMM was established. The patient subsequently developed pleural hemorrhage; although hemostasis was achieved through thoracoscopy, his condition stabilized only temporarily. He ultimately succumbed to lung infection and multiple organ failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PMMM presenting with pleural effusion lacks distinct clinical features, highlighting the importance of pathological diagnosis. Pleural hemorrhage associated with pleural metastasis may be a characteristic feature, and the prognosis for such cases is poor. Enhanced recognition and early intervention are essential to improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lu Sun, Fan Luo, Yajuan Zhou, Xiyou Liu, Pingping Zhang, Dan Li, Yi Peng
Purpose: Spinal metastases may cause pain, neurological compromise, paraplegia, and limb movement disorders; their management requires a comprehensive approach. Alongside systemic anti-tumor therapies, focal interventions such as radiotherapy, bone-modifying agents, and surgery are crucial for slowing disease progression and managing pain in spinal metastases. However, substantial variations exist in radiotherapy regimens for spinal metastases. In this study, we aimed to investigate the safety and efficacy of hypofractionated radiation therapy (HFRT) regimens at our hospital, specifically to evaluate pain relief and incidence of re-irradiation after HFRT.
Methods: In this retrospective study, data from 58 patients diagnosed with spinal metastasis who received HFRT (4.5-10Gy * 3-7F) at our center between December 2017 and June 2022 were analyzed. All patients were followed up from the initiation of HFRT to either death or their last follow-up visit. Degree of pain was assessed using the numeric rating scale (NRS) before and after 1 month of HFRT. A multivariate Cox regression model was established to identify the independent risk factors for prognostic analysis of spinal metastasis.
Results: HFRT could effectively manage pain in patients with spinal metastasis. The pain scores were significantly decreased after HFRT (3.43 vs. 1.5, p < 0.001), with 84.5% patients experiencing improved pain relief 1 month after radiotherapy. No cases of radiation myelitis were observed during the follow-up period. Furthermore, the incidence of re-radiotherapy was significantly increased in patients with spinal metastases who received moderate HFRT (< 5 Gy/day) (p = 0.01, HR = 0.43).
Conclusion: HFRT significantly reduced pain scores and reirradiation rates without increasing radiation myelitis incidence for spinal metastases.
目的：脊柱转移可能导致疼痛、神经系统损害、截瘫和肢体运动障碍；他们的管理需要一个综合的方法。除了全身抗肿瘤治疗外，局部干预如放疗、骨修饰剂和手术对于减缓疾病进展和控制脊柱转移的疼痛至关重要。然而，脊髓转移的放疗方案存在实质性差异。在本研究中，我们旨在探讨我院低分割放射治疗（HFRT）方案的安全性和有效性，特别是评估HFRT后的疼痛缓解和再照射发生率。方法：回顾性分析2017年12月至2022年6月在本中心接受HFRT （4.5-10Gy * 3-7F）治疗的58例脊柱转移患者的数据。从HFRT开始到死亡或最后一次随访，对所有患者进行随访。采用数值评定量表（NRS）对HFRT前后1个月的疼痛程度进行评估。建立多变量Cox回归模型，以确定脊柱转移预后分析的独立危险因素。结果：HFRT能有效控制脊柱转移患者的疼痛。HFRT后疼痛评分显著降低（3.43 vs. 1.5, p）。结论：HFRT显著降低疼痛评分和再照射率，且未增加脊柱转移性放射性脊髓炎的发生率。
{"title":"Hypofractionated Radiation Therapy for Pain Relief of Patients With Spinal Metastasis: A Real-World Analysis.","authors":"Lu Sun, Fan Luo, Yajuan Zhou, Xiyou Liu, Pingping Zhang, Dan Li, Yi Peng","doi":"10.1002/cnr2.70451","DOIUrl":"10.1002/cnr2.70451","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal metastases may cause pain, neurological compromise, paraplegia, and limb movement disorders; their management requires a comprehensive approach. Alongside systemic anti-tumor therapies, focal interventions such as radiotherapy, bone-modifying agents, and surgery are crucial for slowing disease progression and managing pain in spinal metastases. However, substantial variations exist in radiotherapy regimens for spinal metastases. In this study, we aimed to investigate the safety and efficacy of hypofractionated radiation therapy (HFRT) regimens at our hospital, specifically to evaluate pain relief and incidence of re-irradiation after HFRT.</p><p><strong>Methods: </strong>In this retrospective study, data from 58 patients diagnosed with spinal metastasis who received HFRT (4.5-10Gy * 3-7F) at our center between December 2017 and June 2022 were analyzed. All patients were followed up from the initiation of HFRT to either death or their last follow-up visit. Degree of pain was assessed using the numeric rating scale (NRS) before and after 1 month of HFRT. A multivariate Cox regression model was established to identify the independent risk factors for prognostic analysis of spinal metastasis.</p><p><strong>Results: </strong>HFRT could effectively manage pain in patients with spinal metastasis. The pain scores were significantly decreased after HFRT (3.43 vs. 1.5, p < 0.001), with 84.5% patients experiencing improved pain relief 1 month after radiotherapy. No cases of radiation myelitis were observed during the follow-up period. Furthermore, the incidence of re-radiotherapy was significantly increased in patients with spinal metastases who received moderate HFRT (< 5 Gy/day) (p = 0.01, HR = 0.43).</p><p><strong>Conclusion: </strong>HFRT significantly reduced pain scores and reirradiation rates without increasing radiation myelitis incidence for spinal metastases.</p>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":"e70451"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Renal cell carcinoma (RCC), a prevalent malignancy in China, manifests annually in excess of 70 000 instances. At initial diagnosis, approximately one-tenth of these patients present with metastatic disease. The predominant sites for distant dissemination encompass pulmonary, osseous, hepatic, and adrenal regions, whereas gastric involvement remains exceedingly rare. We clinically characterized a case by postprandially abdominal discomfort, which was endoscopic-biopsy confirmed as a gastric tumor, and further diagnosis revealed the primary malignancy was kidney-originated.
Case: A 68-year-old male was admitted to our hospital for the evaluation of persistent postprandial abdominal pain and diarrhea that had persisted for 1 month. Gastroscopy revealed a gastric body tumor, leading to the performance of an endoscopic submucosal dissection (ESD). The initial pathological examination identified the tumor as gastric malignancy of undetermined origin. Concurrently, a comprehensive abdominal CT scan detected an additional renal tumor. Subsequent radical nephrectomy of the right kidney was performed, and the pathology confirmed the renal cell carcinoma shared the same origin as the gastric lesion. Over a follow-up period of 38 months postoperatively, there has been no evidence of tumor recurrence or progression.
Conclusion: Renal cell carcinoma has the potential to metastasize to the stomach, albeit this occurrence is not readily detectable in clinical practice unless it manifests as gastric symptoms. In instances where solitary superficial gastric metastasis is identified, aggressive surgical intervention can yield satisfactory clinical outcomes.
{"title":"Metastatic Renal Cell Carcinoma Detected by Postprandial Abdominal Pain: A Case Report.","authors":"Xinguang Wang, Nian Zhang, Shaowen Zeng","doi":"10.1002/cnr2.70490","DOIUrl":"https://doi.org/10.1002/cnr2.70490","url":null,"abstract":"<p><strong>Background: </strong>Renal cell carcinoma (RCC), a prevalent malignancy in China, manifests annually in excess of 70 000 instances. At initial diagnosis, approximately one-tenth of these patients present with metastatic disease. The predominant sites for distant dissemination encompass pulmonary, osseous, hepatic, and adrenal regions, whereas gastric involvement remains exceedingly rare. We clinically characterized a case by postprandially abdominal discomfort, which was endoscopic-biopsy confirmed as a gastric tumor, and further diagnosis revealed the primary malignancy was kidney-originated.</p><p><strong>Case: </strong>A 68-year-old male was admitted to our hospital for the evaluation of persistent postprandial abdominal pain and diarrhea that had persisted for 1 month. Gastroscopy revealed a gastric body tumor, leading to the performance of an endoscopic submucosal dissection (ESD). The initial pathological examination identified the tumor as gastric malignancy of undetermined origin. Concurrently, a comprehensive abdominal CT scan detected an additional renal tumor. Subsequent radical nephrectomy of the right kidney was performed, and the pathology confirmed the renal cell carcinoma shared the same origin as the gastric lesion. Over a follow-up period of 38 months postoperatively, there has been no evidence of tumor recurrence or progression.</p><p><strong>Conclusion: </strong>Renal cell carcinoma has the potential to metastasize to the stomach, albeit this occurrence is not readily detectable in clinical practice unless it manifests as gastric symptoms. In instances where solitary superficial gastric metastasis is identified, aggressive surgical intervention can yield satisfactory clinical outcomes.</p>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":"e70490"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renan Brito Gadelha, Beatriz Maria Dias Nogueira, Caio Bezerra Machado, Flávia Melo Cunha de Pinho Pessoa, Anna Karolyna da Costa Machado, Germison Silva Lopes, Paulo Henrique Silva Rodrigues, Henrique Girão Martins, Deivide de Sousa Oliveira, Rodrigo Monteiro Ribeiro, Ricardo Parente Garcia Vieira, Manoel Odorico de Moraes Filho, Maria Elisabete Amaral de Moraes, André Salim Khayat, Caroline Aquino Moreira-Nunes
Background: Acute myeloid leukemia (AML) is a prevalent hematologic malignancy in adults, marked by clonal disorders in hematopoietic cells, rapid progression, and genetic heterogeneity. The WRAP53 gene, which is associated with genomic stability due to its involvement in activities, such as DNA repair, TP53 regulation, and association with telomerase (hTERT), was the focus of this study.
Aims: This study aimed to identify new potential molecular markers with prognostic value, based on specific targets, in order to contribute to a more accurate stratification of patients.
Methods and results: We assessed WRAP53 and hTERT expression in 110 AML patients classified according to World Health Organization (WHO) guidelines. Using real-time quantitative PCR, we investigated their expression and correlation with clinical outcome variables. WRAP53 expression was significantly decreased in AML patients compared to controls, whereas we did not detect differences in hTERT expression. Correlation analysis revealed a moderate positive relationship between WRAP53 and hTERT expression. Concerning the clinical parameters analyzed, significant differences were observed for WRAP53 in terms of sex and age, whereas for hTERT, no differences in the parameters analyzed were observed. Overall survival analysis did not reveal a significant difference for either WRAP53 or hTERT. The results presented demonstrate a downregulation of WRAP53 in the studied sample and that, furthermore, the expression of the WRAP53 and hTERT genes was correlated. In addition, the expression of hTERT, which is already indicated as a biomarker in AML, could not be correlated with the clinical characteristics analyzed in this study.
Conclusion: We also suggest that the low expression of WRAP53 may be associated with other mechanisms in AML, such as DNA repair, thus becoming a possible new promising molecular biomarker related to genomic stability in AML.
{"title":"WRAP53 is Downregulated in Acute Myeloid Leukemia Patients and Positively Correlates With HTERT Expression.","authors":"Renan Brito Gadelha, Beatriz Maria Dias Nogueira, Caio Bezerra Machado, Flávia Melo Cunha de Pinho Pessoa, Anna Karolyna da Costa Machado, Germison Silva Lopes, Paulo Henrique Silva Rodrigues, Henrique Girão Martins, Deivide de Sousa Oliveira, Rodrigo Monteiro Ribeiro, Ricardo Parente Garcia Vieira, Manoel Odorico de Moraes Filho, Maria Elisabete Amaral de Moraes, André Salim Khayat, Caroline Aquino Moreira-Nunes","doi":"10.1002/cnr2.70464","DOIUrl":"https://doi.org/10.1002/cnr2.70464","url":null,"abstract":"<p><strong>Background: </strong>Acute myeloid leukemia (AML) is a prevalent hematologic malignancy in adults, marked by clonal disorders in hematopoietic cells, rapid progression, and genetic heterogeneity. The WRAP53 gene, which is associated with genomic stability due to its involvement in activities, such as DNA repair, TP53 regulation, and association with telomerase (hTERT), was the focus of this study.</p><p><strong>Aims: </strong>This study aimed to identify new potential molecular markers with prognostic value, based on specific targets, in order to contribute to a more accurate stratification of patients.</p><p><strong>Methods and results: </strong>We assessed WRAP53 and hTERT expression in 110 AML patients classified according to World Health Organization (WHO) guidelines. Using real-time quantitative PCR, we investigated their expression and correlation with clinical outcome variables. WRAP53 expression was significantly decreased in AML patients compared to controls, whereas we did not detect differences in hTERT expression. Correlation analysis revealed a moderate positive relationship between WRAP53 and hTERT expression. Concerning the clinical parameters analyzed, significant differences were observed for WRAP53 in terms of sex and age, whereas for hTERT, no differences in the parameters analyzed were observed. Overall survival analysis did not reveal a significant difference for either WRAP53 or hTERT. The results presented demonstrate a downregulation of WRAP53 in the studied sample and that, furthermore, the expression of the WRAP53 and hTERT genes was correlated. In addition, the expression of hTERT, which is already indicated as a biomarker in AML, could not be correlated with the clinical characteristics analyzed in this study.</p><p><strong>Conclusion: </strong>We also suggest that the low expression of WRAP53 may be associated with other mechanisms in AML, such as DNA repair, thus becoming a possible new promising molecular biomarker related to genomic stability in AML.</p>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":"e70464"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniela Mendiola, Betsaida Ortiz, Oscar Nieto, Marisol I González, Danielle Vannan, Bertus Eksteen, Alejandro Martínez, Diego Mateos, Mónica G Mendoza-Rodríguez, Miriam Rodríguez-Sosa, Luis I Terrazas, José L Reyes
Background: Autophagy-related proteins (ATGs) regulate a great variety of cellular responses beyond autophagy. In cancer, the role of ATG proteins is central, as evidenced in spontaneous cancer emerging in animals lacking ATG proteins.
Aim: To determine whether ATG16L1 may be participating in tumorigenesis in colonic and oral mucosa and its likely association with adaptive immune cell deregulation (e.g., B cells).
Methods: Wild-type (WT) and ATG16L1 hypomorphic mice (ATG16L1HM) were induced with colitis-associated colon cancer (CAC) by delivering azoxymethane (AOM) and dextran sodium sulfate (DSS), whereas oral cancer was generated by administering 4-nitroquinoline-1-oxide (4NQO) in tap water. Tissue samples were collected and the histopathological damage was assessed. Also, secondary lymphoid organs (i.e., spleen and draining lymph nodes) were assayed for cytokine output and lymphocyte distribution by means of flow cytometry, and IgG levels were assayed in plasma samples.
Results: ATG16L1HM animals turned out to be more susceptible to colon and oral carcinogenesis than WT mice. In CAC, WT mice preserved colon length and presented individual colonic tumors, whereas ATG16L1HM mice presented shortened colons and tumor masses. Likewise, WT mice exhibited oral leukoplakia (pre-neoplastic lesions), whereas ATG16L1HM mice showed tumors. The greater susceptibility observed in ATG16L1HM animals was associated with imbalanced cytokine production (increased IL-4 levels and lower IL-15 output) and higher numbers of B cells in secondary lymphoid organs. This latter was also found under steady conditions, and despite having more B cells, cancer-induced ATG16L1HM mice presented lower levels of total circulating IgG.
Conclusion: Suboptimal expression of the autophagic protein ATG16L1 results in accelerated carcinogenesis, and an altered B cell response may be one of the aggravating factors.
{"title":"Insufficient Expression of the Autophagic Protein ATG16L1 Results in Accelerated Carcinogenesis Related to an Aberrant B Cell Response.","authors":"Daniela Mendiola, Betsaida Ortiz, Oscar Nieto, Marisol I González, Danielle Vannan, Bertus Eksteen, Alejandro Martínez, Diego Mateos, Mónica G Mendoza-Rodríguez, Miriam Rodríguez-Sosa, Luis I Terrazas, José L Reyes","doi":"10.1002/cnr2.70438","DOIUrl":"https://doi.org/10.1002/cnr2.70438","url":null,"abstract":"<p><strong>Background: </strong>Autophagy-related proteins (ATGs) regulate a great variety of cellular responses beyond autophagy. In cancer, the role of ATG proteins is central, as evidenced in spontaneous cancer emerging in animals lacking ATG proteins.</p><p><strong>Aim: </strong>To determine whether ATG16L1 may be participating in tumorigenesis in colonic and oral mucosa and its likely association with adaptive immune cell deregulation (e.g., B cells).</p><p><strong>Methods: </strong>Wild-type (WT) and ATG16L1 hypomorphic mice (ATG16L1<sup>HM</sup>) were induced with colitis-associated colon cancer (CAC) by delivering azoxymethane (AOM) and dextran sodium sulfate (DSS), whereas oral cancer was generated by administering 4-nitroquinoline-1-oxide (4NQO) in tap water. Tissue samples were collected and the histopathological damage was assessed. Also, secondary lymphoid organs (i.e., spleen and draining lymph nodes) were assayed for cytokine output and lymphocyte distribution by means of flow cytometry, and IgG levels were assayed in plasma samples.</p><p><strong>Results: </strong>ATG16L1<sup>HM</sup> animals turned out to be more susceptible to colon and oral carcinogenesis than WT mice. In CAC, WT mice preserved colon length and presented individual colonic tumors, whereas ATG16L1<sup>HM</sup> mice presented shortened colons and tumor masses. Likewise, WT mice exhibited oral leukoplakia (pre-neoplastic lesions), whereas ATG16L1<sup>HM</sup> mice showed tumors. The greater susceptibility observed in ATG16L1<sup>HM</sup> animals was associated with imbalanced cytokine production (increased IL-4 levels and lower IL-15 output) and higher numbers of B cells in secondary lymphoid organs. This latter was also found under steady conditions, and despite having more B cells, cancer-induced ATG16L1<sup>HM</sup> mice presented lower levels of total circulating IgG.</p><p><strong>Conclusion: </strong>Suboptimal expression of the autophagic protein ATG16L1 results in accelerated carcinogenesis, and an altered B cell response may be one of the aggravating factors.</p>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":"e70438"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Breast examination and mammography help in the detection of breast cancer and are valid in improving survival by reducing mortality.</p> </section> <section> <h3> Aims</h3> <p>In this study, we aimed to investigate women's knowledge of breast cancer screening in the Prospective Epidemiological Research Studies (PERSIAN) Guilan Cohort Study (PGCS) population.</p> </section> <section> <h3> Methods and Results</h3> <p>This cross-sectional study was conducted on 476 women aged 35–70 among the PGCS population. The demographic and clinical data of participants were collected through a questionnaire. Also, the Champion Health Belief Model Scale, including the perceived benefits of breast self-examination (six phrases), perceived barriers to breast self-examination (nine phrases), perceived benefits of mammography (six phrases), and perceived barriers to mammography (nine phrases), was used to collect the knowledge data. The variables of the questionnaire were assessed using the Likert scale. Data were analyzed using SPSS version 20 by significant level < 0.05.</p> </section> <section> <h3> Results</h3> <p>Most of the research subjects were within the age of 45–55 years (35.9%) and most of them (64.9%) did not mention any history of prior mammography, but among those with positive history of mammography, most of them (55.1%) had done it without any problem and only based on recommendation. The average scores of benefits and barriers for breast self-examination among the participants were 9.9 ± 3.7 and 15.2 ± 4.6, respectively. Similarly, for mammography, the average scores were 9.9 ± 3.6 and 14.2 ± 4.7. In overall, factors including age 35–45 years, having insurance, higher education levels, having former visit of a doctor due to breast problem, family history of breast cancer in first degree relatives, and positive history of performing mammography were associated with better scores of perceived benefits and barriers in both breast self-examination and mammography (<i>p</i> ≤ 0.05).</p> </section> <section> <h3> Conclusion</h3> <p>According to the barriers and benefits identified in this study, it is possible and also necessary to plan for breast cancer screening with organized regional educational plans. It is recommended to focus more on attracting older women to perform screening programs. It is also necessary to encourage doctors to refer women for mammography and support insurance organizations to provide sc
{"title":"Perceived Benefits and Barriers of Breast Self-Examination and Mammography for Breast Cancer Screening in the PERSIAN Guilan Cohort Study (PGCS) Population","authors":"Farahnaz Joukar, Sara Zakaryapour, Fateme Sheida, Faezeh Fashkhami, Zahra Atrkar-Roshan, Farideh Hasavari, Fariborz Mansour-Ghanaei","doi":"10.1002/cnr2.70459","DOIUrl":"10.1002/cnr2.70459","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast examination and mammography help in the detection of breast cancer and are valid in improving survival by reducing mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In this study, we aimed to investigate women's knowledge of breast cancer screening in the Prospective Epidemiological Research Studies (PERSIAN) Guilan Cohort Study (PGCS) population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>This cross-sectional study was conducted on 476 women aged 35–70 among the PGCS population. The demographic and clinical data of participants were collected through a questionnaire. Also, the Champion Health Belief Model Scale, including the perceived benefits of breast self-examination (six phrases), perceived barriers to breast self-examination (nine phrases), perceived benefits of mammography (six phrases), and perceived barriers to mammography (nine phrases), was used to collect the knowledge data. The variables of the questionnaire were assessed using the Likert scale. Data were analyzed using SPSS version 20 by significant level < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most of the research subjects were within the age of 45–55 years (35.9%) and most of them (64.9%) did not mention any history of prior mammography, but among those with positive history of mammography, most of them (55.1%) had done it without any problem and only based on recommendation. The average scores of benefits and barriers for breast self-examination among the participants were 9.9 ± 3.7 and 15.2 ± 4.6, respectively. Similarly, for mammography, the average scores were 9.9 ± 3.6 and 14.2 ± 4.7. In overall, factors including age 35–45 years, having insurance, higher education levels, having former visit of a doctor due to breast problem, family history of breast cancer in first degree relatives, and positive history of performing mammography were associated with better scores of perceived benefits and barriers in both breast self-examination and mammography (<i>p</i> ≤ 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>According to the barriers and benefits identified in this study, it is possible and also necessary to plan for breast cancer screening with organized regional educational plans. It is recommended to focus more on attracting older women to perform screening programs. It is also necessary to encourage doctors to refer women for mammography and support insurance organizations to provide sc","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the case of 72–year-old male with metastatic de-differentiated chondrosarcoma (“DDCS”). DDCS is a rare soft tissue cancer that carries a dismal prognosis in the metastatic stage, and is resistant to both traditional chemotherapy and radiotherapy. There is a distinct lack of proven systemic therapies.
Case
This case report is distinguished in that our patient had a significant clinical response to combination therapy with an immune checkpoint inhibitor (Pembrolizumab) and a multi-targeted tyrosine kinase inhibitor (Pazopanib). Our patient presented with bony pain after suffering a pathological fracture of the left humerus after grabbing a fence. He did not report prior constitutional symptoms or bony pain. On examination he was clinically in atrial fibrillation and reported reduced exercise tolerance with a New York Heart association grading of 2. There were no other pertinent clinical findings. FDG PET-CT scan revealed a 10cmx5cm destructive intra-osseous lesion of the proximal humerus, markedly FDG-avid, without evidence of metastatic disease. He underwent immediate surgical resection, followed by adjuvant radiotherapy to the left humerus. Tumour histology revealed a high-grade DDCS. Genetic sequencing revealed alterations in IDH2, PTCH1 and TERT promoter. Restaging FDG PET scan 3 months after diagnosis revealed lung metastases. The patient was commenced on Vismodegib with best disease response of progressive disease. Eight months after diagnosis he was commenced on combination therapy of Pazopanib and Pembrolizumab, with significant reduction in size of lung metastases. He sustained a progression free period of 6 months on this regime. Treatment course was complicated primarily by hepatotoxicity, which resolved with dose reduction of Pazopanib. Eleven months after diagnosis, FDG PET-CT revealed relapse and significant progression of metastatic disease and systemic therapy was ceased. The patient passed away 14 months after diagnosis.
Conclusion
This case report is a valuable example of promising emerging systemic therapies for advanced DDCS, where the present standard of care lacks a repertoire of effective therapies.
{"title":"A Case Report of Promising Response to Combination Therapy With an Immune Checkpoint Inhibitor (Pembrolizumab) and Multi-Targeted Tyrosine Kinase Inhibitor (Pazopanib) in Metastatic De-Differentiated Chondrosarcoma","authors":"Matthew Youssef, Peter Grimison","doi":"10.1002/cnr2.70426","DOIUrl":"10.1002/cnr2.70426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We present the case of 72–year-old male with metastatic de-differentiated chondrosarcoma (“DDCS”). DDCS is a rare soft tissue cancer that carries a dismal prognosis in the metastatic stage, and is resistant to both traditional chemotherapy and radiotherapy. There is a distinct lack of proven systemic therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>This case report is distinguished in that our patient had a significant clinical response to combination therapy with an immune checkpoint inhibitor (Pembrolizumab) and a multi-targeted tyrosine kinase inhibitor (Pazopanib). Our patient presented with bony pain after suffering a pathological fracture of the left humerus after grabbing a fence. He did not report prior constitutional symptoms or bony pain. On examination he was clinically in atrial fibrillation and reported reduced exercise tolerance with a New York Heart association grading of 2. There were no other pertinent clinical findings. FDG PET-CT scan revealed a 10cmx5cm destructive intra-osseous lesion of the proximal humerus, markedly FDG-avid, without evidence of metastatic disease. He underwent immediate surgical resection, followed by adjuvant radiotherapy to the left humerus. Tumour histology revealed a high-grade DDCS. Genetic sequencing revealed alterations in IDH2, PTCH1 and TERT promoter. Restaging FDG PET scan 3 months after diagnosis revealed lung metastases. The patient was commenced on Vismodegib with best disease response of progressive disease. Eight months after diagnosis he was commenced on combination therapy of Pazopanib and Pembrolizumab, with significant reduction in size of lung metastases. He sustained a progression free period of 6 months on this regime. Treatment course was complicated primarily by hepatotoxicity, which resolved with dose reduction of Pazopanib. Eleven months after diagnosis, FDG PET-CT revealed relapse and significant progression of metastatic disease and systemic therapy was ceased. The patient passed away 14 months after diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case report is a valuable example of promising emerging systemic therapies for advanced DDCS, where the present standard of care lacks a repertoire of effective therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast cancer survival varies widely across middle-income settings and may be influenced by clinical stage at diagnosis and access pathways within oncology care networks. In Brazil, evidence from statewide cohorts using linked registry and mortality data remains limited.
Aim
To investigate the association between clinical factors and breast cancer–specific survival among women treated in all hospitals comprising the Oncology Care Network of a state in Southeastern Brazil.
Methods and Results
A retrospective cohort study was conducted using data from the Hospital Cancer Registry linked to the state Mortality Information System. Women aged ≥ 18 years diagnosed with primary breast cancer (ICD-10: C50.x) between 2000 and 2016 were included and followed until December 31, 2021. Five-year breast cancer–specific survival was estimated using the Kaplan–Meier method, and factors associated with mortality were assessed using cause-specific Cox proportional hazards models with complete-case analysis. A total of 12,096 women were included, of whom 7,191 had complete data for multivariable analysis. The mean age at diagnosis was 54.7 years. Five-year breast cancer–specific survival ranged from 97% (95% CI: 96−97%) in stage I to 32% (95% CI: 31−37%) in stage IV. Women referred from the private healthcare system had a significantly lower risk of breast cancer mortality than those referred from the public system (HR: 0.83; 95% CI: 0.75−0.93; p = 0.001). Advanced clinical stage remained the strongest predictor of mortality, and the presence of distant metastasis at diagnosis increased the risk of breast cancer death by 49% (HR: 1.49; 95% CI: 1.14−1.94; p = 0.003).
Conclusion
Breast cancer–specific survival in Espírito Santo is strongly determined by stage at diagnosis and by differential access pathways within the oncology care network. Strengthening early diagnostic strategies, improving referral coordination, and ensuring equitable access to timely treatment are essential to reduce survival disparities in this setting.
{"title":"Breast Cancer–Specific Survival and Prognostic Factors in a Statewide Oncology Network in Brazil: A Registry-Linked Retrospective Cohort Study","authors":"Raphael Manhães Pessanha, Wesley Rocha Grippa, Luiz Cláudio Barreto Silva Neto, Naira Santos D'Agostini, Luís Carlos Lopes-Júnior","doi":"10.1002/cnr2.70467","DOIUrl":"10.1002/cnr2.70467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast cancer survival varies widely across middle-income settings and may be influenced by clinical stage at diagnosis and access pathways within oncology care networks. In Brazil, evidence from statewide cohorts using linked registry and mortality data remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the association between clinical factors and breast cancer–specific survival among women treated in all hospitals comprising the Oncology Care Network of a state in Southeastern Brazil.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using data from the Hospital Cancer Registry linked to the state Mortality Information System. Women aged ≥ 18 years diagnosed with primary breast cancer (ICD-10: C50.x) between 2000 and 2016 were included and followed until December 31, 2021. Five-year breast cancer–specific survival was estimated using the Kaplan–Meier method, and factors associated with mortality were assessed using cause-specific Cox proportional hazards models with complete-case analysis. A total of 12,096 women were included, of whom 7,191 had complete data for multivariable analysis. The mean age at diagnosis was 54.7 years. Five-year breast cancer–specific survival ranged from 97% (95% CI: 96−97%) in stage I to 32% (95% CI: 31−37%) in stage IV. Women referred from the private healthcare system had a significantly lower risk of breast cancer mortality than those referred from the public system (HR: 0.83; 95% CI: 0.75−0.93; <i>p</i> = 0.001). Advanced clinical stage remained the strongest predictor of mortality, and the presence of distant metastasis at diagnosis increased the risk of breast cancer death by 49% (HR: 1.49; 95% CI: 1.14−1.94; <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Breast cancer–specific survival in Espírito Santo is strongly determined by stage at diagnosis and by differential access pathways within the oncology care network. Strengthening early diagnostic strategies, improving referral coordination, and ensuring equitable access to timely treatment are essential to reduce survival disparities in this setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"9 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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