Purpose: Patients with soft tissue sarcomas (STS) of the extremity require ongoing follow-up to detect treatment failures. There is a significant variation in follow-up schemes among sarcoma specialists due to a lack of evidence. Methods: A retrospective single-center review was performed on all patients with a minimum 1-year follow-up after resection of a localized STS, utilizing a prospectively collected database. Kaplan-Meier curves were used to calculate the incidence of local recurrence and metastases on an annual basis over 10 years. Results: There were 407 patients who met the inclusion criteria. Considering the annual incidence of local recurrence and distant metastasis per STS size and grade, patients with small, low-grade STS should be followed yearly for 10 years. Patients with small, intermediate/high-grade STS and those with large, low-grade STS should be followed every 6 months for the first 2 years and then yearly until 10 years postoperatively. Patients with large, intermediate/high-grade STS should be followed every 3 months for the first 2 years and then every 6 months thereafter until 10 years postoperatively. Conclusion Compared to National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, our proposed scheme has the potential to reduce hospital visits, mainly for patients with small intermediate and high-grade tumors. This protocol validates the previously published scheme, despite being relatively more conservative.

Purpose: The present study investigates the psychological factors impacting female cancer patients receiving radiotherapy and the individuals providing care for them, within a sociocultural environment that frequently marginalizes and depends on women. This research highlights a strategy for cancer care that may enhance results for both patients and caregivers by attending to psychosocial needs. The primary objectives are to measure the levels of anxiety, depression, quality of life, and perceived stress in both patients and caregivers, as well as to determine how psychosocial counseling affects these factors. Methods: It was a single-group pre-post observational study. Before starting radiotherapy, assessment of various psychosocial factors was done in female cancer patients and their respective caregivers. Psychosocial counseling sessions were conducted at weekly intervals during radiotherapy. At the 6th week after radiotherapy, assessment of same psychosocial factors was done again in both the patients as well as their caregivers. Results: The results show that both patients and caregivers had serious psychological disorders, such as anxiety, depression, perceived stress, and decreased quality of life. Psychosocial modulation was associated with improvement in quality of life measures like overall health and emotional and physical functioning. Conclusion The findings highlight how crucial it is to include psychological support in radiotherapy regimens. Despite limitations of the study, such as its exclusive focus on female patients, the results highlight the need to provide clinical staff with psycho-oncological training. The study recommends further investigation to ascertain the long-term effects of psychological health on treatment compliance and patient survival.

Immunoglobulin G4 (IgG4)-related disease is a fibroinflammatory condition that can involve multiple organs. Isolated involvement of the gallbladder is exceptionally uncommon and often radiologically indistinguishable from gallbladder carcinoma, resulting in diagnostic uncertainty before surgery. A 77-year-old man presented with right upper abdominal discomfort lasting 1 month. Cross-sectional imaging revealed irregular gallbladder wall thickening with contrast enhancement, raising suspicion for resectable gallbladder cancer. The patient underwent a radical cholecystectomy with partial hepatectomy. Histopathological analysis demonstrated dense lymphoplasmacytic infiltration, storiform fibrosis, and marked infiltration of IgG4-positive plasma cells exceeding established diagnostic thresholds, consistent with IgG4-related cholecystitis. The postoperative course was uneventful, and no additional treatment was required. IgG4-related cholecystitis should be considered in the differential diagnosis of gallbladder malignancy, particularly in atypical or indeterminate cases. However, when imaging findings strongly suggest carcinoma, radical surgical resection remains an appropriate oncologic approach.

Purpose: Atypical hyperplasia (AH) management remains controversial due to variable malignant disease progression rates. While Western studies report 10% to 25% upgrade rates, data from Asian populations, particularly from referral academic centers, are limited. We aimed to identify predictive factors for malignant upgrade in Korean women with AH at academic hospitals. Methods: This retrospective multi-institutional study analyzed 340 patients diagnosed with AH on initial biopsy who underwent subsequent excision at five Korean academic hospitals from 2000 to 2022. Malignant upgrade was defined as ductal carcinoma in situ or invasive cancer on the final pathology. Multivariate logistic regression was used to identify independent predictors of upgrades. Results: Among 340 patients (319 atypical ductal hyperplasia, 20 atypical lobular hyperplasia, and 1 mixed), 128 (37.6%) experienced a malignant upgrade, 98 (76.6%) to ductal carcinoma in situ, and 30 (23.4%) to invasive cancer. In multivariate analysis, multifocal atypia (odds ratio [OR], 25.61; 95% confidence interval [CI], 11.20–58.55; P<0.001) and Breast Imaging-Reporting and Data System 4c-5 lesions (OR, 11.02; 95% CI, 1.43–84.86; P=0.021) were significant predictors. Multifocal atypia showed an 84.4% upgrade rate. Core needle biopsy had higher upgrade rates than vacuum-assisted biopsy (45.2% vs. 20.0%; P<0.001). The upgrade rates decreased from 50% to 25% over the study period (P<0.05). Conclusion The 37.6% upgrade rate in this tertiary referral cohort exceeded that in Western reports, with multifocal atypia emerging as the strongest predictor. These findings support immediate excision for multifocal atypia while allowing individualized management for unifocal lesions with favorable imaging in Korean tertiary care settings.

Cancer treatment has undergone significant transformation with the emergence of molecularly targeted drugs, aiming to exploit specific vulnerabilities within cancer cells while sparing normal tissues. One critical aspect of this approach is the identification of druggable targets, proteins or pathways that can be modulated by pharmacological agents to inhibit tumor growth or metastasis. The metastasis-associated protein 1 (MTA1) has emerged as a promising druggable target due to its multifaceted roles in cancer progression, including regulation of gene expression, chromatin remodeling, and promotion of epithelial-mesenchymal transition. This abstract provides an overview of the current landscape of MTA1 as a druggable target in cancer therapy, highlighting its diverse functions across different malignancies and its potential as a predictive biomarker for therapeutic response. Finally, it explores future directions and novel strategies for exploiting MTA1 inhibition in precision oncology. Overall, understanding the druggable potential of MTA1 offers new avenues for the development of innovative cancer treatments with improved efficacy and reduced toxicity, ultimately leading to better clinical outcomes for cancer patients.

This article presents two cases of extrahepatic portal vein anomalies that can be challenging during lymph node (LN) dissection in gastric cancer surgery. The first case was a participant for a clinical trial assessing the completeness of D2 LN dissection. The trial utilized near-infrared (NIR) lymphangiography with indocyanine green only after completing dissection of a certain topological LN station to detect any residual lymphatic tissue. However, the patient was excluded from the trial due to an unexpected extrahepatic portal vein confluence anomaly and aberrant common hepatic artery. Consequently, continuous lymphatic navigation with NIR imaging was utilized for remaining surgery. The second case featured a patient with an anteriorly positioned splenic vein, hindering LN dissection along the left gastric artery. Preoperative identification of great vessel anomalies around the stomach is critical to prevent life-threatening complications during LN dissection in gastric cancer surgery. Augmented imaging technology can be a valuable tool in ensuring oncologic safety and precision.

Purpose: This study aimed to evaluate the impact of declining surgical residency program enrollment on patient care and outcomes in colorectal cancer surgeries. Methods: This retrospective observational study included 676 patients (410 males; median age: 69 years) who underwent colorectal cancer surgery at Pusan National University Hospital between January 2018 and June 2024. Patients were divided into Group A (before December 31, 2023; with residents) and Group B (after January 1, 2024; without residents). All surgeries were performed by a single attending surgeon. Results: Preoperative variables were comparable between groups. Group A had more emergency and open surgeries, and a higher proportion of advanced-stage cancers. Overall complication rates were similar, but Group B had a longer hospital stay (9.72 days vs. 11.95 days). Specific complications such as anastomotic leakage and surgical site infections differed significantly. The overall number of surgical procedures declined markedly in 2024 compared to 2018 (77.1% vs. 49.9%). Conclusion The absence of residents did not increase overall complication rates but was associated with longer hospital stays and shifts in clinical practice. Greater reliance on attending surgeons contributed to more defensive decision-making and conservative patient management. Addressing these issues requires systemic reforms, including multidisciplinary collaboration and legal protections to improve surgical care.

Purpose: Endometrial cancer is one of the most common gynecological cancers worldwide, with rising incidence rates. Despite therapeutic advances, it remains a significant cause of cancer-related deaths. Tumor budding (TB), characterized by single cells or small clusters at the invasive tumor front, is a recognized prognostic marker in several cancers but is less studied in endometrial cancer. Methods: This prospective cohort study included 30 patients with endometrial cancer who underwent surgical resection from January 2022 to June 2023. Formalin-fixed, paraffin-embedded tissue blocks were reviewed by two blinded pathologists. TB at the invasive front was assessed using hematoxylin and eosin staining. Clinical and pathological parameters, including age, histological type, grade, stage, myometrial invasion, lymphovascular space invasion, and nodal involvement, were recorded. Fisher’s exact and chi-square tests were used for statistical analyses. Results: Most patients (60%) were aged 51–60 years, with 93.3% diagnosed with endometrioid adenocarcinoma. Tumors were graded as 40% grade 1, 43.3% grade 2, and 16.7% grade 3. Staging showed 36.7% FIGO IA, 36.7% IB, 16.7% II, and 10% III. TB was classified as low (70%), intermediate (23.3%), and high (6.7%). Higher TB levels were significantly associated with higher tumor grade (P=0.03), advanced stage (P=0.02), and nodal involvement (P=0.01). Conclusion TB correlates with adverse features in endometrial cancer, including higher grade, advanced stage, and nodal involvement. These findings underscore TB’s potential as a prognostic marker, warranting validation in larger studies and exploration of its molecular basis to guide personalized treatments.

Purpose: Colorectal cancer (CRC) remains a significant global health burden, necessitating innovative approaches for prevention and treatment. This study proposes a multiepitope vaccine targeting carcinoembryonic antigen (CEA) and insulin-like growth factor-1 receptor (IGF-1R), two prominent biomarkers associated with CRC progression. Methods: Sequences of CEA and IGF-1R proteins were retrieved from NCBI databank, the sequences were aligned on the MEGA5 tool to identify conserved regions. Immunological and structural predictive analysis which include antigenic potential prediction, cytotoxic T-lymphocytes (CTLs), helper-T lymphocytes (HTLs), B-cell epitopes predictions, and prediction of the vaccine secondary and tertiary structure were performed. The vaccine was evaluated to validate its physiochemical and immunological properties. To determine the binding energy and domain, the tertiary structure of the vaccine was docked to Toll-like receptor 4, and viewed on PyMOL and LigPlot+ tools. Results: CEA and IGF-1R were revealed to be highly antigenic, and non-allergens demonstrating the capacity to elicit robust immune responses, which include CTLs, HTLs, and B cells activation. The secondary structure revealed a conformation closely resembling native protein, with alpha helices, beta sheets, and coils, indicative of favorable interactions. Tertiary structure prediction predicted five models, model 0 was selected and validated due its highest confidence, and validation revealed that 87.5% of residues were within favored regions, with a z-score of 4.03. Molecular docking predicted strong binding complex with low binding energy. Conclusion Based on our analysis, the proposed multiepitope vaccine holds promise as an effective preventive measure against colorectal cancer development.

Purpose: Breast cancer is one of the most common cancers globally, with an increasing incidence rate. It is a heterogeneous disease, and early metastasis remains a challenge. Tumor budding, defined as single tumor cells or small clusters at the invasive front, has been suggested as a prognostic marker in various cancers, including breast cancer. This study aims to evaluate tumor budding in invasive breast carcinoma using the International Tumor Budding Consensus Conference (ITBCC) scoring system and explore its association with pathological characteristics and prognosis. Methods: A retrospective study was conducted on 100 mastectomy specimens of histopathologically confirmed invasive breast carcinoma, excluding cases that underwent chemotherapy or radiotherapy. Tumor budding was classified as low, intermediate, or high based on the ITBCC scoring method, and associations with clinicopathological features were analyzed using appropriate statistical tests. Results: Tumor budding was classified as high in 52% of cases. A significant association was found between high tumor budding and higher tumor grade (P<0.001), negative estrogen receptor and progesterone receptor status (P<0.001), positive HER2neu status (P=0.003), and high Ki-67 levels (P<0.001). High tumor budding was also linked to higher T stage, and dermal lymphovascular invasion (P=0.001). Our findings support previous studies showing that high tumor budding is associated with poor prognostic factors such as higher tumor grade, negative hormone receptor status, and higher T stage. Conclusion Tumor budding is a potential prognostic marker in breast cancer, associated with more aggressive tumor characteristics.