Citations

The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel’s discussions on select 2026 updates to the guidelines regarding nonmetastatic disease: the elimination of the very-low-risk group, updates to the Principles of Active Surveillance, and caution in the use of focal therapy in newly diagnosed patients.

Abstract Rationale Quantitative CT using multiple instance learning (MIL)-usual interstitial pneumonia (UIP) classifier and data-driven textural analysis (DTA) provides objective and reproducible measurements of disease pattern and extent, respectively. However, the understanding of their individual or combined relationships with outcomes in fibrotic hypersensitivity pneumonitis (fHP) remains limited. Objectives To determine whether visual CT patterns of fHP or UIP, a MIL-UIP classifier, baseline and changes in DTA over 12-months and DTA at 12 months are associated with progression-free survival (PFS) in fHP. Methods The primary cohort included 134 participants with fHP. Associations between CT variables and subsequent lung function change, and PFS were assessed using linear mixed models and Cox hazards models. Results were validated in a combined dataset from three independent populations (N = 216). Results Visual patterns of fHP or UIP were not associated with PFS. A baseline MIL-UIP classification and DTA were significantly associated with 24-month PFS. However, the MIL-UIP did not predict PFS after adjusting for DTA fibrosis extent. Over 12 months, a 1-point increase in DTA across and within patients resulted in a significant decline in FVC% and DLCO%. A 12-month change in DTA (HR = 1.07, 95%CI 1.01-1.13) and DTA at 12-months (HR = 1.03, 95%CI 1.01-1.05) were associated with subsequent 12-month PFS. Similar estimates were observed in the validation cohort. Conclusions In fHP, the objectively measured extent of lung fibrosis is more prognostic than either a UIP classifier or visual CT patterns of fHP or UIP. Baseline DTA, DTA at 12 months, and its change over 12-months are associated with PFS.

Antiretroviral therapy has transformed treatment of HIV infection from a fatal disease into a chronic condition, yet opportunistic infections remain prevalent in patients with declining CD4 cell counts, requiring a pattern-based radiologic approach and vigilant clinical assessment to differentiate infections, malignancies, and immune reconstitution inflammatory syndrome.

PURPOSE Remote symptom monitoring using patient-reported outcomes (PROs) has been shown to improve symptom control and physical function among patients with advanced cancer. However, it is unclear whether these benefits are similar across demographic groups. This exploratory analysis of the PRO-TECT trial examined whether the effects of electronic symptom monitoring varied by race, age, sex, and educational attainment. METHODS PRO-TECT was a cluster randomized trial conducted across 52 US community oncology practices comparing weekly electronic symptom monitoring with usual care (UC). Adult patients with metastatic solid tumors receiving systemic therapy were enrolled (N = 1,191). Participants in the PRO arm completed weekly symptom surveys including the PRO-CTCAE, triggering alerts to the care team for severe or worsening symptoms. Patients chose whether to complete weekly PROs online or via telephone-based interactive voice response not requiring Internet access. Outcomes were measured using the European Organisation for Research and Treatment of Cancer QLQ-C30 symptom control and physical function scales. Subgroup analyses were performed by race (Black v White), age (<65 v ≥65 years), sex (male v female), and educational attainment (≤high school v >high school). RESULTS From baseline to 3 months, PRO participants showed greater improvements in symptom control (+2.37 v −0.20, P = .002) and physical function (+1.54 v −0.93, P = .02) versus UC. Benefits were most pronounced among younger, female, Black, and less educated participants. Black participants in the PRO arm were more likely to report that symptom reporting made them feel more in control of their care compared with White participants. CONCLUSION Electronic symptom monitoring improved quality-of-life outcomes overall, including among groups who have historically experienced higher symptom burden or barriers to communication. Remote PRO systems may represent an equitable strategy to enhance cancer care delivery.

Background: Diabetic gastroparesis (DG) is associated with a loss in anti-inflammatory muscularis macrophages (MMs), contributing to delayed gastric emptying (DGE). Lyve1 macrophages, known for their anti-inflammatory phenotype, are involved in lipid metabolism across organs. While diabetes is typically associated with increased lipid levels, the dependence of lipid handling on altered function of Lyve1+ MMs in the stomach remains unknown. Aim: To investigate lipid accumulation in MMs and test the effect of palmitate and CD36 on Lyve1+ macrophages. Methods: FACS sorted CD45+ cells were isolated from the gastric muscularis of non-diabetic mice and analyzed using 10X Genomics Cellranger and Seurat package. Gene Set Enrichment Analysis was performed to identify enriched pathways. Separately, the cells underwent flow cytometry to identify Lyve1+/- MMs then determining lipid accumulation by LipidTox intensity. RAW 264.7 macrophage cells were cultured with macrophage colony stimulating factor (M-CSF), IL-4, and dexamethasone for 7 days to induce Lyve1 expression. RNA was collected from cells treated with palmitate and a CD36 inhibitor, Sulfosuccinimidyl oleate (SSO), for RT-qPCR. Lyve1+ and Lyve1- macrophages treated with 300µM palmitate overnight were collected for lipidomic analysis. Untargeted lipidomic analysis was done with Thermo Orbitrap Exploris 120, and data were analyzed using principal component analysis for group clustering and unpaired t-tests for differential analysis. Results: Unbiased clustering analysis revealed 6 transcriptionally distinct gastric MM populations, one of which was notably enriched in Lyve1 expression. Pathway analysis identified that Lyve1 enriched cluster was associated with lysosomal pathways and receptors involved in lipid uptake, such as CD36, as well as anti-inflammatory markers such as HO1 and CD206. Flow cytometry quantification showed that Lyve1+ MMs had higher accumulation of lipids compared to Lyve1- MMs (10.1±0.7 vs 2.9±0.2 mean fluorescence intensity/cell count, p=0.0002). RT-qPCR validated that Lyve1+ RAW 264.7 macrophages exhibited significantly higher expression of Lyve1 (6.95 times fold change, p=0.023) and CD36 (3.27 times fold change, p=0.011) compared to Lyve1- macrophages. Post palmitate treatment, Lyve1+ macrophages had increased expression of the pro-apoptotic gene caspase-3 (12.15-times fold change, p=0.033), as well as the fatty acid oxidation marker ACADM (4.98 times fold change, p=0.045). Notably, these differences were not found in the presence of SSO. Lipidomic analysis identified 171 differentially expressed lipids, particularly increased levels of ceramides and diacylglycerols in Lyve1+ macrophages compared to Lyve1- macrophages when both are treated with palmitate. Conclusions: Lyve1+ macrophages preferentially uptake lipids compared to Lyve1- macrophages consistent with increased expression of CD36. Lipid treatment of Lyve1+ macrophages increases expression of apoptosis and oxidation markers in a CD36-dependent manner that may lead to cell loss. These mechanisms may contribute to Lyve1+ MMs loss in DG. Funding: DK127992; DK129297; DK115255; ANMS Young Investigator grant; AGA grant#36; P30DK084567; Robert and Arlene Kogod Center on Aging Fundamental Mechanisms of Aging Award. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.