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Background: Despite the revolutionary impact of immune checkpoint inhibitors (ICIs) on the treatment of metastatic urothelial carcinoma (mUC), the clinical utility of reliable prognostic biomarkers to foresee survival outcomes remains underexplored. Objectives: The purpose of this study was to ascertain the prognostic significance of serum inflammatory markers in mUC patients undergoing ICI therapy. Design: This is a retrospective, multicenter study. Methods: Data were collected from two independent medical centers in Taiwan, encompassing a validation and a training cohort (TC). Patients with histopathologically confirmed urothelial carcinoma who received at least one cycle of ICI monotherapy were included. Serum inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated prior to ICI therapy. Statistical analyses involved the use of receiver operating characteristic (ROC) curves to determine optimal biomarker cutoffs and Cox proportional hazards models to evaluate the independent predictive capability of these markers. Results: A total of 192 patients were enrolled. In the univariate analysis, serum markers such as NLR, PLR, SII, and Hb were significantly associated with overall survival (OS) in both the training and validation cohorts (VC). White blood cells, NLR, and SII demonstrated a robust correlation with progression-free survival across both cohorts. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status ⩾2 (p < 0.001), visceral metastasis (p < 0.001), leukocytosis (p < 0.001), Hb levels ⩾10 mg/dL (p = 0.008), and NLR ⩾5 (p = 0.032) as independent predictors of OS. A prognostic nomogram integrating these independent factors yielded a C-index for a 3-year OS of 0.769 in the TC and 0.657 in the VC. Conclusion: Serum inflammatory markers, combined with clinicopathologic factors, provide a practical prognostic tool in mUC treatment with ICIs. Plain language summary: Using blood tests and health information to predict survival in bladder cancer patients receiving immune therapy Study overview Despite the success of new immune therapies in treating advanced bladder cancer, we still need better ways to predict how well patients will respond to treatment. Our study looked at certain blood tests that measure inflammation to see if they can help predict patient outcomes. What we did We reviewed the medical records of 192 patients with advanced bladder cancer who were treated at two medical centers in Taiwan. These patients had received immune therapy, and we analyzed their blood for signs of inflammation before they started treatment. We specifically looked at the ratios of different types of blood cells involved in inflammation and immune response. What we found Certain blood markers were linked to how long patients lived after treatment. For example, patients with higher levels of certain inflammatory markers tended to have shorter survival times. We used this information along with other medical data to create a tool that helps predict how patients might do with treatment. What it means Our findings suggest that checking for inflammation in the blood could help doctors better understand who will benefit most from immune therapy for advanced bladder cancer. This could help tailor treatments more effectively for each patient. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis (LC) is common among patients with esophageal squamous cell carcinoma (ESCC) due to shared etiologic factor, alcohol. For non-metastatic ESCC (nmESCC) patients with cirrhosis, surgery is often contraindicated or associated with high morbidity, therefore radiotherapy-based therapy was commonly applied. This study aims to investigate prognosticators for overall survival (OS) in nmESCC and cirrhotic patients receiving radiotherapy-based therapy. Furthermore, we will also evaluate the predictors for the 90-day mortality rate to reduce avoidable treatment-related toxic effects, and prevent medical waste. Methods: Between January 2001 and December 2021, we retrospectively reviewed medical records of 1298 ESCC patients. Total 78 patients with nmESCC and liver cirrhosis identified based on abdominal ultrasonography, computerized tomography, or liver biopsy were enrolled. Clinicopathologic parameters were collected and correlated with OS and 90-day mortality. Results: Univariate analysis revealed that Child-Pugh classification B/C (P< 0.001, versus A), radiotherapy alone (P=0.03, versus chemoradiotherapy), prothrombin time (PT) prolonged≧2 seconds (P=0.024), albumin≦3.5g/dl (P< 0.001), controlled/refractory ascites (P=0.01, versus none of ascites), and total bilirubin≧1.5mg/dl (P=0.004) were significantly associated with inferior OS. In multivariate analyses, albumin≦3.5g/dl (P=0.001, odds ratio (OR): 2.500) and total bilirubin≧1.5mg/dl (P=0.019, OR: 2.012) were independent adverse prognosticators. The 90-day mortality in these 78 patients receiving radiotherapy-based therapy was 10.3% (n=8), including ESCC progression in 4 patients, liver failure in 1 patient, and others in 3. Clinical 8th American Joint Committee on Cancer (AJCC) stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), PT prolonged≧4 seconds (P=0.009), and albumin≦3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality. Logistic model showed albumin≦3.5g/dl (P=0.015, OR: 16.129) and clinical 8th AJCC stage IVA (P=0.012, OR: 17.544) were independently correlated with higher 90-day mortality. Conclusion: Hypoalbuminemia is associated with higher 90-day mortality and poor prognosis in nmESCC and liver cirrhosis patients receiving radiotherapy-based therapy. [ABSTRACT FROM AUTHOR]

Background: Studies on the correlation between high body mass index (BMI) and extended survival among patients receiving immune checkpoint inhibitors (ICIs) have been made, although findings have shown variability. Our research explored the phenomenon of the "obesity paradox" in patients with metastatic urothelial carcinoma (mUC) undergoing treatment with ICIs. Materials and Methods: We conducted a retrospective analysis of patients diagnosed with mUC who received a minimum of one cycle of ICI treatment at two medical centers in Taiwan from September 2015 to January 2023. Features of patients' clinicopathologic factors, including age, sex, primary or metastatic location, treatment line, and BMI were examined. The primary outcome were overall survival (OS) and progression‐free survival (PFS), which were assessed utilizing the Kaplan–Meier method. We employed the Cox‐regression model to adjust for multiple covariates. Results: A total of 215 patients were included, with 128 (59.5%) being male, and the median age was 70 years. In the obese group (BMI ≥25 kg/m2), patients demonstrated significantly better median OS compared to the non‐obese group (BMI <25 kg/m2) (21.9 vs. 8.3 months; p = 0.021). However, there was no significant difference in median PFS between the high and low BMI groups (4.7 vs. 2.8 months; p = 0.16). Post‐hoc subgroup revealed a survival benefit from ICI treatment in male patients within the BMI ≥25 kg/m2 group (HR 0.49, 95% CI 0.30–0.81, p = 0.005). Conclusion: Based on real‐world data from the Asia‐Pacific region, there appears to be a correlation between obesity and prolonged OS in patients receiving ICI treatment for mUC. [ABSTRACT FROM AUTHOR]

Because of a shortage of physical exercise, concerns about adolescents have recently been raised in Taiwan. In educational environments where student exercise has been limited by scheduling constraints and the lack of physical exercise has become a vital problem, "learning while exercising" may be part of a possible solution. This study developed the Ecosystems Augmented Reality Learning System (EARLS) and also made a comparison of EARLS, existing keyboard/mouse-based computer assisted instruction (KMCAI) approaches, and traditional face-to-face teaching methods, in terms of learning achievement and learning attitude. In this study, 1211 subjects were surveyed and divided into 5 groups. Students from the first three groups used EARLS but were exposed to different sections of the system. In terms of learning achievement, learning while exercising groups do not learn less well than the KMCAI or traditional groups. However, they earn extra exercise without diminishing the quality of learning achievement. With regard to the attitude subscales "Usefulness of learning Ecosystems" and "Anxiety in learning Ecosystems", the students in the traditional-teaching group had the significantly lowest scores for both while the students involved in EARLS had the highest ratings on "Usefulness of learning Ecosystems" and the students within KMCAI rated the highest anxiety in learning ecosystems. (Contains 7 tables and 3 figures.)