Gonzalo Peon

Background/Objectives: Human papillomavirus (HPV) is a well-established prognostic marker in oropharyngeal squamous cell carcinoma (OPSCC); however, the short-term treatment response remains heterogeneous, particularly among HPV-positive patients. Given the high prevalence of malnutrition in head and neck cancer, this study examined whether baseline nutritional status, body composition and functional status were associated with early treatment response in OPSCC according to HPV status. Methods: A prospective observational multicenter cohort study of newly diagnosed OPSCC patients eligible for curative-intent treatment was conducted at three tertiary hospitals in Barcelona, Spain. Baseline assessments comprised anthropometry, computed tomography (CT)-based body composition at L3, functional performance tests, systemic inflammatory biomarkers and nutritional diagnosis by the Patient-Generated Subjective Global Assessment (PG-SGA). Early treatment response, assessed around 12 weeks post-therapy, was classified as complete remission (CR) or non-complete remission (NCR). Classification tree analyses were performed separately by HPV status. Results: Of 101 enrolled patients, 97 completed post-treatment assessment, of whom 51% were HPV-positive. Among HPV-positive patients, PG-SGA score was the main discriminating variable for early response within the classification tree model, with CR achieved in 74% of patients scoring <6 versus 33% of those scoring ≥6 (AUC 0.68, 95% CI 0.55–0.82). Conversely, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and age were the primary discriminating variables in HPV-negative patients (AUC 0.81, 95% CI 0.70–0.93). In both HPV subgroups, body composition and inflammatory markers were not retained in the analysis once nutritional and functional status were considered. Conclusions: PG-SGA-defined nutritional status was associated with early treatment response in HPV-positive patients, while functional status was the main variable retained in HPV-negative patients. These findings support the potential clinical value of standardized nutritional assessment in OPSCC and suggest that early identification of poor nutritional status or functional impairment may help refine supportive care planning at treatment initiation.

Objectives: To improve the differentiation of borderline ovarian-adnexal tumours (BOTs) from malignant ovarian-adnexal masses, most of which fall into the indeterminate O-RADS MRI 4 category, by developing a multimodal predictive model that integrates clinical, analytic, and MRI parameters. Methods: This retrospective, single-centre study included 248 women who underwent standardised MRI for ovarian-adnexal mass characterisation between 2019 and 2024. Of these, 201 had true ovarian-adnexal masses (114 benign, 22 borderline, and 65 malignant), confirmed by histopathology or stability after ≥12-month follow-up. Forty-one clinical, laboratory, and imaging variables were initially assessed, and after a bivariate evaluation, 18 final predictors with clinical relevance were selected for model construction with thresholds learned from the data. A classification and regression tree (CART) model (“Full Model”) was applied as a second-stage tool after O-RADS MRI scoring, using 10-fold cross-validation to prevent overfitting. A pruned “Simplified Model” was also derived to enhance interpretability. Results: O-RADS MRI performed well at the extremes (scores 2–3 and 5) but showed limited discrimination between BOTs and malignancies within category 4 (PPV for borderline = 0.50). The decision-tree models significantly improved diagnostic performance, increasing overall accuracy from 0.856 with O-RADS MRI alone to 0.905 (Simplified Model) and 0.955 (Full Model). The PPV for BOTs within the intermediate O-RADS MRI 4 category increased from 0.49 with O-RADS MRI alone to 0.77 and 0.90 with the simplified and full models, respectively, while maintaining high accuracy for benign and malignant lesions. Conclusions: In this retrospective single-centre cohort, the addition of an interpretable rule-based predictive model as a second-line tool within O-RADS MRI category 4 was associated with improved discrimination between borderline and invasive malignant ovarian-adnexal tumours. These findings suggest that multimodal integration of clinical, laboratory, and MRI features may help refine risk stratification in indeterminate cases; however, external validation in prospective multicentre cohorts is required before clinical implementation.

Background: Pneumonia remains a major cause of morbidity and mortality among critically ill children. Lung ultrasound has emerged as a promising bedside diagnostic tool. Methods: A systematic review and meta-analysis across PubMed, Embase, The Cochrane Library, Scopus, World Health Organization Libraries, Epistemonikos, and MedRxiv was conducted to evaluate the diagnostic accuracy of lung ultrasound for pneumonia in paediatric patients. Publication bias was evaluated using the generalised Egger’s test. Diagnostic performance metrics, including sensitivity, specificity, and the area under the receiver operating characteristic curve were pooled using a bivariate random-effects model. Results: Thirty studies comprising a total of 4356 children were included. The studies were of high methodological quality, with minimal heterogeneity. Lung ultrasound pooled sensitivity was 91% (95% CI: 87–94%), and specificity was 90% (95% CI: 83–94%). The ROC curve was 0.95 (95% CI: 0.90–0.95), indicating excellent diagnostic performance. Conclusions: LUS is a reliable and accurate imaging modality for diagnosing pneumonia in critically ill children. The findings support its use as a first-line diagnostic tool in emergency and intensive care settings. PROSPERO Research registration number: CRD42021223679.