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Tumor-intrinsic pathways include enhanced DNA repair, apoptosis evasion, metabolic reprogramming, and transcriptional or epigenetic plasticity, while tumor microenvironmental influences such as hypoxia, immune suppression, and stromal remodeling further sustain resistant phenotypes

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2 Material and methods 2.1 Study design and patients A total of 14 patients diagnosed with Psoriasis (PSO) were included in this study ( Figure 1 )