Clinical Surgical Oncology最新文献_第3页

Establishment and development of minimally invasive surgery for nasopharyngeal carcinoma 鼻咽癌微创手术的建立与发展

Clinical Surgical Oncology

Pub Date : 2025-12-01 Epub Date: 2025-12-04 DOI: 10.1016/j.cson.2025.100111

Tao Jiang, Ming-yuan Chen

Recurrent nasopharyngeal carcinoma (rNPC) is insensitive to radiotherapy, and re-irradiation lead to severe adverse reactions. Studies have confirmed that endoscopic nasopharyngectomy(ENPG) combined with vascularized nasal mucosal flap repair is superior to re-irradiation with intensity-modulated radiation therapy (IMRT) in terms of survival rate, quality of life and medical costs. This surgical approach has been widely recognized and shows advantages in early-stage rNPC, marking minimally invasive surgery (MIS) for rNPC as an important treatment option. However, the efficacy of surgery for patients with de novo early-stage nasopharyngeal carcinoma(NPC) and advanced rNPC remains controversial. With the standardization and popularization of surgical procedures for NPC, the improvement of surgical staging, the perioperative management of the internal carotid artery(ICA), the advancement of skull base defect repair technology, the implementation of reasonable postoperative treatment and follow-up, as well as the innovation of lymph node dissection technology, MIS for NPC will play an increasingly important role in the treatment of NPC. Evidence-based medical evidence have confirmed that MIS offers definite survival benefits and safety advantages rNPC, serving as the core treatment option for resectable rNPC. Meanwhile, its preliminary application in de novo early-stage NPC has demonstrated potential in avoiding radiotherapy-induced injuries, opening up a new direction for disease treatment. Nevertheless, the surgical treatment of NPC still requires more multi-center and clinical studies for further validation and improvement.

复发性鼻咽癌（rNPC）对放疗不敏感，再照射会导致严重的不良反应。研究证实，内镜下鼻咽切除术（ENPG）联合带血管的鼻黏膜瓣修复术在生存率、生活质量和医疗费用方面都优于调强放疗（IMRT）再照射。这种手术方式在早期rNPC中得到广泛认可并显示出优势，标志着微创手术（MIS）作为rNPC的重要治疗选择。然而，手术治疗新发早期鼻咽癌（NPC）和晚期鼻咽癌（rNPC）的疗效仍存在争议。随着鼻咽癌手术程序的规范化和普及，手术分期的完善，颈内动脉围手术期管理的完善，颅底缺损修复技术的进步，术后合理治疗和随访的实施，以及淋巴结清扫技术的创新，鼻咽癌MIS将在鼻咽癌治疗中发挥越来越重要的作用。循证医学证据证实，MIS具有明确的生存效益和安全性优势，可作为可切除的rNPC的核心治疗方案。同时，其在新生早期鼻咽癌中的初步应用显示出避免放疗性损伤的潜力，为疾病治疗开辟了新的方向。然而，鼻咽癌的手术治疗仍需要更多的多中心和临床研究来进一步验证和改进。

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引用次数: 0

Corrigendum to “Outpatient revisits associated with three sentinel lymph node detection techniques for breast cancer: A propensity score weighted analysis” [Clin. Surg. Oncol. 4 (2025)100087] “与乳腺癌三种前哨淋巴结检测技术相关的门诊复诊：倾向评分加权分析”的勘误表[临床。中华外科杂志4 (2025)100087 [j]

Clinical Surgical Oncology

Pub Date : 2025-12-01 Epub Date: 2025-12-18 DOI: 10.1016/j.cson.2025.100114

Michelle P. Sosa , Deirdre G. McNicholas , Arbelina B. Bebla , Seth Emont , Zhun Cao , Manu Tyagi , Craig Lipkin , Sommer Gunia

引用次数: 0

Automated CT-based sarcopenia assessment for risk stratification of patients undergoing colorectal cancer resection 基于ct的肌肉减少症自动评估结直肠癌切除术患者的风险分层

Clinical Surgical Oncology

Pub Date : 2025-12-01 Epub Date: 2025-11-16 DOI: 10.1016/j.cson.2025.100105

Johannes Vogelsang , Gernot Pucher , Fabian Hörst , René Hosch , Johannes Haubold , Philipp Keyl , Christopher M. Sauer , David Albers , Peter Markus , Jan P. Neuhaus , Andreas D. Rink , Jürgen Treckmann , Ulf P. Neumann , Kai Nassenstein , Michael Forsting , Hideo A. Baba , Jan Egger , Stefan Kasper , Martin Schuler , Felix Nensa , Julius Keyl

Despite the prognostic relevance of sarcopenia in colorectal cancer, it has not yet been incorporated into routine clinical patient assessment. This study investigates the potential of automatically CT-derived muscle-to-bone ratio (MBR) for preoperative stratification of colorectal cancer patients.

We retrospectively analyzed CT images of 117 colorectal cancer patients undergoing surgical resection. A deep learning model was used to assess the abdominal MBR as a measure of sarcopenia. Univariable and multivariable analyses were performed to analyze the association between MBR and overall survival (OS), in-hospital mortality, length of stay (LOS), and postoperative C-reactive protein (CRP) levels.

In univariable analysis, preoperative MBR was significantly associated with OS (hazard ratio (HR) 0.29, 95 % CI: 0.13–0.64, p < 0.005). In multivariable analysis adjusted for age, sex, and UICC stage, higher MBR remained independently associated with improved OS (HR 0.28, 95 % CI: 0.10–0.79, p = 0.017) and reduced in-hospital mortality (coefficient (β) = -2.58, p = 0.031). Subgroups based on MBR showed significantly different OS in Kaplan-Meier analysis (p < 0.005). Furthermore, patients with low preoperative MBR exhibited significantly higher postoperative CRP values (p = 0.039). No significant association was observed between MBR and LOS.

Our study demonstrates the potential of deep learning-derived MBR for automated sarcopenia assessment and patient stratification in colorectal cancer surgery.

尽管结直肠癌中肌肉减少症与预后相关，但尚未纳入常规临床患者评估。本研究探讨了自动ct衍生的肌骨比（MBR）在结直肠癌患者术前分层中的潜力。我们回顾性分析117例结直肠癌手术切除患者的CT图像。使用深度学习模型评估腹部MBR作为肌肉减少症的测量。进行单变量和多变量分析，分析MBR与总生存期（OS）、住院死亡率、住院时间（LOS）和术后c反应蛋白（CRP）水平之间的关系。单变量分析中，术前MBR与OS显著相关（风险比0.29,95% CI: 0.13-0.64, p < 0.005）。在调整了年龄、性别和UICC分期的多变量分析中，较高的MBR仍然与改善的OS （HR 0.28, 95% CI: 0.10-0.79, p = 0.017）和降低的住院死亡率（系数(β) = -2.58, p = 0.031）独立相关。Kaplan-Meier分析显示，基于MBR的亚组OS差异显著（p < 0.005）。此外，术前MBR较低的患者术后CRP值明显较高（p = 0.039）。MBR和LOS之间没有明显的关联。我们的研究证明了基于深度学习的MBR在结肠直肠癌手术中用于自动肌肉减少症评估和患者分层的潜力。

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引用次数: 0

Breaking barriers: Pembrolizumab's role in overcoming targeted therapy resistance in BRAF-mutant melanoma 突破障碍：Pembrolizumab在克服braf突变黑色素瘤靶向治疗耐药中的作用

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-08-29 DOI: 10.1016/j.cson.2025.100095

Omer A. Idris , Abdulaziz Shebrain , Ali Jawad , Sabrina C. Pacione , Delour Haj , Hanin Bzizi , Yaqub O. Ahmedfiqi , Bahar Saadaie Jahromi , Nicholas Deleon , Tiantian Zhang , Amanda Hunt , Ramona Meraz Lewis , Diana Westgate

Melanoma, a malignancy of melanocytes, has increased globally, posing significant treatment challenges. BRAF mutations, particularly V600E and V600K variants, occur in approximately 40–60 % of cutaneous melanomas and activate the MAPK/ERK signaling pathway. Although BRAF and MEK inhibitors have improved response rates and survival, acquired resistance—due to genetic alterations, activation of alternative pathways, and phenotypic changes—remains a major hurdle.

Pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, has emerged as a promising option to overcome resistance to targeted therapies. This review explores the rationale for using pembrolizumab post-resistance, emphasizing its ability to enhance immune recognition through the immunogenic effects of prior targeted therapies and its synergistic potential when combined with BRAF and MEK inhibitors. Clinical evidence from KEYNOTE trials and real-world studies demonstrates pembrolizumab's efficacy as monotherapy and in combination regimens, leading to improved progression-free and overall survival in patients with advanced melanoma. Mechanistic insights from preclinical studies suggest that targeted therapies modulate the tumor microenvironment and enhance antigen presentation, augmenting the effectiveness of pembrolizumab. Novel biomarkers such as tumor mutational burden (TMB), PD-L1 expression, and circulating tumor DNA (ctDNA) are examined for their potential to predict treatment response and guide personalized therapy. Challenges related to increased toxicity in combination therapies, economic impact, and patient heterogeneity are discussed, highlighting the need for careful patient selection and management strategies. Future directions include optimizing treatment sequencing, exploring novel therapeutic combinations, and advancing personalized medicine through integrative genomic and immunologic data. This review underscores the pivotal role of pembrolizumab in managing BRAF-mutant melanoma and emphasizes the importance of integrated therapeutic strategies to improve patient outcomes.

黑色素瘤是一种黑色素细胞的恶性肿瘤，在全球范围内呈上升趋势，带来了重大的治疗挑战。BRAF突变，特别是V600E和V600K突变，发生在大约40 - 60%的皮肤黑色素瘤中，并激活MAPK/ERK信号通路。尽管BRAF和MEK抑制剂提高了反应率和生存率，但由于遗传改变、替代途径的激活和表型改变，获得性耐药仍然是一个主要障碍。Pembrolizumab是一种抗pd -1免疫检查点抑制剂，已成为克服靶向治疗耐药的有希望的选择。本综述探讨了耐药后使用派姆单抗的基本原理，强调其通过先前靶向治疗的免疫原性效应增强免疫识别的能力，以及与BRAF和MEK抑制剂联合使用时的协同潜力。KEYNOTE试验和现实世界研究的临床证据表明，pembrolizumab作为单药治疗和联合治疗方案的疗效，可改善晚期黑色素瘤患者的无进展和总生存期。临床前研究的机制见解表明，靶向治疗调节肿瘤微环境并增强抗原呈递，从而增强派姆单抗的有效性。新的生物标志物，如肿瘤突变负荷（TMB）， PD-L1表达和循环肿瘤DNA （ctDNA）被检查其预测治疗反应和指导个性化治疗的潜力。讨论了与联合治疗毒性增加、经济影响和患者异质性相关的挑战，强调了谨慎选择患者和管理策略的必要性。未来的发展方向包括优化治疗序列，探索新的治疗组合，以及通过整合基因组和免疫数据推进个性化医疗。本综述强调了派姆单抗在治疗braf突变黑色素瘤中的关键作用，并强调了综合治疗策略对改善患者预后的重要性。

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引用次数: 0

Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy 计划进行CRS和HIPEC但仅进行探查性剖腹手术的患者的结果

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-08-27 DOI: 10.1016/j.cson.2025.100093

Valentinus Valdimarsson, Ingvar Syk, Victor Verwaal

Background

Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.

Methods

All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.

Results

A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 %) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 %). Three patients (11 %) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 %) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.

Conclusion

Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.

一些计划进行细胞减少手术（CRS）和腹腔内高温化疗（HIPEC）的患者由于肿瘤广泛扩散或难以实现完全细胞减少（CC0），只能进行探查性剖腹手术（开/闭手术）。本研究旨在评估腹膜表面恶性肿瘤（PSM）患者仅行开腹/闭腹手术的手术效果和总生存率。方法纳入2015年至2023年期间在瑞典Malmö进行CRS和HIPEC手术的所有仅行开腹/闭腹手术的患者。排除无恶性诊断的患者。分析临床、生存和并发症数据。结果28例患者仅行开腹/闭腹手术。开腹前，15例（54%）患者接受了诊断性腹腔镜检查，PCI评分中位数为13.0 （IQR 10.0-19.0）。剖腹手术时，PCI评分中位数为29.0 （IQR 25.5-33.0）。不进行CRS和HIPEC手术的最常见原因是PCI评分高（61%）。3例患者（11%）出现严重的术后并发症（Clavien-Dindo≥3b）， 1例患者在术后第一天死亡。探查性剖腹手术后，21例（78%）患者接受了姑息性化疗（中位生存期为13.4个月），而6例患者未接受姑息性化疗（中位生存期为3.5个月），其中1例患者数据缺失。结论单纯剖腹探查（开腹/闭腹）诊断为PSM的患者预后极差。剖腹探查术存在严重的术后并发症风险，并且住院时间较长。迫切需要改进的诊断工具来帮助确定适合CRS和HIPEC治疗的患者。

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引用次数: 0

Bibliometric and visualized analysis of fertility preservation in patients with gynecological malignancies from 2014 to 2023 2014 - 2023年妇科恶性肿瘤患者生育能力保存文献计量及可视化分析

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-06-27 DOI: 10.1016/j.cson.2025.100085

Zhanghuan Li , Wenqi Du , Yufei Qin , Yinghui Yang , Yuxia Gao , Jing Yang , Xiaojie Feng , Wenqiang Fan , Wenxiang Wang

Objective

Fertility preservation in patients with gynecological malignancies (FP-GM) has gained increasing attention. This study conducts a bibliometric analysis of FP-GM research, aiming to identify key themes, influential publications, major contributors, and emerging trends that have shaped the field over the last decade.

Methods

Data were sourced from the Web of Science Core Collection (WOSCC). Tools such as CiteSpace and VOSviewer were utilized to conduct a detailed bibliometric analysis, focusing on keyword co-occurrence, citation bursts, collaboration networks, and clusters of influential references.

Results

A total of 2029 original articles were identified, involving 11446 authors from 342 countries and 8693 institutions, and published across 417 academic journals. Annual Publication generally shows an increasing trend. The USA is leading much of the advancement in this field. The International Journal of Gynecological Cancer published the most articles, and the journal with the most citations was Fertility and Sterility. Grynberg, Michael was the author with the most publications, and Donnez, J was the author with the most citations. The most frequently occurring keywords were “fertility preservation”, “cancer”, “women” and “chemotherapy”. Clusters of references including “cryopreservation techniques”, “ovarian cancer”, “cervical cancer”, “endometrial cancer” and so on. Citation bursts underscored the impact of guidelines and experimental research on the evolution of FP-GM.

Conclusion

Research on FP-GM is dominated by cryopreservation techniques and the reproductive consequences of cancer treatments. Influential guidelines and experimental research have shaped the field, with emerging interest in fertility-sparing treatments and hormonal preservation strategies, indicating a continuous evolution in clinical practices.

目的保存妇科恶性肿瘤患者的生育能力已受到越来越多的关注。本研究对FP-GM研究进行了文献计量分析，旨在确定在过去十年中塑造该领域的关键主题、有影响力的出版物、主要贡献者和新兴趋势。方法数据来源于Web of Science Core Collection （WOSCC）。利用CiteSpace和VOSviewer等工具进行详细的文献计量分析，重点关注关键词共现、引文爆发、协作网络和有影响力的参考文献集群。结果共发现原创文章2029篇，作者11446人，来自342个国家8693个机构，发表于417种学术期刊。年度出版物总体呈增长趋势。美国在这一领域处于领先地位。发表文章最多的是《国际妇科癌症杂志》，被引用次数最多的是《生育与不育》。格林伯格，迈克尔是发表文章最多的作者，Donnez， J是被引用最多的作者。出现频率最高的关键词是“保留生育能力”、“癌症”、“女性”和“化疗”。参考文献簇包括“冷冻保存技术”、“卵巢癌”、“宫颈癌”、“子宫内膜癌”等。大量引用强调了指南和实验研究对FP-GM进化的影响。结论FP-GM的研究主要集中在冷冻保存技术和肿瘤治疗对生殖的影响。有影响力的指导方针和实验研究塑造了这一领域，对保留生育能力的治疗和激素保存策略的兴趣日益浓厚，表明临床实践在不断发展。

{"title":"Bibliometric and visualized analysis of fertility preservation in patients with gynecological malignancies from 2014 to 2023","authors":"Zhanghuan Li , Wenqi Du , Yufei Qin , Yinghui Yang , Yuxia Gao , Jing Yang , Xiaojie Feng , Wenqiang Fan , Wenxiang Wang","doi":"10.1016/j.cson.2025.100085","DOIUrl":"10.1016/j.cson.2025.100085","url":null,"abstract":"<div><h3>Objective</h3><div>Fertility preservation in patients with gynecological malignancies (FP-GM) has gained increasing attention. This study conducts a bibliometric analysis of FP-GM research, aiming to identify key themes, influential publications, major contributors, and emerging trends that have shaped the field over the last decade.</div></div><div><h3>Methods</h3><div>Data were sourced from the Web of Science Core Collection (WOSCC). Tools such as CiteSpace and VOSviewer were utilized to conduct a detailed bibliometric analysis, focusing on keyword co-occurrence, citation bursts, collaboration networks, and clusters of influential references.</div></div><div><h3>Results</h3><div>A total of 2029 original articles were identified, involving 11446 authors from 342 countries and 8693 institutions, and published across 417 academic journals. Annual Publication generally shows an increasing trend. The USA is leading much of the advancement in this field. <em>The International Journal of Gynecological Cancer</em> published the most articles, and the journal with the most citations was <em>Fertility and Sterility</em>. Grynberg, Michael was the author with the most publications, and Donnez, J was the author with the most citations. The most frequently occurring keywords were “fertility preservation”, “cancer”, “women” and “chemotherapy”. Clusters of references including “cryopreservation techniques”, “ovarian cancer”, “cervical cancer”, “endometrial cancer” and so on. Citation bursts underscored the impact of guidelines and experimental research on the evolution of FP-GM.</div></div><div><h3>Conclusion</h3><div>Research on FP-GM is dominated by cryopreservation techniques and the reproductive consequences of cancer treatments. Influential guidelines and experimental research have shaped the field, with emerging interest in fertility-sparing treatments and hormonal preservation strategies, indicating a continuous evolution in clinical practices.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial intelligence and machine learning in thoracic surgery- A scoping review 胸外科中的人工智能和机器学习-范围综述

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1016/j.cson.2025.100086

K. Kutywayo , K. Chandarana , I. Das , S. Rathinam

Artificial intelligence (AI) and machine learning (ML) are rapidly transforming thoracic surgery, offering innovative solutions to enhance patient care, improve surgical outcomes, improve surgical training, and increase efficiency. This scoping review provides a comprehensive overview of the current applications, challenges, and future directions of AI and ML in thoracic surgery.

Key applications of AI in thoracic imaging include lung nodule detection and characterisation, with deep learning algorithms demonstrating performance comparable to or exceeding that of human radiologists. Radiomics combined with ML techniques show promise in tumour characterisation and classification of non-small cell lung cancer subtypes. In preoperative planning, AI-powered 3D reconstruction and virtual reality systems enable detailed surgical simulation and risk assessment.

Augmented reality and computer-assisted navigation systems are being developed to enhance surgical precision intraoperatively. While fully autonomous robotic surgery remains a distant goal, AI-enhanced robotic platforms are advancing rapidly. Postoperatively, AI algorithms show potential for predicting outcomes, interpreting pulmonary function tests, and guiding rehabilitation strategies.

Despite these advancements, several challenges persist, including data quality and quantity issues, algorithm interpretability, and the need for rigorous clinical validation. Ethical considerations surrounding AI implementation in healthcare also require careful attention.

Future directions include integrating multimodal data, developing real-time intraoperative guidance systems, and creating adaptive AI models capable of continuous learning. As these technologies mature, they have the potential to revolutionise thoracic surgical practice, ultimately improving patient outcomes.

人工智能（AI）和机器学习（ML）正在迅速改变胸外科手术，提供创新的解决方案，以加强患者护理，改善手术结果，改善手术培训并提高效率。本文综述了人工智能和机器学习在胸外科中的当前应用、挑战和未来方向。人工智能在胸部成像中的关键应用包括肺结节检测和表征，其深度学习算法的表现与人类放射科医生相当或超过。放射组学结合ML技术在非小细胞肺癌亚型的肿瘤特征和分类方面显示出希望。在术前规划中，人工智能支持的3D重建和虚拟现实系统可以进行详细的手术模拟和风险评估。正在开发增强现实和计算机辅助导航系统，以提高术中手术的精度。虽然完全自主的机器人手术仍然是一个遥远的目标，但人工智能增强的机器人平台正在迅速发展。术后，人工智能算法显示出预测结果、解释肺功能测试和指导康复策略的潜力。尽管取得了这些进步，但仍存在一些挑战，包括数据质量和数量问题、算法可解释性以及严格的临床验证需求。在医疗保健中实施人工智能的伦理考虑也需要仔细关注。未来的方向包括整合多模态数据，开发实时术中引导系统，以及创建能够持续学习的自适应人工智能模型。随着这些技术的成熟，它们有可能彻底改变胸外科手术实践，最终改善患者的治疗效果。

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引用次数: 0

Evaluating the quality and readability of AI-generated ophthalmic surgery education: A four model comparison 评价人工智能眼科外科教育的质量和可读性：四种模式的比较

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-08-19 DOI: 10.1016/j.cson.2025.100092

Rickvir S. Sidhu , Arrane Selvamogan

引用次数: 0

AI-driven surgical oncology: Innovations, challenges, and the path ahead 人工智能驱动的外科肿瘤学：创新、挑战和未来的道路

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-07-11 DOI: 10.1016/j.cson.2025.100088

Wen Yuan Chung

引用次数: 0

Outpatient revisits associated with three sentinel lymph node detection techniques for breast cancer: A propensity score weighted analysis 与三种前哨淋巴结检测技术相关的门诊复诊：倾向评分加权分析

Clinical Surgical Oncology

Pub Date : 2025-09-01 Epub Date: 2025-06-23 DOI: 10.1016/j.cson.2025.100087

Michelle P. Sosa , Deirdre G. McNicholas , Arbelina B. Bebla , Seth Emont , Zhun Cao , Manu Tyagi , Craig Lipkin , Sommer Gunia

Introduction

This study evaluates whether near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is associated with a lower outpatient (OP) revisit rate compared to isosulfan blue (IB) or methylene blue (MB) when combined with technetium-99m (Tc99m) for sentinel lymph node (SLN) mapping of breast cancer.

Materials and methods

This retrospective observational study included adult female patients with a breast cancer diagnosis who underwent SLN mapping and had an index OP discharge between July 1, 2017 and August 31, 2022 at a U.S. hospital contributing to the Premier Healthcare Database. Patients were grouped by SLN mapping method: IB + Tc99m, MB + Tc99m, and ICG + Tc99m. The primary outcome was OP revisit rates at 30, 60, and 90 days post-discharge. Propensity score weighting adjusted for differences in baseline characteristics.

Results

5.6 % (n = 60,068) of the 1,067,677 adult female patients with a breast cancer diagnosis underwent SLN mapping, and 54.9 % (n = 32,970) met the inclusion criteria. In the propensity-weighted sample (n = 2002), the ICG + Tc99m cohort had the lowest OP revisit rates at all time points compared to IB + Tc99m and MB + Tc99m: at 30 days, 36.4 % vs. 43.1 % vs. 43.2 %; at 60 days, 50.9 % vs. 55.8 % vs. 56.2 %; and at 90 days, 55.9 % vs. 59.7 % vs. 60.0 % (all p < .05). Adjusted odds ratios (aORs) confirmed the ICG + Tc99m cohort's reduced OP revisits: 30-day aOR, 0.74 (0.63–0.88); 60-day aOR, 0.80 (0.68–0.94); and 90-day aOR, 0.84 (0.71–0.99) (all p < .05).

Conclusion

NIRF with ICG + Tc99m was associated with significantly fewer OP revisits, suggesting that this method may improve patient outcomes and the continuum of care for breast cancer patients.

本研究评估近红外荧光（NIRF）成像与吲哚菁绿（ICG）相比，与异硫丹蓝（IB）或亚甲基蓝（MB）联合锝-99m （Tc99m）进行乳腺癌前哨淋巴结（SLN）定位时，是否与较低的门诊（OP）重访率相关。材料和方法本回顾性观察性研究纳入了2017年7月1日至2022年8月31日期间在美国一家医院接受SLN定位并有指数OP出院的乳腺癌成年女性患者，这些患者为Premier医疗数据库提供了资料。采用SLN作图法对患者进行分组：IB + Tc99m、MB + Tc99m、ICG + Tc99m。主要结果是出院后30,60和90天的OP重访率。结果在1,067,677例诊断为乳腺癌的成年女性患者中，5.6% （n = 60,068）进行了SLN定位，54.9% （n = 32,970）符合纳入标准。在倾向加权样本（n = 2002）中，与IB + Tc99m和MB + Tc99m相比，ICG + Tc99m队列在所有时间点的OP重访率最低：在30天，36.4%比43.1%比43.2%；60天，50.9% vs. 55.8% vs. 56.2%；在第90天，55.9% vs. 59.7% vs. 60.0% (p <；. 05)。调整后的优势比（aORs）证实ICG + tc9900万组的OP复诊次数减少：30天的aOR为0.74 (0.63-0.88)；60天aOR为0.80 (0.68-0.94)；90天aOR为0.84(0.71-0.99)(均p <；. 05)。结论ICG + Tc99m的nirf与OP复诊次数显著减少相关，提示该方法可改善患者预后和乳腺癌患者的持续护理。

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引用次数: 0