Pub Date : 2025-12-18DOI: 10.1016/j.ejso.2025.111355
Veronica Tius , Cristina Taliento , Martina Arcieri , Sara Filippin , Miriam Isola , Maria De Martino , Nicolò Bizzarri , Matteo Pavone , Mauro Signorelli , Domenica Lorusso , Paolo Scollo , Sandro Pignata , Vito Chiantera , Giorgio Bogani , Jvan Casarin , Anna Fagotti , Stefano Restaino , Giuseppe Vizzielli
The best surgical timing for advanced epithelial ovarian cancer, whether primary debulking surgery or interval debulking surgery, remains debated. Recent data, including the preliminary ones from TRUST trial, necessitates an updated critical evaluation. A systematic search of PubMed identified only randomized controlled trials comparing interval debulking surgery versus primary debulking surgery in patients with newly diagnosed advanced ovarian cancer. Primary outcomes included overall survival (OS) and progression-free survival (PFS). A random-effects meta-analysis, meta-regression, cumulative synthesis, and leave-one-out influence analysis were performed. A total of 2303 patients were included. Compared to primary debulking surgery, interval debulking surgery was associated with lower rates of postoperative complications (OR = 0.37; 95 % CI: 0.18–0.79; P = 0.01) and mortality (OR = 0.23; 95 % CI: 0.09–0.57; P = 0.002). Meta-analysis showed higher rates of complete cytoreduction with interval debulking surgery (OR = 3.84; 95 % CI: 2.14–6.91; P < 0.00001) and lower rates of macroscopic residual disease (OR = 0.20; 95 % CI: 0.13–0.30; P < 0.00001). Pooled data revealed no significant difference in OS (HR = 0.95; 95 % CI: 0.87–1.04; P = 0.26) or PFS (HR = 0.94; 95 % CI: 0.85–1.03; P = 0.16). Subgroup analyses by stage and residual disease confirmed similar survival outcomes. The meta-regression results suggested that even in trials with very high complete cytoreduction rates, no clinically meaningful OS benefit was observed for upfront surgery. In conclusion, interval debulking surgery offers comparable survival outcomes to primary debulking, with reduced perioperative morbidity and mortality, supporting its role as a valid surgical alternative.
Prospero registration number
CRD420251105308.
晚期上皮性卵巢癌的最佳手术时机,是原发性减瘤手术还是间歇减瘤手术,仍然存在争议。最近的数据,包括TRUST试验的初步数据,需要进行更新的关键评估。PubMed的系统搜索只发现了随机对照试验,比较了新诊断的晚期卵巢癌患者的间隔降压手术和原发性降压手术。主要结局包括总生存期(OS)和无进展生存期(PFS)。进行随机效应荟萃分析、荟萃回归、累积综合和遗漏影响分析。共纳入2303例患者。与初次降压手术相比,间歇降压手术的术后并发症发生率(OR = 0.37; 95% CI: 0.18-0.79; P = 0.01)和死亡率(OR = 0.23; 95% CI: 0.09-0.57; P = 0.002)较低。荟萃分析显示,间歇减容手术的完全细胞减少率更高(OR = 3.84; 95% CI: 2.14-6.91; P < 0.00001),宏观残留疾病率更低(OR = 0.20; 95% CI: 0.13-0.30; P < 0.00001)。合并数据显示OS (HR = 0.95; 95% CI: 0.87-1.04; P = 0.26)或PFS (HR = 0.94; 95% CI: 0.85-1.03; P = 0.16)无显著差异。分期和残留疾病的亚组分析证实了相似的生存结果。meta回归结果表明,即使在具有非常高的完全细胞减少率的试验中,也没有观察到前期手术有临床意义的OS获益。总之,间隔期去囊术与初次去囊术相比,生存率相当,且围手术期发病率和死亡率较低,支持其作为一种有效的手术选择的作用。普洛斯彼罗注册号crd420251105308。
{"title":"Surgical timing in advanced ovarian cancer during the TRUST trial era: A systematic review, meta-analysis and study-level meta-regression of randomized controlled trials","authors":"Veronica Tius , Cristina Taliento , Martina Arcieri , Sara Filippin , Miriam Isola , Maria De Martino , Nicolò Bizzarri , Matteo Pavone , Mauro Signorelli , Domenica Lorusso , Paolo Scollo , Sandro Pignata , Vito Chiantera , Giorgio Bogani , Jvan Casarin , Anna Fagotti , Stefano Restaino , Giuseppe Vizzielli","doi":"10.1016/j.ejso.2025.111355","DOIUrl":"10.1016/j.ejso.2025.111355","url":null,"abstract":"<div><div>The best surgical timing for advanced epithelial ovarian cancer, whether primary debulking surgery or interval debulking surgery, remains debated. Recent data, including the preliminary ones from TRUST trial, necessitates an updated critical evaluation. A systematic search of PubMed identified only randomized controlled trials comparing interval debulking surgery versus primary debulking surgery in patients with newly diagnosed advanced ovarian cancer. Primary outcomes included overall survival (OS) and progression-free survival (PFS). A random-effects meta-analysis, meta-regression, cumulative synthesis, and leave-one-out influence analysis were performed. A total of 2303 patients were included. Compared to primary debulking surgery, interval debulking surgery was associated with lower rates of postoperative complications (OR = 0.37; 95 % CI: 0.18–0.79; P = 0.01) and mortality (OR = 0.23; 95 % CI: 0.09–0.57; P = 0.002). Meta-analysis showed higher rates of complete cytoreduction with interval debulking surgery (OR = 3.84; 95 % CI: 2.14–6.91; P < 0.00001) and lower rates of macroscopic residual disease (OR = 0.20; 95 % CI: 0.13–0.30; P < 0.00001). Pooled data revealed no significant difference in OS (HR = 0.95; 95 % CI: 0.87–1.04; P = 0.26) or PFS (HR = 0.94; 95 % CI: 0.85–1.03; P = 0.16). Subgroup analyses by stage and residual disease confirmed similar survival outcomes. The meta-regression results suggested that even in trials with very high complete cytoreduction rates, no clinically meaningful OS benefit was observed for upfront surgery. In conclusion, interval debulking surgery offers comparable survival outcomes to primary debulking, with reduced perioperative morbidity and mortality, supporting its role as a valid surgical alternative.</div></div><div><h3>Prospero registration number</h3><div>CRD420251105308.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111355"},"PeriodicalIF":2.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ejso.2025.111360
Jianfei Zhu , Yu Ma , Yanlu Xiong , Yu Bai , Hongtao Wang , Tao Jiang , Yawei Dou , Feng Wang , Ran Yang , Zhentao Yu , Xiangyang Yu
Background
Studies investigating recurrence patterns and adjuvant therapy strategies in patients with esophageal squamous cell carcinoma (ESCC) who achieve pathological complete response (pCR) following neoadjuvant immunochemotherapy (nICT) remain scarce.
Methods
A retrospective analysis was conducted in patients from three medical centers who underwent nICT followed by surgery and were pathologically confirmed to have achieved pCR between 2020 and 2022. The recurrence patterns and temporal distributions were evaluated. Univariate and multivariate analyses were performed to identify the predictors of disease-free survival (DFS) and overall survival (OS).
Results
Eighty-three patients who achieved pCR were included in the study. The 1- and 3-year DFS rates were 86 % and 71 %, respectively. Recurrence or metastasis occurred in 15.7 % (13/83) of patients following esophagectomy. Among these, six patients developed mediastinal lymph node recurrence; two patients each developed peritoneal and supraclavicular lymph node metastasis, and one patient each developed liver, lung, and bone metastases. The median recurrence time was 10.6 months (range: 4.4–39.4 months). Multivariable analysis demonstrated that cT stage was an independent factor affecting OS in patients with pCR, whereas drinking status was identified as an independent predictor of DFS. Notably, postoperative adjuvant therapy did not confer a significant benefit in either OS (P = 0.846) or DFS (P = 0.066) in these patients.
Conclusions
Patients with ESCC who underwent nICT followed by esophagectomy continued to experience relapse. Within this limited study cohort, no benefit was observed from adjuvant therapy.
{"title":"Recurrence patterns and adjuvant therapy strategies in patients with esophageal squamous cell carcinoma who achieved pathological complete response after neoadjuvant immunochemotherapy: A high-volume retrospective study","authors":"Jianfei Zhu , Yu Ma , Yanlu Xiong , Yu Bai , Hongtao Wang , Tao Jiang , Yawei Dou , Feng Wang , Ran Yang , Zhentao Yu , Xiangyang Yu","doi":"10.1016/j.ejso.2025.111360","DOIUrl":"10.1016/j.ejso.2025.111360","url":null,"abstract":"<div><h3>Background</h3><div>Studies investigating recurrence patterns and adjuvant therapy strategies in patients with esophageal squamous cell carcinoma (ESCC) who achieve pathological complete response (pCR) following neoadjuvant immunochemotherapy (nICT) remain scarce.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted in patients from three medical centers who underwent nICT followed by surgery and were pathologically confirmed to have achieved pCR between 2020 and 2022. The recurrence patterns and temporal distributions were evaluated. Univariate and multivariate analyses were performed to identify the predictors of disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Eighty-three patients who achieved pCR were included in the study. The 1- and 3-year DFS rates were 86 % and 71 %, respectively. Recurrence or metastasis occurred in 15.7 % (13/83) of patients following esophagectomy. Among these, six patients developed mediastinal lymph node recurrence; two patients each developed peritoneal and supraclavicular lymph node metastasis, and one patient each developed liver, lung, and bone metastases. The median recurrence time was 10.6 months (range: 4.4–39.4 months). Multivariable analysis demonstrated that cT stage was an independent factor affecting OS in patients with pCR, whereas drinking status was identified as an independent predictor of DFS. Notably, postoperative adjuvant therapy did not confer a significant benefit in either OS (P = 0.846) or DFS (P = 0.066) in these patients.</div></div><div><h3>Conclusions</h3><div>Patients with ESCC who underwent nICT followed by esophagectomy continued to experience relapse. Within this limited study cohort, no benefit was observed from adjuvant therapy.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111360"},"PeriodicalIF":2.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.ejso.2025.111362
Yanhong Lin , Peipei Zhang , Mingqiang Kang , Ziyang Han
Background
Esophageal squamous cell carcinoma (ESCC) carries a poor prognosis, with lymph node status being a critical determinant. Traditional N staging and the lymph node ratio (LNR), which rely solely on the number of positive lymph nodes, may lack precision. This study proposes a novel staging system based on the sum of regional lymph node ratios (SRRN) to enhance prognostic assessment.
Methods
In this single-center, retrospective cohort study, we retrospectively analyzed 1208 ESCC patients who underwent radical resection at Fujian Medical University Union Hospital between 2010 and 2020. The regional lymph node ratio (RLNR) was calculated for each lymph node station and summed to define SRRN. Patients were stratified into SRRN0–3 groups using X-tile. The prognostic value of SRRN versus traditional N staging was evaluated using Cox regression and random survival forest (RSF) models, while survival differences among groups were compared via Kaplan–Meier analysis.
Results
SRRN emerged as an independent predictor of overall survival (OS). Compared to N staging, SRRN demonstrated superior predictive performance in both Cox and RSF models, with higher AUC and C-index values. Kaplan–Meier curves revealed more pronounced survival differences among SRRN groups. Kaplan–Meier curves revealed substantially greater prognostic separation among SRRN groups, with 5-year OS rates of 66.7 % for SRRN0 compared to only 7.9 % for SRRN3. Nomograms incorporating SRRN showed good calibration and potential clinical utility.
Conclusion
The SRRN staging system outperforms traditional N staging in prognostic stratification and may guide optimized staging and individualized treatment decisions for patients with ESCC.
{"title":"SRRN: A regional lymph node ratio–based staging system enhancing prognostic accuracy in esophageal squamous cell carcinoma","authors":"Yanhong Lin , Peipei Zhang , Mingqiang Kang , Ziyang Han","doi":"10.1016/j.ejso.2025.111362","DOIUrl":"10.1016/j.ejso.2025.111362","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal squamous cell carcinoma (ESCC) carries a poor prognosis, with lymph node status being a critical determinant. Traditional N staging and the lymph node ratio (LNR), which rely solely on the number of positive lymph nodes, may lack precision. This study proposes a novel staging system based on the sum of regional lymph node ratios (SRRN) to enhance prognostic assessment.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective cohort study, we retrospectively analyzed 1208 ESCC patients who underwent radical resection at Fujian Medical University Union Hospital between 2010 and 2020. The regional lymph node ratio (RLNR) was calculated for each lymph node station and summed to define SRRN. Patients were stratified into SRRN0–3 groups using X-tile. The prognostic value of SRRN versus traditional N staging was evaluated using Cox regression and random survival forest (RSF) models, while survival differences among groups were compared via Kaplan–Meier analysis.</div></div><div><h3>Results</h3><div>SRRN emerged as an independent predictor of overall survival (OS). Compared to N staging, SRRN demonstrated superior predictive performance in both Cox and RSF models, with higher AUC and C-index values. Kaplan–Meier curves revealed more pronounced survival differences among SRRN groups. Kaplan–Meier curves revealed substantially greater prognostic separation among SRRN groups, with 5-year OS rates of 66.7 % for SRRN0 compared to only 7.9 % for SRRN3. Nomograms incorporating SRRN showed good calibration and potential clinical utility.</div></div><div><h3>Conclusion</h3><div>The SRRN staging system outperforms traditional N staging in prognostic stratification and may guide optimized staging and individualized treatment decisions for patients with ESCC.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111362"},"PeriodicalIF":2.9,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Locally advanced gastric cancer is usually treated with D2 lymphadenectomy, although extended D2+ dissection (Nos. 12b, 12p, 13, and 14v) is occasionally performed. This study evaluated the efficacy and optimal indications for D2+ lymphadenectomy based on the therapeutic value index (TVI).
Materials and methods
Patients undergoing curative gastrectomy with D2+ lymphadenectomy (n = 373) were retrospectively analyzed. The TVI for each station was calculated by multiplying the metastatic rate by the 5‐year survival rate. Factors associated with lymph node metastasis were identified via multivariate logistic regression analysis.
Results
The metastatic rate and TVI, respectively, were 8 % and 2.6 for No. 12b/12p, 8 % and 2.4 for No. 13, and 7 % and 3.9 for No. 14v. Higher TVIs were seen among patients with duodenal invasion versus those without (No. 12b/12p, 3.9 vs. 0; No. 13, 3.8 vs. 0; No. 14v, 9.0 vs. 2.7). On multivariate analysis, preoperative duodenal invasion (odds ratio 2.59 [95 % confidence interval, 1.06–6.31]; p = 0.037) and clinical No. 6 metastasis (odds ratio 3.96 [95 % confidence interval, 1.63–9.63]; p = 0.002) were independent predictors of No. 14v involvement.
Conclusions
Dissection of Nos. 12b, 12p, and 13 may be beneficial in patients with duodenal invasion. No. 14v dissection should be considered in patients with clinical No. 6 involvement or duodenal invasion.
背景:局部进展期胃癌通常行D2淋巴结切除术,但偶尔也行D2+淋巴结清扫术(编号12b、12p、13和14v)。本研究基于治疗价值指数(TVI)评价D2+淋巴结切除术的疗效和最佳适应症。材料与方法:回顾性分析373例根治性胃切除术合并D2+淋巴结切除术患者的资料。通过将转移率乘以5年生存率来计算每个站点的TVI。通过多因素logistic回归分析确定与淋巴结转移相关的因素。结果:No. 12b/12p的转移率和TVI分别为8%和2.6,No. 13的转移率分别为8%和2.4,No. 14v的转移率分别为7%和3.9。十二指肠侵犯患者的TVIs高于未侵犯患者(No. 12b/12p, 3.9 vs. 0; No. 13, 3.8 vs. 0; No. 14v, 9.0 vs. 2.7)。在多因素分析中,术前十二指肠侵犯(优势比2.59[95%可信区间,1.06-6.31],p = 0.037)和临床6号转移(优势比3.96[95%可信区间,1.63-9.63],p = 0.002)是No. 14v受损伤的独立预测因素。结论:12b、12p、13号淋巴结清扫术对十二指肠侵犯患者有益。临床有6号受累或十二指肠侵犯的患者应考虑No. 14v解剖。
{"title":"Efficacy of D2 plus lymph node dissection for gastric cancer","authors":"Yosuke Matsumoto, Masanori Terashima, Yusuke Koseki, Kenichiro Furukawa, Keiichi Fujiya, Yutaka Tanizawa, Etsuro Bando","doi":"10.1016/j.ejso.2025.111361","DOIUrl":"10.1016/j.ejso.2025.111361","url":null,"abstract":"<div><h3>Background</h3><div>Locally advanced gastric cancer is usually treated with D2 lymphadenectomy, although extended D2+ dissection (Nos. 12b, 12p, 13, and 14v) is occasionally performed. This study evaluated the efficacy and optimal indications for D2+ lymphadenectomy based on the therapeutic value index (TVI).</div></div><div><h3>Materials and methods</h3><div>Patients undergoing curative gastrectomy with D2+ lymphadenectomy (n = 373) were retrospectively analyzed. The TVI for each station was calculated by multiplying the metastatic rate by the 5‐year survival rate. Factors associated with lymph node metastasis were identified via multivariate logistic regression analysis.</div></div><div><h3>Results</h3><div>The metastatic rate and TVI, respectively, were 8 % and 2.6 for No. 12b/12p, 8 % and 2.4 for No. 13, and 7 % and 3.9 for No. 14v. Higher TVIs were seen among patients with duodenal invasion versus those without (No. 12b/12p, 3.9 vs. 0; No. 13, 3.8 vs. 0; No. 14v, 9.0 vs. 2.7). On multivariate analysis, preoperative duodenal invasion (odds ratio 2.59 [95 % confidence interval, 1.06–6.31]; p = 0.037) and clinical No. 6 metastasis (odds ratio 3.96 [95 % confidence interval, 1.63–9.63]; p = 0.002) were independent predictors of No. 14v involvement.</div></div><div><h3>Conclusions</h3><div>Dissection of Nos. 12b, 12p, and 13 may be beneficial in patients with duodenal invasion. No. 14v dissection should be considered in patients with clinical No. 6 involvement or duodenal invasion.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111361"},"PeriodicalIF":2.9,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ejso.2025.111359
Guirong Tan , Zhenyang Feng , Gang Xiao , Weiyin Vivian Liu , Wenjing Han , Lingjing Hu , Haihui Jiang , Ming Guo , Lijuan Zhong , Xiang Liu
Purpose
Accurate preoperative assessment of tumor consistency is critical for surgical outcome in meningioma patients. This study aims to confirm whether machine learning (ML) based radiomics demonstrates superior performance compared to conventional methods, including tumor/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratios and manual regions of interest-based apparent diffusion coefficient (ROIs-based ADC) measurements, in predicting meningioma consistency.
Material and methods
168 meningioma patients were enrolled in this study. Referring to the Zada's consistency grading system, meningioma consistency was classified into three categories: soft (grades 1 and 2), moderate (grade 3), and hard (grades 4 and 5). TCTI ratios were calculated and ADC values were measured. Radiomics features were extracted from post-contrast T1WI, T2WI, and ADC. Predicting models were constructed using support vector machine, and predictive performance was evaluated by the area under the receiver operating characteristic curve (AUC).
Results
30 meningiomas were classified as soft, 92 moderate, and 46 hard. For “soft” prediction, the best AUC values of ROIs-based ADC measurements and TCTI ratios were 0.56 and 0.74 in the validation set, respectively. In contrast, radiomics model achieved an AUC of 0.88 in the validation set. For “hard” prediction, the best AUC values of ROIs-based ADC measurements and TCTI ratios were 0.63 and 0.69 respectively for the validation set. The radiomics model had an AUC value of 0.79 in the validation set.
Conclusion
Radiomics models outperform ROIs-based ADC measurements and TCTI ratios in the non-invasive prediction of meningioma consistency. Our results may promote the applications of ML techniques in clinical practices.
{"title":"Machine learning based radiomics outperforms tumor/cerebellar peduncle T2-weighted imaging intensity ratios and ROIs-based apparent diffusion coefficient measurements in the preoperative prediction of meningioma consistency","authors":"Guirong Tan , Zhenyang Feng , Gang Xiao , Weiyin Vivian Liu , Wenjing Han , Lingjing Hu , Haihui Jiang , Ming Guo , Lijuan Zhong , Xiang Liu","doi":"10.1016/j.ejso.2025.111359","DOIUrl":"10.1016/j.ejso.2025.111359","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate preoperative assessment of tumor consistency is critical for surgical outcome in meningioma patients. This study aims to confirm whether machine learning (ML) based radiomics demonstrates superior performance compared to conventional methods, including tumor/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratios and manual regions of interest-based apparent diffusion coefficient (ROIs-based ADC) measurements, in predicting meningioma consistency.</div></div><div><h3>Material and methods</h3><div>168 meningioma patients were enrolled in this study. Referring to the Zada's consistency grading system, meningioma consistency was classified into three categories: soft (grades 1 and 2), moderate (grade 3), and hard (grades 4 and 5). TCTI ratios were calculated and ADC values were measured. Radiomics features were extracted from post-contrast T1WI, T2WI, and ADC. Predicting models were constructed using support vector machine, and predictive performance was evaluated by the area under the receiver operating characteristic curve (AUC).</div></div><div><h3>Results</h3><div>30 meningiomas were classified as soft, 92 moderate, and 46 hard. For “soft” prediction, the best AUC values of ROIs-based ADC measurements and TCTI ratios were 0.56 and 0.74 in the validation set, respectively. In contrast, radiomics model achieved an AUC of 0.88 in the validation set. For “hard” prediction, the best AUC values of ROIs-based ADC measurements and TCTI ratios were 0.63 and 0.69 respectively for the validation set. The radiomics model had an AUC value of 0.79 in the validation set.</div></div><div><h3>Conclusion</h3><div>Radiomics models outperform ROIs-based ADC measurements and TCTI ratios in the non-invasive prediction of meningioma consistency. Our results may promote the applications of ML techniques in clinical practices.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111359"},"PeriodicalIF":2.9,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ejso.2025.111354
Sebastian Djerf , Oscar Åkesson , Magnus Nilsson , Mats Lindblad , Jakob Hedberg , Jan Johansson , Attila Frigyesi
Introduction
Oesophageal resection carries significant morbidity and mortality. Artificial intelligence (AI) advances in medical research enable enhanced predictions, flexibility, and interpretability, especially for complex interactions and nonlinear relationships.
Material and methods
We used a register-based case-control design nested within prospectively collected data from the Swedish National Quality Register for Oesophageal and Gastric Cancer (NREV) to perform traditional logistic regression (LR) and machine learning (ML) with explainable AI (XAI) to predict 90-day mortality and anastomotic leakage in 1846 patients who underwent oesophageal resection between November 2005 and February 2018.
Results
The 90-day mortality was 6.0 % and anastomotic leakage was 12.4 %. XAI models yielded an area under the curve (AUC) of 0.95 for 90-day mortality, compared to 0.88 for LR. For anastomotic leakage, the AUC was 0.84 with XAI versus 0.74 with LR. LR identified significant odds ratios for 90-day mortality associated with age, ASA 2–3, BMI, and anastomotic leakage. ML models identified the same variables plus year of surgery as significant. For anastomotic leakage, LR was significant only for ASA 3, whereas ML found all examined variables to be significant predictors. XAI showed age and perioperative bleeding as important survival factors, while high BMI and age were significant risk factors for anastomotic leakage. All factors demonstrated nonlinear associations. XAI also visualises individual risk assessments for each procedure.
Conclusions
By applying XAI, we advance surgical understanding of anastomotic leakage and mortality after oesophagectomy. Our data contain significant nonlinear relationships that cannot be visualised LR. With XAI, we extract personalised risk assessments, bringing oesophageal surgery closer to personalised medicine.
{"title":"Advancing 90-day mortality and anastomotic leakage predictions after oesophagectomy for cancer using Explainable Artificial Intelligence","authors":"Sebastian Djerf , Oscar Åkesson , Magnus Nilsson , Mats Lindblad , Jakob Hedberg , Jan Johansson , Attila Frigyesi","doi":"10.1016/j.ejso.2025.111354","DOIUrl":"10.1016/j.ejso.2025.111354","url":null,"abstract":"<div><h3>Introduction</h3><div>Oesophageal resection carries significant morbidity and mortality. Artificial intelligence (AI) advances in medical research enable enhanced predictions, flexibility, and interpretability, especially for complex interactions and nonlinear relationships.</div></div><div><h3>Material and methods</h3><div>We used a register-based case-control design nested within prospectively collected data from the Swedish National Quality Register for Oesophageal and Gastric Cancer (NREV) to perform traditional logistic regression (LR) and machine learning (ML) with explainable AI (XAI) to predict 90-day mortality and anastomotic leakage in 1846 patients who underwent oesophageal resection between November 2005 and February 2018.</div></div><div><h3>Results</h3><div>The 90-day mortality was 6.0 % and anastomotic leakage was 12.4 %. XAI models yielded an area under the curve (AUC) of 0.95 for 90-day mortality, compared to 0.88 for LR. For anastomotic leakage, the AUC was 0.84 with XAI versus 0.74 with LR. LR identified significant odds ratios for 90-day mortality associated with age, ASA 2–3, BMI, and anastomotic leakage. ML models identified the same variables plus year of surgery as significant. For anastomotic leakage, LR was significant only for ASA 3, whereas ML found all examined variables to be significant predictors. XAI showed age and perioperative bleeding as important survival factors, while high BMI and age were significant risk factors for anastomotic leakage. All factors demonstrated nonlinear associations. XAI also visualises individual risk assessments for each procedure.</div></div><div><h3>Conclusions</h3><div>By applying XAI, we advance surgical understanding of anastomotic leakage and mortality after oesophagectomy. Our data contain significant nonlinear relationships that cannot be visualised LR. With XAI, we extract personalised risk assessments, bringing oesophageal surgery closer to personalised medicine.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111354"},"PeriodicalIF":2.9,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ejso.2025.111357
Dannel Yeo , Xiaoqi Liang , Althea Bastian , Heidi Strauss , Grace Lim , Fawaz M. Mahfouz , Masako Dunn , Saima K. Siddiqui , Jenny H. Lee , Veronica K. Cheung , James Wykes , Tsu-Hui Hubert Low , Carsten E. Palme , Jonathan R. Clark , Jean YH. Yang , John EJ. Rasko , Ruta Gupta
Background
Head and neck cancers (HNC) are common globally with high rates of locoregional recurrence. The detection and enumeration of circulating tumor cells (CTCs) are emerging prognostic biomarkers in solid tumors. This study aimed to detect CTCs in HNC patients, particularly head and neck mucosal squamous cell carcinoma (HNmSCC), and evaluate its prognostic value for predicting relapse.
Method
HNC patients undergoing surgical resection were prospectively recruited. Peripheral blood samples were collected preoperatively and postoperatively, then analysed for CTCs using the AccuCyte-CyteFinder platform. Prognostic performance was assessed using multivariate logistic regressions, ROC analysis and recurrence-free survival.
Results
Among 106 recruited patients, 79 had available preoperative blood samples and epithelial malignancies, with 57 (72 %) classified as HNmSCC. CTCs were detected in 81 % (46/57) of HNmSCC patients with a mean of 19 CTCs per 7.5 mL of blood (median = 9). Using a cutoff of ≥5 CTCs in a preoperative blood sample, CTC-high status was significantly associated with relapse (odds ratio = 9.52, p = 0.022) and a worse recurrence-free survival (p = 0.016). In multivariable analysis, CTC-high status remained independently significant after adjusting for other clinicopathologic parameters with consistent effect sizes across models (adjusted odds ratio = 8–10). Notably, both CTCs and margin involvement remained independently significant (margins: adjusted odds ratio = 6.17, p = 0.024) demonstrating complementary prognostic value. In exploratory postoperative follow-up samples (N = 36), CTC-high status was significantly associated with relapse (odds ratio = 26.71, p = 0.0009).
Conclusion
CTCs detected using the AccuCyte-CyteFinder platform demonstrate independent prognostic value in HNmSCC patients, complementing conventional pathologic assessment, particularly margin involvement. This proof-of-concept study provides preliminary evidence that preoperative CTC enumeration could enhance risk stratification to identify patients at high risk of relapse, potentially enabling more personalised surveillance and treatments.
{"title":"Circulating tumor cells predict relapse in head and neck mucosal squamous cell carcinoma","authors":"Dannel Yeo , Xiaoqi Liang , Althea Bastian , Heidi Strauss , Grace Lim , Fawaz M. Mahfouz , Masako Dunn , Saima K. Siddiqui , Jenny H. Lee , Veronica K. Cheung , James Wykes , Tsu-Hui Hubert Low , Carsten E. Palme , Jonathan R. Clark , Jean YH. Yang , John EJ. Rasko , Ruta Gupta","doi":"10.1016/j.ejso.2025.111357","DOIUrl":"10.1016/j.ejso.2025.111357","url":null,"abstract":"<div><h3>Background</h3><div>Head and neck cancers (HNC) are common globally with high rates of locoregional recurrence. The detection and enumeration of circulating tumor cells (CTCs) are emerging prognostic biomarkers in solid tumors. This study aimed to detect CTCs in HNC patients, particularly head and neck mucosal squamous cell carcinoma (HNmSCC), and evaluate its prognostic value for predicting relapse.</div></div><div><h3>Method</h3><div>HNC patients undergoing surgical resection were prospectively recruited. Peripheral blood samples were collected preoperatively and postoperatively, then analysed for CTCs using the AccuCyte-CyteFinder platform. Prognostic performance was assessed using multivariate logistic regressions, ROC analysis and recurrence-free survival.</div></div><div><h3>Results</h3><div>Among 106 recruited patients, 79 had available preoperative blood samples and epithelial malignancies, with 57 (72 %) classified as HNmSCC. CTCs were detected in 81 % (46/57) of HNmSCC patients with a mean of 19 CTCs per 7.5 mL of blood (median = 9). Using a cutoff of ≥5 CTCs in a preoperative blood sample, CTC-high status was significantly associated with relapse (odds ratio = 9.52, p = 0.022) and a worse recurrence-free survival (p = 0.016). In multivariable analysis, CTC-high status remained independently significant after adjusting for other clinicopathologic parameters with consistent effect sizes across models (adjusted odds ratio = 8–10). Notably, both CTCs and margin involvement remained independently significant (margins: adjusted odds ratio = 6.17, p = 0.024) demonstrating complementary prognostic value. In exploratory postoperative follow-up samples (N = 36), CTC-high status was significantly associated with relapse (odds ratio = 26.71, p = 0.0009).</div></div><div><h3>Conclusion</h3><div>CTCs detected using the AccuCyte-CyteFinder platform demonstrate independent prognostic value in HNmSCC patients, complementing conventional pathologic assessment, particularly margin involvement. This proof-of-concept study provides preliminary evidence that preoperative CTC enumeration could enhance risk stratification to identify patients at high risk of relapse, potentially enabling more personalised surveillance and treatments.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111357"},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ejso.2025.111356
Cecilia Pompili , Pooja Bhatnagar , Katy Clarke , Kevin Franks , Joshil Lodhia , Marco Nardini , Daniel Otter , Elaine Teh , Peter Tcherveniakov , Alessandro Brunelli
Background
We aimed to assess the outcome of patients who were stage-eligible for neoadjuvant chemo-immunotherapy but did not start the treatment and received surgery upfront.
Methods
All consecutive patients undergoing lung resection with or without prior neoadjuvant chemo-immunotherapy (nivolumab) for clinical stage II and III NSCLC (April 2023 through December 2024) were included in this analysis. The main reasons for not receiving the neoadjuvant treatment were described. Subgroup analyses were performed to assess outcomes by presence of neoadjuvant treatment.
Results
129 patients were included. 47 % received neoadjuvant nivolumab in combination with platinum-based chemotherapy (IO group), whereas 53 % did not receive neoadjuvant treatment and proceeded to surgery upfront (S group). There was no difference in minimally invasive approach between procedures performed after neoadjuvant treatment and those without (75 % vs. 73.9 %, p = 0.88).
Neoadjuvant treatment was not associated with increased risk of postoperative cardiopulmonary complications (IO = 35 % vs. S = 38 %, p = 0.75) or prolonged hospital stay (IO = 5 days vs. S = 6, p = 0.24). The most frequent reason for not starting neoadjuvant treatment was the lack of adequate tissue sampling for molecular testing or diagnosis/nodal staging confirmation (32 %), followed by the presence of actionable genetic alterations (16 %), patient choice (11.5 %) and underlying immune-related disease (11.5 %).
Conclusions
A large proportion of patients who could qualify for neoadjuvant systemic anticancer treatment never started it. Our findings may inform future discussions on how to improve the treatment pathway of patients with NSCLC and candidates to neoadjuvant or perioperative immunotherapy.
本研究的目的是评估分期符合新辅助化疗免疫治疗条件但未开始治疗且提前接受手术的患者的预后。方法所有连续接受肺切除术的临床II期和III期NSCLC患者(2023年4月至2024年12月)均接受或未接受新辅助化疗免疫治疗(纳武单抗)。描述了不接受新辅助治疗的主要原因。进行亚组分析以评估新辅助治疗的结果。结果共纳入129例患者。47%的患者接受了新辅助纳武单抗联合铂基化疗(IO组),而53%的患者未接受新辅助治疗并提前进行手术(S组)。在微创入路方面,新辅助治疗后与未进行新辅助治疗的患者无差异(75% vs. 73.9%, p = 0.88)。新辅助治疗与术后心肺并发症风险增加(IO = 35% vs. S = 38%, p = 0.75)或住院时间延长(IO = 5天vs. S = 6天,p = 0.24)无关。不开始新辅助治疗的最常见原因是缺乏足够的组织样本进行分子检测或诊断/淋巴结分期确认(32%),其次是存在可操作的遗传改变(16%),患者选择(11.5%)和潜在的免疫相关疾病(11.5%)。结论有很大一部分符合新辅助全身抗癌治疗条件的患者从未开始接受新辅助全身抗癌治疗。我们的研究结果可能为未来关于如何改善非小细胞肺癌患者的治疗途径以及新辅助或围手术期免疫治疗候选人的讨论提供信息。
{"title":"Outcome of stage-eligible patients not receiving neoadjuvant chemo-immunotherapy for clinical or procedural reasons: a real practice analysis","authors":"Cecilia Pompili , Pooja Bhatnagar , Katy Clarke , Kevin Franks , Joshil Lodhia , Marco Nardini , Daniel Otter , Elaine Teh , Peter Tcherveniakov , Alessandro Brunelli","doi":"10.1016/j.ejso.2025.111356","DOIUrl":"10.1016/j.ejso.2025.111356","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to assess the outcome of patients who were stage-eligible for neoadjuvant chemo-immunotherapy but did not start the treatment and received surgery upfront.</div></div><div><h3>Methods</h3><div>All consecutive patients undergoing lung resection with or without prior neoadjuvant chemo-immunotherapy (nivolumab) for clinical stage II and III NSCLC (April 2023 through December 2024) were included in this analysis. The main reasons for not receiving the neoadjuvant treatment were described. Subgroup analyses were performed to assess outcomes by presence of neoadjuvant treatment.</div></div><div><h3>Results</h3><div>129 patients were included. 47 % received neoadjuvant nivolumab in combination with platinum-based chemotherapy (IO group), whereas 53 % did not receive neoadjuvant treatment and proceeded to surgery upfront (S group). There was no difference in minimally invasive approach between procedures performed after neoadjuvant treatment and those without (75 % vs. 73.9 %, p = 0.88).</div><div>Neoadjuvant treatment was not associated with increased risk of postoperative cardiopulmonary complications (IO = 35 % vs. S = 38 %, p = 0.75) or prolonged hospital stay (IO = 5 days vs. S = 6, p = 0.24). The most frequent reason for not starting neoadjuvant treatment was the lack of adequate tissue sampling for molecular testing or diagnosis/nodal staging confirmation (32 %), followed by the presence of actionable genetic alterations (16 %), patient choice (11.5 %) and underlying immune-related disease (11.5 %).</div></div><div><h3>Conclusions</h3><div>A large proportion of patients who could qualify for neoadjuvant systemic anticancer treatment never started it. Our findings may inform future discussions on how to improve the treatment pathway of patients with NSCLC and candidates to neoadjuvant or perioperative immunotherapy.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 2","pages":"Article 111356"},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/S0748-7983(25)01751-2
{"title":"IFC: Advert- ESSO Course on Basics of Oncology for Surgeons","authors":"","doi":"10.1016/S0748-7983(25)01751-2","DOIUrl":"10.1016/S0748-7983(25)01751-2","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 1","pages":"Article 111323"},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}