Ejso最新文献

{"title":"Evaluation of the efficacy and safety of combined surgery with intraoperative radiotherapy and postoperative PVC for hepatocellular carcinoma with mPVTT","authors":"Zebing Song ,&nbsp;Hang Li ,&nbsp;Hailong Chen ,&nbsp;Bingqing Du ,&nbsp;Zongbing Cheng ,&nbsp;Zengyi Mo,&nbsp;Zejun Huang,&nbsp;Sihan Hu,&nbsp;Yujian Feng,&nbsp;Wujian Deng,&nbsp;Huihong Liang,&nbsp;Xuewei Yang,&nbsp;Xiaodong Song,&nbsp;Zili Shao","doi":"10.1016/j.ejso.2025.109727","DOIUrl":"10.1016/j.ejso.2025.109727","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) accompanied by main portal vein tumor thrombosis (mPVTT) is associated with poor prognosis and limited treatment options. This study aimed to evaluate the efficacy and safety of a novel triple therapy approach combining surgery, intraoperative radiotherapy (IORT), and postoperative portal vein infusion chemotherapy (PVC) for HCC with mPVTT.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 56 patients diagnosed with HCC and mPVTT. Patients were divided into two groups: the surgery-IORT-PVC group (n = 21) and the transcatheter arterial chemoembolization (TACE) combined with hepatic arterial infusion chemotherapy (HAIC) group (n = 35). Baseline characteristics, treatment procedures, postoperative complications, and survival outcomes were compared between the two groups.</div></div><div><h3>Results</h3><div>The surgery-IORT-PVC group (n = 21) demonstrated superior median overall survival (OS) (not reached vs. 7 months, <em>P</em> &lt; 0.05 4.99(2.543–9.792)) and median progression-free survival (PFS) (not reached vs. 4 months, <em>P</em> &lt; 0.05 5.268(2.765–10.03)) compared to the TACE-HAIC group (n = 35). Additional, the 1-year, 2-year, and 3-year OS (75.6 %, 60.5 %, 60.5 % vs 28.8 %, 8.2 %, 8.2 %) and PFS (73.3 %, 64.1 %, 64.1 % vs 9.5 %, 9.5 %, 9.5 %) of the surgery-IORT-PVC group significantly superior to that of the TACE-HAIC group. Multivariate analysis identified the treatment modality as an independent factor influencing both OS and PFS. Postoperative complications in the surgery-IORT-PVC group were manageable. No severe adverse events were reported in either group.</div></div><div><h3>Conclusion</h3><div>Overall, this novel treatment modality offers a potential effective therapy modality for patients with HCC and mPVTT who previously had limited therapeutic options.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109727"},"PeriodicalIF":3.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562999","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}

{"title":"Diagnostic performance of fluorescent lymphography-guided lymph node dissection during minimally invasive gastrectomy following chemotherapy","authors":"Ji Yoon Jeong ,&nbsp;Ja Kyung Yoon ,&nbsp;Jawon Hwang ,&nbsp;Sung Hyun Park ,&nbsp;Minah Cho ,&nbsp;Yoo Min Kim ,&nbsp;Hyoung-Il Kim ,&nbsp;Hyunki Kim ,&nbsp;Woo Jin Hyung","doi":"10.1016/j.ejso.2025.109738","DOIUrl":"10.1016/j.ejso.2025.109738","url":null,"abstract":"<div><h3>Introduction</h3><div>Fluorescent lymphography-guided lymph node dissection (FL) using indocyanine green (ICG) during radical gastrectomy for gastric cancer has shown enhanced lymph node (LN) retrieval and high sensitivity in detecting LN metastases. However, the impact of FL during gastrectomy following chemotherapy remains uncertain because changes in the ICG injection site due to tumor shrinkage may potentially visualize different lymphatic drainage from the tumor. This study aimed to assess the diagnostic performance of FL during gastrectomy after preoperative chemotherapy.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included patients who underwent minimally invasive gastrectomy with FL following chemotherapy between January 2013 and February 2024. Patients were categorized according to their tumor response after chemotherapy based on endoscopic, radiologic, and pathological findings.</div></div><div><h3>Results</h3><div>Of 29 patients, 9.4 (range 8–12) LN stations containing 6.9 (range 3–11) fluorescent LN stations, which had 56.3 (range 33–99) LNs including 33.4 (range 11–68) fluorescent LNs, were retrieved per patient. While 52 metastatic LN stations were fluorescent, three non-fluorescent metastatic LN stations were identified in one patient (3.4 %). FL showed 94.5 % (52/55) sensitivity and 95.9 % (70/73) negative predictive value for detecting metastatic LN stations. There was no significant difference in the number of retrieved LNs and the sensitivity for detecting metastatic LN stations between responders and non-responders.</div></div><div><h3>Conclusion</h3><div>Tumor response after chemotherapy did not influence the diagnostic performance of FL. The diagnostic performance of FL during gastrectomy following chemotherapy was acceptable. Similar to upfront surgery, FL can be safely applied even after chemotherapy.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109738"},"PeriodicalIF":3.5,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550925","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}

{"title":"Long-term survival analysis after radical gastrectomy for Epstein-Barr virus-associated gastric cancer: A multicenter study","authors":"Rong-Zhen Xie ,&nbsp;Ze-Ning Huang ,&nbsp;Xing-Qi Zhang ,&nbsp;Yu-Qin Sun ,&nbsp;Jiao-Bao Huang ,&nbsp;Qi-Yue Chen ,&nbsp;Jian-Wei Xie ,&nbsp;Chao-Hui Zheng ,&nbsp;Chang-Ming Huang ,&nbsp;Jian-Xian Lin ,&nbsp;Ping Li","doi":"10.1016/j.ejso.2025.109737","DOIUrl":"10.1016/j.ejso.2025.109737","url":null,"abstract":"<div><h3>Background</h3><div>The prognosis of Epstein-Barr virus-associated gastric cancer (EBVaGC)needs to be validated by high-quality studies. This study aimed to assess the long-term survival of EBVaGC patients after radical gastrectomy using multicenter data to explore the potential value of EBV infection status as a prognostic predictor.</div></div><div><h3>Methods</h3><div>We analyzed the clinical data of patients with EBVaGC and Epstein-Barr virus-negative gastric cancer (EBVnGC) who underwent radical gastrectomy from January 2013 to July 2020. The Kaplan-Meier method and Cox regression analysis were used to evaluate overall survival (OS) and disease-free survival (DFS). A Random Survival Forest (RSF) model was constructed to predict the prognosis.</div></div><div><h3>Results</h3><div>After propensity score matching, 205 and 410 patients were included in the EBVaGC and EBVnGC groups, respectively. The 3-year OS and DFS rates in the EBVaGC group were significantly higher than those in the EBVnGC group. Multivariate analysis indicated that EBER(Epstein-Barr virus-encoded small RNA) positivity was an independent protective factor for OS and DFS. Among stage II and III EBVaGC patients, those receiving ≥4 cycles of chemotherapy had a 3-year OS significantly better than those receiving &lt;4 cycles. The RSF model based on EBER status outperformed the Cox model and TNM staging system in predicting the 3-year OS and DFS.</div></div><div><h3>Conclusion</h3><div>The prognostic prediction model established based on the EBER status has good clinical application value and can provide a new reference for clinical follow-up management. It is recommended that patients with stage II and III EBVaGC receive at least four cycles of chemotherapy postoperatively to improve survival.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109737"},"PeriodicalIF":3.5,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550926","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}

{"title":"Simultaneous versus delayed resection of synchronous colorectal liver metastases: A systematic review and meta-analysis","authors":"Adil S. Lakha ,&nbsp;Vikas Sud ,&nbsp;Younis Alemour ,&nbsp;Nikhil J. Perera ,&nbsp;Hannah McGivern ,&nbsp;Carolyn Smith ,&nbsp;Alex Gordon-Weeks","doi":"10.1016/j.ejso.2025.109732","DOIUrl":"10.1016/j.ejso.2025.109732","url":null,"abstract":"<div><div>Colorectal cancer is a leading malignancy, with synchronous colorectal liver metastases (CRLM) presenting in 20 % of patients. Resection remains the gold standard treatment for CRLMs, significantly improving survival outcomes. However, the optimal timing of resection of these synchronous lesions — simultaneous versus staged — remains controversial. This systematic review and meta-analysis synthesises data exclusively from propensity-score-matched and prospective studies.</div><div>A comprehensive search of five databases identified 11 eligible studies, encompassing 2884 patients. Of these, 1453 underwent simultaneous resection, and 1431 underwent staged procedures. The primary outcome was 5-year overall survival (OS), with secondary outcomes including disease-free survival (DFS), surgical morbidity, operating time, and length of hospital stay.</div><div>Meta-analysis demonstrated no significant difference in 5-year OS between simultaneous and staged resection groups (odds ratio [OR] 1.10, 95 % CI 0.75–1.61; p = 0.83). However, simultaneous resection was associated with significantly higher 3-year DFS (OR 1.67, 95 % CI 1.28–2.17; p = 0.0001) but also increased major surgical complications (Clavien-Dindo ≥ III: OR 1.32, 95 % CI 1.03–1.68; p = 0.03).</div><div>This review highlights a lack of oncological advantage for simultaneous resection, coupled with higher morbidity, suggesting its use should be limited to select patients with low surgical risk. The findings underscore the need for well-powered, randomised trials to confirm these conclusions, as well as assess quality of life and economic outcomes, however delivering such trials in this patient cohort brings unique challenges. Until such data are available, clinical decision-making should remain individualised, guided by multidisciplinary discussion and available local expertise.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109732"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful pregnancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancies","authors":"Haggai Benvenisti ,&nbsp;Dan Assaf ,&nbsp;Eyal Mor ,&nbsp;Danielle Mor-Hadar ,&nbsp;Vahan Kepenekian ,&nbsp;Nicolas Flamey ,&nbsp;Rui Yang ,&nbsp;Douglas Zippel ,&nbsp;Almog Ben-Yaacov ,&nbsp;Yan Li ,&nbsp;Brendan Moran ,&nbsp;Olivier Glehen ,&nbsp;Aviram Nissan","doi":"10.1016/j.ejso.2025.109725","DOIUrl":"10.1016/j.ejso.2025.109725","url":null,"abstract":"<div><h3>Background</h3><div>Cytoreductive surgery (CRS) with Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) has become a successful, potentially curative, treatment option for peritoneal surface malignancies (PSM). CRS and HIPEC (CRS/HIPEC) are performed with curative intent for several intra-peritoneal pathologies. An increasing number of patients with PSM are diagnosed at a relatively young age. Given the long-term survival in some patients following CRS/HIPEC, the reproductive health of patients in this age group requires consideration.</div></div><div><h3>Methods</h3><div>Surgical oncology teams participating in the Peritoneal Surface Oncology Group International (PSOGI) were offered the opportunity to share their experience and data regarding the obstetric outcomes of female patients who had undergone CRS/HIPEC.</div></div><div><h3>Results</h3><div>Nineteen (19) patients were reported to have had a baby following CRS/HIPEC. The median interval between CRS/HIPEC and pregnancy was 37 months, and 16 patients had a normal vaginal delivery. All of the newborns were healthy, without medical issues attributed to CRS or HIPEC chemotherapy. Overall, 89 % of mothers had no evidence of disease at their last follow-up.</div></div><div><h3>Conclusion</h3><div>Successful pregnancies following CRS/HIPEC are seldom reported in the literature, and fertility preservation is not uniformly discussed. Data from this international collaboration highlights the reproductive potential in patients with PSM following CRS/HIPEC and the value of pre-operative obstetric and fertility advice and management to achieve that end.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109725"},"PeriodicalIF":3.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552233","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}

{"title":"Non-invasive classification of non-neoplastic and neoplastic gallbladder polyps based on clinical imaging and ultrasound radiomics features: An interpretable machine learning model","authors":"Minghui Dou ,&nbsp;Hengchao Liu ,&nbsp;Zhenqi Tang ,&nbsp;Longxi Quan ,&nbsp;Mai Xu ,&nbsp;Feiqian Wang ,&nbsp;Zhilin Du ,&nbsp;Zhimin Geng ,&nbsp;Qi Li ,&nbsp;Dong Zhang","doi":"10.1016/j.ejso.2025.109709","DOIUrl":"10.1016/j.ejso.2025.109709","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder (GB) adenomas, precancerous lesions for gallbladder carcinoma (GBC), lack reliable non-invasive tools for preoperative differentiation of neoplastic polyps from cholesterol polyps. This study aimed to evaluate an interpretable machine learning (ML) combined model for the precise differentiation of the pathological nature of gallbladder polyps (GPs).</div></div><div><h3>Methods</h3><div>This study consecutively enrolled 744 patients from Xi'an Jiaotong University First Affiliated Hospital between January 2017 and December 2023 who were pathologically diagnosed postoperatively with cholesterol polyps, adenomas or T1-stage GBC. Radiomics features were extracted and selected, while clinical variables were subjected to univariate and multivariate logistic regression analyses to identify significant predictors of neoplastic polyps. A optimal ML-based radiomics model was developed, and separate clinical, US and combined models were constructed. Finally, SHapley Additive exPlanations (SHAP) was employed to visualize the classification process.</div></div><div><h3>Results</h3><div>The areas under the curves (AUCs) of the CatBoost-based radiomics model were 0.852 (95 % <em>CI</em>: 0.818–0.884) and 0.824 (95 % <em>CI</em>: 0.758–0.881) for the training and test sets, respectively. The combined model demonstrated the best performance with an improved AUC of 0.910 (95 % <em>CI</em>: 0.885–0.934) and 0.869 (95 % <em>CI</em>: 0.812–0.919), outperformed the clinical, radiomics, and US model (all <em>P</em> &lt; 0.05), and reduced the rate of unnecessary cholecystectomies. SHAP analysis revealed that the polyp short diameter is a crucial independent risk factor in predicting the nature of the GPs.</div></div><div><h3>Conclusion</h3><div>The ML-based combined model may be an effective non-invasive tool for improving the precision treatment of GPs, utilizing SHAP to visualize the classification process can enhance its clinical application.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109709"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519342","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}

{"title":"Liver metastases from colorectal cancer: A joint ESSO–EAHPBA–UEMS core curriculum collaboration","authors":"Lucia Carrion-Alvarez ,&nbsp;Florian Primavesi ,&nbsp;Kjetil Søreide ,&nbsp;Dana Sochorova ,&nbsp;Rafael Diaz-Nieto ,&nbsp;Cristina Dopazo ,&nbsp;Alejandro Serrablo ,&nbsp;Ibrahim Edhemovic ,&nbsp;Stefan Stättner","doi":"10.1016/j.ejso.2025.109728","DOIUrl":"10.1016/j.ejso.2025.109728","url":null,"abstract":"<div><div>Colorectal liver metastases (CRLM) are a major indication for liver surgery in Europe, highlighting the need for standardized knowledge and training in surgical oncology. The European Society of Surgical Oncology (ESSO) has updated its core curriculum to provide a structured framework for education. Previous publications have addressed pancreatic, hepatocellular, and biliary tract cancers to support candidates preparing for the European Board of Surgery Qualification (EBSQ) exams in Surgical Oncology and Hepato-Pancreato-Biliary Surgery. However, a dedicated guide for CRLM remains absent.</div><div>This article aims to fill that gap by offering a structured reference on CRLM, covering epidemiology, staging, genetics, and diagnosis of metastatic colorectal cancer. It also outlines multidisciplinary treatment strategies, including systemic, surgical, interventional, and palliative approaches. A structured literature review was conducted using PubMed to identify the most updated (inter)national management guidelines, prioritizing recent multicentre studies, systematic reviews, and meta-analyses published from January 2020 to January 2025.</div><div>By bridging the gap between the ESSO core curriculum and detailed subspecialty training, this guide provides an essential resource for hepatobiliary surgeons and surgical oncologists. It serves as a valuable tool for those preparing for board examinations while promoting a standardized approach to CRLM education and management across Europe.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109728"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative electron radiotherapy (IOERT) in colorectal cancer: Updated systematic review of techniques, oncological outcomes and complications","authors":"Abhinav Tiwari ,&nbsp;Sheah Lin Lee ,&nbsp;Tom MacCabe ,&nbsp;Michal Woyton ,&nbsp;Charles T. West ,&nbsp;Rohan Micklethwaite ,&nbsp;Hideaki Yano ,&nbsp;Malcolm A. West ,&nbsp;Alex H. Mirnezami","doi":"10.1016/j.ejso.2025.109724","DOIUrl":"10.1016/j.ejso.2025.109724","url":null,"abstract":"<div><h3>Background</h3><div>Intra-operative electron radiotherapy (IOERT) directly delivers a large fraction of radiation to at-risk margins during surgery. However, the precise benefit of IOERT in patients with locally advanced and locally recurrent colorectal cancer (LACC/LRCC) is unclear. This study aimed to provide an updated summary of the current evidence available regarding IOERT as part of multi-modality treatment of LACC and LRCC.</div></div><div><h3>Method</h3><div>This systematic review update was prospectively registered on PROSPERO (CRD42023438184). An electronic literature search was carried out using Ovid (MEDLINE), EMBASE, Web of Science, and the Cochrane Library databases for studies from July 2011 to April 2024. The inclusion criteria were adult patients who received IOERT as part of multi-modal treatment for LACC or LRCC. The primary outcome was overall survival (OS), disease free survival (DFS) and local control (LC) at 5 years. Secondary outcomes included post-operative complications.</div></div><div><h3>Results</h3><div>16 new studies were identified since the previous analysis, and included (study population 1912 patients) of which two were prospective. High heterogeneity prevented meta-analysis of outcomes except for 5-year OS which suggested a non-significant benefit favouring IOERT. Significant methodological concerns were identified making interpretations challenging, however patients with LACC or LRCC with an R1 resection margin showed a favourable 5-year OS (40 % and 18 % respectively) when compared to current evidence.</div></div><div><h3>Conclusion</h3><div>Although limited by a lack of appropriately conducted randomised evidence, IOERT-containing multi-modality treatment may improve oncological outcomes in LACC and LRCC patients with R1 resections.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109724"},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic ALBI score and FIB-4 index trends to predict complications after resection of hepatocellular carcinoma: A K-means clustering approach","authors":"Miho Akabane ,&nbsp;Jun Kawashima ,&nbsp;Abdullah Altaf ,&nbsp;Selamawit Woldesenbet ,&nbsp;François Cauchy ,&nbsp;Federico Aucejo ,&nbsp;Irinel Popescu ,&nbsp;Minoru Kitago ,&nbsp;Guillaume Martel ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;George A. Poultsides ,&nbsp;Yuki Imaoka ,&nbsp;Andrea Ruzzenente ,&nbsp;Itaru Endo ,&nbsp;Ana Gleisner ,&nbsp;Hugo P. Marques ,&nbsp;Vincent Lam ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.ejso.2025.109723","DOIUrl":"10.1016/j.ejso.2025.109723","url":null,"abstract":"<div><h3>Background</h3><div>Severe postoperative complications still occur following hepatectomy among patients with hepatocellular carcinoma (HCC). There is a need to identify high-risk patients for severe complications to enhance patient safety. We sought to evaluate the combined impact of pre- and postoperative albumin-bilirubin (ALBI) score and Fibrosis-4 (FIB-4) index trends to predict severe complications after HCC resection.</div></div><div><h3>Method</h3><div>Patients with HCC undergoing curative-intent hepatectomy (2000–2023) were identified from an international, multi-institutional database. The cohort was divided into training (n = 439) and testing (n = 651) sets. ALBI score and FIB-4 index trends from preoperative to postoperative days 1, 3, and 5 were used for K-means clustering (K = 3). A logistic regression model was developed using the training set, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC) in both cohorts.</div></div><div><h3>Results</h3><div>Severe complications (Clavien-Dindo Grade ≥ IIIa) occurred in 118 patients (10.8 %); 43 (9.8 %) in training and 75 (11.5 %) in testing set (p = 0.42). K-means clustering identified three groups: Cluster1 (low), Cluster2 (intermediate), and Cluster3 (high), which was associated with a progressively increasing risk of complications (p &lt; 0.01). On multivariable logistic regression, patients in ALBI Cluster1 had 76 % decreased odds (odds ratio[OR] 0.24, 95 % CI 0.07–0.83, p = 0.02) of postoperative complications relative to Cluster3 patients. Individuals categorized into FIB-4 Cluster1 had 85 % decreased odds (OR 0.15, 95 % CI 0.02–1.24, p = 0.07) versus patients in FIB-4 Cluster3. A new prediction model incorporating ALBI and FIB-4 index clusters achieved an AUC of 0.71, outperforming models based on preoperative data. A tool was made available at <span><span>https://nm49jf-miho-akabane.shinyapps.io/HCC_ALBI/</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>A dynamic ALBI score and FIB-4 index trend tool improved risk stratification of patients undergoing resection of HCC relative to severe complications.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109723"},"PeriodicalIF":3.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511661","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}

{"title":"A nomogram for predicting the risk of liver metastasis in non-functional neuroendocrine neoplasms: A population-based study","authors":"Zhipeng Liu ,&nbsp;Faji Yang ,&nbsp;Yijie Hao ,&nbsp;Qirong Jiang,&nbsp;Yupeng Jiang,&nbsp;Shizhe Zhang,&nbsp;Yisu Zhang,&nbsp;Qixuan Zheng,&nbsp;Zheyu Niu,&nbsp;Huaqiang Zhu,&nbsp;Xu Zhou,&nbsp;Jun Lu,&nbsp;Hengjun Gao","doi":"10.1016/j.ejso.2025.109708","DOIUrl":"10.1016/j.ejso.2025.109708","url":null,"abstract":"<div><h3>Background</h3><div>Non-functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors, and liver metastasis is the leading cause of death in patients with GEP-NENs. Due to the difficulty in conducting large cohort studies, no reliable tool currently exists to predict the risk of liver metastasis in these patients. This study aimed to develop and validate a nomogram model based on large cohort clinical data to accurately predict the risk of liver metastasis in patients with non-functional GEP-NENs.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted, encompassing 838 patients with non-functional GEP-NENs diagnosed between 2009 and 2023. Independent risk factors for liver metastasis were identified through univariate and multivariate logistic regression analyses. A nomogram was constructed based on significant predictors, including T stage, N stage, Ki-67 index, primary tumor site, and BMI. The model's performance was evaluated using the C-index, calibration curves, and decision curve analysis (DCA) for both training and validation cohorts.</div></div><div><h3>Results</h3><div>The nomogram demonstrated excellent predictive performance, with C-index values of 0.839 and 0.823 for the training and validation sets, respectively. Risk stratification using the nomogram's total score effectively differentiated high-risk from low-risk patients. Kaplan-Meier survival analysis revealed significant survival differences between these groups (P &lt; 0.0001). Moreover, the calibration curves indicated strong agreement between predicted and observed outcomes.</div></div><div><h3>Conclusions</h3><div>The developed nomogram is a reliable tool for predicting the risk of liver metastasis in non-functional GEP-NENs. It facilitates early identification of high-risk patients, thereby enabling personalized treatment and timely intervention. Future research should focus on multicenter validation and the integration of molecular markers to enhance the robustness and clinical applicability of the model.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109708"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521209","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}