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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 在TRUST试验时期晚期卵巢癌的手术时机:随机对照试验的系统回顾、荟萃分析和研究水平荟萃回归
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-18 DOI: 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。
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引用次数: 0
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 新辅助免疫化疗后达到病理完全缓解的食管鳞状细胞癌患者的复发模式和辅助治疗策略:一项大容量回顾性研究
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-18 DOI: 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.
背景:关于食管鳞状细胞癌(ESCC)患者在新辅助免疫化疗(nICT)后达到病理完全缓解(pCR)的复发模式和辅助治疗策略的研究仍然很少。方法回顾性分析三家医疗中心在2020年至2022年期间接受nICT术后病理证实达到pCR的患者。评估复发模式和时间分布。进行单因素和多因素分析以确定无病生存期(DFS)和总生存期(OS)的预测因子。结果共纳入83例达到pCR标准的患者。1年和3年的DFS率分别为86%和71%。食管切除术后复发或转移的患者占15.7%(13/83)。其中纵隔淋巴结复发6例;2例患者分别发生腹膜和锁骨上淋巴结转移,1例患者分别发生肝、肺和骨转移。中位复发时间10.6个月(范围4.4 ~ 39.4个月)。多变量分析表明,cT分期是影响pCR患者OS的独立因素,而饮酒状态被确定为DFS的独立预测因子。值得注意的是,在这些患者的OS (P = 0.846)或DFS (P = 0.066)中,术后辅助治疗并没有带来显著的益处。结论食管贲门癌患者行nICT后食管切除术后仍有复发。在这个有限的研究队列中,没有观察到辅助治疗的益处。
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引用次数: 0
SRRN: A regional lymph node ratio–based staging system enhancing prognostic accuracy in esophageal squamous cell carcinoma SRRN:基于区域淋巴结比例的分期系统可提高食管鳞状细胞癌的预后准确性
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-16 DOI: 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.
食管鳞状细胞癌(ESCC)预后不良,淋巴结状态是一个关键的决定因素。传统的N分期和淋巴结比例(LNR)仅依赖于阳性淋巴结的数量,可能缺乏准确性。本研究提出了一种基于区域淋巴结比例(SRRN)的新分期系统,以增强预后评估。方法在这项单中心、回顾性队列研究中,我们回顾性分析了2010年至2020年在福建医科大学协和医院行根治性切除的1208例ESCC患者。计算每个淋巴结站的区域淋巴结比(RLNR),并将其相加定义SRRN。采用X-tile将患者分为SRRN0-3组。采用Cox回归和随机生存森林(RSF)模型评估SRRN与传统N分期的预后价值,并通过Kaplan-Meier分析比较各组间的生存差异。结果ssrrn是总生存期(OS)的独立预测因子。与N分期相比,SRRN在Cox和RSF模型中都表现出更好的预测性能,具有更高的AUC和c -指数值。Kaplan-Meier曲线显示SRRN组之间的生存差异更为明显。Kaplan-Meier曲线显示SRRN组的预后分离明显更大,SRRN0的5年OS率为66.7%,而SRRN3的5年OS率仅为7.9%。结合SRRN的图显示了良好的校准和潜在的临床应用。结论SRRN分期系统在预后分层方面优于传统的N分期,可指导ESCC患者的优化分期和个性化治疗决策。
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引用次数: 0
Efficacy of D2 plus lymph node dissection for gastric cancer D2加淋巴结清扫术治疗胃癌疗效观察。
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-16 DOI: 10.1016/j.ejso.2025.111361
Yosuke Matsumoto, Masanori Terashima, Yusuke Koseki, Kenichiro Furukawa, Keiichi Fujiya, Yutaka Tanizawa, Etsuro Bando

Background

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。
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引用次数: 0
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 基于机器学习的放射组学在术前预测脑膜瘤一致性方面优于肿瘤/小脑蒂t2加权成像强度比和基于roi的表观扩散系数测量。
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-12 DOI: 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.
目的:准确的术前肿瘤一致性评估对脑膜瘤患者的手术效果至关重要。本研究旨在证实基于机器学习(ML)的放射组学在预测脑膜瘤一致性方面是否优于传统方法,包括肿瘤/小脑蒂t2加权成像强度(TCTI)比率和人工基于兴趣区域的表观扩散系数(roi -based ADC)测量。材料与方法:168例脑膜瘤患者入组研究。参照Zada一致性分级系统,将脑膜瘤一致性分为软(1级和2级)、中度(3级)和硬(4级和5级)三类。计算TCTI比值,测量ADC值。从对比后的T1WI、T2WI和ADC中提取放射组学特征。利用支持向量机构建预测模型,并以受者工作特征曲线下面积(AUC)评价预测效果。结果:软性脑膜瘤30例,中度脑膜瘤92例,硬性脑膜瘤46例。对于“软”预测,基于roi的ADC测量值和TCTI比率在验证集中的最佳AUC值分别为0.56和0.74。相比之下,放射组学模型在验证集中的AUC为0.88。对于“硬”预测,验证集基于roi的ADC测量值和TCTI比率的最佳AUC值分别为0.63和0.69。放射组学模型在验证集中的AUC值为0.79。结论:放射组学模型在无创性预测脑膜瘤一致性方面优于基于roi的ADC测量和TCTI比值。本研究结果可促进机器学习技术在临床中的应用。
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引用次数: 0
Advancing 90-day mortality and anastomotic leakage predictions after oesophagectomy for cancer using Explainable Artificial Intelligence 使用可解释的人工智能预测食管癌切除术后90天死亡率和吻合口漏。
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-12 DOI: 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.
导读:食道切除术具有显著的发病率和死亡率。人工智能(AI)在医学研究中的进步增强了预测、灵活性和可解释性,特别是对于复杂的相互作用和非线性关系。材料和方法:我们采用基于登记的病例对照设计,嵌套在瑞典国家食管癌和胃癌质量登记(NREV)前瞻性收集的数据中,采用传统的逻辑回归(LR)和机器学习(ML),结合可解释的人工智能(XAI),预测2005年11月至2018年2月期间1846名接受食管切除术的患者的90天死亡率和吻合口漏。结果:90天死亡率为6.0%,吻合口漏12.4%。XAI模型的90天死亡率曲线下面积(AUC)为0.95,而LR模型的AUC为0.88。对于吻合口漏,XAI组的AUC为0.84,LR组为0.74。LR确定了与年龄、ASA 2-3、BMI和吻合口漏相关的90天死亡率的显著优势比。ML模型识别出相同的变量加上手术年份是显著的。对于吻合口漏,LR仅在ASA 3中具有显著性,而ML发现所有检查变量都是显著的预测因子。XAI显示年龄和围手术期出血是重要的生存因素,而高BMI和年龄是吻合口漏的重要危险因素。所有因素均表现出非线性关联。XAI还将每个程序的个人风险评估可视化。结论:通过应用XAI,我们提高了对食管切除术后吻合口漏和死亡率的外科认识。我们的数据包含显著的非线性关系,不能可视化LR。借助XAI,我们提取个性化风险评估,使食管手术更接近个性化医疗。
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引用次数: 0
Circulating tumor cells predict relapse in head and neck mucosal squamous cell carcinoma 循环肿瘤细胞预测头颈部粘膜鳞状细胞癌复发
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-11 DOI: 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.
背景头颈癌(HNC)在全球范围内都很常见,具有很高的局部复发率。循环肿瘤细胞(CTCs)的检测和计数是实体瘤预后的新兴生物标志物。本研究旨在检测HNC患者,特别是头颈部粘膜鳞状细胞癌(HNmSCC)的ctc,并评估其预测复发的预后价值。方法前瞻性招募行手术切除的hnc患者。术前和术后采集外周血样本,然后使用AccuCyte-CyteFinder平台分析ctc。采用多变量logistic回归、ROC分析和无复发生存期评估预后。结果在106例招募的患者中,79例术前有可用的血液样本和上皮恶性肿瘤,其中57例(72%)被归类为HNmSCC。在81%(46/57)的HNmSCC患者中检测到CTCs,平均每7.5 mL血液中有19个CTCs(中位数= 9)。使用术前血液样本中ctc≥5个的截止值,ctc高状态与复发(优势比= 9.52,p = 0.022)和较差的无复发生存期(p = 0.016)显著相关。在多变量分析中,在校正了其他临床病理参数后,ctc -高状态仍然具有独立显著性,各模型的效应大小一致(校正优势比= 8-10)。值得注意的是,ctc和切缘受累仍然是独立显著的(切缘:调整后的优势比= 6.17,p = 0.024),显示了互补的预后价值。术后探查性随访样本(N = 36)中,ctc -高状态与复发显著相关(优势比= 26.71,p = 0.0009)。AccuCyte-CyteFinder平台检测的ctc在HNmSCC患者中显示出独立的预后价值,补充了传统的病理评估,特别是边缘受累。这项概念验证性研究提供了初步证据,表明术前CTC计数可以加强风险分层,以识别复发风险高的患者,从而有可能实现更个性化的监测和治疗。
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引用次数: 0
Outcome of stage-eligible patients not receiving neoadjuvant chemo-immunotherapy for clinical or procedural reasons: a real practice analysis 符合分期条件的患者由于临床或程序原因未接受新辅助化学免疫治疗的结果:一项真实的实践分析
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-11 DOI: 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。
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IFC: Advert- ESSO Course on Basics of Oncology for Surgeons IFC:外科医生肿瘤学基础课程
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-11 DOI: 10.1016/S0748-7983(25)01751-2
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Advert ESSO Congress 2026 广告ESSO大会2026
IF 2.9 2区 医学 Q2 ONCOLOGY Pub Date : 2025-12-11 DOI: 10.1016/S0748-7983(25)01752-4
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