Ejso最新文献

Background: Autologous fat transfer (AFT) has gained popularity as a minimally invasive alternative for autologous breast reconstruction post-mastectomy. It offers aesthetic advantages and improvements in quality-of-life, though concerns persist regarding its oncological safety due to the presence of adipose-derived stem cells (ADSCs).

Methods: This pooled follow-up analysis combined data from the multicentre randomised controlled BREAST-I trial and the nonrandomised clinical BREAST-II trial, including women who underwent total breast reconstruction with AFT between 2015 and 2025. The AFT-cohort was compared with a nationwide control group of breast cancer patients derived from the Netherlands Cancer Registry (IKNL), matched by inverse probability weighting. The primary outcome was overall survival (OS). Local and regional recurrences and distant metastases were not included in statistical analyses due to known underreporting in the national registry, but were descriptively assessed within the study cohort.

Results: A total of 242 AFT-patients and 19936 controls were included. The mean follow-up time was 8.0 years for AFT and 6.9 years for controls. Ten-year crude OS was 97.6 % (95 % CI 95.5-99.7 %) for AFT and 75.7 % (95 % CI 74.7-76.8 %) for controls. After adjustment for confounders and immortal time bias, AFT was not associated with increased mortality (HR 0.34; 95 % CI 0.14-0.88; p = 0.025). Residual confounding and differences in follow-up intensity between cohorts constitute key study limitations.

Conclusions: In this pooled multicentre cohort with long-term follow-up, AFT for total breast reconstruction after mastectomy did not negatively affect mortality compared with national registry controls. These results support the oncological safety of AFT as a reconstructive technique. Future research should include larger cohorts and assess disease-free survival.

Objective: In addition to the standard R classification for assessing radicality in Non-Small Cell Lung Cancer (NSCLC), the concept of uncertain resection [R (un)] has been introduced. This study aimed to evaluate the prognostic impact of R (un) in a cohort of surgically resected pN2 NSCLC patients and to analyze outcome of a possible change in the R (un) description.

Methods: We retrospectively analyzed data from prospective databases of four institutions. All consecutive patients with R0 pN2 NSCLC treated between 2016 and 2021 were included. Each case was re-evaluated and classified as either R0 or R (un). We also assessed a modified R (un) classification considering station 7 as hierarchically superior to stations 5 and 6.

Results: Among 230 patients, 98 (42.6 %) were female. Forty-six patients (20 %) received neoadjuvant therapy, and 178 (77.4 %) underwent lobectomy. Single station pN2 was observed in 143 patients (62.2 %), and 130 (56.5 %) were reclassified as R (un). Adjuvant therapy was administered to 135 patients (58.7 %). Patients classified as R0 had significantly better overall survival (OS, p = 0.044) and disease-free survival (DFS, p = 0.050) compared to those with R (un). However, in multivariable analysis, only adjuvant therapy remained an independent prognostic factor for OS. When applying the modified R (un) definition, R (un) remained associated with worse OS (p = 0.007) and DFS (p < 0.001) and was confirmed as an independent prognostic factor in multivariable analysis.

Conclusions: Our findings confirm the prognostic relevance of the R classification, including R (un). We propose a possible refinement of the R (un) definition potentially improving its prognostic accuracy.

Endometrial carcinoma is biologically heterogeneous. Molecular classification derived from The Cancer Genome Atlas (TCGA) identifies clinically relevant molecular subtypes, each with distinct prognostic and therapeutic implications. FIGO 2023 recognizes tumor biology in staging, and the new 2025 ESGO guidelines incorporate molecular data into risk-stratified management. This is a position paper on the incorporation of molecular classification in endometrial cancer. We focused on molecular taxonomy, diagnostic surrogates, prognostic validation, and therapeutic implications of immune and targeted agents. The five molecular subtypes (POLEmut; MMRd/MSI-H; p53abn; NSMP ER-positive; NSMP ER-negative) provide stronger prognostic discrimination than grade or histotype alone. We recommend that molecular subtype should guide adjuvant treatment de-escalation or intensification, inform the use of immunotherapy and targeted agents, and refine risk stratification beyond conventional parameters. We also discussed implementation challenges, including test standardization, reporting, equity of access, and areas of ongoing uncertainty. This position paper aims to support consistent, equitable, and biologically informed management of endometrial carcinoma in contemporary practice.

Objective: Borderline ovarian tumors (BOT) account for 10-20 % of malignant ovarian tumors affecting up to one third of young patients. Therefore, fertility sparing surgery (FSS) has gained attention followed by fertility preservation program (FPP) mainly using controlled ovarian stimulation (COS). However, the determinants to accept or to refuse fertility FPP remain unclear raising the issue on shared decision making.

Methods: From January 2021 to November 2024, a retrospective analysis from a prospective database of patients with BOT eligible for FPP (patients between 18-, and 43-years-old) were identified and interviewed to evaluate the determinants to refuse FPP. For patients accepting FPP, results of COS were analyzed.

Results: Among which 66 patients with BOT undergoing FSS, 29 were eligible for FPP, among them 18 refused the procedure. The main determinants to refuse the FPP were an age >35-years-old, the futility of FPP in 50 % of case, the renouncement to future pregnancy in one-third of cases, and the stress of recurrence (two patients). One patient refused to answer. Among the 18 patients refusing FPP, five became pregnant spontaneously. For the 11 accepting the FPP with COS, the median delay between FSS and COS was 6 months (3-13 months), nine underwent 1 COS cycle and the two patients underwent 2 COS cycles. The median number of retrieved oocytes per COS cycle was 11 (5-39) and the median number of cryopreserved oocytes was 7 (0-35). None of the patients undergoing FPP demand to use their cryopreserved oocytes at the time of the study completion.

Conclusion: While this represents a moderate cohort of patients, our results demonstrate the low adherence to FPP after FSS for BOT underlining the need of an objective and personalized information for shared decision making to accept FPP.

Introduction: To develop radiomics and deep learning (DL) based interpretable models using MRI for preoperative prediction of perineural invasion (PNI) in intrahepatic cholangiocarcinoma (ICC).

Materials and methods: A total of 165 pathologically confirmed ICC patients with preoperative MRI were retrospectively enrolled from two centers (center1, training set, n = 115; validation set, n = 14; internal test set, n = 15; center 2, external test set, n = 21). Radiomics and DL models were constructed for single-phase (pre-contrast, arterial phase, portal venous phase, hepatobiliary phase [HBP]) and multi-phase MRI using the Shukun AI platform and PNI-MambaNet. Model performance was evaluated with the area under the receiver operating characteristic curve (AUC). Gradient-weighted class activation mapping (Grad-CAM) heatmaps visualized the regions prioritized by the DL models.

Results: The PNI positive rate was 42.4 % (61/144) and 28.6 % (6/21) in the two centers. Radiomics HBP models achieved the highest AUC in the internal test set, while multi-phase model performed best in the external test set (AUC: HBP, 0.778 and 0.733 for the internal and external test sets, respectively; multi-phase, 0.759 and 0.778). For DL models, multi-phase model achieved the highest AUC in the internal test set, while HBP model performed best in the external test set (AUC: HBP, 0.926 and 0.856; multi-phase, 0.944 and 0.844). DL models outperformed radiomics models in the external test set, with Grad-CAM visualizing tumor margin regions as the interest area.

Conclusions: DL models based on MRI effectively predict PNI in ICC, with visualizations enhancing clinical interpretability and potential application.

Objective: To evaluate the detection rate, sensitivity, and negative predictive value (NPV) of sentinel lymph node (SLN) biopsy in patients with apparently early-stage epithelial ovarian cancer (EOC).

Methods: A systematic search of multiple electronic databases was conducted from inception to October 31, 2025. Studies reporting detection rate, sensitivity, and NPV of SLN biopsy in apparently early-stage EOC, with completion pelvic and para-aortic lymphadenectomy as reference standard, were included. Study selection, risk-of-bias assessment, and data extraction were independently performed by four reviewers. Pooled estimates with 95 % confidence intervals (CI) were calculated using random-effects models on a per-patient basis and by anatomical site. Heterogeneity was assessed using the I² statistic.

Results: Fourteen studies comprising 365 patients were included. Most studies used indocyanine green injected into the infundibulopelvic ligament for para-aortic mapping and the utero-ovarian ligament for pelvic mapping. The pooled para-aortic detection rate was 79.9 % (95 %CI 66.1-91.4 %; I² = 74 %), while the pelvic detection rate was 42.7 % (95 %CI 28.5-57.3 %; I² = 71 %). Pooled NPV was 100 % in both para-aortic and pelvic regions (I² = 0 %). Sensitivity was 97.8 % (95 %CI 84.0-100 %) in the para-aortic area and 100 % (95 %CI 75.3-100 %) in the pelvis.

Conclusions: In apparently early-stage EOC, SLN biopsy shows acceptable para-aortic detection but limited pelvic detection. Nonetheless, sensitivity and NPV indicate high diagnostic accuracy. Further studies are needed to optimize pelvic mapping strategies and confirm these findings. At present, sentinel lymph node mapping in apparently early-stage epithelial ovarian cancer should be regarded as investigational and not as standard of care.

Objective: To assess the presence of contralateral inguinal lymph node metastases (ILNM) in unilaterally palpable groins and to identify risk factors (and a risk score) for non-palpable contralateral lymph node involvement.

Materials and methods: A retrospective analysis of 148 patients with unilaterally palpable inguinal lymph nodes who underwent bilateral inguinal lymph node dissection (bILND) was conducted. Survival analysis was performed using the Kaplan-Meier analysis to compare recurrence-free survival (RFS) and overall survival (OS). Logistic regression analysis was used to identify factors that could predict bilateral ILNM. A risk score was developed based on significant factors. The accuracy of the score was evaluated using the Receiver Operating Characteristic (ROC) curve.

Result: Bilateral ILNM was found in 43.9 % of patients and unilateral ILNM in 56.1 %. There was a significant decrement in OS in bilateral ILNM but not in RFS. On multivariate analysis, the number of positive lymph nodes >2, presence of lympho-vascular invasion (LVI), and poor differentiation significantly predicted bilateral ILNM. The probability of finding bilateral ILNM increased from 8.4 % with a score of 0-59.5 %, 73.3 %, and 81.2 % with scores of 1, 2, and 3, respectively. The Area under ROC (AUROC) of the risk scoring system was 0.982.

Conclusion: There is a significant risk of contralateral ILNM in cases of unilaterally palpable lymph nodes. Bilateral ILNM has lower OS than unilateral ILNM. Risk factors predicting bilateral ILNM are identified. bILND is suggested in >/ = 2 risk factors. Proper counselling and shared decision-making should govern the management of contralateral groin in patients with a single or no risk factor.