Pub Date : 2025-02-11DOI: 10.1016/j.ejso.2025.109694
Kun Wang , Shan-shan Dong , Wei Zhang , Yue-wei Li , Jian-hang Wang , Bai-qiang An , Wei Han
Background
In recent years, the incidence of pediatric hepatoblastoma has increased significantly. The aims of our study were to analyze the incidence trends, identify independent risk factors affecting the prognosis, and create a nomogram based on these risk factors to guide clinical treatment.
Methods
The Clinicopathological data from children diagnosed with hepatoblastoma between 2000 and 2018 were extracted from the SEER database to analyze the incidence trends. Independent risk factors were screened by COX, LASSO and BSR to construct a nomogram. X-tile software was used to determine the optimal threshold and to identify high-risk and low-risk groups. Kaplan-Meier method was used to draw the subgroup survival curve.
Results
A total of 810 children with hepatoblastoma were included in this study. The APC was 1.6 % (95 % confidence interval [CI] −0.6 %–3.9 %, P < 0.05). Race, age, tumor size, type of surgery, and chemotherapy were independent risk factors. The time-varying AUC (>0.7) and time-varying c index (>0.7) indicate that nomogram has good discriminative ability. The calibration graphs show that the predicted results of the modal graphs are in good agreement with the actual observed results in the training and validation queues. In addition, DCA demonstrated the value of nomogram in clinical application and differentiation.
Conclusion
The incidence of hepatoblastoma in children has increased. We construct a nomogram to predict prognosis and guide treatment. The combination of surgery and chemotherapy is highly likely to extend survival and improve patient outcomes.
{"title":"Incidence trends and a nomogram for predicting overall survival in children with hepatoblastoma: A population-based analysis","authors":"Kun Wang , Shan-shan Dong , Wei Zhang , Yue-wei Li , Jian-hang Wang , Bai-qiang An , Wei Han","doi":"10.1016/j.ejso.2025.109694","DOIUrl":"10.1016/j.ejso.2025.109694","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the incidence of pediatric hepatoblastoma has increased significantly. The aims of our study were to analyze the incidence trends, identify independent risk factors affecting the prognosis, and create a nomogram based on these risk factors to guide clinical treatment.</div></div><div><h3>Methods</h3><div>The Clinicopathological data from children diagnosed with hepatoblastoma between 2000 and 2018 were extracted from the SEER database to analyze the incidence trends. Independent risk factors were screened by COX, LASSO and BSR to construct a nomogram. X-tile software was used to determine the optimal threshold and to identify high-risk and low-risk groups. Kaplan-Meier method was used to draw the subgroup survival curve.</div></div><div><h3>Results</h3><div>A total of 810 children with hepatoblastoma were included in this study. The APC was 1.6 % (95 % confidence interval [CI] −0.6 %–3.9 %, P < 0.05). Race, age, tumor size, type of surgery, and chemotherapy were independent risk factors. The time-varying AUC (>0.7) and time-varying c index (>0.7) indicate that nomogram has good discriminative ability. The calibration graphs show that the predicted results of the modal graphs are in good agreement with the actual observed results in the training and validation queues. In addition, DCA demonstrated the value of nomogram in clinical application and differentiation.</div></div><div><h3>Conclusion</h3><div>The incidence of hepatoblastoma in children has increased. We construct a nomogram to predict prognosis and guide treatment. The combination of surgery and chemotherapy is highly likely to extend survival and improve patient outcomes.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109694"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507974","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}
Extreme surgery using the hypothermic perfusion technique is often the only treatment option to achieve R0 resection and long-term prognosis for abdominal tumours that are either conventionally unresectable or contraindicated to allotransplantation. We conducted a systematic review and meta-analysis to delineate the indications and outcomes of extreme surgery.
Materials and methods
Human studies on extreme resection for abdominal malignant tumours were searched among five databases between January 1988 to March 2023. The Risk Of Bias In Non-randomised Studies - of Interventions tool was used to assess the risk of bias. A meta-analysis of proportions was performed, pooling 1-, 3- and 5-year overall survival and recurrence rates.
Results
This study comprised 73 studies encompassing 333 patients who underwent extreme liver resection (in situ, n = 127; ante situm, n = 72; ex situ, n = 134). Additionally, 90 patients from 17 studies focusing on extreme resection of other (non-hepatic) organs were included. The pooled 90-day mortality and 1- and 5-year overall survival rates were 7.3 %, 72.3 % and 23.4 %, respectively. The 1- and 5-year recurrence rates were 38.7 % and 86.1 %, respectively. Patients aged <65 years had a significantly lower 90-day mortality (5.5 % vs. 29.6 %; P = 0.022) and a higher 5-year overall survival rate (23.9 % vs. 0 %; P < 0.001) than those aged ≥65 years. Additionally, non-epithelial tumours were associated with favourable prognosis compared with epithelial tumours.
Conclusion
Extreme surgery offers acceptable outcomes for younger patients with non-epithelial tumours that are either unresectable by conventional cancer surgery or contraindicated to allotransplantation.
{"title":"Extreme surgery using the hypothermic perfusion technique for conventionally unresectable abdominal malignant tumours: A systematic review and meta-analysis","authors":"Lianbo Li , Kazuya Hirukawa , Jun Morinaga , Toru Goto , Kaori Isono , Masaki Honda , Yasuhiko Sugawara , Taizo Hibi","doi":"10.1016/j.ejso.2025.109692","DOIUrl":"10.1016/j.ejso.2025.109692","url":null,"abstract":"<div><h3>Background</h3><div>Extreme surgery using the hypothermic perfusion technique is often the only treatment option to achieve R0 resection and long-term prognosis for abdominal tumours that are either conventionally unresectable or contraindicated to allotransplantation. We conducted a systematic review and meta-analysis to delineate the indications and outcomes of extreme surgery.</div></div><div><h3>Materials and methods</h3><div>Human studies on extreme resection for abdominal malignant tumours were searched among five databases between January 1988 to March 2023. The Risk Of Bias In Non-randomised Studies - of Interventions tool was used to assess the risk of bias. A meta-analysis of proportions was performed, pooling 1-, 3- and 5-year overall survival and recurrence rates.</div></div><div><h3>Results</h3><div>This study comprised 73 studies encompassing 333 patients who underwent extreme liver resection (<em>in situ</em>, n = 127; <em>ante situm</em>, n = 72; <em>ex situ</em>, n = 134). Additionally, 90 patients from 17 studies focusing on extreme resection of other (non-hepatic) organs were included. The pooled 90-day mortality and 1- and 5-year overall survival rates were 7.3 %, 72.3 % and 23.4 %, respectively. The 1- and 5-year recurrence rates were 38.7 % and 86.1 %, respectively. Patients aged <65 years had a significantly lower 90-day mortality (5.5 % <em>vs.</em> 29.6 %; <em>P</em> = 0.022) and a higher 5-year overall survival rate (23.9 % <em>vs.</em> 0 %; <em>P</em> < 0.001) than those aged ≥65 years. Additionally, non-epithelial tumours were associated with favourable prognosis compared with epithelial tumours.</div></div><div><h3>Conclusion</h3><div>Extreme surgery offers acceptable outcomes for younger patients with non-epithelial tumours that are either unresectable by conventional cancer surgery or contraindicated to allotransplantation.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109692"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488714","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 : 2025-02-11DOI: 10.1016/j.ejso.2025.109688
Sanna Matilainen , Hanna Liikanen , Riitta Lassila , Minna K. Laitinen
Introduction
Distinguishing primary malignancies from metastases is the primary objective of diagnosing bone tumors of unknown etiology. For metastatic bone disease, recognizing the primary disease is pivotal to plan appropriate treatment. Despite uncertainties, oncological biomarkers are commonly utilized for early diagnostics.
Methods
Laboratory biomarkers were retrospectively collected from electronic patient records of 193 individuals after oncologic examinations for unknown skeletal lesions during a 3-year period. Blood cell count, creatinine, PSA, Ca19-9, Ca15-3, Ca12-5, CEA, S-Prot, myeloma light chains and their ratio were assessed and analyzed statistically.
Results
An elevation in biomarker values was observed across all cancer types, indicating lack of specificity. Patients with increased CEA mostly had breast (29 %, NS) or lung (24 %, p=<0.001) cancer, those with elevated Ca15-3 breast cancer (63 %, p=<0.001) or lung cancer (16 %, p = 0.042). Only 13 % of patients with increased Ca12-5 exhibited gynecological carcinomas (p = 0.025), and 36 % of those with increased Ca19-9 levels had gastrointestinal cancer (p = 0.012). In multivariate analysis, Ca12-5 alone reached significance in lung cancer (p = 0.008). PSA was elevated in patients with prostate cancer (p = 0.015), but only 74 % of those with increased PSA had prostate cancer. The markers S-Prot (p=<0.001) and light chain ratio (p = 0.004) signified myeloma. However, increased values were found among all disease groups, including those with benign lesions.
Conclusions
Carcinoma biomarkers (CEA, Ca12-5, Ca19-9, and Ca15-3) lack specificity, and are not helpful in association with skeletal metastases. PSA and myeloma variables may be useful in selected cases but should be restricted to cases where prostate cancer or multiple myeloma is suspected.
{"title":"Assessing the diagnostic value of oncological biomarkers for identifying primary malignancies in skeletal metastatic disease","authors":"Sanna Matilainen , Hanna Liikanen , Riitta Lassila , Minna K. Laitinen","doi":"10.1016/j.ejso.2025.109688","DOIUrl":"10.1016/j.ejso.2025.109688","url":null,"abstract":"<div><h3>Introduction</h3><div>Distinguishing primary malignancies from metastases is the primary objective of diagnosing bone tumors of unknown etiology. For metastatic bone disease, recognizing the primary disease is pivotal to plan appropriate treatment. Despite uncertainties, oncological biomarkers are commonly utilized for early diagnostics.</div></div><div><h3>Methods</h3><div>Laboratory biomarkers were retrospectively collected from electronic patient records of 193 individuals after oncologic examinations for unknown skeletal lesions during a 3-year period. Blood cell count, creatinine, PSA, Ca19-9, Ca15-3, Ca12-5, CEA, S-Prot, myeloma light chains and their ratio were assessed and analyzed statistically.</div></div><div><h3>Results</h3><div>An elevation in biomarker values was observed across all cancer types, indicating lack of specificity. Patients with increased CEA mostly had breast (29 %, NS) or lung (24 %, p=<0.001) cancer, those with elevated Ca15-3 breast cancer (63 %, p=<0.001) or lung cancer (16 %, p = 0.042). Only 13 % of patients with increased Ca12-5 exhibited gynecological carcinomas (p = 0.025), and 36 % of those with increased Ca19-9 levels had gastrointestinal cancer (p = 0.012). In multivariate analysis, Ca12-5 alone reached significance in lung cancer (p = 0.008). PSA was elevated in patients with prostate cancer (p = 0.015), but only 74 % of those with increased PSA had prostate cancer. The markers S-Prot (p=<0.001) and light chain ratio (p = 0.004) signified myeloma. However, increased values were found among all disease groups, including those with benign lesions.</div></div><div><h3>Conclusions</h3><div>Carcinoma biomarkers (CEA, Ca12-5, Ca19-9, and Ca15-3) lack specificity, and are not helpful in association with skeletal metastases. PSA and myeloma variables may be useful in selected cases but should be restricted to cases where prostate cancer or multiple myeloma is suspected.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109688"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488154","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}
Pub Date : 2025-02-10DOI: 10.1016/j.ejso.2025.109685
Marie Klein , Rene Warschkow , Kristjan Ukegjini , Daniel Krstic , Pascal Burri , Dimitrios Chatziisaak , Pia Antony , Pascal Probst , Thomas Steffen , Bruno Schmied , Ignazio Tarantino
Background
The aim of this study was to analyze whether perioperative blood transfusions are an independent risk factor for a reduced survival in patients after partial pancreaticoduodenectomy (PD) for periampullary malignancies.
Methods
This single-centre retrospective study analysed overall survival (OS) and disease-free survival (DFS) after PD for periampullary malignancies. Patients receiving perioperative blood transfusion were compared to patients receiving no blood transfusion using univariable and multivariable Cox regression analysis and propensity score matched analysis.
Results
Between 2010 and 2022, 214 patients were included, 32 of whom received perioperative blood transfusion. Perioperative blood transfusions were associated with lower preoperative hemoglobin levels (p = 0.004), higher intraoperative blood loss (p = 0.004), longer duration of surgery (p = 0.014), and postpancreatectomy hemorrhage (p < 0.001). In multivariable analysis, blood transfusions were not an independent risk factor for a reduced OS (OR = 1.11, CI: 0.59–2.08, p = 0.724) or DFS (OR = 0.94, CI: 0.51–1.73, p = 0.843). These results were confirmed by propensity matched analysis (OS: OR = 0.79, CI: 0.28–2.20, p = 0.647; DFS: OR = 0.97, CI: 0.46–2.08, p = 0.957).
Conclusion
Perioperative blood transfusions in patients undergoing PD for periampullary malignancies are not an independent risk factor for reduced OS and DFS. As high intraoperative blood loss and post-pancreatectomy hemorrhage impair survival intraoperative blood loss should be minimized and postpancreatectomy hemorrhage should be prevented.
{"title":"Perioperative blood transfusion does not impair survival after partial pancreaticoduodenectomy for periampullary cancer","authors":"Marie Klein , Rene Warschkow , Kristjan Ukegjini , Daniel Krstic , Pascal Burri , Dimitrios Chatziisaak , Pia Antony , Pascal Probst , Thomas Steffen , Bruno Schmied , Ignazio Tarantino","doi":"10.1016/j.ejso.2025.109685","DOIUrl":"10.1016/j.ejso.2025.109685","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to analyze whether perioperative blood transfusions are an independent risk factor for a reduced survival in patients after partial pancreaticoduodenectomy (PD) for periampullary malignancies.</div></div><div><h3>Methods</h3><div>This single-centre retrospective study analysed overall survival (OS) and disease-free survival (DFS) after PD for periampullary malignancies. Patients receiving perioperative blood transfusion were compared to patients receiving no blood transfusion using univariable and multivariable Cox regression analysis and propensity score matched analysis.</div></div><div><h3>Results</h3><div>Between 2010 and 2022, 214 patients were included, 32 of whom received perioperative blood transfusion. Perioperative blood transfusions were associated with lower preoperative hemoglobin levels (p = 0.004), higher intraoperative blood loss (p = 0.004), longer duration of surgery (p = 0.014), and postpancreatectomy hemorrhage (p < 0.001). In multivariable analysis, blood transfusions were not an independent risk factor for a reduced OS (OR = 1.11, CI: 0.59–2.08, p = 0.724) or DFS (OR = 0.94, CI: 0.51–1.73, p = 0.843). These results were confirmed by propensity matched analysis (OS: OR = 0.79, CI: 0.28–2.20, p = 0.647; DFS: OR = 0.97, CI: 0.46–2.08, p = 0.957).</div></div><div><h3>Conclusion</h3><div>Perioperative blood transfusions in patients undergoing PD for periampullary malignancies are not an independent risk factor for reduced OS and DFS. As high intraoperative blood loss and post-pancreatectomy hemorrhage impair survival intraoperative blood loss should be minimized and postpancreatectomy hemorrhage should be prevented.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109685"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488113","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 : 2025-02-10DOI: 10.1016/j.ejso.2025.109684
M.R. Boland , E. Pantiora , C. Rutherford , D. Evoy , R.S. Prichard , F. Warnberg , S. Eriksson , A. Karakatsanis
Superparamagnetic iron oxide(SPIO) is used increasingly in sentinel lymph node(SLN) identification in breast cancer patients. Identification ratios in the upfront setting are comparable to that of radioisotope and blue dye(RI/BD). However, its use in the neoadjuvant(NACT) setting remains under debate. The aim of this study was to assess the outcomes of SPIO in breast cancer patients receiving NACT followed by surgery. A systematic review of major databases was performed. Studies examining SPIO compared to standard of care(RI/BD) for SLN detection after NACT were included. Primary outcomes included individual detection rate(nodal detection) and nodal detection rate (number of nodes detected). Trial Sequential Analysis (TSA) was performed to assess results certainty. Study quality was assessed using the MINORS tool for observational studies. Five studies involving 374 patients were included. Regarding individual detection rate, SPIO was successful in 308/314 patients and RI in 297/314 patients. Pooled individual detection rates for SPIO and RI were 98.1 % vs 94.6 %(weighted Risk Ratio 1.02,95 % CI 0.99,1.05,p = 0.18; I2 = 24.3 %). Four studies examined nodal detection rates. Within these studies, a total of 625 SLNs were retrieved with 569 detected with SPIO and 468 with RI(mean: 2.26 SLN for SPIO and 1.86 for RI) with a respective nodal detection rate of 91.0 % vs 74.9 %(weighted Risk Ratio:1.25,95 % CI 1.06,1.47,p < 0.001; I2 = 89.6). The median MINORS score was 19/24(range 14–24), denoting good quality. In patients treated with NACT, SPIO performed comparably to RI, but seems to identify more SLNs. Routine use of SPIO in the neoadjuvant setting should be considered safe and effective.
{"title":"Use of superparamagnetic iron oxide for sentinel lymph node detection following neoadjuvant systemic therapy. A systematic review and meta-analysis","authors":"M.R. Boland , E. Pantiora , C. Rutherford , D. Evoy , R.S. Prichard , F. Warnberg , S. Eriksson , A. Karakatsanis","doi":"10.1016/j.ejso.2025.109684","DOIUrl":"10.1016/j.ejso.2025.109684","url":null,"abstract":"<div><div>Superparamagnetic iron oxide(SPIO) is used increasingly in sentinel lymph node(SLN) identification in breast cancer patients. Identification ratios in the upfront setting are comparable to that of radioisotope and blue dye(RI/BD). However, its use in the neoadjuvant(NACT) setting remains under debate. The aim of this study was to assess the outcomes of SPIO in breast cancer patients receiving NACT followed by surgery. A systematic review of major databases was performed. Studies examining SPIO compared to standard of care(RI/BD) for SLN detection after NACT were included. Primary outcomes included individual detection rate(nodal detection) and nodal detection rate (number of nodes detected). Trial Sequential Analysis (TSA) was performed to assess results certainty. Study quality was assessed using the MINORS tool for observational studies. Five studies involving 374 patients were included. Regarding individual detection rate, SPIO was successful in 308/314 patients and RI in 297/314 patients. Pooled individual detection rates for SPIO and RI were 98.1 % vs 94.6 %(weighted Risk Ratio 1.02,95 % CI 0.99,1.05,p = 0.18; I<sup>2</sup> = 24.3 %). Four studies examined nodal detection rates. Within these studies, a total of 625 SLNs were retrieved with 569 detected with SPIO and 468 with RI(mean: 2.26 SLN for SPIO and 1.86 for RI) with a respective nodal detection rate of 91.0 % vs 74.9 %(weighted Risk Ratio:1.25,95 % CI 1.06,1.47,p < 0.001; I<sup>2</sup> = 89.6). The median MINORS score was 19/24(range 14–24), denoting good quality. In patients treated with NACT, SPIO performed comparably to RI, but seems to identify more SLNs. Routine use of SPIO in the neoadjuvant setting should be considered safe and effective.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109684"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488102","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 : 2025-02-10DOI: 10.1016/j.ejso.2025.109683
Miho Akabane , Jun Kawashima , Abdullah Altaf , Selamawit Woldesenbet , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik
Background
The association between preoperative imaging and postoperative pathological tumor size disparity, and cancer-specific survival (CSS) among patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains unclear. We sought to evaluate this association and identify predictors of size disparity.
Method
Patients undergoing curative-intent hepatectomy for HCC (2000–2023) were identified from an international, multi-institutional database. Size ratio was defined as the ratio of pathological to imaging tumor size. Patients with a size ratio of 0.5–1.5 were classified as “without size disparity,” while patients outside this range were considered “with size disparity.” Multivariable Cox regression was used to identify predictors of CSS, while logistic regression was utilized to determine factors associated with size disparity. For variables identified as significant in multivariable analyses, further evaluation including cutoff determination, were performed using receiver operating characteristic (ROC) analysis.
Results
Among 833 patients, median size ratio was 1.02, with a strong correlation between imaging and pathological tumor sizes (r = 0.87). Size disparity was present in 106 patients (12.7 %); in general, patients had smaller median imaging sizes (2.85 vs. 4.80 cm; p < 0.001) while size on pathology was noted to be larger(both 4.50 cm; p = 0.370). Patients with size disparity had worse 5-year CSS (60.1% vs. 79.0 %; p < 0.001). Multivariable Cox regression identified higher ALBI score (HR:2.56 [1.50–4.37]; p < 0.001), larger pathological tumor size (HR:1.09 [1.03–1.15]; p = 0.001), and size disparity (HR:2.53 [1.37–4.66]; p = 0.002) as independent predictors of CSS. Logistic regression demonstrated that cirrhosis (OR: 2.68 [1.43–5.02]; p = 0.002) and log alpha-fetoprotein (AFP) (OR:1.11 [1.01–1.22]; p = 0.030) were associated with an increased likelihood of size disparity. Cirrhosis and log AFP could be used to stratify patients relative to probability of a size disparity (low-risk:9.9 %, medium-risk:12.2 %, high-risk:17.7 %). The optimal AFP cutoff value was 3928 ng/mL for non-cirrhotic (AUC:0.90) versus 28.9 ng/mL for cirrhotic (AUC:0.74) patients.
Conclusion
Tumor size disparity was associated with worse CSS among patients with HCC undergoing hepatectomy. Size disparity could be predicted preoperatively using cirrhosis status and AFP level, which may help identify high-risk patients who may benefit from more detailed imaging assessments.
{"title":"Impact of disparity between imaging and pathological tumor size on cancer-specific prognosis among patients with hepatocellular carcinoma","authors":"Miho Akabane , Jun Kawashima , Abdullah Altaf , Selamawit Woldesenbet , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik","doi":"10.1016/j.ejso.2025.109683","DOIUrl":"10.1016/j.ejso.2025.109683","url":null,"abstract":"<div><h3>Background</h3><div>The association between preoperative imaging and postoperative pathological tumor size disparity, and cancer-specific survival (CSS) among patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains unclear. We sought to evaluate this association and identify predictors of size disparity.</div></div><div><h3>Method</h3><div>Patients undergoing curative-intent hepatectomy for HCC (2000–2023) were identified from an international, multi-institutional database. Size ratio was defined as the ratio of pathological to imaging tumor size. Patients with a size ratio of 0.5–1.5 were classified as “without size disparity,” while patients outside this range were considered “with size disparity.” Multivariable Cox regression was used to identify predictors of CSS, while logistic regression was utilized to determine factors associated with size disparity. For variables identified as significant in multivariable analyses, further evaluation including cutoff determination, were performed using receiver operating characteristic (ROC) analysis.</div></div><div><h3>Results</h3><div>Among 833 patients, median size ratio was 1.02, with a strong correlation between imaging and pathological tumor sizes (r = 0.87). Size disparity was present in 106 patients (12.7 %); in general, patients had smaller median imaging sizes (2.85 vs. 4.80 cm; p < 0.001) while size on pathology was noted to be larger(both 4.50 cm; p = 0.370). Patients with size disparity had worse 5-year CSS (60.1% vs. 79.0 %; p < 0.001). Multivariable Cox regression identified higher ALBI score (HR:2.56 [1.50–4.37]; p < 0.001), larger pathological tumor size (HR:1.09 [1.03–1.15]; p = 0.001), and size disparity (HR:2.53 [1.37–4.66]; p = 0.002) as independent predictors of CSS. Logistic regression demonstrated that cirrhosis (OR: 2.68 [1.43–5.02]; p = 0.002) and log alpha-fetoprotein (AFP) (OR:1.11 [1.01–1.22]; p = 0.030) were associated with an increased likelihood of size disparity. Cirrhosis and log AFP could be used to stratify patients relative to probability of a size disparity (low-risk:9.9 %, medium-risk:12.2 %, high-risk:17.7 %). The optimal AFP cutoff value was 3928 ng/mL for non-cirrhotic (AUC:0.90) versus 28.9 ng/mL for cirrhotic (AUC:0.74) patients.</div></div><div><h3>Conclusion</h3><div>Tumor size disparity was associated with worse CSS among patients with HCC undergoing hepatectomy. Size disparity could be predicted preoperatively using cirrhosis status and AFP level, which may help identify high-risk patients who may benefit from more detailed imaging assessments.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109683"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488114","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 : 2025-02-10DOI: 10.1016/j.ejso.2025.109682
Emilia Putila , Olli Helminen , Mika Helmiö , Heikki Huhta , Aapo Jalkanen , Anna Junttila , Raija Kallio , Vesa Koivukangas , Arto Kokkola , Elina Lietzen , Johanna Louhimo , Sanna Meriläinen , Vesa-Matti Pohjanen , Tuomo Rantanen , Ari Ristimäki , Jari V. Räsänen , Eero Sihvo , Vesa Toikkanen , Tuula Tyrväinen , Antti Valtola , Joonas H. Kauppila
Introduction
International studies on preoperative risk factors of postoperative complications after gastrectomy for gastric cancer are few, and studies done in a population-based setting or using standardized definitions are lacking. Gastrectomy for gastric cancer is characterized by high complication rates and mortality, and identifying the risk factors for postoperative complications and mortality enables to improve the postoperative outcomes.
Materials and methods
This nationwide population-based cohort study is based on the Finnish National Esophago-Gastric Cancer Cohort, and it included all patients undergoing gastric cancer surgery in Finland during 2005–2016 aged 18 years or older. The Esophagectomy Complications Consensus Group's (ECCG) standardized list of complications was used for describing different types of postoperative outcomes.
Results
This study analyzed a total of 1993 patients. The results suggested that of potential risk factors, higher ASA-class, and advanced tumor stage increased the risk of major postoperative complications after gastrectomy for gastric cancer, whereas age ≥70 years and distal tumor location may be protective factors. The results suggested that older age, higher ASA-class, comorbidity, and advanced tumor stage were risk factors for 90-day mortality. Older age seemed to be a risk factor for 90-day mortality, whereas it seemed to protect from major postoperative complications and 90-day reoperations.
Conclusions
Higher ASA-class, and advanced tumor stage were risk factors for major complications after gastrectomy for gastric cancer, while older age and distal tumor location seemed to be protective factors.
{"title":"Preoperative predictors of postoperative complications after gastrectomy for gastric cancer, a population-based study in Finland","authors":"Emilia Putila , Olli Helminen , Mika Helmiö , Heikki Huhta , Aapo Jalkanen , Anna Junttila , Raija Kallio , Vesa Koivukangas , Arto Kokkola , Elina Lietzen , Johanna Louhimo , Sanna Meriläinen , Vesa-Matti Pohjanen , Tuomo Rantanen , Ari Ristimäki , Jari V. Räsänen , Eero Sihvo , Vesa Toikkanen , Tuula Tyrväinen , Antti Valtola , Joonas H. Kauppila","doi":"10.1016/j.ejso.2025.109682","DOIUrl":"10.1016/j.ejso.2025.109682","url":null,"abstract":"<div><h3>Introduction</h3><div>International studies on preoperative risk factors of postoperative complications after gastrectomy for gastric cancer are few, and studies done in a population-based setting or using standardized definitions are lacking. Gastrectomy for gastric cancer is characterized by high complication rates and mortality, and identifying the risk factors for postoperative complications and mortality enables to improve the postoperative outcomes.</div></div><div><h3>Materials and methods</h3><div>This nationwide population-based cohort study is based on the Finnish National Esophago-Gastric Cancer Cohort, and it included all patients undergoing gastric cancer surgery in Finland during 2005–2016 aged 18 years or older. The Esophagectomy Complications Consensus Group's (ECCG) standardized list of complications was used for describing different types of postoperative outcomes.</div></div><div><h3>Results</h3><div>This study analyzed a total of 1993 patients. The results suggested that of potential risk factors, higher ASA-class, and advanced tumor stage increased the risk of major postoperative complications after gastrectomy for gastric cancer, whereas age ≥70 years and distal tumor location may be protective factors. The results suggested that older age, higher ASA-class, comorbidity, and advanced tumor stage were risk factors for 90-day mortality. Older age seemed to be a risk factor for 90-day mortality, whereas it seemed to protect from major postoperative complications and 90-day reoperations.</div></div><div><h3>Conclusions</h3><div>Higher ASA-class, and advanced tumor stage were risk factors for major complications after gastrectomy for gastric cancer, while older age and distal tumor location seemed to be protective factors.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109682"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488191","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}
Pub Date : 2025-02-10DOI: 10.1016/j.ejso.2025.109681
Marinde J.G. Bond , Cornelis Verhoef , Geert Kazemier , Niels F.M. Kok , Michael F. Gerhards , Koert F.D. Kuhlmann , Wouter K.G. Leclercq , Arjen M. Rijken , Mike S.L. Liem , Johannes H.W. de Wilt , Joost M. Klaase , Thiery Chapelle , Dirk J. Grünhagen , I. Quintus Molenaar , Ronald R.M. van Dam , Anne M. May , Cornelis J.A. Punt , Rutger-Jan Swijnenburg
Background
Patients with colorectal liver-only metastases (CRLM) eligible for local treatment (resection/ablation) do not always receive this potentially curative treatment due to the lack of clear resectability criteria and expertise in centres not performing liver surgery. We evaluated the potential value of a liver expert panel in daily practice.
Methods
All patients with CRLM starting with systemic treatment in centres not performing liver surgery between 2016 and 2020 were identified in the Netherlands Cancer Registry. A panel of liver surgeons retrospectively re-evaluated patients’ imaging for resectability before and two-monthly during systemic treatment.
Results
Sixty-three patients were included from 24 hospitals requiring a total of 544 resectability assessments by individual panel surgeons. The panel considered 18 (29 %) patients to have resectable CRLM before starting systemic treatment, which increased to 43 (68 %) after up to three evaluations. Eighteen (29 %) patients considered resectable by the panel at any time received no local treatment of whom 9 (50 %) were not referred to a liver surgeon.
Conclusion
In non-liver-surgery centres, over a quarter of patients technically eligible for local treatment of initially unresectable CRLM, sometimes mistakenly categorised as such, did not receive this. This stresses the need for liver expert panels in daily practice to increase local treatment rates.
{"title":"Resectability assessment of colorectal liver metastases by an expert panel: Potential impact on hospitals referring patients for local treatment","authors":"Marinde J.G. Bond , Cornelis Verhoef , Geert Kazemier , Niels F.M. Kok , Michael F. Gerhards , Koert F.D. Kuhlmann , Wouter K.G. Leclercq , Arjen M. Rijken , Mike S.L. Liem , Johannes H.W. de Wilt , Joost M. Klaase , Thiery Chapelle , Dirk J. Grünhagen , I. Quintus Molenaar , Ronald R.M. van Dam , Anne M. May , Cornelis J.A. Punt , Rutger-Jan Swijnenburg","doi":"10.1016/j.ejso.2025.109681","DOIUrl":"10.1016/j.ejso.2025.109681","url":null,"abstract":"<div><h3>Background</h3><div>Patients with colorectal liver-only metastases (CRLM) eligible for local treatment (resection/ablation) do not always receive this potentially curative treatment due to the lack of clear resectability criteria and expertise in centres not performing liver surgery. We evaluated the potential value of a liver expert panel in daily practice.</div></div><div><h3>Methods</h3><div>All patients with CRLM starting with systemic treatment in centres not performing liver surgery between 2016 and 2020 were identified in the Netherlands Cancer Registry. A panel of liver surgeons retrospectively re-evaluated patients’ imaging for resectability before and two-monthly during systemic treatment.</div></div><div><h3>Results</h3><div>Sixty-three patients were included from 24 hospitals requiring a total of 544 resectability assessments by individual panel surgeons. The panel considered 18 (29 %) patients to have resectable CRLM before starting systemic treatment, which increased to 43 (68 %) after up to three evaluations. Eighteen (29 %) patients considered resectable by the panel at any time received no local treatment of whom 9 (50 %) were not referred to a liver surgeon.</div></div><div><h3>Conclusion</h3><div>In non-liver-surgery centres, over a quarter of patients technically eligible for local treatment of initially unresectable CRLM, sometimes mistakenly categorised as such, did not receive this. This stresses the need for liver expert panels in daily practice to increase local treatment rates.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109681"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488259","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 : 2025-02-10DOI: 10.1016/j.ejso.2025.109672
Jeppe S. Gregersen, Trygve U. Solstad, Michael P. Achiam, August A. Olsen
Introduction
Quality assurance in esophagogastric surgery, particularly in an oncological context, is important, especially as long-term survival is highly affected by the short-term outcomes. Textbook Outcome (TO) and Textbook Oncological Outcome (TOO) serve as multidimensional metrics to assess surgical quality by evaluating various perioperative factors, as well as oncological outcomes. TO and TOO have been associated with improved long-term survival.
Aim
This study aimed to examine the incidence of, and the definitions of TO and TOO used in esophagogastric oncological surgery.
Methods
This systematic scoping review followed the PRISMA 2020 guidelines and the PRISMA scoping review extension. The AMSTAR-2 was used to rate the review. A comprehensive systematic search was performed in Medline, Embase, and Web of Science and results were screened through Covidence. Quality assessment was conducted using the Newcastle-Ottawa scale.
Results
A total of 55 observational cohort studies on esophagogastric cancer surgery were included. A total of 245,075 patients was included in the assessment of the achievement of TO and TOO. The rate of TO achievement ranged from 20.4 to 84.2 %, while the rate of TOO achievement ranged from 21.3 to 57.6 %. TO and TOO definitions varied widely, combining a median of nine (range: 4–11) parameters with a total of 45 different parameters being reported.
Conclusion
This systematic scoping review showed significant variations in incidence and in the definitions used for TO and TOO in esophagogastric cancer surgery between the included studies. This highlights the importance of standardizing the definitions of TO and TOO.
{"title":"Textbook outcome and textbook oncological outcome in esophagogastric cancer surgery – A systematic scoping review","authors":"Jeppe S. Gregersen, Trygve U. Solstad, Michael P. Achiam, August A. Olsen","doi":"10.1016/j.ejso.2025.109672","DOIUrl":"10.1016/j.ejso.2025.109672","url":null,"abstract":"<div><h3>Introduction</h3><div>Quality assurance in esophagogastric surgery, particularly in an oncological context, is important, especially as long-term survival is highly affected by the short-term outcomes. Textbook Outcome (TO) and Textbook Oncological Outcome (TOO) serve as multidimensional metrics to assess surgical quality by evaluating various perioperative factors, as well as oncological outcomes. TO and TOO have been associated with improved long-term survival.</div></div><div><h3>Aim</h3><div>This study aimed to examine the incidence of, and the definitions of TO and TOO used in esophagogastric oncological surgery.</div></div><div><h3>Methods</h3><div>This systematic scoping review followed the PRISMA 2020 guidelines and the PRISMA scoping review extension. The AMSTAR-2 was used to rate the review. A comprehensive systematic search was performed in Medline, Embase, and Web of Science and results were screened through Covidence. Quality assessment was conducted using the Newcastle-Ottawa scale.</div></div><div><h3>Results</h3><div>A total of 55 observational cohort studies on esophagogastric cancer surgery were included. A total of 245,075 patients was included in the assessment of the achievement of TO and TOO. The rate of TO achievement ranged from 20.4 to 84.2 %, while the rate of TOO achievement ranged from 21.3 to 57.6 %. TO and TOO definitions varied widely, combining a median of nine (range: 4–11) parameters with a total of 45 different parameters being reported.</div></div><div><h3>Conclusion</h3><div>This systematic scoping review showed significant variations in incidence and in the definitions used for TO and TOO in esophagogastric cancer surgery between the included studies. This highlights the importance of standardizing the definitions of TO and TOO.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109672"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488101","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}
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