Pub Date : 2026-01-17DOI: 10.1016/j.ejso.2026.111408
Lukas Pollmann , Jürgen Zieren , Nicola S. Pollmann , Urs Giger-Pabst , Pompiliu Piso , Michael Ströhlein , Nicola Cerasani , Fabian Kockelmann , Maximilian Schmeding , members of the StuDoQ|HIPEC registry of the German Society for General and Visceral Surgery (DGAV)
Background
For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied.
Methods
A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts.
Results
A comprehensive analysis of 5011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15 % vs. 12 %, p = 0.192) or 30-day mortality (2 % vs. 1 %, p = 0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12 % in both groups (p = 1.000) and similar 30-day mortality (2 % vs. 1 %, p = 0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27 %), pseudomyxoma peritonei (21 %), or colorectal cancer (20 %), mesothelioma (12 %) and ovarian cancer (10 %).
Conclusions
Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.
{"title":"Safety of secondary CRS/HIPEC in peritoneal surface malignancies: Insights from a national cohort study","authors":"Lukas Pollmann , Jürgen Zieren , Nicola S. Pollmann , Urs Giger-Pabst , Pompiliu Piso , Michael Ströhlein , Nicola Cerasani , Fabian Kockelmann , Maximilian Schmeding , members of the StuDoQ|HIPEC registry of the German Society for General and Visceral Surgery (DGAV)","doi":"10.1016/j.ejso.2026.111408","DOIUrl":"10.1016/j.ejso.2026.111408","url":null,"abstract":"<div><h3>Background</h3><div>For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts.</div></div><div><h3>Results</h3><div>A comprehensive analysis of 5011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15 % vs. 12 %, p = 0.192) or 30-day mortality (2 % vs. 1 %, p = 0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12 % in both groups (p = 1.000) and similar 30-day mortality (2 % vs. 1 %, p = 0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27 %), pseudomyxoma peritonei (21 %), or colorectal cancer (20 %), mesothelioma (12 %) and ovarian cancer (10 %).</div></div><div><h3>Conclusions</h3><div>Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111408"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017705","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 : 2026-01-17DOI: 10.1016/j.ejso.2026.111416
Richard Garfinkle , Saba Balvardi , Heather Carmichael , Risa Shorr , Manju George , Krishan Jethwa , Peter Johansen , Mary Lakaszawski , Arun Nagarajan , Neil Smart , Patricia Sylla , Te Vuong , Marylise Boutros , Dean A. Fergusson
Background
The purpose of this scoping review was to systematically review the published literature of randomized controlled trials (RCT) in rectal cancer to generate a comprehensive list of study outcomes. The secondary objectives of this study were to describe trends in outcome reporting in rectal cancer RCTs with a particular focus on patient-reported outcome measures (PROM).
Methods
We systematically searched for rectal cancer RCTs suing several electronic databases. Eligible studies needed to be published after the year 2000 and had to evaluate a locoregional or systemic therapy for non-metastatic rectal cancer as its primary exposure. All reported outcomes were extracted verbatim from the article and subsequently re-categorized into “standardized outcome terms” and within OMERACT Core Areas of health. Data regarding the use of patient-reported outcome measures and the choice of primary outcome were also extracted.
Results
In total, 89 RCT's were included: 56 (62.9 %) were considered neoadjuvant trials, 24 (27.0) surgical trials, and 9 (10.1 %) adjuvant trials. Fifty-three standardized outcome terms were identified and grouped into various domains and Core Areas. The primary outcomes utilized in each RCT were highly variable and differed by study type. In total, 37 (41.6 %) trials used one or more patient-reported outcome measure as an outcome, mainly consisting of health-related quality of life. There were no significant trends in outcome reporting by year or author specialty.
Conclusions
A comprehensive list of study outcomes categorized into several domains and Core Areas was generated.
{"title":"Outcomes reported in randomized controlled trials of rectal cancer treatment: A scoping review for the CORRECT initiative","authors":"Richard Garfinkle , Saba Balvardi , Heather Carmichael , Risa Shorr , Manju George , Krishan Jethwa , Peter Johansen , Mary Lakaszawski , Arun Nagarajan , Neil Smart , Patricia Sylla , Te Vuong , Marylise Boutros , Dean A. Fergusson","doi":"10.1016/j.ejso.2026.111416","DOIUrl":"10.1016/j.ejso.2026.111416","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this scoping review was to systematically review the published literature of randomized controlled trials (RCT) in rectal cancer to generate a comprehensive list of study outcomes. The secondary objectives of this study were to describe trends in outcome reporting in rectal cancer RCTs with a particular focus on patient-reported outcome measures (PROM).</div></div><div><h3>Methods</h3><div>We systematically searched for rectal cancer RCTs suing several electronic databases. Eligible studies needed to be published after the year 2000 and had to evaluate a locoregional or systemic therapy for non-metastatic rectal cancer as its primary exposure. All reported outcomes were extracted verbatim from the article and subsequently re-categorized into “standardized outcome terms” and within OMERACT Core Areas of health. Data regarding the use of patient-reported outcome measures and the choice of primary outcome were also extracted.</div></div><div><h3>Results</h3><div>In total, 89 RCT's were included: 56 (62.9 %) were considered neoadjuvant trials, 24 (27.0) surgical trials, and 9 (10.1 %) adjuvant trials. Fifty-three standardized outcome terms were identified and grouped into various domains and Core Areas. The primary outcomes utilized in each RCT were highly variable and differed by study type. In total, 37 (41.6 %) trials used one or more patient-reported outcome measure as an outcome, mainly consisting of health-related quality of life. There were no significant trends in outcome reporting by year or author specialty.</div></div><div><h3>Conclusions</h3><div>A comprehensive list of study outcomes categorized into several domains and Core Areas was generated.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111416"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017776","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 : 2026-01-17DOI: 10.1016/j.ejso.2026.111412
Becky Leveridge , Edagul Ulucay , Henry D. Robb , Alice E. Baggaley , Christopher J. Peters , George B. Hanna , Russell Petty , Piers R. Boshier
Peritoneal metastasis from (PM) remains a significant therapeutic challenge due to poor response to systemic chemotherapy, largely attributable to limited peritoneal drug penetration. Normothermic catheter-based intraperitoneal chemotherapy (IPC) offers a promising alternative, enabling high local drug concentrations with reduced systemic toxicity. This review applies the IDEAL Framework to assess the evolution of normothermic catheter-based IPC for PM treatment. A systematic review identified 205 original studies and 47 trial protocols or registrations. Normothermic catheter-based IPC has advanced through IDEAL Stages 0 to 3, with preclinical data establishing feasibility, early-phase trials demonstrating safety and efficacy, and recent randomised controlled trials, mainly in Asia, suggesting survival benefit. However, uptake remains limited, and IDEAL Stage 4 data, including long-term follow-up and registry outcomes are lacking. These findings underscore normothermic catheter-based IPC’s potential as part of multimodal PM treatment. Further prospective, globally representative trials and long-term data collection are needed to guide broader clinical adoption.
{"title":"Normothermic catheter-based intraperitoneal chemotherapy: Systematic review using the IDEAL framework","authors":"Becky Leveridge , Edagul Ulucay , Henry D. Robb , Alice E. Baggaley , Christopher J. Peters , George B. Hanna , Russell Petty , Piers R. Boshier","doi":"10.1016/j.ejso.2026.111412","DOIUrl":"10.1016/j.ejso.2026.111412","url":null,"abstract":"<div><div>Peritoneal metastasis from (PM) remains a significant therapeutic challenge due to poor response to systemic chemotherapy, largely attributable to limited peritoneal drug penetration. Normothermic catheter-based intraperitoneal chemotherapy (IPC) offers a promising alternative, enabling high local drug concentrations with reduced systemic toxicity. This review applies the IDEAL Framework to assess the evolution of normothermic catheter-based IPC for PM treatment. A systematic review identified 205 original studies and 47 trial protocols or registrations. Normothermic catheter-based IPC has advanced through IDEAL Stages 0 to 3, with preclinical data establishing feasibility, early-phase trials demonstrating safety and efficacy, and recent randomised controlled trials, mainly in Asia, suggesting survival benefit. However, uptake remains limited, and IDEAL Stage 4 data, including long-term follow-up and registry outcomes are lacking. These findings underscore normothermic catheter-based IPC’s potential as part of multimodal PM treatment. Further prospective, globally representative trials and long-term data collection are needed to guide broader clinical adoption.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111412"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017702","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 : 2026-01-16DOI: 10.1016/j.ejso.2026.111411
Shelley Potter , Mairead MacKenzie , Stuart McIntosh , Toral Gathani , Sileida Oliveros , David Dodwell
Improved outcomes, particularly the marked reduction in locoregional recurrence, and the increasing numbers of survivors of early breast cancer, have led to the wish to reduce treatment morbidity, without compromising long-term outcomes.
Trials to assess reduced breast and axillary surgery, radiotherapy and endocrine therapy have all been conducted and led to new standards of care and reduced toxicity.
In some cases, however, implementation of research findings has been compromised by a relative lack of quality control in trials, substitution of a de-escalated treatment by an alternative, a lack of patient-relevant endpoints and the difficulties in the design and powering of ‘non-inferiority’ trials.
We summarize the current landscape of care and clinical research in this area, explore the problems identified in some studies and suggest how they may be mitigated.
{"title":"Reducing locoregional treatments in low risk early invasive breast cancer","authors":"Shelley Potter , Mairead MacKenzie , Stuart McIntosh , Toral Gathani , Sileida Oliveros , David Dodwell","doi":"10.1016/j.ejso.2026.111411","DOIUrl":"10.1016/j.ejso.2026.111411","url":null,"abstract":"<div><div>Improved outcomes, particularly the marked reduction in locoregional recurrence, and the increasing numbers of survivors of early breast cancer, have led to the wish to reduce treatment morbidity, without compromising long-term outcomes.</div><div>Trials to assess reduced breast and axillary surgery, radiotherapy and endocrine therapy have all been conducted and led to new standards of care and reduced toxicity.</div><div>In some cases, however, implementation of research findings has been compromised by a relative lack of quality control in trials, substitution of a de-escalated treatment by an alternative, a lack of patient-relevant endpoints and the difficulties in the design and powering of ‘non-inferiority’ trials.</div><div>We summarize the current landscape of care and clinical research in this area, explore the problems identified in some studies and suggest how they may be mitigated.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111411"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017740","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 : 2026-01-16DOI: 10.1016/j.ejso.2026.111386
Chuanquan Lin , Xian Gong , Rui Tong , Shaojia Chen , Hao Chen , Guobing Xu , Bin Zheng , Chun Chen , Wei Zheng , Zhang Yang
Objectives
Postoperative complications remain common after neoadjuvant therapy and esophagectomy for esophageal squamous cell carcinoma (ESCC), and existing risk scores have limited bedside utility. We developed and validated an interpretable machine-learning model to predict morbidity.
Methods
We retrospectively included ESCC patients who underwent neoadjuvant therapy and curative esophagectomy from 2018 to 2022. Cases from 2018 to 2021 were the training cohort; cases from 2022 were the validation cohort. The endpoint was Clavien–Dindo grade ≥ II complications within 90 days. Multimodal preoperative and intraoperative variables trained several machine-learning algorithms. Performance was evaluated by cross-validation and independent validation. Interpretability used SHapley Additive exPlanations (SHAP), and top features yielded a simplified model.
Results
In total, 239 patients were analyzed in two temporally distinct cohorts (training set, n = 174; validation set, n = 65). XGBoost achieved the best overall performance, with accuracy 0.82, AUC 0.86, and precision 0.78. SHAP analysis identified prognostic nutritional index, smoking status, carcinoembryonic antigen, age, and lymphocyte-to-monocyte ratio as the most influential predictors. A simplified five-variable model preserved predictive performance and enabled clinically actionable risk stratification: in the low-risk group, 9.1 % experienced complications, compared with 23.8 % in the medium-risk group and 68.2 % in the high-risk group. Locked cutpoints—PNI 44.07, CEA 2.98 ng/mL, age 64.00 years, and LMR 3.22—were applied without modification in the validation cohort and yielded clear stratification of incidence across threshold-defined groups.
Conclusions
An interpretable machine-learning model based on routinely available clinical variables accurately predicts postoperative complications in ESCC after neoadjuvant therapy. The simplified model enables clinically meaningful risk stratification and may support personalized perioperative management.
{"title":"Interpretable machine learning model for predicting postoperative complications in esophageal squamous cell carcinoma following neoadjuvant therapy and esophagectomy","authors":"Chuanquan Lin , Xian Gong , Rui Tong , Shaojia Chen , Hao Chen , Guobing Xu , Bin Zheng , Chun Chen , Wei Zheng , Zhang Yang","doi":"10.1016/j.ejso.2026.111386","DOIUrl":"10.1016/j.ejso.2026.111386","url":null,"abstract":"<div><h3>Objectives</h3><div>Postoperative complications remain common after neoadjuvant therapy and esophagectomy for esophageal squamous cell carcinoma (ESCC), and existing risk scores have limited bedside utility. We developed and validated an interpretable machine-learning model to predict morbidity.</div></div><div><h3>Methods</h3><div>We retrospectively included ESCC patients who underwent neoadjuvant therapy and curative esophagectomy from 2018 to 2022. Cases from 2018 to 2021 were the training cohort; cases from 2022 were the validation cohort. The endpoint was Clavien–Dindo grade ≥ II complications within 90 days. Multimodal preoperative and intraoperative variables trained several machine-learning algorithms. Performance was evaluated by cross-validation and independent validation. Interpretability used SHapley Additive exPlanations (SHAP), and top features yielded a simplified model.</div></div><div><h3>Results</h3><div>In total, 239 patients were analyzed in two temporally distinct cohorts (training set, n = 174; validation set, n = 65). XGBoost achieved the best overall performance, with accuracy 0.82, AUC 0.86, and precision 0.78. SHAP analysis identified prognostic nutritional index, smoking status, carcinoembryonic antigen, age, and lymphocyte-to-monocyte ratio as the most influential predictors. A simplified five-variable model preserved predictive performance and enabled clinically actionable risk stratification: in the low-risk group, 9.1 % experienced complications, compared with 23.8 % in the medium-risk group and 68.2 % in the high-risk group. Locked cutpoints—PNI 44.07, CEA 2.98 ng/mL, age 64.00 years, and LMR 3.22—were applied without modification in the validation cohort and yielded clear stratification of incidence across threshold-defined groups.</div></div><div><h3>Conclusions</h3><div>An interpretable machine-learning model based on routinely available clinical variables accurately predicts postoperative complications in ESCC after neoadjuvant therapy. The simplified model enables clinically meaningful risk stratification and may support personalized perioperative management.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111386"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074766","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 : 2026-01-16DOI: 10.1016/j.ejso.2026.111410
Sven J.E. Ermans , Romy Maas , T. Martyn Hill , Sasha I. Usiskin , Lejla Alic , Michael Douek
Introduction
Accurate estimation of tumour extent is crucial for breast cancer treatment and achieving tumour-free surgical margins. Breast MRI is a widely used imaging modality; however, the high cost and limited availability of MRI have increased interest in contrast-enhanced mammography (CEM) as a potential alternative. This meta-analysis compares the accuracy of tumour extent estimation between MRI and CEM, using histopathological size as the reference standard.
Method
Literature up to October 2024 was reviewed. Two independent reviewers extracted relevant data. For both modalities in comparison with pathology, mean differences in tumour size and pooled correlation coefficients were calculated. A direct comparison of tumour size estimates between both modalities was conducted using R2 and a two-sample t-test. The I2-statistic was used to assess between-study heterogeneity.
Results
Twenty-one studies involving 1060 patients were included. Both modalities showed a mean overestimation of tumour size by ∼3 mm, with no statistical significance (P = 0.345 and P = 0.308). Correlation coefficients with pathology were 0.78 for MRI and 0.79 for CEM. Direct comparison demonstrated strong agreement (R2 = 0.81) between the two modalities, and no significant difference (P = 0.65). Limited data suggested higher sensitivity but reduced specificity for MRI in the detection of multifocal/multicentric disease.
Conclusion
MRI and CEM showed comparable performance in tumour size estimation, with no significant differences compared to pathology or each other. These findings suggest CEM could potentially be an alternative for MRI, especially in resource-limited settings or for patients contraindicated for MRI. However, small study sizes and limited subgroup data highlight the need for large-scale prospective research.
{"title":"Comparison of contrast-enhanced mammography and breast MRI in tumour extent assessment: A systematic review and meta-analysis","authors":"Sven J.E. Ermans , Romy Maas , T. Martyn Hill , Sasha I. Usiskin , Lejla Alic , Michael Douek","doi":"10.1016/j.ejso.2026.111410","DOIUrl":"10.1016/j.ejso.2026.111410","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate estimation of tumour extent is crucial for breast cancer treatment and achieving tumour-free surgical margins. Breast MRI is a widely used imaging modality; however, the high cost and limited availability of MRI have increased interest in contrast-enhanced mammography (CEM) as a potential alternative. This meta-analysis compares the accuracy of tumour extent estimation between MRI and CEM, using histopathological size as the reference standard.</div></div><div><h3>Method</h3><div>Literature up to October 2024 was reviewed. Two independent reviewers extracted relevant data. For both modalities in comparison with pathology, mean differences in tumour size and pooled correlation coefficients were calculated. A direct comparison of tumour size estimates between both modalities was conducted using R<sup>2</sup> and a two-sample <em>t</em>-test. The I<sup>2</sup>-statistic was used to assess between-study heterogeneity.</div></div><div><h3>Results</h3><div>Twenty-one studies involving 1060 patients were included. Both modalities showed a mean overestimation of tumour size by ∼3 mm, with no statistical significance (P = 0.345 and P = 0.308). Correlation coefficients with pathology were 0.78 for MRI and 0.79 for CEM. Direct comparison demonstrated strong agreement (R<sup>2</sup> = 0.81) between the two modalities, and no significant difference (P = 0.65). Limited data suggested higher sensitivity but reduced specificity for MRI in the detection of multifocal/multicentric disease.</div></div><div><h3>Conclusion</h3><div>MRI and CEM showed comparable performance in tumour size estimation, with no significant differences compared to pathology or each other. These findings suggest CEM could potentially be an alternative for MRI, especially in resource-limited settings or for patients contraindicated for MRI. However, small study sizes and limited subgroup data highlight the need for large-scale prospective research.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111410"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024200","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}
To compare the clinical outcomes and safety profiles of immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor (VEGF) agents alone versus transarterial chemoembolization (TACE) combined with ICI and anti-VEGF agents in patients with intermediate hepatocellular carcinoma (HCC).
Methods
Patients were stratified into two groups: the triple-therapy (TACE combined with ICI and anti-VEGF agents) and dual-therapy groups (ICI plus anti-VEGF agents). Stabilized inverse probability of treatment weighting (sIPTW) was applied to balance baseline characteristics. Study endpoints included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR). Univariate and multivariate Cox regression analyses were employed to identify independent prognostic factors. Safety was evaluated per CTCAE v5.0.
Results
After sIPTW adjustment, the triple-therapy group demonstrated significantly longer median PFS (20.0 vs. 14.0 months; P < 0.0001) and median OS (26.0 vs. 19.0 months; P < 0.0001) compared to the dual-therapy group. Tumor response was also superior in the triple-therapy group, with higher ORR (63.3 % vs. 39.4 %; P = 0.015) and DCR (85.0 % vs. 60.6 %; P < 0.001). IPTW-weighted Cox regression identified AFP, tumor response, and up-to-7 criteria as independent prognostic factors for PFS, while AFP, up-to-7 criteria, and cirrhosis were independent factors for OS. The safety profile was manageable in both groups, with no new safety signals identified.
Conclusion
This study demonstrates that combining TACE with ICIs and anti-VEGF agents significantly improves PFS, OS, ORR and DCR in intermediate-stage HCC patients compared to dual ICI and anti-VEGF agents therapy, with manageable toxicity.
{"title":"Transarterial chemoembolization combined with immune checkpoint inhibitors and anti-VEGF agents for intermediate HCC: a multicenter study","authors":"Wei-Yi Jiang , Jin-Kai Feng , Bin Zhou , Si-Si Ren , Yu-Chao Hou , Fang-Fang Zhang , Yan-Jun Xiang , Zong-Han Liu , Rong-Chen Chen , Yun-Feng Shan , Chao Liang , Hong-Kun Zhou , Lin Gong , Shu-Qun Cheng","doi":"10.1016/j.ejso.2026.111407","DOIUrl":"10.1016/j.ejso.2026.111407","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the clinical outcomes and safety profiles of immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor (VEGF) agents alone versus transarterial chemoembolization (TACE) combined with ICI and anti-VEGF agents in patients with intermediate hepatocellular carcinoma (HCC).</div></div><div><h3>Methods</h3><div>Patients were stratified into two groups: the triple-therapy (TACE combined with ICI and anti-VEGF agents) and dual-therapy groups (ICI plus anti-VEGF agents). Stabilized inverse probability of treatment weighting (sIPTW) was applied to balance baseline characteristics. Study endpoints included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR). Univariate and multivariate Cox regression analyses were employed to identify independent prognostic factors. Safety was evaluated per CTCAE v5.0.</div></div><div><h3>Results</h3><div>After sIPTW adjustment, the triple-therapy group demonstrated significantly longer median PFS (20.0 vs. 14.0 months; P < 0.0001) and median OS (26.0 vs. 19.0 months; P < 0.0001) compared to the dual-therapy group. Tumor response was also superior in the triple-therapy group, with higher ORR (63.3 % vs. 39.4 %; P = 0.015) and DCR (85.0 % vs. 60.6 %; P < 0.001). IPTW-weighted Cox regression identified AFP, tumor response, and up-to-7 criteria as independent prognostic factors for PFS, while AFP, up-to-7 criteria, and cirrhosis were independent factors for OS. The safety profile was manageable in both groups, with no new safety signals identified.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that combining TACE with ICIs and anti-VEGF agents significantly improves PFS, OS, ORR and DCR in intermediate-stage HCC patients compared to dual ICI and anti-VEGF agents therapy, with manageable toxicity.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111407"},"PeriodicalIF":2.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024137","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 : 2026-01-14DOI: 10.1016/j.ejso.2026.111393
A. Nanda , E. Marshall , M. Attia , D. Alaradi , R. Merh , V. Sinnett , K. Krupa , M.K. Tasoulis , P.A. Barry , G. Gui , J.E. Rusby , R.L. O'Connell
Introduction
Axillary surgery in early breast cancer has evolved towards de-escalation, particularly for patients receiving neoadjuvant systemic therapy (NACT). Targeted axillary dissection (TAD), combining sentinel lymph node biopsy (SLNB) with excision of a clipped metastatic node, reduces false-negative rates and may allow omission of axillary lymph node dissection (ALND). However, evidence for its safety in patients with high lymph node burden (HLNB, ≥4 abnormal nodes) remains limited.
Methods
This retrospective study included women treated with TAD following NACT at The Royal Marsden NHS Foundation Trust (2018–2023). Patients were stratified by baseline nodal burden into low (LLNB, 1–3 nodes) and high (HLNB, ≥4 nodes) groups. Data on clinicopathological features, imaging-pathology concordance, surgical outcomes and oncological follow-up were analysed.
Results
Among 179 women (139 LLNB, 40 HLNB), HER2-positive and triple-negative subtypes were more frequent in the HLNB group. The clipped node contained a Magseed in 83.8 % of cases and was also a sentinel node in 71.3 %. Axillary pathological complete response (pCR) was achieved in 110/179 (61.4 %) patients - 61.2 % LLNB vs 62.5 % HLNB (p = 1.0). Of those with axillary pCR, 98.2 % avoided axillary lymph node dissection (ALND). End-of-treatment axillary ultrasound had a positive predictive value of 56.6 % and negative predictive value of 74.8 % for residual disease. At a median follow-up of 30 months, no axillary recurrences occurred; disease-free survival was comparable between groups (p = 0.32), with a non-significant trend toward poorer overall survival in HLNB (p = 0.055).
Conclusions
TAD after NACT appears oncologically safe in selected patients with both low and high nodal burden, enabling omission of ALND in most cases. Prospective studies are warranted to confirm its role in HLNB disease.
{"title":"Targeted axillary dissection after neoadjuvant chemotherapy in breast cancer patients with a high lymph node burden: Radiological and histological outcomes","authors":"A. Nanda , E. Marshall , M. Attia , D. Alaradi , R. Merh , V. Sinnett , K. Krupa , M.K. Tasoulis , P.A. Barry , G. Gui , J.E. Rusby , R.L. O'Connell","doi":"10.1016/j.ejso.2026.111393","DOIUrl":"10.1016/j.ejso.2026.111393","url":null,"abstract":"<div><h3>Introduction</h3><div>Axillary surgery in early breast cancer has evolved towards de-escalation, particularly for patients receiving neoadjuvant systemic therapy (NACT). Targeted axillary dissection (TAD), combining sentinel lymph node biopsy (SLNB) with excision of a clipped metastatic node, reduces false-negative rates and may allow omission of axillary lymph node dissection (ALND). However, evidence for its safety in patients with high lymph node burden (HLNB, ≥4 abnormal nodes) remains limited.</div></div><div><h3>Methods</h3><div>This retrospective study included women treated with TAD following NACT at The Royal Marsden NHS Foundation Trust (2018–2023). Patients were stratified by baseline nodal burden into low (LLNB, 1–3 nodes) and high (HLNB, ≥4 nodes) groups. Data on clinicopathological features, imaging-pathology concordance, surgical outcomes and oncological follow-up were analysed.</div></div><div><h3>Results</h3><div>Among 179 women (139 LLNB, 40 HLNB), HER2-positive and triple-negative subtypes were more frequent in the HLNB group. The clipped node contained a Magseed in 83.8 % of cases and was also a sentinel node in 71.3 %. Axillary pathological complete response (pCR) was achieved in 110/179 (61.4 %) patients - 61.2 % LLNB vs 62.5 % HLNB (p = 1.0). Of those with axillary pCR, 98.2 % avoided axillary lymph node dissection (ALND). End-of-treatment axillary ultrasound had a positive predictive value of 56.6 % and negative predictive value of 74.8 % for residual disease. At a median follow-up of 30 months, no axillary recurrences occurred; disease-free survival was comparable between groups (p = 0.32), with a non-significant trend toward poorer overall survival in HLNB (p = 0.055).</div></div><div><h3>Conclusions</h3><div>TAD after NACT appears oncologically safe in selected patients with both low and high nodal burden, enabling omission of ALND in most cases. Prospective studies are warranted to confirm its role in HLNB disease.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111393"},"PeriodicalIF":2.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997634","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 : 2026-01-14DOI: 10.1016/j.ejso.2026.111404
He Du, Wei Li, Jingyi Wang, Shixing Wu, Nan Song, Ziwei Wan, Jingyun Shi, Fengying Wu
Background: As an extremely rare independent pathological subtype of lung adenocarcinoma, PEAC exhibits potentially distinct clinicopathological, radiological, and molecular characteristics. Currently, there were no large-sample studies reporting its features.
Methods: Patients with PEAC who underwent surgical resection from March 2013 to December 2023 were included in the study. The clinicopathological, imaging features, radiological subtypes and recurrence patterns were analyzed. Recurrence-free survival (RFS) and overall survival (OS) were assessed by Kaplan-Meier curves and compared between groups using log-rank tests. Cox proportional hazards models were used to assess associations with outcomes.
Results: The final study population consisted of 81 patients (mean age, 63 years; age range, 36-79 years) including 60 men and 21 women. Radiologically, lesion subtypes were categorized as part-solid (6.2 %, 5/81), pure-solid (90.1 %, 73/81), and pneumonic-type PEAC (3.7 %, 3/81). Pneumonic-type PEACs were more prevalent in higher clinical T stages, whereas all part-solid PEACs were confined to the T1 stage (P = .001). In the part-solid subtype group, both RFS and OS rate were significantly higher than those in the pneumonic-type group and the pure-solid group (P = .001 and P = .0095). Tumor-node-metastasis(TNM) stage III emerged as an independent risk factor for recurrence (hazard ratio, 4.699 [95 % confidence interval: 1.967, 11.080]; P < .001). Pathological nodal involvement (hazard ratio, 24.301 [95 % confidence interval: 5.172, 114.195]; P < .001) was as independent predictor of poor OS. Intrapulmonary metastasis was identified as the predominant recurrence pattern in PEAC.
Conclusion: PEAC had distinct imaging characteristics. Survival outcomes vary significantly across different imaging subtypes, with prognosis largely determined by TNM stage.
{"title":"Primary pulmonary enteric adenocarcinoma: A single-institute retrospective study on its imaging classification and survival outcomes.","authors":"He Du, Wei Li, Jingyi Wang, Shixing Wu, Nan Song, Ziwei Wan, Jingyun Shi, Fengying Wu","doi":"10.1016/j.ejso.2026.111404","DOIUrl":"https://doi.org/10.1016/j.ejso.2026.111404","url":null,"abstract":"<p><strong>Background: </strong>As an extremely rare independent pathological subtype of lung adenocarcinoma, PEAC exhibits potentially distinct clinicopathological, radiological, and molecular characteristics. Currently, there were no large-sample studies reporting its features.</p><p><strong>Methods: </strong>Patients with PEAC who underwent surgical resection from March 2013 to December 2023 were included in the study. The clinicopathological, imaging features, radiological subtypes and recurrence patterns were analyzed. Recurrence-free survival (RFS) and overall survival (OS) were assessed by Kaplan-Meier curves and compared between groups using log-rank tests. Cox proportional hazards models were used to assess associations with outcomes.</p><p><strong>Results: </strong>The final study population consisted of 81 patients (mean age, 63 years; age range, 36-79 years) including 60 men and 21 women. Radiologically, lesion subtypes were categorized as part-solid (6.2 %, 5/81), pure-solid (90.1 %, 73/81), and pneumonic-type PEAC (3.7 %, 3/81). Pneumonic-type PEACs were more prevalent in higher clinical T stages, whereas all part-solid PEACs were confined to the T1 stage (P = .001). In the part-solid subtype group, both RFS and OS rate were significantly higher than those in the pneumonic-type group and the pure-solid group (P = .001 and P = .0095). Tumor-node-metastasis(TNM) stage III emerged as an independent risk factor for recurrence (hazard ratio, 4.699 [95 % confidence interval: 1.967, 11.080]; P < .001). Pathological nodal involvement (hazard ratio, 24.301 [95 % confidence interval: 5.172, 114.195]; P < .001) was as independent predictor of poor OS. Intrapulmonary metastasis was identified as the predominant recurrence pattern in PEAC.</p><p><strong>Conclusion: </strong>PEAC had distinct imaging characteristics. Survival outcomes vary significantly across different imaging subtypes, with prognosis largely determined by TNM stage.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"111404"},"PeriodicalIF":2.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124211","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 : 2026-01-14DOI: 10.1016/j.ejso.2026.111405
Cuma Fidan
Background
The primary objective of this study is to compare health-related quality of life (HRQoL) of cancer patients undergoing first and last follow-up after robotic surgery (RS). The secondary objective of the study is to reveal effect of moderator variables on HRQoL of cancer patients after surgery.
Methods
Random effects model was used for meta-analysis, sensitivity, publication bias, meta-anova and meta-regression analyses. Threshold values have been calculated to evaluate clinical significance.
Results
13 studies were included in the meta-analysis (total of 2.399 cancer patients). Results of meta-analysis and sensitivity analysis show that cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up. There is no publication bias. Results of meta-anova analysis show that (1) RS method has better HRQoL than other methods, (2) In gynaecologic cancers, cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up, and (3) In cases where difference between last and first follow-up after RS is above or below 43, cancer patients undergoing last follow-up have better HRQoL than first follow-up. These results are both statistically and clinically significant.
Conclusion
RS treatment is effective in terms of HRQoL in cancer patients, both statistically and clinically. Therefore, RS treatment improves HRQoL of cancer patients. The results of this study could help surgeons develop patient-centred treatment strategies.
{"title":"Comparison of health-related quality of life of cancer patients undergoing first and last follow-up after robotic surgery: A meta-analysis","authors":"Cuma Fidan","doi":"10.1016/j.ejso.2026.111405","DOIUrl":"10.1016/j.ejso.2026.111405","url":null,"abstract":"<div><h3>Background</h3><div>The primary objective of this study is to compare health-related quality of life (HRQoL) of cancer patients undergoing first and last follow-up after robotic surgery (RS). The secondary objective of the study is to reveal effect of moderator variables on HRQoL of cancer patients after surgery.</div></div><div><h3>Methods</h3><div>Random effects model was used for meta-analysis, sensitivity, publication bias, meta-anova and meta-regression analyses. Threshold values have been calculated to evaluate clinical significance.</div></div><div><h3>Results</h3><div>13 studies were included in the meta-analysis (total of 2.399 cancer patients). Results of meta-analysis and sensitivity analysis show that cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up. There is no publication bias. Results of meta-anova analysis show that (1) RS method has better HRQoL than other methods, (2) In gynaecologic cancers, cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up, and (3) In cases where difference between last and first follow-up after RS is above or below 43, cancer patients undergoing last follow-up have better HRQoL than first follow-up. These results are both statistically and clinically significant.</div></div><div><h3>Conclusion</h3><div>RS treatment is effective in terms of HRQoL in cancer patients, both statistically and clinically. Therefore, RS treatment improves HRQoL of cancer patients. The results of this study could help surgeons develop patient-centred treatment strategies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111405"},"PeriodicalIF":2.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975081","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}
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