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.2026.111410
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}
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}
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}
The rapid advancement of generative artificial intelligence (gen-AI) has prompted interest in whether it can recognize and respond to individual clinical backgrounds in treatment decision-making. To explore this, we developed a virtual patient model for lymphedema and conducted an observational study to examine what treatments AI would recommend, whether the recommendations were individualized, and what tendencies the AI exhibited.
Methods
A virtual cohort of 100 patients with secondary upper extremity lymphedema following breast cancer surgery was constructed using generative pre-trained transformer-4 omni (GPT-4o). For each virtual patient, six clinical questions, based on the Japanese Lymphedema Guidelines 2024, were submitted to the AI to elicit individualized recommendations. The answers obtained were compared with guidelines-defined recommendation levels to assess concordance, deviation, and treatment tendencies, analyzed by patient factors.
Results
Multivariate analysis demonstrated that GPT-4o-generated recommendations were tailored to individual patient characteristics. They showed high concordance with guideline-defined recommendations for conservative care but greater variability and bias toward invasive options in surgical contexts.
Conclusion
The preference of gen-AI for invasive treatments may reflect an overestimation of the benefits of performing treatments rather than withholding them, especially in invasive treatments. This bias shows a limitation of current gen-AI in complex decisions. Our reproducible simulation framework identified this bias and variability, clarifying both strengths and limitations of gen-AI. This type of AI-on-AI observational study may help improve the accuracy of AI and support its future role in clinical care.
背景：生成式人工智能（gen-AI）的快速发展引起了人们对其能否在治疗决策中识别和响应个体临床背景的兴趣。为了探索这一点，我们开发了一个淋巴水肿的虚拟患者模型，并进行了一项观察性研究，以检查AI会推荐什么治疗方法，这些建议是否个体化，以及AI表现出什么倾向。方法：使用生成式预训练变压器-4 omni （gpt - 40）构建100例乳腺癌手术后继发上肢淋巴水肿患者的虚拟队列。对于每个虚拟患者，根据日本淋巴水肿指南2024，将六个临床问题提交给人工智能，以引出个性化建议。将得到的答案与指南定义的推荐水平进行比较，以评估一致性、偏差和治疗倾向，并根据患者因素进行分析。结果：多变量分析表明，gpt - 40产生的建议是针对个体患者的特征量身定制的。它们与指南定义的保守治疗建议高度一致，但在手术环境下更大的变异性和偏向于侵入性选择。结论：gen-AI对侵入性治疗的偏好可能反映了对进行治疗而不是不进行治疗的益处的高估，特别是在侵入性治疗中。这种偏见显示了当前gen-AI在复杂决策中的局限性。我们的可重复模拟框架确定了这种偏差和可变性，阐明了gen-AI的优势和局限性。这种人工智能对人工智能的观察性研究可能有助于提高人工智能的准确性，并支持其未来在临床护理中的作用。
{"title":"Virtual patient modeling for generative-AI-assisted treatment decision-making in lymphedema care: AI tends to favor more aggressive treatment","authors":"Yuki Tsujimoto , Makoto Shiraishi , Hiroki Yamanaka , Haesu Lee , Mutsumi Okazaki , Naoki Morimoto","doi":"10.1016/j.ejso.2026.111391","DOIUrl":"10.1016/j.ejso.2026.111391","url":null,"abstract":"<div><h3>Background</h3><div>The rapid advancement of generative artificial intelligence (gen-AI) has prompted interest in whether it can recognize and respond to individual clinical backgrounds in treatment decision-making. To explore this, we developed a virtual patient model for lymphedema and conducted an observational study to examine what treatments AI would recommend, whether the recommendations were individualized, and what tendencies the AI exhibited.</div></div><div><h3>Methods</h3><div>A virtual cohort of 100 patients with secondary upper extremity lymphedema following breast cancer surgery was constructed using generative pre-trained transformer-4 omni (GPT-4o). For each virtual patient, six clinical questions, based on the Japanese Lymphedema Guidelines 2024, were submitted to the AI to elicit individualized recommendations. The answers obtained were compared with guidelines-defined recommendation levels to assess concordance, deviation, and treatment tendencies, analyzed by patient factors.</div></div><div><h3>Results</h3><div>Multivariate analysis demonstrated that GPT-4o-generated recommendations were tailored to individual patient characteristics. They showed high concordance with guideline-defined recommendations for conservative care but greater variability and bias toward invasive options in surgical contexts.</div></div><div><h3>Conclusion</h3><div>The preference of gen-AI for invasive treatments may reflect an overestimation of the benefits of performing treatments rather than withholding them, especially in invasive treatments. This bias shows a limitation of current gen-AI in complex decisions. Our reproducible simulation framework identified this bias and variability, clarifying both strengths and limitations of gen-AI. This type of AI-on-AI observational study may help improve the accuracy of AI and support its future role in clinical care.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111391"},"PeriodicalIF":2.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017786","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 : 2026-01-13DOI: 10.1016/j.ejso.2026.111396
Charlotte E. Terry, James M. Halle-Smith, Nabeel Merali, Ravi Marudanayagam, Nikolaos Chatzizacharias, Bobby V.M. Dasari, David C. Bartlett, Syed S. Raza, Adam E. Frampton, Robert P. Sutcliffe, Keith J. Roberts
Background
Evidence suggests that the biliary microbiome influences the progression of pancreatic ductal adenocarcinoma (PDAC) in patients undergoing adjuvant chemotherapy. Specifically, Gammaproteobacteria (GPB) has been shown to have the potential to develop mutations which can metabolise gemcitabine into an inactive form. This study hypothesised that GPB influences survival in patients with PDAC undergoing adjuvant gemcitabine-based chemotherapy following surgery.
Methods
This was a retrospective study of patients undergoing pancreatoduodenectomy from 2010 to 2020. Associations between patient and tumour characteristics, survival data, and results of intraoperative bile cultures (GPB + or GPB-) were investigated. Analysis of patients matched by chemotherapy regimen and numbers of cycles of adjuvant therapy was also performed. Survival was analysed using Kaplan–Meier curves and Cox regression analysis.
Results
Analysis of 313 patients revealed that adjuvant gemcitabine-based therapy improved overall survival (OS). Patients who receive gemcitabine-based chemotherapy with a GPB + biliary culture had a shorter OS compared to those who were GPB-, and a median survival of 17.9 vs 26.2 months, P = 0.002. After matching for key chemotherapy variables, survival was greater in the GPB- group 26.8 vs 19.8 months, P = 0.016. This association was not seen among patients who received no adjuvant therapy or non-gemcitabine based therapy.
Conclusion
Patients receiving gemcitabine-based chemotherapy after surgery are likely to have reduction in OS if they have a biliary culture positive for GPB.
{"title":"Colonization of bile with gammaproteobacteria is associated with reduced survival after surgery for pancreatic cancer in patients receiving gemcitabine-based adjuvant chemotherapy","authors":"Charlotte E. Terry, James M. Halle-Smith, Nabeel Merali, Ravi Marudanayagam, Nikolaos Chatzizacharias, Bobby V.M. Dasari, David C. Bartlett, Syed S. Raza, Adam E. Frampton, Robert P. Sutcliffe, Keith J. Roberts","doi":"10.1016/j.ejso.2026.111396","DOIUrl":"10.1016/j.ejso.2026.111396","url":null,"abstract":"<div><h3>Background</h3><div>Evidence suggests that the biliary microbiome influences the progression of pancreatic ductal adenocarcinoma (PDAC) in patients undergoing adjuvant chemotherapy. Specifically, <em>Gammaproteobacteria (GPB)</em> has been shown to have the potential to develop mutations which can metabolise gemcitabine into an inactive form. This study hypothesised that GPB influences survival in patients with PDAC undergoing adjuvant gemcitabine-based chemotherapy following surgery.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients undergoing pancreatoduodenectomy from 2010 to 2020. Associations between patient and tumour characteristics, survival data, and results of intraoperative bile cultures (GPB + or GPB-) were investigated. Analysis of patients matched by chemotherapy regimen and numbers of cycles of adjuvant therapy was also performed. Survival was analysed using Kaplan–Meier curves and Cox regression analysis.</div></div><div><h3>Results</h3><div>Analysis of 313 patients revealed that adjuvant gemcitabine-based therapy improved overall survival (OS). Patients who receive gemcitabine-based chemotherapy with a GPB + biliary culture had a shorter OS compared to those who were GPB-, and a median survival of 17.9 vs 26.2 months, P = 0.002. After matching for key chemotherapy variables, survival was greater in the GPB- group 26.8 vs 19.8 months, P = 0.016. This association was not seen among patients who received no adjuvant therapy or non-gemcitabine based therapy.</div></div><div><h3>Conclusion</h3><div>Patients receiving gemcitabine-based chemotherapy after surgery are likely to have reduction in OS if they have a biliary culture positive for GPB.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111396"},"PeriodicalIF":2.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017190","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 : 2026-01-12DOI: 10.1016/j.ejso.2026.111403
Julia V.C. Lytchiér , Melis I. Okur , Wiktor Rutkowski , Hildur Helgadottir , Alberto Falk Delgado
Introduction
Neoadjuvant immune checkpoint inhibitors (ICI) have recently entered clinical practice in management of melanoma, yet its impact on surgical outcomes remains unclear.
This study evaluated the influence of neoadjuvant ICI on postoperative complications, surgical metrics, adjuvant treatment delay and survival in patients with stage III-IV melanoma following therapeutic lymph node dissections.
Material and methods
This retrospective cohort included patients that underwent surgery for nodal recurrence between 2019 and 2024. Patient characteristics, adverse events of ICI, surgical metrics, postoperative complications, postponement of adjuvant therapy, number of outpatient visits as well as survival were analyzed.
Results
81 patients were included, 19 patients received anti-PD-1 monotherapy followed by surgery and 62 patients underwent upfront surgery. Surgical duration was longer in the neoadjuvant group (p < 0.001), regardless of site and lymph nodes removed. Complications were observed in 63.2 % in neoadjuvant patients vs. 80.6 % in upfront patients (p = 0.13). The number of nurse outpatient visits was higher for neoadjuvant patients (p = 0.02) and increased with the number of removed lymph nodes (p = 0.05). The neoadjuvant patients started adjuvant therapy at median 6.0 weeks after surgery compared to 9.1 weeks in upfront (p < 0.001). At one year the overall survival was 100 % (95 % CI 100 - 100 %) in the neoadjuvant group and 90.3 % (95 % CI 83.3–98.0 %) in upfront surgery (P = 0.04).
Conclusion
Neoadjuvant ICI did not increase postoperative complications. It was associated with prolonged surgical duration and increased follow-up visits, but also shorter time until starting adjuvant treatment.
{"title":"Surgical complications after therapeutic lymph node dissection in stage III–IV melanoma: impact of neoadjuvant immunotherapy","authors":"Julia V.C. Lytchiér , Melis I. Okur , Wiktor Rutkowski , Hildur Helgadottir , Alberto Falk Delgado","doi":"10.1016/j.ejso.2026.111403","DOIUrl":"10.1016/j.ejso.2026.111403","url":null,"abstract":"<div><h3>Introduction</h3><div>Neoadjuvant immune checkpoint inhibitors (ICI) have recently entered clinical practice in management of melanoma, yet its impact on surgical outcomes remains unclear.</div><div>This study evaluated the influence of neoadjuvant ICI on postoperative complications, surgical metrics, adjuvant treatment delay and survival in patients with stage III-IV melanoma following therapeutic lymph node dissections.</div></div><div><h3>Material and methods</h3><div>This retrospective cohort included patients that underwent surgery for nodal recurrence between 2019 and 2024. Patient characteristics, adverse events of ICI, surgical metrics, postoperative complications, postponement of adjuvant therapy, number of outpatient visits as well as survival were analyzed.</div></div><div><h3>Results</h3><div>81 patients were included, 19 patients received anti-PD-1 monotherapy followed by surgery and 62 patients underwent upfront surgery. Surgical duration was longer in the neoadjuvant group (p < 0.001), regardless of site and lymph nodes removed. Complications were observed in 63.2 % in neoadjuvant patients vs. 80.6 % in upfront patients (p = 0.13). The number of nurse outpatient visits was higher for neoadjuvant patients (p = 0.02) and increased with the number of removed lymph nodes (p = 0.05). The neoadjuvant patients started adjuvant therapy at median 6.0 weeks after surgery compared to 9.1 weeks in upfront (p < 0.001). At one year the overall survival was 100 % (95 % CI 100 - 100 %) in the neoadjuvant group and 90.3 % (95 % CI 83.3–98.0 %) in upfront surgery (P = 0.04).</div></div><div><h3>Conclusion</h3><div>Neoadjuvant ICI did not increase postoperative complications. It was associated with prolonged surgical duration and increased follow-up visits, but also shorter time until starting adjuvant treatment.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111403"},"PeriodicalIF":2.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024138","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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