International journal of surgery最新文献

Background: To develop and externally validate CT-based radiomics-clinical nomograms integrating dual-region radiomics features and preoperative-intraoperative clinical factors for predicting early renal function decline in patients with localized renal cell carcinoma (RCC) undergoing partial nephrectomy (PN).

Methods: This multicenter retrospective study included 1440 patients with localized RCC who underwent PN and preoperative contrast-enhanced CT. Radiomics features were extracted from both the tumor and ipsilateral normal renal parenchyma across corticomedullary, nephrographic, and excretory phases. After reproducibility filtering, high-correlation removal, and least absolute shrinkage and selection operator (LASSO) regression, three radiomics signatures were constructed. Independent clinical predictors identified via multivariate logistic regression were combined with radiomics signatures to develop a preoperative nomogram and a preoperative-intraoperative nomogram. Model performance was assessed using ROC analysis, AUC, calibration curves, Hosmer-Lemeshow tests, decision curve analysis (DCA), and 1000-iteration bootstrap validation. External validation was conducted across 10 independent medical centers and an online public dataset (KITS23).

Results: Twelve tumor-derived and 8 kidney-derived radiomics features were selected, and the combined radiomics signature demonstrated superior predictive ability across cohorts. Independent predictors included age, diabetes, preoperative eGFR, RENAL score, ischemia time, and the radiomics signature. The preoperative nomogram showed excellent discrimination (AUC = 0.952, 0.909, 0.931, 0.914, 0.926), robust calibration, and favorable DCA performance. Bootstrap analysis confirmed its internal stability (mean AUC = 0.948; 95% CI: 0.927-0.972).The preoperative-intraoperative nomogram further improved discriminative performance (AUC = 0.962, 0.926, 0.947, 0.947, 0.933), with strong calibration and consistent clinical utility across all cohorts. Bootstrap validation also demonstrated excellent internal robustness (mean AUC = 0.960; 95% CI: 0.947-0.990).

Conclusions: Radiomics signatures derived from CT images of both tumor and normal renal tissue, when integrated with clinical parameters, can accurately predict early renal function decline following PN. The proposed nomograms may facilitate individualized risk stratification and optimize surgical decision-making.

Background: Compared to male cancer patients, female patients have a higher incidence and severity of adverse events (AEs) associated with anticancer treatment. The mechanism underlying these disparities is largely unknown, especially in the context of radiotherapy. Notably, the composition and metabolism of the gut microbiota differ between sexes, and such differences have been implicated in multiple physiological and pathological processes. In this study, we aimed to investigate the sex differences in hematologic toxicities during chemoradiotherapy in patients with locally advanced rectal cancer (LARC) and to explore the potential role of the gut microbiota in mediating these differences.

Materials and methods: This real-world study included 329 patients with LARC receiving neoadjuvant chemoradiotherapy (nCRT). Hematologic AEs were evaluated according to Common Terminology Criteria for Adverse Events 5.0. 16S rRNA sequencing, metatranscriptome sequencing, and metabolome detection were performed on longitudinal fecal samples. Mendelian randomization analyses were performed to investigate the correlation between stem cell and gut microbial traits.

Results: In this cohort, females had a higher severity of hematologic AEs than males. Using integrated longitudinal multi-omics data, we identified sex-biased bacterial species (e.g., Parasutterella excrementihominis and Bifidobacterium adolescentis) and microbiota-mediated arginine metabolism associated with hematologic toxicities. Gut microbiome-mediated arginine metabolism is associated with an abundance of hematopoietic stem cells and may be involved in the occurrence of sex-biased radiotherapy-induced hematologic AEs.

Conclusion: These results indicate that the differences in gut microbial composition and metabolism between the two sexes are associated with the sex-biased hematologic AEs induced by nCRT. Females require greater attention regarding the hematologic toxicity of chemoradiotherapy, and that gut microbes may serve as potential targets for sex-tailored strategies to restore hematopoietic function following chemoradiotherapy.