Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5513
Anna M Sawka,Sangeet Ghai,David P Goldstein
{"title":"Durability of Active Surveillance in Thyroid Cancer-Reply.","authors":"Anna M Sawka,Sangeet Ghai,David P Goldstein","doi":"10.1001/jamasurg.2025.5513","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5513","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5556
Olamide Alabi, Rae Rokosh, Xinyan Zheng, Caitlin W. Hicks, Emily L. Spangler, Gabriela Velazquez, Kakra Hughes, Philip Goodney, Elizabeth L. George, Jialin Mao, Shipra Arya, Matthew A. Corriere
Importance Claudication is associated with walking impairment, but amputation risk is generally low unless symptoms progress to chronic limb-threatening ischemia (CLTI). Disparities in amputation risk have been described previously, but population-specific rates of revascularization for claudication, postrevascularization progression from claudication to CLTI, and rates of guideline-based risk-reduction pharmacotherapy are unknown. Objective To explore the impact of intersectional identity among a cohort of patients with claudication on progression to CLTI, amputation, and mortality following revascularization. Design, Setting, and Participants This national cohort study was conducted using the Vascular Quality Initiative (VQI) procedural registry, which was linked to the Medicare dataset of patients who underwent index revascularization for claudication from January 1, 2016, to December 31, 2019. Patients with claudication undergoing an index lower-extremity revascularization procedure (aortoiliac and infrainguinal arterial occlusive disease) at VQI-participating centers were eligible for inclusion. Data analysis was conducted from December 2024 to February 2025. Exposure The primary exposure was an intersectional variable combining race, ethnicity, and sex. Main Outcomes and Measures The primary outcome was development of CLTI within 180 days after index revascularization (defined by a validated CLTI-specific <jats:italic toggle="yes">International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10]</jats:italic> code). Secondary outcomes included major amputation and mortality. Survival analyses were used to examine outcomes. Results Among 10 012 patients undergoing revascularization for claudication (median [IQR] age, 71 [66-76] years; 3850 female patients [38.5%]), self-identified intersectional identity distribution was 151 (1.5%) Hispanic men, 92 (0.9%) Hispanic women, 502 (5.0%) non-Hispanic Black men, 422 (4.2%) non-Hispanic Black women, 5509 (55.0%) non-Hispanic White men, and 3336 (33.3%) non-Hispanic White women. Black and Hispanic patients with claudication were more likely to have diabetes and be undergoing dialysis. Black men had the highest prevalence of active smokers (38.6%) while Hispanic women were more often never smokers (30.4%). A higher proportion of White men (80.9%) were receiving preoperative statin therapy compared to all other groups. The highest rates of postrevascularization progression to CLTI within 180 days were observed among Black women (11.8%; Hispanic: 3.8%; White: 5.9%), followed by Hispanic men (8.8%; Black: 7.2%; White: 5.2%). Major amputation rates were also highest among Black patients (180 days: Black women, 0.8%; Black men, 0.7%). Conclusions and Relevance According to the results of this cohort study, Black women had the highest rate of postrevascularization progression from claudication to CLTI. Development of practice- and policy-level standards incentivizing
{"title":"Progression to Chronic Limb-Threatening Ischemia After Index Revascularization for Claudication","authors":"Olamide Alabi, Rae Rokosh, Xinyan Zheng, Caitlin W. Hicks, Emily L. Spangler, Gabriela Velazquez, Kakra Hughes, Philip Goodney, Elizabeth L. George, Jialin Mao, Shipra Arya, Matthew A. Corriere","doi":"10.1001/jamasurg.2025.5556","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5556","url":null,"abstract":"Importance Claudication is associated with walking impairment, but amputation risk is generally low unless symptoms progress to chronic limb-threatening ischemia (CLTI). Disparities in amputation risk have been described previously, but population-specific rates of revascularization for claudication, postrevascularization progression from claudication to CLTI, and rates of guideline-based risk-reduction pharmacotherapy are unknown. Objective To explore the impact of intersectional identity among a cohort of patients with claudication on progression to CLTI, amputation, and mortality following revascularization. Design, Setting, and Participants This national cohort study was conducted using the Vascular Quality Initiative (VQI) procedural registry, which was linked to the Medicare dataset of patients who underwent index revascularization for claudication from January 1, 2016, to December 31, 2019. Patients with claudication undergoing an index lower-extremity revascularization procedure (aortoiliac and infrainguinal arterial occlusive disease) at VQI-participating centers were eligible for inclusion. Data analysis was conducted from December 2024 to February 2025. Exposure The primary exposure was an intersectional variable combining race, ethnicity, and sex. Main Outcomes and Measures The primary outcome was development of CLTI within 180 days after index revascularization (defined by a validated CLTI-specific <jats:italic toggle=\"yes\">International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10]</jats:italic> code). Secondary outcomes included major amputation and mortality. Survival analyses were used to examine outcomes. Results Among 10 012 patients undergoing revascularization for claudication (median [IQR] age, 71 [66-76] years; 3850 female patients [38.5%]), self-identified intersectional identity distribution was 151 (1.5%) Hispanic men, 92 (0.9%) Hispanic women, 502 (5.0%) non-Hispanic Black men, 422 (4.2%) non-Hispanic Black women, 5509 (55.0%) non-Hispanic White men, and 3336 (33.3%) non-Hispanic White women. Black and Hispanic patients with claudication were more likely to have diabetes and be undergoing dialysis. Black men had the highest prevalence of active smokers (38.6%) while Hispanic women were more often never smokers (30.4%). A higher proportion of White men (80.9%) were receiving preoperative statin therapy compared to all other groups. The highest rates of postrevascularization progression to CLTI within 180 days were observed among Black women (11.8%; Hispanic: 3.8%; White: 5.9%), followed by Hispanic men (8.8%; Black: 7.2%; White: 5.2%). Major amputation rates were also highest among Black patients (180 days: Black women, 0.8%; Black men, 0.7%). Conclusions and Relevance According to the results of this cohort study, Black women had the highest rate of postrevascularization progression from claudication to CLTI. Development of practice- and policy-level standards incentivizing ","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"21 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5486
Rachael C. Acker, Sarah I. Landau, James E. Sharpe, Rachel R. Kelz
This cross-sectional study examines the association between surgery residents’ sense of belonging and their performance on the American Board of Surgery In-Service Training Examination.
本研究旨在探讨外科住院医师的归属感与他们在美国外科在职培训考试中的表现之间的关系。
{"title":"Sense of Belonging in Surgery and Resident Performance","authors":"Rachael C. Acker, Sarah I. Landau, James E. Sharpe, Rachel R. Kelz","doi":"10.1001/jamasurg.2025.5486","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5486","url":null,"abstract":"This cross-sectional study examines the association between surgery residents’ sense of belonging and their performance on the American Board of Surgery In-Service Training Examination.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"4 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5498
Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Gabriel Henrique Acedo Martins, Mariana Lima Azevedo, Eric Pasqualotto, Thiago Celestino Chulam, Sérgio Mazzola Poli de Figueiredo
Importance Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. Objective To evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. Data Sources PubMed, Embase, and Cochrane Library were systematically searched from inception to April 3, 2025. Study Selection Randomized clinical trials (RCTs) comparing TXA to placebo in adult patients undergoing general surgery and reporting at least 1 predefined outcome of interest were included. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> statistic. Results Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, −35.85 mL; 95% CI, −57.20 to −14.51 mL; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 91%; <jats:italic toggle="yes">P</jats:italic> = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 54%; <jats:italic toggle="yes">P</jats:italic> = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle="yes">P</jats:italic> = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 15%; <jats:italic toggle="yes">P</jats:italic> = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle="yes">P</jats:italic> = .71), and length of stay (MD, −0.54 days; 95% CI, −1.15 to 0.06 days; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 73%; <jats:italic toggle="yes">P</jats:italic> = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle="yes">P</jats:italic> = .01), while no significant differences were observed for the other outcomes. Conclusions and Relevance This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in th
重要性氨甲环酸（TXA）越来越多地用于减少围手术期出血。然而，其在普通外科手术中的有效性和安全性尚不清楚。目的评价预防性TXA在减少普通外科术中出血量、输血需求和大出血方面的有效性和安全性，同时评估其与血栓栓塞事件和死亡率的关系。数据来源PubMed， Embase和Cochrane图书馆系统检索从成立到2025年4月3日。研究选择：比较TXA与安慰剂在接受普通手术的成人患者中的随机临床试验（rct），并报告了至少1个预先确定的结果。两名审稿人独立提取数据并评估偏倚风险。使用随机效应模型汇总95% ci的平均差异（md）和风险比（rr）。采用i2统计量评估异质性。结果纳入26项随机对照试验，共6976例患者。TXA的使用与术中出血量减少（MD, - 35.85 mL; 95% CI, - 57.20至- 14.51 mL; I 2 = 91%; P = 0.001）、输血需求减少（RR, 0.75; 95% CI, 0.60-0.94; I 2 = 54%; P = 0.01）和大出血事件减少（RR, 0.72; 95% CI, 0.59-0.89; I 2 = 0%; P = 0.002）相关。在静脉血栓栓塞（RR, 1.09; 95% CI, 0.62-1.92; i2 = 15%; P = 0.75）、死亡率（RR, 1.08; 95% CI, 0.72-1.61; i2 = 0%; P = 0.71）和住院时间（MD, - 0.54天；95% CI, - 1.15至0.06天；i2 = 73%; P = 0.08）方面无显著差异。在仅限于腹部手术的亚组分析中，在总体人群中观察到的术中出血量和输血需求的益处不再存在。在肝胆亚组中，TXA与大出血的显著减少相关（RR, 0.59; 95% CI, 0.39-0.90; I 2 = 0%; P = 0.01），而其他结果无显著差异。结论和相关性：本系统综述和荟萃分析发现，预防性使用TXA与术中出血量、输血需求和大出血降低相关，且未观察到血栓栓塞或死亡风险增加。虽然这些研究结果支持在普通外科手术中使用TXA，但使用TXA的决定应考虑到个体患者的特点和正在进行的具体手术。
{"title":"Perioperative Use of Tranexamic Acid in General Surgery","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Gabriel Henrique Acedo Martins, Mariana Lima Azevedo, Eric Pasqualotto, Thiago Celestino Chulam, Sérgio Mazzola Poli de Figueiredo","doi":"10.1001/jamasurg.2025.5498","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5498","url":null,"abstract":"Importance Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. Objective To evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. Data Sources PubMed, Embase, and Cochrane Library were systematically searched from inception to April 3, 2025. Study Selection Randomized clinical trials (RCTs) comparing TXA to placebo in adult patients undergoing general surgery and reporting at least 1 predefined outcome of interest were included. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> statistic. Results Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, −35.85 mL; 95% CI, −57.20 to −14.51 mL; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 91%; <jats:italic toggle=\"yes\">P</jats:italic> = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 54%; <jats:italic toggle=\"yes\">P</jats:italic> = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle=\"yes\">P</jats:italic> = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 15%; <jats:italic toggle=\"yes\">P</jats:italic> = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle=\"yes\">P</jats:italic> = .71), and length of stay (MD, −0.54 days; 95% CI, −1.15 to 0.06 days; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 73%; <jats:italic toggle=\"yes\">P</jats:italic> = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; <jats:italic toggle=\"yes\">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle=\"yes\">P</jats:italic> = .01), while no significant differences were observed for the other outcomes. Conclusions and Relevance This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in th","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"4 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5565
M Libby Weaver,Benjamin S Brooke
{"title":"The Hidden Social Determinant of Health-Physician Behavior.","authors":"M Libby Weaver,Benjamin S Brooke","doi":"10.1001/jamasurg.2025.5565","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5565","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5401
Marco Ventin, Shahrzad Arya, Liti Zhang, Alexandra Gangi, Carlos Fernandez del-Castillo, Motaz Qadan, Andrew E. Hendifar, Giulia Cattaneo, Luigi Liguori, Arsen Osipov, Francesco Sabbatino, Nicholas N. Nissen, Kambiz Kosari, Keith D. Lillemoe, Alice C. Wei, Jin He, Amer H. Zureikat, Cristina R. Ferrone
Importance Lymph node (LN) metastasis is a strong predictor of tumor recurrence following pancreatectomy for localized pancreatic neuroendocrine tumors (PanNETs). However, most patients lack LN metastasis and many tumors recur. Tools to guide risk-adapted surveillance in this group are lacking. Objective To develop and validate a tumor recurrence and survival risk score for patients with LN-negative PanNETs. Design, Setting, and Participants This retrospective, case-control study of patients with localized PanNETs took place at 5 high-volume US institutions from 2000 to 2023. Inclusion required 8 or more evaluated LNs and negative nodal status. Median follow-up was 50.6 months. These data were analyzed from March 2025 to May 2025. Exposure Surgical resection of localized PanNETs per clinical guidelines. Main Outcomes and Measures The primary outcome was tumor recurrence. Independent predictors were identified using multivariable logistic regression and used to construct a 13-point composite risk score. Performance was assessed using C statistics. Kaplan-Meier and log-rank methods evaluated disease-free survival (DFS). Genomic profiling was conducted in an external validation cohort to identify and validate recurrence-associated mutational risk scores. Results Of 2024 patients, 770 met inclusion criteria. Median age was 58.7 (IQR, 18.4) years; 405 were male (52.6%) and 365 were female (47.4%). Most tumors were sporadic (94.1%), nonfunctional (90.4%), and located in the body/neck (50.9%). Recurrence occurred in 82 patients (10.6%) at a median of 32.4 (IQR, 16.3-82.0) months after surgery. Independent predictors included male sex (odds ratio [OR], 2.2; 95% CI, 1.3-3.9), tumor size 3 cm or larger (OR, 2.64; 95% CI, 1.5-4.6), World Health Organization grade 2 or higher (OR, 3.70; 95% CI, 1.4-10.0), and lymphovascular invasion (OR, 3.84; 95% CI, 2.1-6.9). The risk score showed strong performance (area under the receiver operating characteristic, 0.83 internally; 0.95 externally). Recurrence rates by risk group were 2.4%, 9.0%, and 27.7% ( <jats:italic toggle="yes">P</jats:italic> &lt; .001), and 10-year DFS rates of 96.1%, 83.6%, and 51.3%, for low-risk, moderate-risk, and high-risk groups, respectively ( <jats:italic toggle="yes">P</jats:italic> &lt; .001). Genomic analyses revealed higher tumor mutational burden, somatic mutation count, and somatic mutations in <jats:italic toggle="yes">CDC42BPB</jats:italic> , <jats:italic toggle="yes">DAXX</jats:italic> , <jats:italic toggle="yes">ERI2</jats:italic> , <jats:italic toggle="yes">GALNT9</jats:italic> , <jats:italic toggle="yes">MTOR</jats:italic> , <jats:italic toggle="yes">NUMA1</jats:italic> , and <jats:italic toggle="yes">TRPC7</jats:italic> genes among recurrent tumors. Conclusions and Relevance Despite LN-negative status, a subset of patients with PanNETs remained at high risk for recurrence. This validated risk score stratifies recurrence and survival risk showing biological rele
{"title":"Recurrence in Patients With Lymph Node-Negative Pancreatic Neuroendocrine Tumors","authors":"Marco Ventin, Shahrzad Arya, Liti Zhang, Alexandra Gangi, Carlos Fernandez del-Castillo, Motaz Qadan, Andrew E. Hendifar, Giulia Cattaneo, Luigi Liguori, Arsen Osipov, Francesco Sabbatino, Nicholas N. Nissen, Kambiz Kosari, Keith D. Lillemoe, Alice C. Wei, Jin He, Amer H. Zureikat, Cristina R. Ferrone","doi":"10.1001/jamasurg.2025.5401","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5401","url":null,"abstract":"Importance Lymph node (LN) metastasis is a strong predictor of tumor recurrence following pancreatectomy for localized pancreatic neuroendocrine tumors (PanNETs). However, most patients lack LN metastasis and many tumors recur. Tools to guide risk-adapted surveillance in this group are lacking. Objective To develop and validate a tumor recurrence and survival risk score for patients with LN-negative PanNETs. Design, Setting, and Participants This retrospective, case-control study of patients with localized PanNETs took place at 5 high-volume US institutions from 2000 to 2023. Inclusion required 8 or more evaluated LNs and negative nodal status. Median follow-up was 50.6 months. These data were analyzed from March 2025 to May 2025. Exposure Surgical resection of localized PanNETs per clinical guidelines. Main Outcomes and Measures The primary outcome was tumor recurrence. Independent predictors were identified using multivariable logistic regression and used to construct a 13-point composite risk score. Performance was assessed using C statistics. Kaplan-Meier and log-rank methods evaluated disease-free survival (DFS). Genomic profiling was conducted in an external validation cohort to identify and validate recurrence-associated mutational risk scores. Results Of 2024 patients, 770 met inclusion criteria. Median age was 58.7 (IQR, 18.4) years; 405 were male (52.6%) and 365 were female (47.4%). Most tumors were sporadic (94.1%), nonfunctional (90.4%), and located in the body/neck (50.9%). Recurrence occurred in 82 patients (10.6%) at a median of 32.4 (IQR, 16.3-82.0) months after surgery. Independent predictors included male sex (odds ratio [OR], 2.2; 95% CI, 1.3-3.9), tumor size 3 cm or larger (OR, 2.64; 95% CI, 1.5-4.6), World Health Organization grade 2 or higher (OR, 3.70; 95% CI, 1.4-10.0), and lymphovascular invasion (OR, 3.84; 95% CI, 2.1-6.9). The risk score showed strong performance (area under the receiver operating characteristic, 0.83 internally; 0.95 externally). Recurrence rates by risk group were 2.4%, 9.0%, and 27.7% ( <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), and 10-year DFS rates of 96.1%, 83.6%, and 51.3%, for low-risk, moderate-risk, and high-risk groups, respectively ( <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Genomic analyses revealed higher tumor mutational burden, somatic mutation count, and somatic mutations in <jats:italic toggle=\"yes\">CDC42BPB</jats:italic> , <jats:italic toggle=\"yes\">DAXX</jats:italic> , <jats:italic toggle=\"yes\">ERI2</jats:italic> , <jats:italic toggle=\"yes\">GALNT9</jats:italic> , <jats:italic toggle=\"yes\">MTOR</jats:italic> , <jats:italic toggle=\"yes\">NUMA1</jats:italic> , and <jats:italic toggle=\"yes\">TRPC7</jats:italic> genes among recurrent tumors. Conclusions and Relevance Despite LN-negative status, a subset of patients with PanNETs remained at high risk for recurrence. This validated risk score stratifies recurrence and survival risk showing biological rele","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"167 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5510
Raja Haris Shahid,Muhammad Areeb Khan,Maryam Shahid
{"title":"Durability of Active Surveillance in Thyroid Cancer.","authors":"Raja Haris Shahid,Muhammad Areeb Khan,Maryam Shahid","doi":"10.1001/jamasurg.2025.5510","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5510","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1001/jamasurg.2025.5507
Thomas S Helling
{"title":"General Surgeons and Tranexamic Acid.","authors":"Thomas S Helling","doi":"10.1001/jamasurg.2025.5507","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5507","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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