Reem Y. Albuainain, Reem Althawadi, Raja Eid, Hussain A. Abdulla
Background and Objectives
Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that sentinel lymph node biopsy (SLNB) is necessary to inform adjuvant radiotherapy and systemic therapy decisions. The aim was to assess the oncological and survival outcomes of omitting surgical axillary staging in early breast cancer.
Methods
A systematic literature search of relevant databases was performed. Eligible studies compared omission of axillary surgery with conventional axillary staging. A meta-analysis using the Mantel-Haenszel method was performed to calculate pooled risk ratios (RR) for axillary recurrence (AR), disease-free survival (DFS) and overall survival (OS) for omission of axillary surgery compared with conventional axillary surgery.
Results
Five studies involving 8108 patients were included. Omission of axillary surgery was associated with a higher risk of AR (RR 3.82 95% CI 1.48–9.82, p < 0.005). No significant differences were observed in in DFS (RR 1.09 95% CI 0.91–1.30, p = 0.33) or OS (RR 1.06 95% CI 0.72–1.55; p = 0.78).
Conclusions
Axillary surgery may be safely omitted in a highly select group of older patients with favourable tumour biology undergoing BCS. Multidisciplinary team input remains essential to appropriately select adjuvant treatments when nodal staging is omitted.
背景和目的：越来越多的证据支持早期乳腺癌患者行保乳手术（BCS）时省略腋窝手术的肿瘤学安全性。然而，有人担心前哨淋巴结活检（SLNB）对于辅助放疗和全身治疗决策是必要的。目的是评估早期乳腺癌省略手术腋窝分期的肿瘤学和生存结果。方法：对相关数据库进行系统的文献检索。符合条件的研究比较了遗漏腋窝手术与常规腋窝分期。采用Mantel-Haenszel方法进行荟萃分析，计算与常规腋窝手术相比，遗漏腋窝手术的腋窝复发（AR）、无病生存（DFS）和总生存（OS）的合并风险比（RR）。结果：纳入5项研究，共8108例患者。省略腋窝手术与AR的高风险相关（RR 3.82 95% CI 1.48-9.82, p）。结论：在高度选择性的肿瘤生物学良好的老年患者行BCS时，可以安全省略腋窝手术。当忽略淋巴结分期时，多学科团队的投入对于适当选择辅助治疗仍然至关重要。
{"title":"Oncological Outcomes of Omitting Axillary Surgery in Early Breast Cancer: A Systematic Review and Meta-Analysis","authors":"Reem Y. Albuainain, Reem Althawadi, Raja Eid, Hussain A. Abdulla","doi":"10.1002/jso.70145","DOIUrl":"10.1002/jso.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that sentinel lymph node biopsy (SLNB) is necessary to inform adjuvant radiotherapy and systemic therapy decisions. The aim was to assess the oncological and survival outcomes of omitting surgical axillary staging in early breast cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search of relevant databases was performed. Eligible studies compared omission of axillary surgery with conventional axillary staging. A meta-analysis using the Mantel-Haenszel method was performed to calculate pooled risk ratios (RR) for axillary recurrence (AR), disease-free survival (DFS) and overall survival (OS) for omission of axillary surgery compared with conventional axillary surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five studies involving 8108 patients were included. Omission of axillary surgery was associated with a higher risk of AR (RR 3.82 95% CI 1.48–9.82, <i>p</i> < 0.005). No significant differences were observed in in DFS (RR 1.09 95% CI 0.91–1.30, <i>p</i> = 0.33) or OS (RR 1.06 95% CI 0.72–1.55; <i>p</i> = 0.78).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Axillary surgery may be safely omitted in a highly select group of older patients with favourable tumour biology undergoing BCS. Multidisciplinary team input remains essential to appropriately select adjuvant treatments when nodal staging is omitted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 2","pages":"133-140"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed Alnajar, Mehmet Akcin, John I. Lew, Tanaz M. Vaghaiwalla
Background
Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs.
Methods
The 2010–2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0–1) or SDH– burden (score 2–4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed.
Results
Among 2688 patients (median age 64; 48% female), 57% were SDH–. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH–. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH–. Median survival for SDH– patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH– status was linked to worse survival (HR 1.24, p < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, p < 0.001). Black patients had higher mortality risk (HR 1.20, p = 0.002); no difference was observed for Hispanic patients.
Conclusion
Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.
{"title":"Higher Composite Social Determinants of Health Scores Are Associated With Worse Survival in Patients With Small Bowel Neuroendocrine Tumors","authors":"Ahmed Alnajar, Mehmet Akcin, John I. Lew, Tanaz M. Vaghaiwalla","doi":"10.1002/jso.70143","DOIUrl":"10.1002/jso.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2010–2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0–1) or SDH– burden (score 2–4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2688 patients (median age 64; 48% female), 57% were SDH–. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH–. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH–. Median survival for SDH– patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH– status was linked to worse survival (HR 1.24, <i>p</i> < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, <i>p</i> < 0.001). Black patients had higher mortality risk (HR 1.20, <i>p</i> = 0.002); no difference was observed for Hispanic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"117-125"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rena A. Li, Antoinette T. Nguyen, Kethan Bajaj, Brigid M. Coles, Robert D. Galiano
Backgrounds and Methods
American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates.
Results
The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12–1.82, p = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16–2.65, p = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.
Conclusion
This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.
Discussion
These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.
背景和方法：美国印第安人和阿拉斯加原住民（AI/AN）人群在多种癌症类型中面临显著的健康差异，但黑色素瘤特异性结局仍未得到充分研究。Embase、Scopus和PubMed的综合检索确定了20项符合纳入标准的研究。使用随机效应模型进行了三项荟萃分析，以评估：(1)死亡率风险的校正风险比，(2)晚期诊断的校正优势比，(3)年龄校正发病率。结果：荟萃分析显示AI/AN患者的黑色素瘤结局存在显著差异。与白人患者相比，AI/AN患者的死亡风险高43%（合并aHR = 1.43, 95% CI: 1.12-1.82, p = 0.0041），晚期诊断的可能性高75%（合并调整OR = 1.75, 95% CI: 1.16-2.65, p = 0.0080）。AI/AN患者始终表现出较差的预后因素，包括更高的Breslow厚度、溃疡率增加和更晚期的疾病阶段。结论：本研究提供了第一个荟萃分析证据，证明AI/AN人群中黑色素瘤结局的统计学显著差异。系统性障碍包括保险差异、地理隔离、治疗延误和获得专业皮肤科护理的机会有限。讨论：这些发现证明有针对性的干预措施是合理的，包括加强筛查计划、改善医疗基础设施和政策改革，以解决影响人工智能/人工智能社区的保险和获取障碍。
{"title":"Disparities in Cutaneous Melanoma Diagnosis and Survival Among American Indian and Alaskan Native Patients: A Systematic Review and Meta-Analysis","authors":"Rena A. Li, Antoinette T. Nguyen, Kethan Bajaj, Brigid M. Coles, Robert D. Galiano","doi":"10.1002/jso.70136","DOIUrl":"10.1002/jso.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds and Methods</h3>\u0000 \u0000 <p>American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12–1.82, <i>p</i> = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16–2.65, <i>p</i> = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"54-72"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anouk Benseler, Adina Tanen, Taymaa May, Lisa Avery, Genevieve Bouchard-Fortier, Marcus Q. Bernardini, Liat Hogen
Background and Objective
Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) “aggressiveness” and outcome on survival.
Methods
A single-center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including “aggressive” CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox-proportional hazard models.
Results
Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) (p = 0.014). Supradiaphragmatic lymph-node metastasis differed across groups (p = 0.042). “Aggressive” CS was performed in 53.6% of the surgical cohort, with 54.86% no-gross-residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively (p = 0.006).
Conclusions
OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.
{"title":"Treatment Strategy and Residual Disease as Determinants of Survival in Stage IVB High-Grade Serous Ovarian Cancer: A Retrospective Cohort Study","authors":"Anouk Benseler, Adina Tanen, Taymaa May, Lisa Avery, Genevieve Bouchard-Fortier, Marcus Q. Bernardini, Liat Hogen","doi":"10.1002/jso.70142","DOIUrl":"10.1002/jso.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) “aggressiveness” and outcome on survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including “aggressive” CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox-proportional hazard models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) (<i>p</i> = 0.014). Supradiaphragmatic lymph-node metastasis differed across groups (<i>p</i> = 0.042). “Aggressive” CS was performed in 53.6% of the surgical cohort, with 54.86% no-gross-residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"73-80"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larissa Fernanda Campos Moreira da Silva, Fabiana Pirani Carneiro, Andrea Barretto Motoyama
This integrative review examines the differential expression of miRNAs in breast cancer patients across various disease stages. Through analysis of 42 articles published between 2005 and 2023, the review identifies multiple miRNAs with significant diagnostic, prognostic, and predictive potential in breast cancer management. These small noncoding RNAs, accessible through liquid biopsy, demonstrate notable potential for early detection, molecular subtype classification, treatment response prediction, and relapse monitoring. The findings highlight miRNAs as promising biomarkers for precision medicine approaches, potentially enhancing clinical decision-making and improving patient outcomes. Notably, miRNAs such as miR-21, miR-155, and members of the miR-200 family show consistent associations with clinical parameters across multiple studies. The accessibility of miRNAs in blood and other body fluids, combined with their stability and specificity, positions them as valuable tools that could complement conventional diagnostic methods and support more personalized treatment strategies in breast cancer care.
{"title":"MicroRNA Expression in Breast Cancer Patients, an Integrative Review","authors":"Larissa Fernanda Campos Moreira da Silva, Fabiana Pirani Carneiro, Andrea Barretto Motoyama","doi":"10.1002/jso.70132","DOIUrl":"10.1002/jso.70132","url":null,"abstract":"<p>This integrative review examines the differential expression of miRNAs in breast cancer patients across various disease stages. Through analysis of 42 articles published between 2005 and 2023, the review identifies multiple miRNAs with significant diagnostic, prognostic, and predictive potential in breast cancer management. These small noncoding RNAs, accessible through liquid biopsy, demonstrate notable potential for early detection, molecular subtype classification, treatment response prediction, and relapse monitoring. The findings highlight miRNAs as promising biomarkers for precision medicine approaches, potentially enhancing clinical decision-making and improving patient outcomes. Notably, miRNAs such as miR-21, miR-155, and members of the miR-200 family show consistent associations with clinical parameters across multiple studies. The accessibility of miRNAs in blood and other body fluids, combined with their stability and specificity, positions them as valuable tools that could complement conventional diagnostic methods and support more personalized treatment strategies in breast cancer care.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"31-38"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristen N. Kaiser, Alexa J. Hughes, Jeannette W. Chung, Adam S. Wilk, Katie Ross-Driscoll, Rachel E. Patzer, Karl Y. Bilimoria, Ryan J. Ellis
Introduction
Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies.
Methods
Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model.
Results
Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7–33.8 cases/year (optimal cutpoints), and 11–18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input.
Conclusion
Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.
{"title":"Reproducibility and Consistency of Methods to Define Hospital-Level Procedural Volume Thresholds for Pancreatectomy","authors":"Kristen N. Kaiser, Alexa J. Hughes, Jeannette W. Chung, Adam S. Wilk, Katie Ross-Driscoll, Rachel E. Patzer, Karl Y. Bilimoria, Ryan J. Ellis","doi":"10.1002/jso.70134","DOIUrl":"10.1002/jso.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7–33.8 cases/year (optimal cutpoints), and 11–18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"92-100"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason M. Aubrey, Hannah R Liefeld, Colleen Armstrong, Anna Levine, Jessica Thompson, Amie Hop, G. Paul Wright
Background
Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution.
Methods
Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures.
Results
A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, p < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, p = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, p < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, p = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, p = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, p < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619.
Conclusions
Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.
背景：乳腺癌管理需要复杂的决策，在国际、国家和机构层面差异很大。我们的研究评估了对单个机构内单个外科医生的实践模式进行非惩罚性、实时评估的影响。方法：每6个月回顾一次前瞻性乳腺癌数据库中过去12个月的数据。在没有任何基准或惩罚措施的情况下，外科医生将他们的做法与同事进行了三次评估。结果：平均每12个月复查663例。我们观察到实践模式的显著变化，包括再切除率的显著降低（20.1% vs. 11.2%）。结论：实践模式回顾显著改变了手术实践，减少了临床差异，并证明对质量倡议的战略投资可以极大地提高资源利用率，并产生大量的成本节约。
{"title":"Prospective Review of Practice Patterns in Breast Cancer Surgery Facilitates Rapid Practice Change, Reduced Clinical Variation, and Cost Savings","authors":"Jason M. Aubrey, Hannah R Liefeld, Colleen Armstrong, Anna Levine, Jessica Thompson, Amie Hop, G. Paul Wright","doi":"10.1002/jso.70130","DOIUrl":"10.1002/jso.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, <i>p</i> < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, <i>p</i> = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, <i>p</i> < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, <i>p</i> = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, <i>p</i> = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, <i>p</i> < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"39-45"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alanna Hickey, Gabriel De la Cruz Ku, Caroline King, Camila Franco, Saman Namazian, Sarah Roberts, Kabir A. Torres, Sarah Persing, Salvatore Nardello, Abhishek Chatterjee
Background
The 21-gene recurrence score is a useful tool to predict the recurrence risk in patients with early hormone receptor positive (HR + ) and human epidermal receptor-2 negative (HER2-) breast cancer, which helps to determine those patients who may benefit from chemotherapy. Our goal was to assess whether there was a disparity in the use of the 21-gene recurrence score, especially between races and income levels.
Methods
Using the SEER Medicare database, we analyzed breast cancer patients diagnosed from 2012 to 2017. Inclusion criteria were HR + /HER2- phenotype, clinical stages I and II in post-menopausal women, and Stage 1 cancers in premenopausal women. Differences in the application of the 21-gene recurrence score with regard to race and income level were studied using chi-square analysis.
Results
Overall, 124 761 patients were included. Of these, 99.1% were females, and 32.9% had 21-gene recurrence score testing. The median age was 70 years (range 27–100). Most patients had invasive ductal carcinoma (86.6%) followed by invasive lobular carcinoma (13.4%), of which 66.0% were stage I and 34.0% as stage II. When comparing subgroups based on testing, White race had a lower application rate (83.8% vs. 84.3%, p = 0.031), compared to African-Americans (8.7% vs. 8.3%, p = 0.031). Similarly, patients with ≥ 10% poverty index showed a lower frequency of testing (46.0% vs. 47.3%, p < 0.001). However, clinically meaningful disparities by race or income were not observed. Underuse of 21-gene recurrence score was more evident among older patients ( ≥ 65, 76.9% vs. 61%, p < 0.001), separated/divorced/widowed individuals (38.7% vs. 28.4%, p < 0.001), and those undergoing mastectomy (39% vs. 29.5%, p < 0.001) compared to breast-conserving surgery.
Conclusions
No clinically significant disparities were observed in race or income level in the application of the 21-gene recurrence score, which is reassuring, particularly as chemotherapy treatment regimens continue to trend appropriately trend toward de-escalation. However, underuse was more evident among older patients, separated/divorced/widowed individuals, and those undergoing mastectomy, highlighting opportunities to improve equity and adherence to guideline-based testing.
{"title":"Do Racial and Income Disparities Exist in the Application of 21-Gene Recurrence Score?","authors":"Alanna Hickey, Gabriel De la Cruz Ku, Caroline King, Camila Franco, Saman Namazian, Sarah Roberts, Kabir A. Torres, Sarah Persing, Salvatore Nardello, Abhishek Chatterjee","doi":"10.1002/jso.70128","DOIUrl":"10.1002/jso.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The 21-gene recurrence score is a useful tool to predict the recurrence risk in patients with early hormone receptor positive (HR + ) and human epidermal receptor-2 negative (HER2-) breast cancer, which helps to determine those patients who may benefit from chemotherapy. Our goal was to assess whether there was a disparity in the use of the 21-gene recurrence score, especially between races and income levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the SEER Medicare database, we analyzed breast cancer patients diagnosed from 2012 to 2017. Inclusion criteria were HR + /HER2- phenotype, clinical stages I and II in post-menopausal women, and Stage 1 cancers in premenopausal women. Differences in the application of the 21-gene recurrence score with regard to race and income level were studied using chi-square analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 124 761 patients were included. Of these, 99.1% were females, and 32.9% had 21-gene recurrence score testing. The median age was 70 years (range 27–100). Most patients had invasive ductal carcinoma (86.6%) followed by invasive lobular carcinoma (13.4%), of which 66.0% were stage I and 34.0% as stage II. When comparing subgroups based on testing, White race had a lower application rate (83.8% vs. 84.3%, <i>p</i> = 0.031), compared to African-Americans (8.7% vs. 8.3%, <i>p</i> = 0.031). Similarly, patients with ≥ 10% poverty index showed a lower frequency of testing (46.0% vs. 47.3%, <i>p</i> < 0.001). However, clinically meaningful disparities by race or income were not observed. Underuse of 21-gene recurrence score was more evident among older patients ( ≥ 65, 76.9% vs. 61%, <i>p</i> < 0.001), separated/divorced/widowed individuals (38.7% vs. 28.4%, <i>p</i> < 0.001), and those undergoing mastectomy (39% vs. 29.5%, <i>p</i> < 0.001) compared to breast-conserving surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>No clinically significant disparities were observed in race or income level in the application of the 21-gene recurrence score, which is reassuring, particularly as chemotherapy treatment regimens continue to trend appropriately trend toward de-escalation. However, underuse was more evident among older patients, separated/divorced/widowed individuals, and those undergoing mastectomy, highlighting opportunities to improve equity and adherence to guideline-based testing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"16-30"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asad Gul Rao, Muhammad Ahmad Nadeem, Abdul Rafeh Awan, Chase J. Wehrle, Abby Gross, Antonio Giuseppucci, Beren Berber, Syed Mohiuddin, Tyler Stevens, Hassan Siddiki, Kathryn A. Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon, R. Matthew Walsh, Rob Naples
Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis of LAPC patients, EDS enabled quicker recovery and chemotherapy but had higher re-intervention rates, while GJ offered greater durability. Our systematic review showed EUS-GE had high success and low re-intervention in malignant GOO, though LAPC-specific data were lacking. Further comparative studies are needed to guide individualized treatment.
{"title":"Comparing Palliative Approaches for GOO in Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis","authors":"Asad Gul Rao, Muhammad Ahmad Nadeem, Abdul Rafeh Awan, Chase J. Wehrle, Abby Gross, Antonio Giuseppucci, Beren Berber, Syed Mohiuddin, Tyler Stevens, Hassan Siddiki, Kathryn A. Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon, R. Matthew Walsh, Rob Naples","doi":"10.1002/jso.70131","DOIUrl":"10.1002/jso.70131","url":null,"abstract":"<div>\u0000 \u0000 <p>Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis of LAPC patients, EDS enabled quicker recovery and chemotherapy but had higher re-intervention rates, while GJ offered greater durability. Our systematic review showed EUS-GE had high success and low re-intervention in malignant GOO, though LAPC-specific data were lacking. Further comparative studies are needed to guide individualized treatment.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"81-91"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor: Comment on: “Factors Associated With Residual Positive Lymph Nodes With Targeted Axillary Lymph Node Dissection for Breast Cancer and Accuracy of Clipped Node Retrieval in Non-Mapping Patients”","authors":"Liyan Wang, Jing Zhou, Hong Zhao","doi":"10.1002/jso.70126","DOIUrl":"10.1002/jso.70126","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 8","pages":"1305-1306"},"PeriodicalIF":1.9,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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