Pub Date : 2025-12-27DOI: 10.1016/j.suronc.2025.102346
Ana León Bretscher , Javier Ripollés Melchor , María García Nebreda , Ane Abad Motos , Carla Iglesias Morales , José María Tena Guerrero , Cristina Gil Lapetra , Francisco José Orts Micó , Manuel Llácer Pérez , Patricia Galán Menéndez , Enrique Alday-Muñoz , Jorge Puertas Domínguez , Bakarne Ugarte Sierra , Ana Maria Pascual Bellosta , Rosalia Navarro-Perez , Raquel Risco , Virginia Moreno Blanco , Raquel García Álvarez , Irene Mojarro Zamora , Alfredo Abad Gurumeta , Gloria Paseiro Crespo
Background
Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.
Methods
This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019–2020). ERAS adherence was assessed by quartiles. Primary outcome: timely RIOT (chemotherapy initiation ≤56 days post-surgery). Secondary outcome: time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.
Results
Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42–0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g., IIIC: HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.
Conclusions
While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.
手术后增强恢复（ERAS）途径改善了腹部手术的短期预后，但其对胃癌患者及时开始辅助化疗（返回预期肿瘤治疗，RIOT）的影响仍不确定。方法这项多中心前瞻性队列研究（POWER4, NCT03865810）分析了西班牙72家医院（2019-2020年）的742例胃切除术患者。ERAS依从性以四分位数评估。主要终点：及时的RIOT（化疗开始≤术后56天）。次要结果：发生暴动的时间（天）。多变量logistic和Cox回归模型调整临床/肿瘤因素。结果742例患者中，65%的患者获得了及时的RIOT。基于四分位数的单变量分析显示，依从性越高，RIOT时间越短（Q4 vs. Q1: HR 0.64, 95% CI 0.42-0.97, *p* = 0.034），但这种关联在多变量模型中消失。晚期TNM分期（如IIIC: HR 18.6, *p* < 0.001）和ASA等级是延迟性RIOT的较强预测因子。虽然ERAS途径可能有助于恢复，但其对RIOT的影响取决于高依从性，并被肿瘤相关因素所掩盖。未来的努力应将ERAS与高危患者的康复结合起来，目标依从性阈值≥70%。
{"title":"ERAS pathway adherence and its association with return to intended oncological therapy after gastrectomy","authors":"Ana León Bretscher , Javier Ripollés Melchor , María García Nebreda , Ane Abad Motos , Carla Iglesias Morales , José María Tena Guerrero , Cristina Gil Lapetra , Francisco José Orts Micó , Manuel Llácer Pérez , Patricia Galán Menéndez , Enrique Alday-Muñoz , Jorge Puertas Domínguez , Bakarne Ugarte Sierra , Ana Maria Pascual Bellosta , Rosalia Navarro-Perez , Raquel Risco , Virginia Moreno Blanco , Raquel García Álvarez , Irene Mojarro Zamora , Alfredo Abad Gurumeta , Gloria Paseiro Crespo","doi":"10.1016/j.suronc.2025.102346","DOIUrl":"10.1016/j.suronc.2025.102346","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.</div></div><div><h3>Methods</h3><div>This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019–2020). ERAS adherence was assessed by quartiles. Primary outcome: timely RIOT (chemotherapy initiation ≤56 days post-surgery). Secondary outcome: time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.</div></div><div><h3>Results</h3><div>Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42–0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g., IIIC: HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.</div></div><div><h3>Conclusions</h3><div>While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102346"},"PeriodicalIF":2.4,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.suronc.2025.102347
M. Pachl , C. Bowen
Introduction
Wilms tumor (WT) is the commonest renal cancer in children. It has excellent overall survival rates of >85 %, but relapsed disease is difficult to treat. Surgeons usually undertake a total nephrectomy but can occasionally perform nephron sparing surgery (NSS) in selected cases to preserve renal tissue. However, if margins are positive, the child then needs chemotherapy intensification and radiotherapy. Intraoperative guidance is limited to knowledge of the anatomy and intra-operative ultrasound, neither of which is perfect. This study uses an ex-vivo platform to study whether Indocyanine Green (ICG) can define tumor margins at a macroscopic and microscopic level.
Material and methods
UK Research Ethics committee approved the study. Patients having nephrectomy were eligible and parents were approached for enrolment. Patient demographics, anatomy of tumor and remaining kidney, ex-vivo macroscopic and microscopic white light and near infrared (NIR) findings were assessed. Microscopic pixel brightness was recorded as grayscale with peak and range. Final histopathology was also recorded.
Statistics were presented as median (range) and comparative data as Mann-Whitney U with a p of >0.01 taken as significant.
Results
Eleven consecutive patients having unilateral total nephroureterectomy for presumed WT. Two were excluded with nine kidneys (4F:5M) receiving ex-vivo intra-arterial injection of ICG.
In all specimen's normal renal parenchyma exhibited macroscopic and microscopic fluorescence. Low (n = 1) and intermediate risk tumors (n = 6) had obvious margins under NIR at macroscopic or microscopic levels. High risk blastemal tumors (n = 2) showed fluorescence throughout the tumor as well as the parenchyma with no obvious margins.
Grayscale readings showed blastemal was not significantly different to normal kidney (p = 0.477) but epithelial(E) (p = 0.01); stromal(S) (p = 0.003); combined E/S/necrotic(N) (p = 0.00018) and combined E/S/N/Tumor capsule (p = 0.00006) were.
Conclusion
ICG and NIR can be used to assess tumor margins in low and intermediate risk disease but not in blastemal high-risk tumors. It can act as an additional measure of safety but should not be used alone.
{"title":"Does Indocyanine Green define margins in Wilms tumour? A novel macroscopic and microscopic ex-vivo study","authors":"M. Pachl , C. Bowen","doi":"10.1016/j.suronc.2025.102347","DOIUrl":"10.1016/j.suronc.2025.102347","url":null,"abstract":"<div><h3>Introduction</h3><div>Wilms tumor (WT) is the commonest renal cancer in children. It has excellent overall survival rates of >85 %, but relapsed disease is difficult to treat. Surgeons usually undertake a total nephrectomy but can occasionally perform nephron sparing surgery (NSS) in selected cases to preserve renal tissue. However, if margins are positive, the child then needs chemotherapy intensification and radiotherapy. Intraoperative guidance is limited to knowledge of the anatomy and intra-operative ultrasound, neither of which is perfect. This study uses an ex-vivo platform to study whether Indocyanine Green (ICG) can define tumor margins at a macroscopic and microscopic level.</div></div><div><h3>Material and methods</h3><div>UK Research Ethics committee approved the study. Patients having nephrectomy were eligible and parents were approached for enrolment. Patient demographics, anatomy of tumor and remaining kidney, ex-vivo macroscopic and microscopic white light and near infrared (NIR) findings were assessed. Microscopic pixel brightness was recorded as grayscale with peak and range. Final histopathology was also recorded.</div><div>Statistics were presented as median (range) and comparative data as Mann-Whitney U with a p of >0.01 taken as significant.</div></div><div><h3>Results</h3><div>Eleven consecutive patients having unilateral total nephroureterectomy for presumed WT. Two were excluded with nine kidneys (4F:5M) receiving ex-vivo intra-arterial injection of ICG.</div><div>In all specimen's normal renal parenchyma exhibited macroscopic and microscopic fluorescence. Low (n = 1) and intermediate risk tumors (n = 6) had obvious margins under NIR at macroscopic or microscopic levels. High risk blastemal tumors (n = 2) showed fluorescence throughout the tumor as well as the parenchyma with no obvious margins.</div><div>Grayscale readings showed blastemal was not significantly different to normal kidney (p = 0.477) but epithelial(E) (p = 0.01); stromal(S) (p = 0.003); combined E/S/necrotic(N) (p = 0.00018) and combined E/S/N/Tumor capsule (p = 0.00006) were.</div></div><div><h3>Conclusion</h3><div>ICG and NIR can be used to assess tumor margins in low and intermediate risk disease but not in blastemal high-risk tumors. It can act as an additional measure of safety but should not be used alone.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102347"},"PeriodicalIF":2.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.suronc.2025.102345
Antonio Sarubbi , Giovanni Tacchi , Filippo Longo , Luca Frasca , Valentina Piccioni , Pierfilippo Crucitti
Background
Early‐stage non‐small cell lung cancer (NSCLC) is increasingly diagnosed in octogenarians due to rising global life expectancy, still optimal surgical management in this age group remains uncertain. This systematic review synthesizes current literature on lobectomy versus sublobar approaches focusing on overall and disease‐free survival to investigate the best type of resection in patients aged ≥80 years affected by early-stage NSCLC.
Methods
A comprehensive literature review conducted over the last 10 years across major electronic databases was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included the following keywords: "octogenarians," "elderly," "age over 80," "non-small cell lung cancer," "early-stage," "lung resection," "lobectomy," and "sublobar resection”. The primary outcome was overall survival among octogenarians, evaluated according to the type of lung resection performed. Secondary outcomes included postoperative mortality, disease-free survival, and postoperative complications.
Results
A total of 13 studies encompassing 17,073 octogenarian patients met the inclusion criteria. Lobectomy accounted for 67.7 % of procedures, while sublobar resections (wedge resection 19.1 %, segmentectomy 13.2 %) comprised the remainder. The variables mainly considered were overall survival, disease-free survival and postoperative complications. Postoperative complication rates were generally higher after lobectomy (17.6–56.8 %) compared to sublobar resection (10.5–41 %), with several studies demonstrating a statistically lower incidence of pulmonary and cardiac adverse events following wedge resection.
Conclusions
Current evidence suggests that sublobar resections in octogenarian patients with early-stage NSCLC achieve oncologic outcomes comparable to lobectomy while seemingly reducing postoperative morbidity. These lung-sparing approaches seem to be a viable option in carefully selected elderly patients.
{"title":"Feasibility of different types of lung resection for early-stage non-small cell lung cancer in octogenarians: A systematic review","authors":"Antonio Sarubbi , Giovanni Tacchi , Filippo Longo , Luca Frasca , Valentina Piccioni , Pierfilippo Crucitti","doi":"10.1016/j.suronc.2025.102345","DOIUrl":"10.1016/j.suronc.2025.102345","url":null,"abstract":"<div><h3>Background</h3><div>Early‐stage non‐small cell lung cancer (NSCLC) is increasingly diagnosed in octogenarians due to rising global life expectancy, still optimal surgical management in this age group remains uncertain. This systematic review synthesizes current literature on lobectomy versus sublobar approaches focusing on overall and disease‐free survival to investigate the best type of resection in patients aged ≥80 years affected by early-stage NSCLC.</div></div><div><h3>Methods</h3><div>A comprehensive literature review conducted over the last 10 years across major electronic databases was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included the following keywords: \"octogenarians,\" \"elderly,\" \"age over 80,\" \"non-small cell lung cancer,\" \"early-stage,\" \"lung resection,\" \"lobectomy,\" and \"sublobar resection”. The primary outcome was overall survival among octogenarians, evaluated according to the type of lung resection performed. Secondary outcomes included postoperative mortality, disease-free survival, and postoperative complications.</div></div><div><h3>Results</h3><div>A total of 13 studies encompassing 17,073 octogenarian patients met the inclusion criteria. Lobectomy accounted for 67.7 % of procedures, while sublobar resections (wedge resection 19.1 %, segmentectomy 13.2 %) comprised the remainder. The variables mainly considered were overall survival, disease-free survival and postoperative complications. Postoperative complication rates were generally higher after lobectomy (17.6–56.8 %) compared to sublobar resection (10.5–41 %), with several studies demonstrating a statistically lower incidence of pulmonary and cardiac adverse events following wedge resection.</div></div><div><h3>Conclusions</h3><div>Current evidence suggests that sublobar resections in octogenarian patients with early-stage NSCLC achieve oncologic outcomes comparable to lobectomy while seemingly reducing postoperative morbidity. These lung-sparing approaches seem to be a viable option in carefully selected elderly patients.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102345"},"PeriodicalIF":2.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.suronc.2025.102344
Kadir Can Sahin , Muhammed Fatih Simsekoglu , Sami Berk Ozden , Birgi Ercili , Ahmet Vural , Iclal Gurses , Cetin Demirdag
Introduction
Bladder cancer is a major global health concern, and urothelial carcinoma (UC) often presents with diverse histologic subtypes and differentiations associated with aggressive behavior and poorer survival with no standardized treatment recommendations. This study aimed to compare clinicopathologic characteristics and survival outcomes between patients with histologic/divergent UC subtypes and those with pure UC at initial presentation.
Patients and methods
We retrospectively analyzed 506 patients with de novo UC identified at initial transurethral resection of the bladder (TUR-BT) between 2015 and 2023. Demographic and clinical characteristics, pathologic features, treatment strategies, and survival outcomes were compiled and compared between groups. Treatment strategies, including radical cystectomy and neoadjuvant chemotherapy, were also evaluated to examine how histologic subtypes influenced clinical decision-making.
Results
Median follow-up period was 71 months (95 % CI, 68.0–74.0). Patients with histologic subtypes and divergent differentiations demonstrated significantly more aggressive tumor features at diagnosis, including higher rates of muscle invasion (46.1 % vs. 28.8 %, p < 0.001) and lymphovascular invasion (LVI) (38 % vs. 13.5 %, p < 0.001). Both overall survival (OS) and metastasis-free survival (MFS) were significantly worse in the UC with histologic subtype and differentiation group (five-year OS: 48.1 % vs. 73.1 %, p < 0.001; five-year MFS: 58.3 % vs. 87.4 %, p < 0.001). In multivariate analyses, presence of histologic subtypes and LVI were independently associated with poorer OS and MFS across all models. Age remained a significant factor for OS in all categories. ASA score ≥2 and surgical margin positivity were also associated with OS in the overall and muscle invasive patient cohorts.
Conclusion
Histologic subtypes of UC are associated with more aggressive clinicopathologic features and significantly worse survival outcomes. Early and accurate recognition of these subtypes and divergent differentiations at initial TUR-BT is critical, highlighting the need for tailored management strategies to improve patient prognosis.
膀胱癌是一个主要的全球健康问题，尿路上皮癌（UC）通常表现为不同的组织学亚型和分化，与侵袭性行为和较差的生存率相关，没有标准化的治疗建议。本研究旨在比较组织学/分化型UC和单纯UC患者的临床病理特征和生存结果。患者和方法我们回顾性分析了2015年至2023年间506例首次经尿道膀胱切除术（turt - bt）发现的新发UC患者。统计和比较两组间的人口学和临床特征、病理特征、治疗策略和生存结果。治疗策略，包括根治性膀胱切除术和新辅助化疗，也被评估，以检查组织学亚型如何影响临床决策。结果中位随访时间为71个月（95% CI, 68.0 ~ 74.0）。组织学亚型和分化不同的患者在诊断时表现出更强的肿瘤特征，包括更高的肌肉侵袭率（46.1%比28.8%,p < 0.001）和淋巴血管侵袭（LVI）（38%比13.5%,p < 0.001）。总生存率（OS）和无转移生存率（MFS）在具有组织学亚型和分化的UC组中均明显较差（5年OS: 48.1% vs. 73.1%, p < 0.001； 5年MFS: 58.3% vs. 87.4%, p < 0.001）。在多变量分析中，所有模型中组织学亚型和LVI的存在与较差的OS和MFS独立相关。在所有类别中，年龄仍然是OS的重要因素。ASA评分≥2和手术切缘阳性也与总体和肌肉侵袭性患者队列的OS相关。结论UC的组织学亚型与更具侵袭性的临床病理特征和明显较差的生存结果相关。早期和准确识别这些亚型和早期turt - bt分化是至关重要的，强调需要量身定制的管理策略，以改善患者预后。
{"title":"Histologic subtypes and divergent differentiations of urothelial carcinoma: Prognostic implications and clinical insights","authors":"Kadir Can Sahin , Muhammed Fatih Simsekoglu , Sami Berk Ozden , Birgi Ercili , Ahmet Vural , Iclal Gurses , Cetin Demirdag","doi":"10.1016/j.suronc.2025.102344","DOIUrl":"10.1016/j.suronc.2025.102344","url":null,"abstract":"<div><h3>Introduction</h3><div>Bladder cancer is a major global health concern, and urothelial carcinoma (UC) often presents with diverse histologic subtypes and differentiations associated with aggressive behavior and poorer survival with no standardized treatment recommendations. This study aimed to compare clinicopathologic characteristics and survival outcomes between patients with histologic/divergent UC subtypes and those with pure UC at initial presentation.</div></div><div><h3>Patients and methods</h3><div>We retrospectively analyzed 506 patients with de novo UC identified at initial transurethral resection of the bladder (TUR-BT) between 2015 and 2023. Demographic and clinical characteristics, pathologic features, treatment strategies, and survival outcomes were compiled and compared between groups. Treatment strategies, including radical cystectomy and neoadjuvant chemotherapy, were also evaluated to examine how histologic subtypes influenced clinical decision-making.</div></div><div><h3>Results</h3><div>Median follow-up period was 71 months (95 % CI, 68.0–74.0). Patients with histologic subtypes and divergent differentiations demonstrated significantly more aggressive tumor features at diagnosis, including higher rates of muscle invasion (46.1 % vs. 28.8 %, p < 0.001) and lymphovascular invasion (LVI) (38 % vs. 13.5 %, p < 0.001). Both overall survival (OS) and metastasis-free survival (MFS) were significantly worse in the UC with histologic subtype and differentiation group (five-year OS: 48.1 % vs. 73.1 %, p < 0.001; five-year MFS: 58.3 % vs. 87.4 %, p < 0.001). In multivariate analyses, presence of histologic subtypes and LVI were independently associated with poorer OS and MFS across all models. Age remained a significant factor for OS in all categories. ASA score ≥2 and surgical margin positivity were also associated with OS in the overall and muscle invasive patient cohorts.</div></div><div><h3>Conclusion</h3><div>Histologic subtypes of UC are associated with more aggressive clinicopathologic features and significantly worse survival outcomes. Early and accurate recognition of these subtypes and divergent differentiations at initial TUR-BT is critical, highlighting the need for tailored management strategies to improve patient prognosis.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102344"},"PeriodicalIF":2.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.suronc.2025.102339
Mehran Pashirzad , Alexandra E. Butler , Prashant Kesharwani , Amirhossein Sahebkar
We conducted a comprehensive assessment of the prognostic significance of CDK1 expression in patients diagnosed with cancer. Pooled hazard ratios (HRs), odds ratios (ORs), and 95 % confidence interval (CI) were calculated to determine the associations between CDK1 expression and overall survival (OS), disease-free survival (DFS), as well as various clinicopathological characteristics. A total of 20 studies, comprising 2470 patients, were included in this meta-analysis. Elevated CDK1 expression was significantly associated with reduced OS in both univariate and multivariate analyses, with pooled HRs of 1.55 (95 % CI: 1.31–1.81) and 1.89 (95 % CI: 1.52–2.36), respectively. Furthermore, higher CDK1 expression levels correlated significantly with adverse pathological features, including tumor size (OR = 1.50; 95 % CI, 1.08–2.09), lymph node metastasis (LNM; OR = 2.41; 95 % CI, 1.69–3.44), higher histological grade (OR = 2.40; 95 % CI, 1.69–3.39) and advanced tumor stage (OR = 1.76; 95 % CI, 1.25–2.48). These findings suggest that CDK1 over-expression may serve as a robust prognostic biomarker associated with unfavorable clinical outcomes in patients with cancer.
{"title":"Analysis of the clinicopathological relevance and prognostic value of CDK1 in human malignancy: Insights from meta and bioinformatics analysis","authors":"Mehran Pashirzad , Alexandra E. Butler , Prashant Kesharwani , Amirhossein Sahebkar","doi":"10.1016/j.suronc.2025.102339","DOIUrl":"10.1016/j.suronc.2025.102339","url":null,"abstract":"<div><div>We conducted a comprehensive assessment of the prognostic significance of CDK1 expression in patients diagnosed with cancer. Pooled hazard ratios (HRs), odds ratios (ORs), and 95 % confidence interval (CI) were calculated to determine the associations between CDK1 expression and overall survival (OS), disease-free survival (DFS), as well as various clinicopathological characteristics. A total of 20 studies, comprising 2470 patients, were included in this meta-analysis. Elevated CDK1 expression was significantly associated with reduced OS in both univariate and multivariate analyses, with pooled HRs of 1.55 (95 % CI: 1.31–1.81) and 1.89 (95 % CI: 1.52–2.36), respectively. Furthermore, higher CDK1 expression levels correlated significantly with adverse pathological features, including tumor size (OR = 1.50; 95 % CI, 1.08–2.09), lymph node metastasis (LNM; OR = 2.41; 95 % CI, 1.69–3.44), higher histological grade (OR = 2.40; 95 % CI, 1.69–3.39) and advanced tumor stage (OR = 1.76; 95 % CI, 1.25–2.48). These findings suggest that CDK1 over-expression may serve as a robust prognostic biomarker associated with unfavorable clinical outcomes in patients with cancer.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102339"},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.suronc.2025.102341
Daniel Alejandro Vega Moreno , Gervith Reyes Soto , Julio Cesar Lopez-Valdes , Alfonso Arellano-Mata , Henar Galicia Palacios , Miguel Agustín Amador Hernandez , Manuel de Jesús Encarnación-Ramirez
Spinal metastases are the most common tumors found in the neuraxis. They correspond to 90 % of all tumors at this level. The thoracic region is the most frequently affected area, followed by the lumbar region, with the cervical region being the least frequently affected place. Back pain is the most common symptom, appearing in up to 95 % of patients who present with spinal cord compression syndrome. The evaluation of patients with spinal cord compression syndrome is complex and requires an entire multidisciplinary team for diagnosis, management, and treatment. In the medical part, treatment is based on pain control with analgesic medications and the use of steroids, mainly dexamethasone, which has demonstrated efficacy and safety in the context of patients with spinal cord compression syndrome for functional recovery. Radiotherapy treatment is essential both as a definitive treatment and as a complementary treatment to surgery and although to date there are several treatment schemes, doses and fractions must be individualized based on the clinical context of each patient. On the other hand, metastatic spinal surgery is considered part of the definitive treatment, and although in a palliative context there are multiple approaches and indications for it. The importance of considering surgery is in those patients who are unstable since surgery, although it is not curative, poses a substantial improvement in symptoms as well as in pain recovery. We propose a diagnosis and treatment algorithm for patients with metastatic spinal cord compression syndrome in which decision-making is based on individualization and joint management by a multidisciplinary team.
{"title":"Comprehensive guide to the diagnosis, management, and treatment of metastatic spinal cord compression syndrome","authors":"Daniel Alejandro Vega Moreno , Gervith Reyes Soto , Julio Cesar Lopez-Valdes , Alfonso Arellano-Mata , Henar Galicia Palacios , Miguel Agustín Amador Hernandez , Manuel de Jesús Encarnación-Ramirez","doi":"10.1016/j.suronc.2025.102341","DOIUrl":"10.1016/j.suronc.2025.102341","url":null,"abstract":"<div><div>Spinal metastases are the most common tumors found in the neuraxis. They correspond to 90 % of all tumors at this level. The thoracic region is the most frequently affected area, followed by the lumbar region, with the cervical region being the least frequently affected place. Back pain is the most common symptom, appearing in up to 95 % of patients who present with spinal cord compression syndrome. The evaluation of patients with spinal cord compression syndrome is complex and requires an entire multidisciplinary team for diagnosis, management, and treatment. In the medical part, treatment is based on pain control with analgesic medications and the use of steroids, mainly dexamethasone, which has demonstrated efficacy and safety in the context of patients with spinal cord compression syndrome for functional recovery. Radiotherapy treatment is essential both as a definitive treatment and as a complementary treatment to surgery and although to date there are several treatment schemes, doses and fractions must be individualized based on the clinical context of each patient. On the other hand, metastatic spinal surgery is considered part of the definitive treatment, and although in a palliative context there are multiple approaches and indications for it. The importance of considering surgery is in those patients who are unstable since surgery, although it is not curative, poses a substantial improvement in symptoms as well as in pain recovery. We propose a diagnosis and treatment algorithm for patients with metastatic spinal cord compression syndrome in which decision-making is based on individualization and joint management by a multidisciplinary team.</div></div><div><h3>Clinical trial number</h3><div>not applicable.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102341"},"PeriodicalIF":2.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robotic liver resection has widely spread in hepatopancreatobiliary surgery, with growing evidence even in challenging scenarios. However, the results of robotic hepatectomy in patients who have had previous liver operations (repeat Robotic Liver Resections, r-RLR) have not been deeply investigated so far.
Methods
A systematic review of the MEDLINE and SCOPUS databases was performed, including studies published until April 2025.
Results
A total of 4 studies including 118 patients met the inclusion criteria. Nineteen patients (16.1 %) had received 2 or more previous liver resections, with 92.4 % (n = 109) of the r-RLR that were performed for malignant lesions. Colorectal liver metastases represented the most common malignant indication (40.7 %), followed by recurrent hepatocellular carcinoma (36.4 %). Tumor size varied between 10 and 33 mm in the largest diameter. The weighted mean operative time was 200.8 min (SD: 112.3), and the weighted mean estimated blood loss was 134.3 mL (SD: 121.9). The weighted mean hospital length of stay was 4.7 days (SD: 4.7). One case of open conversion was reported (0.8 %). Six patients experienced major complications (5 %), with 1 (0.8 %) postoperative death.
Conclusion
Few retrospective studies investigating the outcomes of r-RLR are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic redo hepatectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings.
背景：机器人肝切除在肝胆胰手术中广泛应用，即使在具有挑战性的情况下也有越来越多的证据。然而，机器人肝切除术对既往肝手术患者的效果（重复机器人肝切除术，r-RLR）迄今尚未深入研究。方法：对MEDLINE和SCOPUS数据库进行系统回顾，包括截至2025年4月发表的研究。结果：共有4项研究118例患者符合纳入标准。19例（16.1%）患者曾接受过2次或2次以上的肝脏切除术，其中92.4% （n = 109）的r-RLR是针对恶性病变进行的。结直肠肝转移是最常见的恶性指征（40.7%），其次是复发性肝细胞癌（36.4%）。肿瘤最大直径在10 ~ 33mm之间。加权平均手术时间200.8 min (SD: 112.3)，加权平均估计失血量134.3 mL （SD: 121.9）。加权平均住院时间为4.7天（SD: 4.7）。报告1例（0.8%）。6例患者出现严重并发症（5%），1例（0.8%）术后死亡。结论：目前文献中很少有回顾性研究调查r-RLR的结果。从已发表的数据来看，对于转介HPB中心的选定患者，它可能是一种安全可行的替代开放式和腹腔镜重做肝切除术的方法。需要更大样本量的进一步研究来证实这些初步发现。
{"title":"Perioperative outcomes after robotic repeat hepatectomy: A systematic review","authors":"Gianluca Cassese , Fabrizio Panaro , Fabio Giannone , Mariantonietta Alagia , Marco Palucci , Cristina Ciulli , Alessandro Fogliati , Mattia Garancini , Mauro Alessandro Scotti , Fabio Benedetti , Fabrizio Romano","doi":"10.1016/j.suronc.2025.102342","DOIUrl":"10.1016/j.suronc.2025.102342","url":null,"abstract":"<div><h3>Background</h3><div>Robotic liver resection has widely spread in hepatopancreatobiliary surgery, with growing evidence even in challenging scenarios. However, the results of robotic hepatectomy in patients who have had previous liver operations (repeat Robotic Liver Resections, r-RLR) have not been deeply investigated so far.</div></div><div><h3>Methods</h3><div>A systematic review of the MEDLINE and SCOPUS databases was performed, including studies published until April 2025.</div></div><div><h3>Results</h3><div>A total of 4 studies including 118 patients met the inclusion criteria. Nineteen patients (16.1 %) had received 2 or more previous liver resections, with 92.4 % (n = 109) of the r-RLR that were performed for malignant lesions. Colorectal liver metastases represented the most common malignant indication (40.7 %), followed by recurrent hepatocellular carcinoma (36.4 %). Tumor size varied between 10 and 33 mm in the largest diameter. The weighted mean operative time was 200.8 min (SD: 112.3), and the weighted mean estimated blood loss was 134.3 mL (SD: 121.9). The weighted mean hospital length of stay was 4.7 days (SD: 4.7). One case of open conversion was reported (0.8 %). Six patients experienced major complications (5 %), with 1 (0.8 %) postoperative death.</div></div><div><h3>Conclusion</h3><div>Few retrospective studies investigating the outcomes of r-RLR are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic redo hepatectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102342"},"PeriodicalIF":2.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salvage surgery is one of the treatment options for recurrent metastatic head and neck cancer (RMHNC). Salvage surgery with reconstruction for patients with a history of reconstructive surgery and radiation therapy (RT) is especially difficult and carries a high risk of complications.
Methods
This study included patients with RMHNC who had a history of reconstructive surgery and RT. The prognosis and complications were evaluated by dividing patients into those who underwent salvage surgery with reconstruction and those who underwent non-surgical treatments.
Results
Fifty-seven patients were enrolled. The overall survival (OS) of the salvage surgery with reconstruction group was better than that of the non-surgical treatment groups (median OS; 50.6 months vs. 21.6 months, p = 0.0373), but the progression-free survival (PFS) was similar (median PFS; 14.5 months vs. 12.9 months, p = 0.48). The salvage surgery with reconstruction group also showed a better prognosis than the immune checkpoint inhibitor (ICI) group (median OS; 50.6 months vs. 30.9 months, p = 0.209). In the salvage surgery with reconstruction group, 85.8 % of cases experienced postoperative complications, while in the patients who underwent non-surgical treatments, 58.8 % experienced adverse events (p = 0.0724). There were no cases of Grade IIIb or higher that required general anesthesia.
Conclusion
Salvage surgery with reconstruction showed a better prognosis than other non-surgical treatments, including ICI. Furthermore, with careful case selection and thorough postoperative care, salvage surgery with reconstruction can be performed relatively safely without any serious complications.
{"title":"Usefulness and safety of salvage surgery with reconstruction for recurrent head and neck cancer with a history of reconstruction surgery and radiation therapy","authors":"Saki Akita , Masashi Kuroki , Ryota Iinuma , Tatsuhiko Yamada , Ryo Kawaura , Hiroshi Okuda , Kousuke Terazawa , Kenichi Mori , Hirofumi Shibata , Natsuko Obara , Keishi Kohyama , Hisakazu Kato , Takenori Ogawa","doi":"10.1016/j.suronc.2025.102340","DOIUrl":"10.1016/j.suronc.2025.102340","url":null,"abstract":"<div><h3>Background</h3><div>Salvage surgery is one of the treatment options for recurrent metastatic head and neck cancer (RMHNC). Salvage surgery with reconstruction for patients with a history of reconstructive surgery and radiation therapy (RT) is especially difficult and carries a high risk of complications.</div></div><div><h3>Methods</h3><div>This study included patients with RMHNC who had a history of reconstructive surgery and RT. The prognosis and complications were evaluated by dividing patients into those who underwent salvage surgery with reconstruction and those who underwent non-surgical treatments.</div></div><div><h3>Results</h3><div>Fifty-seven patients were enrolled. The overall survival (OS) of the salvage surgery with reconstruction group was better than that of the non-surgical treatment groups (median OS; 50.6 months vs. 21.6 months, p = 0.0373), but the progression-free survival (PFS) was similar (median PFS; 14.5 months vs. 12.9 months, p = 0.48). The salvage surgery with reconstruction group also showed a better prognosis than the immune checkpoint inhibitor (ICI) group (median OS; 50.6 months vs. 30.9 months, p = 0.209). In the salvage surgery with reconstruction group, 85.8 % of cases experienced postoperative complications, while in the patients who underwent non-surgical treatments, 58.8 % experienced adverse events (p = 0.0724). There were no cases of Grade IIIb or higher that required general anesthesia.</div></div><div><h3>Conclusion</h3><div>Salvage surgery with reconstruction showed a better prognosis than other non-surgical treatments, including ICI. Furthermore, with careful case selection and thorough postoperative care, salvage surgery with reconstruction can be performed relatively safely without any serious complications.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102340"},"PeriodicalIF":2.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.suronc.2025.102338
Taiga Wakabayashi, Sara Pepe, Muhammad Naeem, Go Wakabayashi
Background
Anatomic liver resection (ALR) requires precise transection along the true intersegmental/sectional plane while preserving vascular integrity of the remnant liver. Conventional approaches often rely on ischemic demarcation or venous landmarks, which may not perfectly match anatomical boundaries. Robotic platforms and indocyanine green (ICG) fluorescence have enabled refined visualization and dexterity, supporting the concept of bona fide ALR—defined as anatomical resection that exactly follows the Glissonean territory while preserving remnant inflow and outflow integrity. The “detachment technique” denotes a robotic ICG-guided approach that achieves natural parenchymal separation along the demarcated plane through controlled traction–countertraction dynamics, ensuring anatomical precision without unnecessary vessel sacrifice. Conceptually, this principle applies to any segmental or subsegmental unit of the liver representing the smallest anatomical territory supplied by a Glissonean pedicle.
Methods
We report robotic right hepatectomy in a woman in her 50s with abdominal fullness due to a giant hepatic hemangioma. Using the Da Vinci Xi system, cystic plate cholecystectomy was performed, and the right hepatic artery was ligated to reduce tumor tension. After encirclement of the hepatoduodenal ligament, the right Glissonean pedicle was isolated using an extrahepatic approach. Intravenous injection of 0.25 mg ICG enabled negative staining, which delineated the transection plane. Parenchymal transection was carried out with a Maryland bipolar dissector under robotic countertraction, facilitating natural detachment along the Main Portal Fissure. Firefly mode provided real-time visualization, and the anterior and posterior Glissonean pedicles and the right hepatic vein were divided with staplers.
Results
The procedure was completed in 407 minutes with an estimated blood loss of 116 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 7.
Conclusion
Robotic right hepatectomy with a Glissonean approach and ICG-guided negative staining illustrates the feasibility of bona fide anatomic liver resection (ALR). While demonstrated in a single case of hemangioma, this technique requires expertise in the extrahepatic Glissonean approach and should be validated in multicentric cohorts to assess its generalizability and long-term outcomes.
{"title":"Robotic bona fide right hepatectomy with ICG-guided detachment technique","authors":"Taiga Wakabayashi, Sara Pepe, Muhammad Naeem, Go Wakabayashi","doi":"10.1016/j.suronc.2025.102338","DOIUrl":"10.1016/j.suronc.2025.102338","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic liver resection (ALR) requires precise transection along the true intersegmental/sectional plane while preserving vascular integrity of the remnant liver. Conventional approaches often rely on ischemic demarcation or venous landmarks, which may not perfectly match anatomical boundaries. Robotic platforms and indocyanine green (ICG) fluorescence have enabled refined visualization and dexterity, supporting the concept of bona fide ALR—defined as anatomical resection that exactly follows the Glissonean territory while preserving remnant inflow and outflow integrity. The “detachment technique” denotes a robotic ICG-guided approach that achieves natural parenchymal separation along the demarcated plane through controlled traction–countertraction dynamics, ensuring anatomical precision without unnecessary vessel sacrifice. Conceptually, this principle applies to any segmental or subsegmental unit of the liver representing the smallest anatomical territory supplied by a Glissonean pedicle.</div></div><div><h3>Methods</h3><div>We report robotic right hepatectomy in a woman in her 50s with abdominal fullness due to a giant hepatic hemangioma. Using the Da Vinci Xi system, cystic plate cholecystectomy was performed, and the right hepatic artery was ligated to reduce tumor tension. After encirclement of the hepatoduodenal ligament, the right Glissonean pedicle was isolated using an extrahepatic approach. Intravenous injection of 0.25 mg ICG enabled negative staining, which delineated the transection plane. Parenchymal transection was carried out with a Maryland bipolar dissector under robotic countertraction, facilitating natural detachment along the Main Portal Fissure. Firefly mode provided real-time visualization, and the anterior and posterior Glissonean pedicles and the right hepatic vein were divided with staplers.</div></div><div><h3>Results</h3><div>The procedure was completed in 407 minutes with an estimated blood loss of 116 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 7.</div></div><div><h3>Conclusion</h3><div>Robotic right hepatectomy with a Glissonean approach and ICG-guided negative staining illustrates the feasibility of bona fide anatomic liver resection (ALR). While demonstrated in a single case of hemangioma, this technique requires expertise in the extrahepatic Glissonean approach and should be validated in multicentric cohorts to assess its generalizability and long-term outcomes.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102338"},"PeriodicalIF":2.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.suronc.2025.102335
Keita Takahashi, Masami Yuda, Yoshitaka Ishikawa, Takanori Kurogochi, Akira Matsumoto, Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Fumiaki Yano, Ken Eto
Purpose
The contribution of the trend of neutrophil-to-lymphocyte ratio (NLR) values during neoadjuvant chemotherapy (NAC) remains poorly understood in patients with esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to clarify the influence of sustained-high-NLR during NAC on the prognosis of ESCC patients undergoing curative esophagectomy after NAC.
Methods
This study analyzed 108 ESCC patients. Patients were divided into four groups as the remained-low-NLR group, the elevated-NLR group, the decreased-NLR group, and the sustained-high-NLR group according to the NLR levels before and after NAC. After that, the backgrounds and perioperative factors were compared among the four groups. Finally, Independent prognostic factors were identified.
Results
The overall survival (OS) was significantly different among the four groups (p = 0.02) and relapse-free survival (RFS) tended to be different among the groups (p = 0.08), with the sustained-high-NLR group having the poorest survival. In a multivariate analysis for OS and RFS, sustained-high-NLR was a significant adverse prognostic factor (p < 0.01; HR, 3.16; 95 % CI, 1.38–7.22 and p = 0.01; HR, 2.45; 95 % CI, 1.22–4.93, respectively).
Conclusions
Consistently elevated NLR during NAC was correlated with an unfavorable prognosis in patients who underwent NAC followed by esophagectomy for ESCC. Additionally, sustainedly high NLR may be a useful biomarker for adjuvant nivolumab.
{"title":"Sustained high neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy predicts worse prognosis in patients after esophagectomy for esophageal squamous cell carcinoma","authors":"Keita Takahashi, Masami Yuda, Yoshitaka Ishikawa, Takanori Kurogochi, Akira Matsumoto, Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Fumiaki Yano, Ken Eto","doi":"10.1016/j.suronc.2025.102335","DOIUrl":"10.1016/j.suronc.2025.102335","url":null,"abstract":"<div><h3>Purpose</h3><div>The contribution of the trend of neutrophil-to-lymphocyte ratio (NLR) values during neoadjuvant chemotherapy (NAC) remains poorly understood in patients with esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to clarify the influence of sustained-high-NLR during NAC on the prognosis of ESCC patients undergoing curative esophagectomy after NAC.</div></div><div><h3>Methods</h3><div>This study analyzed 108 ESCC patients. Patients were divided into four groups as the remained-low-NLR group, the elevated-NLR group, the decreased-NLR group, and the sustained-high-NLR group according to the NLR levels before and after NAC. After that, the backgrounds and perioperative factors were compared among the four groups. Finally, Independent prognostic factors were identified.</div></div><div><h3>Results</h3><div>The overall survival (OS) was significantly different among the four groups (p = 0.02) and relapse-free survival (RFS) tended to be different among the groups (p = 0.08), with the sustained-high-NLR group having the poorest survival. In a multivariate analysis for OS and RFS, sustained-high-NLR was a significant adverse prognostic factor (p < 0.01; HR, 3.16; 95 % CI, 1.38–7.22 and p = 0.01; HR, 2.45; 95 % CI, 1.22–4.93, respectively).</div></div><div><h3>Conclusions</h3><div>Consistently elevated NLR during NAC was correlated with an unfavorable prognosis in patients who underwent NAC followed by esophagectomy for ESCC. Additionally, sustainedly high NLR may be a useful biomarker for adjuvant nivolumab.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102335"},"PeriodicalIF":2.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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