Surgical Oncology-Oxford最新文献_第4页

Survival benefit of resectability determined by multiple surgeons in BCLC-C Stage: A single-center cohort study 多名外科医生决定BCLC-C期可切除性的生存获益：一项单中心队列研究。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-11-08 DOI: 10.1016/j.suronc.2025.102328

Kyung Chul Yoon , Sanggyun Suh , YoungRok Choi , Jeong-Moo Lee , Minseob Kim , Jaewon Lee , Jae-Yoon Kim , Jiyoung Kim , Won-Gun Yun , Chang-Sup Lim , Su young Hong , Suk Kyun Hong , Nam-Joon Yi , Kwang-Woong Lee , Kyung-Suk Suh

Background

Systemic therapy remains the standard treatment for Barcelona Clinic Liver Cancer Stage C (BCLC C). However, the heterogeneity of this patient cohort has prompted investigation into alternative or additional therapeutic approaches. Potential bias exists in previous comparisons among treatment groups. Therefore, we compared survival outcomes between resectable and unresectable groups, as determined by four experienced surgeons.

Methods

We used data from patients who were initially diagnosed with liver cancer and treated at Seoul National University Hospital from January 2015 to December 2017. Four experienced liver surgeons participated, and each patient was classified as 'resectable' only when the two reviewing surgeons agreed that it was 'resectable’ based on medical records and imaging.

Results

The cohort included 1351 patients, of whom 212 had BCLC C. Among them, 162 were classified as resectable and 50 as unresectable. Portal vein tumor thrombus was present in 92.6 % and 86 % in the unresectable and resectable groups, respectively. The resectable group had better survival rates than the unresectable group, with 1-, 3-, and 5-year survival rates of 75.4, 52.3, and 45.1 % vs. 47 %, 22.2 %, and 13 %, respectively (P < 0.01). In the resectable group, 21 patients underwent resection and 28 received transarterial chemoembolization. The resection subgroup demonstrated superior 1-, 3-, and 5-year survival rates: 90.2 %, 75.2 %, and 64.4 %, vs. 63.1 %, 33.4 %, and 28.7 %, respectively (P < 0.01). Bile duct invasion (HR: 0.6477 [1.309–32.05], P = 0.02) and resection (HR: 0.247 [0.072–0.854], P = 0.02) were significant factors for OS.

Conclusions

Determining resectability at the BCLC-C stage and performing resection may improve survival.

背景：全身治疗仍然是巴塞罗那临床C期肝癌（BCLC - C）的标准治疗方法。然而，该患者队列的异质性促使对替代或额外治疗方法的研究。先前治疗组间的比较存在潜在的偏倚。因此，我们比较了可切除组和不可切除组的生存结果，由四位经验丰富的外科医生确定。方法：我们使用了2015年1月至2017年12月在首尔国立大学医院首次诊断为肝癌并接受治疗的患者的数据。四名经验丰富的肝脏外科医生参与了调查，只有当两名审查的外科医生根据医疗记录和影像学检查一致认为可以“切除”时，每位患者才会被归类为“可切除”。结果：纳入1351例患者，其中BCLC c 212例，可切除162例，不可切除50例。不可切除组和可切除组门静脉肿瘤血栓发生率分别为92.6%和86%。可切除组的生存率高于不可切除组，1年、3年和5年生存率分别为75.4、52.3%和45.1%，而不可切除组分别为47%、22.2%和13% (P结论：在BCLC-C期确定可切除性并进行切除可提高生存率。

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引用次数: 0

Early closure of defunctioning ileostomy after low-pelvic surgery for rectal cancer: Systematic review and meta-analysis of safety and functional outcomes 直肠癌低盆腔手术后早期关闭失功能回肠造口：安全性和功能结局的系统回顾和荟萃分析

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-11-08 DOI: 10.1016/j.suronc.2025.102326

Parbatraj Regmi , Bikash Kumar Sah , Vijay Pratap Sah , Bhawani Khanal , Abhijeet Kumar , Tomas Janusonis , Zygimantas Juodeikis , Darius Cincikas , Alfredas Kilius , Narimantas Evaldas Samalavicius , Rakesh Kumar Gupta

Background

Preventive defunctioning ileostomy is widely used to prevent leaks in high-risk colorectal anastomosis, but here is no international consensus on the timing of stoma reversal. In this study we aim to evaluate the safety and functional outcomes of early versus late defunctioning ileostomy after low-pelvic surgery for rectal cancer.

Methods

Systematic literature search was performed in multiple electronic databases until September 30, 2025. Meta-analysis and trial-sequantial analysis (TSA) were performed using the RevMan 5.4 and Copenhagen Trial Unit TSA software.

Results

There was no significant difference in overall postoperative morbidity, major morbidity, operation time, blood loss, incidence of postoperative ileus/bowel obstruction, length of stay (LOS), and reoperation rate between two groups. Functional outcomes like the incidence of major low anterior resection syndrome (LARS) and the minor LARS were also similar in two groups.

Conclusion

There is no increased risk of morbidity with early closure of defunctioning ileostomy after colorectal cancer surgery and the functional outcomes were also similar. Therefore, early reversal may be a safe and feasible approach in precisely selected cases when the clinician feels supported in doing so.

背景：预防性失功能回肠造口术被广泛应用于预防高危结肠吻合术中的瘘漏，但对于造口逆转的时机，国际上尚无共识。在这项研究中，我们的目的是评估低盆腔手术后早期与晚期失功能回肠造口术的安全性和功能结果。方法于2025年9月30日在多个电子数据库进行系统文献检索。采用RevMan 5.4和Copenhagen Trial Unit TSA软件进行meta分析和试验序列分析（TSA）。结果两组患者术后总发病率、主要发病率、手术时间、出血量、术后肠梗阻发生率、住院时间（LOS）、再手术率差异无统计学意义。两组患者的功能预后，如主要前低位切除综合征（LARS）和次要前低位切除综合征的发生率也相似。结论结直肠癌术后功能失活回肠造口早期闭合未增加发病风险，功能结局相似。因此，早期逆转可能是一个安全可行的方法，在精确选择的情况下，临床医生认为支持这样做。

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引用次数: 0

Cavity shave technique for safe resection margins in breast cancer conserving surgery: a randomized clinical trial 乳腺癌保癌手术中安全切除边缘的刮腔技术：随机临床试验。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-30 DOI: 10.1016/j.suronc.2025.102315

Gianluca Vanni , Marco Pellicciaro , Marco Materazzo , Alice Bertolo , Denisa Eskiu , Alessia Petricca , Michele Treglia , Benedetto Longo , Valerio Cervelli , Oreste Claudio Buonomo

Background/aim

In the modern era, breast surgery aims to adopt conservative strategies that ensure both oncological safety and aesthetic outcomes. However, one of the major challenges is the risk of positive margins, which may require a second surgery. Various strategies have been adopted to minimize this risk. The most commonly used strategies include the selective resection of suspicious margins after intraoperative evaluation and the routine circumferential resection of additional tissue around the cavity left by a lumpectomy, known as the Cavity-Shave (CS) Technique.

Methods

A blind randomized clinical trial was conducted, in which standard selective margin resections were compared to the CS technique, in a 1:1 ratio, comparing oncological outcomes, aesthetic results, and surgical time.

Results

A total of 185 patients were enrolled in the study, with a mean age of 62.04 ± 14.02. The sample was randomly assigned to two groups: 91(49.2 %) were allocated to the cavity shave (CS) Group and 94 (50.8 %) to the no-CS-Group. The rate of positive margins was 20.9 % versus 18.1 %, p-value:0.631 vs p-value:0.577. The re-excision rate was 12.1 % vs 14.9 %, in the CS-group and in the no-Cs-Group respectively. The mean operating room occupancy time was 77.9 ± 23.5 min in the CS-group versus 95.6 ± 34.9 min in the no-Cs-Group, with a p-value<0.001. Aesthetic outcomes were comparable between the two groups (p-value:0.706), despite a statistically significant difference in the total volume excised, 67.2 ± 16.4 cm³ in the CS-Group versus 51.5 ± 17.2 cm³ in the no-CS-Group, p-value:0.021.

Conclusion

CS and selective margin resection with intraoperative histopathological evaluation showed similar oncological and aesthetic outcomes; however, CS was associated with a statistically significant reduction in surgical time.

背景/目的：在现代，乳房手术旨在采用保守策略，以确保肿瘤安全和美观效果。然而，主要的挑战之一是正切的风险，这可能需要第二次手术。采取了各种策略来尽量减少这种风险。最常用的策略包括术中评估后选择性切除可疑边缘，以及常规切除乳房肿瘤切除术后留下的腔周围额外组织，称为腔剃（CS）技术。方法：进行盲随机临床试验，将标准选择性切缘切除术与CS技术按1:1的比例进行比较，比较肿瘤预后、美观效果和手术时间。结果：共入组185例患者，平均年龄62.04±14.02岁。将样本随机分为两组：91例（49.2%）分为刮刀组（CS）， 94例（50.8%）分为不刮刀组（CS）。阳性边缘率分别为20.9%和18.1%，p值分别为0.631和0.577。cs组和无cs组的再切除率分别为12.1%和14.9%。cs组平均手术室占用时间为77.9±23.5 min，无cs组为95.6±34.9 min， p值为3，无cs组为51.5±17.2 cm3， p值为0.021。结论：CS与选择性切缘切除术中组织病理学评价具有相似的肿瘤学和美学结果；然而，CS与手术时间的减少有统计学意义。

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引用次数: 0

Validation of a prognostic calculator to predict recurrence and mortality in melanoma patients undergoing sentinel lymph node biopsy 在接受前哨淋巴结活检的黑色素瘤患者中，预测复发和死亡率的预后计算器的验证。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-29 DOI: 10.1016/j.suronc.2025.102311

Julia Downey , Christopher Baliski

Background

The American Joint Committee on Cancer staging system (AJCC) is currently the gold standard for determining melanoma prognosis. However, it may not accurately reflect survival in certain substages, nor recurrence risk, prompting development of other predictive models. A validated predictive tool has been shown to perform well in two academic centers. We sought to investigate the performance of this nomogram in a regional cancer referral center, with the goal of future use for adjuvant treatment decisions.

Methods

A retrospective review of patients with T1b or greater melanomas, undergoing sentinel lymph node biopsy at a tertiary referral center between January 1, 2005, and June 30, 2022, was performed. Those with microsatellites or in-transit metastasis were excluded. Demographic, pathologic and treatment-related factors were linked to recurrence and survival data. The nomogram was assessed for the ability to discriminate recurrence and survival utilizing 6 prognostic factors (Breslow thickness, ulceration, age, tumour location, sentinel lymph node status and maximal lymph node metastasis diameter).

Results

486 patients were eligible for inclusion. The median age was 64 years (IQR: 54–73), with a Breslow thickness of 1.8 mm (IQR: 1.2–3.0). 95 patients (19.5 %) had pathologically positive sentinel lymph nodes, with 138 patients (28.4 %) developing recurrent disease. When applying this model to our population, the AUC for recurrence-free survival was 0.75 (95 % CI: 0.66–0.84), while melanoma-specific survival was 0.85 (95 % CI: 0.76–0.94).

Conclusion

The melanoma predictive tool performed well at predicting recurrence and survival in our population. The online calculator may assist clinicians advising patients on the merits of adjuvant treatments.

背景：美国癌症分期系统联合委员会（AJCC）目前是确定黑色素瘤预后的金标准。然而，它可能不能准确反映某些亚阶段的生存率，也不能准确反映复发风险，这促使了其他预测模型的发展。一个经过验证的预测工具在两个学术中心表现良好。我们试图调查该nomogram在区域性癌症转诊中心的表现，目的是为了将来辅助治疗决策的使用。方法：回顾性分析2005年1月1日至2022年6月30日在三级转诊中心接受前哨淋巴结活检的T1b或更大黑色素瘤患者。排除微卫星或转移过程中的转移。人口学、病理和治疗相关因素与复发和生存数据有关。利用6个预后因素（brreslow厚度、溃疡、年龄、肿瘤位置、前哨淋巴结状态和最大淋巴结转移直径）评估nomogram区分复发和生存的能力。结果：486例患者符合纳入条件。中位年龄64岁（IQR: 54-73）， Breslow厚度1.8 mm （IQR: 1.2-3.0）。前哨淋巴结病理阳性95例（19.5%），复发138例（28.4%）。当将该模型应用于我们的人群时，无复发生存的AUC为0.75 (95% CI: 0.66-0.84)，而黑色素瘤特异性生存为0.85 （95% CI: 0.76-0.94）。结论：黑色素瘤预测工具在预测我们人群的复发和生存方面表现良好。在线计算器可以帮助临床医生就辅助治疗的优点向患者提供建议。

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引用次数: 0

Impact of minimally invasive surgical approach on oncological completeness of resection in lung cancer surgery 微创手术入路对肺癌手术肿瘤切除完整性的影响。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-28 DOI: 10.1016/j.suronc.2025.102310

Clara Forcada , María Teresa Gómez-Hernández , Cristina E. Rivas , Marta G. Fuentes , Óscar Colmenares , Mario Manama , José Luis Aranda , Marta Rodríguez , Mercedes Sánchez , Marcelo F. Jiménez

Objectives

Oncological radicality, defined as complete resection, is essential in lung cancer surgery. This study aimed to compare the oncological quality of anatomical lung resections performed via video-assisted thoracoscopic surgery (VATS) versus robotic-assisted thoracic surgery (RATS), focusing on completeness of resection. Secondary objectives included lymphadenectomy quality, nodal upstaging, residual disease, and the number of dissected lymph node stations and retrieved lymph nodes.

Methods

A prospective single-center study included consecutive patients undergoing minimally invasive anatomical lung resection for lung cancer (September 2023–April 2025). Overlap weighting based on propensity scores—calculated using histology, clinical T and N stage, and extent of resection—was applied. Outcomes related to oncological radicality were compared between the VATS and RATS groups using appropriate statistical tests based on variable type and distribution.

Results

Of 358 patients, 255 met the inclusion criteria (84 RATS, 171 VATS). The rates of complete, incomplete, and uncertain resection were 62.0 %, 3.5 %, and 34.5 %, respectively. After overlap weighting, no significant differences were observed between RATS and VATS in complete resection (66.5 % vs. 60 %, p = 0.557), residual disease (2.17 % vs. 1.92 %, p = 0.802), adequate lymphadenectomy (70.7 % vs. 61.8 %, p = 0.181), or nodal upstaging (19.7 % vs. 11.3 %, p = 0.087). However, RATS yielded a higher number of mediastinal nodal stations dissected (median: 4 vs. 3, p < 0.001) and lymph nodes retrieved (median: 9 vs. 7, p < 0.001).

Conclusions

RATS and VATS achieved similar oncological radicality. However, RATS was associated with more extensive lymphadenectomy, potentially improving staging accuracy.

目的：肿瘤根治性，定义为完全切除，在肺癌手术中是必不可少的。本研究旨在比较通过视频辅助胸腔镜手术（VATS）和机器人辅助胸外科手术（RATS）进行的解剖性肺切除术的肿瘤学质量，重点是切除的完整性。次要目标包括淋巴结切除术的质量、淋巴结的分期、残留病变、淋巴结清扫和淋巴结回收的数量。方法：一项前瞻性单中心研究纳入了2023年9月至2025年4月连续接受微创解剖性肺癌肺切除术的患者。使用基于倾向评分的重叠加权-使用组织学，临床T和N分期以及切除程度计算。采用基于变量类型和分布的适当统计检验，比较VATS组和RATS组与肿瘤根治性相关的结果。结果：358例患者中，255例符合纳入标准（rat 84例，VATS 171例）。完全切除、不完全切除和不确定切除的比例分别为62.0%、3.5%和34.5%。重叠加权后，大鼠和VATS在完全切除（66.5% vs. 60%, p = 0.557）、残留病变（2.17% vs. 1.92%, p = 0.802）、充分淋巴结切除术（70.7% vs. 61.8%, p = 0.181）或淋巴结分期（19.7% vs. 11.3%, p = 0.087）方面无显著差异。然而，大鼠获得了更高数量的纵隔淋巴结清扫（中位数：4比3，p）。然而，RATS与更广泛的淋巴结切除术相关，可能提高分期准确性。

{"title":"Impact of minimally invasive surgical approach on oncological completeness of resection in lung cancer surgery","authors":"Clara Forcada , María Teresa Gómez-Hernández , Cristina E. Rivas , Marta G. Fuentes , Óscar Colmenares , Mario Manama , José Luis Aranda , Marta Rodríguez , Mercedes Sánchez , Marcelo F. Jiménez","doi":"10.1016/j.suronc.2025.102310","DOIUrl":"10.1016/j.suronc.2025.102310","url":null,"abstract":"<div><h3>Objectives</h3><div>Oncological radicality, defined as complete resection, is essential in lung cancer surgery. This study aimed to compare the oncological quality of anatomical lung resections performed via video-assisted thoracoscopic surgery (VATS) versus robotic-assisted thoracic surgery (RATS), focusing on completeness of resection. Secondary objectives included lymphadenectomy quality, nodal upstaging, residual disease, and the number of dissected lymph node stations and retrieved lymph nodes.</div></div><div><h3>Methods</h3><div>A prospective single-center study included consecutive patients undergoing minimally invasive anatomical lung resection for lung cancer (September 2023–April 2025). Overlap weighting based on propensity scores—calculated using histology, clinical T and N stage, and extent of resection—was applied. Outcomes related to oncological radicality were compared between the VATS and RATS groups using appropriate statistical tests based on variable type and distribution.</div></div><div><h3>Results</h3><div>Of 358 patients, 255 met the inclusion criteria (84 RATS, 171 VATS). The rates of complete, incomplete, and uncertain resection were 62.0 %, 3.5 %, and 34.5 %, respectively. After overlap weighting, no significant differences were observed between RATS and VATS in complete resection (66.5 % vs. 60 %, p = 0.557), residual disease (2.17 % vs. 1.92 %, p = 0.802), adequate lymphadenectomy (70.7 % vs. 61.8 %, p = 0.181), or nodal upstaging (19.7 % vs. 11.3 %, p = 0.087). However, RATS yielded a higher number of mediastinal nodal stations dissected (median: 4 vs. 3, p < 0.001) and lymph nodes retrieved (median: 9 vs. 7, p < 0.001).</div></div><div><h3>Conclusions</h3><div>RATS and VATS achieved similar oncological radicality. However, RATS was associated with more extensive lymphadenectomy, potentially improving staging accuracy.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102310"},"PeriodicalIF":2.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446554","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}

引用次数: 0

Combined retroperitoneal resection with cytoreductive surgery and heated intraperitoneal chemotherapy for metastatic colorectal cancer with retroperitoneal and peritoneal metastases 腹膜后及腹膜后转移性结直肠癌联合减胞术及腹腔热化疗

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-28 DOI: 10.1016/j.suronc.2025.102313

Shachar Laks , Shahar Feiglin , Gal Schtrechman , Liog Segev , Haggai Benvenisti , Dan Assaf , Nedaa Mahmeed , Mohammad Adileh , Ronen Brenner , Adam Goldstein , Almog Ben Yaacov , Aviram Nissan

Introduction

Colorectal peritoneal metastases (CRPM) and retroperitoneal lymphatic metastases (RLM) are each considered poor prognostic indicators in colorectal cancer (CRC). Current data suggests that surgery for each including cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for CRPM and retroperitoneal resection (RR) for RLM may improve survival. Given the poor prognosis of each finding individually, each condition is generally considered a contraindication to the other. We describe the first series of combined RR and CRS/HIPEC.

Materials and methods

Retrospective analysis of a prospectively maintained tertiary institution database comparing perioperative and oncological outcomes of combined RR + CRS/HIPEC to CRS/HIPEC only in CRC.

Results

Included 238 CRS/HIPEC and divided to 17 with RR + CRS/HIPEC and 221 with CRS/HIPEC only. Demographic/perioperative characteristics were similar including tumor characteristics and peritoneal cancer index. Longer operative times observed in RR + CRS/HIPEC cohort (5 versus 4 h, p = 0.024). Complications were similar except more postoperative bleeding events and deep vein thrombosis in the RR + CRS/HIPEC cohort (24 % versus 5.0 %, p = 0.024 and 12 % versus 2.3 %, p = 0.026, respectively). This did not translate to longer length of stay, reoperations, or major complications. Median disease free survival was shorter in the RR + CRS/HIPEC cohort (7.3 versus 11.3 months, p = 0.032), but similar overall survival observed (29.5 versus 43.9 months, p = 0.34). Less retroperitoneal recurrences occurred after regional lymphadenectomy (12 %) compared to mass only resection (44 %).

Conclusion

Our study demonstrates the safety and oncological efficacy of RR + CRS/HIPEC. We believe that RR + CRS/HIPEC in highly selected patients is a suitable option and hope this leads to larger multi-institutional studies to corroborate these findings.

结直肠腹膜转移（CRPM）和腹膜后淋巴转移（RLM）都被认为是结直肠癌（CRC）的不良预后指标。目前的数据表明，包括细胞减少手术和加热腹腔化疗（CRS/HIPEC）的CRPM和腹膜后切除术（RR）的RLM的手术可以提高生存率。鉴于每一种发现的预后都很差，每种情况通常被认为是另一种情况的禁忌症。我们描述了第一个系列联合RR和CRS/HIPEC。材料和方法回顾性分析一个前瞻性维护的高等院校数据库，比较RR + CRS/HIPEC与CRS/HIPEC联合治疗CRC的围手术期和肿瘤预后。结果CRS/HIPEC 238例，RR + CRS/HIPEC 17例，单纯CRS/HIPEC 221例。人口统计学/围手术期特征相似，包括肿瘤特征和腹膜癌指数。RR + CRS/HIPEC组的手术时间更长（5小时比4小时，p = 0.024）。RR + CRS/HIPEC组的并发症相似，但术后出血事件和深静脉血栓发生率更高（分别为24%对5.0%,p = 0.024和12%对2.3%,p = 0.026）。这并没有导致更长的住院时间、再手术或重大并发症。RR + CRS/HIPEC队列的中位无病生存期较短（7.3个月对11.3个月，p = 0.032），但观察到的总生存期相似（29.5个月对43.9个月，p = 0.34）。局部淋巴结切除术后腹膜后复发较少（12%），而单纯肿块切除术后腹膜后复发较少（44%）。结论本研究证实了RR + CRS/HIPEC的安全性和肿瘤疗效。我们认为，在高选择性患者中，RR + CRS/HIPEC是一个合适的选择，并希望这能导致更大规模的多机构研究来证实这些发现。

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引用次数: 0

Predicting long term survival in myxofibrosarcoma: Development and evaluation of Machine learning models for 2- and 5-year outcomes 预测黏液纤维肉瘤的长期生存：2年和5年预后的机器学习模型的开发和评估

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-28 DOI: 10.1016/j.suronc.2025.102314

Sanjeev Rampam , Andrew G. Girgis , Bishoy M. Galoaa , Joseph O. Werenski , Marcos R. Gonzalez , Santiago A. Lozano-Calderón

Background and objectives

Myxofibrosarcoma is a rare soft tissue sarcoma with complex growth patterns and variable survival outcomes, making prognosis challenging. Machine learning (ML) offers a promising approach to enhance survival predictions. This study explored key predictive features and assessed ML model performance and generalizability.

Methods

We included 3400 patients from the National Cancer Database for model training, and 112 patients from our institutional registry for external validation. We employed a Random Forest algorithm to identify predictive features. These features were used to train four models: Random Forest, single Neural Network, Neural Network Ensemble, and Weighted Ensemble combining all approaches. Model performance was assessed using area under the curve (AUC), F1-scores, and Brier scores.

Results

Tumor size, age, and metastatic status were identified as key predictors of survival across models. In internal validation, multiple models showed promise, but the Neural Network Ensemble demonstrated balanced performance for both 2- and 5-year overall survival. In external validation, the Neural Network Ensemble outperformed the Random Forest model, and achieved AUC of 0.965 and 0.934 for 2- and 5-year overall survival, respectively.

Conclusions

We successfully developed and validated ML algorithms that accurately predicted survival outcomes in patients with myxofibrosarcoma, with insights for model selection.

背景与目的黏液纤维肉瘤是一种罕见的软组织肉瘤，其生长模式复杂，生存结局多变，预后困难。机器学习（ML）提供了一种很有前途的方法来增强生存预测。本研究探索了关键的预测特征，并评估了ML模型的性能和泛化性。方法：我们从国家癌症数据库中纳入3400例患者进行模型训练，从我们的机构登记处纳入112例患者进行外部验证。我们采用随机森林算法来识别预测特征。利用这些特征训练四种模型：随机森林模型、单一神经网络模型、神经网络集成模型和加权集成模型。采用曲线下面积（AUC）、f1评分和Brier评分评估模型性能。结果肿瘤大小、年龄和转移状态被确定为所有模型中生存的关键预测因素。在内部验证中，多个模型都显示出了希望，但神经网络集成在2年和5年总生存率方面表现出了平衡的性能。在外部验证中，神经网络集成优于随机森林模型，2年和5年总生存期的AUC分别为0.965和0.934。我们成功开发并验证了ML算法，该算法可以准确预测黏液纤维肉瘤患者的生存结果，并为模型选择提供了见解。

{"title":"Predicting long term survival in myxofibrosarcoma: Development and evaluation of Machine learning models for 2- and 5-year outcomes","authors":"Sanjeev Rampam , Andrew G. Girgis , Bishoy M. Galoaa , Joseph O. Werenski , Marcos R. Gonzalez , Santiago A. Lozano-Calderón","doi":"10.1016/j.suronc.2025.102314","DOIUrl":"10.1016/j.suronc.2025.102314","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Myxofibrosarcoma is a rare soft tissue sarcoma with complex growth patterns and variable survival outcomes, making prognosis challenging. Machine learning (ML) offers a promising approach to enhance survival predictions. This study explored key predictive features and assessed ML model performance and generalizability.</div></div><div><h3>Methods</h3><div>We included 3400 patients from the National Cancer Database for model training, and 112 patients from our institutional registry for external validation. We employed a Random Forest algorithm to identify predictive features. These features were used to train four models: Random Forest, single Neural Network, Neural Network Ensemble, and Weighted Ensemble combining all approaches. Model performance was assessed using area under the curve (AUC), F1-scores, and Brier scores.</div></div><div><h3>Results</h3><div>Tumor size, age, and metastatic status were identified as key predictors of survival across models. In internal validation, multiple models showed promise, but the Neural Network Ensemble demonstrated balanced performance for both 2- and 5-year overall survival. In external validation, the Neural Network Ensemble outperformed the Random Forest model, and achieved AUC of 0.965 and 0.934 for 2- and 5-year overall survival, respectively.</div></div><div><h3>Conclusions</h3><div>We successfully developed and validated ML algorithms that accurately predicted survival outcomes in patients with myxofibrosarcoma, with insights for model selection.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102314"},"PeriodicalIF":2.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425574","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}

引用次数: 0

Fully robotic Ivor Lewis Esophagectomy with side - to - side linear stapled anastomosis: our standardized 15 - step technique and perioperative outcomes 全机器人Ivor Lewis食管切除术与侧对侧线性吻合术：我们标准化的15步技术和围手术期结果。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-28 DOI: 10.1016/j.suronc.2025.102312

Giuseppe Giuliani, Francesco Guerra, Angela Tribuzi, Lorenzo De Franco, Erica Monati, Francesco Matarazzo, Michele Di Marino, Andrea Coratti

Backgraund

In recent years, robotic surgery for the treatment of esophageal cancer has expanded rapidly. In this study, we report on our standardized steps for RILE, including our perioperative outcomes.

Methods

The study includes every single step that we systematically perform during the abdominal and thoracic phases of the RILE. All consecutive patients undergoing RILE by a single surgical team were included in this analysis.

Results

A total of 68 patients were included in the analysis. There was one intraoperative complication and no conversion occurred. The rate of major postoperative complications (Clavien and Dindo > II) was 14 %: with anastomotic-related morbidity in particular, 4 (6 %) patients developed anastomotic leakage. The median number of harvested lymph nodes was 41 (range 13–113), while the rate of R0 resection was 97 %.

Conclusions

In our opinion our standardisation of RILE could help new surgical teams to start using a robotic approach for two field esophagectomy.

背景：近年来，机器人手术在食管癌治疗中的应用迅速扩大。在这项研究中，我们报告了我们的标准化步骤，包括我们的围手术期结果。方法：该研究包括我们系统地在腹部和胸部阶段进行的每一个步骤。所有连续由一个外科团队接受RILE的患者都包括在本分析中。结果：共纳入68例患者。术中并发症1例，无转换发生。术后主要并发症（Clavien和Dindo > II）发生率为14%，特别是吻合口相关的发病率，4例（6%）患者发生吻合口瘘。中位淋巴结数目为41（范围13-113），R0切除率为97%。结论：在我们看来，我们对RILE的标准化可以帮助新的手术团队开始使用机器人入路进行两野食管切除术。

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引用次数: 0

Sarcomatoid dedifferentiation as a predictor of overall mortality in surgically treated metastatic renal cell carcinoma 肉瘤样去分化作为手术治疗转移性肾细胞癌总死亡率的预测因子。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-24 DOI: 10.1016/j.suronc.2025.102306

Reha-Baris Incesu , Lukas Scheipner , Simone Morra , Andrea Baudo , Carolin Siech , Letizia Maria Ippolita Jannello , Mario de Angelis , Anis Assad , Zhe Tian , Fred Saad , Shahrokh F. Shariat , Alberto Briganti , Ottavio de Cobelli , Felix K.H. Chun , Luca Carmignani , Nicola Longo , Sascha Ahyai , Derya Tilki , Markus Graefen , Pierre I. Karakiewicz

Background

In metastatic clear-cell renal cell carcinoma (ccmRCC), sarcomatoid dedifferentiation is routinely reported in G4 patients, but routine reporting is not recommended in G3 patients. We tested independent predictor status of sarcomatoid dedifferentiation in G4 ccmRCC. Additionally, we explored whether sarcomatoid dedifferentiation may have a role in overall mortality (OM) prediction in G3 ccmRCC.

Methods

Within the Surveillance, Epidemiology, and End Results database, univariable and multivariable Cox-regression models assessed cytoreductive nephrectomy (CN)-treated ccmRCC patients (2010–2020).

Results

Of 2644 CN-treated ccmRCC patients, 1336 (51 %) harbored G4, of whom 528 (40 %) harbored sarcomatoid dedifferentiation. In G4, median overall survival (OS) according to presence vs. absence of sarcomatoid dedifferentiation was 20 vs. 21 months (p = 0.6) and sarcomatoid dedifferentiation was not independent predictor in multivariable analyses. Of all, 1308 (49 %) harbored G3, of whom 79 (6 %) harbored sarcomatoid dedifferentiation. In G3, median OS according to presence vs. absence of sarcomatoid dedifferentiation was 22 vs. 38 months (p < 0.001) and sarcomatoid dedifferentiation independently predicted higher OM in multivariable analyses (hazard ratio 1.7, p < 0.001).

Conclusions

Reporting of sarcomatoid dedifferentiation in G4 RCC is routinely recommended. However, in G4 ccmRCC, presence of sarcomatoid dedifferentiation does not independently predict higher OM and its inclusion is not essential in multivariable considerations in G4 patients. Conversely, despite absence of standard reporting recommendation for sarcomatoid dedifferentiation in G3, presence of sarcomatoid dedifferentiation is associated with significantly higher mortality and achieved independent predictor status. Therefore, it possibly should be routinely reported and routinely included in multivariable analyses addressing G3 ccmRCC patients.

背景：在转移性透明细胞肾细胞癌（ccmRCC）中，G4患者常规报告肉瘤样去分化，但G3患者不建议常规报告。我们测试了G4 ccmRCC中肉瘤样去分化的独立预测因子状态。此外，我们探讨了肉瘤样去分化是否可能在G3 ccmRCC的总死亡率（OM）预测中发挥作用。方法：在监测、流行病学和最终结果数据库中，单变量和多变量cox回归模型评估了2010-2020年接受CN治疗的ccmRCC患者。结果：在2644例cn治疗的ccmRCC患者中，1336例（51%）存在G4，其中528例（40%）存在肉瘤样去分化。在G4中，根据存在和不存在肉瘤样去分化的中位总生存期（OS）为20个月对21个月（p = 0.6），并且在多变量分析中，肉瘤样去分化不是独立的预测因子。其中1308例（49%）存在G3, 79例（6%）存在肉瘤样去分化。在G3中，根据存在和不存在肉瘤样去分化的中位生存期为22个月对38个月(p)。结论：G4 RCC报告肉瘤样去分化是常规推荐的。然而，在G4 ccmRCC中，肉瘤样去分化的存在并不能独立预测更高的OM，并且在G4患者的多变量考虑中，它的包含也不是必需的。相反，尽管G3中没有肉瘤样去分化的标准报告建议，但肉瘤样去分化的存在与明显较高的死亡率相关，并具有独立的预测指标地位。因此，可能应该常规报告并常规纳入针对G3 ccmRCC患者的多变量分析。

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引用次数: 0

Mediastinal staging with video-assisted mediastinoscopic lymphadenectomy after endobronchial ultrasound-guided transbronchial needle aspiration: real-world evidence in 228 patients 超声引导下经支气管针吸后电视辅助纵隔镜淋巴结切除术的纵隔分期：228例患者的真实证据。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-10-14 DOI: 10.1016/j.suronc.2025.102309

Dominik Herrmann , Santiago Ewig , Katharina Greif , Kolja Milobinski , Tugba Bas Kaya , Melanie Oggiano , Thorsten Walles , Stefan Welter , Erich Hecker

Background

Accurate staging of mediastinal lymph nodes in patients with non-small-cell lung cancer (NSCLC) is essential to determine further management. Current guidelines recommend confirmatory mediastinoscopy for patients with suspicious mediastinal lymph node metastases in image-based staging but negative findings on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In clinical practice, adherence to these recommendations is low and many physicians omit invasive surgical staging. This study aimed to assess the results of subsequent video-assisted mediastinoscopic lymphadenectomy (VAMLA).

Methods

Retrospective single-center cohort analysis of patients who underwent surgery between 2015 and 2019. All patients were diagnosed with potentially resectable lung cancer or FDG-avid pulmonary nodule suspicious for NSCLC and underwent VAMLA following N0-N2 EBUS-TBNA for mediastinal staging.

Results

VAMLA was performed in 228 patients. Nodal upstaging after EBUS-TBNA occurred in 17.5 % of the cases (n = 40). During EBUS-TBNA, 1.72 (±1.06) lymph node stations were sampled, compared to 5.59 (±1.1) resected stations in VAMLA (p < 0.001). Clinical nodal status staged by PET/CT was significantly correlated with the occurrence of nodal upstaging by VAMLA, with an odds ratio of 7.69 in cN2 and 5.88 in patients with cN3, compared to cN0. Complications occurred in 8 patients (3.59 %). VAMLA was false negative in 1 patient (0.4 %).

Conclusion

Subsequent VAMLA enables the accurate staging of patients after negative EBUS-TBNA. Overall, 17.5 % of cases had nodal upstaging and would otherwise not have received guideline-compliant treatment for NSCLC. These results underline the role of surgical mediastinal staging after negative EBUS-TBNA in patients with suspicious radiologic findings.

背景：非小细胞肺癌（NSCLC）患者纵隔淋巴结的准确分期对于确定进一步的治疗至关重要。目前的指南建议对可疑纵隔淋巴结转移的患者进行影像学分期，但超声引导下经支气管针吸（EBUS-TBNA）阴性结果的确诊性纵隔镜检查。在临床实践中，这些建议的依从性很低，许多医生忽略了侵入性手术分期。本研究旨在评估随后的视频辅助纵隔镜淋巴结切除术（VAMLA）的结果。方法：对2015 - 2019年接受手术的患者进行回顾性单中心队列分析。所有患者均被诊断为可能可切除的肺癌或疑似NSCLC的FDG-avid肺结节，并在N0-N2 EBUS-TBNA进行纵隔分期后接受VAMLA。结果：228例患者行VAMLA手术。17.5%的病例（n = 40）发生EBUS-TBNA后淋巴结占优。在EBUS-TBNA期间，取样了1.72（±1.06）个淋巴结站，而在VAMLA中切除了5.59（±1.1）个淋巴结站(p结论：后续的VAMLA能够准确地分期EBUS-TBNA阴性患者。总体而言，17.5%的病例出现淋巴结占优，否则无法接受指南规定的非小细胞肺癌治疗。这些结果强调了EBUS-TBNA阴性患者放射学表现可疑后手术纵隔分期的作用。

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引用次数: 0