Ejso最新文献

{"title":"Robot-assisted radical nephroureterectomy for locally advanced upper tract urothelial carcinoma: a multicenter study by the Junior ERUS/YAU Working Group on Robot-assisted Surgery","authors":"Fabrizio Di Maida ,&nbsp;Carlo Andrea Bravi ,&nbsp;Ruben De Groote ,&nbsp;Federico Piramide ,&nbsp;Filippo Turri ,&nbsp;Mike Wenzel ,&nbsp;Gopal Sharma ,&nbsp;Christoph Würnschimmel ,&nbsp;Iulia Andras ,&nbsp;Edward Lambert ,&nbsp;Paolo Dell’Oglio ,&nbsp;Marcio Covas Moschovas ,&nbsp;Riccardo Campi ,&nbsp;Antonio Andrea Grosso ,&nbsp;Nikolaos Liakos ,&nbsp;Roman Mayr ,&nbsp;Andrea Mari ,&nbsp;Danny Darlington Carbin Joseph ,&nbsp;Ahmed Eraky ,&nbsp;Marco Paciotti ,&nbsp;Alessandro Larcher","doi":"10.1016/j.ejso.2025.110396","DOIUrl":"10.1016/j.ejso.2025.110396","url":null,"abstract":"<div><h3>Introduction</h3><div>Aim of the study was investigate outcomes of patients affected by locally advanced (pT3-pT4 and/or pN+) upper tract urothelial carcinoma (UTUC) and treated with robot-assisted radical nephroureterectomy (RNU).</div></div><div><h3>Materials and methods</h3><div>Clinical and surgical data of newly-diagnosed UTUC patients referring to 9 high-volume centres from January 2019 to March 2023 undergoing RNU were collected.</div></div><div><h3>Results</h3><div>191 patients showed locally advanced disease. Da Vinci and Hugo RAS ™ System were employed in 95.8 % and 4.2 % of cases, respectively. Bladder cuff removal was carried out in 161 (84.3 %) patients, by using either an intravesical and extravesical approach in 50 (31.1 %) and 111 (68.9 %) respectively. Open and robotic approaches for bladder cuff removal were preferred in 107 (66.5 %) and 54 (33.5 %) patients, respectively. Lymph node dissection was performed in 55 % of patients. Median follow up was 19 (IQR 10–23) months and 31 (16.4 %) patients experienced bladder recurrence. On multivariate analysis, in those patients receiving RNU and bladder cuff removal, the approach for bladder cuff management (extravesical vs intravesical) was the only independent predictor of bladder recurrence (hazard ratio [HR]: 1.34; 95 % confidence interval [CI] 1.12–2.11; p = 0.03). Surgical approach for bladder cuff management (open vs robot) was not independently associated with bladder recurrence or tumor progression (both p &gt; 0.05)</div></div><div><h3>Conclusions</h3><div>In experienced hands, the robotic approach showed satisfactory survival outcomes also for the surgical treatment of pathological locally advanced UTUC. Extravesical approach for bladder cuff management may be burdened by a higher risk for bladder recurrence in locally advanced disease.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110396"},"PeriodicalIF":2.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is surgery futile? A systematic review of conflicting definitions and patterns in surgical care for advanced gastrointestinal cancer","authors":"Leonard Lee ,&nbsp;Sharon Xin Yun Tan ,&nbsp;Michael Solomon ,&nbsp;Sascha Karunaratne ,&nbsp;Kilian GM. Brown ,&nbsp;Daniel Steffens ,&nbsp;Cherry Koh","doi":"10.1016/j.ejso.2025.110399","DOIUrl":"10.1016/j.ejso.2025.110399","url":null,"abstract":"<div><h3>Objective</h3><div>To report current definitions of futility and futility rates for patients undergoing advanced gastrointestinal (GI) cancer surgery.</div></div><div><h3>Background</h3><div>Surgery remains the primary treatment option for selected patients with advanced GI cancer, demonstrating significant survival benefits when successful. However, surgeries that fall short of expectations may be viewed as ‘futile’. Despite the clinical and ethical importance of futility, no universally accepted definition of futility exists in this cohort.</div></div><div><h3>Methods</h3><div>MEDLINE, CINAHL, Scopus, Embase, Cochrane Register, and Web of Science were searched on 26 September, 2024, adhering to PRISMA guidelines. Studies involving curative intent surgery for advanced GI cancers were included. Two independent authors extracted study characteristics, futility definitions and rates. Risk of bias was assessed using the JBI Critical Appraisal Checklist.</div></div><div><h3>Results</h3><div>23 studies were included (74 839 patients). Liver cancer (n = 10) and colorectal cancer (n = 7) were the most studied cohorts. Definitions of futility varied widely, and were broadly categorised into recurrence (n = 12, 52 %), mortality (n = 5, 21 %), or both (n = 5, 21 %), with heterogeneous timeframes. Irrespective of definition, the average futility rate was 27.3 %, with pancreatic cancer reporting the highest rate (31.9 %). One study defined futility qualitatively (harm outweighing benefit). Notably, no studies incorporated patient perspectives on futility.</div></div><div><h3>Conclusion</h3><div>Significant heterogeneity exists in futility definitions for advanced GI malignancy surgery, limiting generalizability. The lack of patient perspectives represents a critical gap. Future research should prioritize developing a consensus definition that includes diverse stakeholder viewpoints to improve clinical decision-making and patient-centred care.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110399"},"PeriodicalIF":2.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The financial impact of implementation of a prehabilitation program for colorectal cancer patients in the Netherlands: A budget impact analysis","authors":"C.R. Sabajo ,&nbsp;C.T.J. Michels ,&nbsp;A. van der Hout ,&nbsp;B. van den Heuvel ,&nbsp;J.W. Dekker ,&nbsp;J.M. Klaase ,&nbsp;G.D. Slooter","doi":"10.1016/j.ejso.2025.110375","DOIUrl":"10.1016/j.ejso.2025.110375","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation is proven to be clinically effective, it has shown to decrease complication rate and length of hospital stay after colorectal cancer surgery. However, for broad implementation, information is needed on the financial impact of prehabilitation. This study evaluates the budget impact of a prehabilitation program for colorectal cancer surgery patients in the Netherlands.</div></div><div><h3>Methods</h3><div>This budget impact analysis was based on real world data from Dutch hospitals and available data in literature. It was assessed for a period of five years, considering an annual rate of approximately 10,500 colorectal cancer surgeries in the Netherlands. Several scenarios were assessed, varying population size, prehabilitation program cost, and uptake of prehabilitation.</div></div><div><h3>Results</h3><div>The total mean hospital admission costs per patient was €3060 for the prehabilitation program and €3636 for standard care. Calculated over a one-year period, this was €77.9 million for patients with a prehabilitation program, while the standard care costs €90.8 million.</div></div><div><h3>Conclusion</h3><div>Implementation of a prehabilitation program for colorectal cancer surgery patients in the Netherlands may reduce hospital costs. The program could generate savings of approximately €64.3 million over five years, supporting its broader adoption.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110375"},"PeriodicalIF":2.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European guideline informed RAG-based GPT-4 decision support tool in tumor board meetings for breast cancer treatment","authors":"Nuran Abdullayev ,&nbsp;Jonathan Kottlors ,&nbsp;Hikmat Habibov ,&nbsp;Fahrettin Yilmaz ,&nbsp;Chantal Zimmer ,&nbsp;Nils Große Hokamp ,&nbsp;Simon Lennartz ,&nbsp;Vilayat Valiyev ,&nbsp;Cavid Abbasli ,&nbsp;Lukas Goertz ,&nbsp;Jan Borggrefe ,&nbsp;David Maintz ,&nbsp;Koray Ersahin ,&nbsp;Sebastian Sanduleanu","doi":"10.1016/j.ejso.2025.110384","DOIUrl":"10.1016/j.ejso.2025.110384","url":null,"abstract":"<div><div>Breast cancer is the most common cancer among women worldwide. Treatment decision-making in multidisciplinary tumor boards is complex, involving integration of clinical guidelines, patient data, and preferences.</div><div>We retrospectively evaluated MammaBoardGPT, an few-shot in-context learning and Retrieval Augmented Generation (RAG) enhanced GPT-4 model with European guidelines and five Tumor Board labeled cases, against standard GPT-4 in 25 breast cancer cases discussed at a German hospital.</div><div>After recursive prompting, MammaBoardGPT achieved complete agreement with tumor board decisions in 84 % of cases, partial agreement in 16 % and no disagreements; standard GPT-4 showed 76 % complete agreement, 20 % partial agreement, and 4 % complete disagreements.</div><div>A significant difference was observed in MammaBoardGPT's (Stuart-Maxwell P = 0.0048) but not for GPT-4 agreement with tumor board decisions before versus after recursive prompting (Stuart-Maxwell P = 0.135), neither for MammaBoardGPT and GPT-4 in their tumor board decision agreement post-recursive prompting (Stuart-Maxwell P = 0.37).</div><div>These findings support MammaBoardGPT's potential for tumor board decision support, warranting prospective validation and real-time assessment.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110384"},"PeriodicalIF":2.9,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery and survival after elective surgery for colorectal cancer - propensity score weighting analysis of 2,865 prospective patients","authors":"Marco Catarci ,&nbsp;Stefano Guadagni ,&nbsp;Marco Scatizzi ,&nbsp;Raffaele De Luca ,&nbsp;Paolo Delrio ,&nbsp;Giacomo Ruffo ,&nbsp;Felice Borghi ,&nbsp;Francesco Masedu","doi":"10.1016/j.ejso.2025.110379","DOIUrl":"10.1016/j.ejso.2025.110379","url":null,"abstract":"<div><h3>Background</h3><div>The impact of enhanced recovery pathway (ERP) on survival after colorectal cancer surgery (CCS) remains controversial.</div></div><div><h3>Materials and methods</h3><div>A total of 2865 adults enrolled in a multicenter cohort study (iCral3 study) after CCS were followed up. The percentage adherence to the ERP was recorded, and the patients were grouped according to their quartiles. Other patient-, center-, disease-, and treatment-related factors were considered in a machine learning generalized boosted model (GBM) to estimate the 22 covariates propensity score weights for the binary comparisons between the reference treatment (1st quartile, ERP adherence rates &lt;57.7 %) and the other treatment arms (2nd, 3rd, and 4th quartile). The primary endpoint was overall survival (OS). A GBM-weighted Cox model balanced on the same covariates was used to estimate the hazard ratio (HR) and 95 % confidence interval (95 %CI).</div></div><div><h3>Results</h3><div>Patients in the 4th quartile (ERP adherence rates ≥80.8 %) showed a significant lower risk of death from any cause (HR, 0.69; 95 %CI 0.49–0.96; p = 0.026).</div></div><div><h3>Conclusions</h3><div>High adherence to ERP was associated to a significant impact on long-term overall survival, supporting the efforts towards proper ERP implementation after CCS.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110379"},"PeriodicalIF":2.9,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A standardized surgical approach to multifocal locoregionally recurrent left-sided adrenocortical carcinoma","authors":"Shruthi R. Perati ,&nbsp;Alyssa V. Eade ,&nbsp;Aaron Dinerman ,&nbsp;Katherine M. Barrows ,&nbsp;Rachael Lowney ,&nbsp;Lindsay R. Friedman ,&nbsp;Tracey Pu ,&nbsp;Carolina Larrain ,&nbsp;Leila Sarvestani ,&nbsp;Ashley Rainey ,&nbsp;Cathleen Hannah ,&nbsp;Tamika Magee ,&nbsp;Andrew M. Blakely ,&nbsp;Jeremy L. Davis ,&nbsp;Naris N. Nilubol ,&nbsp;Jaydira del Rivero ,&nbsp;Jonathan M. Hernandez","doi":"10.1016/j.ejso.2025.110395","DOIUrl":"10.1016/j.ejso.2025.110395","url":null,"abstract":"<div><h3>Introduction</h3><div>Society guidelines recommend surgery for recurrent adrenocortical carcinoma (ACC) in selected patients; however, no standards exist to guide surgeons, and this may be particularly problematic in the management of multifocal locoregional recurrence.</div></div><div><h3>Materials and methods</h3><div>A standardized approach was developed for patients with multifocal locoregionally recurrent left-sided ACC as part of an NCI study (NCT05237934). <em>En bloc</em> resection included the distal pancreas, spleen, left kidney, portion of left diaphragm, and possibly a portion of the left lateral liver, greater curve of the stomach, and/or descending colon. Morbidity, survival, and quality of life (QoL) were assessed.</div></div><div><h3>Results</h3><div>From 2018 to 2024, ten patients (median age 59 years) underwent multi-visceral <em>en bloc</em> resections for multifocal locoregionally recurrent left-sided ACC. Prior to surgery, 90 % of patients had undergone systemic therapy and a median of one prior operation (range 1–4). Size of local recurrence(s) averaged 6.5 cm (range 1.9–12.2 cm) at largest diameter, with a median of 3 (range 2–8) foci of disease identifiable on pre-operative imaging. Two patients (20 %) developed a Grade 1B post-operative pancreatic fistula. There were no peri-operative mortalities. Median locoregional recurrence-free survival was 22.1 months at 19.3 months of median follow-up. 50 % of QoL survey respondents reported feeling recovered/back to baseline activity level within 4 months of surgery.</div></div><div><h3>Conclusion</h3><div>Locoregional control can be obtained with reasonable success and acceptable morbidity in select patients with multifocal locoregionally recurrent left-sided ACC using a standardized left upper quadrant <em>en bloc</em> multi-visceral resection approach. Verification of the results of this technique is required in other experienced centers.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110395"},"PeriodicalIF":2.9,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sentinel lymph node biopsy in apparently early-stage ovarian cancer: beyond removal of green nodes and surgical experience","authors":"Stefano Uccella,&nbsp;Anna Catozzo,&nbsp;Beatrice Cattin,&nbsp;Pier Carlo Zorzato,&nbsp;Anna Festi,&nbsp;Mariachiara Bosco,&nbsp;Simone Garzon","doi":"10.1016/j.ejso.2025.110394","DOIUrl":"10.1016/j.ejso.2025.110394","url":null,"abstract":"<div><h3>Background</h3><div>Systematic pelvic and para-aortic lymphadenectomy is the standard procedure for surgical staging in apparently early-stage ovarian cancer. The role of sentinel lymph node biopsy remains unclear.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic accuracy, feasibility, and safety of sentinel lymph node biopsy when performed by a single operator with a standardized technique.</div></div><div><h3>Methods</h3><div>Case series of 36 patients with apparently early-stage ovarian cancer who underwent surgery performed by a single operator following the SELLY trial protocol. Sentinel lymph node mapping was performed by injecting the tracer into the infundibulopelvic and utero-ovarian ligaments. Sentinel node biopsy was followed by systematic pelvic and para-aortic lymphadenectomy.</div></div><div><h3>Results</h3><div>Thirty-six consecutive patients with apparently early-stage ovarian cancer were enrolled; 22 patients underwent immediate surgery and 14 delayed procedures after incidental diagnosis. 86.1 % of patients had successful mapping of at least one SLN, and 54.8 % had successful mapping in both pelvic and para-aortic regions. Three patients had isolated tumor cells (ITCs) and one patient had macro-metastasis in SLN. No cases of false negative SLN were observed. The sensitivity and negative predictive value were 100 %. We had five (13.9 %) postoperative complications not related to the SLN procedure itself.</div></div><div><h3>Conclusion</h3><div>SLN is a reliable and safe surgical procedure in apparent early-stage ovarian cancer regardless of immediate and delayed surgery, but strict protocol adherence and expert surgeons are mandatory. SLN mapping in apparent early-stage ovarian cancer is feasible and accurate in detecting lymph node metastasis.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110394"},"PeriodicalIF":2.9,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axillary surgery in early breast cancer: real-world analysis of the INSEMA-trial at three certified university breast cancer centers in Germany regarding the omission of sentinel lymph node biopsy","authors":"Nikolas Tauber ,&nbsp;Anna-Christina Rambow ,&nbsp;Clara Gasthaus ,&nbsp;Franziska Fick ,&nbsp;Isabell Grande-Nagel ,&nbsp;Lisbeth Hilmer ,&nbsp;Fabian Kohls ,&nbsp;Natalia Krawczyk ,&nbsp;Huy Duc Le ,&nbsp;Mohamed Elessawy ,&nbsp;Nicolai Maass ,&nbsp;Volkmar Müller ,&nbsp;Achim Rody ,&nbsp;Karl W.F. Schäfer ,&nbsp;Barbara Schmalfeldt ,&nbsp;Lisa Steinhilper ,&nbsp;Maggie Banys-Paluchowski ,&nbsp;Marion Tina van Mackelenbergh","doi":"10.1016/j.ejso.2025.110392","DOIUrl":"10.1016/j.ejso.2025.110392","url":null,"abstract":"<div><h3>Background</h3><div>Recent trials such as INSEMA and SOUND have demonstrated the oncological safety of omitting sentinel lymph node biopsy in selected patients with hormone receptor-positive, HER2-negative early breast cancer. However, the implications for adjuvant treatment decisions in routine clinical practice remain unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicenter cohort study from university breast cancer centers, analyzing 867 patients diagnosed between 2020 and 2024 who met INSEMA criteria: cT1, G1-2, age ≥50 years, clinically node-negative, undergoing breast-conserving surgery. We evaluated the incidence of pathologically positive lymph nodes, frequency of postoperative upgrades in tumor stage or grading, and potential impact on adjuvant therapy decisions, including indications for CDK4/6 inhibitors, secondary axillary surgery or radiation.</div></div><div><h3>Results</h3><div>Sentinel lymph node biopsy revealed occult lymph node metastases in 14.3 % (n = 124) of patients, with a false-negative rate of 10.5 % when micrometastases and isolated tumor cells were excluded. In 11.6 % of cases, nodal positivity led to relevant therapeutic changes, including chemotherapy, axillary radiation, or potential adjuvant CDK4/6 inhibitor therapy. Moreover, 18.8 % of patients would have required secondary axillary surgery due to postoperative upgrades in tumor characteristics. The number needed to operate to prevent one invasive recurrence with CDK4/6 inhibitors varies significantly based on age and clinical tumor size, ranging from 1:333 (maximum) to 1:111 (minimum).</div></div><div><h3>Conclusion</h3><div>While omission of sentinel lymph node biopsy appears safe in selected patients, our real-world data suggest that axillary staging retains clinical relevance for guiding personalized treatment, unless other prognostic tests like gene expression profiles are used.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"Article 110392"},"PeriodicalIF":2.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-treatment S-index as a promising prognostic indicator of treatment response and survival in patients with synchronous colorectal liver metastases: A retrospective multi-center study","authors":"Yiqiao Deng ,&nbsp;Yuan Li ,&nbsp;Rui Zhang ,&nbsp;Zhijie Wang ,&nbsp;Rui Guo ,&nbsp;Xinyu Bi ,&nbsp;Jianjun Zhao ,&nbsp;Jianguo Zhou ,&nbsp;Zhiyu Li ,&nbsp;Rui Zhang ,&nbsp;Qichen Chen ,&nbsp;Hong Zhao","doi":"10.1016/j.ejso.2025.110371","DOIUrl":"10.1016/j.ejso.2025.110371","url":null,"abstract":"<div><h3>Background</h3><div>Patients with synchronous colorectal cancer liver metastasis (CRLM) often face sub-optimal outcomes from systemic therapy or resection. This study investigates the prognostic value of the pre-treatment S-index, a reliable non-invasive marker for liver fibrosis, for outcomes in synchronous CRLM patients.</div></div><div><h3>Methods</h3><div>This study included two populations of patients with synchronous CRLM: one population undergoing resection and another population receiving systemic therapy for unresectable CRLM. Pre-treatment S-index levels were assessed from blood samples. Patients were categorized into high and low S-index groups, and comparisons were made regarding outcomes: progression-free survival (PFS), early post-operative recurrence and fibrosis in liver metastases in the resection population, and treatment response in the systemic therapy population. Multiplex immunohistochemistry/immunofluorescence (mIHC/IF) was used to investigate the distribution of immunosuppressive T-cell subsets in liver metastases.</div></div><div><h3>Results</h3><div>For synchronous CRLM patients receiving resection (n = 1000), patients with high preoperative S-index demonstrated significantly worse PFS both before (HR = 1.556, 95 % CI: 1.255–1.929; <em>P</em> &lt; 0.001) and after IPTW-adjusted Cox proportional hazards regression analysis (IPTW-adjusted HR = 1.439, 95 % CI: 1.094–1.894; <em>P</em> = 0.036). High S-index patients also exhibited an elevated risk of early recurrence, both before and after adjustment (OR = 1.556, 95 % CI: 1.255–1.929, <em>P</em> &lt; 0.001; IPTW-adjusted OR = 1.439, 95 % CI: 1.094–1.894, <em>P</em> = 0.009). For synchronous CRLM patients receiving system therapy (n = 123), a high pre-treatment S-index (OR = 34.691, <em>P</em> = 0.005) was a significant predictor of progression disease in multivariate analyses. Further, the S-index showed an AUC of 0.814 (95 %CI: 0.762–0.866, <em>P</em> &lt; 0.001) for detecting fibrosis in liver metastases, with a specificity of 0.928. mIHC/IF analysis revealed that inhibitory T cells, especially CD4⁺PD1⁺ T cells and CD4⁺FOXP3⁺ T cells, were significantly elevated in the liver metastases of the high S-index group.</div></div><div><h3>Conclusion</h3><div>This study contributed valuable evidence regarding pre-treatment S-index for association with outcomes among synchronous CRLM patients receiving resection or system therapy. Furthermore, it underscores a significant association between a high S-index and the presence of fibrosis in liver metastases, as well as more infiltration of immunosuppressive T cells in the tumor.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110371"},"PeriodicalIF":2.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transparency in Externally Validated Models: A systematic review of machine learning vs. logistic regression for predicting colorectal anastomotic leakage","authors":"Sara Ben Hmido ,&nbsp;Houssam Abder Rahim ,&nbsp;Erik W. Ingwersen ,&nbsp;George Burchell ,&nbsp;Roel Hompes ,&nbsp;Donald van der Peet ,&nbsp;Eric Sonneveld ,&nbsp;Geert Kazemier ,&nbsp;Freek Daams","doi":"10.1016/j.ejso.2025.110367","DOIUrl":"10.1016/j.ejso.2025.110367","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal resection carries a 2.8 %–30 % risk of anastomotic leakage. Machine learning can estimate risks and guide decisions, but clinical implementation remains inadequate due to transparency issues. This review assesses the performance and transparency of machine learning models compared to logistic regression.</div></div><div><h3>Methods</h3><div>A systematic review followed PRISMA guidelines. Medline, Embase, Web of Science, and Cochrane databases were searched for studies using Logistic Regression or Machine Learning with external validation for colorectal anastomotic leakage prediction. Data were extracted using CHARMS, risk of bias assessed with PROBAST, and transparency with TRIPOD + AI.</div></div><div><h3>Results</h3><div>Ten studies were included. Machine learning models were validated on smaller cohorts than logistic regression. Transparency scores ranged from 29 % to 63 %, averaging 45 % for logistic regression and 43 % for machine learning. Reporting of missing data was inconsistent, and external validation was limited. Most studies had a high risk of bias due to small sample sizes and low event counts.</div></div><div><h3>Conclusion</h3><div>In comparison to Logistic regression studies, machine learning studies are limited by small cohorts, low outcome numbers, and a lower level of transparency. Future research should prioritise transparency, adhere to TRIPOD + AI standards, and develop LR and ML models in parallel using the same datasets while ensuring separate models for colon and rectal surgery. Currently, these models are not yet suitable for clinical implementation; more robust and transparent models must be developed based on these recommendations before they can be applied in clinical practice.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"Article 110367"},"PeriodicalIF":2.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}