Ejso最新文献

{"title":"Efficacy and safety of extended duration postoperative thromboprophylaxis with low molecular weight heparin among subgroups of patients undergoing surgical resection of colorectal cancer: A post-hoc analysis of the PERIOP-01 trial","authors":"Laura Girardi ,&nbsp;Ranjeeta Mallick ,&nbsp;Tzu-Fei Wang ,&nbsp;Marc Carrier ,&nbsp;Rebecca Auer ,&nbsp;the PERIOP-01 investigators","doi":"10.1016/j.ejso.2025.109701","DOIUrl":"10.1016/j.ejso.2025.109701","url":null,"abstract":"<div><h3>Background</h3><div>Extended duration postoperative thromboprophylaxis is suggested by clinical practice guidelines after any cancer-related major abdominal surgeries. However, recent evidence reported relatively low rates of symptomatic venous thromboembolism (VTE) after colorectal cancer surgeries, suggesting the need of a careful risk-benefit assessment in this setting.</div></div><div><h3>Methods</h3><div>This is a pre-planned post-hoc analysis of the PERIOP-01 trial which compared extended to standard thromboprophylaxis in patients undergoing surgical resection of localized colorectal cancer. Subgroup analyses were performed based on different baseline characteristics. The primary efficacy and safety outcomes were major VTE and clinically relevant bleeding events, respectively.</div></div><div><h3>Results</h3><div>A total of 614 patients were included in the modified intention-to-treat analysis (307 patients in each group). Major VTE events occurred in 2 % and 1 % of the extended and standard-duration thromboprophylaxis groups, respectively. Clinically relevant bleeding events occurred in 3 % of each group. No specific characteristics were found to be associated with a decreased incidence of major VTE among patients receiving extended thromboprophylaxis. Patients with colon cancer resection receiving extended thromboprophylaxis were at an increased risk of clinically relevant bleeding (HR 2.57, 95%CI 1.25–5.30). Other characteristics that may be associated with an increased incidence of bleeding included age (≥75) (HR 2.37, 95%CI 0.47–11.98) and sex (HR 2.13, 95%CI 0.20–23.17).</div></div><div><h3>Conclusions</h3><div>In the PERIOP-01 trial, extended thromboprophylaxis did not reduce the incidence of major VTE in any subgroups of patients. However, this strategy may be associated with an increased incidence of bleeding among patients with colon cancer, and perhaps among male and elderly patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109701"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term morbidity following primary closure, skin grafting and flap reconstruction after surgical resection of extremity soft-tissue sarcomas: Pushing the limits of limb preservation","authors":"J.D. Generaal ,&nbsp;M.R.F. Bosscher ,&nbsp;L.B. Been ,&nbsp;B.L. van Leeuwen","doi":"10.1016/j.ejso.2025.109705","DOIUrl":"10.1016/j.ejso.2025.109705","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding short-term morbidity following extremity soft-tissue sarcoma (ESTS) treatment remains complex due to diverse findings and the absence of a standardized wound complication assessment. This retrospective cohort study evaluated short-term morbidity following primary closure, skin grafting, and flap reconstruction.</div></div><div><h3>Materials and methods</h3><div>All ESTS patients treated in a sarcoma center in the Netherlands from 1-1–2010 until 1-8-2022 were included. Short-term morbidity, defined as a wound complication following surgery, was assessed by the Toronto Sarcoma Flap Score (TSFS). The TSFS is an ordinal scale, where 0 indicates the absence of complications, while 10 signifies reconstructive failure necessitating amputation. Hospital stay duration and readmission rates were also analyzed.</div></div><div><h3>Results</h3><div>Limb preservation was achieved in 128 (97.7 %) of 131 patients. Wound complications occurred in 43 (44.3 %) of patients with primary closure, 8 (57.1 %) with skin grafting and 16 (80.0 %) with flap reconstruction, p = 0.01. Patients undergoing flap reconstructions had higher TSFSs (6 [IQR 7], versus 0 [IQR 3] for primary closure and 3 [IQR 6] for skin grafting), longer duration of hospital stays (14 [IQR 18] days versus 4 [IQR 3] days for primary closure and 5 [IQR 7] days for skin grafting, p &lt; 0.01) and were more frequently readmitted (40.0 %, versus 17.5 % for primary closure and 21.4 % for skin grafting, p = 0.09).</div></div><div><h3>Conclusion</h3><div>High limb preservation rates were achieved. Reconstructive surgery allows for the closure of extensive soft-tissue defects following ESTS resection, but it adds to surgical complexity. Patients undergoing flap reconstruction seem to be at a higher risk of short-term morbidity.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109705"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An R0 resection margin does improve overall survival after PDAC resection– real-world evidence from 6.000 cases from the German Cancer Registry Group","authors":"Lennart von Fritsch ,&nbsp;Jannis Duhn ,&nbsp;Thaer S.A. Abdalla ,&nbsp;Kim C. Honselmann ,&nbsp;Louisa Bolm ,&nbsp;Rüdiger Braun ,&nbsp;Markus Kist ,&nbsp;Hryhoriy Lapshyn ,&nbsp;Sylke Ruth Zeissig ,&nbsp;Monika Klinkhammer-Schalke ,&nbsp;Kees Kleihues van Tol ,&nbsp;Stanislav Litkevych ,&nbsp;Fabian Reinwald ,&nbsp;Andrea Sackmann ,&nbsp;Bianca Franke ,&nbsp;Bernd Holleczek ,&nbsp;Anna Krauß ,&nbsp;Steffen Deichmann ,&nbsp;Tobias Keck ,&nbsp;Ulrich F. Wellner","doi":"10.1016/j.ejso.2025.109693","DOIUrl":"10.1016/j.ejso.2025.109693","url":null,"abstract":"<div><h3>Background</h3><div>To date surgical resection is the only curative treatment option for pancreatic ductal adenocarcinoma (PDAC). However, survival rates are poor. Resection margins have long been used as a surrogate to evaluate success of the surgery. Their prognostic value and biologic implications remain disputed.</div></div><div><h3>Methods</h3><div>Data was obtained from pooled data of 17 clinical cancer registries in Germany collated by the German Cancer Registry Group of the Association of German Tumor Centers. Overall and disease-free survival (OS/DFS) after 5.997 PDAC resections with documented margin status were analyzed using Kaplan-Meier analyses. Subgroups by type of surgery and lymph node involvement were analyzed. Cox regression for OS and multivariable regression analysis for the endpoint resection margin negative/positive (R0/R1) were performed.</div></div><div><h3>Results</h3><div>Both the median OS (19.3 vs. 13.4 months, R0/R1, respectively) and DFS (14.2 vs. 10.9 months, R0/R1, respectively) were improved for margin negative cases (R0). These differences were also observed after stratifying for lymph node involvement or the type of surgery (pancreas head resection, left resection, or total pancreatectomy). Cox regression revealed a positive margin (R1) to be independently associated with a poor survival (hazard ratio 1.41). Tumor size, perineural invasion, and lymph node involvement were the strongest predictors of a margin-positive resection (R1) in multivariable regression analysis.</div></div><div><h3>Conclusion</h3><div>In this large population-based study, margin status was an independent risk factor for OS and DFS after PDAC resection, even after controlling for confounding factors. Therefore, resection margin is not only a mediator variable between tumor biology and outcome.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109693"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the tumor location in rectal cancer – Practice variations and impact on treatment decision making","authors":"Elisabeth P. Goedegebuure ,&nbsp;Francesco M. Arico ,&nbsp;Max J. Lahaye ,&nbsp;Monique Maas ,&nbsp;Geerard L. Beets ,&nbsp;Femke P. Peters ,&nbsp;Monique E. van Leerdam ,&nbsp;Regina G.H. Beets-Tan ,&nbsp;Doenja M.J. Lambregts","doi":"10.1016/j.ejso.2025.109700","DOIUrl":"10.1016/j.ejso.2025.109700","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize differences in current guideline recommendations for rectal tumor localization and generate an overview of published MRI measurement methods and their correlation with endoscopy.</div></div><div><h3>Summaryof background data</h3><div>Rectal tumor location is a well-known factor that impacts treatment planning, but there is currently no consensus on the optimal method to define it.</div></div><div><h3>Methods</h3><div>A literature search was conducted to retrieve clinical and radiological rectal cancer guidelines as well as original research studies on MRI-based measurements. Guidelines were assessed for definitions, landmarks, modalities and measurement methods to define tumor location, and how these impact treatment planning. Research studies were evaluated to compare MRI-methods and their correlation with endoscopy.</div></div><div><h3>Results</h3><div>18 clinical and 6 radiological guidelines were retrieved. In 83 % of clinical guidelines tumor location (low/middle/high) is included in the treatment algorithm as a factor impacting surgical and/or neoadjuvant treatment. Measurement cut-offs and landmarks vary significantly with the anal verge being the most commonly used landmark (28 %). Thirty-nine percent of clinical guidelines offer no definitions to define rectal tumor location. The majority of research studies (67 %) reported good-excellent agreement between MRI and endoscopy, though measurement differences of up to 2.5 cm were reported.</div></div><div><h3>Conclusion</h3><div>There is substantial variation in definitions and landmarks recommended in current guidelines to measure and classify rectal tumor location. This may affect treatment planning as well as trial inclusions, highlighting the need for standardized methods that better align between clinical and radiological guidelines.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109700"},"PeriodicalIF":3.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663005","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":"Neoadjuvant chemotherapy and chemoradiotherapy versus chemoradiotherapy alone in high-risk locally advanced rectal cancer: A retrospective comparison of two Dutch tertiary referral centres","authors":"K. van den Berg ,&nbsp;E. Banken ,&nbsp;J.M. van Rees ,&nbsp;L.M. Coolen ,&nbsp;M. de Vries ,&nbsp;E.L.K. Voogt ,&nbsp;J. Rothbarth ,&nbsp;H.J.T. Rutten ,&nbsp;J. Nederend ,&nbsp;I.E.G. van Hellemond ,&nbsp;G.J.M. Creemers ,&nbsp;C. Verhoef ,&nbsp;J.W.A. Burger","doi":"10.1016/j.ejso.2025.109699","DOIUrl":"10.1016/j.ejso.2025.109699","url":null,"abstract":"<div><h3>Introduction</h3><div>The effect of neoadjuvant chemotherapy and chemoradiotherapy in patients with locally advanced rectal cancer, at increased risk of failing current treatment regimens, is unknown. This study compared the complete response rate and long-term survival of these patients treated with or without neoadjuvant chemotherapy prior to chemoradiotherapy.</div></div><div><h3>Materials and methods</h3><div>Patients with high-risk locally advanced rectal cancer, who were surgically treated or entered a watch and wait approach after neoadjuvant chemoradiotherapy with or without neoadjuvant chemotherapy in Erasmus Medical Centre or Catharina Hospital between 2016 and 2020, were retrospectively identified. High-risk was defined as the presence of tumour invasion into the mesorectal fascia, grade 4 extramural venous invasion, enlarged lateral lymph nodes, or tumour deposits. The primary endpoint was complete response rate, which was defined as a histopathological complete response or a sustained (during 12 months) clinical complete response. Long-term oncological outcomes were evaluated based on Kaplan-Meier and Cox regression survival analyses.</div></div><div><h3>Results</h3><div>The neoadjuvant chemotherapy group consisted of 64 patients, of whom 61 (95.3 %) were treated with chemotherapy prior to chemoradiotherapy, the chemoradiotherapy group of 194 patients. The complete response rates were 25.0 % and 9.8 %, respectively (<em>P</em> = 0.002<em>)</em>. The estimated 3-year overall survival was 92.2 % in the neoadjuvant chemotherapy group versus 66.9 % in the chemoradiotherapy group.</div></div><div><h3>Conclusion</h3><div>Excellent oncological outcomes were observed in patients with high-risk locally advanced rectal cancer selected during a multidisciplinary team (MDT) meeting for neoadjuvant chemotherapy and chemoradiotherapy. The actual difference with patients treated with chemoradiotherapy alone should be investigated in prospective trials. Pretreatment referral to expert MDTs is encouraged.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109699"},"PeriodicalIF":3.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471707","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":"Optimal timing of surgery after neoadjuvant chemoradiotherapy in rectal cancer: A retrospective analysis","authors":"Mojtaba Ahmadinejad ,&nbsp;Arash Parvizi ,&nbsp;Saman Sheikhi ,&nbsp;Fatemeh Eghbal ,&nbsp;Susan Navabian ,&nbsp;Faranak Chaboki ,&nbsp;Mohammad Hadi Bahri ,&nbsp;Ramin Bozorgmehr ,&nbsp;Javad Zebarjadi Bagherpour ,&nbsp;Shirin Ziaie","doi":"10.1016/j.ejso.2025.109702","DOIUrl":"10.1016/j.ejso.2025.109702","url":null,"abstract":"<div><h3>Background</h3><div>Determining the optimal interval between neoadjuvant chemoradiotherapy (NCRT) and surgery in patients with locally advanced rectal cancer (LARC) remains crucial for improving treatment outcomes. Extending the interval may increase rates of pathological complete response (pCR), potentially enhancing survival and reducing recurrence.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 226 patients with LARC who underwent NCRT followed by surgery. ROC analysis was used to establish the optimal interval between NCRT and surgery for achieving pCR, and multivariate logistic regression assessed independent predictors of pCR. Spline regression further analyzed the relationship between surgery timing and the probability of pCR.</div></div><div><h3>Results</h3><div>ROC analysis identified 10.5 weeks as the optimal interval, showing increased pCR rates within this period. Multivariate analysis confirmed that surgery interval (OR = 2.603, P = 0.045) significantly predicted pCR. Both ROC and spline regression indicated that a 9–11-week interval maximizes pCR probability. Notably, the comparison of postoperative complications between groups with surgery intervals ≤10 weeks and &gt;10 weeks showed no statistically significant differences (P = 0.518).</div></div><div><h3>Conclusion</h3><div>An interval of 9–11 weeks between NCRT and surgery optimizes pCR rates without increasing postoperative risks. This timeframe may serve as a favorable window for surgical intervention to enhance outcomes in rectal cancer patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109702"},"PeriodicalIF":3.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488260","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":"Fit4Surgery app: Home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery","authors":"Lennaert CB. Groen ,&nbsp;Thomas GC. Timmers ,&nbsp;Freek D. Daams ,&nbsp;Hieronymus J. Doodeman ,&nbsp;Hermien WH. Schreurs ,&nbsp;Emma RJ. Bruns","doi":"10.1016/j.ejso.2025.109691","DOIUrl":"10.1016/j.ejso.2025.109691","url":null,"abstract":"<div><h3>Background</h3><div>Supervised multimodal prehabilitation prior to colorectal cancer (CRC) surgery is associated with reduced complications and enhanced recovery. However, it is labor intensive and expensive. In an aging population with increasing demand and costs on healthcare and staff shortages, home-based prehabilitation (HBP) with an app could be of interest. This study assessed the effectiveness of a Fit4Surgery app in CRC surgery.</div></div><div><h3>Method</h3><div>The app was effectuated in a prospective cohort study of 100 CRC patients <strong>≥</strong>60 years from October 2021–December 2022. The primary outcome was preservation or improvement of the 6-minute walking test (6MWT) six weeks postoperative, compared to baseline. Secondary outcomes were 90-day complication and mortality rate, 90-day readmission, length of stay, 6MWT and Short Performance Physical Battery (SPPB) at different timepoints and total costs.</div></div><div><h3>Results</h3><div>Three patients needed urgent surgery, remaining 97 patients (mean age 72) using the app for at least three weeks. The 6MWT was preserved in 74.7 % with a 12.1 m higher mean six weeks postoperative, compared to baseline (p = 0.194). A significant higher 6MWT was observed after prehabilitation and one year postoperative, compared to baseline (p=&lt;0.001). The SPPB was significant higher at all timepoints. Overall 90-day complication rate was 25.8 %, readmission rate 6.3 % and mortality occurred in 2.1 %. Total costs were €518.50 per patient.</div></div><div><h3>Conclusion</h3><div>This is the first study of multimodal HBP by an app for CRC surgery patients with high compliance. Results show promising results regarding functional capacity and a low occurrence of complications, in line with multimodal supervised prehabilitation. This by reducing costs by half.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109691"},"PeriodicalIF":3.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552234","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 exciting journey of progress: Exploring FIGO 2023 staging for endometrial cancer at a leading ESGO institution","authors":"Tommaso Occhiali ,&nbsp;Alice Poli ,&nbsp;Martina Arcieri ,&nbsp;Lorenza Driul ,&nbsp;Antonino Ditto ,&nbsp;Giorgio Bogani ,&nbsp;Andrea Mariani ,&nbsp;Giovanni Scambia ,&nbsp;Stefano Restaino ,&nbsp;Giuseppe Vizzielli","doi":"10.1016/j.ejso.2025.109695","DOIUrl":"10.1016/j.ejso.2025.109695","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2023 FIGO staging of endometrial cancer integrates tumor grade and histology along with molecular features that recognize the prognostic significance of p53 and POLE mutations, accounting for potential conflicts such as lymphovascular space invasion and subserosal invasion.</div></div><div><h3>Materials and methods</h3><div>In this single-institution retrospective study, data were collected on 229 endometrial cancer patients from January 2020 to September 2024 and re-stage them according to FIGO 2023 criteria.</div></div><div><h3>Results</h3><div>From FIGO stage 2009 IA, 70 patients do not cross stage (21 are FIGO 2023 IA1 and 49 IA2), 8 patients are upgraded to FIGO IC because of aggressive histotype; 1 is upstaged because of substantial LVSI, and 12 because of aggressive myoinfiltrating tumors (23 % of upstaging). From FIGO 2009 stage IB 34 patients remain in FIGO 2023 IB, while 5 become stage IIB (LVSI) and 27 IIC (aggressive myoinfiltrating), for a total of 32 upstages (48 % of upstaging). Within FIGO 2009 stage II, no proper upstage was possible. We observed a statistical correlation between stages and BMI, as well as between stages and age, for both FIGO 2009 (p = 0.009 and p &lt; 0.001 respectively) and FIGO 2023 (p = 0.002 and p = 0.003 respectively) classifications. Additionally, a correlation was found between tumor grade and BMI (p = 0.02).</div></div><div><h3>Conclusions</h3><div>The FIGO 2023 staging system is gaining importance as recent studies highlight the role of molecular classification in prognosis and personalized therapy. Updating our study's follow-up data will clarify its impact in clinical practice.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109695"},"PeriodicalIF":3.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological characteristics, long-term prognosis and follow-up recommendations of primary and secondary cutaneous angiosarcoma: A Danish nationwide population-based cohort study","authors":"Kiya Abebe ,&nbsp;Ida Wulff ,&nbsp;Katrine Voss Thorsen ,&nbsp;Anne Lene Wagenblast ,&nbsp;Grethe Schmidt ,&nbsp;David Hebbelstrup Jensen ,&nbsp;Christina Enciso Holm ,&nbsp;Michael M. Petersen ,&nbsp;Anand C. Loya ,&nbsp;Thomas Mentzel ,&nbsp;Mikkel Herly ,&nbsp;Mathias Ørholt ,&nbsp;Peter Vester-Glowinski","doi":"10.1016/j.ejso.2025.109680","DOIUrl":"10.1016/j.ejso.2025.109680","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic impact of subclassifying tumors as primary and secondary cutaneous angiosarcoma (cAS) in terms of the risk of local recurrence, metastasis, disease-specific mortality, and overall survival has not been extensively investigated in previous studies.</div><div>This study aimed to characterize the clinicopathological features and estimate the 2-, 5-, and 10-year rates of local recurrence, metastasis, disease-specific death, and overall survival for patients with primary and secondary cAS, and to propose a follow-up recommendation for these patients.</div></div><div><h3>Methods</h3><div>All Danish patients diagnosed with cAS between 2000 and 2023 were included. The prognosis was estimated using age- and sex-standardized stratified cause-specific Cox-regression with all-cause mortality as a competing risk.</div></div><div><h3>Results</h3><div>A total of 192 patients were included, comprising 99 patients with primary cAS and 93 with secondary cAS. The 5-year local recurrence rate was similar between primary (42 %) and secondary cAS (39 %). However, patients with primary cAS exhibited a higher 5-year rate of metastasis (50 %) compared to those with secondary cAS (33 %). Similarly, the 5-year disease-specific mortality was substantially higher in patients with primary cAS (57 %) compared to secondary cAS (35 %). Correspondingly, the 5-year overall survival rate was low in both primary (32 %) and secondary cAS (49 %).</div></div><div><h3>Conclusion</h3><div>Primary cAS is associated with poorer 5-year outcomes of metastasis, disease-specific death, and overall survival compared with secondary cAS. Follow-up could be limited to 5 years, as &gt;95 % of the relapses occurred within this period and may include clinical examinations and local MRI to detect local recurrences, and cross-sectional imaging to detect regional and distant metastases.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109680"},"PeriodicalIF":3.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of changes in stage by the new N category in the 9th edition of lung cancer staging for resected non-small cell lung cancer","authors":"Yura Ahn ,&nbsp;Sang Min Lee ,&nbsp;Jooae Choe ,&nbsp;Sehoon Choi ,&nbsp;Kyung-Hyun Do ,&nbsp;Joon Beom Seo","doi":"10.1016/j.ejso.2025.109690","DOIUrl":"10.1016/j.ejso.2025.109690","url":null,"abstract":"<div><h3>Introduction</h3><div>The reclassification following N2 subcategorization (N2a vs. N2b) in the 9th edition of lung cancer staging has not yet been externally validated. This study aimed to evaluate and compare the survival outcomes of reclassified stages in patients with resected non-small cell lung cancer.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent lobectomy or pneumonectomy for non-small cell lung cancer between January 2015 and December 2021 were retrospectively analyzed. Overall survival (OS) comparison and risk stratification within the pathologic N category (pN0, 1, 2a, 2b), node-positive T1 tumors (T1N1, T1N2a, T1N2b), stage IIB tumors (T1N2a, T2N1, T3N0), and T2–3N2 tumors (stage IIIA, IIIB) were performed using the Kaplan–Meier method and multivariable Cox proportional hazards analysis.</div></div><div><h3>Results</h3><div>A total of 3864 patients were analyzed, including 962 patients with pathologically node-positive tumors. pN2a and pN2b tumors exhibited distinct survival (<em>p</em> &lt; 0.001). Survival separation between neighboring pT1N1-2b tumors was statistically marginal (<em>p</em> = 0.06 and 0.09); however, clear separation was observed in clinical T1 tumors (<em>p</em> &lt; 0.05). pT1N2a tumors that were downstaged from stage IIIA to stage IIB showed comparable survival to other stage IIB tumors (vs. pT2N1 and pT3N0; <em>p</em> = 0.79 and 0.35, respectively). In pT2-3 tumors (stage IIIA and IIIB), OS risk stratification between pN2a and pN2b tumors, except for between pT3N2a and pT2N2b, was valid (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The reclassification of stages in the 9th edition of lung cancer staging based on N2 subcategorization is considered reasonable.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109690"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488107","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}