Ejso最新文献

{"title":"Survival outcome comparison of neoadjuvant and perioperative ICI-based therapies in patients with non-small cell lung cancer achieving MPR or pCR: a systematic review and meta-analysis","authors":"Ye Tao ,&nbsp;Xiang Li ,&nbsp;Xinrun Cui ,&nbsp;Dachuan Zhao ,&nbsp;Bing Liu ,&nbsp;Yaqi Wang ,&nbsp;Haoxuan Du ,&nbsp;Zengjin Wen ,&nbsp;Shi Yan ,&nbsp;Nan Wu","doi":"10.1016/j.ejso.2025.110148","DOIUrl":"10.1016/j.ejso.2025.110148","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to compare the survival benefits of perioperative versus neoadjuvant immune checkpoint inhibitors (ICI)-based therapy in patients with resectable non-small cell lung cancer (NSCLC), focusing specifically on those who achieve major pathological response (MPR) or pathological complete response (pCR) following neoadjuvant ICI-based treatment.</div></div><div><h3>Method</h3><div>s: A systematic literature review was performed using PubMed, Embase, Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases. A trial-level proportional meta-analysis was conducted to compare the two treatment modalities. A patient-level-based analysis was also conducted to obtain more evidence of different perioperative treatment regimens. Cox regression and accelerated failure time models were used to analyze the survival benefits in patients who achieved MPR or pCR for the proper treatment modality.</div></div><div><h3>Results</h3><div>Twenty-three studies were included in the trial-level proportional meta-analysis, wherein no statistical significance was observed in the 1-, 2-, and 3-year event-free survival (EFS) rates between patients with MPR and pCR receiving perioperative or neoadjuvant ICI-based therapy. The pooled median EFS (mEFS) was 40.1 and 32.1 months in patients with MPR receiving perioperative and neoadjuvant ICI-based therapies, respectively. Meanwhile, the pooled mEFS was 35.4 and 34.2 months in patients with pCR receiving perioperative and neoadjuvant ICI-based therapies, respectively. Multivariable Cox analysis showed that perioperative chemoimmunotherapy was a favorable prognostic factor compared with neoadjuvant chemoimmunotherapy in MPR patients (P = 0.038), but not in those with pCR (P = 0.408).</div></div><div><h3>Conclusions</h3><div>The EFS were similar among patients with NSCLC who received neoadjuvant and perioperative ICI-based treatment and achieved MPR or pCR. Multivariable Cox analysis indicated that perioperative chemoimmunotherapy was a favorable prognostic factor in patients who achieved MPR after neoadjuvant chemoimmunotherapy, but not in those who reached pCR.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110148"},"PeriodicalIF":3.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167692","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 prognostic effect of recurrent laryngeal nerve palsy after esophagectomy in locally advanced esophageal squamous cell carcinoma: A multi-center retrospective study","authors":"Koichi Ogawa ,&nbsp;Takeshi Toyozumi ,&nbsp;Kazuhiro Noma ,&nbsp;Yoshimasa Akashi ,&nbsp;Yohei Owada ,&nbsp;Masashi Hashimoto ,&nbsp;Zennichiro Saze ,&nbsp;Masayuki Kano ,&nbsp;Yoshihiro Nabeya ,&nbsp;Koji Kono ,&nbsp;Toshiyoshi Fujiwawa ,&nbsp;Kazushi Maruo ,&nbsp;Hisahiro Matsubara ,&nbsp;Tatsuya Oda","doi":"10.1016/j.ejso.2025.110151","DOIUrl":"10.1016/j.ejso.2025.110151","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pneumonia following esophagectomy has been shown to adversely affect prognosis, whereas the prognostic significance of recurrent laryngeal nerve palsy (RLNP) remains unclear. This multicenter Japanese study aimed to evaluate the impact of RLNP on prognosis in patients undergoing esophagectomy for locally advanced esophageal squamous cell carcinoma (ESCC).</div></div><div><h3>Methods</h3><div>A total of 343 patients with clinical Stage I–IVA ESCC who underwent esophagectomy between 2010 and 2019 at five Japanese specialized esophageal cancer centers was retrospectively collected. The occurrence of RLNP was assessed for its association with short- and long-term outcomes.</div></div><div><h3>Results</h3><div>RLNP was observed in 65 patients (19.0 %). The 3-year overall survival (OS) rates were 69.8 % in the RLNP+ group and 70.5 % in the RLNP− group, with no significant difference (hazard ratio [HR]: 1.02, 95 % confidence interval [CI]: 0.65–1.59, p = 0.95). RLNP was significantly associated with clinical N-positive status (p = 0.04) and intrathoracic anastomosis (p = 0.03) but was not correlated with other clinicopathological or perioperative factors. Although RLNP+ patients had longer postoperative hospital stays, there were no significant differences in operative time, blood loss, number of harvested lymph nodes, or rates of postoperative complications, including pneumonia and anastomotic leakage. Multivariable analysis identified postoperative pneumonia as a poor prognostic factor for OS (HR: 1.60, 95 % CI: 1.06–2.41, p = 0.03), whereas RLNP was not (HR: 0.91, 95 % CI: 0.58–1.43, p = 0.69).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that RLNP following esophagectomy for locally advanced ESCC does not significantly affect long-term survival.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110151"},"PeriodicalIF":3.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089285","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":"Investigation of neoadjuvant gemcitabine plus cisplatin-based triplet regimens on biliary tract cancer with possible lymph node metastasis","authors":"Shogo Kobayashi,&nbsp;Hirofumi Akita,&nbsp;Daisaku Yamada,&nbsp;Kazuki Sasaki,&nbsp;Shinichiro Hasegawa,&nbsp;Yoshito Tomimaru,&nbsp;Takehiro Noda,&nbsp;Hidenori Takahashi,&nbsp;Yuichiro Doki,&nbsp;Hidetoshi Eguchi","doi":"10.1016/j.ejso.2025.110149","DOIUrl":"10.1016/j.ejso.2025.110149","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary tract cancer (BTC) is rare. The treatment outcomes in patients with lymph node (LN) metastasis diagnosed by FDG-PET or a biopsy—who are considered to be ‘biologically borderline resectable’—are poor. However, perioperative treatment is still under development. Recently, gemcitabine plus cisplatin (GC)-based triplet regimens for unresectable BTC have been developed. We applied GC-based triplet therapy in BTC with LN metastasis.</div></div><div><h3>Methods</h3><div>We administered GC plus S-1 therapy (GCS) or nab-paclitaxel therapy (GCnP) to 30 patients with LN metastasis diagnosed by FDG-PET or a biopsy (GC-based triplet group). A dataset of BTC with FDG-positive LNs, previously used for an analysis of the diagnosis and treatment outcomes according to FDG uptake, was used as a control (upfront surgery group, n = 19).</div></div><div><h3>Results</h3><div>GCS and GCnP were used by 22 and 8 patients, respectively. The median treatment period was 79 days, the objective response rate was 47 %, the tumor control rate was 87 %, and 22 patients underwent R0 resection (73 %). The groups showed no significant differences with the exception of the FDG uptake by the main tumor. The three-year overall survival (OS) rates in the GC-based triplet and upfront surgery groups were 45.4 % and 15.8 %, respectively (P = 0.0052); there were no significant differences in progression-free or recurrence-free survival. A sub-analysis showed that normalized CA19-9 levels provided better survival than non-normalized CA19-9 levels.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant GC-based triplet regimens could provide survival benefits in BTC with LN metastasis diagnosed by FGD-PET or a biopsy. CA19-9 normalization may be useful for indicating surgery.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110149"},"PeriodicalIF":3.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124547","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":"Negative serum alpha-fetoprotein at recurrence predicts good prognosis in recurrent hepatocellular carcinoma patients receiving repeated hepatectomy:a single-center retrospective cohort study","authors":"Zimin Song ,&nbsp;Bin Chen ,&nbsp;Haoxiang Wen ,&nbsp;Qian Zhou ,&nbsp;Shuirong Lin ,&nbsp;Baifeng Qian ,&nbsp;Yihao Huang ,&nbsp;Xi Yu ,&nbsp;Shunli Shen","doi":"10.1016/j.ejso.2025.110145","DOIUrl":"10.1016/j.ejso.2025.110145","url":null,"abstract":"<div><h3>Background</h3><div>The serum alpha-fetoprotein (AFP) serves as a crucial prognostic indicator in patients diagnosed with hepatocellular carcinoma (HCC). Examining the impact of baseline-AFP (b-AFP), recurrence -AFP (r-AFP), and changes in AFP levels on the prognosis of individuals with recurrent hepatocellular carcinoma (RHCC) who undergo repeated hepatectomy holds substantial clinical significance.</div></div><div><h3>Method</h3><div>A total of 400 RHCC patients who had undergone repeated hepatectomy in the Center of Hepato-Pancreato-Biliary Surgery at the First Affiliated Hospital of Sun Yat-Sen University between January 1, 2006, and December 31, 2019 were included in this study. The analysis focused on evaluating the impact of b-AFP, r-AFP, and changes in AFP levels on the prognosis of RHCC patients.</div></div><div><h3>Results</h3><div>The recurrence rate among HCC patients who underwent hepatectomy was approximately 40.03 %. Among the 400 HCC patients who underwent twice hepatectomy, the 5-year mortality rate was 34.25 %, with an overall mortality rate of 38.75 %. Survival analysis indicated statistically significant disparities in overall survival (OS) and recurrence-free survival (RFS) between the b-AFP (−) group and the b-AFP (+) group, with the latter exhibiting shorter OS and RFS. The 3-year mortality rates for the two groups were 31.7 % and 42.5 %, respectively. The median overall survival (mOS) for the two groups were 107.4 months and 89.5 months, respectively. A statistically significant discrepancy in recurrence-death survival (RDS) was observed between the r-AFP (−) and r-AFP (+) groups (<em>P</em> &lt; 0.0001), with patients in the r-AFP (+) category experiencing a shorter RDS. The median RDS for these two groups were 88.1 months and 31.7 months, respectively. Significant differences in both overall survival (OS) and RDS were observed among the AFP (+/+), AFP (±), AFP (−/+), and AFP (−/−) groups. The order of OS and RDS from lowest to highest was as follows: AFP (+/+) group &lt; AFP (−/+) group &lt; AFP (−/−) group &lt; AFP (±) group. Irrespective of the b-AFP status, patients with positive r-AFP exhibited notably shorter OS and RFS compared to their r-AFP negative counterparts. The 3-year mortality rates for the four groups were 50.9 %, 26.1 %, 39.3 %, and 29.7 %, respectively. Median OS values were 42.4 months, not reached (NA), 77.1 months, and 107.4 months, respectively. Furthermore, an analysis of the cumulative 1-year, 3-year, and 5-year OS, RDS, and RFS rates for each group was conducted.</div></div><div><h3>Conclusion</h3><div>The b-AFP, r-AFP and AFP fluctuations serve as valuable prognostic indicators in individuals who have undergone hepatectomy for HCC on two occasions. These indicators can offer valuable insights for guiding the diagnosis and treatment strategies for HCC recurrence in such patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110145"},"PeriodicalIF":3.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083725","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":"GOLF: An easy and useful acronym to improve soft tissue sarcoma detection","authors":"Olivares-Ripoll Vicente,&nbsp;Gil-Gómez Elena,&nbsp;González-Gil Alida,&nbsp;Cascales-Campos Pedro","doi":"10.1016/j.ejso.2025.110140","DOIUrl":"10.1016/j.ejso.2025.110140","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110140"},"PeriodicalIF":3.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099571","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":"Letter to the Editor \"Validation of a simulator for oncoplastic breast conserving surgery\".","authors":"Qi Xu","doi":"10.1016/j.ejso.2025.110133","DOIUrl":"https://doi.org/10.1016/j.ejso.2025.110133","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"110133"},"PeriodicalIF":3.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141661","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":"Impact of socioeconomic determinants of health on delays to care in gastric cancer: A national cancer database analysis","authors":"Elliott J. Yee ,&nbsp;Christina M. Stuart ,&nbsp;Sunnie Kim ,&nbsp;Martin D. McCarter ,&nbsp;Benedetto Mungo","doi":"10.1016/j.ejso.2025.110136","DOIUrl":"10.1016/j.ejso.2025.110136","url":null,"abstract":"<div><h3>Introduction</h3><div>The impact of demographic and socioeconomic backgrounds on delays to cancer care and subsequent mortality for those with resectable gastric adenocarcinoma is not well studied. We sought to investigate the relationship between sociodemographic determinants of health, delays to consensus guideline therapy, and survival outcomes for gastric cancer.</div></div><div><h3>Methods</h3><div>Patients with gastric cancer from the National Cancer Database (2004–2020) were partitioned into early-stage (AJCC Stage 0-I) and locoregionally advanced (Stage II-resectable stage IV) disease receiving upfront surgery and neoadjuvant therapy (NAT) followed by surgical resection, respectively. The primary outcome was odds of delay to upfront surgery or NAT initiation/post-NAT resection. Secondary outcomes were short-term (30-, 90-day) mortality and long-term survival.</div></div><div><h3>Results</h3><div>A total of 18,307 patients were identified; 10,623 and 7684 patients had early-stage and locoregionally advanced disease, respectively. The median [interquartile range] time to upfront surgery: 42 [22–66] days, NAT initiation: 40 [29–54] days, and post-NAT resection: 55 [44–69] days from end of NAT. In adjusted analysis, African American race, Medicaid or non-Medicare governmental insurance coverage, and lower educational and/or income status were significantly associated with delayed initiation of preoperative therapies. Delayed upfront surgery was associated with worse long-term survival (HR 1.15 [1.05–1.23], p &lt; 0.001); delayed post-NAT surgery but not delayed NAT initiation portended worse 90-day mortality (HR 1.31 [1.02–1.69], p = 0.038) and long-term survival (HR 1.21 [1.10–1.32], p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Demographic and socioeconomic characteristics are associated with delays in receiving consensus guideline therapy for gastric cancer and translate to significantly worse survival outcomes.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110136"},"PeriodicalIF":3.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089283","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":"Extracapsular tumor spread does not influence survival outcomes in resected N1-patients with intrahepatic cholangiocarcinoma– a retrospectively controlled cohort study","authors":"Constantin Scholz ,&nbsp;Tiemo Sven Gerber ,&nbsp;Maria Hoppe-Lotichius ,&nbsp;Lisa Katherina Gröger ,&nbsp;Franziska Renger ,&nbsp;Monia Passalacqua ,&nbsp;Rabea Margies ,&nbsp;Beate Katharina Straub ,&nbsp;Friedrich Foerster ,&nbsp;Arndt Weinmann ,&nbsp;Evangelos Tagkalos ,&nbsp;Fabian Bartsch ,&nbsp;Hauke Lang","doi":"10.1016/j.ejso.2025.110143","DOIUrl":"10.1016/j.ejso.2025.110143","url":null,"abstract":"<div><h3>Background</h3><div>Extracapsular tumor spread (ECS) in lymph nodes is a known predictor of recurrence and decreased survival across various malignancies, including breast and head and neck cancers. However, its prognostic value in patients with intrahepatic cholangiocarcinoma (iCCA) undergoing curative surgery has not yet been explored.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted, including all patients with lymph node-positive disease (N1) who underwent curative resection for iCCA between 2008 and November 2023. Patients were followed up for at least one year postoperatively. Cases with ECS-positive lymph nodes (N1/ECS+) were compared to those without extracapsular tumor infiltration (N1/ECS-). Statistical analyses included the T-test for continuous variables and the Chi-square test for categorical variables. Survival outcomes were evaluated using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>70 patients with N1 disease following potentially curative resection were included. Baseline characteristics were comparable between groups (N1/ECS + n = 30, N1/ECS- n = 40), with no significant differences in age (p = 0.853), resection type (p = 0.511), T-stage (p = 0.785), resection margins (p = 0.687) or the number of tumor-positive lymph nodes (p = 0.052). The median overall survival (OS) was 17.2 months in the N1/ECS + group and 17.3 months in the N1/ECS- group (p = 0.466). Similarly, recurrence-free survival (RFS) was not significantly different, with a median of 4.4 months for N1/ECS + patients versus 7.7 months for N1/ECS- patients (p = 0.335).</div></div><div><h3>Conclusion</h3><div>Extracapsular tumor spread in lymph nodes was not associated with significant differences in overall or recurrence-free survival in patients with intrahepatic cholangiocarcinoma undergoing curative resection. Based on these findings, ECS does not appear to serve as a prognostic predictor of outcomes in this population.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110143"},"PeriodicalIF":3.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089284","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":"Progress in treatment and follow-up of pheochromocytoma","authors":"Yifan Zhou ,&nbsp;Yanghao Tai ,&nbsp;Jiwen Shang","doi":"10.1016/j.ejso.2025.110144","DOIUrl":"10.1016/j.ejso.2025.110144","url":null,"abstract":"<div><div>Pheochromocytoma (PHEO) is an uncommon neuroendocrine tumor originating from the chromaffin cells of the adrenal medulla. These tumors are capable of producing and releasing substantial amounts of catecholamine (CA) hormones. Individuals with PHEO often experience transient blood pressure fluctuations, headaches, and palpitations, among other symptoms. In extreme cases, they may develop severe complications, including cardiovascular and cerebrovascular incidents, myocardial disorders, and gastrointestinal issues. At the advanced stage, PHEO can affect multiple organs, potentially leading to pheochromocytoma crisis. However, the clinical manifestations of pheochromocytoma may be diverse. Some patients have no typical triad of headache, palpitations, and sweating, and are not accompanied by obvious clinical symptoms or signs. There are only abnormalities in imaging and biochemical indicators, which will pose a challenge for early diagnosis. The primary treatment options for PHEO encompass surgical and non-surgical approaches. In contrast to many other adrenal pathologies, there is currently no consensus on the optimal surgical versus non-surgical management of PHEO. Laparoscopic surgery, as opposed to traditional open surgery, offers numerous benefits. However, whether retroperitoneal or transperitoneal laparoscopic adrenalectomy remains controversial. Da Vinci robot-assisted adrenalectomy has the advantages of highly precise operation and excellent hemostasis capabilities. The day surgery management model for adrenalectomy procedures has proven to be both safe and feasible. However, current research on its long - term effectiveness and wide - scale application still has limitations. Additionally, the application of the Senhance robot in urology, particularly in adrenalectomy, has seen relatively little investigation thus far. In terms of non-surgical treatment for pheochromocytoma, chemotherapy, radionuclide therapy, targeted therapy and immunotherapy, as well as radiofrequency ablation and microwave ablation chemotherapy have all advanced significantly. This article aims to review the latest advancements in the treatment of pheochromocytoma.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 8","pages":"Article 110144"},"PeriodicalIF":3.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941442","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":"Impact of lymph node metastasis on prognosis in colorectal cancer patients with liver metastasis and staging systems Refinement: An international multicenter retrospective cohort study","authors":"Yueyang Zhang ,&nbsp;Jiale Li ,&nbsp;Xu Guan ,&nbsp;Siyuan Wang ,&nbsp;Nan Jiang ,&nbsp;Shuai Jiao ,&nbsp;Yunxiao Liu ,&nbsp;Weiyuan Zhang ,&nbsp;Hanqing Hu ,&nbsp;Guiyu Wang ,&nbsp;Haiyi Liu ,&nbsp;Xishan Wang ,&nbsp;Wenqi Bai ,&nbsp;Haitao Zhou ,&nbsp;Shuo Jin","doi":"10.1016/j.ejso.2025.110124","DOIUrl":"10.1016/j.ejso.2025.110124","url":null,"abstract":"<div><h3>Background</h3><div>The current AJCC staging for colorectal cancer liver metastasis (CRLM) classifies stages IVA, IVB, and IVC based on organ metastasis, disregarding lymph node metastasis (LNM). We evaluated the prognostic impact of LNM in CRLM and proposed incorporating LNM into staging criteria.</div></div><div><h3>Methods</h3><div>Data were extracted from the SEER database (2010–2017) and a Chinese cohort (2009–2018), including 11,266 CRLM patients (9648 SEER; 1618 Chinese cohort). Kaplan-Meier and Cox regression analyses assessed cancer-specific survival (CSS) between LNM and non-LNM groups. Inverse probability treatment weighting (IPTW) was used for primary analysis, with subgroup analyses exploring LNM's prognostic impact.</div></div><div><h3>Results</h3><div>In both the SEER and Chinese cohorts, patients with LNM were significantly associated with worse CSS than patients without LNM before and after IPTW/sIPTW (all p &lt; 0.001). Furthermore, LNM in the M1a subgroup still led to poorer prognosis (all log-rank p &lt; 0.001). In contrast, in the M1b subgroup, the prognostic difference between those with and without LNM was not significant (log-rank p = 0.031 and 0.037, respectively, in the SEER and Chinese cohorts) because the P_FDR was set at 0.025. Additionally, in both cohorts, the 5-year CSS rates of M1a stage CRLM patients decreased with advancing N staging, regardless of the resectability of liver metastasis (all log-rank P &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>LNM has significant association with worse survival outcomes in CRLM patients, although this prognostic impact exhibits progressive attenuation with increasing liver metastatic burden. For patients with M1a stage CRLM, we suggest that incorporating N staging into their prognostic evaluation can further refine the AJCC TNM staging system.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110124"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083642","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}