Ejso最新文献

{"title":"A novel risk score after neoadjuvant imatinib predicts relapse-free survival in patients with gastrointestinal stromal tumours (GIST)","authors":"Javier Pozas ,&nbsp;Daniel Lindsay ,&nbsp;Alanna Wall ,&nbsp;Leonidas Mavroeidis ,&nbsp;Khin Thway ,&nbsp;Myles Smith ,&nbsp;Andrew Hayes ,&nbsp;Jens Strohaeker ,&nbsp;Charlotte Benson ,&nbsp;Christina Messiou ,&nbsp;Paul Huang ,&nbsp;Robin L. Jones ,&nbsp;Andrea Napolitano","doi":"10.1016/j.ejso.2025.110473","DOIUrl":"10.1016/j.ejso.2025.110473","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgery remains the cornerstone of management of localized GIST. Neoadjuvant imatinib facilitates surgery and allows <em>in vivo</em> monitoring of tumour response to therapy. There are no predictive tools to guide the duration of treatment. This study evaluates the impact of clinical and pathological variables on relapse-free survival (RFS) after neoadjuvant imatinib.</div></div><div><h3>Material and methods</h3><div>Single-centre retrospective study of 90 GIST patients who underwent radical surgery after neoadjuvant imatinib. Univariate and multivariate Cox regression analyses were performed to determine the association of clinicopathological variables to RFS. Evaluate Cut-points were used to identify values associated with significantly different outcomes. Between-group differences were assessed with the use of the stratified log-rank test.</div></div><div><h3>Results</h3><div>Univariate Cox regression analyses showed a significant association of RFS with initial tumour size (ITS) (HR 1.11, p = 0.002), maximal tumour shrinkage (MTS) (HR 11.7, p = 0.023) and residual mitotic count (RMC) (HR 1.09, p ≪ 0.001). These results were confirmed in a multivariate model (ITS, p = 0.001; MTS, p = 0.003; RMC, p ≪ 0.001). Cut-points for ITS, MTS and RMC were established at 9.8 cm, 41 % reduction in size and 2 mitoses, respectively. Patients with large tumours ≥9.8 cm, ≤41 % reduction in size and ≥2 mitoses had shorter RFS. A combined score of these three variables allowed for accurate classification into two risk categories (p ≪&lt; 0.001): low (0 or 1 factor) and high-risk (2 or 3 factors). Post-operative imatinib did not influence survival outcomes in either low -risk (HR 1.2, p = 0.83) or high-risk patients (HR 1.6, p = 0.35).</div></div><div><h3>Discussion</h3><div>ITS, MTS and RMC are associated with shorter RFS in patients with localized GIST treated with neoadjuvant imatinib. If validated, these findings could guide the design of prospective studies that de-escalate or intensify adjuvant treatment.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110473"},"PeriodicalIF":2.9,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120464","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":"Risk factors and intraoperative identification of non-lepidic predominant lung adenocarcinoma presenting as subsolid nodule: A multicenter study","authors":"Donglai Chen ,&nbsp;Qifeng Ding ,&nbsp;Yongzhong Li ,&nbsp;Zhangqiang Chen ,&nbsp;Jian Shu ,&nbsp;Yiming Mao ,&nbsp;Shanzhou Duan ,&nbsp;Lijie Tan ,&nbsp;Yongbing Chen","doi":"10.1016/j.ejso.2025.110471","DOIUrl":"10.1016/j.ejso.2025.110471","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to assess the prognostic factors for non-lepidic invasive adenocarcinoma presenting as subsolid nodules. The feasibility of detecting non-lepidic predominant patterns on frozen section (FS) was also evaluated.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of 614 patients with clinical T1N0M0 non-lepidic invasive adenocarcinoma presenting as subsolid nodule was included. Two subgroups were divided based on the consolidation-to-tumor ratio (CTR) on lung window: ground glass opacity (GGO)-dominant subgroup (CTR&lt;0.5), solid-dominant subgroup (CTR≥0.5). Kaplan-Meier approach and multivariable Cox models were used to identify risk factors for recurrence-free survival (RFS) and overall survival (OS). FS and final pathology (FP) of 100 specimens were also reviewed by five pathologists for tumor grading synchronously.</div></div><div><h3>Results</h3><div>Multivariate analysis indicated that segmentectomy was a risk factor for shortened RFS and OS in the solid-dominant subgroup rather than in the GGO-dominant one. Subset analysis demonstrated survival disadvantages of segmentectomy for high-grade adenocarcinoma but not for intermediate-grade one in the solid-dominant subgroup. However, segmentectomy exhibited non-inferiority to lobectomy in the GGO-dominant subgroup irrespective of tumor grade. The overall accuracy of identifying non-lepidic patterns was 84 % with a good interobserver agreement. Multivariable logistic analysis identified presence of complex glandular pattern and acinar pattern as independent predictors of the discrepancy between FS and FP.</div></div><div><h3>Conclusions</h3><div>Segmentectomy should be cautiously performed for patients with radiologically solid-dominant non-lepidic invasive adenocarcinoma, especially for those with high-grade patterns. FS had high diagnostic accuracy and satisfactory interobserver agreement for tumor grading, which might aid surgeons in determining the appropriate surgical procedure.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110471"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156658","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":"Risk factors and intraoperative identification of non-lepidic predominant lung adenocarcinoma presenting as subsolid nodule: A multicenter study","authors":"Donglai Chen ,&nbsp;Qifeng Ding ,&nbsp;Yongzhong Li ,&nbsp;Zhangqiang Chen ,&nbsp;Jian Shu ,&nbsp;Yiming Mao ,&nbsp;Shanzhou Duan ,&nbsp;Lijie Tan ,&nbsp;Yongbing Chen","doi":"10.1016/j.ejso.2025.110471","DOIUrl":"10.1016/j.ejso.2025.110471","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to assess the prognostic factors for non-lepidic invasive adenocarcinoma presenting as subsolid nodules. The feasibility of detecting non-lepidic predominant patterns on frozen section (FS) was also evaluated.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of 614 patients with clinical T1N0M0 non-lepidic invasive adenocarcinoma presenting as subsolid nodule was included. Two subgroups were divided based on the consolidation-to-tumor ratio (CTR) on lung window: ground glass opacity (GGO)-dominant subgroup (CTR&lt;0.5), solid-dominant subgroup (CTR≥0.5). Kaplan-Meier approach and multivariable Cox models were used to identify risk factors for recurrence-free survival (RFS) and overall survival (OS). FS and final pathology (FP) of 100 specimens were also reviewed by five pathologists for tumor grading synchronously.</div></div><div><h3>Results</h3><div>Multivariate analysis indicated that segmentectomy was a risk factor for shortened RFS and OS in the solid-dominant subgroup rather than in the GGO-dominant one. Subset analysis demonstrated survival disadvantages of segmentectomy for high-grade adenocarcinoma but not for intermediate-grade one in the solid-dominant subgroup. However, segmentectomy exhibited non-inferiority to lobectomy in the GGO-dominant subgroup irrespective of tumor grade. The overall accuracy of identifying non-lepidic patterns was 84 % with a good interobserver agreement. Multivariable logistic analysis identified presence of complex glandular pattern and acinar pattern as independent predictors of the discrepancy between FS and FP.</div></div><div><h3>Conclusions</h3><div>Segmentectomy should be cautiously performed for patients with radiologically solid-dominant non-lepidic invasive adenocarcinoma, especially for those with high-grade patterns. FS had high diagnostic accuracy and satisfactory interobserver agreement for tumor grading, which might aid surgeons in determining the appropriate surgical procedure.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110471"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157121","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":"Long-term impact of preoperative radiotherapy for rectal cancer on testicular function","authors":"Louise de la Motte ,&nbsp;John Tapper ,&nbsp;Stefan Arver ,&nbsp;Torbjörn Holm ,&nbsp;Josefin Segelman ,&nbsp;Ravi Jasuja ,&nbsp;Anna Martling ,&nbsp;Christian Buchli","doi":"10.1016/j.ejso.2025.110458","DOIUrl":"10.1016/j.ejso.2025.110458","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim was to assess long-term impact of preoperative radiotherapy (RT) for rectal cancer on testicular function, its clinical relevance regarding sexual function and cancer-related events.</div></div><div><h3>Materials and methods</h3><div>This analysis of an original cohort with longitudinal design included 163 men with rectal or prostate cancer stage I-III treated with surgery in Stockholm, Sweden, between 2010 and 2014. Exposure to RT (n = 91) was quantified by cumulative mean testicular dose. Repeated measurement of serum Testosterone (T), free T and Luteinizing hormone (LH) respectively questionnaires of sexual function (IIEF and AMS) were collected before treatment (baseline), one and two years postoperatively. Data on cancer recurrence were collected from medical records during the standard five-year cancer follow-up. Association between hormone levels and patient reported outcome measures for sexual function was assessed by linear random-effect models with final analysis adjusted for age, BMI and ASA-score.</div></div><div><h3>Results</h3><div>Testicular dose was associated with a preoperative decline in T and free T, with a consecutive increase in LH and LH/T ratio during the study period. Not all androgen levels recovered within two years. Testosterone levels were associated with patient reported outcome measures for sexual function. Elevated LH one year after surgery for rectal cancer was associated with a three-times increased risk for cancer recurrence.</div></div><div><h3>Conclusion</h3><div>Endocrine testicular function is related to sexual symptoms in men treated for rectal- or prostate cancer. Monitoring of testicular function in these patients could be valuable to improve interventions for treatment-related sexual dysfunction. The association between elevated LH and cancer recurrence requires further investigation.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110458"},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148062","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":"51.10 ESSO announcements","authors":"","doi":"10.1016/j.ejso.2025.110453","DOIUrl":"10.1016/j.ejso.2025.110453","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"Article 110453"},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154772","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 readmission location on survival after oesophagectomy and gastrectomy","authors":"Ganesh K. Velayudham ,&nbsp;Arjan S. Shankar ,&nbsp;Sebastian J. Fox ,&nbsp;James Bundred ,&nbsp;Faiz Ahmed ,&nbsp;Paul S. Sundaram ,&nbsp;Benjamin I. Rouse ,&nbsp;Hansel S. Canagarajah ,&nbsp;Dillon A. Chithuranjan ,&nbsp;Samuel G. Thomas ,&nbsp;John Whiting ,&nbsp;Richard PT. Evans ,&nbsp;Ewen A. Griffiths","doi":"10.1016/j.ejso.2025.110470","DOIUrl":"10.1016/j.ejso.2025.110470","url":null,"abstract":"<div><h3>Background</h3><div>Readmissions following oesophagogastric cancer surgery pose a substantial burden on healthcare systems and can adversely impact patient outcomes. While centralisation has improved postoperative mortality, concerns persist about the management of complex complications at peripheral hospitals. This study evaluates 90-day readmission rates following oesophagectomy and gastrectomy, distinguishing between index (hospital where primary surgery was performed) and non-index (peripheral hospital) readmissions. Secondary objectives include identifying risk factors for readmission and assessing the impact of readmission location on long-term survival.</div></div><div><h3>Methods</h3><div>A retrospective single-centre analysis was conducted on patients undergoing oesophagectomy or gastrectomy between 2011 and 2024. The primary outcome was unplanned readmission within 90 days of discharge. Multivariable logistic regression identified readmission risk factors. Survival analysis was conducted using Kaplan-Meier and Cox regression models.</div></div><div><h3>Results</h3><div>Of 881 patients (571 oesophagectomy, 310 gastrectomy), readmission rates were 26.1 % and 24.2 %, respectively. Risk factors for readmission included non-severe anastomotic leaks (OR 2.93; P = 0.004) and severe complications (OR 2.19; P = 0.003) for oesophagectomy, and prolonged hospital stay for gastrectomy (OR 1.04; P &lt; 0.001). Protective factors included severe respiratory complications (OR 0.48; P = 0.024) and severe complications in gastrectomy patients (OR 0.33; P = 0.036). Index readmission was associated with improved survival on univariable analysis only.</div></div><div><h3>Conclusion</h3><div>Complication-readmission patterns vary by procedure type. While the survival benefit of index readmission remains unclear, our results highlight the importance of structured postoperative care to mitigate postoperative morbidity. Further research should identify complications best managed at tertiary centres to guide targeted readmission pathways.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110470"},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211939","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":"Evaluation of risk-reducing radical fimbriectomy followed by delayed oophorectomy in high-risk Women: A single-center retrospective study","authors":"Sophie Schoenen ,&nbsp;Carlos Martinez Gomez ,&nbsp;Camille Pasquesoone ,&nbsp;Julie Alline ,&nbsp;Mathilde Duchatelet ,&nbsp;Séverine Risbourg ,&nbsp;Audrey Mailliez ,&nbsp;Aïcha Ben Miled ,&nbsp;Mathilde Saint-Ghislain ,&nbsp;Benjamin Serouart ,&nbsp;Tom Fidlers ,&nbsp;Lucie Bresson ,&nbsp;Anne-Sophie Navarro ,&nbsp;Marie-Cécile Le Deley ,&nbsp;Fabrice Narducci","doi":"10.1016/j.ejso.2025.110469","DOIUrl":"10.1016/j.ejso.2025.110469","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian carcinoma is a leading cause of cancer-related mortality in women. Approximately 20 % of cases are hereditary, mainly BRCA mutations. Current clinical guidelines recommend bilateral salpingo-oophorectomy between ages 35–45 for high-risk individuals, leading to premature menopause. Given evidence supporting the tubal origin of most ovarian cancers, radical fimbriectomy followed by delayed oophorectomy may offer a menopause-sparing alternative for women refusing early ovariectomy.</div></div><div><h3>Objective</h3><div>To evaluate the oncologic safety and clinical outcomes of this two-step risk-reducing strategy.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included all high-risk premenopausal women who had completed childbearing, declined BSO and underwent radical fimbriectomy between 2014 and 2022. The primary outcome was the incidence of ovarian or pelvic cancer following radical fimbriectomy, estimated using the Kalbfleisch-Prentice method. Secondary outcomes included surgical complications, tubal lesions, menopause onset, breast cancer incidence and delayed oophorectomy rate.</div></div><div><h3>Results</h3><div>A total of 132 women were included; 62.9 % had BRCA1, 25.8 % BRCA2, and 11.3 % other high-risk mutations (RAD51C, PALB2). No tubal lesions were found in 121 cases (91.7 %), while 11 (8.3 %) had abnormalities: one high-grade serous carcinoma, six serous tubal intraepithelial carcinoma, and four minor lesions. After a median 30.4-month follow-up, no high-grade serous carcinoma was reported. Delayed bilateral oophorectomy was performed in 24 women (18.5 %), and menopause occurred in 27 at a median age of 45. One pregnancy occurred post-fimbriectomy via assisted reproductive technology.</div></div><div><h3>Conclusion</h3><div>Radical fimbriectomy with delayed oophorectomy may be a safe and feasible option for high-risk women seeking to avoid early menopause. Longer-term prospective studies are needed.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110469"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205928","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":"Contour-like model for precision risk stratification in gastric cancer patients underwent neoadjuvant therapy: A multicenter retrospective study","authors":"Siwei Pan ,&nbsp;Weiwei Zhu ,&nbsp;Yanqiang Zhang ,&nbsp;Ruolan Zhang ,&nbsp;Qing Yang ,&nbsp;Yizhou Wei ,&nbsp;Mengya Zhou ,&nbsp;Ruixin Xu ,&nbsp;Jintao He ,&nbsp;Ke Shen ,&nbsp;Xiangdong Cheng ,&nbsp;Guoliang Zheng ,&nbsp;Can Hu ,&nbsp;Zhiyuan Xu","doi":"10.1016/j.ejso.2025.110455","DOIUrl":"10.1016/j.ejso.2025.110455","url":null,"abstract":"<div><h3>Background</h3><div>Lymph node metastasis (LNM) is a critical determinant of prognosis in gastric cancer (GC). Accurate evaluation of lymph node involvement enhances prognostic accuracy and informs postoperative strategies.</div></div><div><h3>Methods</h3><div>This retrospective study included 649 GC patients who received neoadjuvant chemotherapy followed by curative surgery at two centers between 2009 and 2019. An additional cohort of 292 patients was selected from the SEER database using matching criteria. Collected variables included the number of retrieved lymph nodes (rLNs), positive lymph nodes (pLNs), pathological T stage after treatment (ypT), and Tumor Regression Grade. A novel contour-like ypTN (Con-ypTN) model was constructed using a Gaussian process-augmented Cox regression approach to predict the overall prognosis. Model performance was evaluated through receiver operating characteristic curve analysis, the Delong test, calibration plots, and decision curve analysis.</div></div><div><h3>Results</h3><div>The Con-ypTN model demonstrated strong prognostic discrimination. AUC values were 0.853 (95 % CI: 0.807–0.900) in the training cohort. Calibration plots and Delong test results showed good agreement between predicted and actual outcomes across all datasets. Notably, the Con-ypTN model significantly outperformed all comparator staging systems (P &lt; 0.05). Patients classified as high risk by the Con-ypTN model had significantly worse survival outcomes than those in the low-risk group (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The Con-ypTN model provides a robust and clinically relevant tool for prognostic stratification of GC patients treated with neoadjuvant chemotherapy. The model enables precise identification of high-risk individuals, offering improved guidance for postoperative clinical decision-making.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110455"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091352","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":"Influence of lymphadenectomy extent on the efficacy of immunotherapy in recurrent gastric cancer patients","authors":"Danni Zhu ,&nbsp;Zhuoran Fang ,&nbsp;Teng Yang ,&nbsp;Yiming Lu ,&nbsp;Ke Shen ,&nbsp;Xiu Zhu ,&nbsp;Guangjun Jin ,&nbsp;Qing Wei ,&nbsp;Xiangdong Cheng","doi":"10.1016/j.ejso.2025.110454","DOIUrl":"10.1016/j.ejso.2025.110454","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines recommend ≥16 lymph node (LN) dissection for gastric cancer, preferably &gt;30. However, optimal LN count for immunotherapy after recurrence remains unclear.</div></div><div><h3>Methods</h3><div>Retrospective study of 147 gastric adenocarcinoma patients receiving immunotherapy for postoperative recurrence (2017–2023). Participants were grouped by dissected LN (DLN) count. Outcomes included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR).</div></div><div><h3>Results</h3><div>We collected data from 147 patients and stratified them into three groups by DLN count. Stratification revealed: Group A (DLN≤15, 6.1 %, n = 9), Group B (16–30, 44.2 %, n = 65), and Group C (&gt;30, 49.7 %, n = 73). The median disease-free survival (DFS) post-initial surgery was 19.0 months. PFS under immunotherapy differed significantly: Group A (6.0 months) had worse outcomes than B (8.0 months), while C showed intermediate results (7.0 months; <em>P</em> = 0.017). OS followed a similar trend, with Group B having the longest median survival (18.0 months <em>vs</em>. 14.0 for A and 13.0 for C; <em>P</em> = 0.223). ORR was 34.0 %, with progressive disease (PD) more frequent in Group C (30.1 % <em>vs</em>. 20.0 % in B; <em>P</em> = 0.244). Multivariate analysis confirmed DLN count as the sole independent predictor of outcomes.</div></div><div><h3>Conclusion</h3><div>DLN count exhibits a U-shaped association with immunotherapy efficacy: both insufficient (≤15) and excessive (&gt;30) dissection correlate with poorer PFS/OS versus moderate resection (16–30). Inadequate lymphadenectomy may cause stage migration, while excessive dissection could disrupt antitumor immunity. Precision lymphadenectomy balancing oncologic radicality and immune preservation is advocated.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110454"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154654","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":"T3 gallbladder cancer: surgical outcomes according to the mode of tumor spread and treatment considerations for oncological resectability","authors":"Yusuke Kawachi ,&nbsp;Jun Sakata ,&nbsp;Tatsuya Nomura ,&nbsp;Kabuto Takano ,&nbsp;Takuya Ando ,&nbsp;Koji Toge ,&nbsp;Yuki Hirose ,&nbsp;Kazuyasu Takizawa ,&nbsp;Hirosuke Ishikawa ,&nbsp;Shun Abe ,&nbsp;Hiroshi Ichikawa ,&nbsp;Yoshifumi Shimada ,&nbsp;Takashi Kobayashi ,&nbsp;Toshifumi Wakai","doi":"10.1016/j.ejso.2025.110457","DOIUrl":"10.1016/j.ejso.2025.110457","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to clarify surgical outcomes for patients with pT3 gallbladder cancer according to the mode of tumor spread.</div></div><div><h3>Methods</h3><div>A total of 85 patients with pT3 gallbladder cancer who underwent curative-intent surgery were analyzed. Each tumor was classified according to the mode of spread.</div></div><div><h3>Results</h3><div>Five-year overall survival (OS) in patients with involvement of the liver alone (n = 25), involvement of the extrahepatic bile duct alone (n = 29), involvement of one other organ/structure alone or perforation of the peritoneal side of the serosa alone (n = 9), and involvement of both the liver and one other organ/structure (n = 22) was 36.0%, 29.0%, 22.2%, and 9.1%, respectively. For patients with involvement of the liver alone, 5-year OS was &gt; 30% regardless of type of hepatectomy. Among 29 patients with involvement of the extrahepatic bile duct alone, 8 patients survived ≥ 5 years; 3 underwent extended cholecystectomy and 5 underwent more extensive resection. Despite performing extensive resection, 5-year OS was 12.5% for patients with involvement of both the liver and one other organ/structure. The mode of spread other than involvement of the liver alone or extrahepatic bile duct alone was an independent predictor of worse OS (hazard ratio 1.675; p = 0.046).</div></div><div><h3>Conclusions</h3><div>Surgery is an acceptable option for pT3 gallbladder cancer with involvement of the liver alone or extrahepatic bile duct alone regardless of the type of resection procedure. However, the survival benefit of surgery is limited for this tumor with other modes of spread.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110457"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156659","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}