Ejso最新文献

{"title":"Non-invasive classification of non-neoplastic and neoplastic gallbladder polyps based on clinical imaging and ultrasound radiomics features: An interpretable machine learning model","authors":"Minghui Dou ,&nbsp;Hengchao Liu ,&nbsp;Zhenqi Tang ,&nbsp;Longxi Quan ,&nbsp;Mai Xu ,&nbsp;Feiqian Wang ,&nbsp;Zhilin Du ,&nbsp;Zhimin Geng ,&nbsp;Qi Li ,&nbsp;Dong Zhang","doi":"10.1016/j.ejso.2025.109709","DOIUrl":"10.1016/j.ejso.2025.109709","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder (GB) adenomas, precancerous lesions for gallbladder carcinoma (GBC), lack reliable non-invasive tools for preoperative differentiation of neoplastic polyps from cholesterol polyps. This study aimed to evaluate an interpretable machine learning (ML) combined model for the precise differentiation of the pathological nature of gallbladder polyps (GPs).</div></div><div><h3>Methods</h3><div>This study consecutively enrolled 744 patients from Xi'an Jiaotong University First Affiliated Hospital between January 2017 and December 2023 who were pathologically diagnosed postoperatively with cholesterol polyps, adenomas or T1-stage GBC. Radiomics features were extracted and selected, while clinical variables were subjected to univariate and multivariate logistic regression analyses to identify significant predictors of neoplastic polyps. A optimal ML-based radiomics model was developed, and separate clinical, US and combined models were constructed. Finally, SHapley Additive exPlanations (SHAP) was employed to visualize the classification process.</div></div><div><h3>Results</h3><div>The areas under the curves (AUCs) of the CatBoost-based radiomics model were 0.852 (95 % <em>CI</em>: 0.818–0.884) and 0.824 (95 % <em>CI</em>: 0.758–0.881) for the training and test sets, respectively. The combined model demonstrated the best performance with an improved AUC of 0.910 (95 % <em>CI</em>: 0.885–0.934) and 0.869 (95 % <em>CI</em>: 0.812–0.919), outperformed the clinical, radiomics, and US model (all <em>P</em> &lt; 0.05), and reduced the rate of unnecessary cholecystectomies. SHAP analysis revealed that the polyp short diameter is a crucial independent risk factor in predicting the nature of the GPs.</div></div><div><h3>Conclusion</h3><div>The ML-based combined model may be an effective non-invasive tool for improving the precision treatment of GPs, utilizing SHAP to visualize the classification process can enhance its clinical application.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109709"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519342","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":"Liver metastases from colorectal cancer: A joint ESSO–EAHPBA–UEMS core curriculum collaboration","authors":"Lucia Carrion-Alvarez ,&nbsp;Florian Primavesi ,&nbsp;Kjetil Søreide ,&nbsp;Dana Sochorova ,&nbsp;Rafael Diaz-Nieto ,&nbsp;Cristina Dopazo ,&nbsp;Alejandro Serrablo ,&nbsp;Ibrahim Edhemovic ,&nbsp;Stefan Stättner","doi":"10.1016/j.ejso.2025.109728","DOIUrl":"10.1016/j.ejso.2025.109728","url":null,"abstract":"<div><div>Colorectal liver metastases (CRLM) are a major indication for liver surgery in Europe, highlighting the need for standardized knowledge and training in surgical oncology. The European Society of Surgical Oncology (ESSO) has updated its core curriculum to provide a structured framework for education. Previous publications have addressed pancreatic, hepatocellular, and biliary tract cancers to support candidates preparing for the European Board of Surgery Qualification (EBSQ) exams in Surgical Oncology and Hepato-Pancreato-Biliary Surgery. However, a dedicated guide for CRLM remains absent.</div><div>This article aims to fill that gap by offering a structured reference on CRLM, covering epidemiology, staging, genetics, and diagnosis of metastatic colorectal cancer. It also outlines multidisciplinary treatment strategies, including systemic, surgical, interventional, and palliative approaches. A structured literature review was conducted using PubMed to identify the most updated (inter)national management guidelines, prioritizing recent multicentre studies, systematic reviews, and meta-analyses published from January 2020 to January 2025.</div><div>By bridging the gap between the ESSO core curriculum and detailed subspecialty training, this guide provides an essential resource for hepatobiliary surgeons and surgical oncologists. It serves as a valuable tool for those preparing for board examinations while promoting a standardized approach to CRLM education and management across Europe.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109728"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511660","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":"Development and evaluation of a multivariable prediction model for overall survival in advanced stage pulmonary carcinoid using machine learning","authors":"Huiping Dai ,&nbsp;Guang Li ,&nbsp;Cheng Zhang ,&nbsp;Qi Huo ,&nbsp;Tingting Tang ,&nbsp;Fei Ding ,&nbsp;Jianjun Wang ,&nbsp;Guangliang Duan","doi":"10.1016/j.ejso.2025.109729","DOIUrl":"10.1016/j.ejso.2025.109729","url":null,"abstract":"<div><h3>Background</h3><div>Evidence is limited on whether patients with advanced pulmonary carcinoid (APC) benefit from comprehensive pulmonary resection (CPR), chemotherapy, or radiotherapy. Existing prognostic models for APC are limited and do not guide treatment selection. This study aims to develop and evaluate a multivariable machine learning model to predict overall survival in APC patients and provide a web-based prognostic tool.</div></div><div><h3>Methods</h3><div>Clinical data of APC patients were obtained from SEER database. Propensity score matching reduced retrospective study bias. Kaplan-Meier analysis evaluated survival differences between CPR vs. nonCPR, chemotherapy (Chem) vs. no chemotherapy (nonChem), and radiotherapy (Radio) vs. no radiotherapy (nonRadio). Univariate and multivariate Cox regression identified survival-associated variables. Using these clinical variables, 91 machine learning models were developed to predict APC survival, and the best model led to a web-based prognostic tool.</div></div><div><h3>Results</h3><div>Among 1077 APC patients, 37.0 % underwent CPR, 30.2 % received chemotherapy, and 19.9 % received radiotherapy. After matching, overall survival was significantly improved in the CPR compared to the nonCPR. However, there were no significant differences in survival between the Chem and nonChem groups or between the Radio and nonRadio groups. Eight out of 13 clinical variables were significant prognostic variables. Models with eight variables reached a mean C-index of 0.770 and a 5-year AUC of 0.835. Using all 13 variables, a C-index of 0.785 and an AUC of 0.850 was achieved. An online tool (<span><span>https://apcmodel.shinyapps.io/APCsp/</span><svg><path></path></svg></span>) displays survival curves for different treatments.</div></div><div><h3>Conclusion</h3><div>The developed prognostic model enables individualized survival predictions and supports evidence-based treatment decisions for APC patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109729"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580649","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":"Intraoperative electron radiotherapy (IOERT) in colorectal cancer: Updated systematic review of techniques, oncological outcomes and complications","authors":"Abhinav Tiwari ,&nbsp;Sheah Lin Lee ,&nbsp;Tom MacCabe ,&nbsp;Michal Woyton ,&nbsp;Charles T. West ,&nbsp;Rohan Micklethwaite ,&nbsp;Hideaki Yano ,&nbsp;Malcolm A. West ,&nbsp;Alex H. Mirnezami","doi":"10.1016/j.ejso.2025.109724","DOIUrl":"10.1016/j.ejso.2025.109724","url":null,"abstract":"<div><h3>Background</h3><div>Intra-operative electron radiotherapy (IOERT) directly delivers a large fraction of radiation to at-risk margins during surgery. However, the precise benefit of IOERT in patients with locally advanced and locally recurrent colorectal cancer (LACC/LRCC) is unclear. This study aimed to provide an updated summary of the current evidence available regarding IOERT as part of multi-modality treatment of LACC and LRCC.</div></div><div><h3>Method</h3><div>This systematic review update was prospectively registered on PROSPERO (CRD42023438184). An electronic literature search was carried out using Ovid (MEDLINE), EMBASE, Web of Science, and the Cochrane Library databases for studies from July 2011 to April 2024. The inclusion criteria were adult patients who received IOERT as part of multi-modal treatment for LACC or LRCC. The primary outcome was overall survival (OS), disease free survival (DFS) and local control (LC) at 5 years. Secondary outcomes included post-operative complications.</div></div><div><h3>Results</h3><div>16 new studies were identified since the previous analysis, and included (study population 1912 patients) of which two were prospective. High heterogeneity prevented meta-analysis of outcomes except for 5-year OS which suggested a non-significant benefit favouring IOERT. Significant methodological concerns were identified making interpretations challenging, however patients with LACC or LRCC with an R1 resection margin showed a favourable 5-year OS (40 % and 18 % respectively) when compared to current evidence.</div></div><div><h3>Conclusion</h3><div>Although limited by a lack of appropriately conducted randomised evidence, IOERT-containing multi-modality treatment may improve oncological outcomes in LACC and LRCC patients with R1 resections.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109724"},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512013","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":"Dynamic ALBI score and FIB-4 index trends to predict complications after resection of hepatocellular carcinoma: A K-means clustering approach","authors":"Miho Akabane ,&nbsp;Jun Kawashima ,&nbsp;Abdullah Altaf ,&nbsp;Selamawit Woldesenbet ,&nbsp;François Cauchy ,&nbsp;Federico Aucejo ,&nbsp;Irinel Popescu ,&nbsp;Minoru Kitago ,&nbsp;Guillaume Martel ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;George A. Poultsides ,&nbsp;Yuki Imaoka ,&nbsp;Andrea Ruzzenente ,&nbsp;Itaru Endo ,&nbsp;Ana Gleisner ,&nbsp;Hugo P. Marques ,&nbsp;Vincent Lam ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.ejso.2025.109723","DOIUrl":"10.1016/j.ejso.2025.109723","url":null,"abstract":"<div><h3>Background</h3><div>Severe postoperative complications still occur following hepatectomy among patients with hepatocellular carcinoma (HCC). There is a need to identify high-risk patients for severe complications to enhance patient safety. We sought to evaluate the combined impact of pre- and postoperative albumin-bilirubin (ALBI) score and Fibrosis-4 (FIB-4) index trends to predict severe complications after HCC resection.</div></div><div><h3>Method</h3><div>Patients with HCC undergoing curative-intent hepatectomy (2000–2023) were identified from an international, multi-institutional database. The cohort was divided into training (n = 439) and testing (n = 651) sets. ALBI score and FIB-4 index trends from preoperative to postoperative days 1, 3, and 5 were used for K-means clustering (K = 3). A logistic regression model was developed using the training set, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC) in both cohorts.</div></div><div><h3>Results</h3><div>Severe complications (Clavien-Dindo Grade ≥ IIIa) occurred in 118 patients (10.8 %); 43 (9.8 %) in training and 75 (11.5 %) in testing set (p = 0.42). K-means clustering identified three groups: Cluster1 (low), Cluster2 (intermediate), and Cluster3 (high), which was associated with a progressively increasing risk of complications (p &lt; 0.01). On multivariable logistic regression, patients in ALBI Cluster1 had 76 % decreased odds (odds ratio[OR] 0.24, 95 % CI 0.07–0.83, p = 0.02) of postoperative complications relative to Cluster3 patients. Individuals categorized into FIB-4 Cluster1 had 85 % decreased odds (OR 0.15, 95 % CI 0.02–1.24, p = 0.07) versus patients in FIB-4 Cluster3. A new prediction model incorporating ALBI and FIB-4 index clusters achieved an AUC of 0.71, outperforming models based on preoperative data. A tool was made available at <span><span>https://nm49jf-miho-akabane.shinyapps.io/HCC_ALBI/</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>A dynamic ALBI score and FIB-4 index trend tool improved risk stratification of patients undergoing resection of HCC relative to severe complications.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109723"},"PeriodicalIF":3.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511661","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 in response to \"Biliary tract cancer\"","authors":"Batool Sami Mohamed","doi":"10.1016/j.ejso.2025.109722","DOIUrl":"10.1016/j.ejso.2025.109722","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109722"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644921","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 nomogram for predicting the risk of liver metastasis in non-functional neuroendocrine neoplasms: A population-based study","authors":"Zhipeng Liu ,&nbsp;Faji Yang ,&nbsp;Yijie Hao ,&nbsp;Qirong Jiang,&nbsp;Yupeng Jiang,&nbsp;Shizhe Zhang,&nbsp;Yisu Zhang,&nbsp;Qixuan Zheng,&nbsp;Zheyu Niu,&nbsp;Huaqiang Zhu,&nbsp;Xu Zhou,&nbsp;Jun Lu,&nbsp;Hengjun Gao","doi":"10.1016/j.ejso.2025.109708","DOIUrl":"10.1016/j.ejso.2025.109708","url":null,"abstract":"<div><h3>Background</h3><div>Non-functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors, and liver metastasis is the leading cause of death in patients with GEP-NENs. Due to the difficulty in conducting large cohort studies, no reliable tool currently exists to predict the risk of liver metastasis in these patients. This study aimed to develop and validate a nomogram model based on large cohort clinical data to accurately predict the risk of liver metastasis in patients with non-functional GEP-NENs.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted, encompassing 838 patients with non-functional GEP-NENs diagnosed between 2009 and 2023. Independent risk factors for liver metastasis were identified through univariate and multivariate logistic regression analyses. A nomogram was constructed based on significant predictors, including T stage, N stage, Ki-67 index, primary tumor site, and BMI. The model's performance was evaluated using the C-index, calibration curves, and decision curve analysis (DCA) for both training and validation cohorts.</div></div><div><h3>Results</h3><div>The nomogram demonstrated excellent predictive performance, with C-index values of 0.839 and 0.823 for the training and validation sets, respectively. Risk stratification using the nomogram's total score effectively differentiated high-risk from low-risk patients. Kaplan-Meier survival analysis revealed significant survival differences between these groups (P &lt; 0.0001). Moreover, the calibration curves indicated strong agreement between predicted and observed outcomes.</div></div><div><h3>Conclusions</h3><div>The developed nomogram is a reliable tool for predicting the risk of liver metastasis in non-functional GEP-NENs. It facilitates early identification of high-risk patients, thereby enabling personalized treatment and timely intervention. Future research should focus on multicenter validation and the integration of molecular markers to enhance the robustness and clinical applicability of the model.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 5","pages":"Article 109708"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521209","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":"Tumor deposits in gastric cancer cannot be regarded as metastatic lymph nodes: A single-center retrospective study","authors":"Ran Xu ,&nbsp;Yang Li ,&nbsp;Haiyuan Zhao ,&nbsp;Zhengguang Wang ,&nbsp;Ke Chen ,&nbsp;Jun Zhao ,&nbsp;Yisheng Zhang","doi":"10.1016/j.ejso.2025.109719","DOIUrl":"10.1016/j.ejso.2025.109719","url":null,"abstract":"<div><h3>Background</h3><div>In gastric cancer (GC), the significance of the number of tumor deposits (TDs) in prognostic evaluation remains a subject of debate.</div><div>This study aims to investigate whether TDs can be equated to regional metastatic lymph nodes, potentially improving the accuracy of prognostic assessments in patients with TDs.</div></div><div><h3>Methods</h3><div>A retrospective analysis of clinicopathologic and follow-up data from patients who underwent radical gastrectomy at Yijishan Hospital of Wannan Medical College over a decade, from January 2012 to December 2021, was conducted. Patients were classified into TDs-negative and TDs-positive groups on the basis of the detection of TDs in their postoperative pathology reports.</div></div><div><h3>Results</h3><div>The study included 4972 patients, with 575 (11.56 %) identified as having TDs. Among these, 524 TDs-positive patients were matched at a 1:1 ratio with 524 TDs-negative patients. Under the original TNM staging system, the chi-square (χ²) value was 58.234, with a C-index of 0.593. When TDs were classified as regional metastatic lymph nodes, the χ² value for the modified TNM staging system rose to 72.269, with an improved C-index of 0.609. Nevertheless, the prognosis within the TDs-positive subgroups IIIa, IIIb, and IIIc was still significantly worse than those in the TDs-negative subgroup, even when TDs were reclassified for staging purposes (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Although treating TDs as regional metastatic lymph nodes can increase the accuracy of disease staging in GC patients, it does not necessarily convey the true prognostic value of TDs.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109719"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684376","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":"Preoperative tumor marker elevations in colorectal cancer patients with peritoneal metastases should be used to help select patients for cytoreductive surgery","authors":"Shadin Ghabra ,&nbsp;David Chang ,&nbsp;Paul H. Sugarbaker","doi":"10.1016/j.ejso.2025.109720","DOIUrl":"10.1016/j.ejso.2025.109720","url":null,"abstract":"<div><h3>Background</h3><div>Tumor markers are used routinely for surveillance in patients treated for colorectal cancer (CRC). However, the prognostic implications of elevated preoperative tumor markers in patients treated for CRC and peritoneal metastases (PM) has not been well defined. The utility of carcinoembryonic antigen (CEA), carbohydrate antigen 19–9 (CA19-9) and cancer antigen 125 (CA125) to predict outcome for these patients is reported.</div></div><div><h3>Methods</h3><div>Clinical and histologic features plus preoperative tumor markers were recorded within 1 week prior to CRS. Impact on overall survival of these factors was analyzed by univariate and multivariate analysis.</div></div><div><h3>Results</h3><div>Two hundred and four patients were in our database and 140 patients (75.3 %) had at least a single elevated preoperative tumor marker. In an analysis of clinical and histologic parameters preoperatively, a poorly differentiated tumor, signet ring morphology, a peritoneal cancer index (PCI) of ≥16 and an incomplete cytoreduction had a negative impact on median survival. In a multivariate analysis of clinical and histologic features together with tumor markers, an elevated CA19-9 and CA125 was independently associated with reduced overall survival (HR 2.7, p &lt; 0.0001 and HR 2.2, p = 0.005), respectively. Quantitative assessment of CEA (HR 0.5, p = 0.0094) and CA19-9 (HR 4.9, p &lt; 0.001) greater than x10 ULN showed reduced survival.</div></div><div><h3>Conclusion</h3><div>Preoperative assessment of symptoms and histopathology, PCI and a complete CRS combined with tumor markers CEA, CA19-9 and CA125 are independent prognostic indicators for selection by the multidisciplinary team of CRC PM patients for CRS and HIPEC. All three tumor markers are needed for a meaningful assessment.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109720"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519341","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 efficacy and oncological safety of minimally invasive axillary procedures in patients with node-positive breast cancer receiving neoadjuvant chemotherapy: A network meta-regression and trial sequential analysis","authors":"James Lucocq ,&nbsp;Hassan Baig ,&nbsp;Esther McNeill ,&nbsp;J Michael Dixon","doi":"10.1016/j.ejso.2025.109689","DOIUrl":"10.1016/j.ejso.2025.109689","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant chemotherapy (NAC) can downstage axillary nodes in breast cancer, prompting debate over the optimal axillary management after NAC. While axillary dissection (ALND) provides detailed assessment of node status, minimally invasive methods such as sentinel lymph node biopsy (SLNB), marked lymph node biopsy (MLNB) and targeted axillary dissection (TAD) are showing promise. This meta-analysis aims to assess the efficacy and safety of these strategies.</div></div><div><h3>Methods</h3><div>A systematic search of Medline, Embase and Cochrane Central was conducted and relevant RCTs were identified. Random-effects meta-analysis, meta-regression and trial sequential analysis (TSA) were conducted for diagnostic outcomes (identification rates [IFR], false negative rates [FNR] and negative predictive value [NPV]) and survival outcomes (overall survival [OS], disease-free survival [DFS]) to compare SLNB, MLNB and TAD with ALND.</div></div><div><h3>Results</h3><div>Twenty-eight studies (SLNB, n = 3392; MLNB, n = 1130; TAD, n = 946) investigated diagnostic outcomes and nine studies investigated survival outcomes (n = 5647). The pooled IFR, FNR and NPV of TAD was 96.8 %, 4.7 % and 93.2 %, respectively, and all values were superior to SLNB (91.9 %, 13.7 % and 84.8 %; meta-regression, p &lt; 0.001) (SLNB vs. MLNB concordance = 73 %). The FNR of SLNB decreased with the number of nodes removed (≥3 nodes, 8.1 %) but remained inferior to TAD (p = 0.001). The IFR of SLNB in the ycN0 group was statistically lower than all patients (ycN0/+), 85.8 % vs. 91.9 % (p &lt; 0.001). Pooled hazard ratios for DFS in SLNB/TAD, SLNB and TAD were 0.90 (95%CI, 0.77–1.04; p = 0.45), 0.89 (95%CI, 0.74–1.08; p = 0.25) and 0.91 (95%CI, 0.64–1.29; p = 0.58) (TSA 2.08&gt;threshold). Indirect comparison between TAD and SLNB demonstrated no significant difference in DFS (HR 0.98; 0.64–1.32; 95%CI, p = 0.95).</div></div><div><h3>Conclusion</h3><div>Targeted axillary dissection is the optimal minimally invasive axillary technique in terms of diagnostic accuracy. De-escalation of axillary surgery following NAC does not negatively impact DFS in patients with node-positive breast cancer</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109689"},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684356","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}