International journal of surgery最新文献

{"title":"Artificial intelligence-based multimodal prediction for nuclear grading status and prognosis of clear cell renal cell carcinoma: a multicenter cohort study.","authors":"Qingyuan Zheng, Haonan Mei, Xiaodong Weng, Rui Yang, Panpan Jiao, Xinmiao Ni, Xiangxiang Yang, Jiejun Wu, Junjie Fan, Jingping Yuan, Xiuheng Liu, Zhiyuan Chen","doi":"10.1097/JS9.0000000000002368","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002368","url":null,"abstract":"<p><strong>Background: </strong>The assessment of the International Society of Urological Pathology (ISUP) nuclear grade is crucial for the management and treatment of clear cell renal cell carcinoma (ccRCC). This study aimed to explore the value of using integrated multimodal information for ISUP grading and prognostic stratification in ccRCC patients, to guide postoperative adjuvant therapy.</p><p><strong>Methods: </strong>This retrospective study analyzed a total of 729 patients from three cohorts, utilizing whole slide images and computed tomography (CT) images. Artificial intelligence algorithms were used to extract morphological and textural features from whole slide images and CT images separately, creating single-modality predictive models for ISUP grading. By combining the CT and pathology single-modality predictive features, a multimodal predictive signature (MPS) was developed. The prognostic performance of the MPS model was further validated in two independent cohorts.</p><p><strong>Results: </strong>The single-modality predictive models for CT and pathology performed well in predicting ISUP grade for ccRCC. The MPS model achieved higher area under the curve values of 0.95, 0.93, and 0.95 across three independent patient cohorts. Additionally, the MPS model was able to distinguish patients with poorer overall survival. In the external validation cohort, uni- and multivariate analyses showed hazard ratios of 2.542 (95% confidence interval [CI]: 1.363-4.741, P < 0.0001) and 1.723 (95% CI: 0.888-3.357, P = 0.003), respectively. The C-index values for the two cohorts were 0.75 and 0.71. Furthermore, the MPS outperformed single-modality models, providing a complementary tool for current risk stratification in ccRCC adjuvant therapy.</p><p><strong>Conclusion: </strong>Our novel MPS model demonstrated high accuracy in ISUP grading for ccRCC patients. With further validation across multiple centers, the MPS model could be used for precise detection of nuclear grading in ccRCC, serving as an effective tool for assisting clinical decision-making.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719339","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 novel approach to cancer rehabilitation: assessing the influence of exercise intervention on postoperative recovery and survival rates.","authors":"Xiaoyan Chen, Zhi Li, Junfeng Zhang","doi":"10.1097/JS9.0000000000002323","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002323","url":null,"abstract":"<p><p>Cancer rehabilitation is the crucial process by which cancer patients regain their physical abilities and enhance their quality of life through diverse methods following treatment. As the cure rate of cancer continues to rise, the need for postoperative rehabilitation is becoming increasingly evident. This is particularly crucial for enhancing patient survival rates and minimizing the chances of cancer recurrence. Exercise intervention has become increasingly popular and widely used as a proactive rehabilitation therapy in recent years. This article examines the influence of exercise intervention on the recovery and survival rates of cancer patients after surgery. It specifically investigates the effects and mechanisms of various exercise interventions, such as aerobic exercise, strength training, and flexibility training, on patients with lung cancer, gastric cancer, colorectal cancer, and other forms of cancer. Exercise therapies before and after surgery can greatly boost patients' physical abilities, decrease postoperative problems, minimize hospital stays, and improve overall quality of life. In addition, implementing exercise intervention can enhance the long-term survival rates of patients. Future studies should investigate the most effective exercise programs and their suitability for various types of cancer, with the goal of offering better evidence-based clinical advice.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719336","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 perspective of modern transplant science -transplant arteriosclerosis: Inspiration derived from mitochondria associated endoplasmic reticulum membrane dysfunction in arterial diseases (review article).","authors":"Jingyi Li, Qian Lin, Chao Ren, Xiaodong Li, Xiaowei Li, Haofeng Li, Shadan Li","doi":"10.1097/JS9.0000000000002362","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002362","url":null,"abstract":"<p><p>The mitochondria-associated endoplasmic reticulum membrane (MAM) is a crucial structure connecting mitochondria and the endoplasmic reticulum (ER), regulating intracellular calcium homeostasis, lipid metabolism, and various signaling pathways essential for arterial health. Recent studies highlight MAM's significant role in modulating vascular endothelial cells (EC) and vascular smooth muscle cells (VSMC), establishing it as a key regulator of arterial health and a contributor to vascular disease pathogenesis. Organ transplantation is the preferred treatment for end-stage organ failure, but transplant arteriosclerosis (TA) can lead to chronic transplant dysfunction (CTD), significantly impacting patient survival. TA, like other vascular diseases, features endothelial dysfunction and abnormal proliferation and migration of VSMC. Previous research on TA has focused on immune factors, the pathological and physiological changes in grafts following immune system attacks have garnered insufficient attention. For example, the potential roles of MAM in TA has not been thoroughly investigated. Investigating the relationship between MAM and TA, as well as the mechanisms behind TA progression, is essential. This review aims to outline the fundamental structure and the primary functions of MAM, summarize its key molecular regulators of vascular health, and explore future prospects for MAM in the context of TA research, providing insights for both basic research and clinical management of TA.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729969","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":"ESWT is able to change macromorphological and micromorphological parameters in patellar tendinopathy: a prospective cohort study.","authors":"Jakub Katolický, Petra Poklopová, Gregory Bashford, Tereza Katolická, Kryštof Voleský, Stanislav Machač, Tomáš Nedělka","doi":"10.1097/JS9.0000000000002351","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002351","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the mid-term effects of focused extracorporeal shockwave therapy (ESWT) on clinical symptoms and tendon structure in patellar tendinopathy. Ultrasound (US) evaluation and an innovative in vivo analysis of intra-tendinous morphology using validated spatial frequency analysis (SFA) software were employed to quantify the organization and density of collagen fascicles.</p><p><strong>Methods: </strong>This prospective cohort study included 21 recreational athletes (mean age 29.9 ± 9.3 years) with chronic unilateral symptomatic patellar tendinopathy. ESWT was applied as monotherapy over four weekly sessions. Pain was assessed using the Numeric Rating Scale (NRS) and disease severity with the Victorian Institute of Sports Assessment - Patella (VISA-P) questionnaire. Morphological parameters, such as tendon diameter (TD), were assessed with US and analyzed using SFA software. The asymptomatic tendons served as controls. Follow-up assessments were conducted at the end of the treatment period and 3 months posttreatment.</p><p><strong>Results: </strong>Baseline evaluations revealed increased TD in proximal part of the tendon (P = 0.001) and decreased organization of collagen fascicles (P = 0.013) in symptomatic tendons compared to asymptomatic controls. At the 3-month follow-up, symptomatic tendons showed significant reductions in TD (P < 0.001) and improvements in both organization and density of collagen fascicles throughout various parameters - PSFR (P = 0.024), P6 (P = 0.05), Q6 (P = 0.016), PPP (P = 0.003). No significant morphological changes were observed in asymptomatic tendons. Clinical evaluations demonstrated significant reductions in NRS (P < 0.001) and increases in VISA-P scores (P < 0.001) at all time points.</p><p><strong>Conclusion: </strong>The study suggests that ESWT may have the potential to induce positive structural changes in patellar tendinopathy, including improved organization and density of collagen fascicles. These findings indicate that ESWT could be a promising noninvasive approach to managing patellar tendinopathy, with observed improvements in clinical symptoms and tendon structure. However, further high-quality research is needed to confirm these results and establish their long-term efficacy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718381","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":"TP53-centric ctDNA complements PET/CT for non-invasive assessment of pathological complete response and survival after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma: a prospective cohort study.","authors":"Weixiong Yang, Si-Cong Ma, Zengli Fang, Yao Liu, Xin Zhang, Fang Wang, Chenxuan Wang, Yuze Wang, Xiaoyan Wang, Wenfang Chen, Hui Luo, Lingling Yang, Shuishen Zhang, Bo Zeng, Zhenguo Liu, Qiuxiang Ou, Junchao Cai, Sai-Ching Jim Yeung, Chao Cheng","doi":"10.1097/JS9.0000000000002341","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002341","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of pathologic complete response (pCR) after neoadjuvant immunochemotherapy (NICT) is crucial to implement active surveillance or tailor therapeutic strategies for esophageal squamous cell carcinoma (ESCC), while reliable non-invasive methods for pCR prediction are lacking. We aimed to evaluate the potential of integrating circulating tumor DNA (ctDNA) and PET/CT for predicting pCR to NICT for ESCC.</p><p><strong>Methods: </strong>A total of 123 eligible patients were enrolled, including 68 patients from our prospective clinical trial (ChiCTR200002****) and a real-world study (NCT0482****) that formed the discovery cohort, as well as 55 patients from another clinical trial (ChiCTR210005****) comprising the validation cohort. Blood samples for ctDNA sequencing and PET/CT metrics were collected before and after NICT.</p><p><strong>Results: </strong>The post-NICT, rather than pre-NICT, ctDNA status and PET/CT parameters significantly differentiated pCR from non-pCR patients. ctDNA and PET/CT synergistically enhanced the prediction of pCR from perspectives of sensitivity and specificity, respectively. The model integrating ctDNA concentration and mean standardized uptake value (SUVmean) demonstrated area under curves (AUCs) of 0.860 in the discovery cohort and 0.798 in the validation cohort for pCR prediction and stratified patients into high- and low-risk groups with differential survival prospects. The key gene modules converged on TP53 as the core mutation for pCR prediction, among which those located in the exon regions contributed the most to its predictive capacity. The model constructed based on TP53 mutation and SUVmean differentiated pCR from non-pCR with comparable performance to the model based on PET/CT and the overall ctDNA concentration.</p><p><strong>Conclusion: </strong>The combination of post-treatment TP53-centric ctDNA and PET/CT synergistically enhances the prediction of pCR following NICT in ESCC patients, indicating the potential to inform clinical decision-making for these patients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719163","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 efficacy and progression patterns of paclitaxel plus cisplatin and 5-fluorouracil induction chemotherapy for locally advanced borderline-resectable esophageal squamous cell carcinoma: results from a phase II NEOCRTEC1601 study.","authors":"Jia-Di Wu, Zhi-Qiang Wang, Qiao-Qiao Li, Chao Ren, Sheng Huang, Cai-Yan Fang, De-Shen Wang, Ji-Yang Chen, Qiong Tan, Yu-Hong Li, Hong Yang","doi":"10.1097/JS9.0000000000002360","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002360","url":null,"abstract":"<p><strong>Introduction: </strong>The NEOCRTEC1601 trial aimed to evaluate the efficacy and safety of paclitaxel in combination with cisplatin and 5-fluorouracil (TPF) as induction chemotherapy for BR-ESCC. This study presented an updated 5-year analysis to further elucidate the impact of TPF chemotherapy followed by surgery.</p><p><strong>Method: </strong>This study was conducted as a single-center, phase II, clinical trial. Eligibility was extended to patients diagnosed with BR-ESCC, characterized by a primary tumor or bulky lymph nodes with potential invasion into adjacent organs. The treatment protocol commenced with TPF chemotherapy, followed by surgery if the tumor was deemed resectable, or by concurrent chemoradiation in cases where resection was not feasible. This updated report delineates the 5-year overall survival and progression-free survival rate.</p><p><strong>Result: </strong>Surgery was performed for 27 patients (57.4%), and R0 resection was confirmed in 25 patients (53.2%). Pathologic complete response was confirmed in four patients (8.5%). Following a minimum follow-up period exceeding 60 months for all patients, the total number of deaths was 31 (65.96%). The OS and PFS for the R0 group were significantly longer than the non-R0 group (median OS: 53.0 months vs. 13.9 months, HR 0.36, 95%CI 0.17-0.76, p = 0.0032; median PFS: 50.84 months vs. 5.42 months, HR 0.40, 95%CI 0.19-0.84, p = 0.0076). The 5-year OS rate was 50.0% (34.0%-73.4%) for the R0 group compared to 19.0% (7.9%-46.0%) for the non-R0 group (HR 0.36, 95%CI 0.17-0.79, p = 0.0041).</p><p><strong>Conclusion: </strong>Long-term follow-up evaluation confirmed that the OS and PFS were significantly improved in patients who underwent R0 resection compared to those who did not. The 5-year OS rate for patients who achieved R0 resection was 50.0%. R0 resection might be the independent prognostic factors for OS. To further improve the R0 resection rate and prognosis, more effective induction treatment regimens need to be explored.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718982","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":"Comparison of safety and efficacy of negative pressure aspiration assisted retrograde intrarenal surgery and traditional percutaneous nephrolithotomy in the treatment of upper urinary tract stones larger than 2cm: a systematic review and meta-analysis.","authors":"Zhaoxin Ying, Shaoxiong Ming, Rui Yang, Bangyu Zou, Yiying Jia, Meng Shu, Ziyu Fang, Xiaofeng Gao","doi":"10.1097/JS9.0000000000002363","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002363","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is widely regarded as the first-line treatment for upper urinary tract stones larger than 2 cm, as recommended by major urological associations. However, a growing body of research highlights the safety and effectiveness of retrograde intrarenal surgery (RIRS) for managing stones of this size in the upper urinary tract, especially with the advent of suction-assisted techniques in RIRS. This study aims to systematically evaluate the safety and efficacy of negative pressure aspiration-assisted retrograde intrarenal surgery (NPAA-RIRS) in comparison to traditional PCNL.</p><p><strong>Method: </strong>Eligible studies were found by searching the PubMed, Embase, Web of Science and the CNKI databases for relevant reports published until July 2024. Outcome measures included initial and final stone-free rate (SFR), secondary operation, operation time, hemoglobin level reduction, blood transfusion, interventional embolization, postoperative hospital stay, complications. The assessment of publication bias was conducted using a funnel plot. Ten studies from nine articles were included, involving 1,259 patients.</p><p><strong>Results: </strong>NPAA-RIRS group showed lower hemoglobin level reduction (WMD = - 1.31, 95% CI [-1.64, - 0.99], P < 0.001), less blood transfusion (RR = 0.15, 95% CI [0.05, 0.50], P = 0.002), shorter postoperative hospital stay (WMD: - 1.93, 95% CI [-2.54, - 1.32], P < 0.001), lower Clavien-Dindo I-II complication rate (RR: 0.51, 95% CI [0.38, 0.67], P < 0.001), and lower overall complication rate (RR = 0.52, 95% CI [0.40, 0.68], P < 0.001) compared to the PCNL group. The PCNL group had shorter operation time (WMD = 0.68, 95% CI [0.22, 1.13], P = 0.003), higher initial SFR (RR = 0.87, 95% CI [0.83, 0.92], P < 0.001), and lower rate of secondary operation (RR = 2.51, 95% CI [1.52, 4.12], P < 0.001) compared to the NPAA-RIRS group. There were no statistically significant differences between the two groups in interventional embolization (RR = 0.28, 95% CI [0.06, 1.33], P = 0.11), final SFR (RR = 0.98, 95% CI [0.94, 1.01], P = 0.740), and Clavien-Dindo III-IV complication rate (RR: 0.65, 95% CI [0.28, 1.51], P = 0.316).</p><p><strong>Conclusion: </strong>For upper urinary tract stones larger than 2 cm, both NPAA-RIRS and PCNL are equally safe and effective, achieving comparable final SFR. NPAA-RIRS offers advantages in terms of reduced complications, whereas PCNL shows benefits in shorter operation times and a lower likelihood of requiring secondary procedures. Clinicians can therefore select the most suitable approach based on individual patient circumstances.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729952","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":"Ethical considerations on the role of artificial intelligence in defining the futility in emergency surgery.","authors":"Valentina Bianchi, Filomena Misuriello, Edoardo Piras, Carmen Nesci, Maria Michela Chiarello, Giuseppe Brisinda","doi":"10.1097/JS9.0000000000002347","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002347","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718503","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":"Development and validation of a machine learning-based risk model for metastatic disease in NmCRPC patients: a tumour marker prognostic study.","authors":"Xudong Ni, Ziyun Wang, Xiaomeng Li, Jixinnan Sui, Weiwei Ma, Jian Pan, Dingwei Ye, Yao Zhu","doi":"10.1097/JS9.0000000000002321","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002321","url":null,"abstract":"<p><strong>Background: </strong>Nonmetastatic castration-resistant prostate cancer (nmCRPC) is a clinical challenge due to the high progression rate to metastasis and mortality. To date, no prognostic model has been developed to predict the metastatic probability for nmCRPC patients. In this study, we developed and externally validated a machine-learning model capable of calculating risk scores and predicting the likelihood of metastasis in nmCRPC patients.</p><p><strong>Patients and methods: </strong>A total of 2,716 nmCRPC patients were included in this study. The training and testing datasets were derived from Clinical Trial A (The clinical trial's name and NCT number are concealed by the double-blind review policy) and Clinical Trial B, respectively. Regarding metastasis-free survival (MFS) as the endpoint, we subjected 13 clinical features to 10 machine-learning models and their combinations to predict metastasis. Model performance was assessed through accuracy (AUC), calibration (slope and intercept), and clinical utility (DCA). The risk score calculated by the model and risk factors based on eight identified variates were used for metastatic risk stratification.</p><p><strong>Results: </strong>The final prognostic model included eight prognostic factors, including novel hormone therapy (NHT) application, Gleason score, previous treatments received (both surgery and radiotherapy, or neither), Race (White), PSA doubling time (PSADT), hemoglobin (HGB), and lgPSA. The prognostic model resulted in a C-index of 0.724 (95% CI 0.700-0.747) in internal validation and relatively good performance through tAUC (>0.70 at 3-month intervals between 6 and 39 months) in external validation. In the risk score stratifying strategy, compared with the low-risk group, the metastasis HRs for medium- and high-risk groups were 1.72 (95% CI 1.39-2.12) and 4.43 (95% CI 3.66-5.38); as for risk factor count, the HRs are 1.98 (95% CI 1.50-2.61) and 4.17 (95% CI 3.16-5.52), respectively.</p><p><strong>Conclusions: </strong>In this study, we developed and validated a machine learning prognostic model to predict the risk of metastasis in nmCRPC patients. This model can assist in the risk stratification of nmCRPC patients, guide follow-up strategies, and aid in selecting personalized treatment intensities.</p><p><strong>Key words: </strong>Nonmetastatic castration-resistant prostate cancer; Prostate Cancer; Machine learning; Prognostic model; Metastasis-Free Survival.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718380","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":"Systemic therapy plus HAIC versus systemic therapy for hepatocellular carcinoma: a systematic review and meta-analysis.","authors":"Donghai Lu, Han Li, Pengfei Sun, Jincheng Tian, Kefan Jiao, Qihang Cao, Yuxuan Wang, Jisen Jia, Qiao He, Shengxuan Peng, Daolin Zhang, Zhaoru Dong, Dongxu Wang, Tao Li","doi":"10.1097/JS9.0000000000002326","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002326","url":null,"abstract":"<p><strong>Background: </strong>Hepatic arterial infusion chemotherapy (HAIC) exhibits synergistic anticancer effects with systemic therapy in treating hepatocellular carcinoma (HCC). The approach combining systemic therapy and HAIC is likely to establish a new survival benchmark for advanced HCC. However, related evidence is still lacking.</p><p><strong>Method: </strong>PubMed, Embase, Cochrane Library, and Web of Science were searched from January 1990 to July 2024. The extracted data were pooled using fixed- or random-effects models and expressed as hazard ratios (HRs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs). Meta-regression, subgroup analysis, prognostic factor analysis, correlation analysis, as well as trial sequential analysis were further conducted.</p><p><strong>Result: </strong>Seventeen trials involving 3070 participants were included. Patients receiving HAIC combined systemic therapy displayed superior overall survival (OS) (HR, 0.52; 95% CI, 0.48-0.58), progression-free survival (PFS) (HR, 0.54; 95% CI, 0.46-0.63), objective response rate (ORR) (RR, 2.20; 95% CI, 1.77-2.72) and disease control rate (RR, 1.21; 95% CI, 1.14-1.29) over systemic therapy. Combining HAIC resulted in higher incidences of grade ≥3 manageable adverse events. Subgroup analyses showed that HAIC could bring significant survival improvement for almost all specific populations; however, patients without portal vein tumor thrombosis might not benefit from it (HR, 0.74; 95% CI, 0.53-1.03). Prognostic factor analyses found extra HAIC was a protective factor for both OS (HR, 0.42; 95% CI, 0.34-0.51) and PFS (HR, 0.44; 95% CI, 0.36-0.53). Correlation analyses demonstrated a robust association between ORR and OS when applying systemic therapy with HAIC (P-value = 0.031). In addition, trial sequential analyses visually showed the present data were compelling to draw reliable conclusions.</p><p><strong>Conclusion: </strong>With manageable toxicity, integrating HAIC with systemic therapy could bring favorable survival benefits for HCC patients. Further evidence is necessary to standardize the integration of HAIC with first-line systemic therapy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719142","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}