Journal of Clinical Medicine最新文献

{"title":"Psychological Mechanisms of Caregiver Involvement in Caregiving for Individuals with Alzheimer's Disease: Analysis of the Moderated Mediation Model.","authors":"Anna Sołtys, Marcin Wnuk","doi":"10.3390/jcm14145134","DOIUrl":"10.3390/jcm14145134","url":null,"abstract":"<p><p>Providing long-term care for a person with Alzheimer's disease is associated with chronic stress and emotional overload. One of the key predictors of emotional burden is the amount of time devoted to caregiving, which intensifies the experienced stress. Additional risk factors include the stage of the illness, difficulties in the care recipient's activities of daily living, the caregiver's neglect of their own needs, and challenging behaviours exhibited by the person receiving care. Therefore, it is essential to identify the psychological protective resources of caregivers that can buffer the impact of stress. <b>Background/Objectives</b>: The objective of the study was to explore the psychological mechanisms underlying the involvement of caregivers supporting individuals with Alzheimer's disease. A moderated mediation model was employed, in which stress indirectly affects caregiver involvement through a sense of coherence, and the strength of this relationship is moderated by the amount of time devoted to caregiving. <b>Methods</b>: The bootstrapping method was applied using 5000 resamples within a 95% bias-corrected confidence interval. The analysis accounted for variables such as stress levels, sense of coherence, involvement in caregiving, duration of care, education, gender, age, and stage of the illness. <b>Results</b>: The sense of coherence mediated the relationship between stress and involvement in caring (B = 0.0063, SE = 0.0031, 95% CI [0.0012, 0.0135]), and this indirect effect was contingent upon the amount of time devoted to helping. The relationship between sense of coherence and involvement in caring was significant at the mean level (B = 0.005, SE = 0.002, 95% CI [0.0004, 0.0101]) and became stronger at high levels of time devoted to caring (+1 SD; B = 0.009, SE = 0.003, 95% CI [0.0030, 0.0148]). These results indicate that the positive association between sense of coherence and caregiver involvement increases with the amount of time spent caring. <b>Conclusions</b>: The results highlight the importance of strengthening caregivers' resilience resources-such as a sense of coherence-in preventing overload. The model may serve as a foundation for developing interventions aimed at supporting caregivers' mental health.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Punctate Hyperfluorescence as a Favorable Predictive Factor for Treatment Response Following a Switch to Brolucizumab for Patients with Aflibercept-Refractory Neovascular Age-Related Macular Degeneration.","authors":"Hiroyuki Kamao, Katsutoshi Goto, Kenichi Mizukawa, Ryutaro Hiraki, Atsushi Miki, Shuhei Kimura","doi":"10.3390/jcm14145141","DOIUrl":"10.3390/jcm14145141","url":null,"abstract":"<p><p><b>Background/Objectives:</b> To identify the predictive biomarkers of treatment response following a switch to brolucizumab in patients with aflibercept-refractory neovascular age-related macular degeneration (nAMD). <b>Methods</b>: This retrospective study included 47 eyes of 44 patients with nAMD who were switched to brolucizumab; a two-year follow-up was completed for 37 eyes of 34 patients after the switch. The patients were classified into two groups based on the presence (fluid group) or absence (dry group) of retinal fluid at one and two years after switching, and their visual acuity, central retinal thickness, subfoveal choroidal thickness, injection interval, and dry macular rate were evaluated. <b>Results</b>: A dry macula was achieved for approximately 80% of patients at two years after the switch (<i>p</i> < 0.001), and the mean injection interval was significantly extended from 6.4 ± 1.8 weeks to 10.5 ± 2.6 weeks during the same period (<i>p</i> < 0.001). Both the mean central retinal thickness and subfoveal choroidal thickness showed a significant decrease at two years after the switch (<i>p</i> < 0.001 for both). A significantly higher proportion of patients in the Dry group exhibited punctate hyperfluorescence in the fellow eye (<i>p</i> < 0.001), and all patients in the dry group achieved a dry macula at two years. <b>Conclusions</b>: Switching to brolucizumab may be an effective treatment option for patients with aflibercept-refractory nAMD. Punctate hyperfluorescence may serve as a favorable prognostic factor following a switch to brolucizumab.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Healing Abutment Height on Secondary Implant Stability Using Resonance Frequency Analysis: A Prospective Clinical Study.","authors":"Alicia Martín-Martín, Esteban Pérez-Pevida, Saray Férnandez-Hernández, Jaime Lubillo-Valdeón, Aritza Brizuela-Velasco","doi":"10.3390/jcm14145140","DOIUrl":"10.3390/jcm14145140","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The aim of the present study is to evaluate the influence of the healing abutment height on secondary implant stability measured by resonance frequency analysis. In this prospective observational clinical study of 30 implants, the secondary stability of the implant was measured via resonance frequency analysis of the abutment during the osseointegration process. <b>Methods:</b> Two groups were compared: a <4 group (<i>n</i> = 15), with a space between the healing abutment and the antagonist of <4 mm, and a ≥4 group (<i>n</i> = 15), with a space of ≥4 mm. <b>Results:</b> Statistically significant differences (<i>p</i> < 0.05) in the implant stability values obtained at surgery (T0) and at the eighth week of osseointegration (T8) were observed between the two groups, with higher values for the <4 group. Pearson's correlation analysis revealed a trend towards a significant relationship with the mean force (-0.6546) and a linear inverse relationship, so that by decreasing the distance between the abutment and the contact with the antagonist, the secondary implant stability values increased. A comparison of the mesial and distal peri-implant marginal bone levels at T0 and T8 did not reveal statistically significant differences (<i>p</i> > 0.05). A greater healing abutment height, placing it closer to the antagonist, increases and accelerates secondary stability, as measured by resonance frequency analysis. <b>Conclusions:</b> The results of the study support the recommendation of using high healing abutments, placing the abutment close to the opposing occlusal plane, according to biomechanical criteria.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myopia Management in Ontario, Canada.","authors":"Amy H Y Chow, Barbara Caffery, Sarah Guthrie, Mira Acs, Angela Di Marco, Stephanie Fromstein, Stephanie Ramdass, Vishakha Thakrar, Shalu Pal, Matthew Zeidenberg, Deborah A Jones","doi":"10.3390/jcm14145132","DOIUrl":"10.3390/jcm14145132","url":null,"abstract":"<p><p><b>Objectives:</b> To determine how optometrists in Canada manage their pediatric myopia patients and to assess whether this has changed over time. <b>Methods:</b> In a retrospective chart review, records for children aged 6-10 years who had an eye exam between 2017 to 2021 were reviewed. Children were grouped by presenting refraction (myopes ≤ -0.50 D or pre-myopes ≤ +0.75 D). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) for each group (myopes and pre-myopes), for a maximum of 250 files per practice. Demographic information, refraction, and recommended interventions were recorded. Logistic regression was used to model the likelihood of being prescribed a myopia control intervention based on patient and optometrist characteristics. <b>Results:</b> A total of 2905 patients (<i>n</i> = 1467 (50%) female) from 15 practices across Ontario, Canada, were included, accounting for 8546 visits. Optometrists predominantly prescribed single-vision spectacle correction as a first-line intervention for myopic children, although this declined from 98.2% in 2017 to 56.7% in 2023. The use of myopia control modalities increased from 1.8% to 43.3% over this same period. Optometrists began recommending myopia control at lower myopic refractive errors over time (-2.63 DS in 2017 vs and -1.49 DS in 2020). Myopia control spectacles were the most commonly prescribed intervention, despite the observation that optometrists are not hesitant to fit contact lenses in younger children. Optometrists who had been in practice longer were more likely to prescribe older forms of myopia control (e.g., bifocals/progressives) than more recent graduates. <b>Conclusions:</b> While single-vision spectacle correction remains a primary approach for initial myopia management in Ontario, Canada, optometrists increasingly recommend myopia control and are initiating interventions earlier.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy and Delivery After Solid Organ and Uterus Transplantation: A Review.","authors":"Iori Kisu, Mitsutoshi Yamada, Satoru Ikenoue, Wataru Yamagami","doi":"10.3390/jcm14145138","DOIUrl":"10.3390/jcm14145138","url":null,"abstract":"<p><p>In recent years, advances in organ transplantation medicine have led to an increase in pregnancies and births following transplantation. Pregnancy after organ transplantation is considered high-risk, and its impact on both the recipient and the child must be carefully evaluated. In this review, we summarize the current landscape of pregnancy and childbirth after organ transplantation, with a particular focus on uterus transplantation (UTx). Traditionally, organ transplants have involved vital organs; however, UTx, developed for women with absolute uterine factor infertility, represents a novel approach. Although the number of births following UTx remains limited, it is expected to grow due to the international expansion of this procedure. Importantly, the concept of pregnancy and delivery following UTx is fundamentally different from that of other organ transplants. UTx is a life-enhancing, non-vital, and temporary transplant uniquely intended to enable the creation of new life. Pregnancy after UTx carries specific risks such as a higher incidence of miscarriage, preterm birth, hypertensive disorders of pregnancy, and gestational diabetes. All deliveries are performed via cesarean section, and conception is typically allowed after a relatively short period following transplantation, given the temporary nature of the graft and the goal to minimize recipient burden, with generally good neonatal outcomes. As pregnancies after both solid organ transplantation and UTx continue to rise worldwide, the development of standardized, organ-specific perinatal management strategies, particularly for UTx, is essential. Multidisciplinary collaboration will be critical to supporting these high-risk pregnancies and ensuring the best possible maternal and neonatal outcomes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Concentrations of Vascular Endothelial Growth Factor in Polish Patients with Systemic Lupus Erythematosus Are Associated with Cardiovascular Risk and Autoantibody Profiles.","authors":"Katarzyna Fischer, Hanna Przepiera-Będzak, Marcin Sawicki, Maciej Brzosko, Marek Brzosko","doi":"10.3390/jcm14145133","DOIUrl":"10.3390/jcm14145133","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study was conducted to analyze the associations between vascular endothelial growth factor (VEGF) serum concentrations and immunological biomarkers, inflammatory parameters, classical atherosclerosis risk factors, and cardiovascular manifestations in systemic lupus erythematosus (SLE) patients. <b>Methods</b>: The project included 83 individuals suffering from SLE, with 20 healthy individuals as controls. The serum levels of VEGF were determined through the ELISA method using R&D Systems tests. Laboratory markers, autoantibody profiles, traditional atherosclerotic risk factors, and organ manifestations were evaluated. Atherosclerotic changes were determined based on several indices including carotid intima-media thickness, ankle-brachial index and high resistance index assessments. <b>Results</b>: The reference range of serum VEGF concentrations was established based on the 25th and 75th percentiles obtained in the controls. High VEGF levels were significantly correlated with the presence of selected anti-phospholipid antibodies such as anti-prothrombin (OR = 10.7; 95%CI: 2.1-53.4) and anti-beta2 glycoprotein I (OR = 3.5; 95%CI: 1.1-10.8), as well as cardiac disorders (OR = 8.0; 95%CI: 1.6-39.5). On the other hand, low concentrations of VEGF were significantly related to lower frequencies of anti-double-stranded DNA antibodies (OR = 0.31; 95%CI: 0.11-0.91) and anti-endothelial cell antibodies (OR = 0.30; 95%CI: 0.11-0.85). Patients with low VEGF levels showed significantly reduced risks of atherosclerotic lesions (OR = 0.24; 95%CI: 0.04-0.99) and vasculitis development (OR = 0.17; 95%CI = 0.03-0.91). <b>Conclusions</b>: In conclusion, VEGF's pathogenetic role in SLE and SLE-related atherothrombosis is manifested in close correlation with aPLs which may enhance their direct impact on endothelium. High VEGF levels are helpful for identifying cardiovascular risk in patients, while low concentrations indicate lower disease activity, as well as a lower risk of organ involvement.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evaluation of Polish Women's Knowledge of Perineal Incision: A Cross-Sectional Study.","authors":"Romana Buchert, Katarzyna Wszołek, Kinga Bednarek, Marcin Wierzchowski, Maciej Wilczak, Karolina Chmaj-Wierzchowska","doi":"10.3390/jcm14145142","DOIUrl":"10.3390/jcm14145142","url":null,"abstract":"<p><p><b>Background/Objectives</b>: A perineal incision (episiotomy) is a surgical procedure involving the controlled cutting of perineal tissues to widen the vaginal outlet during the second stage of labor. The aim of this study was to assess Polish women's knowledge regarding perineal incision. <b>Methods</b>: This study was conducted using an unvalidated, anonymous questionnaire created in Google Forms. <b>Results</b>: Women with higher education, those who had undergone childbirth, and those who identified the Internet, medical personnel, medical personnel on social media, and medical journals as sources had significantly higher levels of knowledge. Respondents aged 25 years or younger had significantly lower knowledge levels compared to those aged over 26. Additionally, respondents living in cities with populations of up to 500,000 had significantly lower levels of knowledge compared to women living in larger cities. <b>Conclusions</b>: The level of women's knowledge about perineal incision varies and is influenced by several factors. Significant determinants of higher levels of knowledge were higher education, having a history of obstetric delivery, being over 25 years old, and using information provided by medical personnel, including those present on social media.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on Pregnancy Outcomes: A Phase-Based Analysis from a Spanish Tertiary Hospital (2020-2023).","authors":"María-Asunción Quijada-Cazorla, María-Virgilia Simó-Rodríguez, Ana-María Palacios-Marqués, María Peláez-García, José-Manuel Ramos-Rincón","doi":"10.3390/jcm14145136","DOIUrl":"10.3390/jcm14145136","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Pregnancy has been considered a risk factor for severe SARS-CoV-2 infection, as well as for adverse maternal and neonatal outcomes. This study aimed to assess the clinical impact of COVID-19 on pregnant women managed at a Spanish tertiary care hospital across different phases of the pandemic. <b>Methods:</b> A retrospective observational study was conducted at Dr. Balmis General University Hospital (Alicante, Spain) between March 2020 and May 2023. All pregnant women who received hospital care with confirmed SARS-CoV-2 infection were included. Maternal and neonatal outcomes were analyzed and compared with the 6120 total births recorded during the same period. <b>Results:</b> A total of 249 pregnant women with COVID-19 were included, with 30.8%, 25.0%, and 7.9% hospitalized during each respective pandemic phase. The overall incidence of infection was 41 cases per 1000 births. Hospitalized pregnant women showed significantly higher rates of preterm birth, labor induction (70.4% vs. 47.0%; OR: 2.67; 95% CI: 1.12-6.43), and cesarean delivery (46.9% vs. 24.9%, OR: 2.60; 95% CI: 1.27-5.50). Neonatal outcomes included lower Apgar scores, increased admission to the neonatal unit (25.8% vs. 8.2%, <i>p</i> = 0.007), and a higher rate of neonatal complications (23.3% vs. 7.7%, <i>p</i> = 0.015). Maternal obesity and non-Spanish nationality were associated with more severe maternal disease. Vaccination against SARS-CoV-2 significantly reduced the risk of hospitalization due to the infection (OR: 0.30; 95% CI: 0.13-0.69). <b>Conclusions:</b> Pregnant women admitted with COVID-19 had increased risks of adverse obstetric and neonatal outcomes, underscoring the importance of preventive strategies, such as vaccination.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Role of CD318 in Tumor Immunity Affecting Prognosis in Colorectal Cancer Compared to Other Adenocarcinomas.","authors":"Bhaumik Patel, Marina Curcic, Mohamed Ashraf Eltokhy, Sahdeo Prasad","doi":"10.3390/jcm14145139","DOIUrl":"10.3390/jcm14145139","url":null,"abstract":"<p><p><b>Background/Objectives</b>: CD318 (also known as CDCP1) is a transmembrane protein that is overexpressed in many cancers and contributes to tumor progression, invasion, and metastasis by activating SRC family kinases through phosphorylation. Emerging evidence also suggests that CD318 plays a role in modulating the tumor immune microenvironment, although its precise mechanism in tumor progression is still not well understood. <b>Methods</b>: To investigate this, we analyzed the expression and immune-related functions of CD318 using the publicly available data from The Cancer Genome Atlas (TCGA) across colorectal adenocarcinoma (COAD), cervical squamous cell carcinoma (CESC), lung adenocarcinoma (LUAD), and pancreatic adenocarcinoma (PAAD). <b>Results</b>: All four cancers exhibited a high level of CD318 expression. Notably, in CESC, LUAD, and PAAD, plasmin-mediated cleavage of CD318 leads to phosphorylation of SRC and protein kinase C delta (PKCδ), which activates HIF1α and/or p38 MAPK. These downstream effectors translocate to the nucleus and promote the transcriptional upregulation of TGFβ1, fostering an immunosuppressive tumor microenvironment through Treg cell recruitment. In contrast, this signaling cascade appears to be absent in COAD. Instead, our analysis indicate that intact CD318 in COAD interacts with the surface receptors CD96 and CD160, which are found on CD8⁺ T cells and NK cells. <b>Conclusions</b>: This interaction enhances cytotoxic immune responses in COAD by promoting CD8⁺ T cell and NK cell activity, offering a possible explanation for the favorable prognosis associated with high CD318 expression in COAD, compared to the poorer outcomes observed in CESC, LUAD, and PAAD.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of KRAS-TP53 Co-Mutations in Patients with Early-Stage Non-Small Cell Lung Cancer: A Single-Center Retrospective Study.","authors":"Lucia Motta, Francesca Molinari, Jana Pankovics, Benjamin Pedrazzini, Alexandra Valera, Samantha Epistolio, Luca Giudici, Stefania Freguia, Miriam Patella, Martina Imbimbo, Giovanna Schiavone, Milo Frattini, Patrizia Froesch","doi":"10.3390/jcm14145135","DOIUrl":"10.3390/jcm14145135","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The clinical value of <i>KRAS</i> mutations in lung adenocarcinoma, alone or in combination with other mutations, has been assessed especially in advanced stages. This study evaluates how <i>KRAS</i> and the presence of co-mutations could affect survival in early-stage lung. <b>Methods</b>: We analyzed a real-world cohort including all staged NSCLC patients diagnosed and treated from 2018 to 2022 at our Institute with availability of NGS molecular data. Statistical analyses were made using log-rank test, the two-tailed Fisher's exact test and Kaplan-Meier survival curves. <b>Results</b>: <i>KRAS</i> mutations were observed in 179/464 cases (38.6%). The majority of <i>KRAS</i> co-mutations were in <i>TP53</i> (74%) and <i>STK11</i> (14.3%) genes. <i>KRAS</i>+<i>TP53</i> co-mutations were more frequent compared to <i>KRAS</i>-only tumors in stage IV NSCLC (<i>p</i> = 0.01). In early stage and locally advanced cases (stage I-III), better prognosis was associated to <i>KRAS</i>-only mutated NSCLC and to <i>KRAS</i>+<i>STK11</i> mutated cases compared to <i>KRAS</i>+<i>TP53</i> (<i>p</i> = 0.008). In particular, patients carrying <i>KRAS</i>+<i>TP53</i> in stage I and II displayed a shorter survival, similar to patients diagnosed at stage III. <b>Conclusions</b>: Routine NGS provides important information for potential actionable mutations but also for the prognostic and predictive role of the presence of co-occurring mutations. In particular, the presence of <i>KRAS</i>+<i>TP53</i> in stage I and II NSCLC may be considered an unfavorable prognostic marker possibly leading to adapt the perioperative chemo-immunotherapy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}