Journal of Surgical Oncology最新文献

{"title":"Hepatic Adenomas in Men: Diagnostic Considerations and Management in the Modern Era.","authors":"Teresa Belledent, Julie Nwosu, Kiers Brevik, Raegen M Abbey, Timothy Pawlik, Dae Sun Hwang, Terry L Hayes, Ikenna Nwosu, Mohammed O Suraju, Hassan Aziz","doi":"10.1002/jso.70415","DOIUrl":"https://doi.org/10.1002/jso.70415","url":null,"abstract":"<p><p>Hepatic adenomas (HAs) are rare benign liver tumors traditionally associated with young women, yet contemporary epidemiologic trends reveal increasing recognition among men. Historically, universal resection in males has been recommended because of a nearly tenfold increased risk of malignant transformation as reported by Farges et al. in a single-institution surgical series; however, advances in molecular profiling and imaging have challenged this paradigm. β-catenin-activated and inflammatory subtypes account for most cases in men, often associated with anabolic steroid exposure, obesity, or metabolic syndrome. β-catenin-activated adenomas-particularly those harboring CTNNB1 exon 3 mutations-demonstrate the strongest correlation with malignant potential. Magnetic resonance imaging with hepatobiliary contrast agents can suggest subtype but lacks perfect accuracy; biopsy offers improved diagnostic precision and enables molecular confirmation. Current ACG and EASL guidelines still endorse routine resection for all hepatic adenomas in males; however, available retrospective data suggest that malignant transformation appears to be uncommon in small (5 cm) lesions lacking exon 3 CTNNB1 mutations; however, this observation is derived from limited, predominantly retrospective data and does not exclude the possibility of malignant transformation in this subgroup. These data support selective, biopsy-guided surveillance for small, indeterminate tumors within experienced multidisciplinary centers where longitudinal follow-up is reliable. Resection remains the standard recommendation for large or β-catenin-mutated adenomas, with minimally invasive surgery demonstrating excellent outcomes. Modern management of hepatic adenomas in men should be individualized, integrating molecular subtype, size, risk factors, and patient context. A multidisciplinary and molecularly informed strategy is essential to optimize outcomes while avoiding unnecessary intervention.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conditional Recurrence-Free Survival After Hepatectomy for Colorectal Liver Metastases: Time-Dependent Prognostic Relevance of Liver Metastasis Number.","authors":"Taiki Mori, Nozomu Sakai, Tsukasa Takayashiki, Shigetsugu Takano, Isamu Hosokawa, Takanori Konishi, Kensuke Suzuki, Hitoe Nishino, Shinichiro Nakada, Masayuki Ohtsuka","doi":"10.1002/jso.70428","DOIUrl":"https://doi.org/10.1002/jso.70428","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recurrence risk after hepatectomy for colorectal liver metastases (CRLMs) changes during follow-up, but whether baseline tumor burden remains prognostically relevant with increasing recurrence-free time is unclear. We evaluated the time-dependent prognostic relevance of liver metastasis number.</p><p><strong>Methods: </strong>We retrospectively analyzed 226 patients who underwent initial curative-intent hepatectomy for CRLMs between 2007 and 2022. Three-year conditional recurrence-free survival (RFS) was estimated at surgery and after 6, 12, and 24 months without recurrence. Landmark Cox models evaluated liver metastasis number (< 4 vs. ≥ 4), adjusting for RAS status, with supplementary expanded models.</p><p><strong>Results: </strong>Three-year conditional RFS improved from 27.1% at surgery to 33.3%, 49.3%, and 76.6% after 6, 12, and 24 months without recurrence, respectively. However, subsequent RFS remained worse in patients with ≥ 4 liver metastases at the 6-month (adjusted hazard ratio [HR]: 1.83, 95% confidence interval [CI]: 1.14-2.94; p = 0.012) and 12-month (HR: 2.14, 95% CI: 1.08-4.27; p = 0.030) landmarks. In supplementary expanded models, the associations remained directionally similar but were attenuated.</p><p><strong>Conclusions: </strong>Recurrence risk improved with increasing recurrence-free time, but survivors remained heterogeneous according to baseline tumor burden. Liver metastasis number retained prognostic relevance at early postoperative landmarks.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Patient Expectations in Goldilocks-Based Breast Reconstruction: A Qualitative Study Using the Ottawa Decision Support Framework.","authors":"Priyanka Meesa, Jing Xu, Rajiv Parikh, Laura K Tom","doi":"10.1002/jso.70420","DOIUrl":"https://doi.org/10.1002/jso.70420","url":null,"abstract":"<p><strong>Background and objectives: </strong>Goldilocks-based breast reconstruction (GBR) offers an autologous, implant-free option for patients seeking breast mound restoration after mastectomy. It is particularly suited for patients with macromastia, ptosis, or significant comorbidities. Despite its growing adoption, limited studies have examined patient understanding and expectations.</p><p><strong>Methods: </strong>We interviewed patients who underwent GBR after mastectomy within our institution. Demographic, oncologic, and perioperative data were collected. Semi-structured interviews were conducted to explore patient understanding, decision making process and post-operative experience based on Ottawa Decision Support Framework.</p><p><strong>Results: </strong>Nine participants were included. Mean age was 58.1 years (range: 41-71), and mean body mass index was 34.9 kg/m² (range: 24.3-46.1). Most participants demonstrated a good understanding of the procedure and why it was offered. Common reasons for selecting this approach were a desire to avoid implants and additional surgeries. Misunderstandings regarding the amount of residual breast tissue, expected postoperative volume, and the need for post-mastectomy surveillance contributed to dissatisfaction. However, decisional regrets were rare.</p><p><strong>Conclusions: </strong>Motivations for choosing GBR consistently revolve around avoidance of implant placement and desire for single-stage surgery. Common misconceptions regarding the extent of oncological resection and expectations for achievable volume from GBR should be addressed pre-operatively.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcome Measures in Musculoskeletal Oncology: Current Concepts, Barriers, and the Future.","authors":"Shujaa T Khan, Rowan J Barker-Clarke, Brian Benyamini, Zachary D Burke, Nathan W Mesko, Lukas M Nystrom","doi":"10.1002/jso.70424","DOIUrl":"https://doi.org/10.1002/jso.70424","url":null,"abstract":"<p><p>Patient-reported outcome measures (PROMs) remain underutilized in musculoskeletal oncology, with only 4.9% of tumor-focused articles incorporating them. This review synthesizes current PROM instruments-including Toronto Extremity Salvage Score, PROMIS, and emerging tools such as the Sarcoma Assessment Measure-and identifies barriers unique to this population, including psychological distress, workflow complexity, and disease heterogeneity. Future directions include flexible baseline collection, EHR-integrated dashboards, national registry linkage, wearable technology, and AI-driven processing to increase PROMs utilization.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Incisions in Retroperitoneal Sarcoma Surgery: Safe Access Without Added Morbidity in a Single Center Retrospective Analysis.","authors":"Bat El Dahan, Nir Messer, Sivan Shamai, Danit Dayan, Osnat Sher, Ofer Merimsky, Guy Lahat, Eliad Karin, Eran Nizri","doi":"10.1002/jso.70430","DOIUrl":"https://doi.org/10.1002/jso.70430","url":null,"abstract":"<p><strong>Introduction: </strong>Incisional hernia is a prevalent long-term complication after open abdominal surgery, with reported rates exceeding 20%-30%. Despite extensive research on abdominal wall failure, evidence regarding incisional hernia after retroperitoneal sarcoma resections is scarce. Retroperitoneal sarcoma frequently requires wide exposure, and combined incisions are often used, yet their effect on incisional hernia risk is unknown. Our aim was to determine the incisional hernia rate in these surgeries and to determine its association with incision type.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 134 patients who underwent primary RPS resection between 2004 and 2025 at a tertiary referral center. Patients were grouped according to incision type: single midline or combined incisions. Clinicopathologic variables were collected from a prospectively maintained institutional database. Incisional hernia was identified by cross-sectional imaging.</p><p><strong>Results: </strong>Incisional hernia occurred in 33.5% of patients, with no significant difference between simple and combined incision groups (32.7% vs. 37.0%, p = 0.883). Time to hernia development was similar (log-rank p = 0.829). Tumor size was the only independent predictor of incisional hernia in a logistic regression model: larger tumors were associated with reduced hernia risk (OR 0.68, 95% CI 0.47-0.98, p = 0.042). Incision type and other known risk factors were not associated with incisional hernia.</p><p><strong>Conclusion: </strong>Combined incisions were not associated with a higher risk of incisional hernia, indicating that the additional exposure required for complex retroperitoneal sarcoma resections does not compromise long-term abdominal wall integrity. These findings support prioritizing optimal oncologic exposure when selecting incision type, without concern for increased hernia risk.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Adjuvant Radiotherapy De-Escalation With Outcomes Following Oncoplastic Breast-Conserving Surgery.","authors":"Abbas M Hassan, Carson Park, Kathryn Borders, Rachel M Danforth, Ravinder Bamba, R Jason VonDerHaar, Ivan Hadad, Mary E Lester, Carla S Fisher, Aladdin H Hassanein","doi":"10.1002/jso.70425","DOIUrl":"https://doi.org/10.1002/jso.70425","url":null,"abstract":"<p><strong>Background: </strong>Adjuvant radiotherapy (RT) following breast-conserving surgery reduces local recurrence but can introduce reconstructive morbidity. Although recent trials support the safe omission of RT in selected patients, its impact on surgical and patient-reported outcomes following oncoplastic breast-conserving surgery (OPBCS) remains poorly defined. We evaluated surgical and long-term patient-reported outcomes in patients undergoing OPBCS, stratified by receipt of RT.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients who underwent OPBCS between 2017 and 2024 for stage 0-3 breast cancer. Patients were stratified based on receipt of RT. Postoperative complications, unplanned reoperation, and revision procedures were compared between cohorts. Long-term patient-reported outcomes were assessed using the validated BREAST-Q Reconstruction Module. Multivariable regression was used to evaluate the independent association between RT status and outcomes.</p><p><strong>Results: </strong>We identified 257 patients; 210 patients received RT (81.7%) and 47 underwent RT de-escalation (18.3%). Surgical site infection (p = 0.100), delayed wound healing (p = 0.300), and skin flap necrosis rates (p = 0.0300) were similar between cohorts. Seroma (30% vs. 13%; p = 0.006) and unplanned reoperation (21% vs. 7.1%; p = 0.006) were more frequent with RT omission. Patients who did not receive RT demonstrated significantly higher mean Satisfaction with Breasts scores compared with those who received RT (57 ± 25 vs. 23 ± 24; p = 0.001). In adjusted models, RT de-escalation was associated with a 36-point increase in Satisfaction with Breasts scores (β = 36.0; 95% CI, 18.0-54.0; p < 0.001).</p><p><strong>Conclusions: </strong>RT omission was independently associated with higher patient-reported satisfaction with breasts, though patients had higher seroma and reoperation rates. These data support balanced shared decision-making for RT de-escalation in appropriately selected patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Care, Missed Opportunities: Health and Economic Impact of Delayed or Forgone Care Among Adults With a History of Gastrointestinal Cancer.","authors":"Areesh Mevawalla, Meher Angez, Odysseas P Chatzipanagiotou, Azza Sarfraz, Qaidar Alizai, Timothy M Pawlik","doi":"10.1002/jso.70423","DOIUrl":"https://doi.org/10.1002/jso.70423","url":null,"abstract":"<p><strong>Background: </strong>Timely medical intervention is critical to achieve optimal outcomes in gastrointestinal (GI) cancers, yet numerous patients experience delayed or forgone (D/F) medical care. This study aimed to evaluate the national impact of D/F care on emergency surgical interventions and associated healthcare expenditures among patients with GI cancers.</p><p><strong>Methods: </strong>Adults with a self-reported history of GI cancer were identified from the Medical Expenditure Panel Survey, 2007-2017. Multivariable regression analyzes was performed to assess associations between D/F medical care, ED-associated GI surgery, inpatient utilization, and related healthcare expenditures after adjusting for demographic and socioeconomic variables.</p><p><strong>Results: </strong>Among a weighted sample of 6 517 883 patients with GI cancers, 8.5% (n = 552 751) reported D/F medical care. Patients with D/F care were older (76 years [IQR: 69-82] vs. 68 years [IQR: 58-76]), more frequently male (57.3% vs. 50.6%) and frequently had family income below the poverty line (40.2% vs. 11.3%) (all p < 0.001). Furthermore, individuals reporting D/F care were more likely to have emergency department visits (44.2% vs. 27.4%), hospitalizations (64.6% vs. 34.5%) (both p < 0.05), or undergo ED-associated GI surgery (41.0% vs. 19.1%; p < 0.001). In multivariable analysis, after adjusting for relevant factors, D/F care was associated with markedly greater odds of ED-associated GI surgery (OR 2.70, 95%CI 1.47-4.95) and higher annual inpatient healthcare costs (β +$31,410, 95% CI $23,592-$39,227) compared with individuals who did not report D/F care.</p><p><strong>Conclusion: </strong>Self-reported D/F medical care was associated with greater acute healthcare utilization, higher odds of ED-associated GI surgery, and greater healthcare expenditures. These findings highlight the importance of understanding barriers to healthcare access among adults with a history of GI cancer.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat Breast Cancer Surgeries After Segmental Mastectomy Meaningfully Increase Long Term Healthcare Costs.","authors":"Alexandra L Mathews, Mara A Piltin, Sam E Wing, Naomi C Hamm, Yuki Liu, Feibi Zheng, Kate Kopkash","doi":"10.1002/jso.70419","DOIUrl":"https://doi.org/10.1002/jso.70419","url":null,"abstract":"<p><strong>Background and objectives: </strong>Among patient with early-stage breast cancer, breast conservation surgery (BCS) is the most performed surgery, utilized in approximately two-thirds of patients. While 5-year overall-survival rates are strong-typically above 90%-additional re-excisions can occur in up to 25% of patients who undergo index BCS and some patients will require subsequent surgery for new breast cancer or recurrences. As such, these additional procedures can complicate patients' pathway to survivorship, negatively impact quality of life, and lead to excess healthcare costs.</p><p><strong>Methods: </strong>This retrospective cohort study used linked claims and an electronic healthcare record database to (1) characterize patients at higher risk for additional breast oncologic surgery (aBOS) following BCS, and (2) quantify the long-term financial impact of aBOS after BCS. In total, 87,190 patients with breast cancer, who had an index BCS between January 1, 2012, to March 31, 2023, were followed for up to 5-years post-operatively. Patients with and without aBOS were analyzed, comparing demographics, tumor characteristics, healthcare utilization, and per-person-per-month (PPPM) costs.</p><p><strong>Results: </strong>Twenty-three percent (n = 20,212) of patients underwent aBOS. These patients were younger, had higher tumor grades and larger tumor sizes, and incurred greater healthcare costs compared to patients who did not undergo a secondary surgery.</p><p><strong>Conclusion: </strong>This study highlights significant factors influencing BCS outcomes and healthcare utilization, underscoring the need for tailored therapeutic strategies for patients with breast cancer.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy After Resection of Pancreatic Ductal Adenocarcinoma: Impact of Different Regimens in a Real-World Population.","authors":"N C Biesma, G A Cirkel, N Haj Mohammad, M Los, R C Verdonk, I Q Molenaar, L A Daamen, H C van Santvoort","doi":"10.1002/jso.70391","DOIUrl":"https://doi.org/10.1002/jso.70391","url":null,"abstract":"<p><strong>Introduction: </strong>The PRODIGE 24/CCTG PA.6- trial has shown an overall survival (OS) up to 55 months in patients treated with (modified) 5-fluorouracil, leucovorin, irinotecan and oxaliplatin ((m)FOLFIRINOX) chemotherapy after resection of pancreatic ductal adenocarcinoma (PDAC). The applicability of these results to a real-world patient population is, however, unknown. This study aimed to assess the efficacy of (m)FOLFIRINOX compared to other adjuvant chemotherapy regimens in a real-world cohort.</p><p><strong>Methods: </strong>We performed a post-hoc analysis in a prospectively maintained cohort of patients undergoing PDAC resection in the Regional Academic Cancer Centre Utrecht, the Netherlands, from 2016 to 2020. Median OS was evaluated using Kaplan-Meier curves, primarily stratified by adjuvant chemotherapy regimen and secondarily by eligibility for the PRODIGE 24/CCTG PA.6- trial. Multivariable Cox regression was used to assess the association between chemotherapy regimen and OS, presented as hazard ratio's (HR) with 95% confidence interval (95%CI).</p><p><strong>Results: </strong>A total of 161 patients with a median follow-up of 51 months (interquartile range (IQR) 43-61) were included. With (m)FOLFIRINOX (n = 30), OS was 29 months (IQR 22-42; [HR 0.26, 95%CI 0.14-0.47, p < 0.01]). Comparing (m)FOLFIRINOX with gemcitabine monotherapy yielded a HR of 0.62 (95%CI 0.33-1.17, p = 0.14), while (m)FOLFIRINOX versus gemcitabine combination therapy had a HR of 0.66 (95% CI 0.35-1.24 p = 0.20). Patients without adjuvant therapy (n = 71) had a median OS of 13 months (IQR 11-23, reference group). In patients receiving gemcitabine monotherapy (n = 31), median OS was 21 months (IQR 15-31; [HR 0.41 95%CI 0.25-0.69, p < 0.01]); for gemcitabine combination therapy (n = 29), OS was 28 months (IQR 23-43; [HR 0.39, 95%CI 0.23-0.66, p < 0.01]) In patients who received (m)FOLFIRINOX and who did or did not meet trial eligibility criteria, OS was 27 months (IQR 12-NR), compared to 30 months (IQR 21-NR) (p = 0.16), respectively.</p><p><strong>Conclusion: </strong>The survival benefit of (m)FOLFIRINOX observed in the clinical trial setting was not observed in our real-world cohort, not even in the selected subset of patients who would have deemed eligible for inclusion in the PRODIGE 24/CCTG PA.6- trial. Survival was not different for patients treated with (m)FOLFIRINOX and gemcitabine combination therapy.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Recurrence and Survival Prediction in a Large Institutional Upper Extremity Soft Tissue Sarcoma Cohort.","authors":"Kameel Khabaz, Nicole J Newman-Hung, Ruiwen Ding, Derek Pham, Nicholas J Jackson, William Hsu, Nicholas M Bernthal, Lauren E Wessel","doi":"10.1002/jso.70422","DOIUrl":"https://doi.org/10.1002/jso.70422","url":null,"abstract":"<p><strong>Background and objectives: </strong>Upper extremity soft tissue sarcomas (UE STS) present unique management challenges; existing prognostic nomograms were developed from mixed anatomic cohorts. This study develops anatomically specific machine learning (ML) models to predict UE-STS outcomes and benchmarks them against established tools.</p><p><strong>Methods: </strong>Time-to-event models for local recurrence (LR), distant metastasis (DM), and overall survival (OS) were developed in 188 patients treated at a single sarcoma center, treating death as a competing risk. Five survival algorithms were compared within a nested cross-validation framework. Discrimination was benchmarked against the Sarculator, PERSARC, and MSKCC nomograms.</p><p><strong>Results: </strong>Five-year event rates were 24% (LR), 20% (DM), and 13% (death) over a median follow-up of 3.9 years. Best-performing models achieved competing-risks concordance indices of 0.79 (LR), 0.67 (DM), and 0.75 (OS). Parsimonious models performed comparably. Discrimination was similar to Sarculator and PERSARC and higher than the MSKCC nomogram for LR (C-index 0.90 vs. 0.68). Predicted-risk groups separated clearly on cumulative-incidence and survival curves (p < 0.001).</p><p><strong>Conclusions: </strong>These results demonstrate the feasibility and potential value of anatomy-specific, time-to-event risk modeling in UE STS, achieving discrimination comparable to established nomograms despite a smaller cohort. Multicenter cohorts and multidimensional data may strengthen future efforts. External validation is warranted.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}