Journal of Surgical Oncology最新文献

{"title":"Clinical Applications of 3D Specimen Scanning and Margin Mapping in Musculoskeletal Oncology: A 36 Patient Case Series.","authors":"Riley S Gilbertson, Sakshi Krishna, Joaquin Austerlitz, Andreja Radevic, Michael J Colello, Alexander N Perez, Reena Singh, Jennifer L Halpern, Herbert S Schwartz, Michael C Topf, Joshua M Lawrenz, Daniel J Johnson","doi":"10.1002/jso.70382","DOIUrl":"https://doi.org/10.1002/jso.70382","url":null,"abstract":"<p><strong>Background: </strong>Text-based pathology reports inadequately communicate complex three-dimensional (3D) relationships in musculoskeletal oncology, potentially contributing to errors in re-resection and adjuvant treatment planning. While our prior 7-case pilot study established technical feasibility, the scalability of this workflow and its utility as a platform for further innovation have not been demonstrated.</p><p><strong>Methods: </strong>We conducted a prospective implementation study of 36 musculoskeletal oncology specimens at a tertiary sarcoma center between April 2023 and November 2025. Specimens underwent ex vivo 3D scanning using a structured light scanner, followed by virtual annotation using computer-aided design software to mirror the standard-of-care grossing process and create visual pathology reports (VPRs). The primary outcome was systematic implementation without disrupting standard processing. Secondary outcomes included platform-derived applications: augmented reality (AR)-guided re-resection, 3D margin heat maps, and 3D wound-bed scans.</p><p><strong>Results: </strong>All 36 specimens were scanned and mapped (21 soft tissue, 13 bone, 2 metastatic; median greatest specimen dimension 12.7 cm). Positive margins occurred in 13.9% (N = 5) of cases. VPRs were presented in multidisciplinary tumor boards in three of these five cases. AR guidance was implemented in eight staged-resection cases (N = 4 for positive margin re-resection, N = 4 for pre-reconstruction planning), 3D heat maps were created for eight cases, and intraoperative wound bed scanning was piloted once.</p><p><strong>Discussion/conclusion: </strong>3D specimen scanning and virtual mapping are scalable workflows providing a permanent visual record of resected specimens and functioning as a foundational platform for novel interventions. AR-guided surgery and 3D heat mapping demonstrate potential paradigm shifts from static reporting to dynamic, visual pathologic reporting and surgical guidance.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865492","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":"How Does the Surgical Margin Status Affect the Association Between Mesorectal Excision Quality and Overall Survival in Patients With Locally Advanced Rectal Cancer? A Contemporary Analysis From the NCDB.","authors":"Sameh Hany Emile, Nir Horesh, Maher Al Khaldi, Zubair Bayat, Noam Kahana, Michal Perets, David Maron, Marylise Boutros","doi":"10.1002/jso.70378","DOIUrl":"https://doi.org/10.1002/jso.70378","url":null,"abstract":"<p><strong>Background: </strong>The quality of mesorectal excision completeness is a key determinant of oncologic outcomes in rectal cancer; however, it is unclear how surgical margin status influences the survival impact of mesorectal excision quality. The present study aimed to assess the survival outcomes of incomplete total mesorectal excision (TME) in patients with locally advanced rectal cancer, according to surgical margin status.</p><p><strong>Methods: </strong>Using a contemporary (2022-2023) cohort from the US National Cancer Database, adult patients with clinical stage II-III rectal adenocarcinoma who underwent proctectomy were included. Complete and near-complete TME were analyzed as a single group and compared with incomplete TME. Multivariable logistic regression was used to identify predictors of incomplete TME. Kaplan-Meier statistics and multivariable Cox proportional hazard analysis were used to assess 3-year overall survival (OS), stratified by margin, stage, and neoadjuvant chemoradiation therapy (nCRT).</p><p><strong>Results: </strong>Among 4889 patients (61.6% males), 12.6% had an incomplete TME. Incomplete TME was associated with higher rates of positive CRM (37.5% vs. 11.1%) and positive margins (39.7% vs. 12.5%). Incomplete TME was associated with reduced 3-year OS (82.0% vs. 87.9%, p < 0.001). This survival decrement was more notable in patients with positive CRM (71.0% vs. 81.2%) than in patients with negative CRM (87.9% vs. 88.6%). The adverse survival effect of incomplete TME was strongest in patients who did not receive nCRT. Incomplete TME was not independently associated with reduced OS after adjustment for confounders (HR: 1.583, 95% CI: 0.892-2.807, p = 0.116).</p><p><strong>Conclusions: </strong>Incomplete TME was not independently associated with significantly reduced OS. However, it may have an adverse survival effect in patients with positive CRM or who did not receive nCRT. Margin status was found to be a critical modifier of the TME-survival relationship.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865499","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":"Effects of Auricular Acupressure Combined With Heat-Sensitive Moxibustion on Gastrointestinal Hormone Levels and Recovery of Gastrointestinal Function After Laparoscopic Colorectal Cancer Surgery.","authors":"Xin Lin, Yun Zheng","doi":"10.1002/jso.70386","DOIUrl":"https://doi.org/10.1002/jso.70386","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This single-center retrospective cohort study aimed to evaluate the efficacy of auricular acupressure combined with heat-sensitive moxibustion in promoting gastrointestinal functional recovery and regulating gastrointestinal hormone levels in patients who underwent laparoscopic colorectal cancer surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 68 patients with colorectal cancer who underwent laparoscopic radical resection at Ningde Municipal Hospital affiliated to Ningde Normal University from January to December 2022 were retrospectively enrolled. According to the postoperative intervention measures received, the patients were divided into an intervention group (n = 34, standard postoperative care plus auricular acupressure combined with heat-sensitive moxibustion) and a control group (n = 34, only standard postoperative care). The primary outcome indicators included the time to first flatus, time to recovery of bowel sounds, and time to first defecation after surgery. The secondary outcome indicators included the incidence and severity of postoperative abdominal distension, abdominal distension scores and bowel sound scores at 12, 24, 48 and 72 h after surgery, and the levels of gastrointestinal hormones (gastrin [GAS], motilin [MTL], gastric inhibitory polypeptide [GIP]) detected by radioimmunoassay before surgery and 5 days after surgery. The clinical data of the two groups were collected and statistically analyzed to compare the differences in each outcome indicator.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were no statistically significant differences in baseline demographic data, clinical characteristics and operative variables between the two groups (p &gt; 0.05), with good comparability. The time to first flatus, time to recovery of bowel sounds and time to first defecation in the intervention group were significantly shorter than those in the control group (all p &lt; 0.05). At 72 h after surgery, the incidence of abdominal distension in the intervention group (67.65%) was significantly lower than that in the control group (88.24%), and the severity of abdominal distension in the intervention group was milder than that in the control group (p &lt; 0.05). The abdominal distension scores and bowel sound scores of the intervention group at 12, 24, 48 and 72 h after surgery were significantly lower than those of the control group (all p &lt; 0.05). There were no significant differences in the levels of GAS, MTL and GIP between the two groups before surgery (p &gt; 0.05). At 5 days after surgery, the levels of the three gastrointestinal hormones in both groups were changed compared with those before surgery, and the levels of GAS, MTL and GIP in the intervention group were significantly higher than those in the control group (all p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Auricular acupressure combined with heat-sensitive moxibustion can effectively shorten the recovery time of gastrointestinal function, reduce the inciden","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865478","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":"Prognostic Value of the Preoperative Tumor-to-Blood Pool Standardized Uptake Value Ratio Derived From FDG-PET/CT in Distal Bile Duct and Ampullary Cancers.","authors":"Hiroyuki Matsukawa, Hironobu Suto, Yasuhisa Ando, Minoru Oshima, Takuro Fuke, Yoshio Shimizu, Mina Nagao, Kenichi Tanaka, Kensuke Kumamoto, Keiichi Okano","doi":"10.1002/jso.70390","DOIUrl":"https://doi.org/10.1002/jso.70390","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the prognostic value of the preoperative tumor-to-blood pool standardized uptake value ratio (TBR) on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients undergoing pancreatoduodenectomy (PD) for distal bile duct and ampullary cancers.</p><p><strong>Methods: </strong>We retrospectively reviewed 100 patients who underwent PD between January 2011 and December 2024. TBR was calculated as tumor SUVmax divided by the SUV of the descending aorta. The optimal cutoff for overall survival (OS) was determined using time-dependent ROC curve analysis. Survival outcomes were evaluated using Kaplan-Meier and multivariable Cox regression analyses.</p><p><strong>Results: </strong>A TBR cutoff of 2.30 was identified. Patients with high TBR (≥ 2.30) had significantly higher preoperative bilirubin, C-reactive protein, and CA19-9 levels, more frequent lymph node metastasis, poorer differentiation, and longer operation time than those with low TBR. High TBR was associated with worse OS and recurrence-free survival (RFS) (both p < 0.001). Multivariate Cox regression confirmed high TBR as an independent predictor of poor OS (Hazard Ratio: 2.88, p = 0.044).</p><p><strong>Conclusions: </strong>Preoperative TBR on FDG-PET/CT was associated with adverse pathological features and inferior survival in patients undergoing PD for distal bile duct and ampullary cancers. These findings suggest that TBR may be useful as an adjunctive PET-derived marker for preoperative risk stratification.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865538","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":"When Explant Surprises: Management and Outcomes of Hepatocellular Carcinoma Beyond Milan Criteria Discovered Post-Transplant- A Narrative Review of Literature.","authors":"Serkan Sucu, Brian Longbottom, Hassan Aziz","doi":"10.1002/jso.70380","DOIUrl":"https://doi.org/10.1002/jso.70380","url":null,"abstract":"<p><p>Liver transplantation (LT) is the definitive treatment for early hepatocellular carcinoma (HCC), based on established criteria. Pre-transplant imaging occasionally underestimates the tumor burden or biological aggressiveness, leading to explant pathology that exceeds the projection criteria, such as Milan. This paper aims to review the incidence, prognostic implications, post-transplant management, and outcomes of explant pathology in patients with HCC beyond Milan. We conducted a narrative review of the literature focusing on imaging-pathology discrepancies, recurrence risk stratification, immunosuppression strategies, surveillance, and adjuvant therapeutic considerations. A significant proportion of LT recipients had explant findings that exceeded the predicted criteria. These patients are at higher risk of recurrence, particularly those with microvascular invasion and poor differentiation. Currently, no standard adjuvant therapy exists; however, individualized surveillance and immunosuppression optimization, including sirolimus-based regimens, are reasonable strategies. Prospective studies are needed to define the optimal post-transplant pathways. Explant-beyond-criteria HCC represents a distinct high-risk population that requires individualized post-transplant management. While no validated adjuvant therapy exists, risk stratification using tools such as the RETREAT score, immunosuppression optimization with mammalian target of rapamycin (mTOR) inhibitors, and intensified surveillance may improve outcomes. Prospective studies are needed to define the optimal management strategies for this challenging population.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865526","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":"Unplanned Healthcare Utilization Following the Surgical Management of Musculoskeletal Tumors: A Retrospective Cohort Study.","authors":"Devika A Shenoy, William C Cruz, Kevin A Wu, Aaron D Therien, Malcolm DeBaun, Christian A Pean, Brian Brigman, Julia D Visgauss, William C Eward","doi":"10.1002/jso.70384","DOIUrl":"https://doi.org/10.1002/jso.70384","url":null,"abstract":"<p><strong>Background and objectives: </strong>Orthopaedic oncology patients are susceptible to unplanned return to the emergency department (RTED) and readmission postoperatively. This study aims to explore factors contributing to unplanned healthcare utilization in patients undergoing surgery for musculoskeletal tumors.</p><p><strong>Methods: </strong>We conducted a single-institution retrospective cohort study of orthopaedic oncology patients from 2017 to 2023. Demographic variables (race, ethnicity, language, insurance, age) and procedure details were collected. Multivariable logistic regressions were used to determine the associations between these variables and RTED/readmission.</p><p><strong>Results: </strong>Of 1832 orthopaedic oncology patients, 245 (13.4%) had an unplanned RTED and 157 had an unplanned readmission (8.6%) within 90 days. Compared to soft tissue procedures, the odds of 90-day RTED were significantly higher for spine/pelvis procedures (OR: 2.88, p = 0.003), oncologic fracture (OR: 2.51, p < 0.001), biopsies (OR: 2.51, p < 0.001), and amputations (OR: 2.06, p = 0.03). The same procedures also had higher odds of 90-day readmission. Medicaid insurance (OR: 2.12, p = 0.008), hypertension (OR: 1.54, p = 0.02), and type 2 diabetes (OR: 1.52, p = 0.04) were associated with higher odds of 90-day RTED.</p><p><strong>Conclusions: </strong>In orthopaedic oncology, patients on Medicaid insurance, patients who undergo high-risk procedures, and patients with medical comorbidities such as type 2 diabetes and hypertension may be at high risk for adverse outcomes.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829599","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":"Prognostic Determinants of Overall Survival After Resection for Pancreatic Ductal Adenocarcinoma: A Consensus-Based Conceptual Framework.","authors":"Muhammad Maisam Ali, Kaleem S Ahmed, Clayton T Marcinak, Syed Ali Tayyeb Hasan, Anne D Letocha, Noorain Ahmad, Haider Bin Khalid, Kainat Fatima, Syed Nabeel Zafar","doi":"10.1002/jso.70362","DOIUrl":"https://doi.org/10.1002/jso.70362","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDAC) carries a dismal prognosis despite surgical resection, yet the prognostic literature remains fragmented across hundreds of single-institution studies that vary in design, covariates, and analytical approaches. A synthesis of this evidence is needed to identify which factors most consistently predict overall survival (OS) after curative-intent resection and standardize covariate selection for future outcomes research and trial design. Following PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and CINAHL (1990-2023) for studies reporting on factors associated with OS following curative-intent resection for PDAC. Prognostic variables from multivariable analyses were extracted and categorized into six conceptual domains: demographics and socioeconomic factors, clinical characteristics, laboratory parameters, molecular biomarkers, tumor characteristics, and treatment-related factors. Strength of agreement across studies was classified as consensus (≥ 75% concordance), fair (> 50%-74%), or weak/none (≤ 50%). The protocol was pre-registered in PROSPERO (CRD42021278699). Of 49 867 identified records, 947 studies encompassing 1 430 411 patients met inclusion criteria. A total of 650 prognostic factors were tested with OS across the literature; 58 were incorporated into the conceptual framework. Among tumor characteristics, pathological nodal status (pN; 82.1%, consensus) and tumor grade (75.0%, consensus) were the strongest and most consistent negative predictors of OS. Margin status, perineural invasion, and lymph node ratio reached fair-level negative agreement. Receipt of adjuvant chemotherapy was the most robust positive predictor (80.4%, consensus), followed by treatment at an academic medical center (75.0%, consensus). Socioeconomic determinants-including private insurance and higher income-demonstrated consensus-level positive associations with OS. Most comorbidities, laboratory parameters, and preoperative clinical characteristics showed fair-to-no association with OS in multivariable analyses. Tumor biology and receipt of adjuvant chemotherapy are the most consistent determinants of OS post-PDAC resection. Socioeconomic and structural factors carry consistent prognostic weight and warrant routine inclusion in survival models. Our findings provide a framework for future prognostic modeling, clinical decision-making, and trial design.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829585","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":"Extended Versus Non-Extended Lymphadenectomy in Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis.","authors":"Maria Fernanda Dias Azevedo, Pedro Henrique Souza Brito, Lucas Kallas-Silva, Bruno Liebl, Beatriz Taveira Constantinou, Bianca Caroline Benedicto, Lucas Paschoalino de Oliveira, Mauricio Dener Cordeiro, William Carlos Nahas, Walid Shabana, Walid Shahrour, Leopoldo Alves Ribeiro-Filho, Caio Vinicius Suartz","doi":"10.1002/jso.70334","DOIUrl":"10.1002/jso.70334","url":null,"abstract":"<p><p>Pelvic lymph node dissection is an essential component of radical cystectomy (RC) for bladder cancer (BC), but the optimal extent of lymphadenectomy remains uncertain. We conducted a systematic review and meta-analysis to compare oncologic and perioperative outcomes between extended and non-extended lymphadenectomy during RC for BC. PubMed/MEDLINE, Embase, and ClinicalTrials. gov were searched up to October 2025 following PRISMA guidelines and PROSPERO registration. Randomized controlled trials (RCTs) and observational studies comparing extended versus non-extended lymphadenectomy in adults undergoing RC were included. Outcomes included surgery duration, intraoperative blood loss, overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Random-effects meta-analyses were performed, reporting hazard ratios (HRs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2.0 and ROBINS-I, and certainty of evidence using GRADE. Fifteen studies including 5671 patients were analyzed, of which two were RCTs. Extended lymphadenectomy was associated with longer operative time (MD + 26.2 min) and improved DFS (HR: 1.47), but no significant benefit in OS or CSS. Non-extended lymphadenectomy was associated with higher RFS (HR: 0.79). Heterogeneity was moderate to high, and certainty of evidence was very low for most outcomes and low for OS considering only RCTs. Extended lymphadenectomy during RC increases operative time and may improve DFS; however, the available evidence does not clearly support a consistent oncologic benefit.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829634","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":"Multimodal Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma (PDAC) With Vascular Involvement: What Is the Impact of Radiation on Perioperative Outcomes, Local Control, and Survival?","authors":"Dhruv J Patel, Lauren M Janczewski, Joseph H Cotler, George Molina, Brett L Ecker, David Bentrem, Shishir K Maithel, Mohamed E Abazeed, John P Hayes, Bryan Palis, Amanda B Francescatti, Ronald J Weigel, Judy Boughey, Lesly Dossett, Akhil Chawla","doi":"10.1002/jso.70387","DOIUrl":"https://doi.org/10.1002/jso.70387","url":null,"abstract":"<p><strong>Objectives: </strong>Neoadjuvant chemoradiation for PDAC with vascular invasion remains understudied. The aim of this study is to compare neoadjuvant chemotherapy with chemoradiation (NAC + CRT) versus neoadjuvant chemotherapy (NAC) for PDAC with vascular involvement.</p><p><strong>Methods: </strong>The National Cancer Database was reviewed between 2018 and 2023, including patients with T4 PDAC initiating NAC or NAC + CRT. The primary outcome of overall survival (OS) was examined among unresected and resected cohorts. Secondary outcomes included pathologic complete response (pCR), node-negative (ypN0) pathology, and R0 resection. Multilevel logistic and Cox models were fit to identify factors associated with outcomes.</p><p><strong>Results: </strong>In total, 2950 patients met inclusion, of which 1407 (47.7%) underwent NAC + CRT. In total, 1291 (44.4%) underwent surgery. Use of NAC + CRT declined by 2.8%/year (p < 0.001). Compared with NAC, use of NAC + CRT was associated with R0 resection (OR: 0.62, 95% CI: [0.43, 0.89], p = 0.010) and ypN0 (OR: 2.19, 95% CI: [1.63, 2.93], p < 0.001) but not pCR (OR: 1.78, 95% CI: [0.99, 3.20], p = 0.056). NAC + CRT was associated with improved OS among the full cohort (hazard ratio [HR]: 0.67, 95% CI: [0.60, 0.74], p < 0.001) but not the resected cohort (HR: 0.98, 95% CI: [0.81, 1.19], p = 0.848).</p><p><strong>Conclusions: </strong>Neoadjuvant chemoradiation for T4 PDAC yielded mixed effects on local response with no survival difference among patients undergoing resection.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818798","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":"Disparities in Pancreatic Cancer Survival: The Overlooked Role of Demographic and Socioeconomic Factors.","authors":"Jason Pieri, Courtney Day, Aaron Spaulding, Mary Tice, Cornelius A Thiels, Zhi Ven Fong, John A Stauffer, Katherine E Poruk","doi":"10.1002/jso.70377","DOIUrl":"https://doi.org/10.1002/jso.70377","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pancreatic ductal adenocarcinoma (PDAC) remains highly lethal, but the contribution of nonbiological factors to long-term survival is unclear. We evaluated demographic, socioeconomic, clinical, treatment, and care-delivery factors associated with 3-year survival and whether these associations persisted at 5 years.</p><p><strong>Methods: </strong>National Cancer Database patients with stage I-III PDAC diagnosed from 2012 to 2022 were analyzed using multivariable logistic regression adjusted for treatment pathway.</p><p><strong>Results: </strong>Among 57,053 patients, 51,071 were eligible for a 3-year analysis, and 12,205 (23.9%) survived. Compared with chemotherapy alone, surgery with chemotherapy (OR, 7.12; 95% CI, 6.64-7.63) and surgery alone (OR, 3.84; 95% CI, 3.49-4.23) had the strongest associations with survival. Younger age, lower comorbidity, Asian race, Spanish/Hispanic ethnicity, private insurance, lower grade, body or tail location, and lower nodal burden were independently associated with survival. Black race and treatment timing were not significant after adjustment. Findings were directionally consistent at 5 years.</p><p><strong>Conclusion: </strong>Demographic, socioeconomic, and clinical factors independently influence 3-year survival in PDAC. These findings underscore the need to complement biologic and therapeutic advances with structural interventions, such as insurance expansion and improved access to high-quality centers, to mitigate disparities and improve outcomes in this highly lethal cancer.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794878","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}