World Journal of Surgical Oncology最新文献

{"title":"Serum 5'-tiRNA-iMet-CAT is a novel biomarker for the diagnosis and early postoperative assessment of hepatocellular carcinoma.","authors":"Yan Hong, Shiyi Qin, Xian Li, Rui Ding, Shaoqing Ju","doi":"10.1186/s12957-026-04480-7","DOIUrl":"10.1186/s12957-026-04480-7","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is one of the most common digestive system malignancies and a leading cause of cancer-related mortality worldwide. Alpha-fetoprotein (AFP), although widely used, shows limited sensitivity in early HCC, leading to missed diagnoses. Novel molecular markers that complement existing biomarkers are urgently needed. tRNA-derived small RNAs (tsRNAs), a newly recognized class of noncoding RNAs generated from transfer RNAs, are abundant in cancer cells and body fluids and have emerging roles in tumourigenesis. This study aimed to identify dysregulated tsRNAs in HCC and evaluate their clinical value as biomarkers.</p><p><strong>Methods: </strong>We performed high-throughput sequencing on 3 pairs of HCC tissues and their matched adjacent normal tissues to profile 5'-tiRNA-iMet-CAT, validating its serum levels by quantitative reverse transcription PCR (qRT-PCR). Molecular features and stability were confirmed by electrophoresis, sequencing, and freeze-thaw assays. We assessed clinical correlations, diagnostic potential, and predicted target genes via multiple databases with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis.</p><p><strong>Results: </strong>Serum 5'-tiRNA-iMet-CAT was significantly elevated in HCC patients versus healthy controls. Its high expression correlated with poor differentiation, larger tumour size, and advanced Barcelona Clinic Liver Cancer stage (all P < 0.05). Receiver operating characteristic analysis confirmed strong diagnostic performance, with levels markedly decreasing postoperatively (P < 0.0001).</p><p><strong>Conclusion: </strong>Serum 5'-tiRNA-iMet-CAT is stable, specific, and clinically relevant. It may serve as a promising noninvasive biomarker for HCC diagnosis and evaluating short-term therapeutic response during the early postoperative phase.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406053","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":"LMNTD2-AS1 promotes esophageal squamous cell carcinoma progression by sponging miR-449b-5p to upregulate MYCN.","authors":"Rukeyeguli Wusiman, Zhenhong Chang, Feng Yang, Dian Lin, Jiangqi Xu","doi":"10.1186/s12957-026-04445-w","DOIUrl":"10.1186/s12957-026-04445-w","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous cell carcinoma (ESCC) remains a significant part of the global health burden, increasing the need to make its molecular basis clear in regard to therapeutic development. This study focuses on the long non-coding RNA LMNTD2-AS1 and its regulatory network in ESCC.</p><p><strong>Methods: </strong>The expression level of LMNTD2-AS1 in clinical specimens and selected cell lines was quantified using quantitative RT‑PCR (qRT‑PCR). To assess its impact on malignant phenotypes, functional experiments including CCK‑8, Transwell, and flow cytometry‑based apoptosis assays were conducted. Subsequently, bioinformatic analyses combined with dual‑luciferase reporter assays were employed to validate the existence of a regulatory axis involving LMNTD2‑AS1, miR‑449b‑5p, and MYCN.</p><p><strong>Result: </strong>This study revealed that LMNTD2-AS1 was significantly upregulated in ESCC tissues and cellular models. Downregulation of LMNTD2-AS1 expression decreased the rates of cell vitality and invasion while increasing apoptosis. LMNTD2-AS1 acted as a ceRNA and directly interacted with miR-449b-5p, resulting in the derepression of MYCN. Rescue assays confirmed that miR-449b-5p inhibition rescues the anti-tumor effects caused by LMNTD2-AS1 reduction. Reducing MYCN expression negated the cancer-promoting effects of inhibitory miR-449b-5p.</p><p><strong>Conclusion: </strong>In conclusion, this preliminary study demonstrates that LMNTD2-AS1 promotes ESCC progression via the miR-449b-5p/MYCN axis. By elucidating this network and its downstream signaling, we provide a mechanistic framework for ESCC pathogenesis. While broader clinical and in vivo validation is required, this axis represents a promising target for therapeutic intervention.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148398041","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":"A new paradigm for esophageal disease management: the application and future prospects of Shared Decision Making (SDM).","authors":"Yuanyuan Yin, Jie Zhang, Mei Yang, Chunlin Zhao, Kaidi Li, Cheng Shen","doi":"10.1186/s12957-026-04487-0","DOIUrl":"10.1186/s12957-026-04487-0","url":null,"abstract":"<p><p>Shared Decision Making (SDM), as a \"patient-centered\" medical decision-making model, has gradually demonstrated its application value in the diagnosis and treatment of esophageal diseases. This study is a structured narrative review (without quantitative synthesis or heterogeneity assessment). This structured narrative review systematically searched databases including PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) from 1990 to 2026 for clinical studies, meta-analyses, and guideline documents related to SDM in the field of esophageal diseases.It clarified the application scenarios and implementation pathways of SDM in major esophageal diseases such as esophageal cancer and gastroesophageal reflux disease. especially focusing on surgical decision-making in esophageal cancer.Meanwhile, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, this study critically analyzed the advantages of SDM in enhancing patient decision-making satisfaction, optimizing the doctor-patient relationship, and formulating individualized treatment plans. It also objectively expounded on real-world challenges, including the lag in physicians' conceptual transformation, variations in patients' ability to participate, and limitations in medical resources. This study innovatively constructed a three-dimensional SDM implementation framework of \"disease classification - evidence hierarchy - patient preference\" and proposed differentiated application strategies tailored to the clinical characteristics of different esophageal diseases. The research findings provide evidence-based support for the standardized application of SDM in clinical practice for esophageal diseases and lay a foundation for clarifying future research directions in this field.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391848","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 25(OH)D and HDL-C as site-specific metabolic markers of cervical lymph node metastasis in papillary thyroid carcinoma.","authors":"Shanyu Yin, Nannan Lv, Guo Tian, Jianjian Xiang, Danlei Lu, Tian'an Jiang, Ying Hu","doi":"10.1186/s12957-026-04483-4","DOIUrl":"10.1186/s12957-026-04483-4","url":null,"abstract":"<p><strong>Background: </strong>Preoperative risk stratification for cervical lymph node metastasis (LNM) is challenging in papillary thyroid carcinoma (PTC), metabolic disturbances may contribute to tumor progression and metastasis. This large retrospective cohort study investigated clinical and metabolic profiles to identify independent metabolic correlates associated with cervical LNM, which may complement preoperative risk assessment.</p><p><strong>Methods: </strong>A retrospective cohort analysis of 1,003 PTC patients was performed. Preoperative variables (demographics, clinicopathological features, serum biochemical markers) were profiled; univariate and multivariable logistic regression analyses were utilized to identify independent metabolic factors associated with central (CLNM) and lateral LNM (LLNM).</p><p><strong>Results: </strong>Among 1,003 patients, 35.19% and 3.79% presented with CLNM and LLNM, respectively. The LLNM subgroup was small (n = 38), which limited statistical power and generalizability of the corresponding findings. Multivariable analysis identified HDL-C (OR = 0.63, P = 0.040) as a factor independently associated with CLNM, and 25(OH)D (OR = 0.97, P = 0.012) with LLNM. Patients with 25(OH)D deficiency (< 50 nmol/L) had a higher LLNM incidence than those with sufficient levels (5.07% vs. 1.95%, P < 0.05). Tumor size remained a robust risk factor for both compartments, whereas BRAF V600E mutation showed no significant independent association with metastasis in this dataset (P > 0.05).</p><p><strong>Conclusion: </strong>Our findings suggest that preoperative serum 25(OH)D and HDL-C are associated with site-specific LNM in PTC. These markers may complement preoperative risk stratification, although current evidence remains inconsistent. Given the retrospective, single-center design and small subgroup sizes, our results are preliminary and hypothesis-generating. Further prospective studies are needed to validate their clinical role.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148398036","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":"Retrospective analysis of the occurrence pattern of complications and prognostic influencing factors in elderly patients with squamous cell lung cancer after radical surgery.","authors":"Jie You, Yiping Lang, Jiamin Li","doi":"10.1186/s12957-026-04481-6","DOIUrl":"10.1186/s12957-026-04481-6","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the characteristics of postoperative complications and their prognostic effects in elderly patients with squamous cell lung cancer (SqCLC) who received radical surgery, identify independent prognostic factors, and build an individualized survival prediction model.</p><p><strong>Methods: </strong>This retrospective study included 260 elderly patients with SqCLC who underwent radical surgery. We collected and analyzed their clinicopathological data, postoperative complications and survival outcomes. Univariate and multivariate Cox regression analyses were used to screen prognostic factors for overall survival (OS). A nomogram for 2-year OS prediction was established and validated using receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).</p><p><strong>Results: </strong>The total incidence of postoperative complications was 38.1% (99/260), and pulmonary infection (14.6%) was the most common complication. Univariate analysis indicated that age, Eastern Cooperative Oncology Group Performance Status (ECOG PS), Charlson Comorbidity Index (CCI), 8th edition TNM stage and postoperative complications were significantly correlated with OS and progression-free survival (PFS) (all P < 0.05). Multivariate Cox regression identified advanced TNM stage (III-IV) (HR = 1.65, 95%CI 1.23-2.21, P < 0.001) and ECOG PS ≥ 2 (HR = 1.25, 95%CI 1.01-1.55, P < 0.05) as independent adverse prognostic factors for OS. Postoperative complications were significantly associated with poorer survival in univariate analysis but did not remain an independent prognostic factor in multivariate analysis. The nomogram integrating age, ECOG PS, CCI, TNM stage, and postoperative complication status yielded an area under the curve (AUC) of 0.82 (95%CI 0.77-0.87) for 2-year OS prediction, with excellent calibration and clinical net benefit.</p><p><strong>Conclusion: </strong>Postoperative complications are highly prevalent in elderly SqCLC patients undergoing radical surgery and are significantly associated with inferior survival outcomes in univariate analysis. The proposed postoperative nomogram can accurately predict 2-year OS, and its clinical application is restricted to postoperative scenarios, including individualized prognostic counseling, surveillance planning, and risk stratification for this patient population.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383064","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 lymph node ratio after suboptimal lymphadenectomy in gastric cancer: a retrospective cohort study with interaction analysis.","authors":"Yusuf Emre Aytin, Sezer Berkay Gorca","doi":"10.1186/s12957-026-04482-5","DOIUrl":"10.1186/s12957-026-04482-5","url":null,"abstract":"<p><strong>Background: </strong>Accurate prognostic stratification after gastrectomy is crucial for individualized management of gastric cancer. Although examination of at least 15 lymph nodes is recommended to ensure reliable staging, this threshold is not consistently achieved in routine practice, potentially compromising prognostic accuracy. The lymph node ratio (LNR) has been proposed as an alternative nodal metric; however, its prognostic role in the context of suboptimal lymphadenectomy remains unclear. This study aimed to evaluate the prognostic impact of LNR in patients following suboptimal lymphadenectomy and to assess whether its effectiveness is influenced by the extent of nodal dissection.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 210 patients with non-metastatic gastric adenocarcinoma who underwent curative-intent gastrectomy between January 2016 and January 2021, with a predefined 5-year follow-up period. Suboptimal lymphadenectomy was defined as the retrieval of fewer than 15 lymph nodes. Overall survival (OS) was analyzed using Kaplan-Meier estimates and Cox proportional hazards models. Multivariable analysis was performed in the suboptimal lymphadenectomy group, and an interaction term (LNR × extent of lymphadenectomy) was evaluated in the full cohort.</p><p><strong>Results: </strong>Eighty-nine patients (42.4%) underwent suboptimal lymphadenectomy. Within this group, LNR independently predicted poorer overall survival (adjusted HR 2.50, 95% CI 1.14-5.47; p = 0.022), together with increasing age. In the overall cohort, a significant interaction between LNR and the extent of lymphadenectomy was identified (p = 0.030), indicating that the prognostic impact of LNR varies according to nodal retrieval adequacy.</p><p><strong>Conclusions: </strong>LNR represents an independent prognostic factor in patients following suboptimal lymphadenectomy and interacts with the extent of nodal dissection. These findings support the incorporation of LNR into postoperative risk stratification when lymph node retrieval is inadequate.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377071","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 value of the immune-inflammatory indices in osteosarcoma: a systematic review and meta-analysis.","authors":"Licheng Ni, Huajiang Zheng","doi":"10.1186/s12957-026-04469-2","DOIUrl":"10.1186/s12957-026-04469-2","url":null,"abstract":"<p><strong>Background: </strong>Systemic inflammation plays an important role in driving tumor progression. Several inflammation-related indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII), have been proposed as prognostic biomarkers across various cancers. Nevertheless, their prognostic utility in osteosarcoma remains uncertain. This systematic review and meta-analysis was conducted to evaluate the associations between these indices and survival outcomes in patients with osteosarcoma.</p><p><strong>Methods: </strong>We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library for articles published through 30 June 2025 that assessed the relationship between pretreatment NLR, PLR, LMR, or SII and osteosarcoma patient overall survival (OS), progression-free survival (PFS), and/or event-free survival (EFS). A random-effects model was used to pool summary hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were also conducted, along with publication-bias assessments.</p><p><strong>Results: </strong>A total of 22 studies incorporating 57 cohort comparisons met the inclusion criteria for this meta-analysis. High NLR values were significantly associated with worse OS (HR = 1.52; 95% CI, 1.29-1.78; p < 0.0001). Similarly, high SII values were correlated with reduced OS (HR = 1.84; 95% CI, 1.05-3.21; p = 0.03), and high PLR values predicted poorer OS (HR = 1.21; 95% CI, 1.07-1.37; p = 0.002). In contrast, LMR was not significantly associated with OS (HR = 1.13; 95% CI, 0.91-1.39; p = 0.26). Of the evaluated progression endpoints, only NLR was significantly associated with shorter PFS (HR = 1.84; 95% CI, 1.04-3.25; p = 0.03).</p><p><strong>Conclusions: </strong>Pretreatment immune-inflammatory indices may have prognostic relevance in osteosarcoma, with NLR showing the most consistent association with adverse survival outcomes. Although PLR and SII were associated with poorer OS in pooled analyses, these findings should be interpreted cautiously because of substantial heterogeneity, limited study numbers, potential small-study effects, and sensitivity instability, particularly for SII. Large-scale prospective multicenter studies with standardized cut-off values are required before these indices can be incorporated into routine clinical prognostic evaluation.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377074","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":"Oncologic outcomes after poly-4-hydroxybutyrate scaffold in post-mastectomy breast reconstruction: a retrospective, multi-center cohort study.","authors":"Haytham Gareer, Julia Tchou, Neil M Iyengar, Nicolás Tentoni, E Shelley Hwang, Kiya Movassaghi, Andrea McCracken, Kimberly Krugman","doi":"10.1186/s12957-026-04443-y","DOIUrl":"10.1186/s12957-026-04443-y","url":null,"abstract":"<p><strong>Background: </strong>Poly-4-hydroxybutyrate (P4HB) scaffolds are increasingly used in post-mastectomy implant-based breast reconstruction. Clinical adoption has outpaced evidence regarding oncologic outcomes and recurrence detection in reconstructed breasts.</p><p><strong>Methods: </strong>We conducted a real-world cohort study via the Guardian Research Network database (2016-2023). Female patients with breast cancer undergoing mastectomy and reconstruction were identified; 269 P4HB cases were compared with 269 stratified, randomly sampled non-P4HB controls. Primary endpoints were LRR and LRRFS; secondary endpoints included disease-specific and overall survival. Cumulative incidence functions accounted for competing risk of non-breast cancer death. Administrative censoring at 3 years (as well as time aligned cohorts) was used to mitigate temporal imbalance.</p><p><strong>Results: </strong>Over a median follow-up of 2.2 years in P4HB and 5.5 years in controls, LRR was uncommon (4/269 (1.5%) vs. 6/269 (2.2%)). The 3-year cumulative incidence of LRR was 1.6% in both groups. Disease-specific mortality was rare (0.7% vs. 2.6%). No early signal of differences in locoregional recurrence was observed between groups within the observed follow‑up period.</p><p><strong>Conclusions: </strong>In this real-world, multi-center analysis, no detectable signal of increased locoregional recurrence was observed between cohorts. These findings do not establish evidence of oncologic equivalence, but rather an absence of a detectable early signal of increased risk within the observed follow-up. Larger, time-aligned datasets with plane-stratified surveillance and analyses are warranted to further evaluate oncologic outcomes given the comparator cohort included a greater proportion of earlier-era reconstructions than the P4HB cohort, reflecting more recent clinical adoption of P4HB.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370132","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":"Risk-adapted nodal evaluation in stage IA non-small cell lung cancer: a population-based competing-risk analysis.","authors":"Ziqiang Wang, Yangyang Xie, Tingting Wang, Xue Song, Nian Liu","doi":"10.1186/s12957-026-04485-2","DOIUrl":"10.1186/s12957-026-04485-2","url":null,"abstract":"<p><strong>Background: </strong>The oncologic value of intensified lymph node (LN) evaluation in stage IA non-small cell lung cancer (NSCLC) remains uncertain in the era of surgical de-escalation. Although expanded nodal assessment may reduce understaging, whether it is associated with meaningful survival differences in this favorable-risk population is unclear. Clarifying this issue is essential to balance oncologic adequacy and surgical burden.</p><p><strong>Method: </strong>We conducted a population-based cohort study using the Surveillance, Epidemiology, and End Results database and included patients with surgically treated pathologic stage IA (T1N0M0) NSCLC. The extent of nodal evaluation was quantified by the number of examined lymph nodes. Propensity score matching was used to balance baseline characteristics. Cancer-specific and other-cause death were analyzed using cumulative incidence functions and Fine-Gray competing-risk models. Prespecified subgroup analyses assessed heterogeneity of association, particularly according to tumor size.</p><p><strong>Results: </strong>We included 24,215 patients, with 13,812 after matching. Intensified nodal evaluation, defined as ≥ 6 examined lymph nodes (ELNs), was associated with lower cancer-specific mortality (5-year cumulative incidence, 12.9% vs. 15.3%; absolute risk reduction [ARR] 2.4%; Gray's P < 0.001). In multivariable Fine-Gray analysis, ELNs ≥ 6 remained independently associated with lower cancer-specific mortality (subdistribution hazard ratio 0.78, 95% CI 0.74-0.83). The association was minimal in tumors ≤ 1 cm but more evident in tumors > 1 cm. Sensitivity analyses using ELNs ≥ 10 yielded similar findings.</p><p><strong>Conclusion: </strong>The association between intensified nodal evaluation and lower cancer-specific mortality in stage IA NSCLC varies by tumor size. This association was more evident in tumors > 1 cm, supporting further investigation of a size-based, risk-adapted approach to surgical staging in early-stage NSCLC.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370072","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 reinforced pancreaticojejunostomy with or without tissue adhesive glue modified cyanoacrylate following pancreaticoduodenectomy: a randomized controlled clinical trial.","authors":"Saleh Khairy Saleh, Mohamed Sadek Farahat, Tantawi Abdelnaeem Mohamed, Mina Makram Hendy","doi":"10.1186/s12957-026-04476-3","DOIUrl":"10.1186/s12957-026-04476-3","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula (POPF) remains the most significant complication following pancreaticoduodenectomy (PD). This randomized controlled trial evaluated the efficacy of reinforcing the pancreaticojejunostomy (PJ) with Glubran^®2, a modified N-butyl-2-cyanoacrylate adhesive, in reducing the rate of clinically relevant POPF.</p><p><strong>Methods: </strong>This single-center randomized controlled trial with blinded patients and blinded outcome assessors enrolled 100 consecutive patients undergoing open PD for pancreatic head or periampullary cancer between 15 January 2025 and 15 January 2026. Patients were randomized 1:1 to Glubran^®2-reinforced PJ (Glubran^®2 group) or conventional PJ (Control group). The primary endpoint was the rate of POPF (Grade B/C per ISGPS 2016) within the 90-day postoperative period. Operating surgeons were not blinded; ward physicians, outcome assessors and statisticians were blinded.</p><p><strong>Results: </strong>POPF (Grade B/C) occurred in 3 patients (6%) in the Glubran^®2 group versus 11 patients (22%) in the Control group (p = 0.041; Fisher's exact test). Grade B POPF was 4% versus 16% (p = 0.092) and Grade C POPF was 2% versus 6% (p = 0.617); individual-grade comparisons were prespecified as exploratory. Overall morbidity (any complication) was 18% versus 54% (p < 0.001) and severe complications (Clavien-Dindo ≥ IIIa) were 10% versus 36% (p = 0.004). The Glubran^®2 group had earlier drain removal (median 6 [IQR 5-7] vs. 14 [IQR 9-18] days, p < 0.001) and shorter hospital stay (10.8 ± 3.2 vs. 19.2 ± 7.1 days, p < 0.001). On multivariable analysis, Glubran^®2 use was an independent protective factor (adjusted OR 0.18, 95% CI 0.06-0.54, p = 0.002), after adjustment for soft pancreatic texture and main pancreatic duct ≤ 3 mm. The effect was consistent on per-protocol and surgeon-clustered sensitivity analyses.</p><p><strong>Conclusions: </strong>In this single-center randomized trial, reinforcement of pancreaticojejunostomy with Glubran^®2 was associated with a significantly lower rate of POPF (Grade B/C), shorter time to drain removal, lower overall morbidity, and shorter length of hospital stay, with an acceptable safety profile. These hypothesis-generating findings warrant confirmation in an adequately sized, multicenter trial with operator-independent application before any recommendation for routine clinical adoption.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06756074. Registered 24 December 2024 (prospective). https://clinicaltrials.gov/study/NCT06756074 .</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":"24 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362570","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}