JTCVS open最新文献

{"title":"The impact of race and sex on recent mortality trends after coronary artery bypass grafting","authors":"Anthony V. Norman MD, MSc ,&nbsp;Mohamad El Moheb MD ,&nbsp;Ariaz Goudarzi BS ,&nbsp;Alexander M. Wisniewski MD, MSc ,&nbsp;Matthew P. Weber MD, MS ,&nbsp;Steven Young MD ,&nbsp;Andrew M. Young MD ,&nbsp;Abdulla Damluji MD ,&nbsp;Michael C. Kontos MD ,&nbsp;Mohammed Quader MD ,&nbsp;Ourania Preventza MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.xjon.2025.10.029","DOIUrl":"10.1016/j.xjon.2025.10.029","url":null,"abstract":"<div><h3>Objective</h3><div>Despite declining mortality after coronary artery bypass grafting, it is unclear if Black or female patients similarly benefit. We hypothesized differences in outcomes persist and disproportionately affect Black women.</div></div><div><h3>Methods</h3><div>We examined patients undergoing isolated coronary artery bypass grafting from July 2011 to July 2023 in a multicenter regional collaborative. Patients were stratified by race and sex: White men, White women, Black men, and Black women. Hierarchical logistic regression analyses were performed to identify trends and risk factors associated with operative mortality.</div></div><div><h3>Results</h3><div>Among 27,309 patients, White men, White women, Black men, and Black women made up 66.1%, 19.2%, 9.3%, and 5.4% of the cohort, respectively. Their Society of Thoracic Surgeons Predicted Risk of Mortality was 0.83%, 1.55%, 1.11%, and 1.66%, respectively (<em>P &lt;</em> .001). Mortality (1.5% vs 2.7% vs 2.5% vs 3.2%, <em>P &lt;</em> .001) and major morbidity (8% vs 12% vs 14% vs 17%, <em>P &lt;</em> .001) were highest in Black women. There was no reduction in mortality over time (odds ratio [OR], 1.06 95% CI, 0.95-1.2, <em>P =</em> .338). Compared with White men, White women (OR, 1.53, 95% CI, 1.22-1.91, <em>P &lt;</em> .001), Black men (OR, 1.41, 95% CI, 1.04-1.9, <em>P =</em> .026), and Black women (OR, 1.8, 95% CI, 1.28-2.53, <em>P =</em> .001) had higher risk-adjusted odds of mortality. Society of Thoracic Surgeons Predicted Risk of Mortality (OR, 1.13, 95% CI, 1.11-1.14, <em>P &lt;</em> .001), distress score (OR, 1.01 95% CI, 1.01-1.01, <em>P =</em> .007), log anastomosis ratio (OR, 0.775, 95% CI, 0.625-0.962, <em>P =</em> .021), and bypass time (OR, 1.01, 95% CI, 1.01-1.01, <em>P &lt;</em> .001) were associated with mortality.</div></div><div><h3>Conclusions</h3><div>Differences persist with Black women having the highest risk-adjusted odds of mortality after coronary artery bypass grafting. Reinvigorated efforts are needed in an era of plateauing mortality rates.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101510"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term cardiac surgery outcomes in patients receiving dialysis and with previous kidney transplantation: A national registries analysis","authors":"Dominic Keuskamp PhD ,&nbsp;Christopher E. Davies PhD ,&nbsp;Robert A. Baker PhD ,&nbsp;Kevan R. Polkinghorne MBChB, PhD ,&nbsp;Christopher M. Reid PhD ,&nbsp;Julian A. Smith MBBS, MS ,&nbsp;Lavinia Tran PhD ,&nbsp;Jenni Williams-Spence PhD ,&nbsp;Rory Wolfe PhD ,&nbsp;Stephen P. McDonald MBBS(Hons), PhD","doi":"10.1016/j.xjon.2025.11.019","DOIUrl":"10.1016/j.xjon.2025.11.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Whether patients with kidney failure who undergo cardiac surgery have a survival advantage with previous kidney transplantation is unclear. This study evaluated long-term outcomes after cardiac surgery for kidney transplant recipients and patients dependent on dialysis using national registries.</div></div><div><h3>Methods</h3><div>Probabilistic data linkage was undertaken between registries for the period 2010-2019. Time-to-event analyses were used to estimate the risk after cardiac surgery of (1) survival for kidney-replacement therapy recipients (n = 1250), and (2) graft survival for kidney transplant recipients (n = 225). Using cardiac surgery as a time-varying covariate, kidney graft survival was compared among the national contemporary kidney transplant population (n = 7934).</div></div><div><h3>Results</h3><div>Five-year survival probabilities after cardiac surgery for patients with kidney transplants and receiving dialysis were 70% (95% confidence interval [CI], 61%-76%) and 49% (95% CI, 45%-53%), respectively. The benefit for kidney transplantation persisted in a multivariable Cox regression model (reference: facility hemodialysis; adjusted hazard ratio [HR], 0.53; 95% CI, 0.37-0.74; <em>P</em> &lt; .001). Five-year kidney graft survival probability after cardiac surgery was 60% (95% CI, 52%-68%) and was lower with stage 3 acute kidney injury (reference: none; adjusted HR, 2.61; 95% CI, 1.32-5.16; <em>P</em> = .006). Among the national contemporary kidney transplant recipient population, cardiac surgery was associated with an increased risk of graft loss (adjusted HR, 1.70; 95% CI, 1.07-2.74; <em>P</em> = .026).</div></div><div><h3>Conclusions</h3><div>Among adults with kidney failure undergoing cardiac surgery, kidney transplant recipients experienced a long-term survival advantage compared with patients dependent on dialysis. Transplant recipients undergoing cardiac surgery had greater risk of graft loss than the national contemporary kidney transplant population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101535"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When wedge resection is good enough: Survival outcomes and nodal involvement of ground-glass–dominant stage IA non–small cell lung cancer","authors":"Naoyuki Oka MD ,&nbsp;Masaya Yotsukura MD ,&nbsp;Yukihiro Yoshida MD ,&nbsp;Yasushi Yatabe MD ,&nbsp;Shun-ichi Watanabe MD","doi":"10.1016/j.xjon.2025.101549","DOIUrl":"10.1016/j.xjon.2025.101549","url":null,"abstract":"<div><h3>Objective</h3><div>Whether the indications for wedge resection can be extended to early-stage non–small cell lung cancer (NSCLC) remains unclear. We investigated the survival outcomes and nodal involvement of ground-glass-opacity–dominant stage IA NSCLC undergoing wedge resection, segmentectomy, or lobectomy.</div></div><div><h3>Methods</h3><div>We retrospectively investigated the prognostic and clinicopathological outcomes of patients who underwent lung resection for ground-glass-opacity–dominant clinical stage IA (diameter ≤3 cm; consolidation-to-tumor ratio ≤0.5) NSCLC between 2017 and 2022. Patients with tumors ≤2 cm and consolidation-to-tumor ratio ≤0.25 were excluded. Propensity score matching was performed to equalize the preoperative characteristics of patients undergoing wedge resection and segmentectomy. Overall and relapse-free survival rates were estimated, and differences were compared.</div></div><div><h3>Results</h3><div>Of the 398 patients who met the inclusion criteria, 77, 258, and 63 underwent lobectomy, segmentectomy, and wedge resection, respectively. Two (0.5%) patients experienced disease recurrence, and 6 (1.5%) patients died; however, no lung cancer-related deaths were observed. Two patients developed locoregional recurrence, all of which were nodal. No patients had pN1/2 disease. The 5-year overall and relapse-free survival rates were 97.6% and 96.4%, respectively. Relapse-free survival did not differ significantly according to the extent of lung resection (91.7%, 97.7%, and 100%; <em>P</em> = .146). Even after propensity score matching, overall and relapse-free survival did not differ significantly between wedge resection and segmentectomy.</div></div><div><h3>Conclusions</h3><div>Patients with ground-glass-opacity–dominant clinical stage IA NSCLC showed an excellent prognosis, with no survival differences between procedures. In those patients, wedge resection without nodal dissection may be oncologically equivalent to anatomic resection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101549"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryoablation for ground-glass nodules: Indications and short-term outcomes","authors":"Ji Yun Han MD ,&nbsp;Woohyun Jung MD ,&nbsp;Kun Yung Kim MD ,&nbsp;Yeon Wook Kim MD, PhD ,&nbsp;Jae Hyun Jeon MD ,&nbsp;Sukki Cho MD, PhD ,&nbsp;Chang Jin Yoon MD, PhD ,&nbsp;Kwhanmien Kim MD, PhD","doi":"10.1016/j.xjon.2025.101548","DOIUrl":"10.1016/j.xjon.2025.101548","url":null,"abstract":"<div><h3>Objective</h3><div>We prospectively applied cryoablation to nonsubpleural small ground-glass nodules (GGNs) with risk factors for growth (high-risk GGNs). Herein, we present our inclusion criteria and short-term outcomes.</div></div><div><h3>Methods</h3><div>This is an interim report from a prospective, single-arm observational cohort study of cryoablation for high-risk GGNs. Inclusion criteria were GGN size between 8 and 20 mm; nonsubpleural GGNs; presence of risk factor for growth; clinically predicted as minimally invasive based on standardized uptake value and consolidation-to-tumor ratio; patients aged 20 to 65 years, those with a history of prior lung cancer surgery, or those with impaired pulmonary function test results; and provision of informed consent after thorough explanation. Exclusion criteria were GGNs located within 1 cm of a major vessel or main bronchus, evidence of nodal or distant metastasis, and severe coagulopathy.</div></div><div><h3>Results</h3><div>A total of 14 patients underwent cryoablation for GGNs. The mean age was 68.1 ± 10.5 years. All patients had multiple GGNs, and 11 patients (78.6%) had a history of lung cancer surgery. Mean GGN size was 12 ± 5 mm with standardized uptake value 0.5 ± 0.6 and consolidation-to-tumor ratio 0.6 ± 0.3. All lesions were successfully encompassed within the target −40 °C isotherm zone with 10-mm safety margins. Only Common Terminology Criteria for Adverse Events grade 1 complications occurred. The median hospital stay was 2 days.</div></div><div><h3>Conclusions</h3><div>We have presented the indications of cryoablation for GGNs. This study demonstrates that cryoablation can be safely performed in carefully selected patients, achieving favorable short-term safety outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101548"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk model for mortality in Japanese patients requiring dialysis undergoing transcatheter aortic valve implantation: A report from a Japanese nationwide study","authors":"Kizuku Yamashita MD, PhD ,&nbsp;Koichi Maeda MD, PhD ,&nbsp;Hiraku Kumamaru MD, ScD ,&nbsp;Shun Kohsaka MD, PhD ,&nbsp;Kazuo Shimamura MD, PhD ,&nbsp;Ai Kawamura MD, PhD ,&nbsp;Isamu Mizote MD, PhD ,&nbsp;Daisuke Yoshioka MD, PhD ,&nbsp;Shigeru Miyagawa MD, PhD","doi":"10.1016/j.xjon.2025.101570","DOIUrl":"10.1016/j.xjon.2025.101570","url":null,"abstract":"<div><h3>Objectives</h3><div>Transcatheter aortic valve implantation (TAVI) is widely performed. However, the prognosis of patients requiring dialysis undergoing TAVI remains guarded; therefore, we aimed to establish a risk model to predict their prognosis.</div></div><div><h3>Methods</h3><div>A total of 888 patients requiring dialysis underwent TAVI for severe aortic stenosis between February 2021 and March 2022 at 54 facilities in Japan. Patients from 44 randomly selected facilities were included in the development cohort, and the rest were included in the validation cohort. Based on clinical perspective and prior research, 15 preoperative background factors, including the grade of clinical frailty scale (1-3, 4-6, or 7-9) and serum albumin level, were selected and a prognostic model was constructed using Cox proportional hazards regression.</div></div><div><h3>Results</h3><div>The median age of the patients was 80 years (interquartile range, 75-85 years). Three hundred nineteen men (35.9%) and 587 high-risk (Society of Thoracic Surgeons predicted risk of mortality ≥8%) patients (66.1%) were enrolled. The cumulative overall survival rates at 30 days and 1 year after TAVI were 95.9% and 78.3%, respectively. The exacerbated clinical frailty scale was strongly associated with 1-year mortality in the development cohort (hazard ratio, 2.06; 95% CI, 1.47-2.87). Uno's concordance index in the validation cohort was 0.686 (95% CI, 0.588-0.783). Observed survival rates were 91.7% (95% CI, 53.9%-98.8%) in the group with ≥90% predicted survival, 84.8% (95% CI, 70.7%-92.5%) in the group with 80% to &lt;90% predicted survival, and 64.4% (95% CI, 51.9%-74.5%) in the group with &lt;80% predicted survival.</div></div><div><h3>Conclusions</h3><div>The model developed in this study predicts 1-year survival probability, which is useful in considering indications for TAVI in patients requiring dialysis with a poor prognosis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101570"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic valve neocuspidization in children: A systematic review and meta-analysis","authors":"Andrey Semyashkin MD ,&nbsp;Julia Nesteruk MD ,&nbsp;Lotfi Ben Mime MD","doi":"10.1016/j.xjon.2025.101547","DOIUrl":"10.1016/j.xjon.2025.101547","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve neocuspidization (AVNeo) has emerged as a reconstructive alternative for children with aortic valve disease who are poor candidates for prosthetic replacement or the Ross procedure. Although early clinical results appear favorable, concerns persist regarding mid-term durability and material-related valve degeneration. To clarify these uncertainties, we systematically evaluated global pediatric AVNeo outcomes, focusing on early performance, mid-term reintervention rates, and the influence of pericardial material on valve longevity.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and preprint servers (January 2000-October 2025) identified studies reporting neocuspidization in patients age ≤18 years. Two reviewers independently screened and extracted data. Pooled proportions were calculated with a random-effects model; heterogeneity was assessed with the <em>I</em>² statistic. Risk ratios compared reoperation rates between autologous and xenopericardial reconstructions, and comparative cohorts versus the Ross operation were summarized narratively.</div></div><div><h3>Results</h3><div>Twelve studies including 336 children met the inclusion criteria. Early mortality was 1.2%, and late mortality was 1.1%. The pooled reoperation rate was 15.4% (95% confidence interval [CI], 5.4%-29.2%; <em>I</em>² = 86%). Reoperation was 7-fold more frequent after xenopericardial reconstruction (risk ratio, 7.09; 95% CI, 2.95-17.06). Comparative series consistently favored the Ross operation for mid-term durability.</div></div><div><h3>Conclusions</h3><div>AVNeo provides excellent early outcomes but limited mid-term durability, particularly with xenopericardium. Autologous pericardium markedly reduces reoperation risk and should remain the preferred material.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101547"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive mitral valve repair: Ten-year outcomes of the “Re-Lock technique” for complex bileaflet mitral valve disease","authors":"Giuseppe Speziale MD, PhD ,&nbsp;Raffaele Bonifazi MD ,&nbsp;Tommaso Loizzo MD ,&nbsp;Ernesto Greco MD, PhD ,&nbsp;Giuseppe Nasso MD, PhD","doi":"10.1016/j.xjon.2025.101543","DOIUrl":"10.1016/j.xjon.2025.101543","url":null,"abstract":"<div><h3>Objective</h3><div>The objective was to evaluate the 10-year clinical and echocardiographic outcomes of minimally invasive Re-Lock mitral valve repair for Barlow-type or complex bileaflet degenerative disease, evaluating overall survival, freedom from mitral regurgitation 2+ or greater, need for reoperation, and New York Heart Associaton class.</div></div><div><h3>Methods</h3><div>From 2008 to 2016, 140 consecutive patients with Barlow-type degenerative bileaflet mitral valve disease underwent video-assisted minimally invasive right anterolateral thoracotomy repair at a single institution. In all cases, the repair was based on the Re-Lock maneuver. Patients were classified according to the need for anterior intervention. Group 1 included patients receiving Re-Lock only (n = 33), in whom anterior billowing or mild prolapse became competent after posterior correction and required no additional repair. Group 2 included patients receiving Re-Lock + anterior expanded polytetrafluoroethylene neochordae (n = 107), in whom true anterior prolapse or flail warranted targeted neochordal implantation. Follow-up was completed through scheduled clinical and echocardiographic evaluations, with a median duration of 10.2 years.</div></div><div><h3>Results</h3><div>Technical success with freedom of mitral regurgitation (mild or less on intraoperative transesophageal echocardiography) was 99.3%, with no 30-day mortality. At 10 years, overall survival was 95.7%. Freedom from mitral regurgitation 2+ or greater was 91.2%, and freedom from reoperation was 96.4%. Postoperative New York Heart Association class improved in 130 of 140 patients (92.9%) and maintained class I at last follow-up in 122 of 130 survivors (93.8%). No statistically significant difference was observed in outcomes by technique group (log-rank <em>P =</em> .74). A learning curve was evident, with crossclamp time decreasing from 69.7 ± 11.9 to 45.3 ± 10.4 minutes over time.</div></div><div><h3>Conclusions</h3><div>The minimally invasive Re-Lock technique provides safe, reproducible, and effective long-term results for complex bileaflet mitral valve disease, including Barlow's pathology.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101543"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of days alive and out of hospital 30 days after surgery as an outcome measure in a major cardiac surgical center in Australia","authors":"Rona P. Steel BMedSci, CCP (Aust) ,&nbsp;Jeremy D. Field BSc(Hons), FANZCA ,&nbsp;Jan M. Dieleman PhD, FANZCA","doi":"10.1016/j.xjon.2025.101556","DOIUrl":"10.1016/j.xjon.2025.101556","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative days alive and out of hospital within 30 days (DAH-30) is a validated, patient-centered metric reflecting the quality of care and recovery after surgery. This study aimed to evaluate the feasibility of DAH-30 data collection in an Australian cardiac surgical center and investigate its association with established cardiac risk factors and postoperative complications.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used prospectively collected registry data from patients aged ≥18 years undergoing open-heart surgery. DAH-30 was calculated as the total number of days alive and out of hospital within the first 30 postoperative days, incorporating manually collected data on secondary facility discharge and readmission. Univariable associations were assessed using the Kruskal-Wallis rank sum test. Multivariable analysis used a backward stepwise selection procedure on the parameters of a beta-inflated regression model. Estimated coefficients, 95% confidence intervals, and <em>P</em> values were reported.</div></div><div><h3>Results</h3><div>DAH-30 data collection was efficiently integrated into routine clinical workflow. The median DAH-30 for the cohort was 21 days (interquartile range, 14-23), with 10.6% of patients spending no time at home within 30 days. Univariable analysis revealed significant associations between several preoperative risk factors and postoperative complications with DAH-30. Multivariable analysis identified age, postoperative arrhythmias, and preoperative infective endocarditis as independent predictors of reduced DAH-30.</div></div><div><h3>Conclusions</h3><div>DAH-30 is a feasible, meaningful patient-centered outcome metric that can be efficiently collected using routine clinical data in an Australian cardiac surgical center. It provides valuable insights into patient recovery by integrating the impact of preoperative risk, postoperative complications, and hospital use. DAH-30 holds potential as an important outcome measure in cardiac surgery for guiding clinical practice, informing quality improvement, and monitoring intervention effectiveness.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101556"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of timing of adjuvant chemotherapy on survival for early-stage node-negative small-cell lung cancer","authors":"Arian Mansur MD ,&nbsp;Adele J. Lee BA ,&nbsp;Alexandra L. Potter BS ,&nbsp;Jacob M. Sands MD ,&nbsp;Catherine B. Meador MD, PhD ,&nbsp;Michael Lanuti MD ,&nbsp;Chi-Fu Jeffrey Yang MD","doi":"10.1016/j.xjon.2025.07.013","DOIUrl":"10.1016/j.xjon.2025.07.013","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between timing of adjuvant chemotherapy and survival for early-stage, node-negative small cell lung cancer is not well defined, and no formal guidelines exist. We sought to evaluate whether increasing the time between surgery and adjuvant chemotherapy for pathologic stage I-IIA SCLC would be associated with worse survival.</div></div><div><h3>Methods</h3><div>The association between timing of adjuvant chemotherapy and survival for patients with pathologic stage I-IIA (pT1-2N0M0) SCLC who have 1 or fewer co-morbidities in the National Cancer Database from 2004-2021 was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analysis. Adjuvant chemotherapy received within 21-40 days of surgery was classified as “earlier” while adjuvant chemotherapy received 41-90 days after surgery was classified as “later.”</div></div><div><h3>Results</h3><div>Of 927 patients who met study criteria, the median time to adjuvant chemotherapy was 41 days (interquartile range, 34, 53). In multivariable and propensity score-matched analyses, there was no significant difference in overall survival between earlier and later adjuvant chemotherapy. These findings were consistent when limited to patients who were discharged within 4 days of surgery or when adjusting for minimally invasive surgical approaches.</div></div><div><h3>Conclusions</h3><div>In this national analysis of patients with early-stage node-negative SCLC, there was no significant difference in overall survival based on the timing of adjuvant chemotherapy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101400"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic findings predictive of pathologic upstaging in T2N0 esophageal cancer","authors":"Lillian L. Tsai MD ,&nbsp;Sidharth Bommakanti BS ,&nbsp;Ntemena Kapula MAS ,&nbsp;Mina Satoyoshi MS ,&nbsp;Chris Aboujudom BA ,&nbsp;Irmina A. Elliott MD ,&nbsp;Brandon A. Guenthart MD ,&nbsp;Douglas Z. Liou MD ,&nbsp;Natalie S. Lui MD ,&nbsp;Leah M. Backhus MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Mark F. Berry MD","doi":"10.1016/j.xjon.2025.101561","DOIUrl":"10.1016/j.xjon.2025.101561","url":null,"abstract":"<div><h3>Objective</h3><div>Endoscopic ultrasound (EUS) evaluation of T2N0 esophageal cancers is associated with high rates of staging inaccuracy, impacting whether induction therapy is appropriately selected for these patients. We aimed to identify whether tumor appearance on endoscopy can predict whether preoperative EUS staging appropriately directs management.</div></div><div><h3>Methods</h3><div>The impact of tumors being described on endoscopic reports as bulky, ulcerative, or obstructive on the accuracy of EUS staging for patients with cT2N0 esophageal cancer who underwent esophagectomy without induction therapy at a single institution between 2008 and 2024 was evaluated with χ² analysis. A receiver operating characteristic curve was constructed using a logistic regression model estimating EUS understaging compared with pathologic reports.</div></div><div><h3>Results</h3><div>Of 35 patients with cT2N0 esophageal cancer who underwent esophagectomy without induction therapy, 57.1% (20/35) patients had pT1-2N0 pathology after esophagectomy. Conversely, 42.9% (15/35) of patients were understaged by EUS. There was a significant association between EUS accuracy and tumors endoscopically described as bulky, ulcerative, or obstructive (<em>P</em> = .002). Of the 15 patients who were understaged, the tumor endoscopic description was bulky, ulcerative, or obstructive in 14 (93.3% sensitivity). Of the 20 patients who were not understaged, 13 were negative for those key words (65.0% specificity). Not having the endoscopic key words was associated with tumors not being understaged in 13 of 14 patients (92.9% negative predictive value), whereas having the key words was associated with understaging in 14 of 21 patients (odds ratio, 26.0; <em>P</em> = .004; 66.7% positive predictive value).</div></div><div><h3>Conclusions</h3><div>Patients with cT2N0 esophageal cancer by EUS are likely to be understaged when the tumor endoscopic appearance is bulky, ulcerative, or obstructive.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101561"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}