Annals of Surgical Oncology最新文献

{"title":"Risk-Adapted Use of Adjuvant Systemic Therapy After Nephrectomy for Renal Cell Carcinoma: A Population-Based Study in the Post-approval Era.","authors":"Maximilian Filzmayer, Michele Petix, Leonardo Quarta, Filippo Orlandi, Jordan A Goyal, Luca Carmignani, Alberto Briganti, Salvatore Micali, Shahrokh F Shariat, Mike Wenzel, Yasmine Heß-Busch, Clara Humke, Fred Saad, Felix K-H Chun, Pierre I Karakiewicz","doi":"10.1245/s10434-026-20341-9","DOIUrl":"10.1245/s10434-026-20341-9","url":null,"abstract":"<p><strong>Background: </strong>Real-world adjuvant systemic therapy (AST) use for eligible renal cell carcinoma (RCC) patients remains insufficiently characterized in the contemporary treatment era. In particular, it is unclear whether treatment allocation reflects established high-risk tumor characteristics.</p><p><strong>Methods: </strong>In the Surveillance, Epidemiology, and End Results (SEER) database, the study identified patients eligible for AST after nephrectomy (2018-2022). Temporal trends in AST use were assessed. Multivariable logistic regression models tested associations between histopathologic high-risk features (T4 stage, tumor grade 4, and N1-2 stage) and AST use.</p><p><strong>Results: </strong>Of 6,497 eligible patients, 1,163 (18%) received AST. Annual proportions of AST increased from 13% in 2018 to 36% in 2022. Higher AST use was independently predicted by T4 stage (33% vs. 18%; odds ratio [OR], 1.68; p = 0.006), tumor grade 4 (28% vs. 15%; OR, 1.94; p < 0.001), and N1-2 stage (36% vs. 17%; OR, 2.57; p < 0.001). Patients who had any of these three high-risk features were more likely to receive AST than those who did not (28% vs. 14%; OR, 2.27; p < 0.001). Moreover, a stepwise increase in AST use was observed with an increasing number of high-risk features (one: 26% [OR, 2.09; p < 0.001], two: 37% [OR, 3.56; p < 0.001], three: 40% [OR, 4.04; p = 0.014]).</p><p><strong>Conclusions: </strong>Only a minority of eligible RCC patients received AST after nephrectomy. However, the proportion of AST use increased over time. Use of AST was strongly associated with adverse tumor characteristics. A stratification according to the number of high-risk features showed a dose-response effect. Nevertheless, AST use remained limited even among patients at the highest risk.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10480-10486"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competing-Risk Regression Analysis of Cancer-Specific and Other-Cause Mortality after Partial versus Radical Nephrectomy in T3aN0M0 Renal Cell Carcinoma.","authors":"Xuanji Li, Zhiliang Jiang, Huan Ren, Yaxiong Tang, Xianyanling Yi, Zeyu Han, Jianzhong Ai","doi":"10.1245/s10434-026-20380-2","DOIUrl":"10.1245/s10434-026-20380-2","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical management for T3aN0M0 renal cell carcinoma (RCC) remains debated. Radical nephrectomy (RN) is generally considered the standard treatment, whereas partial nephrectomy (PN) may preserve renal function, but the comparative long-term survival outcomes between these approaches remain unclear.</p><p><strong>Patients and methods: </strong>Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared cancer-specific mortality (CSM) and other-cause mortality (OCM) between PN and RN in patients with T3aN0M0 RCC. One-to-one propensity score matching (PSM) was performed. Cumulative incidence curves were generated, and univariable and multivariable Fine-Gray competing-risk regression (CRR) were applied to evaluate CSM and OCM. Subgroup analyses were performed by tumor size and age.</p><p><strong>Results: </strong>A total of 17,032 patients were included, of whom 2805 underwent PN and 14,227 underwent RN. After PSM, multivariable CRR analysis showed that PN was not associated with increased CSM compared with RN in the overall matched cohort (subdistribution hazard ratio (sHR) 0.77; 95% confidence interval (CI) 0.65-0.90; p < 0.001), with similar findings across subgroup analyses. PN was associated with lower OCM in patients with tumors measuring 1-40 mm (sHR 0.84; 95% CI 0.71-0.99; p = 0.036), whereas no significant OCM difference was observed in other subgroups.</p><p><strong>Conclusions: </strong>PN was not associated with a higher hazard of CSM or OCM than RN in this matched cohort. Our findings should be interpreted cautiously given the inherent limitations of the retrospective study design. PN may be considered in carefully selected patients with smaller tumors when complete resection is feasible without compromising oncologic safety.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10471-10479"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Machine Learning to Predict Breast Cancer-Related Lymphedema Following Axillary Lymph Node Dissection.","authors":"Benjamin D Wagner, Jonlin Chen, Lillian A Boe, Francis D Graziano, Arielle N Roberts, Andrea V Barrio, Michelle R Coriddi, Jonas A Nelson, Babak J Mehrara, Danielle H Rochlin","doi":"10.1245/s10434-026-20309-9","DOIUrl":"10.1245/s10434-026-20309-9","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer-related lymphedema (BCRL) is a common and debilitating sequela of axillary lymph node dissection (ALND). Although machine learning (ML)-based prediction models have been proposed, few focus exclusively on patients undergoing ALND, and direct comparisons with traditional statistical models remain limited. This study aimed to develop accurate and clinically feasible prediction models for BCRL using supervised ML and multivariable logistic regression.</p><p><strong>Methods: </strong>Demographic and clinical data were prospectively collected from women undergoing unilateral ALND for breast cancer at Memorial Sloan Kettering Cancer Center between 2016 and 2024. Supervised ML and multivariable logistic regression models to predict BCRL were trained and internally validated. Model performance was evaluated using area under the receiver operator characteristic curve (AUC), accuracy, sensitivity, specificity, and Brier score. Shapley additive explanations were used for model interpretability.</p><p><strong>Results: </strong>A total of 474 eligible patients were included. BCRL developed in 113 (23.8%) patients at a mean ± standard deviation of 16.6 ± 7.5 months postoperatively. The highest-performing ML model (random forest) achieved an AUC of 0.83, whereas traditional multivariable logistic regression achieved an optimism-corrected AUC of 0.62. Key ML predictors of BCRL on Shapley additive explanations analysis included clinical cancer stage, body mass index, age, and neoadjuvant chemotherapy.</p><p><strong>Conclusions: </strong>ML-based models outperformed traditional logistic regression in predicting BCRL among patients undergoing ALND. These models demonstrate the potential of ML for early BCRL identification and risk stratification but also highlight the difficulties in accurately predicting BCRL development. Further research is needed to improve model predictive performance and facilitate clinical implementation.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10547-10557"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive Intraoperative Frozen Section during Surgery for Junctional and Gastric Cancer: Should We Re-Resect? A Systematic Review and Meta-Analysis.","authors":"C Lastraioli, A M Bonomi, S Granieri, E Gjoni, G L Burchell, M I van Berge Henegouwen, U Fumagalli Romario, S S Gisbertz","doi":"10.1245/s10434-026-20420-x","DOIUrl":"10.1245/s10434-026-20420-x","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative frozen section analysis is used during surgery for esophagogastric adenocarcinoma to achieve radical (R0) resection, but the prognostic impact of conversion to R0 remains debated. A meta-analysis evaluating whether re-excision after a positive frozen section improves overall survival is currently lacking.</p><p><strong>Methods: </strong>We conducted a systematic review of PubMed, Embase, and Web of Science (from inception to February 2025) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included ≥ 25 patients with esophageal, junctional, or gastric adenocarcinoma undergoing curative-intent surgery. The primary outcome was overall survival in R0-converted versus R1 resection patients. Hazard ratios with 95% confidence intervals were used as outcome measures. A random-effects meta-analysis was performed, and risk of bias was assessed using the ROBINS-I tool.</p><p><strong>Results: </strong>Six retrospective studies including 2082 patients were analyzed. Most had gastric (62.5%, n=1301) or junctional (33.6%, n=700) adenocarcinoma. Gastrectomy was performed in 82.5% of patients, including total gastrectomy in 36.3%. Overall, 385 patients had a positive intraoperative frozen section; re-excision was attempted in 63.4% (n=244), and successful R0 conversion was achieved in 83% (n=203). R0-converted patients more frequently underwent total gastrectomy than R1 patients (65.4% vs. 46.1%). Although the primary analysis showed no significant survival difference, sensitivity analysis excluding one influential study demonstrated a survival benefit for R0-converted patients (hazard ratio 0.72; 95% confidence interval 0.60-0.85).</p><p><strong>Conclusion: </strong>Intraoperative frozen section-guided margin clearance improves survival in esophagogastric adenocarcinoma surgery. However, evidence is largely driven by patients with gastric cancer converting from subtotal to total gastrectomy as data on esophageal margin revision after total gastrectomy are limited.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10725-10735"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinical Outcomes of Upper Tract Urothelial Carcinoma between Patients after Renal Transplantation and on Dialysis: A Long-Term Single-Center Cohort Study.","authors":"Lianghao Zhang, Bao Guan, Yicong Du, Chunru Xu, Zhihua Li, Qi Tang, Liqun Zhou, Xuesong Li","doi":"10.1245/s10434-026-20314-y","DOIUrl":"10.1245/s10434-026-20314-y","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare clinical outcomes between patients who received renal transplantation (RT) and those maintained on dialysis.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 133 patients (34 RT, 99 dialysis) with unilateral UTUC treated with unilateral radical nephroureterectomy (RNU). Propensity score matching (PSM) with a 0.02 caliper balanced baseline characteristics, yielding 34 matched pairs. Overall survival was assessed by Kaplan-Meier; cancer-specific survival, bladder recurrence-free survival, and contralateral recurrence-free survival were analyzed via cumulative incidence functions and Gray's test in a competing-risk framework. Multivariate Fine-Gray regression identified independent predictors. Sensitivity analyses used the unmatched cohort, and all models were validated by a biostatistician.</p><p><strong>Results: </strong>Compared with dialysis patients, the RT group was significantly younger and had a higher proportion of larger tumors. Before PSM, Kaplan-Meier analysis revealed significant differences in contralateral recurrence-free survival (CRFS) and cancer-specific survival (CSS) between the two groups, but no significant differences in overall survival (OS) or bladder recurrence-free survival (BRFS). Multivariate Fine-Gray regression identified RT as an independent risk factor for worse CRFS, but not for CSS. After PSM, a significant difference in CRFS persisted between the groups, while no significant differences were observed in OS, CSS, or BRFS.</p><p><strong>Conclusions: </strong>RT yields overall survival comparable to dialysis but confers a substantially increased risk of contralateral recurrence. Prophylactic contralateral nephroureterectomy should be reserved for highly selected high-risk patients after multidisciplinary evaluation.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10487-10494"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: When a New Standard Becomes the Standard: Translating Neoadjuvant Chemo-Immunotherapy for Resectable NSCLC Into Real-World Practice.","authors":"Jiri Vachtenheim, Fernando Casas-Mendez, Rene Novysedlak, Janis Tavandzis, Boris Sepesi, Robert Lischke","doi":"10.1245/s10434-026-20473-y","DOIUrl":"10.1245/s10434-026-20473-y","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10403-10404"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: Refining Early Recurrence Risk with LODDS in cT3 Esophageal Squamous Cell Carcinoma.","authors":"Dae Joon Kim, Byung Jo Park","doi":"10.1245/s10434-026-20376-y","DOIUrl":"10.1245/s10434-026-20376-y","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10399-10400"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Segmental Mid-Transverse Colectomy Guided by Intraoperative Frozen Section of Ileocolic Lymph Nodes.","authors":"Ernesto De Giulio, Daniela Rega, Valentina Tranquillo, Teresa Pagano, Francesco Moccia, Paolo Delrio","doi":"10.1245/s10434-026-20279-y","DOIUrl":"10.1245/s10434-026-20279-y","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10627-10628"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"True Incidence of Appendiceal Neoplasms Among Patients Presenting with Complicated Appendicitis: A Call for a Revised Management Algorithm\".","authors":"Maxime K Collard, Alexandre Challine, Thibault Voron","doi":"10.1245/s10434-026-20259-2","DOIUrl":"10.1245/s10434-026-20259-2","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10243-10244"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Inequalities in Female Breast Cancer Burden by Decomposition and Age-Period-Cohort Analysis, 1990-2021.","authors":"Ke Li, Yiyin Zhang, Zeye Liu, Shu Wang","doi":"10.1245/s10434-026-19798-5","DOIUrl":"10.1245/s10434-026-19798-5","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to analyze temporal trends and geographic disparities in the burden of female breast cancer from 1990 to 2021, focusing on age, period, cohort effects, and socioeconomic inequalities.</p><p><strong>Methods: </strong>Using data from the 2021 Global Burden of Disease (GBD) study, we quantified disability-adjusted life years (DALYs) and deaths. Analyses included socio-demographic index (SDI) stratification, temporal decomposition, and an age-period-cohort (APC) model to estimate net drifts. The slope index of inequality (SII) and the concentration index were determined to measure cross-country inequalities, and a Bayesian APC model was used to predict the burden in 2050.</p><p><strong>Results: </strong>From 1990 to 2021, the DALYs and deaths associated with breast cancer increased worldwide, largely because of population growth and aging. Countries with high SDI values had the highest absolute burden, especially among older women, whereas burdens increased faster among younger groups in regions with low or low-middle SDI values. APC models revealed an increased risk in postmenopausal women and period-related decreases in high SDI countries. In contrast, risks increased or plateaued in low SDI regions. Cohort analysis revealed decreasing risks in high SDI countries but increasing risks in younger cohorts elsewhere. Furthermore, inequality shifted, with greater burdens in low SDI countries. Projections indicate continued global increases, especially after 2040.</p><p><strong>Conclusions: </strong>The global burden of female breast cancer continues to increase with marked regional and age disparities, highlighting the urgent need for region-specific interventions, such as geriatric care in high SDI areas and improved access to screening and treatment in low SDI regions.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10534-10546"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}