Annals of Surgical Oncology最新文献

{"title":"Letter to the Editor of Annals of Surgical Oncology Concerning \"Dissecting Tumor Size Underestimation in Pancreatic Cancer: A Comparative Analysis of Preoperative Treatments\".","authors":"Heyue Zhang, Jin Xu, Yinping Jiang, Xudong Zhu, Hailin Tang","doi":"10.1245/s10434-025-17743-6","DOIUrl":"10.1245/s10434-025-17743-6","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7485-7486"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526187","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":"Right Kidney Preservation During Resection of the Infrarenal Inferior Vena Cava for Paragangliomas.","authors":"Pietro Addeo, Raphael Moog, Chloe Paul, Alessio Imperiale, Philippe Baltzinger, Pierre de Mathelin","doi":"10.1245/s10434-025-17639-5","DOIUrl":"10.1245/s10434-025-17639-5","url":null,"abstract":"<p><strong>Background: </strong>In the case of tumors involving the infrarenal inferior vena cava (IVC), reimplantation of both renal veins is recommended to preserve renal function. The left renal vein can be ligated because of the collateral circulation through the gonadal and/or lumbar veins. On the contrary, right nephrectomy or reconstruction of the right renal vein (when not invaded) is mostly performed because the right kidney has no collateral vein circulation ^1,2.</p><p><strong>Patients and methods: </strong>The patient had a paracaval paraganglioma infiltrating the infrarenal IVC. The confluence of both renal veins was infiltrated, and incomplete surgery had been performed previously. Preoperative imaging showed that the right renal vein was free from tumoral infiltration at the renal hilum. Surgery was performed via a midline incision. To avoid venous congestion a temporary venous shunt between the right renal vein and the portal vein was used². The IVC was resected en-bloc with the both renal veins and reconstructed by a 10 cm long, 20 mm diameter, ringed Goretex® tube. The right renal vein was reimplanted directly over the IVC tube. The left renal vein was anastomosed on the IVC tube by interposing a 5 cm long, 10 mm diameter, ringed Goretex® tube.</p><p><strong>Results: </strong>The postoperative course was uneventful. Long-term imaging showed permeability of the IVC and right renal vein reconstruction, but obstruction of the conduit used to replace the left renal vein, which was drained via the left gonadal vein. No tumoral recurrence was detected.</p><p><strong>Conclusions: </strong>Resection of the infrarenal IVC with preservation of both renal veins can be feasible in selected cases. To avoid venous congestion, a temporary venous shunt between the right renal vein and the portal vein can be useful.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7832-7833"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282269","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":"Overcoming the Challenges of Uncinate Process Oncologic Management: The Left-Side Approach in Minimally Invasive Pancreatoduodenectomy: Step-by-Step Technique and Video.","authors":"Alessia Fassari, Vito De Blasi, Alexandru Amariutei, Edoardo Rosso","doi":"10.1245/s10434-025-17704-z","DOIUrl":"10.1245/s10434-025-17704-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The uncinate process (UP) represents one of the greatest challenges in laparoscopic pancreatoduodenectomy (LPD) due to its deep anatomic location and proximity to major vascular structures. Ensuring complete resection of the UP and mesopancreas is crucial for achieving negative surgical margins and adequate lymphadenectomy with tumors of this region. The standard approach from the right-side of the superior mesenteric artery (SMA) often requires significant tension on mesenteric vessels, increasing the risk of vascular injury. This video describes a step-by-step, left-side approach to UP that minimizes these risks and enhances surgical safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 79-year-old woman underwent LPD for an intraductal papillary mucinous neoplasm (IPMN) of the pancreatic head. Preoperative imaging showed three key anatomic variants that significantly impacted surgical planning. The first variant was a lateral deviation of the abdominal aorta, altering usual retroperitoneal landmarks. The second variant was an aberrant right hepatic artery arising from the SMA, running behind the pancreas and requiring careful preservation during uncinate dissection. The third variant was a rare inferior pancreaticoduodenal artery originating from the posterior aspect of the SMA, posing a challenge during retroperitoneal dissection. The left-side approach begins with an incision of the left duodenomesocolic fold and longitudinal opening of the retroperitoneum. The pancreatic head and duodenum are mobilized from the anterior face of the inferior vena cava. By shifting the lower pancreatic head and third portion of the duodenum leftward, the SMA and superior mesenteric vein (SMV) are exposed. The SMV is fully skeletonized. The first jejunal loop is sectioned at the Treitz ligament, allowing a clear vision of the UP, which is dissected from the SMA with minimal traction on the mesenteric vessels. The SMA then is skeletonized in a left-to-dorsal direction. The small bowel is finally transposed to the right, and the UP is mobilized by careful division of its remaining attachments to the mesenteric vessels. Resection concludes with division of the retro-portal lamina along the SMA's right border.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this case, the operative time was 300 min, with an estimated blood loss of 200 ml, an uneventful recovery, and discharge on postoperative day 14. Histology confirmed IPMN without involvement of the lymph nodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although this video illustrates a case of IPMN that typically requires less extensive lymphadenectomy, the principles demonstrated remain relevant and translatable to more aggressive pathologies. By reducing vascular tension and improving surgical visibility, the left-side approach minimizes complications and ensures complete retroportal lamina resection, achieving the best oncologic results even in challenging cases. A key advantage is the early identification ","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7450-7451"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339790","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":"Activated Hippo Pathway is Associated with a Worse Response to Trastuzumab and Worse Survival in HER2-Positive Breast Cancer.","authors":"Masanori Oshi, Farhad Ghasemi, Akimitsu Yamada, Li Yan, Jianmin Zhang, Scott I Abrams, Itaru Endo, Kazuaki Takabe","doi":"10.1245/s10434-025-17657-3","DOIUrl":"10.1245/s10434-025-17657-3","url":null,"abstract":"<p><strong>Background: </strong>The Hippo signaling pathway is an evolutionarily conserved network that regulates cell proliferation, apoptosis, and stemness. It also plays an important role in tumorigenesis and cancer progression, and previous studies have indicated that Hippo signaling promotes trastuzumab resistance in breast cancer (BC). However, its clinical relevance in patients with BC remains unclear.</p><p><strong>Patients and methods: </strong>Clinical and transcriptomics data from two large cohorts, METABRIC and TCGA, were analyzed. A Hippo pathway score was calculated by applying Gene Set Variation Analysis to the curated Kyoto Encyclopedia of Genes and Genomes (KEGG) Hippo pathway gene set (43 genes). Patients were stratified into high and low groups based on the top tertile of Hippo pathway scores in each cohort.</p><p><strong>Results: </strong>High Hippo pathway scores were significantly associated with worse disease-specific survival (DSS) in HER2-positive BC. In both cohorts, the Hippo pathway score showed the largest hazard ratio (HR) for DSS in HER2-positive BC compared with YAP1 or TAZ, transcription co-activators that are key components in the Hippo pathway (HR = 2.47, p = 0.04, and HR = 41.8, p = 0.03). Breast cancers with high Hippo pathway activity were associated with enrichment of cell proliferation and metastasis-related gene sets, including epithelial-mesenchymal transition, Notch, Hedgehog, and TGF-β signaling. Moreover, high Hippo pathway scores correlated with lower infiltration of anti-cancer immune cells (Th1 cells, dendritic cells, and M1-macrophages). Notably, low Hippo pathway scores were linked to a higher pathological complete response following trastuzumab-based neoadjuvant chemotherapy (p = 0.035).</p><p><strong>Conclusions: </strong>Enhanced Hippo pathway activity in HER2-positive BC is associated with worse prognoses, metastasis-related gene enrichment, and reduced anti-cancer immune cell infiltration, potentially contributing to trastuzumab resistance.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7959-7969"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339785","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":"Expression of Signal Regulatory Protein Alpha in Tumor Cells is the Key Factor in Intrahepatic Cholangiocarcinoma.","authors":"Katsuya Toshida, Shinji Itoh, Yuki Nakayama, Kyohei Yugawa, Takuma Ishikawa, Yuriko Tsutsui, Takahiro Tomiyama, Norifumi Iseda, Sunao Fujiyoshi, Takashi Motomura, Takeo Toshima, Takeshi Iwasaki, Yoshinao Oda, Tomoharu Yoshizumi","doi":"10.1245/s10434-025-17813-9","DOIUrl":"10.1245/s10434-025-17813-9","url":null,"abstract":"<p><strong>Background: </strong>Signal-regulatory protein alpha (SIRPα) has recently garnered attention for its role in the immune system, commonly referred to as the \"don't eat me\" signal. However, the relationship between SIRPα expression in tumor cells and prognosis in patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC) has been scarcely reported.</p><p><strong>Patients and methods: </strong>A total of 117 patients who underwent hepatectomy for ICC were enrolled in this study. Immunohistochemical staining was performed to evaluate SIRPα, programmed cell death-ligand 1 (PD-L1), and cluster of differentiation 8 (CD8). The relationships between SIRPα expression, clinicopathological characteristics, and patient outcomes were analyzed.</p><p><strong>Results: </strong>The macrophage-SIRPα-positive group exhibited a higher rate of lymph node metastasis (p = 0.0013). The tumor-cell-SIRPα-positive group showed lower carcinoembryonic antigen levels (p = 0.0068) and fewer cases of the perihilar type (p = 0.0165). In multivariate analysis, SIRPα positivity in tumor cells was identified as an independent prognostic factor for both disease-free survival (p = 0.0198) and overall survival (p = 0.0089). Notably, SIRPα positivity in tumor cells showed no significant correlation with PD-L1 expression or CD8-positive tumor-infiltrating T cells in ICC.</p><p><strong>Conclusions: </strong>Our findings demonstrate that SIRPα expression in tumor cells is more critical than its expression in macrophages for predicting the prognosis of patients with ICC following hepatic resection.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"8037-8045"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616040","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":"Response to Comment by Memon et al. on \"Comparative Outcomes of Ileocolon Graft versus Gastric Conduit Reconstruction in Esophageal Cancer\".","authors":"Chunji Chen, Chunguang Li, Zhigang Li","doi":"10.1245/s10434-025-17800-0","DOIUrl":"10.1245/s10434-025-17800-0","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7954-7955"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666949","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":"Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer.","authors":"Simran Malhotra, Daniel X Choi, Varadan Sevilimedu, Rachel A Greenup, Audree B Tadros","doi":"10.1245/s10434-025-17865-x","DOIUrl":"10.1245/s10434-025-17865-x","url":null,"abstract":"<p><strong>Background: </strong>Studies show that Medicaid expansion leads to timely diagnosis and treatment of early-stage breast cancer; however, no studies have examined its impact on locally advanced breast cancer (LABC). We assessed LABC rates pre- and post-Medicaid expansion, and evaluated overall survival (OS) in LABC patients treated in expansion and non-expansion states.</p><p><strong>Methods: </strong>Overall, 5147 National Cancer Database participants age 40-64 years diagnosed with LABC between 2010 and 2017 were allocated into the two cohorts. Demographic/clinical variables were compared using the Wilcoxon rank-sum and Pearson's Chi-square tests. A generalized linear model assessed trends in LABC diagnoses over time, while a Cox proportional hazards model evaluated associations between Medicaid expansion status and OS.</p><p><strong>Results: </strong>A total of 3346 and 1801 LABC patients resided in expansion and non-expansion states, respectively. Ninety-one percent of non-expansion patients resided in the Southern United States (p < 0.001) versus 8.2% of expansion patients. Non-expansion patients were more likely to be non-Hispanic Black and/or have lower income (p < 0.001), while expansion patients were more likely to be Asian/Pacific Islander, Hispanic, metropolitan-area residents, and/or academic/research program-treated (p < 0.001). Trimodality therapy use was similarly low between non-expansion and expansion patients (68% and 70%, respectively; p = 0.054), while OS improved in expansion versus non-expansion patients post-policy implementation (p < 0.001). On multivariable analysis, triple-negative subtype (p < 0.001) and residence in a non-expansion state (p = 0.015) were associated with worse survival, while receipt of trimodality therapy (p < 0.001) was associated with improved survival.</p><p><strong>Conclusions: </strong>While trimodality therapy was associated with improved survival, less than three-quarters of patients received this treatment in both state types. Medicaid expansion was associated with improved OS in the post-implementation era, suggesting that these changes in Medicaid coverage may positively impact LABC outcomes.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7762-7773"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741035","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":"Evaluation of Exosome-Based Delivery of Tumor-Suppressive microRNAs for Novel Therapy in Peritoneal Dissemination of Gastric Cancer: Evidence from Experimental Animal Models.","authors":"Taiga Yamamoto, Tomohiro Arita, Hirotaka Konishi, Kenji Nanishi, Kazuya Takabatake, Yuki Shimauchi, Chiaki Ikeshita, Hayato Matsuda, Rie Shibata, Hiroyuki Inoue, Keiji Nishibeppu, Taisuke Imamura, Jun Kiuchi, Hiroki Shimizu, Yusuke Yamamoto, Shuhei Komatsu, Takeshi Kubota, Hitoshi Fujiwara, Atsushi Shiozaki","doi":"10.1245/s10434-025-17837-1","DOIUrl":"10.1245/s10434-025-17837-1","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dissemination poses a critical challenge in advanced gastric cancer and leads to poor outcomes. Exosomes offer a novel platform for the delivery of tumor-suppressive microRNAs (miRNAs). MicroRNA-338-3p (miR-338-3p), a known tumor suppressor, may target tumor cells and enhance the resistance of normal cells to tumor progression. This study evaluated the therapeutic potential of exosomes loaded with miR-338-3p (Exo338) in preventing peritoneal dissemination of gastric cancer.</p><p><strong>Methods: </strong>Exosomes loaded with miR-338-3p using Exo-Fect^™ were characterized for efficient miRNA loading and delivery. In vitro assays assessed the effect of miRNA on gastric cancer cell lines, MKN45 and HGC27, and also the effects of Exo338 on cell adhesion. Additionally, the effect of miRNA on normal mesothelial cells (MeT-5A) was evaluated for resistance to tumor cell adhesion. In vivo, a peritoneal dissemination model in nude mice was used to evaluate tumor burden after intraperitoneal Exo338 administration.</p><p><strong>Results: </strong>Overexpression of miR-338-3p inhibited the proliferation and adhesion of gastric cancer cells in vitro. Exosomes derived from tumor cells showed a lower uptake efficiency, whereas those from MeT-5A cells were efficiently taken up by normal mesothelial cells. Exo338 reduced the ability of tumor cells to adhere to normal mesothelial cells. In vivo, Exo338 administration in a peritoneal dissemination model showed a trend toward a reduced tumor burden.</p><p><strong>Conclusions: </strong>Exosome-mediated delivery of miR-338-3p offers a promising approach for gastric cancer therapy by reducing tumor adhesion to mesothelial cells. This strategy underscores the potential of exosome-based miRNA therapies for the treatment of advanced gastric cancer.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"8046-8059"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726944","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":"Hypothetical Interventions on Frailty Heterogeneous Trajectories of Older Patients with Gastric Cancer Using Parametric G-Formula.","authors":"Yinning Guo, Xueyi Miao, Yimeng Chen, Lingyu Ding, Kang Zhao, Ting Xu, Li Chen, Xinyi Xu, Qin Xu","doi":"10.1245/s10434-025-18026-w","DOIUrl":"10.1245/s10434-025-18026-w","url":null,"abstract":"<p><strong>Background: </strong>Frailty is prevalent in older patients with gastric cancer, seriously affecting their prognosis. The time-varying nature of frailty increases the difficulty of intervention. This study aimed to estimate the effect of hypothetical interventions on the risk of frailty heterogeneous trajectory (FHT) at physical, psychological, familial, and social levels to provide a basis for the subsequent design of intervention programs of FHT.</p><p><strong>Patients and methods: </strong>The data of hypothetical interventions from a longitudinal follow-up study of older patients with gastric cancer were obtained for 381 patients ≥ 60 years complete at admission, discharge, 1, 3, 6, and 12 months after surgery. The parametric g-formula was used to estimate the risk of single hypothetical interventions on nutrition, anxiety, depression, family cohesion and adaptability, social objective and subjective support, and nursing satisfaction, and its joint interventions in different combinations, for FHT, which were compared with observations to calculate population risk ratios and to determine the optimal combination of interventions.</p><p><strong>Results: </strong>The observed risk of FHT was 43.57%. Single intervention on nutrition was the most effective factor in reducing the risk of FHT, with a risk ratio (RR) of 0.790 (95% confidence interval (CI) 0.692-0.974), followed by family cohesion (RR 0.810, 95% CI 0.741-0.917), social objective support (RR 0.822, 95% CI 0.724-0.931), anxiety (RR 0.864, 95% CI 0.681-0.981), and nursing satisfaction (RR 0.967, 95% CI 0.932-0.995). All joint interventions significantly reduced the risk of FHT. Among them, the \"all-factors\" joint intervention reduced the risk by 31.26%, with an RR of 0.323 (95% CI 0.208-0.685).</p><p><strong>Conclusions: </strong>Hypothetical interventions on nutrition, anxiety, family cohesion, social objective support, and nursing satisfaction reduced the risk of FHT in older patients with gastric cancer, both independently and jointly. This suggests that the interventions targeting these factors, as well as any combination of these interventions, may be effective program for improving the FHT in older patients with gastric cancer. It provides theoretical basis and practical guidance for the frailty intervention and is of practical significance for promoting cancer rehabilitation.</p><p><strong>Trial registration: </strong>The study was registered with clinicaltrials.gov (NCT05982899). https://clinicaltrials.gov/ct2/show/NCT05982899 .</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7634-7643"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811628","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":"Novel Risk Score Incorporating Type-IV Collagen, Albumin, and Prothrombin Time (CAP score) to Predict 180-Day Surgery-Related Mortality After Liver Resection for Hepatocellular Carcinoma.","authors":"Tomoaki Hayakawa, Shotaro Miyashita, Maiko Niki, Genki Tanaka, Takayuki Shimizu, Takamune Yamaguchi, Kyung-Hwa Park, Takatsugu Matsumoto, Takayuki Shiraki, Shozo Mori, Taku Aoki","doi":"10.1245/s10434-025-17658-2","DOIUrl":"10.1245/s10434-025-17658-2","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative risk assessment is crucial for patients undergoing liver resection for hepatocellular carcinoma (HCC). The present study developed and validated a novel scoring system for predicting 180-day surgery-related mortality.</p><p><strong>Patients and methods: </strong>This retrospective cohort study enrolled patients who underwent liver resection for HCC between 2000 and 2024. The cohort was divided into training and validation sets on the basis of the operation dates. Multivariate analysis was performed to identify the independent predictors of 180-day surgery-related mortality. The resulting score was compared with the existing models.</p><p><strong>Results: </strong>Three independent predictors were identified and assigned one point each: type-IV collagen ≥ 7.5 ng/mL (odds ratio [OR]: 2.92; 95% confidence interval [CI] 1.20-7.65; P = 0.017), albumin (Alb) ≤ 3.4 g/dL (OR: 3.06, 95% CI 1.23-8.39; P = 0.016), and prothrombin time-international normalized ratio (PT-INR) ≥ 1.26 (OR: 2.82; 95% CI 1.14-6.70; P = 0.026). The 180-day surgery-related mortality rates for the low- (0 point), intermediate- (1-2 points), and high-risk (3 points) groups were 0.8%, 7.6%, and 26.7%, respectively, in the training cohort, and 1.7%, 6.5%, and 20.7%, respectively, in the validation cohort. The collagen-Alb-PT-INR (CAP) score demonstrated superior predictive performance (area under the curve [AUC]: 0.728) as compared with the stratified Model for End-Stage Liver Disease score (AUC: 0.557, P < 0.001), the Child-Pugh classification (AUC: 0.637, P < 0.001), and the Alb-bilirubin grade (AUC: 0.668, P = 0.014).</p><p><strong>Conclusions: </strong>The CAP score is a simple and effective tool for predicting 180-day surgery-related mortality post-liver resection for HCC.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7970-7980"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473911","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}