Annals of Surgical Oncology最新文献

{"title":"Risk Factors for Deep Vein Thrombosis After Surgery in Patients with Gastric or Colorectal Cancer Receiving Anticoagulant Prophylaxis.","authors":"Yuanyuan Ma, Xiong Sun, Qing Wang","doi":"10.1245/s10434-026-20424-7","DOIUrl":"10.1245/s10434-026-20424-7","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to identify perioperative predictors of early postoperative lower-extremity deep vein thrombosis (DVT) in patients undergoing surgery for gastric or colorectal cancer who received routine pharmacologic thromboprophylaxis and to develop a nomogram for postoperative risk stratification.</p><p><strong>Methods: </strong>This retrospective study included patients with gastric or colorectal cancer undergoing surgery from December 2020 to October 2023. All received postoperative low-molecular-weight heparin prophylaxis, and DVT was screened by ultrasonography on postoperative day 3. Predictors were identified by logistic regression and incorporated into a nomogram.</p><p><strong>Results: </strong>A total of 388 eligible patients were included, among whom 124 (32.0%) had screening-detected postoperative lower-extremity DVT. Among patients with DVT, 118 (95.2%) had distal-only DVT and 114 (91.9%) were asymptomatic. Multivariable logistic regression identified age, activated partial thromboplastin time, prothrombin time, and postoperative day 1 D-dimer as independent predictors of postoperative DVT. The nomogram showed acceptable discrimination, with area under the receiver operating characteristic curve values of 0.787 (95% confidence interval 0.731-0.844) in the training cohort and 0.854 (95% confidence interval 0.774-0.934) in the validation cohort. Calibration curves showed good agreement between predicted and observed risks. In decision curve analysis, the nomogram provided greater net benefit for risk classification than strategies classifying all or no patients as high risk.</p><p><strong>Conclusion: </strong>Age, activated partial thromboplastin time, prothrombin time, and postoperative day 1 D-dimer were independently associated with screening-detected early postoperative DVT. The resulting nomogram may help postoperative risk stratification and closer surveillance; however, external validation is required before routine clinical application.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10703-10714"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787458","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":"Incidence of Ovarian Metastases in Reproductive-Aged Women with Appendiceal Cancer: Implications for Fertility Preservation.","authors":"Morgan Bou Zerdan, Sarah Hmaidan, Hailie Ciomperlik, Joya Ghaleb, Charlotte Sun, Jeffrey A How, Laura Detti, Terri Woodard, Pamela T Soliman, Laurie J McKenzie","doi":"10.1245/s10434-026-20315-x","DOIUrl":"10.1245/s10434-026-20315-x","url":null,"abstract":"<p><strong>Purpose: </strong>Incidence of appendiceal cancer is increasing, with one-third of patients diagnosed before age 50 years. Fertility preservation (FP) is important for patients who have not completed childbearing; however, the safety of oocyte and embryo banking remains unclear due to concerns for ovarian metastases. This study evaluates incidence of ovarian metastases at cytoreductive surgery (CRS) and describes FP practices and outcomes among reproductive-aged women with appendiceal cancer.</p><p><strong>Methods: </strong>A retrospective review was conducted of female patients aged 18-45 years treated for appendiceal cancer at MD Anderson Cancer Center from January 2020 to January 2025. Clinical, surgical, pathologic, and fertility-related variables were collected. Descriptive statistics assessed rates and laterality of ovarian metastases, FP practices, and reproductive outcomes.</p><p><strong>Results: </strong>A total of 100 reproductive-aged women (median age 35.9 years, range 19-44 years) with histology-confirmed appendiceal cancer were identified, of whom 47 underwent CRS. Ovarian metastases were documented in 89.4% (42/47), with bilateral involvement in 71.4% (30/42) and unilateral involvement in 28.6% (12/42). Fertility-sparing surgery included retention of one ovary in 25.5% (12/47) and uterine preservation in 19.1% (9/47). Among patients retaining an ovary, 60% developed amenorrhea after adjuvant therapy. Desire for FP was documented in 23.4% (11/47), all were referred for oncofertility consultation. Five patients underwent oocyte or embryo cryopreservation before CRS, including three with confirmed ovarian involvement.</p><p><strong>Conclusion: </strong>Reproductive-aged women with appendiceal cancer have a high and often bilateral incidence of ovarian metastases, with important implications for FP safety. Individualized fertility counseling prior to CRS is essential to optimize reproductive outcomes while maintaining oncologic safety.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10205-10211"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629093","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":"Urine Cell-Free DNA in the Diagnosis of Intraductal Papillary Mucinous Neoplasms: A Prospective Observational Study.","authors":"Masatoshi Sato, Yuji Kitahata, Yuki Nakamura, Hideki Motobayashi, Norio Takemoto, Tomoki Nakai, Takahiko Hyo, Masaki Ueno, Shinya Hayami, Atsushi Miyamoto, Atsushi Shimizu, Tomohiro Yoshimura, Kyohei Matsumoto, Manabu Kawai","doi":"10.1245/s10434-026-20286-z","DOIUrl":"10.1245/s10434-026-20286-z","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasm (IPMN) is a typical precursor lesion of pancreatic cancer, but differential diagnosis and grading of IPMN is often difficult. Currently, grading of diagnosis is based mainly on imaging examinations, but these methods are invasive, and the accuracy is unsatisfactory. Therefore, the current study aimed to determine the usefulness of urine cell-free DNA (cfDNA) as a liquid biopsy, which the authors suggest has potential as a less invasive diagnostic tool for IPMN.</p><p><strong>Methods: </strong>Preoperative plasma and urine samples were collected from 33 patients with a preoperative diagnosis of IPMN. From their plasma and urine, cfDNA was extracted. Analysis of GNAS and KRAS mutations in the cfDNA was performed using droplet digital polymerase chain reaction.</p><p><strong>Results: </strong>The final diagnosis was IPMN in 31 of the 33 cases according to the resected specimens. The positivity rate of GNAS mutations in these 31 patients was 10 % (3/31) in plasma cfDNA, and 32 % (10/31) in urine cfDNA. The positivity rate of KRAS mutations was 19 % (6/31) in plasma cfDNA and 58 % (18/31) in urine cfDNA. In the multivariate analysis of the malignancy diagnosis, the main pancreatic duct diameter was ≥10 mm, and the positivity of both GNAS and KRAS mutations in urine cfDNA were significantly associated with IPMN malignancy (odds ratio [OR], 12.70; P = 0.0200; OR, 8.10; P = 0.0269).</p><p><strong>Conclusions: </strong>Urine cfDNA involves a less invasive liquid biopsy and seems to be useful in the diagnosis of IPMN.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10436-10444"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629254","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":"CT-based Intratumoral Heterogeneity Score for Preoperative Prediction of Lymphovascular Invasion and Prognosis in Lung Adenocarcinoma: A Multicenter Validation and Radiogenomic Interpretation.","authors":"Zhichao Zuo, Yunhua Li, Xuehong Long, Wanyin Qi, Sanhong Zhang","doi":"10.1245/s10434-026-20260-9","DOIUrl":"10.1245/s10434-026-20260-9","url":null,"abstract":"<p><strong>Background: </strong>Lymphovascular invasion (LVI) is a key determinant of recurrence and survival in lung adenocarcinoma (LUAD), but preoperative identification remains challenging. We developed and validated a CT-based intratumoral heterogeneity (ITH) score for LVI prediction, prognostic stratification, and exploratory radiogenomic interpretation.</p><p><strong>Methods: </strong>We retrospectively included 1322 patients from three institutions and one public dataset. The discovery cohort was divided into training (n = 590) and internal validation (n = 253) sets; an independent cohort (n = 362) was used for external validation and prognostic analysis. A Stanford Radiogenomics set (n = 117) was used for exploratory transcriptomic analysis. Multiple machine learning algorithms were trained using the same feature matrix and cohort partitions.</p><p><strong>Results: </strong>Random forest was selected as the final classifier, with AUCs of 0.886 (95% confidence interval [CI] 0.842-0.923) in internal validation and 0.850 (95% CI 0.806-0.892) in external validation. The model showed acceptable calibration and positive net benefit across low-to-intermediate threshold probabilities. High ITH remained associated with worse recurrence-free survival (hazard ratio [HR] 12.92; 95% CI 3.90-42.78; P < 0.001) and overall survival (HR 26.47; 95% CI 3.52-198.76; P = 0.001). Exploratory radiogenomic analysis showed enrichment of hypoxia-, angiogenesis-, epithelial-mesenchymal transition-, and glycolysis-related pathways.</p><p><strong>Conclusions: </strong>The CT-based ITH score may support preoperative risk stratification for LVI and prognosis in LUAD. Radiogenomic findings suggest potential biological correlates and should be considered hypothesis-generating.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10270-10282"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547527","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":"A Decade Later: An Updated Systematic Review and Meta-analysis of Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple-Areolar Recurrence Following Nipple-Sparing Mastectomy.","authors":"Rachel N Rohrich, Hannah Soltani, Isabel Snee, Kenneth L Fan, Beth-Ann Lesnikoski, Lucy M De La Cruz","doi":"10.1245/s10434-026-19808-6","DOIUrl":"10.1245/s10434-026-19808-6","url":null,"abstract":"<p><strong>Background: </strong>Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update on oncologic outcomes following NSM, including overall survival (OS), disease-free survival (DFS), local recurrence (LR), and nipple-areolar complex recurrence (NACR).</p><p><strong>Patients and methods: </strong>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review identified studies reporting oncologic outcomes after NSM. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in the meta-analysis. Studies lacking comparison arms were included in pooled analyses for NSM outcomes using a random-effects model. Weighted averages and 95% confidence intervals (CI) were calculated, and studies were stratified by duration of follow-up.</p><p><strong>Results: </strong>A total of 60 studies comprising 7752 NSM patients were included: 11 studies had comparison arms; 9 studies reporting OS demonstrated a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM (95% CI 0.0-4.3%, p = 0.047); 7 studies reporting DFS showed a nonsignificant pooled risk difference of 4.8% favoring NSM (95% CI -0.8 to 10.3%, p = 0.093); 11 studies reporting LR demonstrated a nonsignificant pooled risk difference of -0.7% (95% CI -2.1 to 0.8%, p = 0.35). The systematic review included all 60 studies. Weighted average follow-up ranged from 25.6 to 133.4 months across groups. Among patients with 10 years of follow-up (n = 391), OS was 82.0% (80.9-93.2%), DFS 60.7% (58.8-62.7%), LR 15.1% (13.9-16.2%), and NACR 1.1% (1.0-1.1%).</p><p><strong>Conclusions: </strong>NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM/MRM, with minimal NAC recurrence in appropriately selected patients, supporting its long-term oncologic safety.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10504-10521"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197196","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":"Evolution of Prognosis and Management in Curative Treatment of Locally Recurrent Rectal Cancer: A Comprehensive Analysis from 2000 to 2023.","authors":"Fleur E C Vande Kerckhove, Davy M J Creemers, Evi Banken, Floor Piqeur, Stijn H J Ketelaers, R R J Coebergh van den Braak, Jip Tolenaar, Robert-Jan Schipper, Grard A P Nieuwenhuijzen, Wikke Setz-Pels, Thijs R van Oudheusden, Alette W Daniëls-Gooszen, Stefan G van Ravensteijn, Irene E G van Hellemond, An-Sofie E Verrijssen, Heike M U Peulen, Johanne G Bloemen, Joost Nederend, Harm J T Rutten, Jacobus W A Burger","doi":"10.1245/s10434-026-20398-6","DOIUrl":"10.1245/s10434-026-20398-6","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in diagnosis and treatment, locally recurrent rectal cancer (LRRC) remains a complex condition associated with a poor prognosis. This study aimed to evaluate long-term trends in the management of and oncological outcomes for patients with LRRC treated in a Dutch tertiary referral center.</p><p><strong>Methods: </strong>All consecutive patients with a confirmed diagnosis of a first LRRC undergoing curative-intent surgical resection at our referral center between 2000 and 2023 were retrospectively analyzed. Primary outcomes were trends in overall survival (OS), disease-free survival (DFS), clear (R0) resection rate, and postoperative complication rates. Cumulative sum (CUSUM) analysis was used to visualize changes in these outcomes over time. Secondary endpoints included temporal changes in prognostic factors associated with improved OS and DFS.</p><p><strong>Results: </strong>A total of 560 patients undergoing curative-intent surgical resection were included. Over time, patients presented with more comorbidities (p < 0.001), more multifocal disease (p < 0.001), and synchronous metastasis (p < 0.001). The R0 resection rate improved from 59% to 78% over the study period (p < 0.001). CUSUM analyses demonstrated an upward trend in OS and DFS, indicating a cumulative improvement in survival relative to the reference survival probability. In univariable Cox regression, the most recent time period (2018-2023) was significantly associated with improved OS (hazard ratio 0.75; 95% confidence interval 0.58-0.97; p = 0.030).</p><p><strong>Conclusions: </strong>Over the past two decades, the outcomes of patients undergoing curative-intent treatment for LRRC have steadily improved. This may reflect advances in diagnostics, neoadjuvant therapy, surgical technique and perioperative care, centralization of care, and patient selection.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10616-10626"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787591","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":"Structure, Not Discretion: What the Retreat from Metrics in Breast Surgical Oncology Fellowship Selection Overlooks.","authors":"Kun Wang","doi":"10.1245/s10434-026-20559-7","DOIUrl":"10.1245/s10434-026-20559-7","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10601-10602"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966584","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: The Promise and Limits of Machine Learning in Lymphedema Risk Prediction.","authors":"Benjamin D Wagner, Babak J Mehrara, Danielle H Rochlin","doi":"10.1245/s10434-026-20470-1","DOIUrl":"10.1245/s10434-026-20470-1","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10586-10587"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787608","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":"Impact of Tumor Size on Neoadjuvant Chemotherapy Outcomes in Breast Cancer.","authors":"Claire LeGall, Lauren Darrigues, Jonathan Sabah, Anne-Sophie Hamy, Floriane Jochum, Florence Coussy, Luc Cabel, Virginie Fourchotte, Fatima Laki, Anne Salomon, Kim Cao, Thomas Gaillard, Enora Laas","doi":"10.1245/s10434-026-20307-x","DOIUrl":"10.1245/s10434-026-20307-x","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy (NAC) is increasingly used in early breast cancer (BC) to assess chemosensitivity and guide postneoadjuvant treatment strategies. Although small tumors < 2 cm are often treated with upfront surgery because of their operability and presumed favorable prognosis, it remains uncertain whether patients with small tumors who do not achieve pathological complete response (pCR) might miss the opportunity for effective postneoadjuvant escalation strategies. We aimed to evaluate whether initial tumor size predicts pCR and residual disease burden across molecular subtypes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 714 patients with stage T1-T3N0-3M0 BC treated with NAC at Institut Curie between 2002 and 2012. Pathological response was assessed by using the Residual Cancer Burden (RCB) index (continuous and categorical). Pathological complete response was defined as ypT0/is ypN0. Associations between tumor size and response were evaluated by using univariate analyses, stratified by molecular subtype.</p><p><strong>Results: </strong>The overall pCR rate was 28%, reaching 38% in triple-negative BC (TNBC) and 39% in HER2-positive tumors, but only 5% in estrogen receptor/HER2-negative (luminal) tumors. Initial tumor size was linearly associated with continuous RCB score (p < 0.001); larger tumors showed greater residual disease. Tumor size was not associated with the likelihood of achieving pCR in any molecular subtype. Among tumors ≤ 2 cm, most had residual disease: 87% of luminal tumors, 46% of TNBC, and 34% of HER2-positive tumors were classified as RCB-II/III. Tumor size remained non-predictive of pCR in multivariate analysis (p = 0.8).</p><p><strong>Conclusions: </strong>Initial tumor size is not predictive of pCR after NAC. Small tumors, including those ≤ 2 cm, do not demonstrate higher pCR rates. Tumor size alone should therefore not be used to exclude patients-particularly those with TNBC or HER2-positive disease-from neoadjuvant treatment strategies that enable post-neoadjuvant therapeutic adaptation.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10574-10583"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787620","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":"Reply to the Letter to the Editor Regarding \"True Incidence of Appendiceal Neoplasms in Patients Presenting with Complicated Appendicitis: A Call for a Revised Management Algorithm\".","authors":"Laleh Foroutani, Thomas M Li, Mohamed Abdelgadir Adam","doi":"10.1245/s10434-026-20263-6","DOIUrl":"10.1245/s10434-026-20263-6","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10245-10246"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663280","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}