The Kaohsiung journal of medical sciences最新文献_第3页

A Data-Driven Threshold for Extreme Hyponatremia in the Emergency Department and Its Association With 28-Day Mortality. 急诊科极度低钠血症的数据驱动阈值及其与28天死亡率的关系

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-24 DOI: 10.1002/kjm2.70291

Yalcin Golcuk, Ömer-Faruk Karakoyun, Fulden Cantaş-Türkiş, İsmail Kırlı, Satuk-Buğra Yıldırım, Bekir Baran, Burcu Kaymak-Golcuk

{"title":"A Data-Driven Threshold for Extreme Hyponatremia in the Emergency Department and Its Association With 28-Day Mortality.","authors":"Yalcin Golcuk, Ömer-Faruk Karakoyun, Fulden Cantaş-Türkiş, İsmail Kırlı, Satuk-Buğra Yıldırım, Bekir Baran, Burcu Kaymak-Golcuk","doi":"10.1002/kjm2.70291","DOIUrl":"10.1002/kjm2.70291","url":null,"abstract":"Hyponatremia is a common electrolyte disorder in the emergency department (ED), but its clinical burden is not evenly distributed across the sodium spectrum. We conducted a retrospective observational cohort study of adult ED encounters at a tertiary referral hospital between July 2019 and July 2024 to identify a data-driven threshold for extreme hyponatremia and evaluate its association with 28-day mortality. Encounters with simultaneous sodium and glucose measurements were included, and sodium values were corrected for hyperglycemia. Kernel density estimation identified a distinct local minimum defining distribution-derived extreme hyponatremia (DDEH). Propensity score matching based on age and sex was used to compare DDEH with nonextreme hyponatremia and normonatremia. Among 227,027 eligible ED patients, density modeling identified an inflection point at 110 mmol/L. Sixty-one patients (0.027%) met criteria for DDEH. In matched analyses (n = 61 per group), 28-day mortality was highest in the DDEH group (36.1%), compared with nonextreme hyponatremia (18.0%) and normonatremia (6.6%) (p < 0.001). Kaplan-Meier analysis showed significantly reduced survival in patients with DDEH (log-rank p < 0.001). A distribution-derived sodium threshold of 110 mmol/L identified a rare but high-risk phenotype of extreme hyponatremia in ED patients. This cohort-derived boundary identified a rare extreme-tail phenotype associated with systemic physiological vulnerability and increased short-term mortality risk, but external validation is required before broader clinical implementation.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70291"},"PeriodicalIF":3.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Depressive Symptoms, sleep Disturbance, and Cardiometabolic Multimorbidity Among Adults With Arthritis: A Cross-Sectional Analysis of NHANES 2013-2020. 成人关节炎患者的抑郁症状、睡眠障碍和心脏代谢多病：NHANES 2013-2020的横断面分析

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-21 DOI: 10.1002/kjm2.70284

Lu-Niao Ma, Jing-Cheng Jiang, Jun-Jie Lan, Yang-Yang Chen, Hui-Min Zhang, Yao Zeng, Xu-Hui Huang, Xiao-Na Tang

{"title":"Depressive Symptoms, sleep Disturbance, and Cardiometabolic Multimorbidity Among Adults With Arthritis: A Cross-Sectional Analysis of NHANES 2013-2020.","authors":"Lu-Niao Ma, Jing-Cheng Jiang, Jun-Jie Lan, Yang-Yang Chen, Hui-Min Zhang, Yao Zeng, Xu-Hui Huang, Xiao-Na Tang","doi":"10.1002/kjm2.70284","DOIUrl":"10.1002/kjm2.70284","url":null,"abstract":"While the association between depressive symptoms and cardiometabolic disease is well established, the relationships among depressive symptoms, sleep disturbance, and cardiometabolic multimorbidity (CMM) in adults with arthritis remain insufficiently understood. This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) 2013-2020 data and included 4031 adults with arthritis. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9), and sleep disturbance was defined by self-reported physician-diagnosed sleep disorder. CMM was defined as the coexistence of at least two cardiometabolic conditions, including hypertension, diabetes, heart disease, and stroke. Survey-weighted multivariable logistic regression examined the associations of depressive symptoms and sleep disturbance with CMM. Subgroup analyses and interaction tests evaluated consistency, and an exploratory mediation analysis assessed the role of sleep disturbance in the observed association between depressive symptoms and CMM. In the fully adjusted model, depressive symptoms were associated with higher odds of CMM (odds ratio [OR] = 1.76, 95% confidence interval [CI]: 1.26-2.45, p = 0.002), and sleep disturbance was independently associated with CMM (OR = 1.52, 95% CI: 1.24-1.88, p < 0.001). The associations remained generally consistent across subgroups. The exploratory mediation analysis suggested that sleep disturbance accounted for approximately 15%-19% of this association. These findings indicate that depressive symptoms and sleep disturbance are independently associated with CMM among adults with arthritis. Sleep disturbance may represent an important co-occurring factor and warrants further investigation in prospective studies.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70284"},"PeriodicalIF":3.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Based on a Single Case, Cardiopulmonary Training Cannot Be Recommended as Therapy for Hemiparesis in MELAS With Ischemic Stroke. 基于单一病例，心肺训练不能作为MELAS伴缺血性脑卒中偏瘫的治疗建议。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-18 DOI: 10.1002/kjm2.70294

Sounira Mehri, Josef Finsterer

引用次数: 0

SOX2 Inhibits Cuproptosis to Affect Cisplatin Resistance in Non-Small Cell Lung Cancer by Activating the Wnt/ATP7B Signaling Pathway. SOX2通过激活Wnt/ATP7B信号通路抑制cuprotosis影响非小细胞肺癌顺铂耐药

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-18 DOI: 10.1002/kjm2.70286

Kun Chen, Fu-Mei He, Ying-Hui Huang, Ting Fang, Yi-Ping Zheng, Jian-Feng Cai

{"title":"SOX2 Inhibits Cuproptosis to Affect Cisplatin Resistance in Non-Small Cell Lung Cancer by Activating the Wnt/ATP7B Signaling Pathway.","authors":"Kun Chen, Fu-Mei He, Ying-Hui Huang, Ting Fang, Yi-Ping Zheng, Jian-Feng Cai","doi":"10.1002/kjm2.70286","DOIUrl":"10.1002/kjm2.70286","url":null,"abstract":"Cisplatin (CDDP) resistance constitutes the principal clinical challenge in the treatment of advanced non-small cell lung cancers (NSCLC). Disturbances in copper metabolism are closely linked with tumor drug resistance. SOX2, a pivotal stemness transcription factor (TF), holds an important role in chemotherapy resistance. However, whether it influences CDDP resistance by modulating cuproptosis remains unknown. SOX2 level was tested by qPCR and WB, and ATP7B level was evaluated by WB and flow cytometry. The oligomerization levels of FDX1, LIAS, and DLAT, together with Cu2+ levels, were determined by WB, confocal microscopy, and a Cu2+ colorimetric assay kit. The proliferation and apoptosis of NSCLC drug-resistant cells were assessed with CCK-8 and flow cytometry. SOX2 was significantly up-regulated in CDDP-resistant NSCLC cells, accompanied by decreased cuproptosis sensitivity. Silencing SOX2 in CDDP-resistant cells increased cuproptosis sensitivity and apoptosis rate and reduced cell viability. These effects of SOX2 silencing on CDDP resistance in NSCLC cells were reversed by the cuproptosis inhibitor TTM. SOX2 up-regulated ATP7B by activating the Wnt/β-catenin signaling pathway. Silencing ATP7B or treatment with the Wnt pathway inhibitor LF3 attenuated SOX2 overexpression-induced promoting effect on CDDP resistance and suppressive effect on cuproptosis in NSCLC. In summary, this study reveals a novel mechanism wherein SOX2 activates the Wnt/β-catenin signaling pathway to upregulate ATP7B expression, thereby suppressing cuproptosis and ultimately driving cisplatin resistance in NSCLC. These findings provide potential therapeutic targets for reversing chemoresistance in NSCLC.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70286"},"PeriodicalIF":3.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bipolar Androgen Therapy as a Potential Mechanistic Bridge to Enhance PARP Inhibitor Efficacy in Prostate Cancer. 双极雄激素治疗作为增强前列腺癌PARP抑制剂疗效的潜在机制桥梁。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-17 DOI: 10.1002/kjm2.70292

Jhen-Hao Jhan, Jiun-Hung Geng, Hung-Lung Ke, Shu-Pin Huang, Li Jia

{"title":"Bipolar Androgen Therapy as a Potential Mechanistic Bridge to Enhance PARP Inhibitor Efficacy in Prostate Cancer.","authors":"Jhen-Hao Jhan, Jiun-Hung Geng, Hung-Lung Ke, Shu-Pin Huang, Li Jia","doi":"10.1002/kjm2.70292","DOIUrl":"10.1002/kjm2.70292","url":null,"abstract":"Prostate cancer remains a leading cause of cancer-related mortality, largely driven by progression to metastatic castration-resistant prostate cancer (mCRPC). Although poly(ADP-ribose) polymerase inhibitors (PARPis) have improved outcomes in patients with homologous recombination repair (HRR) alterations, particularly in BRCA2-mutated disease, their clinical benefit is limited by restricted patient selection, modest efficacy in non-BRCA HRR alterations, and the frequent emergence of resistance. These limitations highlight an unmet need for strategies that can both expand the therapeutic population and overcome PARPi resistance. Bipolar androgen therapy (BAT), which alternates between supraphysiological and near-castrate androgen exposure, has emerged as a paradoxical yet clinically active approach in mCRPC. Unlike conventional androgen deprivation strategies, preclinical evidence suggests that BAT induces acute androgen receptor-mediated DNA damage while simultaneously suppressing HRR gene expression. This dual effect may generate a transcription-coupled homologous recombination-deficient state that is independent of canonical baseline genomic HRR alterations, thereby potentially sensitizing tumors to PARP inhibition. Current clinical trials of BAT combined with PARP inhibitors suggest activity in both HRR-deficient and HRR-proficient disease. Collectively, these findings suggest a preliminary, hypothesis-generating conceptual framework in which BAT may expand the therapeutic scope of PARPis beyond genomically defined HRR-mutated tumors and may help counteract mechanisms of PARPi resistance in mCRPC.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70292"},"PeriodicalIF":3.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors Contributing to Improved Bone Mineral Density in Patients With Transfusion-Dependent Thalassemia. 输血依赖型地中海贫血患者骨矿物质密度改善的相关因素。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-16 DOI: 10.1002/kjm2.70279

Cheng-Ying Hsu, Hui-Pin Hsiao, Shyh-Shin Chiou, Pei-Chin Lin, Yu-Mei Liao, Wan-Yi Hsu, Teng-Hao Wang, Shuo-Yu Wang

{"title":"Factors Contributing to Improved Bone Mineral Density in Patients With Transfusion-Dependent Thalassemia.","authors":"Cheng-Ying Hsu, Hui-Pin Hsiao, Shyh-Shin Chiou, Pei-Chin Lin, Yu-Mei Liao, Wan-Yi Hsu, Teng-Hao Wang, Shuo-Yu Wang","doi":"10.1002/kjm2.70279","DOIUrl":"10.1002/kjm2.70279","url":null,"abstract":"Advances in therapy have extended the life expectancy of patients with thalassemia to near that of the general population; complications such as endocrine disorders and osteoporosis remain prevalent. This study aimed to identify endocrine complications, factors associated with endocrine complications, and changes in bone mineral density (BMD) in patients with transfusion-dependent thalassemia (TDT). This retrospective study reviewed medical records spanning over 10 years from patients aged 20-50 years with TDT, which included longitudinal follow-up data on thalassemia and endocrine function. Fisher's exact test was used for contingency tables, and univariate and multivariate binary logistic regression analyses were performed to identify contributing factors. A total of 44 patients were included, 81.8% of whom had at least one endocrine complication; osteoporosis was the most common (56.8%). All patients with a shorter blood transfusion interval (≤ 28 days) had thalassemia major. Shorter transfusion interval was significantly associated with a higher incidence of diabetes mellitus (DM) and female hypogonadism and a lower proportion of patients free of endocrine complications. No factor was statistically associated with osteoporosis in our study. 54.5% patients with osteoporosis had spontaneous improved BMD without pharmacological treatment. Vitamin D and calcium supplementation for > 1 year and absence of DM were linked to improved BMD in univariate analysis, but only absence of DM remained significantly associated in multivariate analysis. In conclusion, this study is based on real-world clinical data and has several limitations. The incidence of endocrine complications was high among patients with TDT. Osteoporosis was the most common endocrine complication. Absence of DM was associated with greater improvement in BMD of TDT patients with osteoporosis.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70279"},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correction to "IGF2BP3-Dependent N6-Methyladenosine Modification of USP49 Promotes Carboplatin Resistance in Retinoblastoma by Enhancing Autophagy via Regulating the Stabilization of SIRT1". 更正“igf2bp3依赖性n6 -甲基腺苷修饰USP49通过调节SIRT1稳定化增强自噬促进视网膜母细胞瘤的卡铂耐药”。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-09 DOI: 10.1002/kjm2.70289

引用次数: 0

Machine Learning Model for Predicting Hepatocellular Carcinoma Development in Patients With Hepatitis B Virus-Related Cirrhosis Receiving Antiviral Therapy. 预测乙型肝炎病毒相关肝硬化患者接受抗病毒治疗后肝细胞癌发展的机器学习模型

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-07 DOI: 10.1002/kjm2.70290

Pao-Yuan Huang, Heng-Syu Lin, Cheng-Yuan Peng, Ruei-Hau Hsu, Chien-Hung Chen

{"title":"Machine Learning Model for Predicting Hepatocellular Carcinoma Development in Patients With Hepatitis B Virus-Related Cirrhosis Receiving Antiviral Therapy.","authors":"Pao-Yuan Huang, Heng-Syu Lin, Cheng-Yuan Peng, Ruei-Hau Hsu, Chien-Hung Chen","doi":"10.1002/kjm2.70290","DOIUrl":"10.1002/kjm2.70290","url":null,"abstract":"Few prediction models have been specifically designed to evaluate the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B and cirrhosis. This study aimed to develop a machine learning-based prediction model to assess the risk of developing HCC in patients with hepatitis B virus (HBV)-related cirrhosis undergoing nucleos(t)ide analogue (NA) therapy. We included 1592 patients with HBV-related cirrhosis who had received entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide for at least 1 year. Patients were randomized in a 2:1 ratio into derivation or validation groups, and the prediction model was developed using the eXtreme Gradient Boosting (XGBoost) algorithm. The cumulative incidence of HCC for all patients at 5, 8, and 10 years was 15.2%, 22.7%, and 25.7%, respectively. Our ML-HCC model incorporated six parameters: serum albumin and platelet count at treatment initiation, and age, platelet count, serum aspartate transaminase, and serum AFP after 1 year of NA therapy. In the validation group, the AUROCs of the ML-HCC model ranged from 0.79 to 0.80 over 3 to 10 years, outperforming extant models including APA-B, PLAN-B, PAGE-B, mPAGE-B, REACH-B, and CU-HCC (AUROCs: 0.61-0.73, p < 0.05). Risk stratification showed the 10-year incidences of HCC for the low-, intermediate-, and high-risk groups were 9%, 26%, and 67%, respectively. The proposed machine learning model for predicting development of HCC exhibited good predictive performance in patients with HBV-related cirrhosis undergoing NA therapy.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70290"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disulfidptosis- and Ferroptosis-Related Gene Signatures in Rheumatoid Arthritis: Association Analysis and Diagnostic Model Construction. 类风湿关节炎中二硫下垂和铁下垂相关基因特征：关联分析和诊断模型构建。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-03 DOI: 10.1002/kjm2.70287

Ting-Ting Wang, Dong-Mei Wang, Xue Li, Yuan-Li Wei, Ping-Dan Liu, Shi-Lin Li, Si-Ying Xiong, Cai-Zhen Liu, Fan-Xin Zeng, Jian-Hong Wu, Lin Tang

{"title":"Disulfidptosis- and Ferroptosis-Related Gene Signatures in Rheumatoid Arthritis: Association Analysis and Diagnostic Model Construction.","authors":"Ting-Ting Wang, Dong-Mei Wang, Xue Li, Yuan-Li Wei, Ping-Dan Liu, Shi-Lin Li, Si-Ying Xiong, Cai-Zhen Liu, Fan-Xin Zeng, Jian-Hong Wu, Lin Tang","doi":"10.1002/kjm2.70287","DOIUrl":"10.1002/kjm2.70287","url":null,"abstract":"Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation and progressive joint damage. Although ferroptosis has been implicated in RA progression, the role of disulfidptosis and its interaction with ferroptosis remains unclear. This study aimed to identify Disulfidptosis- and Ferroptosis-Related Genes (DFRGs) associated with RA and construct a candidate diagnostic model. Blood transcriptomic data from 154 RA patients and 43 healthy controls were analyzed. Differentially expressed DFRGs were identified, and immune infiltration was assessed using single-sample Gene Set Enrichment Analysis (ssGSEA). Feature genes were selected through correlation analysis and logistic regression, followed by construction of a diagnostic nomogram. External validation was performed using independent datasets. Potential regulatory miRNAs and therapeutic agents were predicted, and single-cell eQTL-based Mendelian randomization (MR) was used to evaluate genetic associations between core gene expression and RA risk. Eleven DFRGs were identified and were enriched in p53, mTOR, and immune-related pathways. Five feature genes, DUOX1, DRD4, ATP6V1G2, ASNS, and CDKN1A, were used to establish a diagnostic model with favorable performance in the training cohort and external validation datasets. Five key miRNAs and 61 potential therapeutic agents were predicted. MR suggested that ASNS expression may be protective, whereas ATP6V1G2 expression may increase RA risk. These findings suggest that DFRGs-related signatures may be involved in RA pathogenesis and immune dysregulation, although further in vitro and in vivo validation is required.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70287"},"PeriodicalIF":3.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development of a Nomogram-Based Clinical Estimation Model for Pathological Upstaging in Patients With Preoperative Ductal Carcinoma In Situ. 术前导管原位癌病理上分期的一种基于nomogram临床评估模型的建立。

IF 3.1

The Kaohsiung journal of medical sciences Pub Date : 2026-09-03 DOI: 10.1002/kjm2.70282

Yu-Hua Chen, Chung-Liang Li, Ping-Fu Yang, Hui-Hua Hsiao, Fang-Ming Chen, Sin-Hua Moi

{"title":"Development of a Nomogram-Based Clinical Estimation Model for Pathological Upstaging in Patients With Preoperative Ductal Carcinoma In Situ.","authors":"Yu-Hua Chen, Chung-Liang Li, Ping-Fu Yang, Hui-Hua Hsiao, Fang-Ming Chen, Sin-Hua Moi","doi":"10.1002/kjm2.70282","DOIUrl":"10.1002/kjm2.70282","url":null,"abstract":"Preoperative diagnosis of ductal carcinoma in situ (DCIS) may be followed by pathological upstaging to invasive ductal carcinoma (IDC) upon surgical excision, a discrepancy that significantly impacts surgical planning and decisions regarding sentinel lymph node biopsy (SLNB). This retrospective study aimed to evaluate clinical indicators associated with such upstaging and develop a nomogram-based clinical estimation model for risk stratification. We reviewed medical records of all consecutively diagnosed patients (n = 445) initially diagnosed with DCIS via core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) between 2013 and 2022 at a single institution. Demographic, imaging, clinicopathological, immunohistochemical, and blood-based biomarkers were categorized and analyzed. Logistic regression analysis was employed to identify independent predictors, from which a visual risk estimation tool was constructed. Among the 445 patients, 137 (30.8%) were upstaged to IDC. In the multivariable analysis, clinical tumor size > 1.5 cm, biopsy modality, and high histologic grade at biopsy emerged as independent predictors of pathological upstaging. Notably, VAB was associated with a lower rate of underestimation than CNB. Subgroup analyses revealed that age > 50 years, larger lesion size, and high grade were associated with upstaging in the CNB group, whereas histologic grade was the primary predictor in the VAB group. The nomogram demonstrated modest discriminative performance (AUC = 0.690) for individualized preoperative assessment. In conclusion, clinical tumor size, biopsy method, and histologic grade provide valuable information for estimating the likelihood of occult invasive disease in patients with preoperative DCIS.","PeriodicalId":94244,"journal":{"name":"The Kaohsiung journal of medical sciences","volume":" ","pages":"e70282"},"PeriodicalIF":3.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0