Early Recurrence Research Articles

Supervised machine learning with a novel set of 20 genes predicts the likelihood of early or late recurrence of high-grade serous ovarian cancer

Supervised machine learning with a novel set of 20 genes predicts the likelihood of early or late recurrence of high-grade serous ovarian cancer

Prognostic significance of early and multiple recurrences after curative resection for hepatocellular carcinoma

BackgroundIn hepatocellular carcinoma (HCC), postoperative recurrence remains high. This study aimed to evaluate the recurrence patterns and prognosis of HCC after curative hepatectomy.MethodsAmong 352 patients with primary HCC who underwent initial hepatectomy between January 2002 and December 2022, 151 with recurrence were assessed for the relationship between recurrence pattern and prognosis.ResultsThe early recurrence group (within 6 months postoperatively; n = 38) had significantly higher serum alpha-fetoprotein (p = 0.002), des-γ-carboxyprothrombin (DCP; p = 0.004) levels and Barcelona Clinic Liver Cancer (BCLC) stage (p < 0.001), larger tumor size (p < 0.001), higher incidence of multiple tumors (p = 0.002) and lower overall survival (OS) (p < 0.001) than the late recurrence group (> 6 months postoperatively; n = 113). The tumor size (p = 0.013) and BCLC stage (p = 0.001) were independent risk factors for early recurrence within 6 months in multivariate analysis.The multiple recurrence group (intrahepatic multinodular recurrence or distant metastasis; n = 89) had significantly lower prognostic nutritional index (p = 0.026), larger tumor size (p = 0.017), lower incidence of liver cirrhosis (p = 0.03) than the single recurrence group (single nodule recurrence; n = 62). The multiple recurrence group, especially patients with ≥ three intrahepatic nodules and distant metastases, had lower postoperative OS (p < 0.001) and shorter time to recurrence (p < 0.001) than the single recurrence group.When the patients were classified into three groups: late recurrence with one or two tumors (Group A; n = 74), early recurrence or three or more tumors or distant metastasis (Group B; n = 54), and early recurrence with three or more tumors or distant metastasis (Group C; n = 23), OS was significantly lower in Groups B and C than Group A (p < 0.001).ConclusionsPatients with early recurrence within 6 months after surgery and three or more recurrence nodule or distant metastasis exhibited poor prognosis after initial recurrence, and they should be carefully followed up.

Early repeat catheter ablation in patients with early recurrent arrhythmia

Abstract Background Repeat catheter ablation reduces adverse cardiovascular endpoints in patients with recurrent atrial tachyarrhythmia after index ablation. However, when to proceed with re-ablation in patients with early recurrent arrhythmia is unknow. Objective In this study, we aim to access the effectiveness of early repeat ablation on cardiovascular outcomes in early recurrent atrial tachycardia patients. Methods A total of 502 post-ablation patients, who experienced early atrial tachyarrhythmia recurrence within 6 months outside the blank period post index ablation and had undergone a repeat ablation, were consecutively enrolled from China AF registry from January 2012 to December 2018. Early repeated ablation (ERA) was defined as patients underwent a subsequent catheter ablation procedure within early recurrent period, then late repeated ablation (LRA) referred to a redo procedure that performed after 6 months since the de novel ablation. Cox proportional hazard models were used to estimate the effect of early re-ablation on primary endpoint (a composite of cardiovascular death, stroke and cardiovascular rehospitalization) and secondary endpoint (each component of primary outcome and AF/AT recurrence). Results The median follow-up time was 26 months after the redo-AF/AT ablation. First primary composite outcome occurred in 39 of the patients received early re-ablation (24.38 per 100 person-years) and in 136 of the patients performed with late re-ablation (39.77 per 100 person-years) (HR = 0.55, 95% CI = 0.38-0.79; P0.001). Cardiovascular re-hospitalization (hazard ratio 0.52 95% confidence interval [0.36; 0.73]) and AF recurrence occurred less often (hazard ratio 0.76, 95% confidence interval [0.58; 0.98]) in the ERA group. No significant difference between the two groups was found in terms of cardiovascular death, stroke and major bleeding events. Conclusion Early initiation of redo-ablation conveys better clinical benefit in patients with early arrhythmia recurrence.

Prediction of atrial fibrillation recurrence after ablation: the impact of machine learning and recurrence during the blanking period

Abstract Introduction Pulmonary vein isolation is superior to antiarrhythmic drugs for rhythm control in patients with atrial fibrillation (AF). Nevertheless, recurrences within the first year are still significant. Several clinical risk scores were developed to predict AF recurrence; however, despite good results in development cohorts, the results in external validation are usually poor, limiting the general applicability of these scores. Purpose We aimed to develop machine learning (ML) models to predict AF recurrences within the first year after catheter ablation and compare their performance with conventional risk scores. Methods We used a retrospective dataset of a tertiary hospital center, including all consecutive patients submitted to the first AF ablation between 2017 and 2021. The dataset included 76 features: patient characteristics, medical history, baseline echocardiography, calcium score, procedure variables, and early recurrence (ER) during the 90-day blanking period. The outcome was defined as the occurrence of an electrocardiographically documented late recurrence (LR) of atrial tachycardia/AF &amp;gt; 30s between 3-12 months. Three different supervised ML models (penalized logistic regression, random forests, and XGBoost) were developed on the training cohort, and hyperparameters were tuned using 10-fold cross-validation. A testing dataset was held out to estimate the final performance (25%). The following risk scores were calculated: APPLE, CAAP-AF, and BASE-AF2 (the last includes ER). Areas under the curve (AUC) of receiver operating characteristic curves were compared using DeLong’s test. Results 679 patients were included: 62.7% males, median age of 59±16 years, and 78.2% with paroxysmal AF. The median time from diagnosis to ablation was 2±4 years. 74.2% underwent radiofrequency ablation and the remaining cryoablation. ER occurred in 12.5%, and most of these patients also experienced LR (68.7 vs 19.6% in those without ER, p&amp;lt;0.001). LR was observed in 25.6%. The XGBoost model showed the best performance with an AUC 0.774, 95% confidence interval (CI) 0.688–0.844) outperforming existing scores (picture 1): APPLE score AUC 0.607, 95% CI 0.562–0.653, p-value&amp;lt;0.001; CAAP-AF score AUC 0.622, 95% CI 0.576–0.668, p-value=0.002; BASE-AF2 AUC 0.628, 95% CI 0.581–0.675, p-value= 0.003. Variable importance analysis showed a significant drop in the performance of the models when ER was not considered, indicating its high importance in predicting LR (picture 2). Conclusions Recurrence during the blanking period was the most important predictor of LR in our population. The ML model was superior to conventional risk scores. ML models might be an essential tool to improve the prediction of outcomes and clinical decision-making for optimal follow-up.ROC curvesFeature Importance

Utilizing cluster analysis of biomarkers alongside echocardiographic deformation parameters to forecast the outcome of atrial fibrillation post-ablation

Abstract Background Atrial fibrillation (AF) management often involves catheter ablation, but its recurrence necessitates careful clinical management and potential adjustments in medication or further ablation procedures. This study aims to investigate the predictive value of biomarkers and echocardiographic parameters for early AF recurrence. Methods In the prospective study, we enrolled patients with symptomatic paroxysmal or persistent atrial fibrillation undergoing catheter ablation. Pulmonary vein isolation was performed in every index procedure, with additional ablation or substrate modification as per physician preference. Blood samples were collected from both the atrium and peripheral vein to assess levels of tumor endothelial marker 1 (TEM1), galectin 3, connective tissue growth factor (CTGF), transforming growth factor-beta (TGF-β), C-terminal propeptide of procollagen type I (PICP), and Smad3. Pre-procedural echocardiographic parameters, including the E/e’ ratio, peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS), were recorded. Clustering models with sparse canonical association analysis (CCA) were employed to develop predictive models integrating biomarker and echocardiographic data for early atrial fibrillation recurrence. Results Out of 80 prospectively enrolled patients, 68 completed the study, with six cases of early atrial fibrillation recurrence observed. Following dimension reduction and clustering, we found that the combined use of biomarkers and echocardiography significantly predicted atrial fibrillation recurrence (HR: 9.44, p=0.05, 95% CI: 1.0-88.9). Notably, among these parameters, TEM1 biomarker sampled from the peripheral vein (p=0.02), left atrium dimension (p=0.07), and left ventricle dimension (p=0.02) exhibited the most significant predictive power. Conclusions Our study highlights the effectiveness of integrating biomarkers and echocardiography parameters in predicting early recurrence of atrial fibrillation post-ablation in patients undergoing catheter ablation.main_figure

Impact of paroxysmal atrial fibrillation ablation on cardiac sympathetic nervous system: a prospective stratified randomized comparative study in patients with and without heart failure

Abstract Background Catheter ablation of atrial fibrillation (AF) might influence the cardiac sympathetic nervous system (CSNS). We sought to investigate the impact of AF ablation with 2nd generation cryoballoon catheter (CB) and contact force sensing radiofrequency ablation catheter (RF) on CSNS and the association of this effect with early AF recurrence in patients with and without heart failure (HF), using cardiac iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy. Methods and Results One hundred sixty-five paroxysmal AF patients who were scheduled for ablation were enrolled. All patients were categorized into two groups: one with HF (n=31), defined as left ventricular ejection fraction ≤ 40% or previous history of hospitalization for worsening HF, and the other without HF (n=134). They were then randomly assigned to CB (17 patients with HF and 68 without HF) or RF (14 with HF and 66 without HF). MIBG scintigraphy was performed at baseline and 3 months post-ablation and the washout rate (WR) was measured. There were no significant changes in WR from baseline to 3 months after RF and CB ablation (28.7±18.6% to 27.9±16.7% in RF and 29.4±16.7% to 30.5±16.4% in CB). WR decreased more in patients with HF at 3 months after ablation than without HF, while WR significantly increased in patients without HF and there was a significant interaction in WR change between with or without HF (interaction p&amp;lt;0.001). WR change from the baseline to 3 months after ablation (dWR) was not significantly different between CB and RF, irrespectively of the HF presence. In the blanking period of 3 months after ablation, early AF recurrence (EAR) was observed in 37 (22%) patients with no antiarrhythmic drugs (17(21%) patients in RF and 20(24%) in CB). dWR was significantly greater in patients with than without EAR (4.0±14.1% vs -0.9±11.0%, p=0.027). Higher dWR (≥ 6.9% (AUC 0.644, 95%CI [0.535-0.753]) by ROC curve analysis) was independently associated with EAR (adjusted odds ratio = 4.15, 95%CI [1.87-9.22], p&amp;lt;0.001, adjusted for age, sex, and left atrial diameter). Conclusions Irrespectively of CB and RF, AF ablation might reduce adrenergic tone in patients with HF, while it might induce more adrenergic tone in patients without HF. Excessive adrenergic tone might be associated with early AF recurrence.WR changes before and after ablationdWR in patients with or without HF

Duration of sinus rhythm after direct current cardioversion does not predict recurrence of atrial fibrillation after subsequent catheter ablation: a multicentre study

Abstract Background Catheter ablation (CA) for persistent atrial fibrillation (PsAF) is associated with high rates of AF recurrence. DC cardioversion (DCCV) is often performed before CA, with wide variation in duration of maintenance of sinus rhythm (SR) post-DCCV. Factors associated with short duration of SR after DCCV, such as raised body mass index, prior duration of AF, prolonged p wave duration on the 12-lead ECG, and indexed left atrial volume, are either associated with or indicative of atrial electrical and structural remodelling, suggesting that shorter duration of SR after DCCV reflects a more advanced substrate for AF, which could in turn also influence the likelihood of success after CA. Objective To determine if post-DCCV SR duration is associated with AF recurrence after subsequent CA. Methods We performed a multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015-2018 with prior DCCV. SR duration after the last DCCV prior to CA was recorded. The primary outcome was the first recurrence of atrial arrhythmia post-CA (after a 90-day post-CA blanking period). We also performed a pre-specified sensitivity analysis for amiodarone use at DCCV, by performing repeat analysis after excluding all such patients across the three groups. Results A total of 331 patients were identified across five centres and categorised by post-DCCV SR duration: &amp;lt;7 days (group 1); 7-31 days (group 2); &amp;gt;31 days (group 3; Table 1). Over median post-CA follow-up of 591 days, 207 patients (62.5%) met the primary outcome. There was no significant between-group difference in the time to primary outcome (log rank p=0.82; Figure 1). There were significantly more blanking period arrhythmias in groups 1 and 2 than group 3 after post hoc Bonferroni correction (pairwise p=0.001, 0.002 respectively; Table 1). After exclusion of patients on amiodarone at time of DCCV, there remained no significant between-group difference in the time to primary outcome (log rank p=0.85). Conclusion Shorter duration of SR post-DCCV is associated with blanking period arrhythmia after CA, but crucially does not predict long-term AF recurrence. Early AF recurrence after DCCV should not influence decisions on CA suitability or be used to predict long-term CA success.

Discordance between left atrial volume and scar burden in patients with atrial fibrillation and its impact on atrial fibrillation recurrence after catheter ablation

Abstract Background Large left atrial (LA) volume and a high burden of LA low voltage zone (LVZ) are associated with atrial fibrillation (AF) recurrence after AF catheter ablation. There is a scarcity of information on the association between LA volume and LVZ and its impact on the risk of AF recurrence. Purpose To investigate the relationship between the LA volume and LVZ, as well as how these factors contribute to the recurrence of atrial fibrillation (AF). Methods From Nov 2021 to Oct 2023, drug-refractory AF patients who underwent AF catheter ablation were included. LA volume was assessed using the LA volume index (LAVI) using echocardiography. The LVZ was evaluated by conducting high-density electroanatomical mapping using a multipolar catheter. The cut-off value associated with AF recurrence was 48ml/m2 in LAVI and 4.5% in scar burden. Patients were categorised into four groups according to the LAVI and scar burden: Group 1 (Low LVZ and small LA), group 2 (Low LVZ and large LA), group 3 (High LVZ and small LA), and group 4 (High LVZ and large LA). Results A total of 170 patients were included (mean age 62± 9 years, 82% of men, 68.2% of non-paroxysmal AF and 81 [48%] in group 1; 32 [19%] in group 2, 27 [16%] in group 3, 30 [17%] in group 4, respectively). Among total, mean follow-up duration was 266.5 ± 174.4 days, and 8.8% of patients received additional LA ablation beyond pulmonary vein isolation. Among the four groups, group 2 and 4 were significantly associated with higher risks of AF recurrence compared to group 1 (HR 2.36 [1.04-5.34], p=0.039; 3.56 [1.59-7.95], p=0.002, respectively). The risk of AF recurrence was highest in group 4, followed by group 2 (log-rank P=0.002). Comparing group 2 and 3, AF recurrence occurred predominantly within 6-month after catheter ablation in group 2, while after 1-year in group 3 (log-rank P=0.83). Conclusion About one-third of patients showed discordance between the LAVI and LVZ, which are both independent predictors for AF recurrence. A substantial LA volume seems to contribute to early AF recurrence, whereas a high scar burden appears to affect late AF recurrence.

Impact of obesity and early recurrence of atrial fibrillation on very late recurrence following cryoballoon pulmonary vein isolation

Abstract Background Obesity and early recurrence of atrial fibrillation (ERAF) post cryoballoon (CB) pulmonary vein isolation (PVI) both portend a lower 1-year success rate of ablation. Even after an initial successful ablation, about 1/3 of patients develop a very late recurrence (VLR) of AF, defined as the first AF recurrence more than a year after ablation (excluding an initial 90 day blanking period [BP]). The impact of obesity and ERAF on VLR is still unknown. Purpose To evaluate the impact of obesity and ERAF on VLR following CB PVI. Methods We enrolled consecutive patients with symptomatic AF who underwent CB PVI and had an implantable loop recorder for long-term ECG monitoring. We identified patients who had no AF recurrence (outside the BP) in the first-year post ablation. ERAF was defined as any episode of AF recorded in the first 90 days post ablation. Patients were grouped as either obese (BMI ≥ 30 kg/m2) or non-obese (BMI &amp;lt;30 kg/ m2). AF recurrences after 1-year post-ablation were ascertained using the loop recorder. Results From the initial cohort of 210 patients, 109 (52%) patients (64 ± 10 years; 75 [68%] male; 64 [59%] PAF; CHA2DS2-VASc 2.3 ± 1.4, 38 [35%] with obesity and 41 [38%] had ERAF) were AF-free during the first year. During a follow-up of 961 ± 196 days, 51 (47%) patients had VLR. Non-obese patients without ERAF had the best outcome (Figure). In multivariate analysis, obesity and ERAF were the only significant predictors of VLR (Table). As compared to non-obese patients without ERAF, obese patients with ERAF had a 4-fold greater likelihood of VLR. Conclusions About 50% of patients have no AF recurrence in the first year after CB PVI. Non-obese patients have the best outcome regardless of ERAF occurrence. On the other hand, obese patients with ERAF almost always have VLR.

Timing of early recurrence of atrial fibrillation during the blanking period after catheter ablation for persistent atrial fibrillation and implications for long-term success: a multicentre study

Abstract Background After catheter ablation (CA) for atrial fibrillation (AF), early recurrences of AF (ERAF) that occur within a 90-day post-ablation "blanking period" are considered to represent transient post-ablation pro-arrhythmia. Purpose To determine if the timing of early recurrence of AF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence after CA for persistent AF (PsAF). Methods We performed a multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015-2018. All patients had undergone pre-CA DCCV. Incidences of ERAF during the post-CA blanking period were reviewed, and patients were categorised into three groups based on the timing of last episode of ERAF during the blanking period: (1) no ERAF (reference population); (2) last ERAF &amp;lt;30 days post-CA; (3) last ERAF 31-90 days post-CA. The primary outcome was long-term recurrence of atrial arrhythmia, i.e. time to first recurrence of atrial arrhythmia occurring beyond the first 90 days after CA. Patients who had ERAF and exited the blanking period in AF (i.e. those with immediate recurrence at 90 days) were excluded from this analysis. Results 331 patients were identified from five centres. 206 patients had no ERAF during follow-up, 124 patients had ERAF during the blanking period, and in one patient the presence of ERAF was not documented. Of the 124 patients experiencing ERAF during the 90-day post-CA blanking period, the timing of the last episode was known in 122 patients (Table 1). Of these, 58 patients exited the 90-day blanking period in AF and were excluded. Over median post-CA follow-up of 590 days, 147 patients (54%) experienced the primary outcome. Compared with Group 1 (no ERAF), ERAF within each of the time periods was associated with a statistically significant progressively increased risk of long-term recurrence (Group 2, last ERAF &amp;lt;30 days post-CA: hazard ratio [HR] 1.95 [95% CI 1.15-3.31]; Group 3, last ERAF 31-90 days post-CA: HR 4.86 [95% CI 2.13-11.08]; Figure 1). Conclusion ERAF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence, with later recurrence within the 90-day period conferring greater risk. Patients with ERAF during the blanking period may need to be considered for earlier repeat intervention where clinically appropriate.

Recurrence scoring system predicting early recurrence for patients with pancreatic ductal adenocarcinoma undergoing pancreatectomy and portomesenteric vein resection

Recurrence scoring system predicting early recurrence for patients with pancreatic ductal adenocarcinoma undergoing pancreatectomy and portomesenteric vein resection

Preoperative prediction of early recurrence in patients with BRAF mutant colorectal cancer using a intergrated nomogram

Objective To explore the predictive value of radiomics nomogram combining with CT radiomics features and clinical features for postoperative early recurrence in patients with BRAF-mutant colorectal cancer. Methods A total of 220 patients with surgically and pathologically confirmed BRAF-mutant colorectal cancer from 2 institutions were retrospectively included. All patients from institution 1 were randomized at a 7:3 ratio into a training cohort (n = 108) and an internal validation cohort (n = 45), and patients from institution 2 were used as an external validation cohort (n = 67). The association between the radiomics features and early recurrence was assessed in the training cohort and verified in the validation cohort. Furthermore, the performance of the radiomics nomogram was evaluated by combining the rad-score and clinical risk factors. The predictive performance was evaluated by receiver operating characteristic curve analysis, calibration curve analysis, and decision curve analysis. Results The dierenees in the Lymphocyte/monocyte ratio (LMR) and Peripheral nerve infiltration (PNI) were statistically significant between the early recurrence in BRAF-mutant colorectal cancer groups and the early non-recurrence in BRAF-mutant colorectal cancer groups (P < 0.05); The two groups showed no significant differenee in clinical parameters including age, sex, and biochemistry serum markers (P > 0.05). Comparing with the pure radiomics or clinical data, combined models can be seen that the addition of LMR and PNI further improveed the predictive efficiency of the model. The rad-score based on LR, generated by 4 selected radiomics features, demonstrated a favorable ability to predict early recurrence in both the training (AUC 0.81), internal validation (AUC 0.73), external validation (AUC 0.63) cohorts. Subsequently, integrating two independent predictors into a nomogram exhibited more favorable discriminatory performance, with the AUC improved to 0.88 and 0.81 in both cohorts. Conclusions The proposed CT-based radiomics signature is associated with early recurrence among the patients with BRAF-mutant colorectal cancer. The present study also proposes a combined model can potentially be applied in the individual preoperative prediction of early recurrence in patients with BRAF-mutant colorectal cancer. Advances in knowledge CT-based radiomics showed satisfactory diagnostic significance for early recurrence in patients with BRAF-mutant colorectal cancer. Key baseline clinical characteristics were associated with early recurrence in patients with BRAF-mutant colorectal cancer. The combined model may be applied in the individual preoperative prediction of early recurrence in patients with BRAF-mutant colorectal cancer.

HBcrAg is associated with prognosis of hepatitis B virus-related hepatocellular carcinoma in patients after hepatectomy undergoing antiviral therapy.

Serum hepatitis B core-related antigen (HBcrAg) is considered a surrogate marker of the amount and activity of intrahepatic covalently closed circular DNA. This study aimed to explore the prognostic value of HBcrAg on patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative hepatectomy undergoing antiviral therapy (AVT). Data of 949 consecutive patients with HBV-related HCC undergoing curative resection between 2010 and 2013 were reviewed. Serum HBcrAg levels were measured at surgery (baseline) for all patients and at the time of 2 years postoperatively (on-treatment) for those without recurrence. Primary endpoint was tumor recurrence. High HBcrAg levels are associated with malignant phenotypes. HBcrAg independently affected both recurrence and overall survival (OS) in patients with negative hepatitis B e antigen (HBeAg-, p = .007 and p = .042, respectively) but not in their positive HBeAg (HBeAg+) counterparts (p = .100 and p = .075, respectively). Patients with high baseline HBcrAg had higher late, but not early recurrence rates than those with low baseline HBcrAg levels, regardless of HBeAg status (HBeAg+: p = .307 for early, p = .001 for late; HBeAg-: p = .937 for early, p < .001 for late). On-treatment HBcrAg independently affected late recurrence in patients stratified by both cirrhosis and HBeAg (p < .001 for all). The predictive power of HBcrAg kinetics for late recurrence was better than that of the baseline and on-treatment HBcrAg. High HBcrAg levels during long-term AVT are associated with late recurrence of HCC after hepatectomy. Combining baseline and on-treatment HBcrAg might be valuable in identifying patients at a high risk of relapse and stratifying surveillance strategies postoperatively.

Development and validation of an inflammation-nutrition indices-based nomogram for predicting early recurrence in patients with stage IB lung adenocarcinoma

To explore the inflammation-nutrition indices and related clinical factors affecting early recurrence in patients with stage IB LUAD. A retrospective analysis was conducted on clinical and pathological data of patients diagnosed with stage IB LUAD who underwent radical surgery in our hospital from January 2016 to January 2021. Using R software, patients were randomly divided into training (n = 140) and validation (n = 59) cohorts in a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed to identify risk factors for RFS and construct a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), and calibration curve. Clinical utility of the model was assessed using decision curve analysis (DCA). Multivariate Cox regression analysis revealed that vascular invasion, visceral pleural invasion, predominant pattern, preoperative NLR > 2.33, preoperative PLR > 127.62, and preoperative PNI ≤ 48.3 were independent risk factors for RFS. The C-index of the nomogram model constructed based on these independent risk factors was 0.825 (95% CI: 0.762–0.881) in the training cohort and 0.772 (95% CI: 0.667–0.876) in the validation cohort. The ROC curves showed AUCs of 0.902, 0.881, and 0.877 for 1-year, 2-year, and 3-year RFS in the training cohort and AUCs of 0.782, 0.825, and 0.732 in the validation cohort respectively. Calibration curve and decision curve analysis indicated good clinical value of the model. The nomogram model based on inflammation-nutrition indices has predictive value for early recurrence in patients with stage IB LUAD.

Early clubfoot recurrence can lead to more frequent and earlier second recurrences.

The frequency of multiple clubfoot recurrences following Ponseti casting and the effect on final outcomes have not been well studied. This study aims to evaluate the effect of early recurrence (during the first 2 years) on the timing and rate of subsequent recurrences. A retrospective review was conducted of children treated with Ponseti casting at a single institution from 2002 to 2023 with minimum follow-up until age 5. Patients who required comprehensive soft tissue surgery to obtain initial correction were excluded. Patient-Reported Outcomes Measurement Information System data were collected when available. A total of 86 patients were included; 69.8% (60) had idiopathic clubfoot. Average follow-up was 5.8 years. Early recurrence (recurrence before age 2) occurred in 26.7% (23). The rate of late recurrence (recurrence after age 2) was higher in the early recurrence group, 73.9% (17) vs. 39.7% (25), P = 0.005. Survival analysis revealed that patients with early recurrence experience late recurrence at a younger age of 3.9 vs. 6.7 years, P ≤ 0.001. The early recurrence group experienced more frequent recurrences, with a median of 3 [interquartile range (IQR): 1-5] total recurrences vs. 0 (IQR: 0-1), P ≤ 0.001. Patients with early recurrence had lower final mobility scores, 40.83 ± 10.88 vs. 48.00 ± 10.60, P = 0.029. In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.

Prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde

ObjectivesDespite the good prognosis of surgical treatment of chronic subdural hematomas, there are some early deaths, recurrences and post-operative complications. The objective of this study is to analyze the prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde. MethodThree hundred and ten cases of chronic subdural hematomas were diagnosed on 3788 patients hospitalized in the neurosurgery departments of two reference university teaching hospitals in the city of Yaounde from January 1st, 2015 to December 31st, 2021 (7 years). The authors collected data from patients in whom surgical treatment was performed and assessed their prognosis with regard to the rate of early and late recurrence, mortality rate and postoperative complications and associated factors. ResultsData from 284 patients were analyzed. The mortality rate was 6.7 % and the recurrence rate was 3.2 % in early postoperative period and 4.5 % after a follow-up of 3–24 months. Prognostic factors for death were age greater than or equal to 80 years (p value = 0.034) and presence of cortico-subcortical atrophy (p value = 0.003). The main recurrence factors were age greater than or equal to 70 years and compartmentalization of the hematoma. ConclusionChronic subdural hematomas are generally of good prognosis when the Glasgow coma score on admission is good and adequate management is carried out as soon as possible. Advanced age, lesions such as cortico-subcortical atrophy and compartmentalization of the hematoma are all factors that predispose to recurrence or early mortality. Those groups of patients should therefore benefit from a closer follow-up in post-operative period.

Treatment regimens for laryngeal and hypopharyngeal squamous cell carcinoma: a "real life" multicenter study of 2307 patients.

This retrospective multicenter study aimed to evaluate surgical versus conservative treatment in patients with hypopharyngeal and laryngeal cancer under real world conditions. This study included 2307 patients diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) in five German tertiary head and neck centers between 01/2004 and 12/2014. Overall, 783 patients with advanced SCC consecutively underwent laryng(opharyng)ectomy (L(P)E). Patient chart data regarding age, sex, tumor location, TNM status, grading, indication for L(P)E, treatment modalities, R status, postoperative complications, and hospitalization time were analyzed. Patients with lacking data and incomplete staging and those who refused treatment or did not comply with the recommended treatment were excluded from survival analysis. A slight but significant increase was observed in L(P)E, referring to an increasing rate of tumor recurrence. While T1/2N0M0 laryngeal and hypopharyngeal cancer patients showed comparable overall survival (OS) for surgical and conservative treatment, surgery showed significantly better OS in lymph node-positive individuals and locally advanced tumor stages. Tumor recurrence occurred in more than one-third of the cases. In particular, in early glottic cancer recurrence, L(P)E represents a curative and safe treatment option, whereas in supraglottic and hypopharyngeal cancer, L(P)E was associated with reduced survival rates. Notably, 36% of patients with supraglottic cancer and 59% of patients with hypopharyngeal cancer recurrence could only be treated with palliative care. Comparable survival rates were demonstrated for cT1/2N0M0 laryngeal and hypopharyngeal SCC compared with primary chemo-/radiotherapy and larynx-preserving surgery. Better OS was achieved after surgery in nodal-positive patients and in those with locally advanced disease. Tumor recurrence should be anticipated in up to 39% of cases. Glottic cancer recurrence can be successfully and safely treated with L(P)E, whereas OS is reduced in hypopharyngeal cancer and possibly in supraglottic cancer.

Preoperative identification of early extrahepatic recurrence after hepatectomy for colorectal liver metastases: A machine learning approach.

Machine learning (ML) may provide novel insights into data patterns and improve model prediction accuracy. The current study sought to develop and validate an ML model to predict early extra-hepatic recurrence (EEHR) among patients undergoing resection of colorectal liver metastasis (CRLM). Patients with CRLM who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. An eXtreme gradient boosting (XGBoost) model was developed to estimate the risk of EEHR, defined as extrahepatic recurrence within 12months after hepatectomy, using clinicopathological factors. The relative importance of factors was determined using Shapley additive explanations (SHAP) values. Among 1410 patients undergoing curative-intent resection, 131 (9.3%) patients experienced EEHR. Median OS among patients with and without EEHR was 35.4months (interquartile range [IQR] 29.9-46.7) versus 120.5months (IQR 97.2-134.0), respectively (p<0.001). The ML predictive model had c-index values of 0.77 (95% CI, 0.72-0.81) and 0.77 (95% CI, 0.73-0.80) in the entire dataset and the validation data set with bootstrapping resamples, respectively. The SHAP algorithm demonstrated that T and N primary tumor categories, as well as tumor burden score were the three most important predictors of EEHR. An easy-to-use risk calculator for EEHR was developed and made available online at: https://junkawashima.shinyapps.io/EEHR/. An easy-to-use online calculator was developed using ML to help clinicians predict the chance of EEHR after curative-intent resection for CRLM. This tool may help clinicians in decision-making related to treatment strategies for patients with CRLM.

Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study

IntroductionThe treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results. Primary objectiveTo evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique. Secondary objectivesTo evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months. MethodProspective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed. Results122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous.There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group. ConclusionsUM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.

Retraction Note: Tumor microenvironment and immune system preservation in early-stage breast cancer: routes for early recurrence after mastectomy and treatment for lobular and ductal forms of disease

Retraction Note: Tumor microenvironment and immune system preservation in early-stage breast cancer: routes for early recurrence after mastectomy and treatment for lobular and ductal forms of disease