Independent Risk Factors For Recurrence Research Articles

Construction and validation of a nomogram model for predicting the risk of recurrence in patients with lower extremity arteriosclerosis obliterans after surgical intervention

ObjectiveTo explore and analyze the risk factors for recurrence in patients with lower extremity arteriosclerosis obliterans (ASO) after surgical intervention and to construct and validate a nomogram prediction model.MethodsA total of 270 patients with ASO treated at our hospital were retrospectively selected as study subjects and divided into a training cohort (189 cases) and a validation cohort (81 cases) based on a 7:3 ratio. Patients in the training cohort were further divided into recurrence and non-recurrence groups based on whether they experienced recurrence within two years post-surgery. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for postoperative recurrence, which were then used to construct a predictive model and generate a nomogram.ResultsOf the 270 patients with ASO included in the study, the training cohort consisted of 189 patients, with 76 (40.21%) in the recurrence group and 113 (59.79%) in the non-recurrence group. The validation cohort consisted of 81 patients, with 32 (39.51%) in the recurrence group and 49 (60.49%) in the non-recurrence group. Univariate analysis in the training cohort revealed significant differences in age, body mass index (BMI), diabetes, hypertension, lesion location classification, use of antiplatelet drugs, triglycerides, fibrinogen (FIB), and di-dimer (D-D) (P < 0.05, respectively). Multivariate logistic regression analysis indicated that age ≥ 60 years, BMI ≥ 24 kg/m², diabetes, hypertension, discontinuation of antiplatelet therapy, FIB, and D-D were independent risk factors for recurrence after surgical intervention in patients with lower extremity ASO (OR = 2.471, 1.625, 4.568, 2.678, 5.974, 2.073 and 3.067; P < 0.05, respectively). When the training and validation cohorts were tested in the established nomogram model, the area under the curve (AUC) of the model was 0.832 (95% CI: 0.765–0.919) in the training cohort and 0.858 (95% CI: 0.745–0.964) in the validation cohort. Calibration curves indicated high consistency between the predicted and actual outcomes in both groups, suggesting good predictive accuracy of the model. Decision curve analysis showed that using this model significantly increased net clinical benefit for patients.ConclusionThe nomogram model constructed for predicting the risk of recurrence in patients with lower extremity ASO after surgical intervention demonstrates good predictive and discriminative abilities, offering valuable guidance for clinical screening of high-risk populations.

Immune checkpoint inhibitors plus anti-angiogenesis in patients with resected high-risk hepatitis B virus-associated hepatocellular carcinoma.

Currently, there is a lack of effective adjuvant therapies for patients at high-risk of recurrent hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) after radical resection. Given the efficacy of anti-programmed death 1/anti-programmed death ligand 1 plus anti-vascular endothelial growth factor receptor agents in advanced HCC, we conducted this study to investigate the efficacy of this combination regimen in the postoperative adjuvant treatment of patients with HBV-HCC. To evaluate the value of postoperative combined therapy (PCT) with anti-programmed death 1/anti-programmed death ligand 1 and anti-vascular endothelial growth factor receptor agents in patients with HBV-HCC. Patients with HBV-HCC who underwent radical resection surgery at Anhui Provincial Hospital Affiliated to Anhui Medical University between July 2020 and April 2023 were included. Recurrence-free survival (RFS) and overall survival were assessed using propensity score matching and inverse probability of treatment weighting. Cox regression analysis was used to identify factors affecting recurrence, and subgroup analysis was conducted to investigate the impact of medications on different populations. Treatment-related adverse events and liver function measurements were evaluated. A total of 150 patients were recruited, of whom 30 underwent PCT and 120 did not. After adjusting for confounders, patients who underwent PCT had better RFS at 6 and 12 months than those who did not (P > 0.05). Similar results were observed in the Kaplan-Meier curves after propensity score matching or inverse probability of treatment weighting, although the difference was not statistically significant (P > 0.05). A maximum diameter of > 5 cm, vascular invasion, satellite nodules, and high gamma-glutamyl transferase levels were independent risk factors for recurrence (P < 0.05). No significant interaction effects were observed in subgroup analyses. The most prevalent adverse event was hypertension (66.7%). PCT was associated with an increased risk of hepatic impairment which may predict RFS rates (P = 0.041). The recurrence rate was not significantly reduced in patients who underwent PCT. Hepatic impairment during treatment may indicate recurrence, and close monitoring of liver function and HBV infection is recommended.

Ultrasound diagnostic value and clinical analysis of 61 uterine intravenous leiomyomatosis cases.

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor, for which the ultrasound features and diagnostic value have rarely been reported due to its infrequent presentation. This study aimed to analyze ultrasonographic characteristics and diagnostic value of uterine IVL and explore risk factors influencing postoperative recurrence. A retrospective analysis was conducted of 61 patients who underwent surgical treatment from December 2014 to December 2023. Intraoperative or postoperative pathology confirmed uterine IVL in these patients. Clinical data and ultrasonographic features were analyzed, including IVL location, the International Federation of Gynecology and Obstetrics (FIGO) classification, shape, involved vessels, extent of involvement, internal blood flow, and ultrasound diagnostic accuracy. Cumulative recurrence rates were calculated using Kaplan-Meier method, and the survival curves for clinical factors were analyzed. Prognostic analysis of IVL recurrence was performed using Cox proportional hazard model. The diagnostic accuracy of ultrasound for IVL was 55.7% (34/61). The diagnostic accuracy of ultrasound was 76.7% for para-uterine IVL (P<0.001), 76.9% for FIGO 8 category (P<0.001), 84.4% for cord-like or beaded morphology (P<0.001), 92.3% for the involvement of the iliac vessels or inferior vena cava (IVC, P=0.003), and 66.7% for abundant internal blood flow (P=0.213). During the follow-up period, IVL in 10 cases (16.4%) recurred. The cumulative recurrence rates were 10.5%, 12.8%, and 18% at 1, 2, and 3 years, respectively. Patients aged ≤46.5 years (P=0.010), with IVL involving the iliac vein or IVC (P=0.017), and undergoing myomectomy (P<0.001) had a higher recurrence rate. Univariate analysis identified age (≤46.5 years) (P=0.035), IVL involving the iliac veins or IVC (P=0.029), and myomectomy (P<0.001) as risk factors for recurrence. Multivariate analysis showed that IVL involving the iliac veins or IVC [P=0.021, hazard ratio (HR) 6.407] and myomectomy (P<0.001, HR 77.360) were independent risk factors for recurrence. The diagnostic accuracy of ultrasound was high for IVL located adjacent to the uterus and in FIGO 8 category, especially when it presented with cord-like or beaded morphology and involved the iliac vessels or IVC. Involvement of the iliac veins or IVC and myomectomy were independent risk factors for IVL recurrence. The risk of recurrence for IVL involving the iliac veins or IVC was 6 times higher than that confined to the uterus or para-uterine veins, and the risk of recurrence was 77 times higher for myomectomy than for hysterectomy with bilateral oophorectomy.

Analysis of the influence of emotional factors on the efficacy and prognosis of endoscopic treatment of functional abdominal pain in children.

This study aimed to explore the influence of emotional factors on the efficacy and prognosis of endoscopic treatment in children with functional abdominal pain (FAP), and to identify related risk factors. A total of 66 children with FAP treated with endoscopy from January 2018 to June 2024 were evaluated using the Child Depression Scale, Child Anxiety Scale, Quality of Life Scale, and visual analog scoring. Patients' demographics, clinical symptoms, treatment methods, and outcomes were recorded. Symptom remission, recurrence rates, and quality of life changes were compared after 6 months. Pearson correlation and logistic regression analyses were conducted. High-anxiety (35 cases) and low-anxiety (31 cases) groups had mean pain scores of 4.85 ± 1.21 and 2.10 ± 0.85, respectively (P = .001). Recurrence rates were 34.3% and 9.7%, respectively (P = .012). Good-mood (20 cases) and bad-mood (46 cases) groups had quality of life scores of 85.50 ± 5.50 and 63.50 ± 7.00 (P < .05). High-depression (25 cases) and low-depression (41 cases) groups had mean pain scores of 5.10 ± 1.10 and 2.40 ± 0.75 (P < .05), with recurrence rates of 36.0% and 14.6%, respectively (P = .009). Anxiety and depression were positively correlated with pain scores (r = 0.60, r = 0.58, P < .05) and negatively correlated with quality of life (r = -0.56, r = -0.54, P < .05). Anxiety (OR = 3.20, P = .003) and depression (OR = 2.80, P = .007) were independent risk factors for recurrence. Emotional factors significantly affect the efficacy and prognosis of endoscopic treatment in children with FAP. Negative emotions increase recurrence risk and reduce treatment efficacy and quality of life. Psychological intervention should be considered to improve outcomes.

Endoscopic Management of Recurrent Anastomotic Biliary Stricture Following Deceased Orthotopic Liver Transplantation.

Background/Objectives: Data on the natural history and endoscopic treatment outcomes of recurrent anastomotic biliary stricture (RABS) after orthotopic liver transplantation (OLT) are limited. This study aimed to evaluate the incidence and outcomes of RABS after OLT. Methods: A retrospective single-center study on OLT patients who underwent successful endoscopic treatment of ABS was conducted. The incidence of RABS, risk factors for recurrence, and outcomes of repeat endoscopic therapy were recorded. Results: A total of 131 OLT patients with ABS underwent endoscopic treatment, of which 119 successfully completed an endoscopic treatment course. After a median follow-up of 51.5 months (IQR 18.5-86.25) from ABS resolution, 26/119 patients (22.7%) developed RABS. All patients with RABS underwent a second endoscopic treatment course; 24 patients received self-expandable metal stents and 2 received plastic stents. Re-treatment was successful in 21 patients (80.8%) after a median of 8.5 months (IQR 5.25-14.50) and a total of 62 ERCPs. Adverse events occurred in two patients (7.4%)-one bacteremia and one suprastenotic biliary stricture. After a median follow-up of 65.5 months (IQR 20.75-125.5) from stent removal, only one patient had a second recurrence, which was treated with a Roux-en-Y hepaticojejunostomy. Multivariate analysis showed that older age at ABS diagnosis (OR 1.1; 95% CI: 1.1-1.2 p = 0.04) was the only independent risk factor for recurrence. Conclusions: RABS affects more than 20% of patients after successful endoscopic treatment. A second endoscopic therapy with covered self-expandable metal stents is a safe and effective option and should be considered before more invasive options.

A combination of hepatic leukemia factor and circulating tumor cells serve as effective biomarkers for lung adenocarcinoma prognosis.

Lung adenocarcinoma (LUAD) is a highly malignant tumor with the highest mortality rate among all cancers. Early diagnosis and prognosis are important factors in treatment. Hepatic leukemia factor (HLF) is thought to be closely associated with lung cancer metastasis. It is downregulated in lung cancer tissues and negatively correlated with the number of metastasis-activating circulating tumor cells (CTCs) in the peripheral blood of patients. In this study, we analyzed data from LUAD samples in TCGA and found that HLF was significantly upregulated in samples with EGFR mutations. Immunohistochemical (IHC) staining of 343 clinical samples also revealed a trend of HLF upregulation in patients with EGFR mutations. EGFR is one of the driver genes in non-small cell lung cancer (NSCLC), and the proportion in LUAD is as high as 50% in the East Asian population. In this study, EGFR mutation was not significantly correlated with the prognosis of LUAD patients and the number of CTC was also not related to EGFR mutation, but was closely related to HLF expression, with more CTCs being captured in the peripheral blood of patients with low expression of HLF (SI ≤ 4). By following up these 343 LUAD patients, high HLF expression (SI > 4) was found to be an independent protective factor for progression-free survival regardless of EGFR status (P<0.001), whereas high CTC count (> 3) was an independent risk factor for recurrence or death in LUAD patients (P<0.001). When low HLF and high CTCs coexisted, patients had the shortest median survival time. Patients with low HLF or high CTCs appeared alone had a moderate median survival time. Patients had the longest median survival time when HLF was high and CTCs were low. In summary, we believe that HLF expression in cancer tissues and the number of CTCs can be used as effective biomarkers for predicting the prognosis of LUAD, which plays an important role in clinical diagnosis and prognosis judgment.

Analysis of risk factors for recurrence after laparoscopic myomectomy: A retrospective study.

At present, there is unclear on the risk factors of recurrence after myomectomy. In this study, we hope to provide reference for the choice of treatment for patients with uterine fibroids and provide basis for the subsequent prediction of recurrence. From October 2020 to October 2022, we enrolled 240 patients with uterine fibroids in Hubei Maternal and Child Health Hospital. According to the inclusion criteria, the collected clinical data of these patients were analyzed and divided into 2 groups according to whether there was recurrence 6 months after surgery(a recurrence group [52 cases] and a non-recurrence group [78 cases]). We compared and analyzed the relevant factors. Univariate analysis showed that there was no significant relationship between fibroid diameter, postoperative pregnancy, contraceptive method, hyperlipidemia, diabetes, endometriosis and postoperative recurrence (P > .05). While, age, number of pregnancies, number of fibroids, type of fibroids, body mass index, endometrial hyperplasia or endometrial polyp were significantly correlated with postoperative recurrence (P < .05). Multivariate Logistic regression analysis demonstrated that body mass index > 24, number of pregnancies > 2, multiple myoma, intermyoma and endometrial hyperplasia were independent risk factors for postoperative myoma recurrence (P < .05). Body mass index > 24, number of pregnancies > 2, multiple fibroids, intermyowall fibroids, and endometrial hyperplasia are all independent risk factors for recurrence after laparoscopic myomectomy in patients with uterine fibroids. Patients with these independent risk factors should be closely reviewed. If they have multiple independent risk factors and have no fertility requirements are present, hysterectomy may be recommended.

COVID-associated left atrial changes as a significant predictor of atrial fibrillation recurrence

Aim. To determine the prognostic significance of left atrial (LA) changes after SARS-CoV-2 infection on the atrial fibrillation recurrence rate after catheter ablation.Material and methods. The study involved 40 patients. All patients were monitored after 3, 6 and 12 months, as well as when the clinical performance of the disease changed. The average follow-up time was 19±3 months. Recurrence of atrial fibrillation was observed in 18 patients (45%).Results. The study groups were completely comparable in age (p=0,382), sex (p=0,604), arrhythmia type (p=0,842), and history of previous surgeries (p=0,949). Arrhythmia recurrence was 9,33 [2,18; 39,96] times more common in patients who had SARS-CoV-2 infection before surgery (p=0,01). Arrhythmia recurrence after catheter ablation caused by left atrial posterior wall fibrosis and without pulmonary vein reconnection is an independent risk factor for recurrence after another ablation attempt (p=0,020). Also, arrhythmia recurrence was 9 [2,09; 38,79] times more common in patients after left atrium posterior wall box isolation (p=0,002). About half of the atrial area in patients with arrhythmia recurrence is represented by myocardium with an amplitude of less than 0,25 mV. In patients without recurrence, the area with this amplitude is on average 15,9% smaller (49±18,4% and 33,1±17,5%, respectively; p=0,020). Differences in the myocardial area with an amplitude of less than 0,5 mV are more pronounced and average 21,4% (p=0,006). LA myocardial tissue with normal signal amplitude (&gt;0,75 mV) is represented by only 17,4% of the area in patients with disease recurrence, which is 2,14 times less than in patients with remission (p=0,011).Conclusion. LA myocardial changes after SARS-CoV-2 infection are stable over time and significantly increase the arrhythmia recurrence risk after catheter ablation. Additional left atrial posterior wall box isolation does not reduce the risk of recurrence and does not significantly affect the duration of sinus rhythm control.

Association of tumor cells at the cardiac myxoma stalk invading into the elastic fiber layer between heart walls with tumor recurrence: a preliminary study

Objective: To analyze the pathological features of recurrent cardiac myxoma to provide a reference basis for clinical treatment and postoperative follow-up. Methods: The pathological data of cardiac myxoma patients who underwent cardiac myxoma surgery in Beijing Anzhen Hospital, Beijing, China from 2002 to 2016 were retrospectively analyzed. According to the grouping criteria, the cases were divided into the recurrence group (n=6) and control group (n=73). Results: In the recurrence group, there were 3 females and 3 males with a median age of 47 years. In the control group, there were 49 females and 24 males, with a median age of 53 years. Cardiac myxoma usually occurred in the left atrium. In the recurrence group, 5 cases occurred in the left atrium and 1 case in the right atrium. In the control group, 68 cases occurred in the left atrium, 4 cases in the right atrium, and 1 case in bilateral atria. Among the 6 cases in the recurrence group, the recurrence time was 1-7 years, with average 4.8 years. In the univariate analysis of recurrent cardiac myxoma pathology, disruption of elastic fiber layer and tumor cells of the tumor stalk invading into the myocardium through the elastic fiber layer were statistically associated with recurrence of cardiac myxoma (P<0.05). Logistic regression analyses showed that the invasion of tumor cells through the elastic fiber layer of the heart wall into the myocardium was an independent risk factor for recurrence (Odds Ratio=0.999, P<0.05). Conclusion: During the pathologic diagnosis, assessing the relationship between tumor cells in the stalk of cardiac myxoma and elastic fiber layer can help estimate the recurrence risk of cardiac myxoma, and thus guide clinical treatment and postoperative follow-up.

Longitudinal Analysis of Recurrence and Risk Factors of Early-Stage Resected Adenocarcinoma With Common EGFR Mutations: A Multicenter Retrospective Cohort Study in South Korea.

Despite curative surgery for lung cancer, 30% to 55% of patients experience recurrence or death, which highlights the importance of adjuvant treatment. Adjuvant osimertinib therapy effectively prolongs disease-free and overall survival in patients with lung cancer harboring common epidermal growth factor receptor (EGFR) mutations. To identify potential candidates for adjuvant osimertinib, it is crucial to understand the rates and identify risk factors of recurrence. This multicenter, retrospective cohort study was conducted in the Republic of Korea and enrolled patients who, between 2010 and 2017, underwent resection of stages I-III adenocarcinomas, with common EGFR mutations. The primary outcomes comprised the rate and risk factors of postoperative recurrence. Among the 759 participants, the overall recurrence rate and median recurrence-free survival were 39.1% and 59.8 (interquartile range [IQR], 26.3-84.2) months, respectively, during a median follow-up of 73.0 (IQR, 55.4-95.0) months. The recurrence rates for stages IA, IB, IIA, IIB, IIIA, and IIIB were 14.7%, 45.5%, 53.8%, 72.5%, 80.3%, and 93.3%, respectively. Multivariate analysis revealed that age ≥ 65 years, body mass index < 18.5 kg/m², the Del19 subtype of EGFR mutation, tumor size ≥ 2.3 cm, N1 involvement, N2 involvement, predominantly micropapillary or solid pattern, and the presence of visceral pleural invasion were independently associated with recurrence. This multicenter cohort study demonstrated that stages I-III EGFR-mutated adenocarcinoma has a postoperative recurrence rate of 39.1%, and identified 7 independent risk factors for recurrence.

Margin thermal ablation eliminates size as a risk factor for recurrence after piecemeal endoscopic mucosal resection of large non-pedunculated colorectal polyps

BackgroundLesion size is an independent risk factor for recurrence following endoscopic mucosal resection of large (≥20 mm) non-pedunculated colorectal polyps. Post-resection margin thermal ablation (MTA) reduces the risk of recurrence....

Long-term clinical outcomes after salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy.

This study aimed to evaluate the clinical outcomes of patients who developed prostate-specific antigen failure after radical prostatectomy and were treated with salvage radiotherapy (SRT). This retrospective study included 167 patients who received SRT between January 2008 and August 2017 at a single center. Cumulative and periodic genitourinary and gastrointestinal adverse events and the chronologic changes in quality of life were evaluated before and 1, 3, 6, 12, 24, 36, 48, and 60months after SRT. The median follow-up duration after SRT was 83months. The 5- and 7-year biochemical recurrence-free rates were 52.6% and 47.9%, respectively. Multivariate analysis revealed the following independent risk factors for recurrence after SRT: higher total Gleason score (≥8), higher pathological T stage, negative resection margin, and shorter period between radical prostatectomy and biochemical recurrence-free. The cumulative incidence rates of grade 2 or higher genitourinary and gastrointestinal adverse events after SRT were 27.4% and 9.4%, respectively. Bowel function worsened after SRT and showed significant deterioration 5years after SRT, compared with pre-treatment. Five years post SRT, the rates of patients whose physical and mental component scores were<50 were 44.1% and 34.3%, respectively. Prostate-specific antigen recurrence occurred in approximately half of the patients after SRT, with a higher Gleason score, higher pathological T stage, negative resection margin, and shorter period between radical prostatectomy and first biochemical recurrence identified as risk factors. Besides the adverse events, careful attention to long-term quality-of-life deterioration must be considered when considering indications for SRT.

Impact of upper tract urothelial carcinoma history on patients with non-muscle invasive bladder cancer undergoing intravesical chemotherapy

This study was designed to evaluate the impact of upper tract urothelial carcinoma (UTUC) history on prognosis in patients with non-muscle-invasive bladder cancer (NMIBC) receiving intravesical chemotherapy. We conducted a single center, retrospective, cohort study of 444 NMIBC patients who received intravesical chemotherapy after transurethral resection of the bladder cancer (TURBT) at Peking University People’s Hospital from 2000 to 2015. Patients were divided into UTUC-NMIBC group (with UTUC history) and primary NMIBC group (without UTUC history) by presence of previous UTUC. Demographic, clinical and pathologic factors were analyzed. Kaplan–Meier curves and the log-rank test were used to depict and compare recurrence-free survival (RFS) and progression-free survival (PFS) between the two groups. Multivariable Cox regression models were constructed to determine the variables associated with RFS and PFS. Compared to the primary NMIBC group (n = 410), the UTUC-NMIBC group (n = 34) had an older median age [72.0 (65.0–81.0) vs. 66.0 (58–75) years; P = 0.007], a higher incidence of multiple tumors (52.9% vs. 33.9%; P = 0.026) and a higher recurrence rate (52.9% vs. 30.7%; P = 0.008) and worse RFS (P < 0.001). In multivariate analysis, UTUC history was an independent risk factor for recurrence (hazard ratio = 2.242; P = 0.001), but not for progression. Interestingly, subgroup analysis indicated patients with recent UTUC history (≤ 24 months between UTUC and NMIBC diagnoses) were associated with increased recurrence rates (73.7% vs. 26.7%; P = 0.014). Presence of UTUC history was an independent risk factor for recurrence in patients with NMIBC who received intravesical chemotherapy, especially in those with a shorter interval between UTUC and NMIBC diagnoses.

Investigating the impact of persistent HPV infection on recurrence of lesions post-surgery for early-stage cervical cancer and related influencing factors.

To explore the influencing factors of recurrence after surgical treatment for early-stage cervical cancer (stages IA1-IIA1) and to investigate the relationship between human papillomavirus (HPV) infection and postoperative recurrence of lesions. A retrospective analysis was conducted on the clinical data of 242 patients who underwent surgical treatment for early-stage cervical cancer (FIGO stages IA1-IIA1) at the Second Affiliated Hospital of Dalian Medical University between 2015 and 2022. Cox regression analysis was employed to evaluate the relationship between persistent postoperative HPV infection and lesion vaginal local recurrence while identifying the associated risk factors for persistent HPV infection following surgery. Within 12 months postoperatively, the HPV clearance rate was 88.11%. HPV infection persisted beyond 12 months in 19 patients (7.9%), with 3 cases demonstrating the same HPV genotypes (types 52, 58) as those identified preoperatively. Multivariate analysis identified persistent postoperative HPV infection (odds ratio [OR] 1.72, 95% confidence interval [CI] -1.14 to 5, p=0.001*) as an independent risk factor for recurrence. Additionally, smoking (OR 7.49, 95% CI 1.19 to 47.13, p=0.032), abnormal vaginal microbiota (OR 0.663, 95% CI 0.403 to 1.088, p=0.001*), and the type of surgical procedure (OR 0.32, 95% CI 0.11 to 0.91, p=0.033) were significantly associated with a higher rate of persistent HPV infection. Persistent HPV infection after surgery is an independent risk factor for postoperative recurrence in early-stage cervical cancer. Surgical approach, abnormal vaginal microbiota, and smoking are associated factors for persistent HPV infection after surgery.

Large L5-S1 Lordosis is an Independent Risk Factor for recurrENCE AFTER BOne Union of Pediatric Lumbar Spondylolysis at L5: A Retrospective Case-control Study.

Retrospective case-control study. To determine risk factors for recurrence of pediatric lumbar spondylolysis at L5 after return to sport in patients who achieved bone union with conservative treatment. Pediatric lumbar spondylolysis is a stress fracture commonly observed in adolescent athletes, particularly at the L5 vertebra. Because some patients experience a recurrence of spondylolysis after bone fusion with conservative treatment, identifying risk factors for recurrence may help athletes continue sports activities, maintain performance levels, and preserve mental health. Of the 375 pediatric patients (<18 years of age) who received conservative treatment for lumbar spondylolysis at L5 between 2015 and 2021, 296 patients who achieved bone fusion and returned to their original sports activities were analyzed. Recurrence rate, sports, pathological stage of spondylolysis at initial examination, presence of spina bifida occulta (SBO), duration of conservative treatment for initial spondylolysis, and radiological parameters including lumber lordosis, L5-S1 lordosis, and sacral slope were examined. Recurrence and non-recurrence groups were compared using univariate and multivariate analyses to investigate risk factors for recurrence. A receiver operating characteristic (ROC) curve was drawn to determine cut-off values of the parameters to predict spondylolysis recurrence. Recurrence was observed in 52 out of 296 patients (17.6%). Multivariate logistic regression analysis revealed that a large L5-S1 lordosis was a significant independent risk factor for recurrence. ROC analysis demonstrated a cut-off value of 24.5° for L5-S1 lordosis. Age, sex, SBO, and duration of conservative treatment for initial spondylolysis were not significant predictors of recurrence. We identified large L5-S1 lordosis as an independent risk factor for recurrence of pediatric lumbar spondylolysis at L5 following conservative treatment. Intensive athletic rehabilitation to prevent recurrence and follow-up measures to monitor and detect recurrence are recommended for patients with large L5-S1 lordosis.

A novel nomogram for predicting post-operative recurrence for patients with intermediate and high-risk non-muscle invasive bladder cancer after thulium laser resection of bladder tumors or conventional transurethral resection of bladder tumors followed by intravesical bacille Calmette-Guérin immunotherapy.

Post-operative recurrence for patients with intermediate and high-risk non-muscular invasive bladder cancer (NMIBC) is common. This study aims to evaluate the potential factors of tumor recurrence, and construct a novel nomogram to predict the probability of tumor recurrence. We retrospectively enrolled patients with intermediate and high-risk NMIBC who received thulium laser resection of bladder tumors (TmLRBT) or transurethral resection of the bladder tumor (TURBT) followed by intravesical bacille Calmette-Guérin (BCG) immunotherapy. The risk factors were screened by the least absolute shrinkage and selection operator (LASSO) regression method. And multivariate logistic regression was applied to recognize the independent risk factors of bladder cancer recurrence. A nomogram was established, and the recurrence probability was calculated based on the model scores. A total of 90 patients with intermediate and high-risk NMIBC were included in this study, of whom 53 underwent TURBT and 37 underwent TmLRBT. During the follow-up period, 22 patients (24.4%) experienced bladder cancer recurrence. Three variables were screened out in the LASSO regression. The multivariate logistic analysis suggested that surgery of TURBT [odds ratio (OR) =6.86760; 95% confidence interval (CI): 1.5048-31.34300] and previous bladder tumor (OR =14.73600; 95% CI: 2.81180-77.23000) were independent risk factors of recurrence, while more BCG treatment sessions (OR =0.26504; 95% CI: 0.12455-0.56398) was independent protective factor of recurrence. Patients with TURBT and previous bladder tumor history were more likely to develop recurrent bladder cancer, while more BCG treatment sessions was independent protective factor of recurrence.

Prognostic Impact of Potentially Curative Resection for Synchronous Peritoneal Carcinomatosis with Lavage Cytology Positivity in Colorectal Cancer: A Retrospective Observational Study

Although curative resection for synchronous peritoneal carcinomatosis has been reported to improve prognosis, cases with positive intraoperative lavage cytology have not been reported. In this study, we investigated the prognostic value of potentially curative resection based on colorectal cancer and lavage cytology positivity in patients with synchronous peritoneal carcinomatosis. We retrospectively evaluated 72 patients who underwent intraoperative lavage cytology and one-stage potentially curative resection of primary and metastatic lesions (lavage cytology-positive, n = 21; lavage cytology-negative, n = 51) between July 2004 and December 2019. We compared the 5-year overall survival and 3-year recurrence rates between the lavage cytology-positive and lavage cytology-negative groups. No significant differences were observed in the 5-year overall survival (48.2% vs. 45.5%, P = 0.924) or 3-year recurrence rates (74.5% vs. 62%, P = 0.143) between the two groups. Univariate analysis for 3-year recurrence revealed that lavage cytology-positive status was not an explanatory variable (hazard ratio: 1.552, 95% confidence interval: 0.83-2.902, P = 0.169). Multivariate analysis identified colon cancer as an independent risk factor of recurrence. In resectable cases, the resection of synchronous peritoneal carcinomatosis from colorectal cancer can be considered even if intraoperative lavage cytology is positive.

Clinical Characteristics and Prognostic Factors Affecting Clinical Outcomes in Cytomegalovirus Retinitis Following Allogeneic Hematopoietic Stem Cell Transplantation.

Background/Objectives: This study aimed to evaluate the clinical characteristics and identify the prognostic factors affecting visual outcomes, retinal detachment, and recurrence in cytomegalovirus retinitis (CMVR) patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A retrospective analysis of 54 CMVR patients (84 eyes) who underwent allo-HSCT between 2015 and 2024 was conducted. Ophthalmologic and systemic evaluations were performed. The visual outcomes were classified as improvement, stabilization, and deterioration. Logistic regression and LASSO regression models were used to identify the prognostic factors. Results: Improved or stabilized visual outcomes were found in 22 eyes, while 62 eyes suffered from deterioration. Larger lesion areas were independently associated with poorer visual outcomes (OR 0.989, p = 0.002). Eight (9.5%) eyes had rhegmatogenous retinal detachment and thirteen (15.5%) eyes suffered from recurrence. Retinal detachment was significantly predicted by higher baseline aqueous CMV DNA load (OR 5.087, p = 0.026). Macula involvement (OR 5.322, p = 0.032) and more intravitreal injections (IVs) (OR 1.263, p = 0.008) were independent risk factors for recurrence. No systemic factors were found to be associated with the clinical outcome of eyes with CMVR. Conclusions: Ocular characteristics, rather than systemic factors, were more useful to predict the clinical outcome of eyes with CMVR. Routine ophthalmic screening and early intervention are essential to improving outcomes in this vulnerable population.

The Role of hCG Expression in Endometrial Cancer Prognosis.

This study aims to investigate the expression pattern of human chorionic gonadotropin (hCG) in the tissue of endometrioid type endometrial cancer (EEC) using immunohistochemistry, and also to investigate the effect of hCG expression pattern on prognosis and survival in EEC. We evaluated patients who were operated between 2010 and 2020 in the obstetrics and gynecology clinic of our center due to EEC. In total, 194 women were determined to be in either the hCG-negative group (n=137) or the hCG-positive group (n=57). The detection rate of deep myometrial invasion (16.8% vs. 36.8%; P=0.002), lymphovascular space invasion (10.9% vs. 24.6%; P=0.015), and metastatic lymph node (6.7% vs. 21.8%; P= 0.003) in patients with hCG-positive staining were analyzed to be significantly higher. Five-year disease-free survival (DFS) (P= 0.015) and overall survival (OS) (P= 0.024) rates were found to be higher in the hCG-negative group. hCG expression was found to be an independent risk factor for recurrence, and DFS in grade I-II EEC was limited to the uterus and with superficial myometrial invasion (low risk). No independent risk factors for OS were analyzed. hCG positivity is a risk factor with poor prognostic factors in endometrial cancer. It was concluded that hCG expression in low-risk EEC is a valuable negative prognostic factor for recurrence and DFS.

Relationship between serum ECP and TIgE levels and the risk of postoperative recurrence in patients with chronic rhinosinusitis with nasal polyps.

This study was undertaken to assess the association between the likelihood of surgical recurrence and serum ECP and TIgE levels in chronic rhinosinusitis with nasal polyps (CRSwNP). Clinical information was gathered retrospectively from 166 cases of surgically treated CRSwNP as well as 60 cases of chronic rhinosinusitis without nasal polyps (CRSsNP). A comparative analysis on serum levels of total immunoglobulin E (TIgE) and eosinophil cationic protein (ECP) was carried out between the two groups. The CRSwNP patients were assigned into recurrence and non-recurrence groups based on the absence/presence of disease recurrence after a 2-year follow-up. An analysis was conducted on the correlation between the patients' clinical data and their serum ECP and TIgE levels. Receiver operating characteristic (ROC) curves were utilized to assess the clinical utility of these two biomarkers. The CRSwNP participants had higher serum levels of ECP and TIgE (4.28 ± 0.81 > 3.58 ± 0.77 ng/L, P < 0.001; 52.99 ± 8.62 > 15.65 ± 3.25 KU/L, P < 0.001) compared to CRSsNP participants. Univariate analysis indicated that neutrophil ratio, lymphocyte ratio, Lund-Kennedy score, Lund-Mackay score, SNOT-22 score, olfactory function score, and postoperative recurrence were significantly correlated with serum ECP and TIgE levels. Higher serum levels of TIgE and ECP (4.89 ± 0.79 < 4.11 ± 0.72, P < 0.001; 58.74 ± 8.27 < 51.40 ± 8.04, P < 0.001) were detected in the recurrence groups vs. the non-recurrence group. Multivariate analysis showed that serum ECP and TIgE were independent risk factors for recurrence of CRSwNP. Serum ECP and TIgE levels were found to be predictive of postoperative recurrence risk in CRSwNP patients (AUC: 0.77, 0.74, 0.84; P < 0.05) according to ROC curve analysis. Significant differences were not observed in any general clinical data. The findings suggest that elevated serum ECP and TIgE levels in patients with CRSwNP can be as good predictors for the risk of recurrence after endoscopic sinus surgery.