Postoperative Prognostic Factors Research Articles

Prognostic factors in postoperative patients with cutaneous melanoma: a systematic review and meta-analysis.

Cutaneous melanoma is a prevalent tumor associated with a poor prognosis. This systematic review and meta-analysis aimed to identify and evaluate prognostic factors for patients with cutaneous melanoma following surgery, thereby providing crucial insights for enhancing patient outcomes. We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science for studies on postoperative prognostic factors of cutaneous melanoma up to March 2024. Literature screening, data extraction, and quality assessment were performed, followed by meta-analysis using RevMan 5.3 software. Trial Sequential Analysis (TSA) was conducted with Stata 17 software to verify the robustness of the findings. Eleven studies encompassing 27,352 patients were included. The meta-analysis identified several prognostic factors impacting disease-specific survival post-surgery: age over 50 years (HR=1.05, 95% CI: 1.02-1.08), female gender (HR=0.71, 95% CI: 0.57-0.87), Breslow thickness greater than 2 mm (HR=1.11, 95% CI: 1.06-1.17), presence of ulceration (HR=2.06, 95% CI: 1.63-2.60), and positive sentinel lymph node (HR=3.03, 95% CI: 2.50-3.66). TSA confirmed the adequacy of the sample size. Aggressive treatment strategies are recommended for patients exhibiting these characteristics to improve prognosis and extend 5-year survival rates.

Can Radiological Tumour Thickness Predict Pathological Prognostic Factors in Clinicoradiologically Node-Negative Oral Squamous Carcinoma? A Prospective Study.

This research investigates potential connections between radiological tumour thickness determined by CT scans and various pathological prognostic factors. These factors include pathological tumour thickness (pTT), pathological depth of invasion (DOI), and positive cervical nodal metastasis. This analysis focuses on cases of clinicoradiologically node-negative squamous cell carcinoma of the buccal mucosa. Sixty-one previously untreated clinicoradiologically node-negative squamous cell carcinoma of buccal mucosa were included in the study. The radiological tumour thickness in the preoperative CT scans is correlated with other prognostic factors like pathological tumour thickness, DOI and presence or absence of neck node. Sixty-one patients were included in the study with a median age of 54 years (Range 27-84). Forty-two patients (68.9%) were male, and 19 were females (31.1%). There was no statistically significant difference in mean values of rTT among patients with positive or negative post-operative nodal metastases. However, a significant correlation could be established with rTT to other potential prognostic factors. Tumor thickness in preoperative CT scans can be used to predict post-operative prognostic factors in oral squamous cell carcinoma.

Prognostic model using postoperative normalization of C-reactive protein levels in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy.

To improve the prediction of outcomes in patients who will undergo radical nephroureterectomy (RN U) for upper tract urothelial carcinoma (UTUC), we investigated the preoperative prognostic factors and developed a risk classification model. A total of 144 patients who underwent RNU with history of neither neoadjuvant nor adjuvant chemotherapy between 2008 and 2022 were retrospectively reviewed. Associations between perioperative/clinicopathologic factors and outcomes, including cancer-specific survival (CSS), were assessed. We specifically focused on preoperative serum C-reactive protein (CRP) and its postoperative normalization. Non-normalization of postoperative serum CRP level and pathologic T3 stage were identified as independent predictive factors of shorter CSS in univariate and multivariate analysis (p=0.0150 and 0.0037, hazard ratio: 3.628 and 4.470, respectively). We classified the patients into three groups using these factors and found that five-year CSS was 88%, 42.5%, and 0% in the low-risk group (zero factors), intermediate-risk group (one factor), and high-risk group (two factors), respectively (p<0.0001). Non-normalization of postoperative serum CRP level and pathologic T stage were identified as independent postoperative prognostic factors in patients with UTUC who underwent RNU. These factors can stratify three prognostic groups and may help urologists in clinical decision-making for adjuvant therapy.

Development and external validation of a nomogram predicting overall survival for Gastric adenocarcinoma patients with radical gastrectomy

Purpose The aim of this study was to develop and externally validate a nomogram to accurately predict the overall survival (OS) of patients with gastric adenocarcinoma who underwent radical gastrectomy. Materials and Methods A total of 3492 patients with gastric adenocarcinoma who underwent radical gastrectomy from 2012 to 2017 were included as the training cohort. Survival analysis was performed via Kaplan Meier method and log-rank test. Independent postoperative prognostic factors in patients with gastric adenocarcinoma were analyzed using univariate and multifactorial COX analysis methods. The prognosis nomogram was established in the training cohort and verified externally in the Surveillance, Epidemiology and End Results (SEER) database. Results According to the univariate and multifactorial COX analyses, metastatic lymph node ratio (MLNR) and five other independent prognostic factors (age at surgery, type of gastrectomy, tumor size, T stage, and pathological grade) were included in the prognostic nomogram. The nomogram had better prognostic predictive ability than the American Joint Committee on Cancer (AJCC) TNM staging in both the training (C-index: 0.736 VS. 0.668) and external validation cohort (C-index: 0.712 VS. 0.627). The calibration plots showed that the predicted survival rate was in good agreement with the actual survival rate. And the decision curve analysis (DCA) curves revealed that nomogram showed stronger ability in predicting 1-year, 3-year, and 5-year OS. Conclusion This study estimated the excellent prognostic predictive power and clinical application potential of the MLNR-based nomogram, which may be used to facilitate postoperative clinical treatment decisions and potentially improve patient survival outcomes.

Preoperative and postoperative prognostic factors effective on overall survival in gastric cancer

BACKGROUND: It is to investigate preoperative and postoperative prognostic factors on general survival in patients undergoing surgery due to gastric cancer.METHODS: Mersin University Medical Faculty Hospital between the years 2007-2015, 97 patients who underwent gastric cancer due to age, gender, preferences of patients and type of surgery (total gastrectomy subtotal) of the patients, histopathological diagnosis, tumor grade, tumor invasion, pathological stage, serum albumin levels, tumor markers, complete blood counts, and survival situations were recorded and retrospectively analyzed. From these data, neutrophil-lymphocyte ratio (NLR) and platellet-lymphocyte ratio (PLR) were calculated. The relationship of these results to postoperative survival was evaluated. IBM SPSS for Windows, version 17.0 was used for statistical tests.RESULTS: Of the patients included in the study, 28 (28.9%) were male and mean age were 62.1±13.4 years. When the patients were grouped according to the development of recurrence, recurrence was observed in 14 (14.4%) patients. TNM stage, depth of invasion, grade and platelet count were found to be significantly higher in patients who developed relapse. When the patients were grouped as 28 (28.7%) who developed mortality and 60 (71.3%) who did not develop mortality, TNM stage, depth of invasion and platelet count were significantly higher in the mortality group, similar to the patients who developed relapse, but tumor grade was not significant. When the parameters associated with the development of recurrence and mortality were evaluated, it was found that TNM stage, depth of invasion and increase in platelet count were associated with both recurrence and mortality, while NLR and PLR did not have a significant effect on mortality and recurrence.CONCLUSIONS: Although the inflammatory response plays an important role in many types of cancer, including gastric cancer, the ideal prognostic factors affecting mortality and overall survival at relapse have still not been clearly identified.

Elevation of the Neutrophil-to-Lymphocyte Ratio Is a Significant Postoperative Poor Prognostic Factor in Patients With Clinical T3-4 Centrally Located Primary Lung Cancer.

In centrally located non-small cell lung cancer (CLNSCLC) surgery, large tumors and extension to neighboring structures prevent the attainment of adequate surgical fields and make operations more difficult, and some patients have extremely poor outcomes. This study aimed to identify novel postoperative prognostic factors in patients with advanced CLNSCLC. CLNSCLC was defined as a tumor requiring pneumonectomy or sleeve lobectomy for complete removal. We retrospectively investigated the clinical courses of 35 patients with cT3-4 CLNSCLC. This study included 21 patients with cT3 and 14 with cT4 lung cancer. Nine patients underwent pneumonectomy and 26 underwent sleeve lobectomy. Univariate analysis revealed that a high neutrophil-to-lymphocyte ratio (NLR, p=0.005) and carcinoembryonic antigen (CEA) positivity (p=0.028) were significant poor prognostic factors. Only high NLR (p=0.020) was a significant independent predictor in multivariate analysis. Nine of 16 patients with high NLR (56%) experienced disease recurrence, whereas 6 of 19 patients without high NLR (32%) had recurrent disease. High NLR and CEA positivity were significant poor prognostic factors in patients with cT3-4 CLNSCLC, and only high NLR was an independent predictor. Our findings may be helpful in selecting optimal treatments for advanced CLNSCLC.

Clinical phenotypes and prognostic factors in persons with hip osteoarthritis undergoing total hip arthroplasty: protocol for a longitudinal prospective cohort study (HIPPROCLIPS)

BackgroundLarge heterogeneity exists in the clinical manifestation of hip osteoarthritis (OA). It is therefore not surprising that pain and disability in individuals with hip OA and after total hip arthroplasty (THA) cannot be explained by biomedical variables alone. Indeed, also maladaptive pain-related cognitions and emotions can contribute to pain and disability, and can lead to poor treatment outcomes. Traumatic experiences, mental disorders, self-efficacy and social support can influence stress appraisal and strategies to cope with pain, but their influence on pain and disability has not yet been established in individuals with hip OA undergoing THA. This study aims (1) to determine the influence of traumatic experiences and mental disorders on pain processing before and shortly after THA (2) to identify preoperative clinical phenotypes in individuals with hip OA eligible for THA, (3) to identify pre- and early postoperative prognostic factors for outcomes in pain and disability after THA, and (4) to identify postoperative clinical phenotypes in individuals after THA.MethodsThis prospective longitudinal cohort study will investigate 200 individuals undergoing THA for hip OA. Phenotyping variables and candidate prognostic factors include pain-related fear-avoidance behaviour, perceived injustice, mental disorders, traumatic experiences, self-efficacy, and social support. Peripheral and central pain mechanisms will be assessed with thermal quantitative sensory testing. The primary outcome measure is the hip disability and osteoarthritis outcome score. Other outcome measures include performance-based measures, hip muscle strength, the patient-specific functional scale, pain intensity, global perceived effect, and outcome satisfaction. All these measurements will be performed before surgery, as well as 6 weeks, 3 months, and 12 months after surgery. Pain-related cognitions and emotions will additionally be assessed in the early postoperative phase, on the first, third, fifth, and seventh day after THA. Main statistical methods that will be used to answer the respective research questions include: LASSO regression, decision tree learning, gradient boosting algorithms, and recurrent neural networks.DiscussionThe identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA.Trial registrationClinicalTrials.gov: NCT05265858. Registered on 04/03/2022.

Prognostic impact of the number of metastatic lymph nodes after surgery in locally advanced hypopharyngeal cancer

BackgroundPostoperative chemoradiotherapy (CRT) is a standard therapy for patients with high-risk factors for head and neck squamous cell carcinoma, including positive margin and extra-nodal extension (ENE). However, the prognostic impact of the number of pathological metastatic lymph nodes (pLNs) in hypopharyngeal carcinoma (HPC) is unclear. Thus, this study aimed to investigate postoperative prognostic factors for locally advanced hypopharyngeal squamous cell carcinoma (LA-HPSCC) with a focus on the number of pLNs.MethodsWe retrospectively analyzed medical records of 99 consecutive patients with LA-HPSCC who underwent total pharyngo-laryngo-esophagectomy (TPLE) and bilateral neck dissection (ND) between December 2002 and May 2019.ResultsThe median follow-up time for all censored patients was 63.2 months. The median overall survival (OS) was 101.0 months (95% confidence interval [CI] 48.1–134.9). patients had pLNs ≥ 3. Forty-six (45.5%) patients were diagnosed with ENE. Twenty (20.2%) patients received postoperative CRT. The multivariate analysis revealed that pLNs ≥ 3 (median OS: 163.2 vs. 31.8 months, hazard ratio [HR] 2.39, 95% CI 1.16–4.94, p < 0.01) and ENE (median OS: 161.0 vs. 26.3 months, HR 4.60, 95% CI 2.26–9.36, p < 0.01) were significantly associated with poor prognosis and that postoperative CRT (HR 0.34, 95% CI 0.16–0.72, p < 0.01) was significantly associated with better prognosis. The cumulative incidence of distant metastasis was higher in patients with pLNs ≥ 3 than in those with pLNs < 3 (p < 0.01).ConclusionpLNs ≥ 3 and ENE were significant poor prognostic factors for patients with LA-HPSCC who underwent TPLE and bilateral ND.

MO27-2 Prognostic impact of the number of metastatic lymph nodes after surgery in locally advanced hypopharyngeal cancer

Postoperative chemoradiotherapy is a standard therapy for the high risk patients with poor prognostic factors of the head and neck squamous cell carcinoma. Although incomplete resection and extra-nodal extension (ENE) were identified as postoperative prognostic factors in the combined analysis of the EORTC 22931 and the RTOG 9501 trials, other factors including the number of pathological metastatic lymph nodes (pLNs) were not significant. Furthermore, proportion of hypopharyngeal cancer (HPC) was small in those trials, and the prognostic impact of the number of pLNs in patients with HPC has been controversial.

Factors affecting clinical outcomes after massive rotator cuff repair using a data mining technique

A data mining technique using decision tree analysis is a method of discovery of new knowledge and patterns from big data. This study aimed to clarify by decision tree analysis the interaction among preoperative and postoperative prognostic factors that affect patient satisfaction after massive rotator cuff repairs (RCR). The study evaluated 1367 shoulders (right 956, left 411) with massive rotator cuff tears. Exclusion criteria were fracture, dislocation, re-tear, nerve paralysis, and insufficient follow-up.

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand.

An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.

An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. The analysis included 83 patients. After a median follow-up of 47months, the median overall survival (OS) was 34.6months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are neededto confirm CRS and HIPEC as the gold standard in this pathology.

Analysis of related factors of prognosis after surgical treatment of patients with non-metastatic colorectal cancer and construction of a normagram prediction model

Objective: To investigate the postoperative prognostic factors of non-metastatic colorectal cancer (non-mCRC), and construct a prognostic prediction model. Methods: A total of 846 patients with colorectal cancer who were admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from July 1, 2014 to December 31, 2016 were included in the study. There were 314 patients in the metastatic colorectal cancer (mCRC) group and 532 patients in the non-mCRC group. The data of clinical characteristics, preoperative blood routine and common serum tumor markers for CRC tests were collected retrospectively. The disease-free survival time (DFS) data of patients in non-mCRC group were obtained by follow-up. Univariate and multivariate Cox regression analyses were used to clarify the independent risk factors of DFS, and then these factors were included to construct a nomogram prediction model. The concordance index (C index), receiver operating characteristic curve (ROC) and calibration curve were used to evaluate the performance of the model. Results: Platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 242 (CA242) in the mCRC group were higher than those of the non-mCRC group, while the lymphocyte/monocyte ratio (LMR) was lower than that of the non-mCRC group (P<0.05). ROC analysis showed that the area under curve (AUC) of CEA, CA19-9, CA242, NLR, LMR and PLR for the diagnosis of mCRC were 0.775, 0.716, 0.712, 0.607, 0.591 and 0.556, respectively. Multivariate Cox regression analysis demonstrated that age, perineural invasion, pN stage and preoperative CA242 level were independent risk factors for DFS of non-mCRC patients (P<0.05). Based on this, a nomogram prediction model predicting 3 years of DFS for non-mCRC patients was constructed, its C index and AUC for non-CRC prognostic prediction were 0.710 and 0.733, respectively, higher than 0.696 and 0.701 of AJCC 7th edition TNM staging system. The calibration curve of nomogram showed that the predicted DFS rate was consistent with the actual DFS rate. Conclusions: Age, perineural invasion, pN stage and preoperative CA242 level are independent risk factors for 3-year DFS of non-mCRC patients. The nomogram prediction model constructed based on these four indictors has a good predictive performance and may provide prognosis evaluation reference for the patients with non-mCRC.

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection.

Recurrence rates of intrahepatic cholangiocarcinoma (iCCA) after curative hepatectomy are as high as 50% to 70%, and about half of these recurrences occur within 2 years. This systematic review aims to define prognostic factors (PFs) for early recurrence (ER, within 24 months) and 24-month disease-free survival (DFS) after curative-intent iCCA resections. Systematic searching was performed from database inception to 14 January 2021. Duplicate independent review and data extraction were performed. Data on 13 predefined PFs were collected. Meta-analysis was performed on PFs for ER and summarized using forest plots. The Quality in Prognostic Factor Studies tool was used for risk-of-bias assessment. The study enrolled 10 studies comprising 4158 patients during an accrual period ranging from 1990 to 2016. In the risk-of-bias assessment of patients who experienced ER after curative-intent iCCA resection, six studies were rated as low risk and four as moderate risk (49.6%; 95% confidence interval [CI], 49.2-50.0). Nine studies were pooled for meta-analysis. Of the postoperative PFs, multiple tumors, microvascular invasion, macrovascular invasion, lymph node metastasis, and R1 resection were associated with an increased hazard for ER or a reduced 24-month DFS, and the opposite was observed for receipt of adjuvant chemo/radiation therapy. Of the preoperative factors, cirrhosis, sex, HBV status were not associated with ER or 24-month DFS. The findings from this systematic review could allow for improved surveillance, prognostication, and treatment decision-making for patients with resectable iCCAs. Further well-designed prospective studies are needed to explore prognostic factors for iCCA ER with a focus on preoperative variables.

Nomograms for predicting the risk of biochemical recurrence in patients with prostate cancer after surgery

Background. Prostate cancer (PCa) patients often develop recurrent disease after radical surgery. A tool that can accurately predict the risk of disease progression in the population of Russian patients will be very helpful to choose an optimal treatment strategy and prevent possible recurrence.Objective: to analyze preoperative and postoperative prognostic factors for PCa progression and identify the most significant of them.Materials and methods. This study included 2,255 patients with localized and locally advanced PCa who underwent radical surgery. We constructed nomograms for predicting the risk of disease progression after surgery using mathematical models.Results. We created nomograms for predicting the risk of biochemical recurrence and probability of relapse-free survival by the level of prostate specific antigen (PSA) in patients with no lymph node metastases (pN0) according to the results of morphological examination and in patients with lymph node metastases (pN1). The accuracy of nomograms reached 71 % (area under the ROC curve (AUC) 0.7119) and 76 % (AUC 0.7617), respectively.Conclusion. The nomograms demonstrated high accuracy of prognosis and can be used in the population of Russian patients.

FACTORES PRONÓSTICOS EN LA SOBREVIDA DE PACIENTES OPERADOS DE ASTROCITOMA GRADO III, EN EL HOSPITAL GUILLERMO ALMENARA LIMA- PERÚ. 2003-2009

Introduction: Anaplastic astrocytoma (AA) or grade III is a primary brain tumor, astrocytic, malignant, and diffusely infiltrating. The survival of patients depends on several clinical and treatment factors, being this unknown in our environment. The objective of this study was to determine the survival of patients operated on for grade III astrocytoma and the impact of preoperative and postoperative prognostic factors. Methods: A retrospective, observational and longitudinal study of 35 patients operated on for astrocytoma grade III at Hospital Guillermo Almenara between 2003 and 2009 was carried out. Data were collected from medical records, operative reports, and telephone interviews. Patients with anaplastic astrocytomas were classified according to prognostic risk group, treatment type, and surgery extent. SPSS 25.0 was used for the analysis. Results: Of a total of 124 patients with astrocytoma, 28.2% (35/124) had a grade III astrocytoma, with an average survival of 34.8 months. According to the clinical prognosis group, the survival of the low, medium, and high-risk groups was 46.7, 28.1, and 8.5 months, respectively. Regarding the type of treatment, the group with the longest survival was surgery + radiotherapy (39.5 months), followed by surgery + radiotherapy + chemotherapy (29.3 months), and the one with the lowest survival was surgery alone (6.5 months). According to the extension of the surgery, the highest survival was obtained by the total resection group (46.2 months), while the lowest survival was for the partial resection group (13.9 months). Conclusions: The average survival of patients operated on for grade III astrocytomas in our hospital was 34.8 months, with the best prognostic factors being the "low risk" clinical group, the combined treatment of surgery + radiotherapy, and total resection. Its classification into prognostic risk groups based on pre-surgical clinical data helps us predict survival. Keywords: Astrocytoma, Prognosis, Brain Neoplasms, Hospitals, Humans (source: MeSH NLM)

Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212).

BackgroundThe JCOG0212 trial was a randomized controlled trial comparing mesorectal excision alone to mesorectal excision with lateral lymph node dissection for stage II/III lower rectal cancer patients without clinical lateral lymph node enlargement. This study aimed to identify clinicopathological prognostic factors for relapse-free survival and overall survival of lower rectal cancer in the trial.MethodsProspective data were selected from 663 patients with complete data. Uni and multivariable Cox regression model was applied to evaluate the preoperative and the combined preoperative and postoperative factors, respectively. Preoperative factors included age, sex, performance status, clinical T, clinical N and operative procedures. Postoperative factors included histological grade, pathological T, number of metastatic lymph nodes and number of dissected lymph nodes. No patient received neoadjuvant treatment.ResultsRegarding preoperative factors, multivariable analysis revealed that performance status 1 (vs. 0: HR 2.079, P = 0.0041) and cT4a (vs. cT2–3: HR 2.721, P = 0.0002) were independent risk factors for relapse-free survival, and those for overall survival were male (vs. female: HR 1.660, P = 0.0228) and cT4a (vs. cT2–3: HR 2.486, P = 0.0473). The only independent preoperative risk factor common for relapse-free survival and overall survival was cT4a. Taking preoperative and postoperative factors together, the number of metastatic lymph nodes was the only independent risk factor common for relapse-free survival and overall survival.ConclusionsClinical stage II/III lower rectal cancer patients with cT4a should be a target of therapeutic development of neoadjuvant therapy. Postoperatively, intensive chemotherapy should be investigated for patients with more metastatic lymph nodes.

Factors predicting skeletal muscle mass loss after gastric cancer surgery: a retrospective observational study

Rationale: After gastric cancer surgery, body weight and muscle mass tend to decrease, and these have been reported as postoperative prognostic factors. We investigated the factors predicting skeletal muscle mass loss after gastric cancer surgery.

Pneumonectomy for lung cancer in the elderly: lessons learned from a multicenter study.

Background60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described.MethodsWe performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre- and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis.ResultsA total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted [median LOS 13.7 days (range, 2–39 days)] and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9–46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an increased mortality rate (P=0.863).ConclusionsAge should not be considered an absolute contraindication for pneumonectomy in elderly patients even after neoadjuvant treatment. It has become apparent that especially in these patients, a patient-tailored approach with a careful selection should be used to define the risk-benefit balance.

Pain and numbness one month after carpal tunnel release predict patient-reported outcome measures at sixth months

A number of outcome predictors for carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) have been reported. However, some predictors are controversial, and few studies have referred to the early postoperative outcome prognostic factors after CTR. The aim of this study was to investigate whether pain and numbness at 1 month post-CTR were early postoperative predictors of clinical outcomes 6 months after surgery. Pain and numbness were evaluated using the visual analog scale (VAS) preoperatively and at 1 month post-surgery. Patient-reported outcome measures (PROMs), including the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) measure, the Hand20 questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), were recorded for each patient 6 months after surgery. The BCTQ consisted of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Multivariable linear regression analysis was performed to investigate the association between the VAS scores and PROMs. We retrospectively identified 93 patients who underwent open carpal tunnel release (OCTR) or endoscopic carpal tunnel release. The mean age of the patients was 67.5 years, and 67 patients (72.0%) were female. Sixty patients were treated by OCTR (65.0%). With multivariable linear regression analysis, we found that pain and numbness, evaluated with VAS 1 month post-surgery had significant correlations with QDASH, Hand20, SSS and FSS 6 months after surgery. In conclusion, pain and numbness 1 month after CTR predict PROMs at 6 months.