The spine is an uncommon metastatic location from thyroid cancer. Here, we describe our experience with spinal cord compression as presentation of metastatic thyroid carcinoma, including surgical management and outcome. Five patients with spinal metastases from thyroid cancer were identified over a 20-year period. This descriptive case series comprised 5 women with a median age of 61 years. Three patients presented to the emergency room without a previous diagnosis of thyroid carcinoma. Clinical symptoms at presentation included pain, ataxia, and bladder and bowel incontinence. Imaging (MRI in four patients and CT in one) revealed thoracic spinal metastases in four cases and a sacral lesion in one case. Surgical treatment consisted of en-bloc resection in one patient and subtotal resection in the remaining four. The median Karnofsky Performance Score improved from 70% to 90%, postoperatively. Histopathological analysis confirmed follicular thyroid carcinoma in all cases. Postoperatively, all patients received radioactive iodine therapy, and three patients additionally underwent radiotherapy. One patient had a recurrence. The median survival time was 69 months (range 19–188 months). The main goals of surgical management in patients with spinal metastases from thyroid cancer are preservation of neurological function and restoration of spinal stability. This is followed by comprehensive evaluation and treatment of the primary malignancy. Multidisciplinary management is essential, with subsequent therapy directed toward control of systemic disease.
Oligometastatic cancer is characterised by a low volume of metastases to a small number of anatomical sites. However, evaluating the impact of metastases-directed therapies (MDTs) on overall survival or quality of life is often challenging. Current clinical trials use a wide range of primary endpoints that might not be validated or suited to MDT. To address this issue, we did a systematic review of international trial registries, alongside a Delphi consensus process involving 30 experts and five patient representatives. The aim was to identify preferred primary endpoints for MDT trials in oligometastatic disease, regardless of tumour type. Overall survival and progression-free survival were the most frequently used endpoints across the 121 comparative trials reviewed. Over four Delphi consensus rounds, overall survival had the highest level of agreement, although its limitations as a sole endpoint were emphasised. In addition to the widely used progression-free survival endpoint, polymetastatic progression-free survival and start-or-switch of systemic therapy-free survival also reached consensus, particularly for trials integrating systemic therapies. Both polymetastatic progression-free survival and systemic therapy-free survival permit repeat MDT without classifying it as treatment failure. Patient representatives highlighted the importance of time-to-deterioration of quality of life. This consensus supports overall survival as a primary endpoint and, in addition to progression-free survival, recommends polymetastatic progression-free survival and systemic therapy-free survival, especially in combination with systemic therapies. Adopting these endpoints will make MDT trials more relevant, comparable, and patient-centred, thereby empowering future clinical and policy decisions.
Finding an unexpected carcinoma in an endoscopically resected colorectal polyp poses a dilemma regarding the subsequent management strategy. Proceeding to surgery with formal segmental bowel resection is associated with a low recurrence risk but substantial morbidity and mortality, whereas surveillance without surgery entails low morbidity but a higher risk of recurrence. Clinical guidelines are based on histopathological risk factors (HRF), but pathology data are often incomplete, and national databases have revealed marked practice variation between hospitals. We aimed to explore between-hospital variation and the basis for treatment decisions after endoscopic resection of malignant colorectal polyps in Denmark. A national cohort of colorectal cancer patients from 2016-2020 was extracted from national clinical and pathology registers. Patients undergoing local resection only (surveillance group) and local resection followed by subsequent bowel resection (surgery group) were compared in uni- and multivariable analyses stratified by reported HRF. Patient- and hospital-related factors were included as covariates with particular focus on between-hospital variation. Overall, 2,188 patients were analyzed, 1,277 in the surveillance group and 911 in the surgery group. Multivariable analyses showed that male sex, older age, comorbidity, lower performance status and left colon or rectum tumor location were significantly associated with surveillance, most even in the presence of HRF. Long higher education and certain hospitals were significantly associated with bowel resection. Predictors of bowel resection despite absence of HRF were certain hospitals and active smoking. In the surgery group without HRF conclusive information was missing in up to 70% of the pathology reports regarding certain HRF. Preoperative image-based overstaging may have resulted in a higher rate of cancer-free specimens. Overall, 63% of bowel resection specimens were cancer-free. We found marked between-hospital practice variation in management strategy for malignant colorectal polyps, even in adjusted analyses. Among the probable explanations were missing or incomplete pathology data and suspicion of more advanced disease based on clinical staging. Consistency in hospital practice, completeness of the pathology reports and overall better collaboration of the multidisciplinary team are needed to improve the decision-making process in patients with endoscopically removed malignant colorectal polyps.
This study aims to explore the application of a multimodal prehabilitation strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to evaluate its impact on postoperative recovery, weight loss, and quality of life. This was a single-center, prospective, randomized controlled trial. A total of 120 eligible patients undergoing elective LSG were enrolled and randomly assigned to either the control group (n = 60), receiving routine perioperative care, or the observation group (n = 60), receiving a structured 5-7-day prehabilitation program. Compared to the control group, the observation group had a significantly shorter postoperative hospital stay (mean difference [MD] -1.23 days; 95% CI -1.67 to -0.79; P < 0.001) and a lower incidence of complications (1.7% vs. 11.7%; odds ratio 0.13, 95% CI 0.02-0.89; P = 0.038). At 6 months, the prehabilitation group showed a greater reduction in BMI (MD -3.78 kg/m2; 95% CI -5.10 to -2.46; P < 0.001) and higher quality of life scores across all eight SF-36 domains (P < 0.001 for all). The application of prehabilitation strategies in patients undergoing laparoscopic sleeve gastrectomy can effectively promote faster postoperative recovery, enhance weight loss, improve quality of life, and reduce the incidence of postoperative complications. It is a safe and effective approach, worthy of clinical promotion. Furthermore, the principles of this multimodal prehabilitation framework offer valuable translational insights for optimizing perioperative supportive care in surgical oncology.
Gastric cancer remains a major global health burden, with persistently high mortality rates despite advances in multimodal treatment. Total gastrectomy (TG) constitutes a cornerstone of curative therapy; however, the factors governing early postoperative survival remain incompletely characterized. This study aimed to identify clinical and pathological predictors of 1-year overall survival (OS) following curative-intent TG, with particular emphasis on the oncological treatment strategy and tumor regression grade (TRG). We retrospectively analyzed 145 patients who underwent TG between 2012 and 2023, excluding n = 4 adjuvant-only cases. To avoid statistical collinearity, multivariable Cox proportional hazards regression was performed in two sequential steps: Model 1 assessed the treatment strategy across the overall cohort (N = 145), while Model 2 evaluated TRG exclusively within the neoadjuvant-treated subgroup (n = 85). Both models incorporated the lymph node ratio (LNR) and surgical approach, and were adjusted for resection margin status (R-status), comorbidity burden (CCI), and severe postoperative complications (Clavien-Dindo ≥ III). A 60-day landmark analysis was conducted to mitigate immortal time bias. Completion of the perioperative chemotherapy sequence was independently associated with significantly improved 1-year OS compared to neoadjuvant therapy alone (HR = 0.20; 95% CI, 0.08–0.50; p = 0.001). This survival advantage remained highly significant in the 60-day landmark analysis (p = 0.004). Notably, 55.3% of patients who initiated neoadjuvant chemotherapy did not proceed to the adjuvant phase, primarily owing to patient refusal or medical contraindications. When evaluated exclusively within the neoadjuvant-treated subgroup, a poorer TRG demonstrated a prognostic trend toward decreased survival (HR = 1.60; 95% CI, 0.98–2.59; p = 0.059). Although severe complications (CD ≥ III) occurred in 55.9% of patients, their incidence did not differ significantly across treatment groups (p = 0.894) and did not diminish the independent prognostic value of treatment completion. The surgical approach (robotic vs. open) exerted no significant effect on 1-year OS (HR = 0.88; p = 0.745). Completion of the perioperative chemotherapy sequence and a favorable TRG represent two distinct and critical determinants of 1-year survival following TG for gastric cancer. While residual selection bias inherent to retrospective analyses must be acknowledged, the prognostic advantage conferred by treatment completion remains robust after adjustment for surgical morbidity, R-status, and immortal time bias. These findings underscore the prognostic importance of treatment adherence and tumor chemosensitivity, and highlight the need for individualized perioperative management strategies. The online version contains supplementary material available at 10.1186/s12957-026-04364-w.
To systematically review the predictive performance of Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), and Edmonton Frailty Scale (EFS) for adverse outcomes including postoperative complications, unplanned readmission, 30-day mortality, prolonged length of stay among cancer patients. A comprehensive search was conducted across English and Chinese databases until October 2, 2025. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 tool. Predictive performance was evaluated by pooling sensitivity, specificity, and summary receiver operating characteristic curves. There were 21 studies (4,435 individuals) that were included for the meta-analysis. TFI demonstrated pooled sensitivities of 0.64 (for postoperative complications), 0.77 (for unplanned readmission), and 0.50 (for prolonged hospital stay), with corresponding specificities of 0.67, 0.54, and 0.64 respectively. The areas under the curve (AUC) were 0.70, 0.71, and 0.60. GFI demonstrated sensitivities of 0.59, 0.65, and 0.55 for complications, 30-day mortality, and functional decline, with specificity of 0.73, 0.63, and 0.77, and the AUC of 0.71, 0.68, and 0.74. EFS had sensitivity 0.39, specificity 0.87, and AUC 0.57 for complications. Subgroup analysis revealed that TFI had reasonable predictive value for adverse outcomes with sensitivity 0.61-0.81 and specificity 0.60-0.68 among most gynecological and gastrointestinal cancer subgroups. In most subgroups, GFI showed higher specificity (0.64-0.84) relative to sensitivity (0.43-0.68). TFI and GFI demonstrated moderate predictive validity for adverse outcomes, whereas EFS exhibited poor predictive performance. These findings highlight the necessity for caution interpretation of frailty assessments in clinical practice and underscore the importance of further validating these tools within diverse oncological contexts.
Postoperative seroma is the most frequent complication of modified radical mastectomy (MRM) with axillary lymph node dissection (ALND). Quilting sutures mechanically obliterate the dead space between the mastectomy flaps and chest wall; however, prior syntheses included heterogeneous breast procedures. We evaluated quilting versus conventional closure after MRM with ALND using only randomized evidence. The protocol was registered with PROSPERO (CRD420251237379). We searched MEDLINE (PubMed), Embase, Scopus, Web of Science, CENTRAL, ClinicalTrials.gov, WHO ICTRP, and Google Scholar from inception to June 1, 2025, using reference list screening. Eligibility: Parallel-group RCTs enrolling adult women undergoing MRM (or equivalent total mastectomy) with level I–II ALND, comparing quilting/flap fixation versus conventional non-quilting closure; studies of breast-conserving surgery, immediate reconstruction/oncoplastic procedures, sentinel node-only surgery, and non-randomized designs were excluded. Two reviewers independently screened/extracted data and assessed the risk of bias using the Cochrane RoB 2. Random-effects meta-analysis (REML with Hartung–Knapp–Sidik–Jonkman adjustments) was used to synthesize risk ratios (RR) and mean differences (MD). A prespecified subgroup analysis compared aggressive dead space obliteration (pectoral-plus-axillary quilting and/or drain reduction) with standard pectoral quilting. The certainty of evidence was assessed using GRADE. Seven randomized controlled trials (1,412 patients) were included. Quilting significantly reduced seroma incidence (RR 0.36, 95% CI 0.23–0.55; moderate-certainty evidence; ≈200 fewer seromas per 1,000 patients [95% CI 141–241 fewer]) and the need for aspiration (RR 0.29, 95% CI 0.20–0.42; moderate-certainty evidence; ≈192 fewer patients requiring aspiration per 1,000 [95% CI 157–216 fewer]), and also reduced the number of aspirations (MD − 1.03, 95% CI − 1.58 to − 0.47) and total drainage volume (MD − 214 mL, 95% CI − 402 to − 27 mL). Quilting did not significantly affect drain removal duration, surgical site infection (RR 0.71, 95% CI 0.39–1.32; ≈10 fewer SSIs per 1,000 [95% CI 10 more to 20 fewer]), or flap necrosis (RR 0.65, 95% CI 0.32–1.32; ≈22 fewer flap necroses per 1,000 [95% CI 20 more to 43 fewer]). Subgroup analysis showed that both aggressive dead space obliteration (RR 0.31, 95% CI 0.22–0.51) and standard pectoral quilting (RR 0.57, 95% CI 0.36–0.80) significantly reduced seroma without significant differences between the techniques (p = 0.89). Leave-one-out sensitivity analyses confirmed the robustness of these findings. Quilting sutures provide a clinically meaningful reduction in postoperative seroma following modified radical mastectomy with axillary dissection and may help support smoother postoperative recovery pathways without compromising wound healing. The online version contains supplementary material available at 10.1186/s12957-026-04327-1.
Gastric cancer remains one of the most frequent oncological diseases, often associated with a high rate of postoperative complications. Prehabilitation has shown benefits in other surgical settings, although its role in gastric cancer patients remains under investigation. To describe the postoperative outcomes of patients with gastric cancer who underwent a prehabilitation programme in a high-complexity referral centre in Bogotá, Colombia. A descriptive observational retrospective cohort study was conducted at Clínica Universitaria Colombia between January 2021 and December 2023. Patients aged 18-80 years with a confirmed diagnosis of gastric cancer who underwent surgical treatment were included. A total of 140 patients with gastric cancer received prehabilitation. The mean age was 60.9 years, and 60% were male. Postoperative complications occurred in 23.6% of patients, with surgical site infection being the most frequent (17.1%). Admission to the intensive care unit was required in 7.1%, and overall mortality was 4.3%. In bivariate analysis, malnourished patients presented higher rates of total complications, surgical site infection, and ICU admission. Malnutrition is consistently associated with worse postoperative outcomes. Therefore, prehabilitation plays a crucial role in improving nutritional and functional parameters that directly influence the recovery and prognosis of patients with gastric cancer.
To evaluate the educational validity of two bench-top simulators for Transurethral Resection of the Prostate (TURP) and Transurethral Resection of Bladder Tumor (TURB), focusing on their realism, ergonomics, and relevance for structured endourology training. Fourteen expert endourologists from multiple European centers assessed both simulators during the European Association of Urology Residents Education Programme (EUREP) 2025. Face validity and content validity were evaluated using 4-point Likert questionnaires. Item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices were calculated for all items and adjusted for core procedural skills. Experts rated both simulators highly for anatomical realism, tissue handling, and overall utility (mean scores > 3.5/4). The TURP simulator achieved an adjusted S-CVI/Ave of 0.92 and the TURB simulator 0.97, indicating excellent consensus on their educational adequacy for key procedural steps. Non-modeled features such as bleeding, obturator reflex, and energy modulation received low ratings, reflecting inherent limitations of bench-top simulation. Both models were considered effective for practicing instrument handling and resection depth control in a risk-free, standardized environment. The TURP and TURB simulators demonstrated strong face and content validity for core resection training. Their modular, non-biological, and reproducible design supports safe, structured skill acquisition and competency assessment in endourology curricula, offering a practical bridge between theoretical learning and clinical performance.
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Lung cancer persists as the predominant oncological cause of mortality globally, underscoring an imperative public health issue that demands effective screening methodologies to mitigate its impact. The National Lung Screening Trial (NLST) from the National Cancer Institute has established that low-dose computed tomography (LDCT) can detect lung cancer at an early stage and decrease mortality. Nonetheless, concerns such as radiation-induced risks, false positives, overdiagnosis, and medical costs demand attention. The importance of Artificial Intelligence (AI) in lung cancer screening is growing due to its superior capabilities for extracting image data and managing complex models. Circulating tumor markers (CTMs), encompassing circulating tumor DNA (ctDNA), circulating tumor RNA (ctRNA), circulating tumor cells (CTCs), and exosomes, present a non-invasive diagnostic and surveillance strategy for lung cancer. Despite their established utility in treatment and prognostic monitoring, the application of CTMs in early lung cancer screening is less documented. However, recent innovations highlight the potential of AI in conjunction with CTMs to enhance early diagnostic capabilities. This review synthesizes current research on the convergence of AI with CTMs, offering innovative avenues to augment and refine lung cancer screening methodologies.
Bladder cancer is one of the most common malignancies of the urinary tract. Among its subtypes, muscle invasive bladder cancer (MIBC) is particularly aggressive and often associated with poor prognosis. The efficacy of platinum-based neoadjuvant chemotherapy and radical cystectomy remains unsatisfactory. In recent years, immune checkpoint inhibitors have shown promising therapeutic potential in MIBC. However, reliable biomarkers for predicting treatment response are still lacking. Moreover, traditional clinical parameters, such as TNM staging, often fail to accurately assess patient outcomes. Therefore, identifying novel biomarkers is crucial for improving prognosis and optimizing treatment strategies in MIBC. We first analyzed the expression pattern and prognostic significance of methylenetetrahydrofolate dehydrogenase (NADP + dependent) 1-like (MTHFD1L) across multiple cancer types. Subsequently, MIBC patient samples from three independent cohorts (TCGA-BLCA, GSE169455, and GSE48075) were used to evaluate the prognostic value of MTHFD1L through univariate and multivariate Cox regression analyses combined with Kaplan-Meier survival analysis. Gene Set Enrichment Analysis and Gene Set Variation Analysis were performed to explore the biological functions of MTHFD1L. Mutation characteristics and immunotherapy response-related features were further analyzed based on MTHFD1L expression levels. Finally, the results were further verified by immunohistochemistry and cell function experiments. MTHFD1L was upregulated in multiple cancer types, and its elevated expression was significantly associated with unfavorable outcomes. In all independent MIBC cohorts, high MTHFD1L expression served as an independent risk factor for poor prognosis. Gene Set Enrichment Analysis indicated that MTHFD1L may promote tumor progression by activating immune-related and proliferative pathways while suppressing metabolic processes. Mutation analysis revealed a higher frequency of TP53 mutations in the MTHFD1L high-expression group. Moreover, immune response prediction suggested that patients with low MTHFD1L expression were more likely to benefit from immune checkpoint inhibitors therapy. Immunohistochemistry confirmed the overexpression of MTHFD1L in MIBC tissues, and cell function experiments demonstrated that MTHFD1L knockdown markedly inhibited bladder cancer cell proliferation, colony formation, and migration. MTHFD1L represents a promising and reliable biomarker for predicting prognosis and immunotherapy response in MIBC, providing a new foundation for the development of precision and personalized therapeutic strategies.
Gastric schwannoma is a rare benign mesenchymal tumour of the stomach that frequently mimics gastrointestinal stromal tumour (GIST) in clinical and radiologic presentation. This narrative review summarises current evidence on the epidemiology, diagnostic challenges, imaging characteristics, pathological features, and management of gastric schwannoma. Available literature from major medical databases was reviewed to synthesise findings related to clinical presentation, radiologic and endoscopic features, histopathological diagnosis, and treatment outcomes. Gastric schwannoma typically presents as an incidental subepithelial lesion in middle-aged adults. Imaging findings frequently overlap with those of GIST, limiting reliable preoperative differentiation. Definitive diagnosis relies on histopathological examination demonstrating spindle cell morphology with peripheral lymphoid cuffing and strong immunoreactivity for S-100 and SOX10 with absence of CD117 and DOG-1 expression. Complete surgical resection with negative margins remains the standard treatment and is associated with excellent long-term outcomes. Although rare, gastric schwannoma should be considered in the differential diagnosis of gastric subepithelial tumours. Accurate pathological diagnosis is essential to guide appropriate management and avoid unnecessary oncologic treatment.
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Tumour proximity to major neurovascular structures complicates resection of deep soft tissue sarcomas (STS), yet its independent impact on overall survival (OS) remains unclear. This study assessed whether anatomical proximity, measured by dichotomised distance and the Fujiwara classification, predicts oncologic outcomes after curative-intent surgery. Patients with high-grade extremity or truncal STS treated between 2004 and 2020 were retrospectively analysed. Minimal tumour–vessel distance (> 1 cm vs. ≤ 1 cm) and Fujiwara type (I–IV) were determined from preoperative MRI. OS was evaluated using Kaplan–Meier and Cox regression. Multivariable Cox models were pre-specified to include established prognostic confounders (age, tumour size, histologic grade, and resection status), irrespective of univariate significance. Fujiwara types III and IV were pooled to improve estimate stability. A total of 113 patients met inclusion criteria (median follow-up 84 months); 47 deaths occurred during follow-up. Tumour proximity ≤ 1 cm was associated with significantly reduced OS (42 vs. 107 months; p = 0.003). The Fujiwara classification was associated with significant survival differences across categories (p < 0.001). In multivariable analysis (Model A), proximity ≤1 cm remained independently associated with OS (HR 3.04; 95% CI 1.38–6.67; p = 0.006), together with age ≥65 years (HR 3.42; p = 0.007) and R2 resection (HR 9.67; p = 0.002). In Model B, pooled Fujiwara type III/IV remained independently associated with impaired OS (HR 3.62; 95% CI 1.47–8.94; p = 0.005), alongside age ≥65 years (HR 3.07; p = 0.015) and R2 resection (HR 7.32; p = 0.007). Higher Fujiwara types correlated with increased local recurrence (p = 0.011), while distant metastasis rates were similar across groups. Tumour proximity to neurovascular structures is independently associated with OS in high-grade deep STS. The Fujiwara classification remained prognostically relevant after adjustment for established risk factors including resection status. These findings suggest that anatomical tumour–vessel relationships provide complementary prognostic information beyond conventional clinicopathologic variables. Prospective multicentre validation is warranted.
Standardized outcome measurement is a core component of value-based healthcare, yet real-world evidence on long-term system-wide implementation remains limited. To evaluate the longitudinal clinical and patient-reported outcome impact of implementing condition-specific, outcome-driven care pathways across multiple specialties. Between 2017 and 2024, 9549 patients were enrolled in ten pathways. Patient-Reported Outcomes (PROMs) collection, digital follow-up, and dedicated monitoring teams were progressively introduced. Temporal trends in risk-adjusted clinical outcomes, functional recovery, and quality-of-life measures were analyzed. Annual enrollment increased from 642 to 1728 patients, while PROMs completion rose from 38% to 70.1%. Twelve-month loss to follow-up declined from 29% to 17%. Case-mix complexity increased (≥ 2 comorbidities: 41% to 53%). Despite this, 30-day readmissions fell from 11.8% to 7.5%, 1-year mortality from 6.4% to 5.3%, length of stay from 6.2 to 5.4 days, and surgical complications from 14.6% to 10.2%. Stroke functional independence increased (52% to 64%), heart failure symptom burden declined, and elderly CHF readmissions decreased (13.0% to 7.5%). Arthroplasty patients more frequently achieved clinically meaningful improvement (76% to 89%), while postoperative readmissions declined. In spinal surgery, disability scores improved and persistent opioid use decreased (28% to 16%). Oncology pathways showed better quality-of-life, faster treatment initiation, and fewer emergency visits. Post-COVID and sepsis survivors demonstrated improved functional recovery, and neonatal pathways showed enhanced parental confidence and reduced emergency visits. Twelve quality-improvement initiatives were launched; eight pathways demonstrated statistically significant post-implementation outcome gains. Systematic outcome measurement was associated with sustained improvements in survival, complications, functional recovery, and quality of life, even in increasingly complex populations, supporting its role as a driver of continuous patient-centered care improvement.
The purpose of this study was to retrospectively compare the prognostic outcomes of patients with colorectal cancer (CRC) who achieved a clinical complete response (CCR) after neoadjuvant immunotherapy (NI) and those who achieved a CCR after surgery. A literature review of publications was conducted in the PubMed database. This study included 70 patients who were diagnosed with mismatch repair deficiency/microsatellite instability high (dMMR/MSI-H) colorectal cancer and who were treated with NI between 2018 and 2024. CCR patients were grouped into the "watch and wait" (W&W) method group or the radical surgery group. Afterwards, the oncological and clinical outcomes of patients who achieved a clinical complete response (CCR) were compared to those of patients who were classified as tumour free. We also conducted a literature review of publications in the PubMed database of clinical studies that compared clinical outcomes between W&W and surgery for CCR dMMR/MSI-H patients. Among the 70 NI-treated dMMR/MSI-H CRC patients, 44 (62.86%) achieved a CCR. Of these, 25 patients were managed with a watch-and-wait (W&W) strategy, while 19 underwent curative-intent surgery. In the surgery group, 16 patients (84.21%) achieved a pathological complete response (pCR). During follow-up, 2 patients (10.53%) in the surgery group developed recurrence, and both subsequently died, while the remaining 17 patients were alive at the last follow-up. No statistically significant differences were observed between the W&W and surgery groups in terms of recurrence or survival outcomes. A literature review including nine studies further demonstrated comparable oncological outcomes between W&W and surgical management in patients who achieved a CCR. Patients in the W&W group presented similar oncological outcomes to those who underwent surgery. Surgery may not be necessary for patients with dMMR/MSI-H colorectal cancer who achieve a clinical complete response after neoadjuvant immunotherapy. However, large sample sizes and multicentre investigations are needed to validate these findings.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. However, data from Sub-Saharan Africa (SSA) remain fragmented, and no prior systematic review has synthesized regional diagnostic and treatment practices. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42024575650). PubMed, Embase, Scopus, Google Scholar, and African Journals Online were searched for studies published between January 2014 and June 2024. Eligible population-, community-, and hospital-based studies reporting on GIST management or prognosis in SSA were included. Study quality was assessed using Joanna Briggs Institute tools. Random-effects models (REML with Hartung-Knapp adjustment) were used to estimate pooled outcomes. Twenty-one studies comprising 410 patients met inclusion criteria. The median age ranged from 52 to 56 years, and the male-to-female ratio was approximately 1.3:1. The stomach was the most frequent tumor site (64.1%), followed by the small intestine (14.6%). Most patients were symptomatic at diagnosis, with abdominal pain (50.4%) and abdominal mass (47.3%) being the predominant complaints. Computed tomography was the primary imaging modality (99.5%). Surgery was performed in 70% of patients, with R0 resection achieved in 68.2%. Imatinib was used as neoadjuvant (n = 58), adjuvant (n = 64), or palliative therapy (n = 75). Among 199 evaluable patients, the pooled disease-control rate was 77.3% (CR: 32.5%; PR: 27.9%; SD: 7.9%), while progressive disease occurred in 18.9%. The pooled median overall survival was 44.0 months. Postoperative mortality was 0.7%, and overall mortality during follow-up was 9.8%. This review provides the first comprehensive synthesis of GIST management in Sub-Saharan Africa. Despite limited diagnostic infrastructure and late presentations, therapeutic outcomes particularly disease control with imatinib and low postoperative mortality appear numerically comparable in selected settings where treatment is accessible, although structural and methodological disparities preclude direct equivalence. Strengthening early detection, expanding immunohistochemistry and molecular testing, and improving access to tyrosine kinase inhibitors remain critical for improving survival in the region.
This study aimed to evaluate whether the combination of tyrosine kinase inhibitors (TKIs) and PD-1 inhibitors can reduce the risk of peritoneal metastasis (PM) in patients with ruptured hepatocellular carcinoma (HCC) after transcatheter chemoembolization/embolization (TACE/TAE). This study included 163 patients with ruptured HCC who received TACE/TAE at 4 centers from June 2015 to June 2023. Patients were categorized into two groups based on their treatment: the combination group, which received TKIs plus PD-1 inhibitors, and the TACE/TAE group, which did not. Propensity score matching (PSM) analysis was performed in a ratio of 1:2 to reduce bias between the groups. The PM rate, overall survival (OS) and the occurrence of adverse events were analyzed and compared between the two groups. Moreover, the independent factors associated with PM were further evaluated. The median follow-up duration was 801 days [95% confidence interval (CI): 720.2-925.7]. After PSM, the combination and TACE/TAE groups comprised 45 and 90 patients, respectively. A significant difference was observed in the peritoneal PM rate (combination group: 6.7% vs. TACE/TAE group: 23.3%, P = 0.032). The corresponding 3-, 6-, 12-, and 24-month PM cumulative incidence was 5.6%, 15.7%, 22.5%, and 24.1% in the TACE/TAE group, and 0%, 0%, 4.9%, and 7.7% in the combination group, respectively (P < 0.001). The combination group exhibited a significantly longer median OS compared to the TACE/TAE group (OS:566 days vs. 120 days, P < 0.001). The multivariate competing risk analysis identified hepatitis B virus (HBV) infection [subdistribution hazard ratio (SHR), 0.420; 95% CI: 0.188-0.939; P = 0.035), Barcelona Clinic Liver Cancer stage C (BCLC C) (SHR, 0.228; 95% CI: 0.059-0.874; P = 0.031), and combination therapy (SHR, 0.267; 95% CI: 0.082-0.866; P = 0.028) as the independent factors for PM. More adverse events were witnessed in the combination group compared with the monotherapy group, most of which were tolerable and manageable. The combination of TKIs and PD-1 inhibitors reduced the risk of PM compared with TACE/TAE in patients with ruptured HCC. Also, PM was less likely to occur in patients with HBV-related and BCLC C ruptured HCC.