IRIS UniSR (’Università Vita-Salute San Raffaele)
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Technical Innovations and Complex Cases in Robotic Surgery for Lung Cancer: A Narrative Review
Full text linkFor over two decades, robotic-assisted thoracic surgery (RATS) has revolutionized thoracic oncology. With enhanced visualization, dexterity, and precision, RATS has reduced blood loss, shortened hospital stays, and sped up recovery compared to traditional surgery or video-assisted thoracoscopic surgery (VATS). The use of 3D high-definition imaging and articulated instruments allows for complex resections and advanced lymph node assessment. RATS delivers oncological outcomes similar to open surgery and VATS, with high rates of complete (R0) resections and acceptable complication rates. Its minimally invasive nature promotes quicker recovery. Advances in imaging software and augmented reality further enhance surgical accuracy and reduce intraoperative risks. However, RATS has some limitations, including high costs and a lack of tactile feedback, and certain complex procedures, such as extended resections and intrapericardial interventions, remain challenging. With growing experience and technological advances, RATS shows promise in reducing morbidity, improving quality of life, and expanding access to advanced oncologic care. This article reviews the evolution, benefits, and limitations of RATS in NSCLC treatment, highlighting its emerging role in managing complex cases
IL-1β+ macrophages and the control of pathogenic inflammation in cancer
No full textWhile highlighting the complexity and heterogeneity of tumor immune microenvironments, the application of single-cell analyses in human cancers has identified recurrent subsets of tumor-associated macrophages (TAMs). Among these, interleukin (IL)-1β+ TAMs – cells with high levels of expression of inflammatory response and tissue repair genes, but with limited capacity to stimulate cytotoxic immunity – are emerging as key drivers of pathogenic inflammation in cancer. In this review we discuss recent literature defining the phenotypical, molecular, and functional properties of IL-1β+ TAMs, as well as their temporal dynamics and spatial organization. Elucidating the biology of these cells across tumor initiation, progression, metastasis, and therapy could inform the design and interpretation of clinical trials targeting IL-1β and/or other inflammatory factors in cancer immunotherapy
Development and validation of the albumin-bilirubin gamma-glutamyl transferase score for enhanced prognostic accuracy after hepatocellular carcinoma resection
No full textBackground: The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection. Methods: Patients undergoing curative-intent HCC resection (2000–2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS). Results: Among 759 patients, the median ALBI score was −2.78 (−3.02 to −2.48), and the median GGT was 55.0 U/L (31.0–93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112–1.950]; P =.007) and GGT (HR, 1.007 [1.004–1.010]; P <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015–1.090]; P =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005–2.161]; P =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58–0.72]), outperforming the ALBI score (0.62 [0.56–0.69]) and GGT (0.65 [0.58–0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; P <.001). Conclusion: ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival
Islet autotransplantation in intraductal papillary mucinous neoplasm: A “Pole Pole” (slowly, slowly) path toward careful expansion of indications
No full textA pleiotropy scan to discover new susceptibility loci for pancreatic ductal adenocarcinoma
No full textVisual outcomes, incidence and risk factors for RPE atrophy in myopic patients with dome-shaped macula and serous retinal detachment
No full textObjective: To evaluate the visual outcomes, incidence, and risk factors for retinal pigment epithelium (RPE) atrophy in highly myopic patients with dome-shaped macula (DSM) and serous retinal detachment (SRD). Methods: Baseline and follow-up data were analyzed for visual acuity (VA), myopic classification, spherical equivalent (SE), and SRD presence. Incomplete RPE atrophy is characterized by discontinuous hypertransmission (<250 μm) with an irregular or interrupted RPE band. Persistent SRD was defined as fluid present in all follow-up visits. The primary outcome was VA change over time and its predictors. RPE atrophy incidence was estimated using Kaplan–Meier analysis, and risk factors were assessed using univariate Cox regression. Results: Thirty eyes from 23 patients were included, mean age (SD) 53.4 ± 11.7 years, with a mean follow-up of 6.8 (2.7) years. Mean SE (SD) was −9.33 (3.6) diopters. Persistent SRD was observed in 18 (60%) eyes. The baseline VA was 0.34 ± 0.26 logMAR. Eyes with patchy atrophy and incomplete RPE atrophy exhibited worse VA (p < 0.01). VA declined minimally over time (+0.02 logMAR/year; p < 0.001). Discussion: Persistent SRD (p = 0.04) and incomplete RPE atrophy (p < 0.01) were associated with faster visual loss. The incidence rate of incomplete RPE atrophy was low (9/100 eye-years, 95% CI: 2.8–15.4). Younger age (HR = 0.95; p = 0.043) was associated with RPE atrophy progression. Across the follow-up period 5 eyes (17%) developed macular neovascularization (MNV). Conclusions: DSM with SRD is characterized by minimal visual decline and a low risk of incomplete RPE atrophy but can be complicated by MNV. SRD is persistent in most eyes but does not accelerate RPE atrophy
Book Review. Diego Bubbio, Hegel, Heidegger and the Quest for the “I”. New York and London: Routledge, 2024
No full textBook review: Diego Bubbio, Hegel, Heidegger and the Quest for the “I”
The impact of molecular alterations in patients with advanced biliary tract cancer receiving cisplatin, gemcitabine, and durvalumab: a large, real-life, worldwide population
No full textBackground Cisplatin, gemcitabine, and durvalumab combination is a standard first-line treatment for advanced biliary tract cancer. This study aimed to assess the impact of genetic alterations on outcomes in patients with advanced biliary tract cancer treated with cisplatin, gemcitabine, and durvalumab in real-world clinical practice.Methods Patients with unresectable, locally advanced, or metastatic biliary tract cancer treated with cisplatin and gemcitabine plus durvalumab across 39 centers in 11 countries in Europe, the United States, and Asia were included in this analysis.Results The cohort included 513 patients with advanced biliary tract cancer. The 5 most frequently altered genes were TP53 (22.1%), KRAS (13.7%), CDKN2A/B (13.6%), ARID1A (12.2%), and IDH1 (9.2%). In multivariate analysis, SMAD4 mutations were associated with improved progression-free survival (PFS) (hazard ratio [HR] = 0.49, P = .018) and overall survival (HR = 0.11, P = .023), while TP53 mutations were linked to worse PFS (HR = 1.62, P = .0047) and TERT mutations to worse overall survival (HR = 8.92, P = .0012). No other genomic alterations were statistically associated with outcomes. Subgroup analysis showed that TP53 mutations negatively affected PFS and overall survival in intrahepatic cholangiocarcinoma, while KRAS mutations were associated with poorer PFS in extrahepatic cholangiocarcinoma. No gene alterations were linked to outcomes in gallbladder cancer.Conclusions This large-scale analysis, with comprehensive molecular profiling, supports the positive prognostic impact of SMAD4 mutations for PFS and overall survival and highlights the negative prognostic roles of TP53 (PFS) and TERT (overall survival) mutations, providing valuable insights for personalized treatment strategies in biliary tract cancer
A common marker of affect recognition dysfunction in the FTD spectrum of disorders
No full textBackground: Poor affect recognition is an early sign of frontotemporal dementia (FTD). Here, we applied the abbreviated version of the Comprehensive Affect Testing System (CATS-A) battery to Italian FTD cases and healthy controls (HC) to provide cut-offs of emotional dysfunction in the whole group and in different FTD clinical syndromes. Methods: One hundred thirty-nine FTD patients (60 behavioural variant [bvFTD],13 semantic behavioural variant of FTD [sbvFTD], 28 progressive supranuclear palsy [PSP], 21 semantic [svPPA] and 17 nonfluent [nfvPPA] variants of primary progressive aphasia) and 116 HC were administered the CATS-A, yielding an Affective Recognition Quotient (ARQ), which was used as outcome measure. Age- and education-adjusted, regression-based norms were derived in HC. In patients, the ARQ was assessed for its internal reliability, factorial validity and construct validity by testing its association with another social cognition paradigm, the Story-Based Empath Task (SET). The diagnostic accuracy of the ARQ in discriminating patients from HC, genetic cases from HC and patient groups among each other was tested via ROC analyses. Results: In the whole FTD cohort, CATS-A proved to be underpinned by a mono-component factor (51.1%) and was internally consistent (McDonald's ω = 0.76). Moreover, the ARQ converged with the SET (r(122) = 0.50; p < 0.001) and optimally discriminated HC from both the whole cohort (AUC = 0.89) and each clinical syndrome (AUC range: 0.83-0.92). Conversely, CATS-A subtests were able to distinguish patient groups. Conclusions: The ARQ score from the CATS-A distinguishes FTD clinical syndromes from HC with high accuracy, making it an excellent tool for immediate use in clinical practice