1,721,223 research outputs found
Endoscopic Ultrasound May Misclassify the Nodal Status of a Small Subset of Patients with Early Gastric Cancer In Reply to Chen and colleagues
No full textInvite comment on Pucciarelli and Spolverato: The fate of the rectum after organ sparing approach to rectal cancer
Full text linkASO Author Reflections: Local Excision Following Neoadjuvant Therapy for Rectal Cancer: A Compromise Between TME and Watch-and-Wait in Patients with Major Response
No full textDefining Which Patients Are at High Risk for Recurrence of Soft Tissue Sarcoma
No full textSeveral studies have investigated the prognosis of soft tissue sarcomas and the influence of a variety of factors, such as size, histology subtype, malignancy grade, site, margins, on overall survival, recurrence-free survival, incidence of local and distant spreading. The impact of genomic and expression profiling on long-term outcomes of patients with sarcomas has been also evaluated in order to fill the knowledge gap of this heterogeneous disease. Nomograms represent a prognostic tool that extends the standard staging systems on an individualized basis, taking into account tumor- and patient-related factors. They are used to assist the health provider and the patients in the decision-making process, for patient counseling, treatment decision-making, follow-up scheduling, and clinical trial eligibility determination. None of the available nomograms include molecular characterization of sarcomas. In the future, omics signatures might be incorporated into prognostic nomograms possibly improving their performance. In the present review, we focus on the complexity of prognostic and predictive factors for extremity and trunk wall as well as for retroperitoneal soft tissue sarcomas, while exploring the available prognostic models
Impact of Hospital Teaching Status on Length of Stay and Mortality Among Patients Undergoing Complex Hepatopancreaticobiliary Surgery in the USA
No full textTo define the impact of hospital teaching status on length of stay and mortality for patients undergoing complex hepatopancreaticobiliary (HPB) surgery in the USA. Using the Nationwide Inpatient Sample, we identified 285,442 patient records that involved a liver resection, pancreatoduodenectomy, other pancreatic resection, or hepaticojejunostomy between years 2000 and 2010. Year-wise distribution of procedures at teaching and non-teaching hospitals was described. The impact of teaching status on in-hospital mortality for operations performed at hospitals in the top tertile of procedure volume was determined using multivariate logistic regression analysis. A majority of patients were under 65 years of age (59.6 %), white (74.0 %), admitted on an elective basis (77.3 %), and had a low comorbidity burden (70.5 %). Ninety percent were operated upon at hospitals in the top tertile of yearly procedure volume. Among patients undergoing an operation at a hospital in the top tertile of procedure volume (> 25/year), non-teaching status was associated with an increased risk of in-hospital death (OR 1.47 [1.3, 1.7]). Other factors associated with increased risk of mortality were older patient age (OR 2.52 [2.3, 2.8]), male gender (OR 1.73 [1.6, 1.9]), higher comorbidity burden (OR 1.49 [1.3, 1.7]), non-elective admission (OR 3.32 [2.9, 4.0]), and having a complication during in-hospital stay (OR 2.53 [2.2, 3.0]), while individuals with private insurance had a lower risk of in-hospital mortality (OR 0.45 [0.4, 0.5]). After controlling for other covariates, undergoing complex HPB surgery at a non-teaching hospital remained independently associated with 32 % increased odds of death as (OR 1.32, 95 % CI 1.11-1.58; P < 0.001). Even among high-volume hospitals, patients undergoing complex HPB have better outcomes at teaching vs. non-teaching hospitals. While procedural volume is an established factor associated with surgical outcomes among patients undergoing complex HPB procedures, other hospital-level factors such as teaching status have an important impact on peri-operative outcomes
Win Statistics in Observational Cancer Research: Integrating Clinical and Quality-of-Life Outcomes
Full text linkBackground: Quality-of-life metrics are increasingly important for oncological patients alongside traditional endpoints like mortality and disease progression. Statistical tools such as Win Ratio, Win Odds, and Net Benefit prioritize clinically significant outcomes using composite endpoints. In randomized trials, Win Statistics provide fair comparisons between treatment and control groups. However, their use in observational studies is complicated by confounding variables. Propensity score (PS) matching mitigates confounding variables but may reduce the sample size, affecting the power of win statistics analyses. Alternatively, PS matching can stratify samples, preserving the sample size. This study aims to assess the long-term impact of these methods on decision making, particularly in colorectal cancer patients. Methods: A motivating example involves a cohort of patients from the ReSARCh observational study (2016–2021) with locally advanced adenocarcinoma of the rectum, situated up to 12 cm from the anal verge. These patients underwent either a watch-and-wait approach (WW) or trans-anal local excision (LE). Win statistics compared the effects of WW and LE on a composite outcome (overall survival, recurrence, presence of ostomy, and rectum excision). For matched win statistics, we used robust inference techniques proposed by Matsouaka et al. (2022), and for stratified win statistics, we applied the method proposed by Dong et al. (2018). A simulation study assessed the coverage probability of matched and stratified win statistics in balanced and unbalanced groups, calculating how often the confidence intervals included the true values of WR, NB, and WO across 1000 simulations. Results: The results suggest a better efficacy of the LE approach when considering efficacy outcomes alone (WR: 0.47 (0.01 to 1.14); NB: −0.16 (−0.34 to 0.02); and WO: 0.73 (0.5 to 1.05)). However, when QoL outcomes are included in the analyses, the estimates are closer to 1 (WR: 0.87 (0.06 to 2.06); WO: 0.93 (0.61 to 1.4)) and to 0 (NB: −0.04 (−0.25 to 0.17)), indicating a negative impact of the treatment effect of LE regarding the presence of ostomy and the excision of the rectum. Moreover, based on the simulation study, our findings underscore the superior performance of matched compared to stratified win statistics in terms of coverage probability (matched WR: 97% vs. stratified WR: 33.3% in a high-imbalance setting; matched WR: 98% vs. stratified WR: 34.4% in a medium-imbalance setting; and matched WR: 99.2% vs. stratified WR: 37.4% in a low-imbalance setting). Conclusions: In conclusion, our study sheds light on the interpretation of the results of win statistics in terms of statistical significance, providing insights into the application of pairwise comparison in observational settings, promoting its use to improve outcomes for cancer patients
- …
