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Immediate breast reconstruction (IBR) in locally advanced breast cancer (LABC) (stage 3A and above) is widely debated, both in terms of delay of adjuvant therapy and oncological safety. This study aims to systematically review and evaluate the long-term oncological safety of IBR in patients with LABC undergoing mastectomy. Search conducted using Medline, Embase, PubMed and Google Scholar between 1 and 24 December 2023 involving patients with LABC who underwent mastectomy with or without IBR were included. The meta-analysis included studies comparing IBR with mastectomy alone in patients with LABC with the primary outcomes of 5-year overall survival, disease-free survival and local and distant recurrence rates. A total of 19,907 patients were included spanning 10 papers. Of these, 89.1% underwent mastectomy alone, while 10.9% underwent IBR (51.2% autologous and 48.8% implant-based reconstruction). The 5-year overall survival rate was higher in IBR compared to mastectomy alone (IBR n = 2038/2491 81.8%, vs. Mx only n = 7468/10,124 73.7%, RR 1.10 [95% CI 1.07–1.12], P < 0.001). No significant difference found in 5-year disease-free survival (IBR n = 510/689 74.0% vs. Mx only n = 1339/1924 69.6%, RR 1.06 [95% CI 0.98–1.15], P = 0.17), 5-year local recurrence groups (IBR n = 52/646 8.0% vs. Mx only n = 122/1708 7.1%, RR 0.80 [95% CI 0.46–1.38], P = 0.42), or 5-year distant recurrence rates (IBR n = 117/594 19.6% vs. Mx only n = 211/882 23.9%, P = 0.11). IBR in LABC may be associated with improved overall 5-year survival rates without affecting disease-free survival or recurrence rates. Therefore, IBR may be a safe option in the treatment of LABC when considering optimal oncological outcomes. [ABSTRACT FROM AUTHOR]

Metastasis to retropharyngeal lymph nodes (RPLN) from oral squamous cell carcinoma is rare and associated with poor outcomes. The poor prognosis of RPLN is multifactorial and includes the clinicopathological aggressiveness of the primary disease and the late presentation. The aim of this systematic review is to assess the evidence on RPLN in patients diagnosed with oral squamous cell carcinoma (OSCC), the quality of the diagnostic modalities and the available treatment options. We aimed to analyse the overall survival of these patients diagnosed with RPLN. A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The initial literature search generated 289 articles. A total of 11 papers satisfied our criteria. Eight papers provided enough data to perform survival analysis and 3 papers compared the diagnostic modalities used in the detection of RPLN. A total of 73 OSCC patients diagnosed with RPLN metastasis were identified. The most common primary tumour subsites included the tongue (20), buccal mucosa (15) and gingiva (11). The cumulative 5-year OS rate was 17.8% while the 2-year overall survival was 35.9%. The presence of nodal metastasis is an independent prognostic factor in head and neck cancer. In this study, RPLN metastasis had a poorer prognosis (5 years overall survival is 17.8%) when compared to the survival rate of oral cancer without RPLN metastasis (5 years overall survival is 40%). There was no statistically significant difference between the overall survival in primary RPLN metastasis and recurrent RPLN disease. [ABSTRACT FROM AUTHOR]

Our paper evaluates the relationship between radiologically abnormal cardiophrenic lymph nodes (CPLN) in advanced ovarian cancer and pattern of disease distribution, tumour burden, surgical complexity, rates of cytoreduction and same-site recurrence. Impact of suspicious CPLN and CPLN dissection on overall survival also determined. Retrospective review of index CT imaging for 151 consecutive patients treated for stage III/IV ovarian malignancy in a large UK cancer centre to identify radiologically abnormal CPLN. Corresponding surgical, histo-pathological and survival data analysed. 42.6% of patients had radiologically 'positive' CPLN on index CT. Radiological identification of CPLN involvement demonstrated a sensitivity of 82% within our centre. Patients with cardiophrenic lymphadenopathy on pre-operative CT had significantly more co-existing ascites (p = 0.003), omental (p = 0.01) and diaphragmatic disease (p < 0.0001). At primary debulking (PDS), suspicious CPLN were associated with significantly higher surgical complexity scores, without feasibility of complete cytoreduction being impacted. Cardiophrenic involvement at initial diagnosis was associated with same-site relapse at recurrence (p = 0.001). No significant difference in overall survival was demonstrated according to CPLN status following either PDS or delayed debulking (DDS). CPLN dissection did not improve patient outcomes. Radiological identification of abnormal CPLN is reliable. Suspicious CPLN appear to represent a surrogate marker of tumour volume – in particular, heralding upper abdominal disease – and should prompt anticipation of high complexity surgery and referral to an appropriate centre. Patients with prior CPLN involvement are more likely to develop same-site recurrence at relapse. Our survival data suggests cardiophrenic LN disease does not worsen patient prognosis and that the therapeutic benefit of CPLN dissection remains unclear. [ABSTRACT FROM AUTHOR]

To determine graft and patient survival and adverse events in patients who undergo orthotopic kidney transplantation. We performed a systematic review and meta-analysis. We search in Medline, Embase, and Central from inception to nowadays. We included observational studies with patients who undergo orthotopic kidney transplantation. The primary outcomes were overall patient and graft survival. We pooled the information in a frequency meta-analysis with a 95% CI. We analyzed bias with the STROBE statement. Of the 106 papers initially retrieved, four met the inclusion criteria. Vascular and urinary tract complications were reported in 19% and 15%, respectively. The overall patient survival was 92% 95%CI (88% to 95%), I2 = 0%, and the overall graft survival was 88% 95 CI (83% to 91%), I2 = 0%. Our analysis showed a high survival rate in patients and kidney grafts after orthotopic kidney transplantation, with a similar complication rate compared to a heterotopic kidney transplant. [ABSTRACT FROM AUTHOR]

Early diagnosis of epilepsy is crucial for patient survival and well-being, making it essential to develop effective methods for early disease detection based on health parameters. This paper introduces a novel approach to enhance electroencephalogram (EEG)--based epileptic seizure detection, presenting a robust Takagi-Sugeno-Kang (TSK) fuzzy classifier. Our key contribution lies in the integration of advanced techniques, specifically, possibility-based clustering with competitive learning (PC-CL), into the classifier. This not only refines fuzzy rule parameters with unprecedented precision but also imparts resilience against noise, elevating the interpretability of the model. The distinctive amalgamation of PC-CL ensures a more nuanced and accurate representation of complex EEG patterns associated with epileptic seizures. Additionally, a hybrid approach combining a twin support vector machine with a fuzzy system (TSVM-PC-CL-TSK) is proposed for epilepsy classification. Results from experiments show that the proposed classifier performs more efficiently than previous, achieving an impressive 99.41 % accuracy rate in identifying abnormal EEG signals associated with epileptic seizures. The research showcases the significant potential of this innovative approach in epilepsy research and clinical applications, offering improved epileptic seizure detection and elevated patient care standards. [ABSTRACT FROM AUTHOR]

Recurrence post hepatectomy for colorectal liver metastases (CRLM) occurs in 70 % of patients within two years. No established guidance on the method or intensity of follow-up currently exists. The aim of this systematic review was to summarise literature and determine whether it is possible to identify an optimal follow up regime. To this date there are no randomised prospective studies investigating this. A systematic review was performed according to PRISMA guidelines. Outcomes included general demographics, method, frequency and duration of follow up, survival and recurrence data. Quality assessment of the papers was performed. Twenty-five articles published between 1994 and 2022 were included, including 9945 patients. CT was the most common imaging modality (n = 14) and CEA most common blood test (n = 11). Intensity of follow up was higher in the first two years post resection and only two papers continued follow up post 5 years resection. There was wide variation in outcome measures - Overall survival (OS) was most commonly reported. Nine papers reported OS ranging between 39 and 78.1 %. There is wide variation in follow up methods and outcome reporting. There is no strong evidence to support intensive follow up, and the benefits of long term follow up are also unknown due to the lack of patient centred data. High quality, prospective studies should be the focus of future research as further retrospective data is unlikely to resolve uncertainties around optimal follow up. [ABSTRACT FROM AUTHOR]

Objective: To reappraise the concept of conditional survival (CS) following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), accounting for the patient's present disease status relative to recurrence. Background: CS, defined as the probability of surviving an additional time frame based on accrued lifespan, offers dynamic survival projections as compared with baseline overall survival. Methods: Patients undergoing pancreatectomy for PDAC at 2 institutions from 2000 to 2013 were retrospectively analyzed. The 12-month CS was estimated separately for patients who were disease-free or with recurrence at the given time points. Next, the conditional probability of reaching 60-months of survival was examined in each conditioning set across strata of prognostic covariates, including American Joint Committee on Cancer stage, tumor grade, R-status, and adjuvant treatment. Results: The study population consisted of 1005 patients. In disease-free patients, the 12-month CS increased as a function of time already survived, showing an opposite trend compared with overall survival. In patients who recurred, the 12-month CS was lower than the disease-free counterpart, especially within 24 months postoperatively. When stratifying by the levels of prognostic covariates, the 60-months CS estimates for disease-free patients tended to level off progressively, indicating that factors independently associated with survival at the time of pancreatectomy lost power over time. This concept did not apply to the conditioning set of patients with recurrence, where CS estimates across variables strata diverged with accrued lifespan. Conclusion: This paper provides new information on how prognosis following pancreatectomy for PDAC evolves over time, adjusting for the time the patient already survived, and for the patient's present disease status relative to recurrence. [ABSTRACT FROM AUTHOR]

Patients with sickle cell disease (SCD) have just one recognized curative therapy option: hematopoietic stem cell transplantation (HSCT), which results in a long-lasting improvement in the clinical phenotype. Here, we assessed the effectiveness of HSCT in treating children with SCD by a systematic review and meta-analysis. Up until January 2024, a comprehensive search was done using Web of Science, CINAHL, Embase, Google Scholar, Cochrane Library, PubMed/Medline, and Embase. Two reviewers worked separately to extract the data, and Newcastle-Ottawa Quality Assessment tool was used to assess the research's quality. The outcomes analyzed were Overall survival (OS), event-free survival (EFS), graft failure (GF) and mortality. Nineteen papers satisfied our inclusion requirements and were assessed to be of fair quality. The pooled rate of OS was high (92%; 95% CI: 90.3%–93.5%). Similar finding was detected for EFS (85.8%; 95% CI: 83.7%–87.7%). In the other hand, pooled rates of GF and mortality were 6.9% (95% CI: 5.3%–8.9%) and 7.4% (95% CI: 5%–10.7%), respectively. A significant publication bias was detected for OS, EFS and GF outcomes. Subgroups analysis showed that study design was the major source of heterogeneity. Our results show that HSCT is effective and safe, with pooled survival rates above 90%. It is important to assess innovative tactics in light of the alarming GF and mortality rates. [ABSTRACT FROM AUTHOR]

The role of breast surgery in the treatment of patients with de novo metastatic breast cancer(dnMBC) remains controversial, with conflicting trial results. We did a meta-analysis to comprehensively investigate and assess whether breast surgery is associated with survival and quality of life outcomes in patients with dnMBC.We systematically searched PubMed, Embase, Google Scholar, Scopus, and Web of Science, from database inception to March 30, 2022, for randomized controlled trials(RCTs) that compared breast surgery or locoregional therapy with non-surgical treatment based on systemic therapy for managing dnMBC.We also reviewed abstracts and presentations from major conference proceedings. We excluded non-randomised trials and considered only papers published in English. The primary outcomes were overall survival(OS),locoregional progression-free survival(LPFS), distant progression-free survival(DPFS), and quality of life(QoL). The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects model or fixed effects model were used to calculate the effect sizes of included RCTs.Quality of evidence was assessed with GRADE criteria. Data analysis was performed with STATA 17.0. A total of 1018 women from seven randomized clinical trials were included in the analysis. Pooled analyses revealed that compared with systemic therapy, breast surgery was not associated with beneficial outcomes in OS(hazard ratio [HR],0.87; 95%CI,0.68 to 1.11; I2 = 53.08 %; p = 0.265),DPFS(HR,1.20; 95%CI,0.94 to 1.54; I2 = 86.45 %; p = 0.136), or QoL-global health status (standardized mean difference[SMD],0.08; 95%CI,-0.15 to 0.32; I2 = 79.45 %; p = 0.478) and QoL-mental-physical functionality(SMD,-0.19; 95%CI,-0.50 to 0.13; I2 = 0.00 %; p = 0.255), but was associated with a benefit in LPFS(HR,0.27; 95%CI,0.19 to 0.38; I2 = 84.16 %; p < 0.001). These findings were consistent in subgroup analyses of the timing of surgery, site and number of metastases and tumor molecular subtype. The evidence grade was moderate because of the substantial heterogeneity among studies. Based on the RCTs evidence, we found that breast surgery may benefit locoregional control but does not prolong OS and improve QoL in patients with dnMBC. The Prospero registration number: CRD42020206460. [ABSTRACT FROM AUTHOR]

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[Display omitted] • Proposed unified framework for glioma survival classification & visual interpretation. • Proposed an integrated modality-specific and modality-concatenated system. • Presented in-depth analysis of designing the classification network. • Generation of attention maps over different convolutional levels & non-predicted labels. An accurate and well-defined survival prediction of High Grade Gliomas (HGGs) is indispensable because of its high incidence and aggressiveness. Therefore, this paper presents a unified framework for fully automatic overall survival classification and its interpretation. Initially, a glioma detection model is utilized to detect the tumorous images. A pre-processing module is designed for extracting 2D slices and creating a survival data array for the classification network. Then, the classification pipeline is integrated with two separate pathways: a modality-specific and a modality-concatenated pathway. The modality-specific pathway runs three separate CNNs for extracting rich predictive features from three sub-regions of HGGs (peritumoral edema, enhancing tumor and necrosis) by using three neuro-imaging modalities. In these pathways, the image vectors of the different modalities are also concatenated to the final fusion layer to overcome the loss of lower-level tumor features. Furthermore, to exploit the intra-modality correlations, a modality-concatenated pathway is also added to the classification pipeline. The experiments are conducted on BraTS 2018 and BraTS 2019 benchmarks, demonstrating that the proposed approach performs competitively in classifying HGG patients into three survival groups, namely, short, mid, and long survivors. The proposed approach achieves an overall classification accuracy, sensitivity, and specificity of about 0.998, 0.997, and 0.999, respectively, for the BraTS 2018 dataset, and for BraTS 2019, these values correspond to 1.000, 0.999, and 0.999. The results indicate that the proposed model achieves the highest values of the evaluation metrics for the overall survival classification of HGG. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Epithelial ovarian cancer is a highly fatal gynecologic malignancy with a poor prognosis. Therefore, identification of new modifiable prognostic factors is important. Due to the fact that the effect of body weight changes during chemotherapy for EOC is still not very well known we aimed to describe, considering evidence, role of body weight changes in relation to survival. MATERIALS AND METHODS: Between October 2014 and August 2015 we systematically searched the following databases: Medline, Scopus, Web of Science and EMBASE to identify the studies describing the influence of body weight changes on survival in patients undergoing chemotherapy for EOC. RESULTS: We identified 601 potentially relevant publications, however finally only one article was included for data extraction and analysis. The overall survival in the selected paper was significantly associated with body weight changes during the first-line chemotherapy. Nevertheless, no influence on progression free survival was found. CONCLUSIONS: The analyzed data provides initial evidence, showing poorer overall survival associated with body weight loss and improved overall survival associated with body weight gain during primary chemotherapy for epithelial ovarian cancer. Prospective and retrospective trials are an urgent calling to confirm this conclusion. [ABSTRACT FROM AUTHOR]

To our knowledge this paper is the first to use recursive partitioning analysis (RPA) for brainstem metastasis (BSM) patient outcomes, after CyberKnife radiosurgery (CKRS; Accuray, Sunnyvale, CA, USA); nine similar previous publications used mainly Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden). Retrospective chart reviews from 2006–2013 of 949 CKRS-treated brain metastasis patients showed 54 BSM patients (5.7%): 35 RPA Class II (65%) and 19 Class III (35%). There were 30 women (56%) and 24 men (44%). The median age was 59 years (range 36–80) and median follow-up was 5 months (range 1–52). Twenty-three patients (43%) had lung carcinoma BSM and 12 (22%) had breast cancer BSM. Fifty-four RPA Class II and III BSM patients had a median overall survival (OS) of 5 months, and for each Class 8 and 2 months, respectively. Of 36 RPA Class II and III patients with available symptoms (n = 31) and findings (n = 33), improvement/stability occurred in the majority for symptoms (86%) and findings (92%). Of 35 cases, 28 (80%) achieved BSM local control (LC); 13/14 with breast histology (93%) and 10/13 with lung histology (77%). All six RPA Class II and III patients with controlled extracranial systemic disease (ESD) experienced LC. Median tumor volume was 0.14 cm 3 ; of 34 RPA Class II and III cases, 26 LC patients had a 0,13 cm 3 median tumor volume while it was 0.27 cm 3 in the eight local failures. Of 35 cases, single session equivalent dosages less than the median (n = 13), at the 17.9 Gy median (n = 5) and greater than the median (n = 17) had BSM LC in 10 (77%), four (80%) and 14 cases (82%), respectively. Univariate analysis showed Karnofsky Performance Score, RPA Class and ESD-control predicted OS. CKRS is useful for RPA Class II and III BSM patients with effective clinical and local BSM control. [ABSTRACT FROM AUTHOR]

• The prognosis of esophageal squamous cell carcinoma (ESCC) is very poor and the overall survival rate is very low, which is a major threat to human health. • Using preoperative pathological information to predict prognostic risk is of great significance for improving prognosis evaluation. • Aiming at the problem that the characteristic variables extracted by different modeling methods are different and the stability is not strong, this paper proposes a scheme that fuses the idea of ensemble learning with feature selection, establishes the final survival risk prediction model for ESCC. • Five classification techniques are integrated to rank the importance of risk factors, including stochastic configuration network (SCN), Logistic regression (LR), support vector machine (SVM), decision tree (DT) and random forest (RF). • The selected important risk factors as predictors of SCN, LR, SVM, DT and RF to construct ESCC prognostic risk assessment models. • The results showed that INR, APTT and albumin are important factors affecting the prognosis of ESCC. • The classification accuracy of SCN, LR, SVM, DT and RF models established by this scheme are all higher than that without using this scheme. • Among them, the RF model established has the best performance (accuracy: 80.19%). The prognosis of esophageal squamous cell carcinoma (ESCC) is very poor and the overall survival rate is very low, which is a major threat to human health. Using preoperative pathological information to predict prognostic risk is of great significance for improving prognosis evaluation. Aiming at the problem that the characteristic variables extracted by different modeling methods are different and the stability is not strong, this paper proposes a scheme that fuses the idea of ensemble learning with feature selection, establishes the final survival risk prediction model for ESCC. Five classification techniques are integrated to rank the importance of risk factors, including stochastic configuration network (SCN), Logistic regression (LR), support vector machine (SVM), decision tree (DT) and random forest (RF). The selected important risk factors as predictors of SCN, LR, SVM, DT and RF to construct ESCC prognostic risk assessment models. The results showed that INR, APTT and albumin are important factors affecting the prognosis of ESCC. The classification accuracy of SCN, LR, SVM, DT and RF models established by this scheme are all higher than that without using this scheme. Among them, the RF model established has the best performance (accuracy: 80.19%). [ABSTRACT FROM AUTHOR]

Abstract: Because of its direct clinical relevance, overall survival is the gold standard endpoint for measuring clinical efficacy. However, achieving improvements in overall survival can be confounded by factors such as crossover to active treatment arms and subsequent treatment with non-experimental active therapies. Powering studies to detect significant overall survival increases requires prohibitively large patient numbers and long follow-up and may not always be practical. Trials incorporating progression free survival (PFS) or time to progression (TTP) as primary outcome measures are likely to be shorter, require fewer patients and are usually more affordable, which may ultimately translate into a more rapid evaluation of potentially effective experimental therapies. In heavily pretreated metastatic breast cancer, significant improvements in progression-free survival may indicate a clinically meaningful benefit for patients with otherwise limited salvage therapy options available. Approval for several newer agents in the advanced resistant or refractory metastatic breast cancer setting has been based on prolonged progression-free survival or time to progression as primary trial endpoints. In this paper, clinical trial data relating to OS, PFS and TTP endpoints are reviewed and the use of surrogate markers of survival for the evaluation of new drugs is considered. [Copyright &y& Elsevier]

Objective. The treatment of relapsed and refractory multiple myeloma (RRMM) remains challenging. The outcomes in highly pretreated populations are unsatisfactory and there is urgent need for novel and safe therapeutic approaches. Recently, daratumumab has been approved for RRMM with promising results even in monotherapy. The aim of this study was to assess the efficacy of single agent daratumumab outside a clinical trial. Patients and Methods. 14 patients with RRMM and significant pretreatment (median 4.5 previous lines) entered a specific healthcare program and received treatment with single agent daratumumab. They were followed for therapeutic response based on IMWG criteria, and incidence of adverse events. The data were collected using the Registry of Monoclonal Gammopathies. Results. The overall response rate was 38.5%. 23.1% of patients reached very good partial response, 15.4% reached partial remission, 15.4% had minimal response, 38.5% had stable disease and 7.7% had progressive disease. The median progression free survival was 4.6 months and median overall survival was not achieved. The toxicities were mostly mild, only infectious complications and hematological toxicity reached grade III. Conclusion. We conclude that daratumumab has significant activity in highly pretreated RRMM even as a single agent, with an acceptable toxicity profile and survival impact. [ABSTRACT FROM AUTHOR]