Background Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. Methods This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. Results In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. Conclusions In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.
BACKGROUND:Fibrosis may coexist with emphysema in COPD, but computed tomography (CT) quantification is challenging. Persistent homology (PH), a topological data analysis technique, provides interpretable structural features in greyscale images. By using PH, this CT study aimed to quantify fibrotic lesions in nonemphysematous and emphysematous lungs and to investigate clinical implications of PH-based fibrosis quantification in patients with COPD. METHODS:The study included subjects from the Lung Cancer Screening (LCS) cohort (n=346) and two prospective COPD cohorts (Kyoto University n=234; Kyoto-Himeji n=166). Based on CT value patterns and spatial topology, PH assigned each voxel as fibrotic or nonfibrotic and calculated the percentage of fibrotic lung volume (PH-fibrosis%) in association with visually identified interstitial lung abnormality and COPD outcomes. RESULTS:Higher PH-fibrosis% was associated with interstitial lung abnormalities in the LCS and Kyoto University cohorts. The two COPD cohorts consistently showed significant associations between higher baseline PH-fibrosis% and future exacerbation risk independent of emphysema and airway wall thickness (hazard ratio (HR) 1.39 and 3.35 for Kyoto University and Kyoto-Himeji, respectively). In the Kyoto University cohort, higher PH-fibrosis% was significantly associated with increased mortality (HR 1.94), with a similar trend in the Kyoto-Himeji cohort (HR 1.86). Longitudinal increases in PH-fibrosis% over median 4.98 years were associated with higher exacerbation frequency and patients experiencing greater increase in PH-fibrosis% subsequently exhibited higher mortality in the Kyoto University cohort. CONCLUSIONS:PH can be used to quantify fibrotic lesions on CT and PH-fibrosis% could be a prognostic imaging marker in patients with COPD.
OBJECTIVES:This study aimed to evaluate the diagnostic performance of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR-2019) classification criteria of systemic lupus erythematosus (SLE) and to clarify the clinical characteristics of Japanese childhood-onset SLE (cSLE). METHODS:We retrospectively analyzed clinical data registered in the Paediatric Rheumatology International Collaboration Unit Registry (PRICURE) version 2 up to March 31, 2023. Frequencies of individual items within the EULAR/ACR-2019 criteria were compared with those observed in a Japanese adult SLE cohort. RESULTS:A total of 105 patients with cSLE, 19 with Juvenile dermatomyositis (JDM), 27 with primary Sjögren's disease (pSjD), and 9 with mixed connective-tissue disease (MCTD) were included. The sensitivity of the EULAR/ACR-2019 criteria was 97.1%. The specificity was 94.7% for JDM, 92.6% for pSjD, 55.6% for MCTD, and 87.3% for all disease controls. cSLE patients in this cohort more frequently exhibited renal involvement, low serum C3 or C4 levels, and positivity for antiphospholipid and anti-double-stranded DNA antibodies, but joint symptoms were less common than in adult SLE patients. CONCLUSIONS:Although the EULAR/ACR-2019 criteria are generally applicable, the limited specificity for MCTD necessitates careful differential diagnosis. Japanese cSLE is commonly characterized by renal involvement, hypocomplementemia, and SLE-related autoantibody positivity.
OBJECTIVE:The aims of this study were to clarify the relationship between the combined forward flexion capacity of the lumbar spine and hip joint, referred to as TrunkAflex, and Lumbar Stiffness Disability Index (LSDI) scores in patients following lumbar spine surgery, and to assess whether TrunkAflex better reflects disabilities with activities of daily living (ADL) than the number of fused segments or lumbar spine flexion alone. METHODS:This prospective, cross-sectional, multicenter study included 147 patients who underwent lumbar spine surgery and completed LSDI questionnaires. Lateral radiographs were obtained in the maximum seated flexion position. Radiographic parameters included pelvic incidence (PI)-corrected lumbar lordosis in flexion (PI-LLflex), representing lumbar spine flexion ability, pelvic femoral angle in flexion (PFAflex), representing hip joint flexion ability, and TrunkAflex, defined as the angle between the axis of the L1 vertebral body and the proximal femoral shaft, mathematically expressed as the sum of PI-LLflex and PFAflex. Correlation analyses were used to determine the relationships between LSDI and these parameters. Subgroup analyses were performed to compare the lumbar fusion (upper instrumented vertebra [UIV] at L1 or below) and thoracolumbar fusion (UIV at T12 or above) groups. RESULTS:The LSDI score was significantly correlated with the number of fused segments (r = 0.328, p < 0.01), and PI-LLflex showed a significant correlation with LSDI (r = -0.354, p < 0.01). However, TrunkAflex demonstrated the strongest correlation with LSDI (r = -0.491, p < 0.01). Subgroup analysis revealed that PI-LLflex was more influential in the lumbar fusion group, while PFAflex was more impactful in the thoracolumbar fusion group. Nevertheless, TrunkAflex consistently showed the strongest correlation with LSDI across all groups. Notably, TrunkAflex was minimally influenced by PI, making it a practical and consistent parameter for trunk forward flexion assessment. CONCLUSIONS:This study demonstrated that the combined forward flexion ability of the lumbar spine and hip joint, represented by TrunkAflex, is a stronger predictor of LSDI scores than the number of fused segments or lumbar spine flexion alone, irrespective of the fusion range. Preoperative assessment of hip joint function is particularly important when planning long-segment fusion, and adjusting surgical strategies to preserve appropriate TrunkAflex may contribute to better postoperative ADL outcomes.
INTRODUCTION:Robotic right hemicolectomy has been widely adopted, but the impact of extraction-site location on postoperative pain in single-port (SP) surgery remains unclear. We aimed to compare short-term outcomes between SP and multiport robotic surgery and to evaluate postoperative wound pain according to extraction-site location. METHODS:This retrospective single-center study included 49 consecutive patients who underwent robotic right hemicolectomy (January 2024-December 2025): 25 in the SP group and 24 in the Xi group. Postoperative pain was assessed using the cumulative pain score (sum of daily maximum NRS values, POD1-POD7). Pain outcomes were compared among SP_P (Pfannenstiel, n = 13), SP_Umb (umbilical, n = 12), and Xi_P (Pfannenstiel, n = 22). RESULTS:Perioperative and oncological outcomes were comparable between the groups. The SP group had significantly shorter operative time (244 vs. 309 min, p = 0.0013) and console time (167 vs. 239 min, p = 0.0014). Postoperative pain differed significantly among the three subgroups (p = 0.0049). Pairwise comparisons showed significantly lower pain in SP_P than in SP_Umb (p = 0.0062), with no significant difference for the other two comparisons. The difference between SP_P and SP_Umb remained significant after adjusting for anastomotic technique and surgical procedure in multiple regression analysis. CONCLUSION:SP-assisted right hemicolectomy was safe, with short-term outcomes comparable to the Xi platform. These findings suggest that postoperative pain following robotic right hemicolectomy may be influenced not only by the number of abdominal ports but also by the location of the extraction incision.
