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.
Helicobacter pylori (H. pylori) infection is the most common human infection worldwide, affecting approximately 40-60% of the global population. Eradication therapy is the primary treatment for preventing the development of peptic ulcers and gastric cancer. H. pylori eradication regimens should be selected based on those expected to achieve the highest eradication rates at treatment initiation in the area/country. In general, eradication regimens capable of achieving eradication rates of ≥90% are considered optimal. The success or failure of eradication therapy depends on several factors, including susceptibility to the antimicrobial agents used, inadequate acid inhibition during therapy, and poor medication adherence. Clinical guidelines and consensus reports for H. pylori infections are periodically updated worldwide. Recommended eradication regimens evolve in response to changing regional antibiotic resistance patterns, the introduction of new antimicrobial agents and acid-suppressing therapies, and regional insurance system-related challenges. Therefore, eradication regimens vary depending on the region covered by specific guidelines and consensus reports. This review aimed to explain regional differences in clinical guidelines and consensus reports for H. pylori infection, track their changes over time, and summarize future directions for eradication therapy.
Backgrounds: The AFIRE (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy was non-inferior in efficacy and superior in safety compared to rivaroxaban plus single antiplatelet therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). This study examined whether systolic blood pressure (SBP) affects clinical outcomes and modifies the impact of antithrombotic therapy. Methods: In this post hoc analysis, participants were stratified based on median SBP at baseline: >126 mmHg (High SBP group, n = 1042) and ≤126 mmHg (Low SBP group, n = 1093). The primary efficacy endpoint was a composite of cardiovascular events and all-cause death. The primary safety endpoint was major bleeding. Results: The mean SBP was 139 mmHg and 114 mmHg in the High and Low SBP groups, respectively. In the propensity score-matched cohort (n = 1684), the Low SBP group had a significantly higher incidence of the primary efficacy endpoint (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.01–1.88; p = 0.039), while the primary safety endpoint was comparable between groups. In the Low SBP group, rivaroxaban monotherapy was associated with lower risks of both the primary efficacy (HR, 0.60; 95% CI, 0.41–0.86; p = 0.006) and safety endpoints (HR, 0.40; 95% CI, 0.22–0.74; p = 0.003) compared with combination therapy, whereas no significant differences were observed in the High SBP group. Conclusions: Lower SBP was associated with increased risk of cardiovascular events and all-cause death. Rivaroxaban monotherapy demonstrated more favorable efficacy and safety outcomes particularly patients with lower SBP.
Background: No studies have compared aspirin to P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with diabetes. Methods and Results: We conducted a prespecified diabetes subgroup analysis of the 1-year STOPDAPT-3 trial; patients were randomized at the time of index PCI, and outcomes from 30 days to 1 year were assessed using a 30-day landmark analysis comparing 1-month DAPT followed by aspirin monotherapy (aspirin group) to 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The effect of aspirin relative to clopidogrel was not significant for the coprimary cardiovascular endpoint (composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) regardless of diabetes (aspirin/clopidogrel 5.3/5.6 vs. 3.9/3.7 per 100 person-years for diabetes vs. non-diabetes, respectively; hazard ratios [HRs] 0.96 [95% confidence interval {CI} 0.67-1.37] and 1.06 [95% CI 0.72-1.55], respectively; Pinteraction=0.71), but there was a significant interaction between diabetes and the effect of aspirin relative to clopidogrel for the coprimary bleeding endpoint (Bleeding Academic Research Consortium 3 or 5; aspirin/clopidogrel 2.8/1.8 vs. 1.3/2.0 per 100 person-years diabetes vs. non-diabetes, respectively; HR 1.54 [95% CI 0.88-2.71] vs. 0.65 [95% CI 0.36-1.17], respectively; Pinteraction=0.04). Conclusions: From 30 days to 1 year after PCI, cardiovascular outcomes were similar between aspirin and clopidogrel regardless of diabetes. A nominal bleeding interaction was observed; given the exploratory and underpowered subgroup analyses, this finding should be interpreted cautiously.
To identify distinct metabolic subtypes among Japanese men with prediabetes and evaluate their association with the future risk of type 2 diabetes. A data-driven cluster k-means cluster analysis was conducted in 2,172 men with prediabetes, defined as a fasting plasma glucose (FPG) concentration of 100–125 mg/dL (5.6–6.9 mmol/L) from the JDOIT-1 cohort. Four biochemical indicators—body mass index (BMI), fasting plasma glucose (FPG), alanine aminotransferase (ALT), and non-HDL cholesterol—were standardized and used for clustering. The optimal number of clusters (k = 3) was determined using the elbow method. The association between cluster membership and 5-year diabetes-free survival was examined. Three metabolic phenotypes were identified: Cluster 1 (MRP, n = 1,149), metabolically resilient; Cluster 2 (OFIP, n = 581), obesity- and insulin-resistant; and Cluster 3 (NOHP, n = 442), non-obese hyperglycemic. Annual diabetes incidence rates were 0.70
