Despite high risk of secondary fracture, osteoporosis treatment rates following hip fracture remain low globally. In April 2022, Japan implemented a reimbursement policy for secondary fracture prevention in patients with hip fracture. We evaluated the impact of this policy on treatment patterns during acute hospitalization. We conducted an interrupted time-series analysis using the Medical Data Vision database for patients aged ≥ 50 years hospitalized with hip fractures from April 2020 to March 2024. Primary outcome was osteoporosis medication treatment rate during hospitalization. Secondary outcomes included drug class distribution and use of medications categorized as recommended or proposed in preventing fractures according to Japanese guidelines. Segmented regression models were used to evaluate level and trend changes associated with policy implementation. Among 71,632 eligible patients with hip fracture (mean age 84, 76
Background Accurate preoperative staging of upper tract urothelial carcinoma (UTUC) remains challenging. This study aimed to develop site-specific scoring systems for predicting muscle-invasive UTUC without ureteroscopic findings. Methods This retrospective multicenter study initially included 386 patients who underwent radical nephroureterectomy for UTUC at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinically node-positive disease or those who received neoadjuvant chemotherapy were excluded. Preoperative variables included age, sex, body mass index, hydronephrosis, urinary cytology, clinical T stage, tumor size, and multifocality. Univariable and multivariable logistic regression analyses were performed separately for ureteral and renal pelvic tumors to identify the predictors of muscle-invasive disease. Results Among 356 eligible patients, 157 (44.1%) had muscle-invasive UTUC. Multivariable analysis identified positive urinary cytology and clinical T stage as independent predictors of muscle-invasive disease in both ureteral and renal pelvic tumors, whereas hydronephrosis was an additional independent predictor in ureteral tumors. Scoring systems incorporating these variables achieved areas under the curve of 0.865 for ureteral cancer and 0.745 for renal pelvic cancer. Optimal cutoff scores based on the Youden index were ≥ 3 for ureteral tumors and ≥ 2 for renal pelvic tumors, with sensitivity rates of 85.4% and 68.0% and specificity rates of 77.4% and 73.6%, respectively. Conclusion Site-specific scoring systems based on routinely available preoperative variables accurately predicted muscle-invasive UTUC without requiring ureteroscopic findings. These models may facilitate preoperative risk stratification, although external validation is required.
BACKGROUND/AIM:Postoperative complications can interfere with the continuation and completion of adjuvant chemotherapy (ACT) in stage III colorectal cancer. However, simple indicators for predicting treatment completion after severe postoperative complications remain unclear. This study evaluated whether total lymphocyte count (TLC) at ACT initiation predicts ACT completion and explored the association between ACT completion and recurrence-free survival. PATIENTS AND METHODS:This retrospective multicenter study included 61 patients with pathological stage III colorectal cancer who developed severe postoperative complications, defined as Clavien-Dindo grade III-IV, and received ACT. The primary endpoint was ACT completion. Recurrence-free survival was evaluated as a secondary oncological outcome. Clinical factors, complication-related factors, treatment-related factors, and laboratory parameters at ACT initiation were compared according to completion status. RESULTS:Among the 61 patients, 47 completed ACT and 14 did not. TLC at ACT initiation was significantly higher in the completion group. The area under the receiver operating characteristic curve of TLC for predicting ACT completion was 0.739. In multivariable logistic regression analysis, high TLC remained significantly associated with ACT completion [odds ratio 7.75, 95% confidence interval (CI)=1.90-31.63, p=0.004]. ACT completion was also associated with favorable recurrence-free survival (hazard ratio=0.387, 95%CI=0.155-0.968, p=0.042). CONCLUSION:TLC at ACT initiation may serve as a practical marker for predicting ACT completion in patients with stage III CRC who develop severe postoperative complications. ACT completion was associated with favorable recurrence-free survival and may reflect both adequate treatment exposure and postoperative recovery sufficient to tolerate ACT.
A unified consensus statement on medication-related osteonecrosis of the jaw (MRONJ) has not yet been established among the Asian member countries or regions of the Asian Federation of Osteoporosis Societies (AFOS). This study aimed to develop a consensus on MRONJ in patients with osteoporosis across these countries and regions. In this study, the term “Asia-Pacific” refers specifically to the Asian member countries and regions of AFOS. A structured survey consisting of nine MRONJ-related questions was distributed across 10 countries and regions to assess the level of agreement and summarize regional perspectives. In addition, a manual literature review and voting were conducted to evaluate the current evidence on MRONJ. The key aspects of MRONJ, including definition, staging, diagnosis, pathogenesis, risk factors, management, and prevention, were generally consistent among the AFOS countries and regions. The annual incidence and incidence rate of MRONJ associated with low-dose antiresorptive therapy in patients with osteoporosis ranged from 0.025% to 0.136% and 21 to 283 cases per 100,000 person-years, respectively. However, evidence regarding the benefits of drug discontinuation before dental surgery, such as tooth extraction, remains insufficient. Large-scale, multinational studies across AFOS countries and regions are warranted to determine the incidence of MRONJ better and evaluate the impact of antiresorptive drug discontinuation before dental procedures. These findings may contribute to the development of effective evidence-based strategies for preventing MRONJ in patients with osteoporosis.
The optimal timing of immune checkpoint inhibitor (ICI) initiation in advanced gastric cancer (GC) remains unclear. In this study, we evaluated the association between ICI initiation timing, tumor response, and survival outcomes in a real-world setting for GC. We conducted a multicenter retrospective study of patients with unresectable or recurrent GC who initiated first-line chemotherapy between January 2015 and September 2025. To adjust for immortal time bias, a clone-censor-weight (CCW) approach was applied to evaluate overall survival (OS) among the patients who received ICIs. Tumor response was assessed in patients treated with first-line S-1 plus oxaliplatin (SOX) or capecitabine plus oxaliplatin (CapeOX), with logistic regression analysis performed to identify factors associated with response. A total of 359 GC patients were included, of whom 219 received ICIs and were included in the CCW analysis. The ICI initiation timing was not significantly associated with OS (hazard ratio 1.03, 95
