BACKGROUND: Japan Clinical Oncology Group (JCOG) defined gastric cancer (GC) with bulky lymph node (Bulky N) and/or para-aortic lymph node (PAN) as extensive lymph node metastasis (ELM), and has developed neoadjuvant chemotherapy followed by D2 gastrectomy with PAN dissection (PAND) through three phase II trials using different regimens (JCOG0001: irinotecan/cisplatin, JCOG0405: cisplatin/S-1, JCOG1002: docetaxel/cisplatin/S-1). However, whether PAND provides survival benefit remains uncertain. METHODS: The therapeutic value index was investigated using integrated data from JCOG0001, JCOG0405, and JCOG1002. Patients were classified into Bulky N group (only bulky N without PAN) and PAN group (PAN regardless of bulky N) based on the clinical diagnosis. The index was calculated by multiplication of incidence of metastasis and percentage 5-year relapse-free survival (5yRFS) of patients with metastasis for each lymph node area. RESULTS: A total of 122 patients were analyzed (Bulky N group: 68, PAN group: 54). In Bulky N group, the proportion of metastasis/5yRFS/index in the PAN area was 15.2%/30.0%/4.5 (JCOG0001: 27.8%/20.0%/5.6, JCOG0405: 13.6%/33.3%/4.5, JCOG1002: 7.7%/50.0%/3.8). The proportion of metastasis decreased across trials. In PAN group, the proportion of metastasis/5yRFS/index in the PAN area was 44.4%/4.2%/1.9 (JCOG0001: 81.3%/7.7%/6.3, JCOG0405: 30.0%/0.0%/0.0, JCOG1002: 27.8%/0.0%/0.0). Notably, the indices of the recent two trials were zero. CONCLUSIONS: PAND may retain a potential role in the Bulky N group, whereas its benefit appears limited in the PAN group. Decreasing trends in PAN metastasis and therapeutic value were observed in both groups. Given the distinct characteristics of these subgroups, the omission of PAND should be determined through separate future validation.
Advancements in cancer treatment have iproved the long-term prognosis, leading to an increasing number of cancer survivors with coexisting heart failure (HF). Cardiovascular (CV) death is one of the major causes of death among cancer survivors with HF, highlighting the crucial need for risk stratification for CV death to improve their long-term prognosis. However, the specific risk factors for CV death in cancer survivors with HF are not fully understood. We enrolled 485 cancer survivors who were admitted to our hospital for treatment of HF between 2011 and 2023. All patients were prospectively followed up for a median period of 545 days with the endpoint of all-cause death. During the follow-up period, there were 107 CV deaths, which accounted for more than half of the total deaths and were four times higher than cancer deaths. Multivariate Fine-Gray analysis showed that low serum albumin levels independently predicted CV death after adjustment for confounding factors (sub-distribution hazard ratio [sHR], 0.740 per 1-SD increase; 95
While neoadjuvant immunochemotherapy has improved outcomes of resectable nonsmall cell lung cancer (NSCLC), treatment-induced tissue changes can increase surgical complexity. This study aimed to identify preoperative predictors of technically challenging surgery following neoadjuvant immunochemotherapy. This multicenter retrospective analysis included 114 patients who underwent surgery after neoadjuvant nivolumab plus platinum-based chemotherapy at 29 institutions between March 2023 and July 2024. Challenging surgery was defined as one requiring bronchoplasty, pulmonary artery angioplasty, or pneumonectomy. Logistic regression was used to identify preoperative predictors for surgical complexity. Twenty-one patients (18.4
BACKGROUND:With the widespread adoption of immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC), local recurrence after immunotherapy has become increasingly frequent. However, limited evidence is available regarding salvage surgery after ICI therapy. METHODS:A multi-institutional retrospective study (CReGYT-05 Immune Checkpoint Inhibitor-Salvage Study) was conducted across 14 centers in Japan, evaluating patients who underwent salvage surgery after ICI therapy between 2016 and 2023. Salvage surgery was classified as conversion surgery (downstaging from initially unresectable to resectable disease) or true salvage surgery (surgery for local recurrence or residual disease). The primary endpoints included perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS). RESULTS:The study analyzed 32 patients. Radiologic response to ICI therapy showed complete response in 4 patients (12.5 %), partial response in 23 patients (71.9 %), and stable disease in 5 patients (15.6 %). Salvage procedures comprised true salvage surgery (n = 17, 53.1 %) and conversion surgery (n = 15, 46.9 %). Lobectomy was performed for 84.4 % of the patients. Perioperative complications occurred in eight (25.0 %) of the patients, with no perioperative mortality. Pathologic complete response was achieved for six (18.8 %) patients. The 3- and 5-year OS rates from the initial diagnosis were 86.9 % and 77.2 %, respectively. Conversion surgery demonstrated superior 3-year RFS compared with true salvage surgery (92.8 % vs 36.3 %; p = 0.010). Univariable analysis identified salvage type as a significant factor for RFS. CONCLUSIONS:Salvage surgery after ICI therapy can be safely performed and is associated with encouraging survival outcomes for carefully selected patients, particularly those undergoing conversion surgery.
BACKGROUND:The efficacy and safety of early direct oral anticoagulant (DOAC) (re)initiation in patients with non-valvular atrial fibrillation (NVAF) after acute onset of intracranial hemorrhage (ICH) are unknown. This study evaluated ischemic and hemorrhagic risks following early DOAC (re)initiation after ICH in patients with NVAF. METHODS AND RESULTS:SAFE-ICH is a multicenter prospective observational single-arm registry study at 32 Japanese hospitals. Eligible patients had NVAF, were aged ≥20 years, and (re)initiated DOAC ≤14 days following symptomatic ICH. Among 240 patients who (re)initiated DOAC (61.3% male; mean [±SD] age 79.4±9.3 years), intraparenchymal hemorrhage predominated (84.6%), followed by subdural (12.9%), intraventricular (1.7%), and epidural (0.8%) hemorrhage. The median (interquartile range) baseline National Institutes of Health Stroke Scale score was 10 (3-16) and time to DOAC (re)initiation was 7 days (5-10 days). Edoxaban, apixaban, and rivaroxaban were used in 55.0%, 35.8%, and 9.2% of patients, respectively. The primary endpoint (composite of symptomatic ICH, any stroke, or death ≤30 days following DOAC [re]initiation) occurred in 12 (5.0%) patients. There were 4 recurrent ICH events (1.7%; all recurrent subdural hemorrhages). Five (2.1%) patients died of non-vascular causes. CONCLUSIONS:In Japanese patients with NVAF, early DOAC (re)initiation ≤14 days after ICH appears to have an acceptable risk for ischemic and hemorrhagic events, particularly in patients with intraparenchymal hemorrhage. In patients with subdural hematoma, early DOAC (re)initiation requires vigilant monitoring.
