Early-onset locally advanced rectal cancer presents unique challenges in treatment and prognosis. This study aimed to develop and validate a prognostic nomogram for patients aged 18–50 years with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy, addressing the lack of tailored prognostic tools for this growing patient population. Using the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed 2,853 patients who received neoadjuvant chemoradiotherapy between 2010 and 2020. Patients were divided into training (n = 1,990) and validation (n = 863) cohorts. Cox proportional hazard regression models identified prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Nomograms were constructed and validated using Harrell’s C-index and receiver operating characteristic (ROC) curve analysis. Independent predictors of poor OS and CSS included male sex, unmarried status (particularly divorced/separated/widowed), non-Hispanic black and American Indian/Alaskan native races, advanced T stage, increased positive regional nodes, and positive carcinoembryonic antigen (CEA). The nomogram demonstrated good discriminative ability in the validation cohort, with area under the curve (AUC) values of 0.767 and 0.742 for 3-year OS and CSS, respectively, and 0.705 and 0.697 for 5-year OS and CSS, respectively. The developed nomogram and identified prognostic factors provide valuable tools for individualized risk stratification and treatment optimization in young patients with locally advanced rectal cancer. These findings can aid in clinical decision-making and patient counseling. However, further external validation and prospective evaluations are necessary to confirm the clinical utility of this prognostic model in diverse healthcare settings.
Long-term effects of laparoscopic sleeve gastrectomy (LSG) on lipid metabolism, particularly beyond 10 years, are not well defined. This study evaluated changes in standard lipid parameters and atherogenic indices more than 11 years after stand-alone LSG. This retrospective cohort study included adults who underwent primary stand-alone LSG between 2005 and 2009. Patients with revisional bariatric procedures or major gastrointestinal or appetite-related disorders were excluded. Lipid profiles were assessed preoperatively and at follow-up beyond 11 years. Primary outcomes were long-term changes in triglycerides, total cholesterol, LDL-C, HDL-C, and non-HDL-C. Secondary outcomes included changes in the atherogenic index of plasma, triglyceride/HDL-C ratio, Castelli risk indices I and II, atherogenic coefficient, and use of lipid-lowering medications. Multivariable linear regression was used to identify independent predictors of lipid change. Eighty-six patients (79.1
Parathyroid carcinoma is a rare endocrine malignancy that remains difficult to distinguish preoperatively from benign causes of primary hyperparathyroidism due to overlapping clinical and biochemical features. This study evaluates the serum parathyroid hormone (PTH)-to-tumor volume ratio as a potential parameter for differentiating parathyroid carcinoma from benign parathyroid lesions. A retrospective analysis was conducted on 344 patients who underwent surgery for primary hyperparathyroidism between 2017 and 2024. Patients were divided into carcinoma (n = 8) and benign lesion groups (n = 336). Clinical, biochemical, and ultrasound-derived tumor volume data were analyzed and compared between groups. Patients with parathyroid carcinoma had significantly higher PTH levels than those with benign lesions (median, 659 vs. 136.4 pg/mL; p = 0.002) and markedly larger tumor volumes (median, 10.14 vs. 0.69 ml; p < 0.001). Despite higher absolute PTH concentrations, the PTH-to-tumor volume ratio was significantly lower in the carcinoma group (median 89.7 vs. 214.56; p = 0.011). In logistic regression analysis, a lower PTH-to-tumor volume ratio was associated with an increased likelihood of parathyroid carcinoma (OR, 0.990; 95
