JTCVS open最新文献_第3页

The surgical management of mediastinal paragangliomas: A modern series reflecting true collaboration between cardiac and thoracic surgeons 纵隔副神经节瘤的外科治疗：反映心脏和胸外科医生之间真正合作的现代系列

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2025-11-19 DOI: 10.1016/j.xjon.2025.10.034

Kayvan Kazerouni MD , Brittany G. Abt MD , Sean C. Wightman MD , Takashi Harano MD , Brooks V. Udelsman MD , Graeme M. Rosenberg MD , Jonathan Praeger MD , Craig J. Baker MD , Vaughn A. Starnes MD , Paul Michael McFadden MD , Anthony W. Kim MD , Scott M. Atay MD

Objective

The study objective was to evaluate the perioperative management and outcomes of operation for patients undergoing mediastinal paraganglioma resection at Keck Medical Center of University of Southern California.

Methods

Six patients underwent surgical management for mediastinal paraganglioma from 2018 to 2024. Perioperative data were collected through retrospective review of the electronic medical record.

Results

The median age was 61 years (range, 27-69). Five patients (83%) demonstrated elevated levels of urinary or plasma metanephrines. Germline genetic testing demonstrated a pathogenic mutation consistent with paraganglioma-pheochromocytoma syndrome in 3 patients (50%). A multidisciplinary approach was used in all cases, with cardiac and thoracic surgical staff attending to each patient. Operative approach was via median sternotomy in 4 patients (67%), clamshell thoracotomy in 1 patient (17%), and right posterolateral thoracotomy in 1 patient (17%). Cardiopulmonary bypass was used in 3 patients (50%); 2 patients required great vessel transection for exposure, and 1 patient required en bloc resection of the right main coronary due to tumor encasement. R0 resection was achieved in all patients. Median intensive care unit and hospital length of stay were 2.5 days (range, 1-4) and 5 days (range, 4-9), respectively. The predominant method of postoperative surveillance was biannual chest computed tomography, with no patients demonstrating radiographic evidence of recurrence during a median follow-up of 22.5 months (range, 6.5-85).

Conclusions

Surgical resection of mediastinal paraganglioma is safe and feasible with a multidisciplinary approach. The use of cardiopulmonary bypass, although occasionally necessary, did not result in adverse outcomes. All patients achieved an R0 resection with minimal postoperative complications, and no evidence of recurrence has been observed during the follow-up period.

目的评价南加州大学Keck医学中心纵隔副神经节瘤切除术患者的围手术期处理及手术效果。方法2018 ~ 2024年6例纵隔副神经节瘤行手术治疗。通过电子病历的回顾性回顾收集围手术期数据。结果患者中位年龄61岁（范围27 ~ 69岁）。5名患者（83%）表现出尿或血浆肾上腺素水平升高。生殖系基因检测显示3例（50%）患者的致病性突变与副神经节瘤-嗜铬细胞瘤综合征一致。所有病例均采用多学科方法，每位患者均由心外科和胸外科工作人员护理。手术入路为胸骨正中切口4例（67%），翻盖式开胸1例（17%），右后外侧开胸1例（17%）。体外循环3例（50%）；2例患者行大血管横断暴露，1例患者因肿瘤包膜行右主干冠状动脉整体切除。所有患者均完成R0切除。重症监护病房和住院时间的中位数分别为2.5天（范围1-4）和5天（范围4-9）。术后监测的主要方法是一年两次的胸部计算机断层扫描，在中位随访22.5个月（范围6.5-85）期间，没有患者显示复发的影像学证据。结论纵隔副神经节瘤经多学科联合手术治疗是安全可行的。体外循环的使用，虽然偶尔是必要的，但没有导致不良后果。所有患者均完成R0切除，术后并发症最小，随访期间无复发迹象。

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引用次数: 0

Outcomes of staged single versus bilateral lung transplantation in the modern era 现代分期单肺移植与双肺移植的预后

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.xjon.2026.101586

Christopher L. He BS , Clayton J. Rust MD , Maria V. Aslam PhD, MPH , William Xu BS , Stephanie K. Tom MD , Ahanna U. Onyenso BS , Ailin Tang BS , Jeffrey Javidfar MD , Michael E. Halkos MD, MSc , Lorenzo Zaffiri MD, PhD , Muath M. Bishawi MD, PhD , Mani A. Daneshmand MD , Joshua L. Chan MD

Objective

Staged single-lung transplantation (SSLT) has been proposed as a strategy for high-risk patients amid donor organ shortages. We aimed to compare modern SSLT versus bilateral lung transplantation (BLT) outcomes and identify factors associated with SSLT long-term survival.

Methods

We retrospectively analyzed the United Network for Organ Sharing registry for all adult lung transplants from 2005 to 2021. Propensity-matched outcomes of SSLT (2 sequential, contralateral single-lung transplants) were compared with BLT. Kaplan-Meier methods were used to assess survival, and multivariable analysis identified independent predictors of mortality after SSLT.

Results

Among 188 recipients of SSLT and 2948 recipients of BLT, recipients of SSLT were older and more likely to have interstitial lung disease. Despite greater 1-year survival among recipients of SSLT (92.0% vs 87.5%), median overall survival was significantly shorter compared with the BLT cohort (5.8 vs 7.1 years), and both 5-year (54.8% vs 63.8%) and 10-year (27.4% vs 43.6%) survival estimates were lower (P < .001). Thirty-day mortality after the second transplant was also greater in SSLT (4.7% vs 2.7%, P = .04). On multivariable analysis, SSLT was associated with greater 3-year mortality (hazard ratio, 1.72; 95% CI, 1.03-2.84), although on subgroup analysis, those with a diagnosis of interstitial lung disease, age ≥65 years, or body mass index ≥30 and duration between staged lung transplantation ≥5 years at time of listing showed similar outcomes.

Conclusions

In the modern era, BLT is associated with superior long-term survival compared with SSLT. SSLT can achieve acceptable early outcomes in select patients or donor-scarce situations, but BLT should remain the preferred approach when feasible.

目的高龄单肺移植（SSLT）已被提出作为供体器官短缺的高危患者的治疗策略。我们的目的是比较现代SSLT与双侧肺移植（BLT）的结果，并确定与SSLT长期生存相关的因素。方法回顾性分析联合器官共享网络2005年至2021年的所有成人肺移植登记。将SSLT（2例序贯、对侧单肺移植）的倾向匹配结果与BLT进行比较。Kaplan-Meier方法用于评估生存率，多变量分析确定了SSLT后死亡率的独立预测因素。结果188例SSLT患者和2948例BLT患者中，SSLT患者年龄较大，更容易发生间质性肺疾病。尽管SSLT接受者的1年生存率更高（92.0% vs 87.5%），但与BLT队列相比，中位总生存率明显较短（5.8 vs 7.1年），5年（54.8% vs 63.8%）和10年（27.4% vs 43.6%）的生存率均较低（P < .001）。第二次移植后30天死亡率也高于SSLT （4.7% vs 2.7%, P = .04）。在多变量分析中，SSLT与更高的3年死亡率相关（风险比，1.72;95% CI, 1.03-2.84），尽管在亚组分析中，那些诊断为间质性肺疾病、年龄≥65岁或体重指数≥30以及在列出时分期肺移植间隔≥5年的患者显示相似的结果。结论在现代，与SSLT相比，BLT具有更好的长期生存。在某些患者或供体稀缺的情况下，SSLT可以获得可接受的早期结果，但在可行的情况下，BLT仍应是首选方法。

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引用次数: 0

Machine learning–enhanced preoperative assessment of spontaneous ventilation risk in diverse video-assisted thoracoscopic surgeries 机器学习增强的各种视频胸腔镜手术中自发通气风险的术前评估

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-03-06 DOI: 10.1016/j.xjon.2026.101715

Xiaohan Ren BS , Fengfa Yang BS , Jiayu Li BS , Shujun Wu BS , Xinyuan Zhu BS , Fuli Feng PhD , Xinting Hu PhD , Lan Lan MD

Objectives

Despite its widespread use, spontaneous ventilation can lead to intraoperative hypoxemia or hypercapnia. In this retrospective study, we developed and validated a preoperative clinical data-based model to predict intraoperative hypoxemia or hypercapnia risk during spontaneous ventilation video-assisted thoracoscopic surgery.

Methods

We enrolled patients who underwent spontaneous ventilation video-assisted thoracoscopic surgery at the National Respiratory Medicine Center of First Affiliated Hospital of Guangzhou Medical University between 2011 and 2023. Four machine learning algorithms—light gradient boosting machine, category boosting, extreme gradient boosting, and random forest—were trained and combined into a weighted ensemble to predict intraoperative hypoxemia (peripheral oxygen saturation <94%) or hypercapnia (partial pressure of end-tidal carbon dioxide >80 mm Hg).

Results

Among 6590 included patients, 12.6% and 3.8% developed intraoperative hypoxemia and severe hypercapnia, respectively. The final risk assessment model achieved an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.68-0.76) and an area under the precision-recall curve of 0.35 (95% CI, 0.29-0.42). The statistical analysis of the data and the risk interpretation from the ensemble machine learning algorithm consistently identified body mass index (23.6 [21.6-25.5] vs 22.2 [20.4-24.0] kg/m²) and age (55 [46-62] vs 50 [41-58] years) as the strongest patient-related predictors positively correlated with intraoperative hypoxemia and severe hypercapnia. Segmentectomy (22.4% vs 14.7%), lobectomy (21.9% vs 17.2%), and surgical location in the right lung (86.4% vs 73.8%) increased risk of intraoperative hypoxia and hypercapnia. Analysis of postoperative hospital stay (3.67 vs 3.49 days), chest tube drainage (1.59 vs 1.47 days), complications (88.1 vs 91%), and incidence of intensive care unit (8.2 vs 7.6%) demonstrated that intraoperative hypoxia and hypercapnia can adversely affect patient postoperative recovery (P < .05).

Conclusions

The predictive model based on preoperative clinical characteristics effectively assessed intraoperative hypoxemia and severe hypercapnia risk in diverse spontaneous ventilation video-assisted thoracoscopic surgery procedures. This model can systematically guide preoperative evaluation to select appropriate patients and improve the intraoperative safety and surgical outcomes of spontaneous ventilation video-assisted thoracoscopic surgery.

目的自发通气虽然应用广泛，但术中仍可能出现低氧血症或高碳酸血症。在这项回顾性研究中，我们开发并验证了一种基于术前临床数据的模型，用于预测自发通气电视胸腔镜手术中术中低氧血症或高碳酸血症的风险。方法选取2011 - 2023年在广州医科大学第一附属医院国家呼吸医学中心接受自主通气电视胸腔镜手术的患者。四种机器学习算法——光梯度增强机、类别增强、极端梯度增强和随机森林——被训练并组合成一个加权集合来预测术中低氧血症（外周氧饱和度<；94%）或高血氧症（潮末二氧化碳分压>； 80mmhg）。结果6590例患者中，术中低氧血症和重度高碳酸血症发生率分别为12.6%和3.8%。最终风险评估模型的受试者工作特征曲线下面积为0.72 (95% CI, 0.68-0.76)，精密度-召回率曲线下面积为0.35 （95% CI, 0.29-0.42）。数据的统计分析和集成机器学习算法的风险解释一致认为，体重指数（23.6 [21.6-25.5]vs 22.2 [20.4-24.0] kg/m2）和年龄（55 [46-62]vs 50[41-58]岁）是与术中低氧血症和严重高碳酸血症呈正相关的最强患者相关预测因素。节段切除术（22.4%对14.7%）、肺叶切除术（21.9%对17.2%）和手术位置在右肺（86.4%对73.8%）增加了术中缺氧和高碳酸血症的风险。术后住院时间（3.67天vs 3.49天）、胸管引流（1.59天vs 1.47天）、并发症（88.1天vs 91%）、重症监护病房发生率（8.2天vs 7.6%）分析显示术中缺氧和高碳酸血症会对患者术后恢复产生不利影响（P < 0.05）。结论基于术前临床特征的预测模型可有效评估多种自主通气胸腔镜手术中术中低氧血症和重度高碳酸血症的风险。该模型可以系统地指导术前评估，选择合适的患者，提高自动通气电视胸腔镜手术的术中安全性和手术效果。

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引用次数: 0

Bioprosthetic versus mechanical surgical aortic valve replacement in patients ≥65 years of age ≥65岁患者的生物修复与机械手术主动脉瓣置换术

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-02-18 DOI: 10.1016/j.xjon.2026.101690

Stanley B. Wolfe MD, MPH, Lawrence Wei MD, J.W. Hayanga MD, Dhaval Chauhan MD, Nestor F. Dans MD, Christopher E. Mascio MD, J. Scott Rankin MD, Vinay Badhwar MD, J. Hunter Mehaffey MD, MSc

Objective

Shared decision-making of prosthesis selection for aortic valve replacement (AVR) weighs patient-specific valve durability with oral anticoagulation requirements. Given evolving strategies of lifetime management, we evaluated contemporary longitudinal outcomes of patients aged 65 years or greater undergoing bioprosthetic versus mechanical AVR.

Methods

Patients aged 65-85 who underwent isolated surgical AVR (2018-2022) were identified in the United States Centers for Medicare and Medicaid Services database and stratified by valve type as bioprosthetic (bAVR) or mechanical (mAVR). Doubly robust risk adjustment of variables including frailty was performed using inverse probability weighting of propensity scores, multivariable logistic regression, and time-to-event analysis with competing risks. The primary outcome was the composite of all-cause mortality, valve reintervention, stroke, and bleeding.

Results

The study cohort included a total of 69,423 patients (62,925 bAVR and 6498 mAVR). After comprehensive risk adjustment was performed, bAVR versus mAVR was associated with superior freedom from the primary composite outcome over the 5-year study period (hazard ratio [HR], 0.82; P < .001), as well as reduction in longitudinal mortality (HR, 0.78; P < .001), all-cause readmissions (HR, 0.89; P < .001), and readmissions for bleeding (HR, 0.47, P < .001) and heart failure (HR, 0.86; P < .001). No difference in aortic valve reintervention was observed between groups (HR, 0.93; P = .65). Similar trends favoring bAVR were observed in subanalyses of patients aged 65 to 69 years. For patients with preoperative end-stage renal disease, there was no difference in the longitudinal primary outcome between bAVR or mAVR.

Conclusions

In Medicare beneficiaries, bAVR was associated with superior risk-adjusted survival, fewer bleeding complications, and fewer readmissions with no difference in valve reintervention compared with mAVR.

目的在主动脉瓣置换术（AVR）假体选择的共同决策中权衡患者特异性瓣膜耐久性和口服抗凝需求。鉴于不断发展的终身管理策略，我们评估了65岁或以上接受生物假体与机械AVR的患者的当代纵向结果。方法从美国医疗保险和医疗补助服务中心的数据库中确定年龄在65-85岁之间接受孤立性手术AVR（2018-2022）的患者，并按瓣膜类型分为生物假体（bAVR）或机械式（mAVR）。采用倾向得分的逆概率加权、多变量逻辑回归和具有竞争风险的事件时间分析，对包括脆弱性在内的变量进行双稳健风险调整。主要结局为全因死亡率、瓣膜再介入治疗、卒中和出血。研究队列共纳入69,423例患者（62,925例bAVR和6498例mAVR）。在进行综合风险调整后，在5年的研究期间，bAVR与mAVR相比具有更好的主要综合结局自由度（风险比[HR]， 0.82; P < 001），纵向死亡率（HR, 0.78; P < 001），全因再入院（HR, 0.89; P < 001），出血再入院（HR, 0.47, P < 001）和心力衰竭（HR, 0.86; P < 001）的降低。两组间主动脉瓣再介入率无差异（HR, 0.93; P = 0.65）。在65 - 69岁患者的亚分析中也观察到类似的倾向于bAVR的趋势。对于术前终末期肾病患者，bAVR和mAVR在纵向主要结局上没有差异。结论：在医疗保险受益人中，与mAVR相比，bAVR具有更高的风险调整生存率，更少的出血并发症和更少的再入院，瓣膜再干预无差异。

{"title":"Bioprosthetic versus mechanical surgical aortic valve replacement in patients ≥65 years of age","authors":"Stanley B. Wolfe MD, MPH, Lawrence Wei MD, J.W. Hayanga MD, Dhaval Chauhan MD, Nestor F. Dans MD, Christopher E. Mascio MD, J. Scott Rankin MD, Vinay Badhwar MD, J. Hunter Mehaffey MD, MSc","doi":"10.1016/j.xjon.2026.101690","DOIUrl":"10.1016/j.xjon.2026.101690","url":null,"abstract":"<div><h3>Objective</h3><div>Shared decision-making of prosthesis selection for aortic valve replacement (AVR) weighs patient-specific valve durability with oral anticoagulation requirements. Given evolving strategies of lifetime management, we evaluated contemporary longitudinal outcomes of patients aged 65 years or greater undergoing bioprosthetic versus mechanical AVR.</div></div><div><h3>Methods</h3><div>Patients aged 65-85 who underwent isolated surgical AVR (2018-2022) were identified in the United States Centers for Medicare and Medicaid Services database and stratified by valve type as bioprosthetic (bAVR) or mechanical (mAVR). Doubly robust risk adjustment of variables including frailty was performed using inverse probability weighting of propensity scores, multivariable logistic regression, and time-to-event analysis with competing risks. The primary outcome was the composite of all-cause mortality, valve reintervention, stroke, and bleeding.</div></div><div><h3>Results</h3><div>The study cohort included a total of 69,423 patients (62,925 bAVR and 6498 mAVR). After comprehensive risk adjustment was performed, bAVR versus mAVR was associated with superior freedom from the primary composite outcome over the 5-year study period (hazard ratio [HR], 0.82; <em>P</em> < .001), as well as reduction in longitudinal mortality (HR, 0.78; <em>P</em> < .001), all-cause readmissions (HR, 0.89; <em>P</em> < .001), and readmissions for bleeding (HR, 0.47, <em>P</em> < .001) and heart failure (HR, 0.86; <em>P</em> < .001). No difference in aortic valve reintervention was observed between groups (HR, 0.93; <em>P</em> = .65). Similar trends favoring bAVR were observed in subanalyses of patients aged 65 to 69 years. For patients with preoperative end-stage renal disease, there was no difference in the longitudinal primary outcome between bAVR or mAVR.</div></div><div><h3>Conclusions</h3><div>In Medicare beneficiaries, bAVR was associated with superior risk-adjusted survival, fewer bleeding complications, and fewer readmissions with no difference in valve reintervention compared with mAVR.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101690"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pulmonary vascular tone failure as a unifying mechanism of arteriovenous malformations after cavopulmonary shunt 肺血管张力衰竭是肺泡肺分流术后动静脉畸形的统一机制

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-02-18 DOI: 10.1016/j.xjon.2026.101693

Akio Ikai MD, PhD

引用次数: 0

Gender disparities in Medicare billings among cardiothoracic surgeons 心胸外科医生医疗保险费用中的性别差异

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-02-12 DOI: 10.1016/j.xjon.2026.101674

Meghamsh Kanuparthy MD, Alexander Joseph BS, Kelsey Muir MD, Shelby Cronkhite BA, Danielle Sawka BS, Christopher Stone MD, Haley Leesley MD, Frank W. Sellke MD

引用次数: 0

Successful lung and heart procurement in the era of abdominal normothermic regional perfusion 腹部常温区域灌注时代肺和心脏的成功获取

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-02-03 DOI: 10.1016/j.xjon.2026.101606

Lauryn Spinetta BA , Brian Jafari BA , Matthias Peltz MD , Suresh Keshavamurthy MD , John Murala MD, MBA

引用次数: 0

European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings 基于临床分期的肺叶切除术和肺节段切除术后早期肺腺癌的欧洲预后评估

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-02-18 DOI: 10.1016/j.xjon.2026.101687

Lukadi Joseph Lula MD , Lin Huang MD, PhD , Clara Forcada Barreda MD , Rita Costa MD , Matic Domjan MD , Aimée J.P.M. Franssen PhD , Crt Jasovic MD , Mohamed Rebei MD , Beatrice Trabalza Marinucci MD , Rebecca Weedle MD , Guillermo Rodriguez MD , Emrah Gökay Özgür PhD , Kiarash Ghasemi MD , Jack Whooley MD , Erino Angelo Rendina MD, PhD , Ronan Ryan MD , Vincent Young MD , Gülnaz Nural Bekiroglu PhD , Karen Redmond MD, PhD , Erik R. de Loos MD, PhD , René Horsleben Petersen MD, PhD

Objectives

To investigate the prognosis of peripheral early-stage lung adenocarcinoma patterns treated by lobectomy or segmentectomy.

Methods

Retrospective multicentric cohort of patients with cT1a-bN0M0 lung adenocarcinoma who underwent lobectomy or segmentectomy with systematic lymph node dissection in 10 European centers (one per country) from 2015 to 2021. Overall survival (OS), disease-free survival (DFS), and lung cancer–specific death (LCSD) between both groups were assessed in entire dataset and in dataset of histologic aggressive patterns, before and after propensity score-matching (PSM). Prognostic risk factors were analyzed using parsimonious model Cox regression. Recurrences were assessed by linearized risks.

Results

Lobectomy and segmentectomy were performed in 1029 (73.1%) and 377 (26.8%) patients, respectively. In total, 427 (30.3%) patients had at least 1 histologic aggressive (micropapillary or solid) pattern, and 88 patients (20.7%) underwent segmentectomy. OS, DFS, and LCSD rates were similar between patients who underwent lobectomy or segmentectomy, in both datasets, before and after PSM. In aggressive dataset, PSM, 5-year OS rates were lobectomy 88.0% (95% CI, 80.9-95.7%), segmentectomy 89.1% (95% CI, 82.2-96.6%), P = .8; 5-year DFS rates were lobectomy 79.8% (95% CI, 70.8-89.8%), segmentectomy 80.6% (95% CI, 71.6-90.6%), P = .6; and 5-year LCSD rates were lobectomy 6.0%, segmentectomy 7.8%, P = .8. Locoregional recurrence was not superior in patients who underwent segmentectomy in entire dataset (linearized risks: lobectomy 0.078, segmentectomy 0.073) and in aggressive dataset (linearized risks: lobectomy 0.036, segmentectomy 0.011) only in the unmatched cohorts. Aggressive histologic patterns impacted on only LCSD, and only when they were dominant.

Conclusions

Segmentectomy seems comparable to lobectomy for patients with peripheral cT1a-bN0M0 lung adenocarcinoma even in case of histologic aggressive patterns.

目的探讨肺叶切除术或肺节段切除术治疗早期周围型肺腺癌的预后。方法：2015年至2021年，10个欧洲中心（每个国家1个）的cT1a-bN0M0肺腺癌患者接受肺叶切除术或节段切除术并系统性淋巴结清扫。在倾向评分匹配（PSM）之前和之后，在整个数据集和组织学侵袭模式数据集中评估两组之间的总生存期（OS）、无病生存期（DFS）和肺癌特异性死亡（LCSD）。采用简约模型Cox回归分析预后危险因素。通过线性化风险评估复发。结果行乳腺切除术1029例（73.1%），节段切除术377例（26.8%）。总共有427例（30.3%）患者至少有1种组织学侵袭性（微乳头状或实性），88例（20.7%）患者接受了节段切除术。在两个数据集中，在PSM之前和之后，接受肺叶切除术或节段切除术的患者的OS、DFS和LCSD率相似。在侵袭性数据集中，PSM的5年OS率为肺叶切除术88.0% (95% CI, 80.9-95.7%)，节段切除术89.1% (95% CI, 82.2-96.6%), P = 0.8；5年DFS率为肺叶切除术79.8% (95% CI, 70.8 ~ 89.8%)，节段切除术80.6% (95% CI, 71.6 ~ 90.6%), P = 0.6；5年LCSD发生率为肺叶切除术6.0%，节段切除术7.8%,P = 0.8。在整个数据集（线性化风险：肺叶切除术0.078，节段切除术0.073）和侵袭性数据集（线性化风险：肺叶切除术0.036，节段切除术0.011）中，仅在未匹配的队列中，局部区域复发并不优于行节段切除术的患者。侵袭性的组织学模式只影响康文署，而且只影响康文署占主导地位的组织学模式。结论对于周围型cT1a-bN0M0肺腺癌患者，即使在组织学上具有侵袭性，节段切除术似乎与肺叶切除术相当。

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引用次数: 0

Comparison of survival outcomes of neoadjuvant immunochemotherapy versus chemotherapy in locally advanced esophageal squamous cell carcinoma 局部晚期食管鳞状细胞癌新辅助免疫化疗与化疗的生存结果比较

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-03-04 DOI: 10.1016/j.xjon.2026.101706

Xinrun Cui MD , Yaqi Wang MD , Shi Yan MD , Bing Liu MD , Xiang Li MD , Ye Tao MD , Quanne Wang MD , Haoxuan Du MD , Shaolei Li MD , Nan Wu MD

Background

Esophageal squamous cell carcinoma (ESCC) poses significant therapeutic challenges, with poor prognosis despite standard treatments including neoadjuvant chemoradiotherapy or chemotherapy. Emerging evidence suggests that adding immune checkpoint blockade to conventional chemotherapy—referred to as neoadjuvant immunochemotherapy (nICT)—enhances pathologic tumor regression; however, real-world data regarding long-term survival outcomes remain limited.

Methods

This single-center retrospective study analyzed data from 204 patients with locally advanced ESCC treated between January 2019 and September 2022. Patients received either neoadjuvant chemotherapy (nCT; n = 95) or nICT (n = 109). To address baseline imbalances, stabilized inverse probability of treatment weighting (sIPTW) based on propensity scores was applied. The primary endpoints were overall survival (OS) and disease-free survival (DFS).

Results

The median duration of follow-up was 36.7 months (95% confidence interval [CI], 33.8-39.6 months). After applying sIPTW, compared to the nCT group, the nICT group exhibited significantly improved OS (hazard ratio [HR], 0.49; 95% CI, 0.26-0.91; P = .03) and DFS (HR, 0.58; 95% CI, 0.35-0.95; P = .04). The 3-year OS and DFS rates were 84.3% and 69.8%, respectively, in the nICT group and 68.8% and 58.1%, respectively, in the nCT group. In the nICT group, pathologic complete response (pCR) and major pathologic response (MPR) were associated with reduced risk of recurrence and death.

Conclusions

nICT was associated with improved OS and DFS in patients with locally advanced ESCC. Higher rates of pCR and MPR were correlated with better survival outcomes. These findings support the integration of immunotherapy into neoadjuvant treatment strategies, although prospective trials remain necessary for validation.

食管鳞状细胞癌（ESCC）的治疗面临着巨大的挑战，尽管标准治疗包括新辅助放化疗或化疗，但预后较差。新出现的证据表明，在常规化疗（称为新辅助免疫化疗（nICT））中添加免疫检查点阻断可增强病理性肿瘤消退；然而，关于长期生存结果的真实数据仍然有限。方法本单中心回顾性研究分析了2019年1月至2022年9月期间接受治疗的204例局部晚期ESCC患者的数据。患者接受新辅助化疗（nCT, n = 95）或nICT （n = 109）。为了解决基线失衡问题，应用了基于倾向得分的稳定逆概率治疗加权（sIPTW）。主要终点是总生存期（OS）和无病生存期（DFS）。结果中位随访时间为36.7个月（95%可信区间[CI]， 33.8 ~ 39.6个月）。应用sIPTW后，与nCT组相比，nICT组的OS（风险比[HR]， 0.49; 95% CI, 0.26-0.91; P = 0.03）和DFS（风险比[HR]， 0.58; 95% CI, 0.35-0.95; P = 0.04）均有显著改善。nICT组的3年OS和DFS分别为84.3%和69.8%，nCT组分别为68.8%和58.1%。在nICT组中，病理完全缓解（pCR）和主要病理缓解（MPR）与复发和死亡风险降低相关。结论snict可改善局部晚期ESCC患者的OS和DFS。较高的pCR和MPR率与较好的生存结果相关。这些发现支持将免疫疗法整合到新辅助治疗策略中，尽管仍需要前瞻性试验来验证。

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引用次数: 0

Myocardial perfusion improvement of saphenous vein Y-composite versus aortocoronary grafts during the first year after surgery y型复合隐静脉与冠状动脉移植术后第一年心肌灌注改善的比较

IF 1.9

JTCVS open

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.xjon.2026.101589

Suk Ho Sohn MD, PhD , Yoonjin Kang MD, PhD , Jin Chul Paeng MD, PhD , Ho Young Hwang MD, PhD

Objectives

This study was conducted to compare improvements in myocardial perfusion between Y-composite and aortocoronary configurations during 1 year after coronary artery bypass grafting (CABG).

Methods

Of 311 off-pump CABG patients using the saphenous vein as Y-composite (composite group) or aortocoronary (aorta group) graft, 204 patients who underwent myocardial single-photon emission computed tomography during the preoperative period, at 3 months after surgery, and at 1 year after surgery were enrolled. After 2:1 propensity score matching, 43 matched sets with 86 composite and 43 aortocoronary patients were compared. Based on a 17-segment model, the degree of perfusion impairment for each segment was evaluated semiquantitatively via a reversibility score, which was defined as rest minus stress perfusion values. The improvement in perfusion was evaluated based on the temporal changes in reversibility scores and was compared using a linear mixed model.

Results

Of 2193 segments, 795 segments (518 and 277 segments in composite and aorta groups, respectively) demonstrated a significant decrease in perfusion on preoperative myocardial single-photon emission computed tomography and were successfully revascularized by CABG. Median (quartile 1, quartile 3) preoperative reversibility scores in the ischemic segments were 7 (4, 13) and 7 (4, 12) in composite and aorta groups, respectively (P = .575). Median (quartile 1, quartile 3) reversibility scores at 3 months and 1 year postsurgery were 0 (0, 4) and 0 (0, 5) in the composite group and 0 (0, 4) and 0 (0, 5) in the aorta group, and there was no significant difference in the pattern of improvement in myocardial perfusion between the groups (P = .592).

Conclusions

Myocardial perfusion improvement during the first year after CABG was not significantly different between Y-composite and aortocoronary configurations.

目的比较冠状动脉旁路移植术（CABG）后1年内y -复合构型与主动脉冠状动脉构型对心肌灌注的改善。方法选取311例采用隐静脉y复合（复合组）或主动脉冠状动脉（主动脉组）行停泵CABG的患者，其中术前、术后3个月及术后1年行心肌单光子发射计算机断层扫描的患者204例。经2:1倾向性评分匹配后，将86例复合患者与43例冠状动脉患者进行43组匹配比较。基于17节段模型，通过可逆性评分半定量评估各节段的灌注损伤程度，可逆性评分定义为休息减去应激灌注值。根据可逆性评分的时间变化来评估灌注的改善，并使用线性混合模型进行比较。结果2193个节段中，795个节段（复合组518个节段，主动脉组277个节段）术前心肌单光子发射计算机断层扫描显示灌注明显减少，经冠脉搭桥重建成功。术前缺血段可逆性评分中位数（四分位数1，四分位数3）复合组为7(4,13)，主动脉组为7(4,12)，差异有统计学意义（P = 0.575）。术后3个月和1年，复合组可逆性评分中位数（四分位数1、三分位数）分别为0（0,4）和0(0,5)，主动脉组为0（0,4）和0(0,5)，两组间心肌灌注改善模式差异无统计学意义（P = 0.592）。结论冠状动脉构型与y复合构型在冠状动脉搭桥术后1年内心肌灌注改善无显著性差异。

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