Diagnostic & Therapeutic Center of Athens Hygeia SA

Although perineural invasion, a negative prognosticator in colorectal cancer, is typically detected after surgical resection, preoperative prediction may be useful. We used a large population-based registry to develop a predictive model of perineural invasion in colorectal cancer, including clinical and pathologic features of tumors.

Retrospective case-control analysis of patients with colorectal adenocarcinoma from the Surveillance, Epidemiology, and End Results Research Data database. The study involved a case-control analysis of predictive factors of perineural invasion in colorectal cancer. The main outcome measures were perineural invasion, overall survival, and cancer-specific survival.

The study included 223,468 patients (52% male, mean age: 66.4 years). Perineural invasion was detected in 13.1%. Independent predictors of perineural invasion were age (odds ratio [OR], 0.99; P < .001), male sex (OR, 1.05; P = .009), Black race (OR, 1.19; P < .001), American Indian race (OR, 0.69; P = .001), left colon cancer (OR, 1.29; P < .001), rectal cancer (OR, 1.32; P < .001), moderately differentiated adenocarcinomas (OR, 1.41; P < .001), poorly differentiated adenocarcinomas (OR, 2.28; P < .001), undifferentiated carcinomas (OR, 2.13; P < .001), mucinous adenocarcinomas (OR, 0.64; P < .001), N1 stage (OR, 2.28; P < .001), N2 stage (OR, 3.83; P < .001), and elevated carcinoembryonic antigen levels (OR, 1.45;P < .001). These predictors were integrated into a risk prediction score, with an excellent negative predictive value of 93%. Perineural invasion was associated with lower 5-year overall survival (54 vs. 76.4%; P < .001) and cancer-specific survival rates (56.6 vs 81.8%; P < .001).

Age, sex, race, tumor location, histology and grade, lymph node involvement, and carcinoembryonic antigen levels were independently associated with perineural invasion. Perineural invasion was an independent predictor of liver and lung metastases and worse overall survival and cancer-specific survival. The Cleveland Clinic Florida-Perineural Invasion Prediction score had an excellent negative predictive value in excluding patients without perineural invasion. Pending those trials, these findings may be considered in multidisciplinary team management conferences and in shared decision-making.

Mitral transcatheter edge-to-edge repair (M-TEER) using the MitraClip device improves clinical outcomes in patients with moderate-to-severe ventricular secondary mitral regurgitation (vSMR) and heart failure (HF). This study evaluated whether the effects of M-TEER on clinical outcomes vary by baseline health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), and assessed the impact of M-TEER on health status post-randomization.

The RESHAPE-HF2 trial included patients with symptomatic HF and moderate-to-severe vSMR (mean effective regurgitant orifice area .25 cm2; 14% &gt;.40 cm2, 23% &lt;.20 cm2). The impact of baseline KCCQ-clinical summary score (CSS) on the effect of M-TEER on clinical outcomes was assessed using Cox proportional hazards models. Changes post-randomization in health status and responder analyses were performed to assess the odds ratio (OR) of improvement and deterioration in KCCQ scores.

Among 505 patients, M-TEER reduced cardiovascular death or HF hospitalization risk [hazard ratio (HR): .71 (.48–1.05), .50 (.29–.85), and .73 (.38–1.41)] across KCCQ-CSS tertiles of &lt;38.9, 38.9–66.1, and &gt;66.1, respectively (P-trend = .53). Similar results were seen for total HF hospitalization (P-trend = .48). M-TEER improved KCCQ-CSS, total symptom score, and overall summary score at 1, 6, 12, and 24 months compared to medical therapy alone (P &lt; .05 at all time points). More patients in the M-TEER arm experienced a ≥5-point [OR 3.38 (2.09–5.45)], ≥10-point [OR 3.12 (1.93–5.02)], and ≥15-point [OR 3.25 (1.94–5.45)] improvement, and less patients had a ≥5-point deterioration [OR .34 (.19–.57)] in KCCQ-CSS at 6 months. Similar results were seen across other KCCQ domains and all time points.

In patients with HF and moderate-to-severe vSMR, M-TEER showed a consistent trend towards a lower risk of HF hospitalization, with or without cardiovascular death, across all KCCQ-CSS tertiles and improved health status over time.

Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer. Compared with other pancreatic tumors, ASCP has a notably poorer prognosis and shorter survival rates. The optimal therapeutic approaches to ASCP have yet to be defined.

This retrospective, multicenter European study included all consecutive patients who underwent elective pancreatic surgery for ASCP at participating centers between 2010 and 2024. The inclusion criteria encompassed all patients who underwent scheduled surgery for ASCP during the study period. The exclusion criteria ruled out patients without a confirmed pathologic diagnosis of ASCP, those who did not undergo surgery, and patients with extra-pancreatic disease.

The study analyzed 194 patients from 29 hospitals in 11 European countries. The overall survival rates were 56.2% at 1 year, 26.3% at 3 years, and 9.8% at 5 years. The disease-free survival rates at the same intervals were 36.6%, 16.5%, and 6.7%, respectively. In the multivariate analysis, significant associations with shorter survival were R2 resections, lymphatic stromal invasion, T4 stage, no adjuvant chemotherapy, and recurrence.

Patients who undergo resection for ASCP experience very low 5-year survival rates (10%). It is advisable to avoid resecting T4 tumors in patients with significant comorbidities or R2 resections. Additionally, failure to provide adjuvant chemotherapy, often due to severe postoperative complications, further deteriorates the prognosis.