bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection
Authors: Ahmed S , Bonnett L , Melhuish A , Adil M T , Aggarwal I , Ali W , Bennett J , Boldock E , Burns F A , Czarniak E , Dennis R , Flower B , Fok R , Goodman A L , Halai S , Hanna T , Hashem M , Hodgson S H , Hughes G , Hurndall K-H , Hyland R , Iqbal M R , Jarchow-MacDonald A , Kailavasan M , Klimovskij M , Laliotis A , Lambourne J , Lawday S , Lee F , Lindsey B , Lund J N , Mabayoje D A , Malik K I , Muir A , Narula H S , Ofor U , Parsons H , Pavelle T , Prescott K , Rajgopal A , Roy I , Sagar J , Scarborough C , Shaikh S , Smart C J , Snape S , Tabaqchali M A , Tennakoon A , Tilley R , Vink E , White L , Burke D , Kirby A 
Published: January 2021

Abstract

Background
Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse.

Methods
A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further.

Results
Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was −0.19 (95 per cent c.i. −0.39 to −0.12) and − 0.01 (− 0.17 to −0.03) respectively.

Conclusion
Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis
Authors: Chua Darren , Syn Nicholas , Koh Ye-Xin , Goh Brian K P 
Published: January 2021

Abstract

Background
Minimally invasive hepatectomy (MIH) has become an important option for the treatment of various liver tumours. A major concern is the learning curve required. The aim of this study was to perform a systematic review and summarize current literature analysing the learning curve for MIH.

Methods
A systematic review of the literature pertaining to learning curves in MIH to July 2019 was performed using PubMed and Scopus databases. All original full-text articles published in English relating to learning curves for both laparoscopic liver resection (LLR), robotic liver resection (RLR), or a combination of these, were included. To explore quantitatively the learning curve for MIH, a meta-regression analysis was performed.

Results
Forty studies relating to learning curves in MIH were included. The median overall number of procedures required in studies utilizing cumulative summative (CUSUM) methodology for LLR was 50 (range 25–58) and for RLR was 25 (16–50). After adjustment for year of adoption of MIH, the CUSUM-derived caseload to surmount the learning curve for RLR was 47.1 (95 per cent c.i. 1.2 to 71.6) per cent; P = 0.046) less than that required for LLR. A year-on-year reduction in the number of procedures needed for MIH was observed, commencing at 48.3 cases in 1995 and decreasing to 23.8 cases in 2015.

Conclusion
The overall learning curve for MIH decreased steadily over time, and appeared less steep for RLR compared with LLR.
Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes
Authors: Morgan J L , Shrestha A , Reed M W R , Herbert E , Bradburn M , Walters S J , Martin C , Collins K , Ward S , Holmes G , Burton M , Lifford K , Edwards A , Ring A , Robinson T , Chater T , Pemberton K , Brennan A , Cheung K L , Todd A , Audisio R , Wright J , Simcock R , Thomson A M , Gosney M , Hatton M , Green T , Revill D , Gath J , Horgan K , Holcombe C , Winter M C , Naik J , Parmeschwar R , Wyld L 
Published: January 2021

Abstract

Background
Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy.

Methods
This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage.

Results
The study recruited 3416 women (median age 77 (range 69–102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains.

Conclusion
Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
Breast Angiosarcoma Surveillance Study: UK national audit of management and outcomes of angiosarcoma of the breast and chest wall
Authors: Banks J , George J , Potter S , Gardiner M D , Ives C , Shaaban A M , Singh J , Sherriff J , Hallissey M T , Horgan K , Harnett A , Desai A , Ferguson D J , Tillett R , Izadi D , Sadideen H , Jain A , Gerrand C , Holcombe C , Hayes A , Teoh V , Wyld L ,   the Breast Angiosarcoma Surveillance Study (BRASS) collaborative, Mallya R , Baker E , Asaad A , Wild B , Ali S , Emam Ahmed , Ayre G , Tsapralis N , Mowatt D , Wigginton H , Al-Himdani S , Knight H , MacInnes E , Scott L , Magdum A , Itte V , Fesatidou V , Winder A , Policastro T , Nanidis T , Konstantinos Tasoulis M , MacNeill F , Baghini F , Hamilton L , McGarry K , McIntosh S , Smith P , Ahmed M , Hallam K , Whisker L , Nadama H , Ashford R , Grundy C , Vella-Baldacchino M , Bond H , Kleidi E , Colfar J , Hardman C , Foster N , Lo S 
Published: January 2021

Abstract

Background
Breast angiosarcomas are rare tumours of vascular origin. Secondary angiosarcoma occurs following radiotherapy for breast cancer. Angiosarcomas have high recurrence and poor survival rates. This is concerning owing to the increasing use of adjuvant radiotherapy for the treatment of invasive breast cancer and ductal cancer in situ (DCIS), which could explain the rising incidence of angiosarcoma. Outcome data are limited and provide a poor evidence base for treatment. This paper presents a national, trainee-led, retrospective, multicentre study of a large angiosarcoma cohort.

Methods
Data for patients with a diagnosis of breast/chest wall angiosarcoma between 2000 and 2015 were collected retrospectively from 15 centres.

Results
The cohort included 183 patients with 34 primary and 149 secondary angiosarcomas. Median latency from breast cancer to secondary angiosarcoma was 6 years. Only 78.9 per cent of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 14 of 28 (50 per cent ) recurrences in patients with primary and 80 of 124 (64.5 per cent ) in those with secondary angiosarcoma at 5 years. Many patients had multiple recurrences: total of 94 recurrences in 162 patients (58.0 per cent). Median survival was 5 (range 0–16) years for patients with primary and 5 (0–15) years for those with secondary angiosarcoma. Development of secondary angiosarcoma had a negative impact on predicted breast cancer survival, with a median 10-year PREDICT prognostic rate of 69.6 per cent, compared with 54.0 per cent in the observed cohort.

Conclusion
A detrimental impact of secondary angiosarcoma on breast cancer survival has been demonstrated. Although not statistically significant, almost all excess deaths were attributable to angiosarcoma. The increased use of adjuvant radiotherapy to treat low-risk breast cancer and DCIS is a cause for concern and warrants further study.
Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features
Authors: Xu S , Huang H , Wang X , Liu S , Xu Z , Liu J 
Published: January 2021

Abstract

Background
Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features.

Methods
Consecutive patients with PTC and at least one high-risk feature treated in 2000–2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis.

Results
Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P &lt; 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case–control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784).

Conclusion
Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.
Faecal immunochemical testing in symptomatic patients to prioritize investigation: diagnostic accuracy from NICE FIT Study
Authors: D’Souza N , Delisle T Georgiou , Chen M , Benton S C , Abulafi M ,   the NICE FIT Steering Committee, Warren O , Ahmadi S , Parchment C , Shanmuganandan A , West N , Mitchell T , Sah S , Jackson N , Myers A , Ziprin P , Bloom I , Kaye S , Ramwell A , Jenkins J T , Monahan K 
Published: January 2021

Abstract

Background
This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation.

Methods
A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy.

Results
The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms.

Conclusion
FIT safely selects patients with high or low risk symptoms of colorectal cancer for investigation.
Indocyanine green fluorescence angiographyversusstandard intraoperative methods for prevention of anastomotic leak in colorectal surgery: meta-analysis
Authors: Trastulli S , Munzi G , Desiderio J , Cirocchi R , Rossi M , Parisi A 
Published: January 2021

AbstractBackgroundAssessment of anastomotic blood perfusion with intraoperative indocyanine green fluorescence angiography (ICG-FA) may be effective in preventing anastomotic leak compared with standard intraoperative methods in colorectal surgery.MethodsMEDLINE, PubMed, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for RCTs and observational studies on intraoperative ICG-FA to May 2020. Odds ratios (ORs), risk differences and mean differences (MDs) were calculated with 95 per cent c.i. based on intention-to-treat analysis. The number needed to treat for an additional beneficial outcome was also estimated.ResultsTwenty-five comparative studies included a total of 7735 patients. The use of intraoperative ICG fluorescence angiography was linked with a significant reduction in all grades anastomotic leak (OR 0.39 (95 per cent c.i. 0.31 to 0.49), P &lt; 0.001; number needed to treat for an additional beneficial outcome (NNTB) 23) and length of hospital stay (MD −0.72 (95 per cent c.i. −1.22 to −0.21) days, P = 0.006). A significantly lower incidence of grade A (OR 0.33 (0.18 to 0.60), P &lt; 0.001), grade B (OR 0.58 (0.35 to 0.97), P = 0.04) and grade C (OR 0.59 (0.38 to 0.92), P = 0.02) anastomotic leak was demonstrated in favour of ICG-FA. For low or ultra-low rectal resection, the odds of developing anastomotic leakage was 0.32 (0.23 to 0.45) (P &lt; 0.001; NNTB 14). There were no differences in duration of surgery, and no adverse events related to ICG fluorescent injection.ConclusionThe use of ICG-FA instead of standard intraoperative methods to assess anastomosis blood perfusion in colorectal surgery leads to a significant reduction in anastomotic leakage and in the need for surgical reintervention for anastomotic leak, especially in patients with low or ultra-low rectal resections.
Sporadic non-functioning pancreatic neuroendocrine tumours: multicentre analysis
Authors: Ricci C , Partelli S , Landoni L , Rinzivillo M , Ingaldi C , Andreasi V , Nessi C , Muffatti F , Fontana M , Tamburrino D , Deiro G , Alberici L , Campana D , Panzuto F , Bassi C , Falconi M , Casadei R 
Published: January 2021

Abstract

Background
Outcomes after surgery for sporadic pancreatic neuroendocrine neoplasms (Pan-NENs) were evaluated.

Methods
This multicentre study included patients who underwent radical pancreatic resection for sporadic non-functioning Pan-NENs. In survival analysis, the risk of mortality in this cohort was analysed in relation to that of the matched healthy Italian population. Relative survival (RS) was calculated as the rate between observed and expected survival. Factors related to RS were investigated using multivariable modelling.

Results
Among 964 patients who had pancreatic resection for sporadic non-functioning Pan-NENs, the overall RS rate was 91.8 (95 per cent c.i. 81.5 to 96.5) per cent. 2019 WHO grade (hazard ratio (HR) 5.75 (s.e. 4.63); P = 0.030) and European Neuroendocrine Tumour Society (ENETS) TNM stage (6.73 (3.61); P &lt; 0.001) were independent predictors of RS. The probability of a normal lifespan for patients with G1, G2, G3 Pan-NENS, and pancreatic neuroendocrine carcinomas (Pan-NECs) was 96.7, 54.8, 0, and 0 per cent respectively. The probability of a normal lifespan was 99.8, 99.3, 79.8, and 46.8 per cent for those with stage I, II, III, and IV disease respectively. The overall disease-free RS rate was 73.6 (65.2 to 79.5) per cent. 2019 WHO grade (HR 2.10 (0.19); P &lt; 0.001) and ENETS TNM stage (HR 2.50 (0.24); P &lt; 0.001) significantly influenced disease-free RS. The probability of disease-free survival was 93.2, 84.9, 45.2, and 6.8 per cent for patients with stage I, II, III, and IV disease, and 91.9, 45.2, 9.4, and 0.7 per cent for those with G1, G2, G3 Pan-NENS, and Pan-NECs, respectively.

Conclusion
A surgical approach seems without benefit for Pan-NECs, and unnecessary for small G1 sporadic Pan-NENs. Surgery alone may be insufficient for stage III–IV and G3 Pan-NENs.
Factors influencing local and distant recurrence following resection of periampullary cancer
Authors: Bhandare M S , Mondal A , Chaudhari V , Bal M , Yadav S , Ramaswamy A , Ostwal V , Shetty N , Shrikhande S V 
Published: January 2021

Abstract

Background
Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences.

Methods
This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed.

Results
Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P &lt; 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM.

Conclusion
Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.
Centralized repeated resectability assessment of patients with colorectal liver metastases during first-line treatment: prospective study
Authors: Isoniemi H , Uutela A , Nordin A , Lantto E , Kellokumpu I , Ovissi A , Kosunen J , Kallio R , Soveri L M , Salminen T , Ålgars A , Lamminmäki A , Halonen P , Ristamäki R , Räsänen J , Karjula H , Vaalavuo Y , Lavonius M , Osterlund P 
Published: January 2021

Abstract

Background
Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases.

Methods
The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival.

Results
Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0–1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0–1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively.

Conclusion
Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.