The predictive value of a covariate is often of interest in studies with a survival endpoint. A common situation is that there are some well established predictors and a potential valuable new marker. The challenge is how to judge the potentially added predictive value of this new marker. We propose to use the positive predictive value (PPV) curve based on a nonparametric scoring rule. The estimand of interest is viewed as a single transformation of the underlying data generating probability measure, which allows us to develop a robust nonparametric estimator of the PPV by first calculating the corresponding efficient influence function. We provide asymptotic results and illustrate the approach with numerical studies and with 2 cancer data studies.

Glioblastoma (GBM) is the most common primary brain malignancy, and standard treatment includes maximal resection of contrast-enhancing tumor. Given recent interest in resection beyond areas of contrast-enhancement, the authors analyzed the role of peri-tumoral resection (PTR) in primary GBM.

This study included 126 adult patients with primary GBM amenable to peri-tumoral resection (PTR) at a tertiary care academic medical center. Patient characteristics and pre/postoperative tumor volumes were collected. Outcome-oriented cut-points for extent of resection of contrast-enhancing tumor (EOR) were determined using maximally selected rank statistics. Multivariable Cox proportional hazards (CPH) model for death was performed.

This cohort had mean age 60.7 ± 11.3 years and median overall survival (OS)/progression-free survival (PFS) 15.2/7.5 months. EOR >92.1% was associated with increased OS compared to <92.1% EOR (23.1 vs.14.0 months, p < .01). Fifty-four (42%) patients received PTR, of which 28 (22%) achieved PTR of >1.74 cm³ beyond the contrast-enhancing region. This latter group demonstrated greater OS than the PTR<1.74 cm³ group (21.6 vs. 16.8 months, p < 0.01). There was no significant difference in postoperative complications between groups. Multivariable CPH model found EOR 92.1%-99% (hazard ratio [HR], 0.30; confidence interval [CI], 0.15-0.60, p < .01) and PTR >1.74 cm³ (HR, 0.27; CI, 0.13-0.56, p < .01) were associated with increased OS. Preoperative T2-FLAIR volume >192 cm³ was associated with worse OS (HR, 3.18; CI, 1.17-8.61, p < .01).

Our results demonstrate increased OS in GBM with resection beyond contrast-enhancing tumor margins. With no associated increase in postoperative deficits, PTR >1.74 cm³ was both effective and safe in select cases.

We explored the incidence, risk factors, and clinical characteristics of acute kidney injury (AKI) within 100 days posttransplantation, and its impact on the prognosis of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in elderly patients. A total of 224 elderly patients diagnosed with acute leukemia received haplo-HSCT between January 1, 2019, and December 31, 2023 at Peking University People's Hospital. AKI affected 54.9% of the patients, with 33.5% in Stage 1, 18.3% in Stage 2, and 3.1% in Stage 3. Being female and having hypoalbuminemia were independent risk factors for developing severe AKI. Three-year overall survival for AKI Stages 0, 1, 2, and 3 were 73.4%, 75.9%, 56.6%, and 14.3%, respectively (p = 0.000). The 3-year event-free survival rates were 70.7%, 73.0%, 46.2%, and 0% (p < 0.001). The 3-year transplantation-related mortality was 13.8% for Stages 0-1 and 48.1% for Stages 2-3 (p < 0.001). Our study showed that more than half of elderly patients who underwent haplo-HSCT developed AKI. Being female and having hypoalbuminemia before transplantation were at a significantly higher risk for severe AKI. Experiencing Stage 2 or more severe AKI was found to be an independent risk factor for increased mortality.

Efficient and affordable diagnosis, coupled with a clear understanding of driver gene prevalence, distribution, and clinicopathological features of driver genes, is crucial for lung cancer treatment and prevention. This study developed a cost-effective targeted sequencing assay for actionable driver mutation and investigated EGFR, KRAS, NRAS, BRAF, PIK3CA, MET, and HER2 in a southern Taiwanese lung cancer population.

Two hundred and twenty-three lung cancer specimens from Chang Gung Memorial Hospital, Chiayi (2009-2020), were retrospectively analyzed.

Among the 223 patients, the mutation frequencies detected by the optimized targeted sequencing assay were: EGFR 48.88%, KRAS 6.28%, PIK3CA 5.83%, NRAS and BRAF both 1.79%, MET 0.90%, and HER2 0.45%. While EGFR mutations in this cohort generally correlated with female sex, never-smoking status, and adenocarcinoma histology, some mutation subtypes deviated from this trend. Conversely, KRAS mutations showed no preference for gender, smoking, or histology, with G12C (42.86%) and G12D (28.57%) being predominant. PIK3CA mutations were more often observed in males and smokers. Concomitant driver mutations were common-except in KRAS and HER2-with prevalence rates of EGFR 5.50%, PIK3CA 61.54%, NRAS 25%, BRAF 50%, and MET 50%.

The established actionable driver mutation targeted sequencing assay can cost-effectively facilitate treatment stratification for over 60% of lung cancer patients. The distinct features caused by mutations in the same gene or genes within similar pathways, coupled with the frequent occurrence of concomitant driver mutations, underscore the importance of economic molecular testing for both patient care and trial stratification.

Objective To analyze the ultrasonographic features of secondary squamous cell carcinoma of the thyroid(SSCC-T)and evaluate the diagnostic value of ultrasound.Methods A retrospective analysis was conducted on clinical and ultrasonographic data from 12 patients with pathologically confirmed SSCC-T treated at Beijing Friendship Hospital,Capital Medical University between January 2016 and January 2025.Evaluated parameters included lesion size,echogenicity,edge,vascularity,calcification,and cervical lymph node metastasis.Descriptive statistical analysis was performed to analyze the ultrasonographic features of SSCC-T,and Fisher's exact test was conducted to analyze the correlation between different ultrasound classifications and thyroid dysfunction.Results The 12 patients showed the following ultrasound classifications:nodular type(50.0%,6/12),diffuse type(33.3%,4/12),and mixed type(16.7%,2/12).All diffuse-type patients exhibited a characteristic cord-like hypoechoic pattern.Cervical lymph node metastasis was observed in all the patients,with 75.0%(9/12)showing lymph nodes >2 cm in maximum diameter.Thyroid dysfunction occurred in 66.7%(8/12)of patients,including 2 patients with dynamic shifts from hyperthyroidism to hypothyroidism.Diffuse and mixed types were associated with hypothyroidism(P=0.038).Conclusions SSCC-T demonstrates specific ultrasonographic features,particularly the cord-like hypoechoic pattern in the diffuse type.For patients with squamous cell carcinoma,regular ultrasound examinations of the thyroid and cervical lymph nodes combined with changes in thyroid function are conducive to the timely detection of thyroid metastasis of squamous cell carcinoma.

Objective To analyze the influencing factors of death in the elderly with coronavirus disease 2019(COVID-19).Methods The case data of death caused by COVID-19 in West China Fourth Hospital from January 1 to July 8,2023 were collected,and surviving cases from the West China Elderly Health Cohort infected with COVID-19 during the same period were selected as the control.LASSO-Logistic regression was adopted to analyze the data after propensity score matching and the validity of the model was verified by drawing the receiver operating characteristic curve.Results A total of 3 239 COVID-19 survivors and 142 deaths with COVID-19 were included.The results of LASSO-Logistic regression showed that smoking(OR=3.33,95%CI=1.46-7.59,P=0.004),stroke(OR=3.55,95%CI=1.15-10.30,P=0.022),malignant tumors(OR=19.93, 95%CI=8.52-49.23, P<0.001),coronary heart disease(OR=7.68, 95%CI=3.52-17.07, P<0.001),fever(OR=0.51, 95%CI=0.26-0.96, P=0.042),difficulty breathing or asthma symptoms(OR=21.48, 95%CI=9.44-51.95, P<0.001),and vomiting(OR=8.19,95%CI=2.87-23.58, P<0.001)increased the risk of death with COVID-19.The prediction model constructed based on the influencing factors achieved an area under the curve of 0.889 in the test set.Conclusions Smoking,stroke,malignant tumors,coronary heart disease,fever,breathing difficulty or asthma symptoms,and vomiting were identified as key factors influencing the death risk in COVID-19.

Extraskeletal myxoid chondrosarcoma is an aggressive tumor in children. Due to its low incidence and nonspecific clinical presentation, as well as its radiological and histopathological characteristics, it is considered a diagnostic challenge. Furthermore, despite the NR4A3 rearrangement being specific to this neoplasm, its evaluation is not routinely performed, as few places have the technology to characterize it. We present the case of a 12-year-old girl with extraskeletal myxoid chondrosarcoma in the right thigh associated with lung metastasis. The diagnosis was ultimately made by integrating the clinical, radiological, histopathological, and ultrastructural features of the chondroblastic differentiation.

Myelolipomas are tumors composed of fat and hematopoietic elements. Typically, these neoplasms are benign and found in the adrenal glands. In certain occurrences, however, they can be found in other physiologic regions. Rarely do these become symptomatic, which may also contribute to the limited instances noted in medical literature. In this report, we outline an incidentally found extra-adrenal myelolipoma in an otherwise healthy patient, along with the subsequent diagnostic and treatment modalities employed. Given the rarity of such cases, this report aims to contribute to the existing literature and help familiarize and guide healthcare professionals in the diagnosis and management of these conditions.

Current guidelines lack nomograms to predict lymph node metastasis (LNM) in thyroid carcinoma (TC) in China. Nomograms are simple, accurate tools to estimate the probability of specific events and have been extensively developed to predict LNM in TC. However, few effective nomograms have been validated in clinical practice.

The recommendations of the Cochrane Prognosis Methods Group were implemented in this systematic review. We conducted searches in PubMed, Web of Science, and Scopus for published research. The nomogram was categorized based on outcomes. We summarized the key characteristics and effectiveness of the nomogram and assessed the overall risk of bias (ROB). We employed random-effects and bivariate mixed-effects models to estimate the efficacy of the nomogram group and its predictive reliability.

The systematic review identified 57 nomogram models from China, of which only 14 had external validation cohorts. While the applicability was acceptable, the heterogeneity among the included nomograms was substantial, leading to a high overall risk of bias (ROB). Ultrasound information was utilized in nearly all studies. Size, extrathyroidal extension (ETE), tumor consistency index (TCI), and multifocality are commonly employed independent risk factors. Both outcome models showed good to excellent predictive efficacy. However, the performance of models that integrate radiomics with clinical features was inferior to those using ultrasound alone.

The feature-combined model offers several potential outcomes and advantages for clinical practice in China. Additionally, the systematic review serves as a reference tool for physicians to select appropriate nomograms based on individual clinical needs. Future research should focus on external validation and evaluation to minimize limitations in clinical utility.

Enhanced recovery after surgery (ERAS) protocols are designed to minimize surgical stress, preserve physiological function, and expedite recovery through standardized perioperative care for primary colorectal surgery patients. This narrative review explores the benefits of current ERAS protocols in improving outcomes for these patients and provides insights into future advancements. Numerous studies have shown that ERAS protocols significantly reduce the length of hospital stays by several days compared to conventional care. Additionally, the implementation of ERAS is linked to a reduction in postoperative complications, including lower incidences of surgical site infections, anastomotic leaks, and postoperative ileus. Patients adhering to ERAS protocols also benefit from quicker gastrointestinal recovery, marked by an earlier return of bowel function. Some research indicates that colorectal cancer patients undergoing surgery with ERAS protocols may experience improved overall survival rates. High compliance with ERAS protocols leads to better outcomes, yet achieving full adherence continues to be a challenge. Despite these advantages, implementation challenges persist, with compliance rates affected by varying clinical practices and resource availability. However, the future of ERAS looks promising with the incorporation of prehabilitation strategies and technologies such as wearable devices and telemedicine. These innovations provide real-time monitoring, enhance patient engagement, and improve postoperative follow-up, potentially transforming perioperative care in colorectal surgery and offering new avenues for enhanced patient outcomes.