Peng L, Zhang Y, Zhao A
… +8 more, Li R, Li Z, Zhao J, Yu P, Liu Y, Shi H, Liang R, Wang H
Ann Surg Oncol
· 2026 Jun · PMID 42289629
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BACKGROUND: This study evaluates the comparative performance of DeepSeek-R1, ChatGPT-5 Pro, and urologists in the specific domains of bladder cancer knowledge retrieval and complex clinical reasoning. METHODS: We constru...BACKGROUND: This study evaluates the comparative performance of DeepSeek-R1, ChatGPT-5 Pro, and urologists in the specific domains of bladder cancer knowledge retrieval and complex clinical reasoning. METHODS: We constructed a benchmark dataset comprising 91 standardized multiple-choice questions on bladder cancer derived from MedQA, MedMCQA, and the Chinese National Medical Licensing Examination, alongside three retrospectively reconstructed real-world cases. Five advanced models, including DeepSeek (V3, R1) and OpenAI variants (ChatGPT-5, ChatGPT-5 Pro, ChatGPT-5 Mini), were evaluated. Accuracy and stability were assessed across three independent runs for standardized questions. In clinical simulations, DeepSeek-R1 and ChatGPT-5 Pro were benchmarked against human urologists. A blinded expert panel of three senior urologists evaluated responses using a 5-point Likert scale across four dimensions: readability, medical accuracy, diagnostic test appropriateness, and logical coherence. RESULTS: In standardized testing, all models achieved >92% accuracy. ChatGPT-5 Pro ranked first (97.52%), followed closely by DeepSeek-R1 (95.04%), with both displaying superior stability. In clinical simulations, DeepSeek-R1 demonstrated logical coherence comparable to both human experts and ChatGPT-5 Pro (P > 0.05). However, DeepSeek-R1 scored significantly lower than ChatGPT-5 Pro regarding readability and "error-free" rates. Notably, human urologists significantly outperformed both AI models in diagnostic test appropriateness (P < 0.01), primarily because DeepSeek-R1 struggled with "test avoidance," tending to recommend redundant investigations (P < 0.0001). CONCLUSIONS: DeepSeek-R1 demonstrates excellent accuracy and expert-level clinical reasoning, exhibiting competitiveness with ChatGPT-5 Pro. Although slightly inferior in readability and prone to suggesting unnecessary tests, its core reasoning capabilities remain favorable.
Tseng WW, Barretta F, Fiore M
… +15 more, Radaelli S, Baia M, Borghi A, Colombo C, Sanfilippo R, Fabbroni C, Stacchiotti S, Di Blasi E, Sangalli C, Allajbej A, Morosi C, Vanzulli A, Pasquali S, Callegaro D, Gronchi A
Ann Surg Oncol
· 2026 Jun · PMID 42283920
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Ann Surg Oncol
· 2026 Jun · PMID 42283919
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BACKGROUND: This study aimed to compare functional and oncologic outcomes between high-intensity focused ultrasound (HIFU) and robot-assisted radical prostatectomy (RARP) for patients with localized prostate cancer (LPCa...BACKGROUND: This study aimed to compare functional and oncologic outcomes between high-intensity focused ultrasound (HIFU) and robot-assisted radical prostatectomy (RARP) for patients with localized prostate cancer (LPCa). METHODS: Four databases (Embase, PubMed, Cochrane Library, Web of Science) were systematically searched from inception to December 2025. The review followed PRISMA 2020 and AMSTAR 2 guidelines. Pooled effect estimates were calculated using Stata 17. Random-effects models were applied when I was 50 % or higher or the P value was lower than 0.10. RESULTS: Five cohort studies (n = 2123) were included. In this review, HIFU was associated with significantly higher International Index of Etile Function (IIEF)-5 scores at 6 months (effect, 3.41; 95 % confidence interval [Cl], 1.88-4.94; P < 0.05), 12 months (effect, 3.75; 95% Cl 3.00-4.49; P < 0.05), and 24 months (effect, 2.72; 95% Cl 0.59-4.85; P < 0.05). Urinary continence overy also favored HIFU (odds ratio [OR], 0.40; 95% Cl 0.27-0.59; P < 0.05) for pad-free rates at baseline and at 6 and 12 months (all P < 0.05). No significant differences were observed in International Prostate Symptom Score (IPSS) or salvage therapy rates. CONCLUSION: For patients with localized prostate cancer, HIFU offers better etile function and urinary continence overy than RARP, with comparable complication and salvage therapy rates. Long-term oncologic outcomes remain to be confirmed.
Hakkesteegt SN, Spaanderman DJ, Colombo C
… +22 more, Schut AW, Vanzulli A, Barretta F, Morosi C, Fiore M, Ferguson P, Suraweera H, Griffin AM, White LM, Shapiro J, Ge D, Grünhagen DJ, van Leenders GJLH, Hanff D, Visser JJ, Niessen WJ, Klein S, Dutch Grafiti Research Group, Gladdy RA, Gronchi A, Verhoef C, Starmans MPA
Ann Surg Oncol
· 2026 Jun · PMID 42277475
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BACKGROUND: Active surveillance (AS) is the first-line approach for desmoid-type fibromatosis (DTF). However, 30 % of patients require active treatment. Identifying these patients will help upfront to define a personaliz...BACKGROUND: Active surveillance (AS) is the first-line approach for desmoid-type fibromatosis (DTF). However, 30 % of patients require active treatment. Identifying these patients will help upfront to define a personalized treatment approach. This study assessed whether radiomics can predict AS failure in patients with DTF. METHODS: This multicenter study included data from the Netherlands (NL), Italy (ITA), and Canada (CAN). The study included patients with extra-abdominal DTF initially managed with AS and baseline MRI. Tumors were segmented using a minimally interactive deep-learning method, and radiomics features were extracted from T1-weighted (T1W) and T2-weighted (T2W) MRI scans. Prediction models to predict AS failure versus no failure were created using various machine-learning approaches. Both an internal cross-validation using all available data and an external leave-one-country-out cross-validation were used to assess model performance. RESULTS: The cohort included 200 patients (72 NL, 62 ITA, 66 CAN), with AS failing for 26 % of the patients. Internal validation of the T1W+T2W imaging model resulted in an overall area under the curve (AUC) of 0.69 (95 % confidence interval [CI] 0.60-0.79). External validation resulted in an AUC of 0.58 (95 % CI 0.42-0.74) in the Dutch cohort, 0.76 (95 % CI 0.60-0.91) in the Italian cohort, and 0.77 (95 % CI 0.65-0.89) in the Canadian cohort. Adding clinical features did not improve the models' performance. CONCLUSIONS: Predicting AS failure with radiomics showed reasonable performance and generalized well to the Italian and Canadian cohorts. Pending improvements to the model or patient selection, the authors' model shows potential to better identify which DTF patients will benefit from AS and which will not.
Giuliante F, Famularo S, Panettieri E
… +7 more, Mele C, De Bellis M, Maresca P, Razionale F, Vellone M, Ardito F, De Rose AM
Ann Surg Oncol
· 2026 Jun · PMID 42274966
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BACKGROUND: Patients with tumor infiltration of both the right hepatic vein (RHV) and left hepatic vein (LHV) at the caval confluence traditionally are considered unresectable. Presence of peripheral communicating veins...BACKGROUND: Patients with tumor infiltration of both the right hepatic vein (RHV) and left hepatic vein (LHV) at the caval confluence traditionally are considered unresectable. Presence of peripheral communicating veins (CVs) allows the resection of these tumors through an innovative parenchyma-sparing strategy-transversal hepatectomies. PATIENTS AND METHODS: A 48-year-old woman with sigmoid colon cancer and synchronous bilateral liver metastases presented with one metastasis in segments 7-8 invading the RHV at its confluence with the inferior vena cava (IVC) and one metastasis in segment 2 involving the LHV at the caval confluence. The middle hepatic vein (MHV) was uninvolved. She underwent primary tumor resection followed by 12 cycles of FOLFOX-bevacizumab, achieving a partial response with persistent infiltration of RHV and LHV. Computed tomography (CT) imaging demonstrated CVs between distal RHV and LHV branches and the MHV, providing venous outflow to the future liver remnant (FLR). RESULTS: Intraoperative ultrasound confirmed MHV patency and adequate drainage from segments 3 and 6 via CVs. R0 resection of segment 2 (with LHV division) and segments 7-8 (with RHV division) was performed under ultrasound guidance and IVC clamping. The MHV was preserved, ensuring venous outflow of the FLR. Post-resection doppler ultrasound confirmed adequate inflow and outflow. No major postoperative complications occurred, and the patient was discharged on postoperative (PO) day 12. CONCLUSIONS: An innovative parenchyma-sparing resection is described: double mini upper transversal hepatectomy. This procedure can be performed when both RHV and LHV confluences are involved and CVs are present. Preservation of a single major hepatic vein supplemented by CV drainage can achieve oncologic radicality while sparing functional reserve.
Are C, Stattner S, Leiphrakpam P
… +4 more, Pitzl T, Audisio RA, Rubio IT, Berman RS
Ann Surg Oncol
· 2026 Jun · PMID 42274963
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BACKGROUND: The rising global cancer burden underscores the need for a skilled cancer surgical workforce. Education in the principles of cancer surgery is essential to ensuring a competent cancer surgical workforce. In r...BACKGROUND: The rising global cancer burden underscores the need for a skilled cancer surgical workforce. Education in the principles of cancer surgery is essential to ensuring a competent cancer surgical workforce. In response, the Society of Surgical Oncology and the European Society of Surgical Oncology jointly published the first Global Curriculum in Surgical Oncology in 2016 to provide a structured framework for the education of cancer surgeons. The updated version of the original curriculum incorporates advances in cancer surgical care from the intervening period, while maintaining the original vision of a globally relevant educational framework. MATERIAL AND METHODS: The global curriculum committees of the Society of Surgical Oncology and the European Society of Surgical Oncology convened a series of meetings to review, revise, and develop the updated global curriculum in surgical oncology. RESULTS: The second edition of the global curriculum in surgical oncology incorporates key advances in cancer surgical care that have occurred since the publication of the original curriculum. The curriculum retains the foundational principles of the first edition, such as: (a) ensuring that the curriculum is resource-stratified, (b) applicability across diverse geographical regions worldwide, and (c) provision of a flexible and modular, foundational framework that can be adapted to local training needs. CONCLUSIONS: The second edition of the global curriculum in surgical oncology provides resource-stratified, geographically agnostic foundational scaffolding for training the global cancer surgical workforce. Implementation of this curriculum can be instrumental in building a competent surgical oncology workforce capable of addressing the rising global cancer burden.
Schlick CJR, Ellis RJ, Dikken JL
… +10 more, Lin ST, Capanu M, Jadeja B, Brennan MF, Strong VE, Ilson DH, Maron SB, Janjigian YY, Tang LH, Coit DG
Ann Surg Oncol
· 2026 Jun · PMID 42271125
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BACKGROUND: Patients with gastric cancer and isolated positive peritoneal cytology have stage IV disease. The clinical significance of cytologic conversion is poorly understood. Our objectives are to (1) describe the cli...BACKGROUND: Patients with gastric cancer and isolated positive peritoneal cytology have stage IV disease. The clinical significance of cytologic conversion is poorly understood. Our objectives are to (1) describe the clinicopathologic characteristics of patients with gastric cancer and isolated positive peritoneal cytology and their association with survival, (2) evaluate patients who underwent second cytologic evaluation for assessment of cytologic conversion, and (3) describe recurrence patterns in patients with cytologic conversion who underwent resection. PATIENTS AND METHODS: Patients with gastric adenocarcinoma and isolated positive peritoneal cytology were identified from a prospectively maintained institutional database from 1996 to 2020 for this cohort study. Patients were characterized by selection for second cytologic evaluation following chemotherapy, cytologic conversion, and selection for surgical resection. Factors associated with overall survival (OS) were evaluated by time-dependent multivariable Cox regression models. RESULTS: Overall, 174 patients were identified, 62 (35.6%) were selected for second cytologic evaluation, 43 (69.4%) were cytologic converters, and 32 (74.4, 18.4% overall) underwent resection. Selection for second cytologic evaluation was associated with improved OS (hazard ratio [HR] 0.56, 95% CI 0.37-0.86), and among those patients, cytologic conversion was associated with improved OS (HR 0.17, 95% CI 0.08-0.35). Ten patients (31.3%) had no evidence of recurrence following resection during the study period. The peritoneum was the most common site of recurrence (n = 17, 53.1%). CONCLUSIONS: Among patients with gastric cancer and isolated positive peritoneal cytology, second cytologic evaluation can provide prognostic information and inform treatment decisions. Cytologic conversion was documented in 25% of patients, with rare instances of long-term disease control.
Dagorno C, Orbach D, Grosman J
… +16 more, Pire A, Dariel A, Sauvat F, Faure C, Mallebranche C, Guérin F, Buisson P, Meignan P, Ballouhey Q, Berrebi D, Philippe-Chomette P, Aquilina L, Arnaud A, Rod J, Fresneau B, Sarnacki S
Ann Surg Oncol
· 2026 Jun · PMID 42271123
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BACKGROUND: Primary retroperitoneal germ cell tumors (GCTs) are rare and often present as large masses with close anatomical relationships to adjacent organs and vessels, which can complicate surgical management. Indicat...BACKGROUND: Primary retroperitoneal germ cell tumors (GCTs) are rare and often present as large masses with close anatomical relationships to adjacent organs and vessels, which can complicate surgical management. Indications for neoadjuvant chemotherapy are guided by pathological features and serum alpha-fetoprotein (AFP) levels; however, these levels may be difficult to interpret in infants. While some tumors respond to neoadjuvant chemotherapy, others may progress during treatment, making surgical resection even more challenging. This study aimed to evaluate the management and outcomes of retroperitoneal GCTs within a national multicenter cohort. PATIENTS AND METHODS: This national retrospective study included pediatric patients with primary retroperitoneal GCTs who underwent surgical resection between 2000 and 2022. Data were identified through the French Very Rare Tumors Committee (FRACTURE) database, the TGM-2013 study, and the Groupe des Chirurgiens Pédiatres Opérant des Tumeurs (GCPOT) collaborative group. RESULTS: A total of 24 children were included (17 girls). The median age and weight at diagnosis were 5.2 months (range 1.6-44 months) and 7.4 kg (range 4-14 kg), respectively. Five patients (29%) had a prenatal diagnosis. The median tumor volume was 563 cm (range 280-986 cm), and 17 patients (71%) initially presented with vascular risk factors. AFP levels were elevated for age in eight patients (33%), including four infants under 1 year old, with a median level of 7500 ng/mL (range 1775-70,860 ng/mL). Eight patients (33%) received neoadjuvant chemotherapy, six of whom had age-elevated AFP. Following chemotherapy, tumor volume decreased in three cases, while five patients experienced tumor progression. Complete (R0) resection was achieved in 18 cases (75%). Histological analysis revealed 11 mature teratomas (46.0%), 9 immature teratomas (37.5%)-including 5 grade 1, 2 grade 2, and 2 grade 3-and 4 malignant GCTs with a yolk sac tumor (YST) component (16.5%). One patient with perioperative tumor capsular rupture and metastatic YST received adjuvant chemotherapy. Major complications (Clavien-Dindo ≥ 3) occurred in five cases (21%). Two deaths were recorded: one postoperatively due to mesenteric ischemia and one due to local and metastatic YST progression. After a median follow-up of 7.1 years (range 2.7-12.3 years), 22 patients (91.6%) are alive with no evidence of recurrence. CONCLUSIONS: This study confirms the favorable oncological prognosis of primary retroperitoneal GCTs in children. Neoadjuvant chemotherapy should be approached with caution, as its impact on tumor volume may be limited. Furthermore, it carries a potential risk of growing teratoma syndrome, which can ultimately lead to even more challenging surgical procedures.
Zarekar R, Singh Y, Kishore S
… +6 more, Trivedi S, Kumar U, Srivastava A, Rajeev TP, Yadav M, Singh R
Ann Surg Oncol
· 2026 Jun · PMID 42265519
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BACKGROUND: Renal cell carcinoma (RCC) is the most common type of kidney cancer and significant patient population experiences relapse and metastasis, resulting in poor survival outcomes. Therefore, there is a need to id...BACKGROUND: Renal cell carcinoma (RCC) is the most common type of kidney cancer and significant patient population experiences relapse and metastasis, resulting in poor survival outcomes. Therefore, there is a need to identify novel biomarkers and therapeutic targets to monitor RCC progression and improve patient outcomes. MicroRNAs (miRNAs) are small non-coding RNAs that regulate post-transcriptional gene expression and have been implicated in tumor progression. METHODS: We analysed publicly available datasets to identify differentially expressed miRNAs and their putative targets were identified using miRDB and Starbase ENCORI database. Further, We analysed the expression levels of identified miRNAs and their selected target mRNAs by qRT-PCR. Diagnostic potential of miRNAs were analysed by ROC analysis. Cox regression analysis were performed with target mRNAs to evaluate the potential prognostic utility and their association with clinical outcomes in ccRCC patients. RESULTS: hsa-miR-200b-3p, hsa-miR-320a-3p were downregulated and hsa-miR-34c-5p was upregulated in ccRCC patients. The target genes of identified miRNAs are critical regulators of the OXPHOS, cell death, and inflammatory pathways, involved in the progression of ccRCC. hsa-miR-200b-3p has an AUC of 0.7273 (p < 0.05; cutoff 3.870, LR+ 4.77). Univariable and multivariable cox regression analysis showed low expression of NDUFS1 independently associated with poor survival outcome (p < 0.001) in ccRCC patients. DISCUSSION: Our study demonstrated, downregulation of hsa-miR-200b-3p in ccRCC holds promise as a potential diagnostic biomarker and its identified target NDUFS1 as an independent prognostic biomarker for patients with ccRCC. These findings need to be validated in a large cohort of patients with RCC.
Pea A, Dall'Olio T, Solinas D
… +8 more, Filippini C, Venturini E, De Pastena M, Luchini C, Crinò S, Zamboni GA, D'Onofrio M, Salvia R
Ann Surg Oncol
· 2026 Jun · PMID 42265517
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BACKGROUND: The management of intraductal papillary mucinous neoplasms (IPMNs) has evolved through successive International Association of Pancreatology guidelines, aiming to refine surgical indications and improve cance...BACKGROUND: The management of intraductal papillary mucinous neoplasms (IPMNs) has evolved through successive International Association of Pancreatology guidelines, aiming to refine surgical indications and improve cancer prevention. With broader adoption of surveillance, the oncologic outcomes of patients resected after follow-up-and the effectiveness of current strategies in preventing malignancy-remain unclear. This study examined how evolving management has influenced surgical selection and cancer prevention, particularly by comparing patients resected at diagnosis versus after surveillance. METHODS: Patients with presumed IPMN across four International Association of Pancreatology guideline periods (pre-2006, 2006-2012 [Sendai], 2012-2017 [Fukuoka], and 2017-2024 [Fukuoka revisions]) were analysed by clinical trajectory: follow-up without surgery, upfront surgery (resection within 12 months of diagnosis), and post-surveillance resection (PR). Endpoints included surgical indications and rates of low-grade dysplasia (LGD), high-grade dysplasia (HGD), and invasive carcinoma (IC). RESULTS: Across guideline periods, patients managed with surveillance increased from 172 before 2006 to 828 in 2006-2012, 1,572 in 2012-2017, and 1,193 after 2017, while PR increased from 11 to 29, 60, and 204, respectively. Overall, among 3,304 patients, 2,452 (74%) were managed with surveillance, 548 (17%) underwent upfront surgery, and 304 (9%) had PR. In the PR group, resections for a single high-risk stigmata (HRS) increased from 9% to 48%, and those with multiple HRS up to 20% after 2017. At pathology, LGD decreased from 46% to 17%, whereas HGD and IC increased from 18 to 28% and from 36 to 45%, respectively. In the upfront surgery group, LGD decreased from 49% to 26%. Development of HRS during follow-up was associated with a higher risk of HGD/IC (odds ratio 2.18, p = 0.008). CONCLUSIONS: While evolving IPMN management has reduced rates of LGD and increased detection of HGD, invasive carcinoma remains frequent at resection after surveillance, as surgery is often delayed until HRS emerge. Improved tools are needed to optimize timing and define appropriate oncologic outcomes.