The prognostic significance of perineural invasion in patients with gastric cancer (GC) is controversial. This study aimed to determine the prognostic value of perineural invasion in patients with stage II/III GC undergoing radical surgery. A total of 1913 patients with stage II/III GC who underwent curative resection between 1994 and 2015 were recruited. Clinicopathological factors, tumor recurrence patterns, disease-free survival, and cancer-specific survival were compared in terms of perineural invasion. The prognostic factors of disease-free survival and cancer-specific survival were determined using univariate and multivariate analyses. Perineural invasion was found in 57.1% of the patients. Age of <65 years, female sex, large tumor size, upper tumor location, total gastrectomy, advanced tumor invasion depth and nodal involvement, greater metastatic to examined lymph node ratio, undifferentiated tumor, and presence of lymphatic or vascular invasion were significantly associated with perineural invasion. The patients with perineural invasion had higher locoregional/peritoneal recurrence rates than those without. Perineural invasion was independently associated with disease-free survival and cancer-specific survival. In conclusion, perineural invasion positivity is associated with aggressive tumor behaviors and higher locoregional/peritoneal recurrence rates in patients with stage II/III GC undergoing curative surgery. It is an independent unfavorable prognostic factor of disease recurrence and cancer-specific survival.

The role of adjuvant chemotherapy in pathological T3N0M0 (pT3N0M0) gastric cancer (GC) remains unclear. The aim of this study was to analyze the prognostic factors of patients with pT3N0M0 GC and to clarify which ones could benefit from adjuvant chemotherapy. A total of 137 patients with pT3N0M0 GC were recruited between 1994 and 2020. Clinicopathological factors and adjuvant chemotherapy regimens were retrospectively collected. Prognostic factors of disease-free survival (DFS) and cancer-specific survival (CSS) were determined using univariate and multivariate analyses. The chemotherapy group was younger (p = 0.012), had had more lymph nodes retrieved (p = 0.042) and had higher percentages of vascular invasion (p = 0.021) or perineural invasion (p = 0.030) than the non-chemotherapy group. There were no significant differences in DFS (p = 0.222) and CSS (p = 0.126) between patients treated with or without adjuvant chemotherapy. Stump cancer, tumor size and perineural invasion were associated with higher rates of recurrence. Tumor size was an independent prognostic factor for DFS (hazard ratio, 4.55; confidence interval, 1.59–12.99; p = 0.005) and CSS (hazard ratio, 3.97; confidence interval, 1.38–11.43; p = 0.011). Tumor size independently influenced survival outcomes in pT3N0M0 patients who underwent radical surgery with and without adjuvant chemotherapy.

Background: Parathyroidectomy for medically refractory secondary hyperparathyroidism in patients with end-stage renal disease (ESRD) traditionally relies on experience-dependent surgical exploration due to limited preoperative localization capabilities. This study evaluates whether four-dimensional computed tomography (4D CT) provides significant improvements in surgical efficiency with measurable operative benefits. Methods: This retrospective comparative study analyzed 103 patients with ESRD undergoing total or subtotal parathyroidectomy between January 2023 and December 2024. Patients were stratified into two groups: 4D CT-guided focused parathyroidectomy ( n = 45) versus conventional imaging-guided surgery using ultrasound ± SPECT(Single Photon Emission Computed Tomography)/CT ( n = 58). Primary endpoints included operative time and intraoperative frozen section requirements. Secondary endpoints assessed diagnostic accuracy and positive predictive value (PPV) of imaging modalities, with postoperative outcomes evaluated to ensure therapeutic equivalence. Results: The 4D CT group demonstrated significantly shorter operative times compared to conventional imaging (162.51 vs. 188.78 min, P = 0.014), representing a 13.9% reduction in surgical duration. Multiple frozen sections were required in 8.9% of 4D CT patients versus 31.0% of conventional patients ( P = 0.013), demonstrating a 3.5-fold reduction in intraoperative histological confirmation needs. 4D CT showed superior diagnostic accuracy (75% vs. 33.33%) and PPV (93.75% vs. 85.0%) compared to conventional imaging. Multivariate analysis identified 4D CT as the only independent predictor of reduced frozen section requirements (odds ratio: 0.21, 95% confidence interval: [0.06–0.68]; P = 0.009). Postoperative outcomes including biochemical control and complication rates were equivalent between groups, demonstrating that enhanced surgical efficiency did not compromise therapeutic effectiveness. Conclusions: 4D CT significantly enhances surgical efficiency in ESRD patients with medically refractory secondary hyperparathyroidism through improved preoperative localization. These efficiency gains are achieved while maintaining therapeutic effectiveness.

We appreciate the authors very much for their interest in our article “Prognostic factors and the role of adjuvant chemotherapy in pathological node-negative T3 gastric cancer”