Citations

2089 Background: Central neurocytomas (CNs) are rare, WHO grade 2 brain tumors that can have relatively high recurrence rates following surgical resection. Owing to the rarity of CNs and limited robust data, the optimal use and timing of radiotherapy (RT) remain undefined, particularly in young adults with low mortality. Tumor proliferation index (Ki-67) may also predict CN recurrence rates, but there is no consensus on its utility in clinical practice. The present collaboration between Northwestern University and the Mayo Clinic describes long-term outcomes of CN as it relates to RT timing and Ki-67 level. Methods: Patients established between 1990-2025 with a tissue diagnosis of CN at Northwestern University and the Mayo Clinic were reviewed. Demographic, treatment, and tumor characteristics (histologic/molecular) were recorded. Recurrence free survival (RFS) and overall survival (OS) were calculated according to the Kaplan Meier-method. Results: Fifty-one patients with CN (51% male, 49% female)--with a median age of 26 years and 9.7 years median follow-up--were included. RFS at 2, 5, and 10 years for the cohort was 79%, 65%, and 59% respectively; OS at 10 years for the cohort was 94%, and no deaths were attributed to uncontrolled CN. Subtotal resection (STR) yielded 2- and 5-year RFS of 74% and 65%, while gross total resection (GTR) yielded 2- and 5-year RFS of 90% and 66%. Median Ki-67 of the cohort was 3%; RFS at 2 and 5 years for Ki-67 <3% was 82% and 76%, compared to 76% and 43% for Ki-67 ≥3% (p<0.02). In patients who underwent resection without adjuvant RT (n=35), those with STR had a 2- and 5-year RFS of 61% and 45%, and those with GTR had a 2- and 5- year RFS of 88% and 61%. Additionally, without adjuvant RT, RFS at 2 and 5 years for Ki-67 <3% was 73% and 64% versus 71% and 24% for Ki-67 ≥3%. Among patients without adjuvant RT and Ki-67 ≥3% (n=14), 2-year RFS was 60% after STR and 78% after GTR. Salvage RT after first recurrence (n=16) had a 5-year RFS of 81%, with a median follow-up of 4.1 years. Conclusions: We report one of the largest cohorts of CN with long-term follow-up. STR and/or Ki-67 ≥3% were associated with shorter RFS. Salvage RT at recurrence achieved durable long-term tumor control, and long-term (~10-year) mortality was low. In appropriately selected patients, observation after resection may be a reasonable initial strategy, with RT reserved for salvage. General cohort characteristics (n=51) with Ki-67 (n=39). Variable Number (%) Median Age (years) 26 (range: 5-57) Gender, Male:Female (M/F) 26:25 (51/49) Subtotal Resection 29 (57) Gross Total Resection 22 (43) Adjuvant Radiotherapy 16 (31) Salvage Radiotherapy 16 (31) No Radiotherapy 19 (38) Ki-67 ≥3 21 (56) Ki-67 <3 18 (44)

11186 Background: Cancer survival is shaped by tumor biology, treatment access, and socioeconomic context, yet population-level quantification of long-term survival disparities related to chemotherapy use and income is limited. We assessed five-year cancer-specific survival across demographic, treatment, and socioeconomic strata in a national registry. Methods: We performed a retrospective, population-based survival analysis using the Surveillance, Epidemiology, and End Results (SEER) database. Cancer-specific survival was evaluated at 12, 24, 36, 48, and 60 months after diagnosis. Outcomes were stratified by sex, race, chemotherapy receipt, and area-level median household income categories. Survival estimates were summarized descriptively and visualized using time-to-event curves. Results: Overall cancer-specific survival declined progressively over five years, from ~84% at 12 months to ~58% at 60 months. Sex differences were minimal, with similar five-year survival among males and females (~57–58%). Racial disparities were substantial: Asian/Pacific Islander patients demonstrated the highest survival across follow-up, while Black and American Indian/Alaska Native patients had lower early survival and persistent gaps at five years. Patients with recorded chemotherapy use had improved survival compared with those without or with unknown chemotherapy status; 12-month survival was ~88% versus ~80%, and five-year survival was ~65% versus ~57%, respectively. A pronounced socioeconomic gradient was observed: individuals in areas with median household income ≥$120,000 had higher five-year survival (~67%), whereas those in areas with income < $40,000 had markedly lower survival (~52%). Conclusions: In this national registry analysis, both chemotherapy utilization and higher socioeconomic status were strongly associated with improved long-term cancer survival, whereas persistent racial and income-related disparities remained evident. These findings highlight ongoing inequities in access to oncologic care and support the need for targeted policy interventions and equity-focused treatment delivery models. Interpretation should account for limitations inherent to observational registry data and potential residual confounding.

OBJECTIVE Craniopharyngiomas are challenging lesions, and aggressive resections may cause significant postoperative morbidity and mortality. To mitigate morbidity, a potential strategy of subtotal resection (STR) and adjuvant radiation therapy (RT) has been used, but its impact on survival when compared to gross-total resection (GTR) has been under-investigated. Thus, the objective of this study was to analyze short-term mortality between patients undergoing STR ± RT and GTR, and differences in overall survival (OS) between patients undergoing STR, STR + RT, and GTR in a large, nationally representative database. METHODS The authors queried the National Cancer Database for patients diagnosed with craniopharyngioma between 2004 and 2017. Tumor characteristics, treatment strategies, and extent of resection were analyzed. Endpoints were 3-month mortality rate and OS, which were compared between treatment modalities. Firth’s logistic regression was used to analyze 3-month mortality and was adjusted for age, sex, Charlson Comorbidity Index score, histopathological diagnosis, income quartile, insurance payor, and maximal tumor diameter. Differences in survival between treatment modalities were compared with log time-to-event analyses after excluding deaths occurring within 3 months to control for immortal time bias. RESULTS A total of 1460 adult and 390 pediatric patients were included. Adults undergoing STR ± RT had a lower rate of 3-month mortality compared to those undergoing GTR in adjusted analysis (2.8% vs 4.6%, odds ratio 0.42; p = 0.03). Survival curves for the STR + RT and GTR cohorts did not significantly differ (p = 0.198). A strategy of STR alone showed worse OS compared with GTR and STR + RT (p < 0.01). The average follow-up length for adults was 65.5 months. For pediatric patients, 3-month mortality for those undergoing GTR and STR ± RT was similar (0% vs 1%, respectively; p = 0.33). Additionally, compared to GTR, there were no significant differences in OS between STR + RT (p = 0.41) and STR alone (p = 0.44). The average follow-up length for the pediatric cohort was 79 months. CONCLUSIONS STR + RT was associated with a favorable perioperative mortality profile when compared with GTR and provided similar long-term survival outcomes. Therefore, STR + RT may be considered when GTR carries significant risks.

ABSTRACT Background Patients with end‐stage renal disease (ESRD) undergoing dialysis have an increased risk of pacemaker‐related complications due to limited vascular access and increased susceptibility to infection. Leadless pacemakers (LPMs) may mitigate these risks compared with conventional transvenous pacemakers (TPMs), but long‐term comparative data in this population remain limited. Methods We conducted a retrospective cohort study using the TriNetX Research Network, including adults (≥ 18 years) with ESRD on dialysis who underwent LPM or TPM implantation between May 2016 and December 2020. Propensity score matching (1:1) was performed using demographics and comorbidities. Outcomes assessed over up to 5 years included all‐cause hospitalization, heart failure hospitalization, device re‐intervention, device‐related complications, infection‐related hospitalization, pacemaker‐induced cardiomyopathy, and all‐cause mortality. Results After matching, 901 patients were included in each group with well‐balanced baseline characteristics. LPM implantation was associated with a significantly lower risk of device re‐intervention compared with TPM (4.1% vs. 9.3%; hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.28–0.69; p < 0.01). There were no significant differences between groups in all‐cause hospitalization (65.5% vs. 68.3%; p = 0.22), heart failure hospitalization (26.9% vs. 30.2%; p = 0.13), all‐cause mortality (37.5% vs. 35.3%; p = 0.34), device‐related complications (14.5% vs. 14.3%; p = 0.94), infection‐related hospitalization (1.6% vs. 2.1%; p = 0.35), or pacemaker‐induced cardiomyopathy (9.0% vs. 8.6%; p = 0.66). Conclusion In a large, propensity‐matched cohort of patients with ESRD on dialysis, LPMs were associated with fewer device re‐interventions and comparable long‐term clinical outcomes compared with TPMs.

Objectives: We evaluated agreement between human papillomavirus (HPV) tests performed on self-collected vaginal and clinician-collected cervical specimens to advance HPV self-collection as a cervical cancer screening option in our health care system. Methods: This diagnostic accuracy study was conducted at an academic medical center. Participants were 25–65 years old with upcoming colposcopy appointments. One cohort (n = 79) self-collected a vaginal specimen in the clinic immediately before a clinician-collected cervical specimen. The second cohort (n = 115) self-collected a vaginal specimen at home, mailed it in, and had a clinician-collected cervical specimen in the clinic. Paired specimens were evaluated for total (TPA), positive (PPA), and negative (NPA) percentage agreement. Extreme temperature stability studies were also conducted. Results: Compared with clinician-collected cervical specimens, in-clinic self-collected vaginal specimens showed a TPA, PPA, and NPA of 98%, 100%, and 97% for HPV16; 99%, 100%, and 99% for HPV18; 86%, 94%, and 79% for high-risk other (HRO) HPV. The TPA, PPA, and NPA for at-home self-collected vaginal specimens compared with clinician-collected cervical specimens were 94%, 79%, and 96% for HPV16; 95%, 43%, and 98% for HPV18; 89%, 80%, and 93% for HRO. Vaginal specimens showed prolonged stability and were unaffected by extreme temperatures. Conclusions: In general, in-clinic and at-home self-collected vaginal HPV specimens for HPV screening demonstrate high agreement with clinician-collected cervical specimens, with the exception of low PPA in the at-home self-collected vaginal HPV18 subgroup. Our findings support the use of HPV self-collection as a practical option to expand access to cervical cancer screening.

Background: The impact of obesity on outcomes following total ankle arthroplasty (TAA) remains unclear, with existing literature reporting mixed results. Although some studies have identified obesity as a risk factor for perioperative complications and poor clinical outcomes, others have found no significant association. Thus, the purpose of this study was to evaluate the association between obesity, across a range of body mass index (BMI) classifications, and postoperative complications after TAA. Methods: Patients undergoing primary TAA were identified from a large national insurance database. Individuals with a BMI ≥30 were identified and matched 1:1 to nonobese controls using propensity score matching based on demographics and comorbidities. Obese patients were further stratified into BMI categories: 30-34.9, 35-39.9, 40-44.9, and ≥45. Ninety-day complications and 2-, 5-, and 10-year surgery-specific outcomes were assessed. Odds ratios (ORs) with 95% CIs and Kaplan-Meier survival analyses were used to evaluate complication risks. Results: After matching, 3364 patients were included in each cohort. No significant differences in 90-day complication rates were observed for patients with BMI 30-44.9 compared with controls. Patients with BMI ≥45 had increased risk of surgical site infection (OR 2.21, 95% CI 1.29-3.79, P = .003), emergency department visits (OR 1.43, 95% CI 1.04-1.96, P = .025), and readmissions (OR 2.31, 95% CI 1.47-3.63, P < .001). The pooled 90-day complication rate was significantly higher in this group as well (12.9% vs 7.6%, OR 1.77, 95% CI 1.26-2.48, P < .001). At 10-year follow-up, Kaplan-Meier analysis demonstrated that patients with a BMI ≥45 had a higher risk of periprosthetic joint infection (PJI compared with controls (hazard ratio 1.75, 95% CI 1.07-2.85, P = .03). Patients with BMI 30-34.9 had a significantly lower risk of aseptic loosening at both 5 years (OR 0.68, 95% CI 0.49-0.94, P = .019) and 10 years (OR 0.65, 95% CI 0.48-0.88, P = .005). Conclusion: BMI ≥45 was associated with higher all-cause health care utilization, including emergency department visits and hospital readmissions, as well as higher long-term risk of PJI following TAA. Level of Evidence: Level III, retrospective cohort study.

ABSTRACT Background Long‐term outcome data for stiff person spectrum disorder (SPSD) remain limited and sustained response to treatment varies. Methods In this retrospective cohort study, we included patients with probable or definite SPSD (Mayo Clinic criteria), evaluated at Mayo Clinic (12/1995‐07/2024) with ≥ 5 years of follow‐up after diagnosis. Primary outcome measures included the modified Rankin scale (mRS) and use of gait aids. Results Fifty‐four patients were included, 41 (76%) were female; median age at onset was 45 years (16–78). Most were antibody‐positive (51 [94%]), with high‐titer (serum, ≥ 20 nmol/L) GAD65‐IgG in 45 (83%). Nine patients had a stiff‐limb presentation (17%). The median interval from onset to diagnosis was 2 years (0–34), and median follow‐up was 9 years (5–26). Most patients (46 [85%]) received immune therapy; 37 (82%) reported improvement. All patients had significant impairment (mRS ≥ 2) at nadir, with 31 (57%) losing functional independence (mRS ≥ 3) and 40 (75%) requiring bilateral gait assistance. The median time from onset to nadir was 6 years (0–39). At last follow‐up, most (37 [69%]) were functionally independent (mRS ≤ 2), including 8 (15%) with minimal restrictions (mRS ≤ 1). Bilateral gait assistance was needed in 22 (41%). Among 40 patients with ≥ 10 years of follow‐up, 22 (56%) had an mRS ≤ 2 and 25 (63%) required a gait aid at last follow‐up. Poor outcome in this population was associated with bilateral gait assistance at nadir and older age ( p < 0.05). Conclusions Although over half of SPSD patients lose functional independence at disease nadir, many regain independence and achieve well‐controlled symptoms.

Image-derived artificial intelligence (AI) risk models have shown promise in short-term risk assessment for improving breast cancer (BC) screening. No image-derived long-term AI risk model for primary prevention has been developed and externally validated. Individuals aged 31 to 94 years were recruited between 2010 and 2020 in two population-based case cohorts (Olmsted County, Minnesota, US, and KARMA, Sweden) and one hospital-based case-control study (EMBED, Atlanta, US). Median follow-up in the case cohorts was 10 years, with BCs diagnosed through June 2022. Additional validation was performed in EMBED with 3-year follow-up. An AI risk model was developed in Sweden, and we report independent validation in Olmsted/KARMA/EMBED. Absolute 10-year risks were estimated at study entry. Time-dependent discriminatory performance [AUC( t )] and expected-to-observed events (E/O) were estimated. Comparisons were performed with clinical risk tools and the image-based Mirai tool. Across Olmsted/KARMA, 8696 individuals (mean age, 54.4±10.6) and 1633 individuals with incident BC (mean age, 57.0±10.6) were included. Average 10-year risks were 3.83 and 3.14%, and E/O ratios were 0.99 and 0.99. Ten-year AUC( t ) for invasive BCs were 0.72 in Olmsted and 0.72 in KARMA. Similar discriminatory results were observed in EMBED. Our AI risk tool performed significantly better than Mirai in Olmsted/KARMA/EMBED. In KARMA, in the top 10% of high-risk individuals, the AI risk tool predicted 33% of BCs compared with 23%/20%/24% predicted by Tyrer-Cuzick-v8/BCSC-v3/Mirai (all P < 0.01). The 10-year image-derived AI risk model showed significantly higher performance than clinical risk models and Mirai in diverse populations, supporting its clinical potential for primary prevention.

Objective(s): To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomy Methods: Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve. Results: Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n = 420). The clinical median follow-up length was 51 days, which extended to a median length of 6.2 years following the survey. The median change in follow-up length was 5.37 years ( P < .001). The recurrence rate was 1% at 5 years, with a median time to first recurrence of 7.54 years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment. Conclusion: Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling. Level of Evidence: 3