Tag: statistics

Front Oncol. 2026 Jun 1;16:1858960. doi: 10.3389/fonc.2026.1858960. eCollection 2026.

ABSTRACT

PURPOSE: This simulation study aims to integrate four-dimensional computed tomography (4DCT) ventilation imaging into functional planning using different radiotherapy (RT) techniques and compare the dosimetric differences across these techniques.

METHODS: 4DCT ventilation images from eighteen lung cancer patients were created using Jacobian values obtained via deformable image registration and a ventilation imaging algorithm. For each patient, we designed both anatomical and functional plans using intensity-modulated radiotherapy (IMRT), hybrid IMRT (static plus IMRT beams treated concurrently), and volumetric modulated arc therapy (VMAT). Dosimetric parameters were systematically compared, with particular attention to the functional lung (FL) radiation dose.

RESULTS: The results showed that regardless of the RT technique (IMRT, hybrid IMRT, or VMAT), functional planning reduced fV₅ (fVx: percentage of functional lung volume receiving ≥ x Gy), fV₁₀, fV₂₀, fV₃₀, and functional mean lung dose (fMLD), while maintaining planning target volume (PTV) dosimetric coverage. Although functional planning increased the radiation dose to most organs at risk (OARs), these increases were not statistically significant. Among the different RT techniques, compared with f-hybrid IMRT, both f-IMRT and f-VMAT reduced radiation dose to the FL and OARs, while achieving superior PTV conformity. Further comparison between f-IMRT and f-VMAT showed that f-VMAT resulted in a lower mean dose (D_mean) to the esophagus.

CONCLUSION: Compared with anatomical planning, functional planning reduces the radiation dose to the FL while preserving target dose coverage and meeting dose constraints for OARs. Among the RT techniques for functional planning, f-VMAT may serve as the preferred technique.

PMID:42306800 | PMC:PMC13265367 | DOI:10.3389/fonc.2026.1858960

Front Oncol. 2026 Jun 1;16:1823812. doi: 10.3389/fonc.2026.1823812. eCollection 2026.

ABSTRACT

BACKGROUND: Cancer is a major threat to public health around the world. Diet is a key factor that we can change to help prevent it. This study explores the association between adherence to the EAT-Lancet diet and cancer incidence and mortality.

METHODS: A systematic search was conducted across PubMed, Web of Science, Embase, and the Cochrane Library for cohort studies published from January 2019 to September 2025. In the primary analyses, we pooled adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the association between EAT-Lancet diet adherence scores and cancer outcomes, prioritizing linear score-increment estimates and using categorical adherence contrasts only when linear estimates were unavailable. Subgroup analyses were performed by cancer type and adherence level; adherence-level subgroup analyses used categorical contrasts reported in the original studies. Sensitivity analysis and publication-bias assessment were conducted.

RESULTS: A total of 15 cohort studies were included. In the primary analyses, higher EAT-Lancet diet adherence scores were linearly associated with lower overall cancer incidence and overall cancer mortality (incidence: HR = 0.90, 95% CI: 0.84-0.95, P<0.001; mortality: HR = 0.92, 95% CI: 0.90-0.95, P<0.001). The clearest site-specific associations were observed for lung cancer incidence (HR = 0.93, 95% CI: 0.90-0.95, P<0.001) and lung cancer mortality (HR = 0.94, 95% CI: 0.90-0.97, P<0.001). No statistically significant associations were observed for breast, prostate, or colorectal cancer incidence (P>0.05).

CONCLUSION: Higher EAT-Lancet diet adherence scores may be associated with lower overall cancer incidence and mortality, with the clearest association observed for lung cancer. These findings should be interpreted cautiously because of heterogeneity, residual confounding, and differences in adherence assessment across cohorts.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251141170.

PMID:42306796 | PMC:PMC13265285 | DOI:10.3389/fonc.2026.1823812

Data Brief. 2026 May 29;67:112898. doi: 10.1016/j.dib.2026.112898. eCollection 2026 Aug.

ABSTRACT

The rapid growth of Vietnam’s transport sector presents challenges for sustainable energy and transport planning, particularly due to rising fuel consumption and associated carbon emissions. To help address these challenges, this paper presents a comprehensive dataset designed to support the modelling of future transport demand, energy use, and CO₂ emissions in Vietnam. The dataset covers population, GDP, passenger and freight activity, vehicle stock, energy intensity, load capacity, and CO₂ factors across nine transport modes: motorcycles, cars, buses, light-duty vehicles, heavy-duty vehicles, rail, inland waterways, maritime, and aviation. These are further disaggregated into nine fuel types: petrol, diesel, compressed natural gas, electricity, biofuel, fuel oil, hydrogen, ammonia, and jet fuel. Data were compiled from national statistics, government reports, online databases, academic journals, and media sources. Structured for use with open-source modelling tools, the dataset supports analyses of transport demand and carbon accounting, offering researchers, policymakers, and consultants a resource to evaluate long-term decarbonisation pathways and inform evidence-based policymaking.

PMID:42306784 | PMC:PMC13266183 | DOI:10.1016/j.dib.2026.112898

J Thorac Dis. 2026 May 31;18(5):502. doi: 10.21037/jtd-2026-1-0291. Epub 2026 Apr 30.

ABSTRACT

BACKGROUND: Severe respiratory failure (SRF) is a major cause of intensive care unit (ICU) admission, while multiple organ dysfunction syndrome (MODS) serves as a critical contributor to poor prognosis. This research examined the risk factors for in-hospital MODS in individuals with SRF based on ultrasound and laboratory parameters. A predictive model was constructed via the least absolute shrinkage and selection operator (LASSO)-Cox regression and subsequently validated.

METHODS: Data were collected from individuals with SRF admitted to the ICU of Wuhan Third Hospital between January 1, 2024, and May 31, 2025. LASSO regression was utilized to identify the risk factors for MODS. A Cox proportional hazards model was then established based on the selected variables by LASSO regression. The predictive performance of the models was appraised via the concordance index (C-index). Risk stratification was conducted via X-tile software, and the performance of the stratification system was assessed with the Kaplan-Meier method.

RESULTS: In total, 246 individuals with SRF were enrolled and randomly stratified into a training cohort (n=173) and a validation cohort (n=73) in a 7:3 ratio. Variables selected by LASSO regression, including pH, HCO₃ ^–, respiratory rate, activated partial thromboplastin time, procalcitonin, and inferior vena cava, were included in the Cox model. The model yielded a C-index of 0.793 in the training cohort and 0.748 in the validation cohort. In the training cohort, the area under the curve (AUC) of the predictive model was 0.824 [95% confidence interval (CI): 0.726-0.923] for the 15-day outcome and 0.809 (95% CI: 0.676-0.942) for the 28-day outcome. In the validation cohort, the corresponding AUCs were 0.721 (95% CI: 0.501-0.942) and 0.737 (95% CI: 0.503-0.971). Based on the constructed model, risk stratification was carried out via X-tile software. According to the optimal cutoff value of 118.4, individuals were categorized into high- and low-risk groups. Statistical analysis demonstrated that the risk of MODS was significantly elevated in the high-risk group in comparison to the low-risk group (P<0.05).

CONCLUSIONS: This research constructed and validated a nomogram based on LASSO-Cox regression to predict the MODS risk among individuals with SRF. This nomogram may assist clinicians in identifying individuals at high risk of MODS and tailoring individualized follow-up and treatment strategies based on risk prediction, thereby improving patients’ long-term outcomes.

PMID:42306759 | PMC:PMC13266719 | DOI:10.21037/jtd-2026-1-0291

J Thorac Dis. 2026 May 31;18(5):475. doi: 10.21037/jtd-2025-1-2790. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Atrial functional mitral regurgitation (AFMR) is caused by atrial enlargement and mitral annular dilation due to atrial fibrillation (AF). Although the outcomes of mitral valve surgery in AFMR have been reported, concomitant Maze procedure outcomes in AFMR remain poorly understood. This study aimed to evaluate the clinical and rhythm outcomes of concomitant mitral valve plasty and the Maze procedure in patients with AFMR.

METHODS: We retrospectively analyzed 122 patients who underwent the mitral valve plasty (repair) concomitant with Maze procedure between August 2010 and June 2025. The cohort was divided into an AFMR group (n=50) and a non-AFMR group (n=72). The cumulative incidence of permanent pacemaker (PPM) implantation was analyzed using the Fine-Gray subdistribution hazard model with death as a competing risk. Postoperative rhythm dynamics were evaluated using a continuous-time multi-state Markov model.

RESULTS: The overall cumulative incidence of PPM implantation was significantly higher in the AFMR group than in the non-AFMR group (P<0.001). While early (≤30 days) PPM implantation rates did not differ (P=0.53), the AFMR group showed a higher risk of late (>30 days) PPM implantation (P<0.001). Multivariable analysis identified AFMR as an independent risk factor of late PPM implantation [subdistribution hazard ratios (sHR) 14.963, P=0.02]. Furthermore, the AFMR group demonstrated a higher rate of postoperative junctional rhythm compared to the non-AFMR group.

CONCLUSIONS: AFMR was not associated with a statistically significant difference in overall survival and the incidence of major adverse cardiovascular events following the Maze procedure compared to the non-AFMR group. However, AFMR was associated with a higher risk of transition to junctional rhythm following the Maze procedure, which was associated with an increased rate of PPM implantation. Notably, the risk of pacemaker implantation was predominantly late-onset, which may be due to a progressive decline in sinus node function. Therefore, close long-term rhythm monitoring and follow-up are warranted.

PMID:42306743 | PMC:PMC13266807 | DOI:10.21037/jtd-2025-1-2790

J Thorac Dis. 2026 May 31;18(5):512. doi: 10.21037/jtd-2025-1-2719. Epub 2026 Apr 26.

ABSTRACT

BACKGROUND: The optimal timing of thoracic radiotherapy (RT) during concurrent chemoradiotherapy (CCRT) for small cell lung cancer (SCLC) remains controversial. This study aimed to evaluate treatment outcomes, prognostic factors, and the role of prophylactic cranial irradiation (PCI) according to thoracic RT timing in patients with limited-disease (LD) SCLC.

METHODS: A retrospective study was conducted on patients with SCLC diagnosed between 2018 and 2022. Survival outcomes, prognostic factors, treatment outcomes, and adverse events were assessed according to thoracic RT timing (early vs. late) and PCI use.

RESULTS: Among 122 patients diagnosed with LD-SCLC, 99 who received CCRT were included in the analysis, comprising 74 patients in the early thoracic RT (ERT) and 25 in the late thoracic RT (LRT) group. After propensity score matching (PSM) based on RT timing, Kaplan-Meier survival analysis demonstrated that the ERT group had significantly longer median overall survival (OS) (20.0 vs. 12.0 months, P=0.041) and progression-free survival (PFS) (16.0 vs. 8.0 months, P=0.01) than the LRT group, whereas brain metastasis-free survival (BMFS) did not differ significantly (P=0.32). Following PSM according to PCI status, OS and PFS were comparable between groups; however, BMFS was significantly longer in the PCI group (P=0.048). In multivariate Cox analysis, both age and thoracic RT timing remained significant prognostic factors for OS and PFS. No statistically significant differences were observed in treatment response or treatment-related adverse events between groups.

CONCLUSIONS: In patients with LD-SCLC treated with CCRT, ERT was associated with improved survival without a significant increase in treatment-related toxicity. Although PCI did not confer a clear survival benefit, it may reduce the risk of brain metastasis.

PMID:42306720 | PMC:PMC13266864 | DOI:10.21037/jtd-2025-1-2719

J Thorac Dis. 2026 May 31;18(5):467. doi: 10.21037/jtd-2026-0500. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Pulmonary rehabilitation plays a crucial role in lung cancer patients after surgery. In this context, traditional Chinese exercises (TCEs) are being increasingly utilized. However, the existing studies are characterized by small sample sizes, inconsistent interventions, and diverse outcome measures, which result in high heterogeneity and limited clinical applicability. This meta-analysis systematically assessed the impacts of two common TCEs on postoperative lung cancer patients, aiming to provide a basis for evidence-based rehabilitation strategies.

METHODS: A systematic search of nine electronic databases was conducted for randomized controlled trials (RCTs) from inception to November 3, 2025. After independent screening, data extraction, and risk-of-bias assessment, meta-analysis was performed.

RESULTS: Twenty-five RCTs involving 1,834 participants were included. The meta-analysis demonstrated that TCE significantly improved pulmonary function outcomes, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and FEV1% predicted. Additionally, TCE increased the 6-minute walk distance (6MWD) and quality of life (QoL) score. Regarding psychological outcomes, TCE significantly alleviated symptoms of anxiety. TCE showed no statistically significant effect on postoperative fatigue, Borg dyspnea scores and depression in lung cancer patients. Subgroup analyses suggested that timing of intervention initiation and settings may account for the observed heterogeneity in respiratory function outcomes. Furthermore, subgroup showed that Liuzijue was more effective than Baduanjin in improving FEV1/FVC (mean difference: 4.88 vs. 2.71), while Baduanjin was more effective than Liuzijue in alleviating anxiety (mean difference: -7.45 vs. -2.20).

CONCLUSIONS: TCE appears to be a beneficial intervention for enhancing pulmonary function, QoL, and mental health in postoperative lung cancer patients. However, further-quality studies are warranted to confirm the robustness of these findings due to limitations in certain outcome measures.

PMID:42306719 | PMC:PMC13266663 | DOI:10.21037/jtd-2026-0500

J Thorac Dis. 2026 May 31;18(5):490. doi: 10.21037/jtd-2026-1-0358. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Concomitant mitral valve surgery and coronary artery bypass grafting (CABG) remains the standard treatment for patients with severe mitral valve disease complicated by coronary artery disease. However, this combined procedure is associated with substantial perioperative risk. While off-pump or on-pump beating heart CABG may reduce aortic cross-clamp and cardiopulmonary bypass times compared with conventional on-pump arrested-heart CABG, evidence comparing these surgical strategies in combined mitral valve and CABG surgery remains limited. Therefore, this study aimed to evaluate the short-term outcomes of mitral valve surgery combined with on-pump arrested-heart CABG versus off-pump or on-pump beating heart CABG.

METHODS: A total of 473 patients who underwent concomitant CABG and mitral valve surgery were retrospectively analyzed. Among these patients, 368 patients underwent on-pump arrested-heart CABG (ONCABG group) and 105 patients underwent off-pump or on-pump beating heart CABG (BHCABG group). Covariate balancing propensity score (CBPS) and inverse probability of treatment weighting (IPTW) was utilized to reduce bias. The primary endpoints were in-hospital mortality and major perioperative complications.

RESULTS: After CBPS and IPTW adjustment, the BHCABG group demonstrated significantly shorter aortic cross-clamp times [ratio =0.765; 95% confidence interval (CI): 0.695-0.843; P<0.001] compared with the ONCABG group, lower peak high-sensitivity cardiac troponin I (hsTnI) levels (P=0.01) and serum creatinine levels (P<0.001). Notably, the risk of new-onset stroke was significantly reduced in the BHCABG group [odds ratio (OR) =0.063; 95% CI: 0.008-0.490; P=0.008]. No statistically significant differences were observed in operative time, mechanical ventilation duration, or in-hospital mortality between the two groups.

CONCLUSIONS: In patients undergoing combined mitral valve surgery and surgical coronary revascularization, off-pump revascularization or on-pump beating heart strategy is associated with attenuated myocardial injury, renal injury and a lower risk of postoperative stroke compared with the conventional on-pump technique.

PMID:42306714 | PMC:PMC13266873 | DOI:10.21037/jtd-2026-1-0358

J Thorac Dis. 2026 May 31;18(5):465. doi: 10.21037/jtd-2026-1-0220. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Severity assessment of human immunodeficiency virus (HIV)-associated Pneumocystis jirovecii pneumonia (PJP) is clinically important because arterial blood gas indices are standard but may not fully capture the heterogeneity of lung involvement on chest computed tomography (CT). We aimed to develop and internally validate a CT radiomics model for classifying severity in adults with confirmed HIV-associated PJP.

METHODS: This retrospective single-center study included 96 adult patients with confirmed HIV-associated PJP who underwent chest CT at presentation. Disease severity was classified as mild or moderate-to-severe according to room-air arterial blood gas criteria, with moderate-to-severe disease defined as arterial partial pressure of oxygen (PaO₂) <70 mmHg or an alveolar-arterial oxygen gradient (A-aDO₂) ≥35 mmHg. Clinical variables were retrospectively collected from medical records. Patients were randomly divided into training and test cohorts at a ratio of 7:3. Radiomics features were extracted from the bilateral lung parenchyma. After least absolute shrinkage and selection operator regression, features with non-zero coefficients were included in the final radiomics model. In parallel, a clinical logistic model incorporating serum lactate dehydrogenase, β-D-glucan, and CD4 count was developed in the training cohort and tested in the test cohort. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs), calibration analysis, decision curve analysis, and pairwise DeLong test comparisons.

RESULTS: Of the 96 patients, 38 were classified as mild and 58 as moderate-to-severe. Patients with moderate-to-severe disease had a higher frequency of dyspnea, higher levels of inflammatory markers, and lower CD4 count. The final radiomics model included 10 features. In the training cohort, the radiomics model achieved an AUC of 0.92 (95% CI: 0.85-0.97), compared with 0.65 (95% CI: 0.51-0.78) for the clinical logistic model. In the test cohort, the radiomics model showed a numerically higher AUC of 0.89 (95% CI: 0.72-1.00), followed by the clinical logistic model at 0.84 (95% CI: 0.68-0.97). Using their respective classification thresholds, the radiomics model yielded a sensitivity of 0.778 (95% CI: 0.548-0.910) and a specificity of 0.818 (95% CI: 0.523-0.949) in the test cohort, while the clinical logistic model yielded a sensitivity of 0.722 (95% CI: 0.491-0.875) and a specificity of 0.909 (95% CI: 0.623-0.984). Pairwise DeLong tests in the test cohort showed no statistically significant difference between the radiomics model and the clinical logistic model.

CONCLUSIONS: In this small single-center study, the CT radiomics model showed promising discrimination for severity classification in HIV-associated PJP, but these findings are preliminary and require external multicenter validation before clinical use.

PMID:42306699 | PMC:PMC13266726 | DOI:10.21037/jtd-2026-1-0220

J Thorac Dis. 2026 May 31;18(5):464. doi: 10.21037/jtd-2025-1870. Epub 2026 Apr 30.

ABSTRACT

BACKGROUND: Pulmonary nodules and masses (PNMs) are closely associated with lung cancer, for which early and accurate diagnosis is essential. However, current diagnostic methods have inherent limitations and may produce false-positive or false-negative results, thereby complicating clinical decision-making. Diffusion-weighted imaging (DWI) has emerged as a promising tool for distinguishing benign lesions from malignant lesions, although the combined diagnostic value of lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) remains underexplored. This study aimed to evaluate the diagnostic value of LSR and ADC in distinguishing benign PNMs from malignant PNMs.

METHODS: Multi-b-value DWI, commonly used for intravoxel incoherent motion (IVIM) acquisition, was retrospectively performed in patients with PNMs. Lesions were classified based on histopathological findings or clinical follow-up. ADC values were calculated from multi-b-value DWI data using a monoexponential fit, and LSR values were measured from DWI images at selected b-values. Independent-samples t-test was employed to assess statistical differences between the benign and malignant groups. Receiver operating characteristic curve analysis was conducted to determine the optimal cutoff values using the maximal Youden index and to evaluate the diagnostic performance of each parameter.

RESULTS: Among 56 lesions, 34 were benign and 22 were malignant. Malignant lesions exhibited significantly lower ADC values and higher LSR values compared with benign lesions (P<0.05). The area under the curve (AUC) for ADC was generally higher than that for LSR (P<0.05). Among ADC parameters, the maximum ADC value had the highest AUC [0.759, 95% confidence interval (CI): 0.631-0.887], with a sensitivity of 0.636 (95% CI: 0.407-0.828), a specificity of 0.824 (95% CI: 0.655-0.932), and a diagnostic threshold of 1.265×10^-3 mm²/s. Among the LSR parameters, LSR at b=500 s/mm² had the highest AUC (0.682, 95% CI: 0.530-0.834), with a sensitivity of 0.591 and a specificity of 0.794. The combination of ADC and LSR outperformed either parameter alone, achieving an AUC of 0.787 (95% CI: 0.658-0.885), a sensitivity of 0.909 (95% CI: 0.708-0.989), and a specificity of 0.559 (95% CI: 0.379-0.728).

CONCLUSIONS: Both ADC and LSR provide valuable diagnostic information for distinguishing benign PNMs from malignant PNMs. Integrating ADC and LSR further enhances diagnostic accuracy, supporting their combined application as a non-invasive, complementary imaging biomarker in clinical evaluation of PNMs.

PMID:42306682 | PMC:PMC13266818 | DOI:10.21037/jtd-2025-1870