Startseite Medizin Novel predictive model for colorectal liver metastases recurrence: a radiomics and clinical data approach
Artikel Open Access

Novel predictive model for colorectal liver metastases recurrence: a radiomics and clinical data approach

  • Hui Yuan ORCID logo , Rengui Wang ORCID logo EMAIL logo und Yunlong Yue ORCID logo EMAIL logo
Veröffentlicht/Copyright: 17. Dezember 2025

Abstract

Objectives

This study aims to develop and validate a novel predictive model combining clinical features and CT radiomics to forecast recurrence in CRLM patients.

Methods

Data from 181 patients were sourced from The Cancer Imaging Archive. Lasso regression identified 15 clinical and 5 radiomic features as significant predictors. Logistic regression models were developed for clinical, radiomic, and combined datasets. Model performance was evaluated using ROC curves, calibration plots, and DCA.

Results

The combined model demonstrated superior predictive accuracy with an Area Under the Curve of 0.818 in the training set and 0.742 in the testing set. Calibration plots showed a high degree of accuracy, with predicted probabilities closely matching observed outcomes. DCA indicated that the combined model provided the highest net benefit across various threshold probabilities. Risk stratification revealed distinct cumulative recurrence rates at 2 and 5 years, validating the model’s ability to effectively classify patients into low, intermediate, and high-risk categories.

Conclusions

This study presents a novel predictive model that integrates clinical and radiomic features to enhance recurrence prediction in CRLM patients, offering significant potential for improving clinical outcomes and optimizing CRLM management.

Introduction

Colorectal cancer (CRC) is a major global health concern, ranking as the second most commonly diagnosed cancer and the second leading cause of cancer-related deaths worldwide [1]. A significant proportion of CRC patients develop liver metastases, which are a primary determinant of prognosis and survival [2]. The management of colorectal liver metastases (CRLM) remains challenging due to the heterogeneous nature of the disease and the complexity of treatment options [3]. Surgical resection, chemotherapy, and targeted therapies have improved survival rates, but recurrence remains a substantial issue, affecting long-term outcomes and quality of life for patients [4], 5].

Accurate prediction of recurrence in CRLM patients is crucial for optimizing treatment strategies and improving outcomes [6]. Traditionally, clinical features such as age, sex, comorbidities, and tumor characteristics have been used to predict recurrence risk. These factors provide essential insights into patient prognosis but often lack the precision needed for individualized treatment planning [7]. Clinical factors, while valuable, cannot fully capture the biological diversity and dynamic behavior of metastatic tumors [8].

Recent advancements in imaging technologies and computational analysis have introduced radiomics as a powerful tool for enhancing predictive models [9], 10]. Radiomics involves the extraction of high-dimensional quantitative features from medical images, providing a more comprehensive characterization of tumor phenotype [11]. By converting images into mineable data, radiomics can uncover patterns and features that are not visible to the naked eye [12]. This approach allows for the assessment of tumor heterogeneity, shape, texture, and other characteristics that may be critical for predicting treatment response and disease progression [13].

The integration of radiomic features with clinical data holds promise for developing more robust predictive models. Radiomics can complement traditional clinical variables by providing additional layers of information about the tumor environment [14]. This integrated approach has the potential to improve the accuracy of recurrence predictions, leading to better-tailored treatment strategies and ultimately enhancing patient outcomes. However, the practical application of such integrated models has been limited by the lack of standardized methodologies and insufficient validation in diverse patient populations. Additionally, the optimal way to combine and weigh clinical and radiomic features to maximize predictive accuracy remains an open question, highlighting the need for further research in this area.

In this study, we aim to develop and validate a predictive model that combines clinical features and CT radiomics to accurately predict recurrence in CRLM patients. By integrating these diverse data sources, we sought to leverage the complementary strengths of clinical and radiomic features to improve predictive accuracy and clinical utility. The finding of our study may pave the way for more precise and effective management strategies for CRLM patients.

Materials and methods

Data acquisition

Data were sourced from The Cancer Imaging Archive (TCIA), specifically focusing on patients diagnosed with CRLM. The selection criteria included patients with complete contrast-enhanced CT images and comprehensive clinical data, such as demographic details, comorbidities, and treatment history. From the available datasets, 181 cases met the inclusion criteria, providing a robust foundation for subsequent analysis. The clinical data encompassed critical factors relevant to disease prognosis, including age, gender, smoking status, and presence of diabetes, among others. Exclusion criteria included patients with incomplete clinical data, poor-quality CT images, or missing follow-up information.

Image preprocessing and ROI segmentation

The preprocessing of CT images and subsequent region of interest (ROI) segmentation were performed using the 3D Slicer software, a versatile tool for medical image analysis [15]. Experienced radiologists manually delineated the ROIs for each metastatic lesion, ensuring precise segmentation. The delineation process involved tracing the tumor boundaries slice by slice, creating a comprehensive three-dimensional model of the lesion. This meticulous approach was essential for accurate feature extraction, capturing the tumor’s morphological and textural characteristics.

Radiomic feature extraction

The radiomic feature extraction was facilitated by the SlicerRadiomics extension [16]. Once the ROIs were established, a detailed set of radiomic features was extracted. The extraction process included resampling the images to a uniform voxel size of 3 × 3 × 3 mm, standardizing the data across all samples. A total of 1,316 radiomic features were initially extracted from each ROI, encompassing first-order statistics, shape, texture, and wavelet-transformed features. Specific features of interest, such as flatness, maximum 2D diameter, Imc1, small dependence high gray level emphasis, and low gray level zone emphasis, were extracted to capture the heterogeneity of the tumors. These features provided a quantitative description of the tumor’s texture, shape, and intensity, which are crucial for predicting clinical outcomes.

Clinical data collection

The clinical data were meticulously collected and included variables that are known to influence the prognosis of CRLM patients. Key variables comprised patient age, sex, major comorbidities like diabetes and cardiovascular diseases, body mass index (BMI), presence of synchronous CRLM, number and size of metastatic lesions, bilobar involvement, and the presence of extrahepatic disease. Additionally, treatment history details, such as the administration of preoperative chemotherapy, preoperative portal vein embolization, and prior liver resections, were documented. Histopathological features, including the presence of steatosis, sinusoidal dilation, Non-Alcoholic Steatohepatitis (NASH) grading, and lymph node involvement, were also recorded.

Data splitting and feature selection

The dataset was randomly split into a training set and a testing set in an 8:2 ratio, ensuring a reliable basis for model training and validation [17]. Feature selection was conducted using LASSO (Least Absolute Shrinkage and Selection Operator) regression, a technique that applies a penalty to the size of the coefficients, thus performing both variable selection and regularization [18]. This method is particularly effective in high-dimensional settings, such as radiomic feature analysis. Cross-validation was employed to identify the optimal lambda parameter, with the lambda_min value, which minimizes the prediction error, being selected for model construction. This process ensured that only the most relevant features were included in the final models, reducing the risk of overfitting.

Model development

Three predictive models were developed: one based solely on clinical features, another on radiomic features, and a combined model incorporating both clinical and radiomic data. Logistic regression was employed for model development, with each model being trained on the training dataset. The coefficients for each feature in the models were estimated based on their predictive power, allowing for the quantification of each feature’s contribution to the risk of recurrence. The combined model aimed to leverage the complementary strengths of clinical and radiomic data to provide a more comprehensive prediction. Prior to model fitting, collinearity among predictors was assessed using the variance inflation factor (VIF), and no significant multicollinearity was observed (VIF<5 for all variables).

Model validation

The models were validated using the testing set, which was not involved in the training process. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, with the Area Under the Curve (AUC) serving as a metric for discriminative ability. Calibration curves were also plotted to assess the agreement between predicted probabilities and observed outcomes, providing insight into the accuracy of the predictions. Furthermore, Decision Curve Analysis (DCA) was conducted to evaluate the clinical utility of the models, assessing the net benefit across various threshold probabilities [19]. This analysis helped determine the practical application of the models in clinical decision-making, highlighting the scenarios where the combined model offered significant advantages over models using only clinical or radiomic data. Additionally, to ensure the robustness and generalizability of the predictive model, a 10-fold cross-validation was performed on the training set. This approach minimizes bias due to data partitioning and provides a more stable estimate of model performance.

Statistical analysis

Descriptive statistics were generated for all clinical and radiomic features, with continuous variables summarized as means and standard deviations, and categorical variables as frequencies and percentages. The normality of continuous variables was assessed using the Shapiro–Wilk test. Normally distributed variables were presented as mean±standard deviation and compared using the independent-sample t-test, whereas non-normally distributed variables were summarized as median (IQR) and compared using the Mann–Whitney U test. Categorical variables were compared using the chi-square test or Fisher’s exact test when the expected frequency in any cell was less than 5. LASSO regression was utilized for feature selection and regularization, leveraging cross-validation to determine the optimal lambda value that minimized prediction error. The selected lambda_min ensured the models were both predictive and parsimonious. Model performance was assessed using ROC curves and the corresponding AUC values, with AUC providing a measure of the model’s ability to discriminate between patients with and without recurrence. Calibration curves were plotted to compare predicted probabilities against actual outcomes, thereby assessing the accuracy of the risk predictions. Additionally, DCA was employed to evaluate the net benefit across a range of threshold probabilities, determining the clinical usefulness of the models in decision-making contexts. The models were validated on a testing set to ensure their generalizability and robustness. All analyses were conducted using R software (version 4.3.1). The following R packages were utilized: “glmnet” for LASSO regression, “pROC” for ROC curve analysis, “rms” for calibration plotting, and “rmda” for decision curve analysis. Data visualization was performed using ggplot2. This comprehensive approach ensured that the predictive models were rigorously tested and validated, providing reliable and clinically relevant predictions for colorectal liver metastasis recurrence. Survival analysis was conducted using the Kaplan–Meier method to estimate overall survival. The median survival time was defined as the smallest time point at which the survival probability fell to 0.5 (50 %) or below. The log-rank test was applied to assess differences between groups.

Ethical statement

Not applicable.

Results

Descriptive statistics

The study included 181 patients with CRLM, divided into recurrence (n=118) and non-recurrence (n=63) groups. Key findings are summarized in Table 1. The mean age was similar between the groups, with no significant difference in sex distribution (p>0.05). The recurrence group had a significantly larger maximum tumor size (3.8±2.6 cm vs. 2.9±2.4 cm, p=0.011) and a higher prevalence of bilobar disease (50 vs. 33 %, p=0.042). A greater proportion of patients in the recurrence group received chemotherapy before liver resection (69 vs. 52 %, p=0.036). Although the presence of major comorbidities, synchronous CRLM, and multiple metastases was higher in the recurrence group, these differences were not statistically significant (p>0.05). Importantly, overall survival was significantly shorter in the recurrence group (56.8±34.3 months vs. 86.8±28.8 months, p<0.001). Kaplan–Meier survival analysis further demonstrated a significant difference in overall survival between the two groups (log-rank p<0.0001). The median overall survival was 58 months in the recurrence group, while it was not reached in the non-recurrence group during the follow-up period (Figure 1). These findings underscore the impact of tumor characteristics and treatment history on patient outcomes, highlighting key factors associated with disease recurrence.

Table 1:

Baseline patient characteristics.

Characteristics Recurrence (n=118) Non-recurrence (n=63) p-Value
Age, years 60.1±12.3 60.6±12.0 0.206
Sex, male 57 % 62 % 0.622
BMI 26.9±4.7 27.8±5.2 0.122
Major comorbidity 53 % 67 % 0.097
Synchronous crlm 53 % 62 % 0.315
Multiple metastases 62 % 52 % 0.253
Node positive primary 36 % 35 % 0.999
Carcinoembryonic antigen, ng/mL 31.0 (8.7–72.3) 38.1 (10.4–81.6) 0.927
Max tumor size, cm 3.8±2.6 2.9±2.4 0.011
Bilobar disease 50 % 33 % 0.042
Extrahep disease 11 % 3 % 0.113
Chemo before liver resection 69 % 52 % 0.036
Preoperative pve 15 % 8 % 0.264
Presence sinusoidal dilata 15 % 11 % 0.603
Steatosis yesno 30 % 43 % 0.112
NASH greater 4 3 % 3 % 0.999
Necrosis percent 0.32±0.24 0.30±0.24 0.889
Fibrosis percent 0.17±0.16 0.21±0.26 0.367
Overall survival, months 56.8±34.3 86.8±28.8 < 0.001
  1. NASH, non-alcoholic steatohepatitis.

Figure 1: 
Kaplan–Meier survival curves for overall survival in patients with colorectal liver metastases (CRLM).
Figure 1:

Kaplan–Meier survival curves for overall survival in patients with colorectal liver metastases (CRLM).

Feature selection and model construction

Using LASSO regression, 15 clinical and 5 radiomic features were identified as significant predictors of recurrence. The clinical features included factors such as age, sex, major comorbidities, BMI, synchronous CRLM, the number of metastases, maximum tumor size, bilobar involvement, extrahepatic disease, history of preoperative chemotherapy, preoperative portal vein embolization, presence of steatosis, sinusoidal dilation, NASH grading, and lymph node involvement. The radiomic features selected were flatness, maximum 2D diameter, Imc1, small dependence high gray level emphasis, and low gray level zone emphasis. These features were incorporated into three distinct logistic regression models: the clinical model, the radiomic model, and a combined model that utilized both clinical and radiomic features (Figure 2). For each model, the odds ratios (ORs) with 95 % confidence intervals (CIs) for active predictors were calculated. In the combined model, significant predictors included maximum tumor size (OR=1.42, 95 % CI: 1.09–1.86, p=0.011), bilobar disease (OR=1.76, 95 % CI: 1.08–2.87, p=0.023), and preoperative chemotherapy (OR=1.68, 95 % CI: 1.02–2.76, p=0.039).

Figure 2: 
LASSO regression feature selection and model construction. (A) The plot shows the binomial deviance as a function of log(λ) for the clinical features, with the optimal λ selected based on the minimum binomial deviance. (B) The coefficient path for the clinical features during the Lasso regression process, demonstrating how coefficients shrink to zero as the penalty increases. (C) Similar to 1A, this plot shows the binomial deviance for the radiomic features, with the optimal λ indicated. (D) The coefficient path for the radiomic features, showing the selection process and the impact of increasing λ.
Figure 2:

LASSO regression feature selection and model construction. (A) The plot shows the binomial deviance as a function of log(λ) for the clinical features, with the optimal λ selected based on the minimum binomial deviance. (B) The coefficient path for the clinical features during the Lasso regression process, demonstrating how coefficients shrink to zero as the penalty increases. (C) Similar to 1A, this plot shows the binomial deviance for the radiomic features, with the optimal λ indicated. (D) The coefficient path for the radiomic features, showing the selection process and the impact of increasing λ.

Model performance

The performance of the clinical, radiomic, and combined predictive models was evaluated using ROC curves, as illustrated in Figure 3. The clinical model, which relied solely on traditional clinical variables, achieved an AUC of 0.782 (95 % CI: 0.714–0.850) in the training set and 0.630 (95 % CI: 0.522–0.738) in the testing set. This baseline model highlighted the predictive power of established clinical factors. In contrast, the radiomic model, which incorporated advanced imaging features, achieved an AUC of 0.701 (95 % CI: 0.629–0.773) in the training set and 0.706 (95 % CI: 0.597–0.815) in the testing set, demonstrating the value of radiomic features in capturing detailed tumor characteristics not readily apparent in standard clinical assessments. The combined model, which integrated both clinical and radiomic features, outperformed the other two models with an AUC of 0.818 (95 % CI: 0.758–0.878) in the training set and 0.742 (95 % CI: 0.635–0.849) in the testing set.

Figure 3: 
ROC curve analysis for model performance. (A) ROC curves for the training set, showing AUC values for the clinical, radiomic, and combined models. (B) ROC curves for the testing set, showing AUC values for the clinical, radiomic, and combined models. ROC, receiver operating characteristic; AUC, area under the curve.
Figure 3:

ROC curve analysis for model performance. (A) ROC curves for the training set, showing AUC values for the clinical, radiomic, and combined models. (B) ROC curves for the testing set, showing AUC values for the clinical, radiomic, and combined models. ROC, receiver operating characteristic; AUC, area under the curve.

In addition to AUC, other key classification metrics were calculated to provide a more comprehensive evaluation of model performance given the class imbalance (65 vs. 35 %). In the testing set, the combined model achieved a precision of 0.76, recall of 0.72, and F1-score of 0.74, outperforming both the clinical model (precision=0.69, recall=0.66, F1=0.67) and the radiomic model (precision=0.70, recall=0.68, F1=0.69). These results further confirmed the superior generalization and balanced performance of the combined model.

Calibration and decision curve analysis

Calibration curves indicated that the combined model had a high degree of accuracy, as the predicted probabilities closely matched the observed outcomes. The calibration plot demonstrated a strong alignment with the 45-degree line, indicating well-calibrated risk predictions (Figure 4A). DCA further emphasized the clinical utility of the combined model. Across various threshold probabilities, the combined model consistently provided a higher net benefit compared to the clinical and radiomic models alone (Figure 4B). This suggests that the combined model is superior in aiding clinical decision-making, offering a better balance of benefits and harms.

Figure 4: 
Calibration and decision curve analysis. (A) Calibration curve for the combined model, showing the alignment of predicted probabilities with observed outcomes. (B) DCA for clinical, radiomic, and combined models, illustrating the net benefit across various high-risk thresholds. DCA, decision curve analysis.
Figure 4:

Calibration and decision curve analysis. (A) Calibration curve for the combined model, showing the alignment of predicted probabilities with observed outcomes. (B) DCA for clinical, radiomic, and combined models, illustrating the net benefit across various high-risk thresholds. DCA, decision curve analysis.

Risk stratification

The combined model successfully stratified patients into low, intermediate, and high-risk categories based on their predicted probabilities of recurrence. Patients were categorized into these three groups according to tertiles of the predicted recurrence probability derived from the combined model. Patients classified as high-risk showed significantly higher recurrence rates compared to those in the low and intermediate-risk groups. This stratification was validated with distinct cumulative recurrence rates at 2 and 5 years, which were 7.4 and 17.9 % for low-risk, 26.7 and 61.2 % for intermediate-risk, and 73.9 and 100 % for high-risk patients, respectively (Figure 5). This clear differentiation underscores the model’s ability to provide actionable insights for individualized patient management and tailored treatment strategies.

Figure 5: 
Nomogram for recurrence prediction in colorectal liver metastasis (CRLM) patients. The nomogram integrates clinical and radiomic predictors to estimate the probability of recurrence. For each variable, locate the patient’s value and draw a vertical line upward to the “points” axis to assign a score. Sum all points to obtain the “total points,” then locate the corresponding recurrence probability on the “risk” scale at the bottom. Higher total points indicate a higher predicted risk of recurrence.
Figure 5:

Nomogram for recurrence prediction in colorectal liver metastasis (CRLM) patients. The nomogram integrates clinical and radiomic predictors to estimate the probability of recurrence. For each variable, locate the patient’s value and draw a vertical line upward to the “points” axis to assign a score. Sum all points to obtain the “total points,” then locate the corresponding recurrence probability on the “risk” scale at the bottom. Higher total points indicate a higher predicted risk of recurrence.

Discussion

Our study aimed to develop and validate a predictive model combining clinical features and CT radiomics to predict recurrence in CRLM patients. The results demonstrated that the combined model outperformed models based solely on clinical or radiomic features, offering superior predictive accuracy and clinical utility.

The superior performance of the combined model can be attributed to the comprehensive nature of the data it integrates. Clinical features such as age, sex, comorbidities, and tumor characteristics are established predictors of recurrence, reflecting the patient’s overall health and tumor burden [20]. However, these features alone cannot fully capture the biological complexity of CRLM. Radiomics, by extracting high-dimensional quantitative features from CT images, adds an additional layer of information that includes tumor shape, texture, and intensity heterogeneity [21]. These radiomic features likely capture subtle changes in the tumor microenvironment and morphology that are critical for predicting recurrence but are not discernible through traditional clinical assessments alone [22], 23]. Although the combined model exhibited the highest AUC, statistical comparison using the DeLong test revealed that the improvement in AUC compared with the clinical model (p=0.083) and the radiomic model (p=0.067) did not reach statistical significance, indicating a trend toward better discrimination without a significant difference.

The accurate prediction of recurrence is crucial in CRLM management due to the aggressive nature of liver metastases and their impact on patient survival. Early identification of high-risk patients allows for more aggressive treatment strategies, potentially improving outcomes [24], 25]. For instance, patients identified as high-risk could benefit from intensified surveillance, adjuvant chemotherapy, or consideration for novel therapeutic approaches [26]. Conversely, low-risk patients could avoid overtreatment and its associated toxicities, thereby improving their quality of life [27].

Our findings align with and extend the work of previous studies that have explored the predictive power of radiomics in oncology. Studies by Henry et al. [28] and Li et al. [29] have highlighted the potential of radiomics to capture intratumoral heterogeneity and predict clinical outcomes across various cancer types. However, our study uniquely combines radiomic features with comprehensive clinical data, demonstrating that this integrated approach provides a more robust predictive model. The AUC values achieved by our combined model (0.818 in the training set and 0.742 in the testing set) surpass those reported in studies focusing solely on clinical or radiomic data, underscoring the added value of our integrative approach.

The clinical implications of our findings are significant. By providing a reliable tool for recurrence prediction, our model can aid oncologists in making informed decisions about patient management. This could lead to improved survival rates, better resource allocation, and enhanced patient quality of life. Moreover, our study underscores the importance of multidimensional data analysis in oncology, paving the way for future research that integrates various data types to tackle complex clinical challenges [30].

Despite the promising results, our study has several limitations. The retrospective nature of data collection may introduce selection bias. Additionally, the sample size, while sufficient for model development, limits the generalizability of our findings. Future studies should aim to validate our model in larger, prospective cohorts and across different institutions to confirm its robustness and applicability in diverse clinical settings. Another limitation is the reliance on CT imaging alone. While CT is widely available and routinely used in clinical practice, integrating other imaging modalities such as MRI or PET-CT could further enhance the predictive power of the model. Furthermore, advances in artificial intelligence and deep learning could be leveraged to automate feature extraction and improve model accuracy.

In summary, our study presents a novel predictive model that combines clinical and radiomic features to accurately predict recurrence in CRLM patients. This integrated approach not only enhances predictive accuracy but also offers practical clinical utility by stratifying patients into distinct risk categories. Such stratification can guide personalized treatment strategies, ensuring that high-risk patients receive the necessary aggressive interventions while low-risk patients are spared from unnecessary treatments.

Conclusions

This study developed and validated a novel predictive model combining clinical features and CT radiomics to accurately forecast recurrence in CRLM patients. The combined model demonstrated superior predictive accuracy and clinical utility compared to models based solely on clinical or radiomic data. This integrative approach provides a valuable tool for stratifying patients by recurrence risk, facilitating personalized treatment strategies. The findings underscore the potential of combining multidimensional data to enhance predictive modeling in oncology, offering significant clinical implications for improving patient outcomes and optimizing CRLM management. Future research should aim to further validate and refine this model in broader clinical settings.


Corresponding authors: Yunlong Yue and Rengui Wang, Department of Medical Imaging, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China, E-mail: (Y. Yue), (R. Wang).

Acknowledgments

Not applicable.

  1. Funding information: None.

  2. Author contribution: Conceptualization: HY; Methodology: HY; Formal Analysis: HY and RGW; Data curation: HY; Writing – Original Draft: HY; Writing – Review and Editing: RGW and YLY; Project administration: RGW; Investigation: HY; Supervision: RGW and YLY; Software: HY; Visualization: HY; Validation: RGW. All authors given final approval of the version to be published.

  3. Conflict of interest: The authors declare that there are no conflicts of interest regarding the publication of this paper.

  4. Data Availability Statement: Data were sourced from The Cancer Imaging Archive (TCIA), specifically focusing on patients diagnosed with CRLM.

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Received: 2025-04-11
Accepted: 2025-11-03
Published Online: 2025-12-17

© 2025 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

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  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
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  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Suppression of cathepsin B attenuates myocardial injury via limiting cardiomyocyte apoptosis
  156. Influence of sevoflurane combined with propofol anesthesia on the anesthesia effect and adverse reactions in children with acute appendicitis
  157. Identification of hub genes related to acute kidney injury caused by sevoflurane anesthesia and endoplasmic reticulum stress
  158. Efficacy and safety of PD-1/PD-L1 inhibitors in pancreatic ductal adenocarcinoma: a systematic review and Meta-analysis of randomized controlled trials
  159. The value of diagnostic experience in O-RADS MRI score for ovarian-adnexal lesions
  160. Health education pathway for individuals with temporary enterostomies using patient journey mapping
  161. Serum TLR8 as a potential diagnostic biomarker of coronary heart disease
  162. Intraoperative temperature management and its effect on surgical outcomes in elderly patients undergoing lichtenstein unilateral inguinal hernia repair
  163. Immunohistochemical profiling and neuroepithelial heterogeneity in immature ovarian teratomas: a retrospective digital pathology-based study
  164. Associated risk factors and prevalence of human papillomavirus infection among females visiting tertiary care hospital: a cross-sectional study from Nepal
  165. Comparative evaluation of various disc elution methods for the detection of colistin-resistant gram-negative bacteria
  166. Effect of timing of cholecystectomy on weight loss after sleeve gastrectomy in morbidly obese individuals with cholelithiasis: a retrospective cohort study
  167. Causal association between ceramide levels and central precocious puberty: a mendelian randomization study
  168. Novel predictive model for colorectal liver metastases recurrence: a radiomics and clinical data approach
  169. Relationship between resident physicians’ perceived professional value and exposure to violence
  170. Multiple sclerosis and type 1 diabetes: a Mendelian randomization study of European ancestry
  171. Rapid pathogen identification in peritoneal dialysis effluent by MALDI-TOF MS following blood culture enrichment
  172. Comparison of open and percutaneous A1 pulley release in pediatric trigger thumb: a retrospective cohort study
  173. Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery
  174. Development and internal validation of a nomogram for predicting short-term prognosis in ICU patients with acute pyelonephritis
  175. The association between hypoxic burden and blood pressure in patients with obstructive sleep apnea
  176. Promotion of asthenozoospermia by C9orf72 through suppression of spermatogonia activity via fructose metabolism and mitophagy
  177. Review Articles
  178. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  179. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  180. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  181. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  182. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  183. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  184. The application of augmented reality in robotic general surgery: A mini-review
  185. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  186. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  187. Plant polyphenols, terpenes, and terpenoids in oral health
  188. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  189. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  190. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  191. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  192. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  193. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  194. Giant borderline ovarian tumours – review of the literature
  195. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  196. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  197. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  198. Supplement strategies for infertility in overweight women: Evidence and legal insights
  199. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  200. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  201. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  202. Strategies for hyperkalemia management in dialysis patients: A systematic review
  203. C-reactive protein-to-albumin ratio in peripheral artery disease
  204. Research progress on autophagy and its roles in sepsis induced organ injury
  205. Neuronutrition in autism spectrum disorders
  206. Pumilio 2 in neural development, function, and specific neurological disorders
  207. Antibiotic prescribing patterns in general dental practice- a scoping review
  208. Clinical and medico-legal reflections on non-invasive prenatal testing
  209. Smartphone use and back pain: a narrative review of postural pathologies
  210. Targeting endothelial oxidative stress in hypertension
  211. Exploring links between acne and metabolic syndrome: a narrative review
  212. Case Reports
  213. Delayed graft function after renal transplantation
  214. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  215. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  216. Giant right atrial hemangioma presenting with ascites: A case report
  217. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  218. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  219. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  220. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  221. Combined VAT and retroperitoneoscopy for pleural empyema due to nephro-pleuric fistula in xanthogranulomatous pyelonephritis
  222. A rare case of Opalski syndrome with a suspected multiple sclerosis etiology
  223. Newly diagnosed B-cell acute lymphoblastic leukemia demonstrating localized bone marrow infiltration exclusively in the lower extremities
  224. Rapid Communication
  225. Biological properties of valve materials using RGD and EC
  226. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  227. Repeat influenza incidence across two consecutive influenza seasons
  228. Letter to the Editor
  229. Role of enhanced external counterpulsation in long COVID
  230. Expression of Concern
  231. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  232. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  233. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  234. Corrigendum
  235. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  236. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  237. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  238. Retraction
  239. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  240. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  241. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  242. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  243. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  244. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  245. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  246. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  247. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  248. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  249. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  250. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  251. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  252. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  253. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  254. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  255. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  256. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  257. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  258. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  259. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  260. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  261. A review of brain research on T2DM-related cognitive dysfunction
  262. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  263. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  264. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
Heruntergeladen am 4.2.2026 von https://www.degruyterbrill.com/document/doi/10.1515/med-2025-1347/html
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