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Abstract: Background: This study aimed to determine the national incidence, characterize clinical features, and evaluate the treatment outcomes of primary vitreoretinal lymphoma (PVRL) in Slovenia. Methods: We conducted a population-based, retrospective case series of all patients diagnosed with PVRL at the Eye Hospital, University Medical Center Ljubljana, between January 2013 and May 2024. The diagnosis was histopathologically confirmed, and primary central nervous system involvement was excluded. Clinical presentation, diagnostic delay, treatment modality, and adverse events were analyzed. Progression-free survival (PFS), overall survival (OS), and lymphoma-specific survival (LSS) were calculated. Results: Twelve patients were diagnosed with PVRL (four men, eight women; median age of 76 years). The average annual incidence was 0.52 cases per million. The median time from symptom onset to diagnosis was 238 days. The two most common symptoms were decreased visual acuity (75%) and floaters (58%). Vitreous cellular infiltration was the predominant clinical sign and was observed in 92% of patients. Five patients presented with unilateral disease, seven with bilateral disease, and three with unilateral disease that progressed to bilateral involvement. The median follow-up was 31.5 months. Eleven patients received one or more treatment modalities: intravitreal rituximab and/or methotrexate, local radiotherapy, and/or systemic chemotherapy. Local remission was achieved in all treated eyes. Two cases of granulomatous uveitis occurred during intravitreal rituximab therapy. The median PFS was 12 months; the two- and three-year PFS rates were 37.5% and 18.8%, respectively. The median OS was not reached; the two- and three-year OS rates were 70% and 56%, respectively. The LSS was 80% at two years and 64% at three years. Conclusions: This Slovenian population-based study provides real-world insights into PVRL management. In elderly and medically fragile patients, local treatment modalities provided effective ocular disease control with acceptable toxicity.
Keywords: methotrexate, population-based study, primary vitreoretinal lymphoma, radiotherapy, survival analysis
Published in DiRROS: 24.04.2026; Views: 168; Downloads: 112
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Abstract: Background: The aim of this nation-wide 2009-2021 cohort study was to analyze postoperative survival of patients with resected appendicular skeletal metastases and endoprosthetic reconstruction in comparison to sarcoma patients and non-oncological reconstructions. Patients and methods: A single institution nation-wide cohort of 144 consecutive patients with tumor endoprosthetic reconstructions (32 resected metastases, 73 resected sarcomas, 39 non-oncological) were stratified into histopathological groups according to the 2013-SPRING prediction model. Their survival was analyzed with the Kaplan-Meier method and Cox regression. Results: The observed patient survival rates after wide resection of fast/moderate/slow growing metastases were 25/55/88% at 2 years and 10/30/83% at 5 years, while in sarcomas the observed survival rates were 80% at 2 years and 69% at 5 years. Estimated mean postoperative survival after resection of skeletal metastases was significantly shorter in comparison to sarcomas (4.6 years vs. 9.1 years, log-rank p < 0.001). Predictors of worse patient survival included higher age, pathologic fracture or >1 metastasis, diagnostic group fast-growing metastases and higher preoperative C-reactive protein (CRP). Conclusions: Wide resection and endoprosthetic reconstruction offer a reliable solution in selected patients with skeletal metastases. Higher age, fast-growing metastases (from bladder cancer, colorectal, hepatocellular, lung cancer, malignant melanoma, unknown origin), pathologic fracture or >1 metastasis and elevated CRP predict shorter patient survival and may represent a relative contraindication in this regard.
Keywords: skeletal metastases, wide resection, endoprosthetic reconstruction, patient survival
Published in DiRROS: 29.01.2026; Views: 342; Downloads: 245
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Abstract: Background: Short-term gastric cancer surgery outcomes depend greatly on hospital surgical volume, whereas long-term survival studies show conflicting results. This study evaluated the effect of surgical volume on the long-term survival of patients who underwent surgery for gastric cancer in Slovenia. Methods: A retrospective cohort analysis was performed using the Slovenian Cancer Registry data. Patients diagnosed between 2016 and 2020 who underwent gastric cancer surgery were categorized into high- and low-volume centers. High-volume centers were defined, as the two University Medical Centers (Ljubljana and Maribor), which together treated 76.4 % of all patients during the study period. Survival analysis was conducted using Kaplan-Meier overall survival and Pohar-Perme net survival estimators, with predefined subgroup analysis. Cox proportional hazards models assessed the independent association between center volume and overall survival. Results: Among the 652 patients, 498 (76.4 %) underwent surgery at high-volume centers (44,2-55,4 mean surgeries/year), which demonstrated higher median overall survival (4.9 vs. 3.2 years) and improved overall and net 1-, 3-, and 5-year survival rates compared with low-volume centers (0,2-6,2 mean surgeries/year). This differences persisted in stratified analyses by stage and neoadjuvant therapy but not by age. In multivariable Cox analysis the hazard ratio remained directionally favorable for high-volume centers but was not statistically significant. Conclusions: Overall, high-volume centers were consistently associated with better long-term survival after gastric cancer surgery in Slovenia, supporting further evaluation of centralization strategies. Future policies should aim to balance the benefits of centralization while maintaining equitable access to timely and high-quality surgical treatment, regardless of location or socioeconomic status.
Keywords: gastric cancer, survival, survival analysis, surgical oncology, centralized hospital services
Published in DiRROS: 07.01.2026; Views: 462; Downloads: 315
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Abstract: A considerable proportion of metastatic melanoma (mM) patients do not respond to immune checkpoint inhibitors (ICIs). There is a great need to develop noninvasive biomarkers to detect patients, who do not respond to ICIs early during the course of treatment. The aim of this study was to evaluate the role of early [18F]2fluoro- 2-deoxy-D-glucose PET/CT (18F-FDG PET/CT) at week four (W4) and other possible prognostic biomarkers of survival in mM patients receiving ICIs. Patients and methods. In this prospective noninterventional clinical study, mM patients receiving ICIs regularly underwent 18F-FDG PET/CT: at baseline, at W4 after ICI initiation, at week sixteen and every 16 weeks thereafter. The tumor response to ICIs at W4 was assessed via modified European Organisation for Research and Treatment of Cancer (EORTC) criteria. Patients with progressive metabolic disease (PMD) were classified into the no clinical benefit group (no-CB), and those with other response types were classified into the clinical benefit group (CB). The primary end point was survival analysis on the basis of the W4 18F-FDG PET/CT response. The secondary endpoints were survival analysis on the basis of LDH, the number of metastatic localizations, and immune-related adverse events (irAEs). Kaplan-Meier analysis and univariate Cox regression analysis were used to assess the impact on survival. Results. Overall, 71 patients were included. The median follow-up was 37.1 months (95% CI = 30.1–38.0). Three (4%) patients had only baseline scans due to rapid disease progression and death prior to W4 18F-FDG-PET/CT. Fifty-one (72%) patients were classified into the CB group, and 17 (24%) were classified into the no-CB group. There was a statistically significant difference in median overall survival (OS) between the CB group (median OS not reached [NR]; 95% CI = 17.8 months – NR) and the no-CB group (median OS 6.2 months; 95% CI = 4.6 months – NR; p = 0.003). Univariate Cox analysis showed HR of 0.4 (95% CI = 0.18 – 0.72; p = 0.004). median OS was also significantly longer in the group with normal serum LDH levels and the group with irAEs and cutaneous irAEs. Conclusions. Evaluation of mM patients with early 18F-FDG-PET/CT at W4, who were treated with ICIs, could serve as prognostic imaging biomarkers. Other recognized prognostic biomarkers were the serum LDH level and occurrence of cutaneous irAEs.
Keywords: melanoma, prognostic biomarkers, survival, immunotherapy
Published in DiRROS: 21.11.2025; Views: 490; Downloads: 193
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Abstract: Primary Coenzyme Q10 (CoQ(10)) deficiency is an ultra-rare disorder caused by defects in genes involved in CoQ(10) biosynthesis leading to multidrug-resistant nephrotic syndrome as the hallmark kidney manifestation. Promising early results have been reported anecdotally with oral CoQ(10) supplementation. However, the long-term efficacy and optimal prescription remain to be established. In a global effort, we collected and analyzed information from 116 patients who received CoQ(10) supplements for primary CoQ(10) deficiency due to biallelic pathogenic variants in either the COQ2, COQ6 or COQ8B genes. Median duration of follow up on treatment was two years. The effect of treatment on proteinuria was assessed, and kidney survival was analyzed in 41 patients younger than 18 years with chronic kidney disease stage 1-4 at the start of treatment compared with that of an untreated cohort matched by genotype, age, kidney function, and proteinuria. CoQ(10) supplementation was associated with a substantial and significant sustained reduction of proteinuria by 88% at 12 months. Complete remission of proteinuria was more frequently observed in COQ6 disease. CoQ(10) supplementation led to significantly better preservation of kidney function (5-year kidney failure-free survival 62% vs. 19%) with an improvement in general condition and neurological manifestations. Side effects of treatment were uncommon and mild. Thus, our findings indicate that all patients diagnosed with primary CoQ(10) deficiency should receive early and life-long CoQ(10) supplementation to decelerate the progression of kidney disease and prevent further damage to other organs.
Keywords: coenzyme Q10, deficiency, supplementation therapy, end-stage kidney disease, ESKD, genetic kidney disease, hereditary, kidney survival, outcome, proteinuria reduction
Published in DiRROS: 21.11.2025; Views: 553; Downloads: 315
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