Siriraj Medical Journal

Clinical Characteristics and Surgical Outcomes of Renal Epithelioid Angiomyolipoma: A Comparison with the Classic Type

Nattaporn Wanvimolkul — 2026-03-01

Objective: To compare clinical characteristics and surgical outcomes between patients with epithelioid angiomyolipoma (EAML) and classic angiomyolipoma (AML), and to identify factors associated with EAML diagnosis.

Materials and Methods: All patients with renal AML who underwent surgery at Siriraj Hospital between January 2013 and December 2024 were reviewed. Clinical features and surgical outcomes were compared between patients with classic AML and those with EAML, and predictors of EAML were evaluated using multivariable analyses.

Results: Among 116 eligible patients, 101 had classic AML and 15 had EAML (12.9%). Most patients were female and were diagnosed in their fifth decade. Demographics, tumor laterality, prevalence of tuberous sclerosis complex gene mutation, and comorbidities did not differ between the 2 groups. Palpable mass (26.7%) and hematuria (13.3%) were more frequent in patients with EAML than in those with classic AML. Most patients with EAML underwent radical or partial nephrectomy due to suspected malignancy. In multivariable analysis, tumor size ≥ 10 cm (odds ratio 15.44; P = 0.003) and a radiologic impression of cancer (odds ratio 46.98; P < 0.001) independently predicted EAML. Four patients with EAML had adverse pathologic features and experienced poor survival; 3 patients died with metastases. The 3-year overall survival was 100% in classic AML and 76.9% in EAML (P < 0.001).

Conclusions: Patients with EAML had less favorable surgical outcomes than those with classic AML. Larger tumor size and a preoperative radiologic impression of malignancy were associated with an EAML diagnosis. Adverse pathologic features in EAML suggest malignant potential.

Development of a Nomogram That Predicts Outcomes After Radical Cystectomy for Bladder Cancer Using Data from Siriraj Hospital, Thailand

Kanawut Sooksatian — 2026-03-01

Objective: This study aimed to develop and validate a prognostic nomogram to estimate individualized overall survival (OS) for bladder cancer patients in Thailand undergoing radical cystectomy (RC), using data from Siriraj Hospital.

Materials and Methods: We retrospectively analyzed a cohort of 304 bladder cancer patients who underwent RC at Siriraj Hospital between 2012 and 2023. The patients were randomly allocated to the training (80%) and testing (20%) cohorts. Cox regression analyses were employed to identify predictors of OS from a range of clinical, pathological, and treatment-related variables. A prognostic nomogram was subsequently constructed and its performance was validated using the concordance index and the area under the receiver operating characteristic curve (AUC).

Results: The median patient age was 68 years and the majority of patients presented with muscle invasive disease. The median duration of follow-up was 61 months, with a median overall survival of 51 months. Multivariate analysis identified five independent predictors of OS: age, preoperative glomerular filtration rate, type of urinary diversion, pathological N stage, and presence of lymphovascular invasion. The nomogram demonstrated strong predictive performance, with AUC values of 86.6% at 12 months, 84.0% at 36 months, and 76.6% at 60 months.

Conclusion: We have developed and validated a prognostic nomogram tailored for Thai bladder cancer patients undergoing RC. This tool provides individualized survival estimates and may be a valuable aid in patient counseling, risk stratification, and formulation of postoperative management strategies. Future multicenter validation and integration of molecular markers will enhance the clinical utility of the prognostic nomogram.

Combining Histopathologic and Gene-Expression Profiling for Risk Stratification of Nodal Metastasis in Colorectal Cancer

Watsaphon Tangkullayanone — 2026-02-01

Objective: To identify gene-expression features associated with lymph node metastasis (LNM) in colorectal cancer (CRC) and to develop a transcriptomic-clinical predictive model for preoperative nodal assessment.

Materials and Methods: A total of 151 CRC tissue samples (74 LNM– and 77 LNM+) were analyzed using RNA sequencing. Differentially expressed genes (DEGs) were identified with DESeq2, and functional enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). A Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model integrating gene-expression features with clinical variables was developed to predict LNM status. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.

Results: A total of 302 DEGs were identified in LNM+ CRC, including 178 upregulated and 124 downregulated genes. Upregulated genes were enriched in chemokine-mediated signaling, epithelial morphogenesis, and intermediate filament organization, whereas downregulated genes were associated with adaptive immune response and complement activation. In multivariate analysis, lymphovascular invasion (LVI) was the only clinical variable independently associated with LNM. The optimized LASSO model, combining LVI with selected transcriptomic features demonstrated excellent discriminatory performance (AUC ≈ 0.92). Key upregulated genes included CCL21, CCL26, DEFB1, LST1, KANK4, TNNC1, PFDN6, TENM1, CST6, and PADI3, while IGHV2-26 was downregulated.

Conclusion: Integration of LVI with transcriptomic signatures enables accurate prediction of lymph node metastasis in CRC and supports biopsy-based risk assessment to guide clinical decision-making.

Predictive Models for Screening of Postoperative Cognitive Dysfunction in Older Surgical Patients

Arunotai Siriussawakul — 2026-03-01

Objective: Postoperative cognitive dysfunction (POCD) substantially impacts the long-term quality of life of patients and caregivers. Early detection of POCD is essential. We devised quick vigilance screening models for application preoperatively (model one) and during the postoperative period (model two) to predict the development of early POCD (one week after surgery).

Materials and Methods: We conducted a cohort study on patients aged ≥ 60 years undergoing cardiac or noncardiac surgeries. POCD was defined as a postoperative Montreal Cognitive Assessment decrease of ≥ two points from the baseline preoperative score. We stipulated that predictive factors should be simple and obtainable by health professionals or trained caregivers. Multivariate analysis results informed our selection of clinically significant variables for constructing the POCD predictive models.

Results: Of the 465 patients in the final analysis, the early POCD incidence was 24.9%. The equation used for predictive model one was (1 x education level lower than high school) + (2 x ischemic heart disease) + (2 x warfarin) + (1.5 x frailty score of 3–5). The equation for model two was (-1 x IADL score) + (6 x isoflurane anesthesia) + (7 x any type of intraoperative blood transfusion). Both models displayed well-calibrated curves. The optimal cut-off values of model one and model two to discriminate between a high and low probability of POCD were 2 and 0, respectively.

Conclusions: The preoperative and immediate postoperative POCD predictive models perform reliably. These models may effectively guide early POCD detection and risk modification in older surgical patients.

Genotoxicity and Cytotoxicity among Pesticide- Exposed Workers: A Systematic Review and Meta- Analysis

Achmad Ilham Tohari — 2026-03-01

Objective: To provide updated evidence on genotoxicity and cytotoxicity among workers occupationally exposed to pesticides.

Materials and Methods: This systematic review and meta-analysis followed PRISMA guidelines. Studies assessing micronuclei and cytotoxicity biomarkers in occupationally pesticide-exposed workers were included. Pooled analyses used Mantel-Haenszel fixed- and random-effects models, and results were expressed as SMDs with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42021279189).

Results: Micronucleus frequencies were significantly higher in lymphocytes (SMD 1.59; 95% CI 0.97–2.20; p<0.001; I2=96%) and buccal cells (SMD 1.20; 95% CI 0.67–1.73; p<0.00001; I2=97%) among exposed workers. Binucleated cells were also increased in lymphocytes (SMD 2.51; 95% CI 1.01–4.02; p<0.001; I2=98%) and buccal cells (SMD 0.56; 95% CI 0.04–1.08; p=0.03; I2=96%). No significant difference was observed for CBPI (SMD –0.18; 95% CI –0.90–0.54; p=0.63; I2=96%).

Conclusion: Occupational pesticide exposure is associated with increased micronucleus and binucleated cell frequencies, although high heterogeneity and potential confounding factors limit certainty. No significant association was found for CBPI. Subgroup analyses showed no sex-related differences, while concurrent smoking appeared to amplify genotoxic markers. The available evidence supports a protective effect of appropriate personal protective equipment against pesticide-induced genotoxicity.