Clinical Surgical Oncology最新文献

Background

Gastric cancer (GC) ranks as the fifth most prevalent malignancy and stands as the third principal contributor to cancer-related fatalities globally. COL8A1 (collagen type VIII, alpha-1) emerges as a pivotal regulator of tumor progression, but whether COL8A1 drives immune infiltration in GC remains elusive. The aim of our investigation is to elucidate the correlation between COL8A1 and the prognosis as well as immune infiltration in gastric cancer.

Methods

The GSE79973 and UALCAN databases were used for assessing the expression of COL8A1. Clinical data was obtained from the TCGA database to analyze the association between the expression of COL8A1 and clinicopathologic features of GC patients. Survival data of GC patients were acquired from the Kaplan-Meier Plotter database. Gene set enrichment analysis was conducted to characterize biological pathways of COL8A1. Immune infiltration analysis was conducted using the CIBERSORT method based on the TCGA database and online analysis within the TIMER2.0 database.

Results

We unveiled a noteworthy upregulation of COL8A1 expression across multiple cancer types, particularly in GC. Subsequent analysis underscored a positive linkage between heightened COL8A1 expression and an unfavorable clinical progression in GC patients. Survival analysis indicated that GC patients with elevated COL8A1 expression exhibited a poorer prognosis. Gene enrichment analysis hinted that COL8A1 might participate in physiological processes such as anatomical structure morphogenesis, cell adhesion, focal adhesion, and ECM-receptor interaction et al. in GC. Eventually, we discerned a established association between COL8A1 expression and immune cell infiltration in GC.

Conclusion

Our results demonstrated that COL8A1 is a key factor which governs immune cell recruitment to GC, representing a valuable prognostic biomarker in GC patients and potentially playing a crucial role in modulating immune cell infiltration.

Liver cancer is currently the third leading cause of cancer-related mortality worldwide. Due to late diagnosis and difficulty in monitoring, there is a pressing need for early detection and recurrence monitoring in patients with liver cancer. Recent advancements in liquid biopsy technology, like circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and exosomes, have made it possible to obtain a tumor’s characteristics and dynamic monitor easily. This, in turn, helps in identifying a personalized therapy for individual patients. However, the application progress of liquid biopsy techniques in liver cancer lag behind due to various challenges in clinical practice. In this review, we aim to provide insights into the development of liquid biopsy technology in liver cancer, highlighting its clinical significance in diagnosis, prognosis and treatment response prediction. We hope to focus on the key opportunities and challenges associated with these biomarkers and inspire a potential direction for future research.

Background

Combination immunotherapy has gradually become the mainstay of systematic therapy for advanced hepatocellular carcinoma (HCC), however, whether preoperative immunotherapy has the potential to reduce tumor activity, increase the resection rate and improve prognosis remains unclear. This study aimed to investigate the efficacy and safety of preoperative combined immunotherapies for patients with initially unresectable HCC.

Methods

This retrospective, real-world study involved patients with initially unresectable HCC receiving combined immunotherapies based on PD-1/L1 blockade before surgery. Tumor treatment responses, pathological manifestations in postoperative specimens and overall survival (OS) were evaluated. Treatment related adverse events (AEs) were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE, version 4.0).

Results

The study consecutively included 54 initially unresectable HCC patients and 34 patients were evaluated for the safety, efficacy, and possibility of subsequent radical surgery. Among these patients with surgical resection, 57.1% (n=8) receiving combination immunotherapy before surgery achieved a partial response (PR). Pathological evaluation of postoperative specimens confirmed that 21.4% (n=3) achieved complete responses, and 78.6% (n=11) achieved PR. 28.6% (4/14) patients encountered grade 3 or 4 AEs. The main AEs included fatigue (n=11; 78.6%), leukocytopenia (n=8; 57.1%) and aspartate aminotransferase (AST) elevation (n=6; 42.9%).

Conclusions

After combination immunotherapy, patients should be comprehensively evaluated whether they meet the criteria for surgical resection. Surgical resection following combination immunotherapy might effectively and safely control tumor progression and could improve the prognosis at least for some patients with initially unresectable HCC.

Introduction

Synchronous rectal and liver resection for metastatic colorectal cancer offers a unique opportunity to treat patients with a single stage procedure. Traditional open resections were out of favour due to a high morbidity profile. Robotic resections offer these benefits with an apparent reduction in morbidity and similar oncological outcomes. The present review aims to ascertain the feasibility, safety and available outcomes for patients undergoing synchronous resections for rectal cancer with liver metastases.

Methods

A systematic review was performed along the PRISMA guidelines with “robotic”, “rectal cancer”, “colorectal”, “synchronous resection” and “liver metastases” as the key words on the MEDLINE, EMBASE and Cochrane databases. Appropriate studies published between May 1^st 2015 and May 1^st 2023 were chosen and the data were collated from individual patients and analysed.

Results

A total of 12 studies were included, comprising of 48 patients. Eight included studies were case series and the rest were case reports and brief communications. There were no appropriate prospective studies for analysis. The median age was 61 years (IQR- 55–73 years) and 80% of patients whose gender data were available (n-15) were men. The median operative duration was 376 ​min (IQR- 312–424 min) with estimated blood loss of 175 ​ml (125–225 ​ml). The median length of hospital stay was 5.5 days (IQR- 3.5-7). There was no mortality and all the resections were R0.

Conclusion

Synchronous robotic resections for rectal cancer with liver metastases is feasible on the current review and has good short term and peri-operative outcomes. However, there is paucity of high quality published data in this subset of patients. Further prospective studies are needed to confirm the findings of the current review and to resolve the lack of high quality evidence.

Background

Two-stage revision remains the gold standard to eradicate deep infection of endoprosthetic replacements following bone tumour removal. We aim to (1) report the infection eradication and limb-salvage rate with two-stage revision surgery and to (2) report the common causative microorganisms.

Patients and methods

A retrospective review of 44 consecutive patients who underwent two-stage revision surgery to treat periprosthetic joint infection was conducted between 1999 and 2018 ​at a tertiary orthopaedic oncology centre from prospectively collated oncology database. Patients’ mean age was 36.1 years (range 12–78 years). The sites of prosthesis were distal femur in 22 patients (50%), proximal femur in five patients (11%), proximal tibia in 16 patients (36%) and total femur with proximal tibia replacement in one patient (2%). The mean duration of follow-up was 96 months (6–251 months).

Results

Infection was eradicated in 26 patients (59%). The infection-free survival was 93% (CI 85–100%) at two years, 78% (66–92%) at five years and 61% (46–80%) at 10 years. 11 patients (25%) had amputation following failure of limb-salvage surgery. The amputation-free survival was at 100% at two years, 89% (79–100%) at five years and 73% (58–92%) at 10 years. Polymicrobial infection was reported in 8 patients (18%) and multi-drug resistance in 14 patients (32%). Coagulase-negative staphylococcus was the commonest microorganism isolated in 21 patients (48%).

Conclusion

Two-stage revision is a reliable approach to achieve limb-salvage. Infected tumour endoprostheses have a high rate of multi-drug resistance and polymicrobial infections. PJI recurrence still has a high rate of amputation.

Background

Cytoreductive surgery (CRS) has been advocated as an additional treatment with survival benefits for advanced gastrointestinal stromal tumor (GIST), especially in patients with responsive disease or focal progression after treatment with imatinib. Ripretinib is a fourth-line therapy for advanced GIST. This single-center pilot study investigated the short-term safety and efficacy of CRS after treatment with ripretinib in selected patients with recurrent or metastatic GIST.

Methods

Medical records of patients with recurrent or metastatic GIST who underwent CRS after ripretinib in the First Affiliated Hospital of Sun Yat-sen University between June 1^st, 2020 and June 1^st, 2022 were retrospectively reviewed. Patients’ clinicopathological characteristics, preoperative treatment and general condition, surgical information, and postoperative management were recorded.

Results

This study included 7 patients who underwent CRS after ripretinib. Radiographic response to ripretinib included partial response (n ​= ​1), stable disease (n ​= ​5), and progressive disease (n ​= ​1). The cumulative size of targeted lesions shrank by 4.8%–45.3% in 5 patients. R0/R1 resection was achieved in 6 (85.7%) patients. Postoperative complications (IId) were reported in 2 (28.6%) patients. There were no delayed post-operative complications. Median follow-up was 11.8 months. Median time-to-progression and median post-operative progression-free survival were not reached. Four patients who did not progress before surgery had no evidence of disease.

Conclusion

Ripretinib combined with CRS is safe and effective in select patients with advanced GIST despite extensive prior therapy.

Purpose

The purpose of our study is to correlate grade of Muscle invasive urothelial carcinoma with prognosis of patients in terms of disease recurrence, metastasis and death.

Materals and methods

We retrieved 48 cases of invasive urothelial carcinomas which on initial presentation had invaded muscularis propria (pT2) or beyond muscularis propria (pT3 or pT4), diagnosed and treated in Shaukat Khanum Memorial hospital Lahore and whose 8–20 years follow up data was available in hospital archives received either as Transurethral resection or cystectomy specimens from 2002 to 2015. Cases diagnosed as primary adenocarcinomas, Neuroendocrine carcinomas or other bladder malignancy other than urothelial carcinoma were excluded.

Results

All 48 pT2 and higher stage patients were high grade. 34/48(70.8%) patients had disease recurrence, 11/48(22.9%) had no recurrence of disease and 3 patients lost to follow up. 43/48(89.5%) patients developed disease metastasis while 5/48(10.4%) did not develop metastatic disease. 39/48(81.2%) died of disease, 3 patients lost to follow up while 6/48(12.5%) patients survived. 5 out of 6 patients who survived had underwent cystectomy while 6 more underwent cystectomy but still died of disease.

Conclusion

Muscle invasion is itself an independent prognostic factor in predicting prognosis of patients and grade of such tumors is not much helpful as either majority of tumors are high grade or even if they are low grade, the prognosis is not good.

Implant breast reconstruction is the most common form of breast reconstruction worldwide. Nipple sparing mastectomy (NSM) has been shown to be oncologically safe in appropriately selected patients and provide superior aesthetic outcomes. Patients with larger ptotic breasts traditionally have not been candidates for nipple sparing mastectomies due to higher rates of nipple and skin flap necrosis, leading to reconstructive failure, and difficulty positioning the nipple areolar complex (NAC) on the breast mound. Patient factors, breast factors and adjuvant oncological therapies should all be taken into account to determine the safest treatment for the patient. Surgical options can be grouped into single staged procedures with skin reducing incisions and direct to implant reconstruction versus staged procedures. This review article aims to highlight risk factors associated with surgical complications and examine the surgical options available to manage this complex problem with their associated outcomes.

Background

Diagnosis of a bone or soft tissue sarcomas is uncommon, and the odds of being present during pregnancy are rare. Hence, the management of sarcoma during pregnancy is more complicated, and to date, no single guideline suits all.

Method

Patients diagnosed with either bone or soft-tissue sarcomas or metastatic sarcoma progression during pregnancy were identified retrospectively between 1983 and 2021 from our orthopaedic oncology database. Demographic and relevant information regarding their management was collected, including maternal and neonatal outcomes, metastatic progression, and survival rates.

Results

A sum of 30 patients diagnosed with sarcoma during pregnancy were included; 16 (53.33%) with bone sarcoma and nine (30%) with soft-tissue sarcoma. Five (16.67%) had metastatic progression of their bone or soft-tissue sarcoma during pregnancy. The median age at diagnosis is 31 years old, youngest at 18 and eldest at 38 years old. Detailed discussions between the sarcoma multidisciplinary team (MDT) and obstetric teams took place throughout each patient's pregnancy follow-up. Seven underwent termination of pregnancy, and six underwent surgical treatment during pregnancy with no maternal or neonatal complications reported. Eight were induced early and four underwent early caesarean section to allow for staging and definitive management without any neonatal complications. Maternal one-year and five-year survival rates for bone sarcomas were 100% and 73.68%, respectively, and 100% and 70%, respectively, for soft-tissue sarcomas. One survived more than five years in the metastatic progression group but succumbed at 7th year due to cerebral metastasis.

Conclusion

The management of bone and soft-tissue sarcomas during pregnancy by sarcoma MDT with collective knowledge and expertise led to good neonatal or maternal outcomes comparable to maternal survival rates of the non-pregnant population. The treatment plan should be based on individual expectations from the patient depending on the gestational period of the pregnancy, the type of pathology, and the location of the sarcoma.

Oligometastasis-directed therapies have shown promise in improving patient outcomes. In this review, we summarized the current understanding of oligometastatic nasopharyngeal carcinoma (NPC) and the role of surgery in its management. Since the majority of clinical evidence supporting the benefit of surgical treatment on oligometastatic NPC is derived from non-controlled, single-arm, observational studies, therefore, findings reported before should be interpreted with caution and it is crucial to identify the right patients for oligometastasectomy to ensure the safety and effectiveness for patients. Future studies investigating the oligometastatic state should employ more robust study designs, such as randomized controlled trials, to guide clinical decision-making. Additionally, a comprehensive understanding of the tumor biology associated with oligometastatic NPC is necessary for developing effective treatment strategies for patients.