Clinical Surgical Oncology最新文献_第5页

Confirmation of the importance of lymphatic leakage in the formation of axillary fluid collections after lymph node dissection for breast cancer 确认淋巴渗漏在乳腺癌淋巴结清扫后腋窝积液形成中的重要性

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 10.1016/j.cson.2024.100071

Roman Mirela Mariana , Karler Clarence , Del Marmol Véronique , Bourgeois Pierre

Background

In patients undergoing complete axillary lymph node dissection (CALND) for breast cancer, axillary lymphatic leakages can be detected using near-infrared fluorescence imaging after subcutaneous injection of indocyanine green (ICG) into the ipsilateral hand. This study investigates the impact of these leaks on postoperative fluid volumes collected in drains (Vd) and through punctures (Vp).

Methods

A total of 55 patients received a single subcutaneous ICG injection in the ipsilateral hand either the day before or on the day of surgery. Postoperative fluid volumes, including drain output (Vd) and puncture collections (Vp), were analyzed and compared in relation to the presence or absence of fluorescence detected perioperatively in axillary lymph nodes (AxLNs) and drains.

Results

Fluorescence in AxLN: The absence of fluorescence in the AxLN was associated with a tendency for lower Vd but showed no significant effect on Vp or the total volume of fluid collected (Vt = Vd + Vp). Fluorescent Axillary Leak: Similar trends were observed for the intraoperative detection of a fluorescent axillary leak, although the statistical significance was less pronounced. Fluorescence in Drains: The absence of fluorescence in postoperative drains was significantly correlated with lower values for all analyzed parameters, including Vd, Vp, Vt, the proportion of patients requiring punctures, and the number of punctures.

Conclusion

The findings support the hypothesis that postoperative fluid collections in the axilla after CALND are due primarily to lymphatic leakage from the arm rather than to the removal of axillary lymph nodes. The detection of fluorescence during surgery offers a foundation for targeted strategies to mitigate lymphatic leakages and associated complications. The efficacy of such approaches should be validated through a prospective, multicenter, randomized trial.

背景：在接受乳腺癌完全性腋窝淋巴结清扫术（CALND）的患者中，在同侧手部皮下注射吲哚菁绿（ICG）后，使用近红外荧光成像可以检测腋窝淋巴渗漏。本研究探讨了这些泄漏对术后引流管（Vd）和穿刺（Vp）收集的液体量的影响。方法55例患者在手术前或手术当日接受同侧手部单次皮下注射ICG。分析和比较术后液体量，包括排液量（Vd）和穿刺收集量（Vp）与围手术期腋窝淋巴结（AxLNs）和排液中荧光检测的存在或不存在的关系。结果AxLN中的荧光：AxLN中荧光的缺失与Vd降低的趋势有关，但对Vp或收集的液体总量（Vt = Vd + Vp）无显著影响。荧光腋窝漏：术中检测到的荧光腋窝漏也有类似的趋势，尽管统计学意义不太明显。引流管中的荧光：术后引流管中没有荧光与所有分析参数（Vd、Vp、Vt、需要穿刺的患者比例、穿刺次数）的较低值显著相关。结论本研究结果支持了CALND术后腋窝积液主要是由于上臂淋巴渗漏而非腋窝淋巴结切除的假设。手术期间荧光检测为有针对性的策略提供了基础，以减轻淋巴泄漏和相关并发症。这些方法的有效性应该通过前瞻性、多中心、随机试验来验证。

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引用次数: 0

Clinical outcome and survival of low-grade appendiceal mucinous neoplasm with different surgical treatment: A multicenter clinical retrospective study 不同手术治疗的低级别阑尾黏液性肿瘤的临床结局和生存：一项多中心临床回顾性研究

Clinical Surgical Oncology

Pub Date : 2025-02-10 DOI: 10.1016/j.cson.2025.100075

Cunlong Lu , Zhenlong Han , Hui Gao , Yongke Liu , Long Li , Tuo Shi , Houxin Zhu , Zhaoli Liu , Liangdong Cheng , Yanbing Zhou

Background

To explore the effects of different surgical strategies on clinical outcome and survival for the low-grade appendiceal mucinous neoplasm (LAMN), providing evidence support for the best treatment strategy.

Materials and methods

This study retrospectively analyzed the clinicopathological and survival outcome of LAMN data between 2013 and 2023 from multicenter, including preoperative, intraoperative, and postoperative data. Kaplan-Meier method and Cox regression analysis model were used for survival analysis.

Results

184 patients pathologically diagnosed with LAMN were included. The median age was 59 (50,69) years. All the patients were performed surgery, including simple appendectomy, appendectomy with caecal resection, ileocecectomy and right hemicolectomy (RHC). Compared with extended resection, local resection achieved better short-term outcome. Appendectomy has higher OS rate compared to the RHC with pairwise comparison (97% vs. 79.2%, χ = 11.14, P < 0.001). Multivariate Cox regression analysis showed that age>60 years (hazard radio (HR) = 1.125, 95%CI: 1.051–1.205, P < 0.01), tumor recurrence (HR = 7.019, 95%CI 2.226–22.135, P < 0.001), adjuvant chemotherapy (HR = 6.486, 95%CI 1.897–22.178, P = 0.003) and recurrence risk (HR = 13.303, 95%CI 4.165–42.493, P = 0.002) were independent risk factors for survival of LAMN.

Conclusion

Appendectomy showed favorable short-term outcome and OS rate compared with right hemicolectomy when the tumor is not ruptured and surgical margin is negative. Tumor recurrence, age>60 years, adjuvant chemotherapy and high recurrence risk indicates poor prognosis. Large clinical trials of surgical therapy for LAMN are urgently needed.

背景探讨不同手术策略对低级别阑尾黏液性肿瘤（LAMN）临床预后和生存的影响，为最佳治疗策略提供证据支持。材料与方法本研究回顾性分析了2013 - 2023年多中心LAMN的临床病理和生存结局，包括术前、术中和术后数据。生存率分析采用Kaplan-Meier法和Cox回归分析模型。结果184例经病理诊断为LAMN的患者入组。中位年龄59岁（50岁，69岁）。所有患者均行手术治疗，包括单纯阑尾切除术、阑尾切除术合并盲肠切除术、回肠切除术和右半结肠切除术（RHC）。与扩大切除相比，局部切除短期疗效更好。两两比较，阑尾切除术的OS率高于RHC (97% vs. 79.2%, χ = 11.14, P <；0.001)。多因素Cox回归分析显示，年龄60岁(HR) = 1.125, 95%CI: 1.051 ~ 1.205, P <；0.01),肿瘤复发(HR = 7.019, 95% ci 2.226 - -22.135, P & lt;0.001)、辅助化疗（HR = 6.486, 95%CI 1.897 ~ 22.178, P = 0.003）和复发风险（HR = 13.303, 95%CI 4.165 ~ 42.493, P = 0.002）是影响LAMN生存的独立危险因素。结论在肿瘤未破裂、切缘阴性的情况下，阑尾切除术较右半结肠切除术具有较好的短期疗效和总生存率。肿瘤复发、年龄60岁、辅助化疗、复发率高提示预后较差。迫切需要对LAMN进行外科治疗的大规模临床试验。

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引用次数: 0

A comprehensive narrative review on paradigm shift in the treatment of esophageal and rectal cancer 食管癌和直肠癌治疗模式转变的综合叙述综述

Clinical Surgical Oncology

Pub Date : 2025-02-09 DOI: 10.1016/j.cson.2025.100074

Dimitrios Chatziisaak , Pascal Burri , Thomas Steffen , Stephan Bischofberger

The incidence of esophageal and rectal cancer is rising globally. The combination of neoadjuvant chemoradiotherapy (nCRT) with watchful waiting (W&W) strategies has been shown to be an effective approach for maintaining a high quality of life (QoL), particularly in the treatment of rectal cancer. This approach has recently been experimentally extended to the treatment of esophageal cancer. This narrative review provides an overview of the current status of nCRT and watchful waiting (W&W) strategies in both cancer types.

The findings of the review indicate that nCRT significantly improves survival and response rates in both cancers. In patients with esophageal cancer, neoadjuvant therapy followed by surgery resulted in a median overall survival that was nearly double the expected survival time and demonstrated high rates of complete pathological response. In the case of rectal cancer, nCRT has been shown to result in high rates of complete response, which in turn has the effect of organ preserving and improving overall oncological outcomes and QoL.

The review concludes that the W&W strategies, initially developed for rectal cancer, can be safely extended to selected cases of esophageal cancer, making organ preservation a feasible option that improves patients' quality of life. It is imperative that internationally accepted guidelines and precise patient selection criteria are established to ensure consistent outcomes and enhance long-term monitoring.

食管癌和直肠癌的发病率在全球范围内呈上升趋势。新辅助放化疗（nCRT）与观察等待（W&；W）策略的结合已被证明是维持高生活质量（QoL）的有效方法，特别是在直肠癌的治疗中。这种方法最近被实验性地扩展到食管癌的治疗中。本文综述了两种癌症类型的nCRT和观察等待（W&；W）策略的现状。回顾的结果表明，nCRT显著提高了两种癌症的生存率和应答率。在食管癌患者中，手术后的新辅助治疗导致中位总生存期几乎是预期生存期的两倍，并显示出高的完全病理反应率。在直肠癌的病例中，nCRT已被证明具有高完全缓解率，这反过来又具有器官保存和改善总体肿瘤预后和生活质量的作用。该综述的结论是，最初为直肠癌开发的W&；W策略可以安全地扩展到选定的食管癌病例，使器官保存成为一种可行的选择，可以提高患者的生活质量。必须制定国际公认的指导方针和精确的患者选择标准，以确保一致的结果并加强长期监测。

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引用次数: 0

A combined scoring system for tumor budding and poorly differentiated clusters in colorectal cancer: A retrospective study 结直肠癌肿瘤出芽和低分化簇的联合评分系统：一项回顾性研究

Clinical Surgical Oncology

Pub Date : 2025-02-03 DOI: 10.1016/j.cson.2025.100073

Adil Aziz Khan, Sana Ahuja, Sristi Barman, Sufian Zaheer

Background

Optimal management of stage II colorectal cancer (CRC) patients is complex due to variability in oncologic outcomes. Tumor budding (TB) and poorly differentiated clusters (PDCs) have emerged as significant prognostic factors. This study evaluates the prognostic significance of a combined scoring system of TB and PDCs in CRC patients.

Materials and methods

A retrospective study included 68 patients who underwent curative surgery. H&E-stained sections were assessed for TB and PDCs. TB was graded according to ITBCC recommendations: Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (≥10 buds). PDCs were counted as clusters of ≥5 cells without gland formation: PDC1 (0–4 clusters), PDC2 (5–9 clusters), and PDC3 (≥10 clusters). TB and PDC scores were combined, resulting in a score range of 2–4. Histological sections were also evaluated for lymphovascular invasion (LVI), perineural invasion (PNI), and other pathological parameters. Statistical analyses were performed using Chi-Square and Fisher's exact tests.

Results

TB was high in 32.35% of cases and low in 47.06%. High PDCs were present in 47.06% of cases. The combined scoring system showed 55.88% of cases with a score of 3, indicating intermediate risk. Statistical significance was observed between combined scores and T stage, LVI, PNI, histological grade, extranodal extension, and tumor size (p < 0.05).

Conclusion

The combined scoring system for TB and PDCs demonstrated superior prognostic performance compared to individual assessments. This system provides a more comprehensive risk stratification, which may guide more tailored treatment decisions in CRC management.

背景：由于肿瘤预后的可变性，II期结直肠癌（CRC）患者的最佳管理是复杂的。肿瘤萌芽（TB）和低分化簇（PDCs）已成为重要的预后因素。本研究评估了结核和前列腺癌联合评分系统在结直肠癌患者中的预后意义。材料与方法回顾性研究68例手术治疗患者。H&； e染色切片检测TB和PDCs。根据ITBCC推荐的结核病分级：Bd1（0-4个芽），Bd2（5-9个芽）和Bd3（≥10个芽）。不形成腺体的PDCs以≥5个细胞为簇计数：PDC1（0-4个簇）、PDC2（5 - 9个簇）和PDC3（≥10个簇）。结合TB和PDC评分，得到2-4分的评分范围。组织切片也评估淋巴血管侵犯（LVI），神经周围侵犯（PNI）和其他病理参数。采用卡方检验和Fisher精确检验进行统计分析。结果stb高发病例占32.35%，低发病例占47.06%。47.06%的病例存在高PDCs。综合评分系统中，55.88%的病例得分为3分，为中等风险。综合评分与T分期、LVI、PNI、组织学分级、结外扩展、肿瘤大小之间的差异均有统计学意义(p <；0.05)。结论与单独评估相比，TB和PDCs联合评分系统具有更好的预后效果。该系统提供了更全面的风险分层，可以指导CRC管理中更有针对性的治疗决策。

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引用次数: 0

Patients who have undergone total gastrectomy investigation of self-management experiences on dumping syndrome 全胃切除术患者倾倒综合征自我管理经验调查

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100066

Cansu Şentürk , Evin Korkmaz

Introduction

This study was planned to investigate in-depth patients' experiences with dumping syndrome after total gastrectomy and their self-management in this condition.

Method

The research was conducted in a qualitative study design. Data were collected using a face-to-face interview method with patients who underwent total gastrectomy surgery in 2023, using a voice recorder when they came to their outpatient clinic appointments. The interviews were completed in 20–40 min. The MAXQDA program was used to analyze the data obtained. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used as a guide for reporting this study.

Results

The study included ten patients who underwent total gastrectomy surgery. The mean age of the patients was 45 years and above. 70% of the patients were male and 30% were female. During the interview with the patients, six main themes and twenty-five sub-themes were formed: 1- Regret about the surgery, 2- Dietary recommendations, 3-Time of complaints, 4- Dietary pattern, 5- What was done for postprandial complaints, 6- Complaints after eating.

Conclusion

It is thought that an integrated team-based approach to postoperative care is necessary for patients to gain self-management skills.

本研究旨在深入探讨全胃切除术后倾倒综合征患者的经历及其自我管理。方法采用定性研究设计。数据是通过对2023年接受全胃切除手术的患者进行面对面访谈的方式收集的，当他们来到门诊预约时使用录音机。访谈在20-40分钟内完成。利用MAXQDA程序对所得数据进行分析。报告定性研究的综合标准（COREQ）被用作报告本研究的指南。结果本研究包括10例接受全胃切除术的患者。患者平均年龄45岁及以上。男性占70%，女性占30%。在对患者的访谈中，形成了6个主题和25个子主题：1-手术后悔，2-饮食建议，3-投诉时间，4-饮食方式，5-餐后投诉做了什么，6-餐后投诉。结论采用以团队为基础的综合护理方法是提高患者自我管理能力的必要条件。

{"title":"Patients who have undergone total gastrectomy investigation of self-management experiences on dumping syndrome","authors":"Cansu Şentürk , Evin Korkmaz","doi":"10.1016/j.cson.2024.100066","DOIUrl":"10.1016/j.cson.2024.100066","url":null,"abstract":"<div><h3>Introduction</h3><div>This study was planned to investigate in-depth patients' experiences with dumping syndrome after total gastrectomy and their self-management in this condition.</div></div><div><h3>Method</h3><div>The research was conducted in a qualitative study design. Data were collected using a face-to-face interview method with patients who underwent total gastrectomy surgery in 2023, using a voice recorder when they came to their outpatient clinic appointments. The interviews were completed in 20–40 min. The MAXQDA program was used to analyze the data obtained. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used as a guide for reporting this study.</div></div><div><h3>Results</h3><div>The study included ten patients who underwent total gastrectomy surgery. The mean age of the patients was 45 years and above. 70% of the patients were male and 30% were female. During the interview with the patients, six main themes and twenty-five sub-themes were formed: 1- Regret about the surgery, 2- Dietary recommendations, 3-Time of complaints, 4- Dietary pattern, 5- What was done for postprandial complaints, 6- Complaints after eating.</div></div><div><h3>Conclusion</h3><div>It is thought that an integrated team-based approach to postoperative care is necessary for patients to gain self-management skills.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"3 4","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical characteristics and treatment outcomes of Vulvar cancer patients at a tertiary setting in Ethiopia: A 6-year review 临床特点和治疗结果外阴癌患者在第三设置在埃塞俄比亚：6年回顾

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100068

Meseret Jeldu, Abraham Fessehaye Sium, Bethel Dereje

Objective

To describe clinical characteristics and treatment outcomes of vulvar cancer patients managed at a gynecologic oncology treatment center in Ethiopia.

Methods and materials

This was a 6-year review of vulvar cancers patients (with and without HIV co-infection) that were managed at St. Paul’s Hospital Millennium Medical College (Ethiopia) between 2017 and 2022. Data were extracted from patient’s medical records using a data extraction tool. Data were analyzed using SPSS version 26. Simple descriptive statistics and Chi-squared test were carried out as appropriate.

Results

After excluding 10 patients for incomplete data, a total of 96 patients were included in the final analysis, out of which 65(67.7%) patients had HIV co-infection. Surgery with or without chemotherapy was the most common (62/96, 64.8%) treatment modality provided for the patients while the remaining 34 patients were treated with primary chemoradiation. Among those who had surgery, the majority of them (43/62, 69.4%) were managed with surgery alone, followed by another 16(25.8%) patients who were treated with neoadjuvant chemotherapy followed by surgery.

Conclusion

In this study, most vulvar cancer patients (more than three-quarters) had favorable survival outcomes at a median follow-up of 3 years post-standard treatment for vulvar cancer.

目的分析埃塞俄比亚某妇科肿瘤治疗中心外阴癌患者的临床特点及治疗效果。方法和材料这是一项对2017年至2022年期间在圣保罗医院千年医学院（埃塞俄比亚）管理的外阴癌患者（伴有和不伴有HIV合并感染）的6年综述。使用数据提取工具从患者的医疗记录中提取数据。数据分析采用SPSS version 26。适当时进行简单描述性统计和卡方检验。结果在排除10例资料不全患者后，最终纳入96例患者，其中65例（67.7%）合并HIV感染。手术加或不加化疗是患者最常见的治疗方式（62/96,64.8%），其余34例患者接受原发性放化疗。手术患者中以单纯手术为主（43/62,69.4%），手术后新辅助化疗为主（16例，25.8%）。在这项研究中，大多数外阴癌患者（超过四分之三）在外阴癌标准治疗后的中位随访3年有良好的生存结果。

{"title":"Clinical characteristics and treatment outcomes of Vulvar cancer patients at a tertiary setting in Ethiopia: A 6-year review","authors":"Meseret Jeldu, Abraham Fessehaye Sium, Bethel Dereje","doi":"10.1016/j.cson.2024.100068","DOIUrl":"10.1016/j.cson.2024.100068","url":null,"abstract":"<div><h3>Objective</h3><div>To describe clinical characteristics and treatment outcomes of vulvar cancer patients managed at a gynecologic oncology treatment center in Ethiopia.</div></div><div><h3>Methods and materials</h3><div>This was a 6-year review of vulvar cancers patients (with and without HIV co-infection) that were managed at St. Paul’s Hospital Millennium Medical College (Ethiopia) between 2017 and 2022. Data were extracted from patient’s medical records using a data extraction tool. Data were analyzed using SPSS version 26. Simple descriptive statistics and Chi-squared test were carried out as appropriate.</div></div><div><h3>Results</h3><div>After excluding 10 patients for incomplete data, a total of 96 patients were included in the final analysis, out of which 65(67.7%) patients had HIV co-infection. Surgery with or without chemotherapy was the most common (62/96, 64.8%) treatment modality provided for the patients while the remaining 34 patients were treated with primary chemoradiation. Among those who had surgery, the majority of them (43/62, 69.4%) were managed with surgery alone, followed by another 16(25.8%) patients who were treated with neoadjuvant chemotherapy followed by surgery.</div></div><div><h3>Conclusion</h3><div>In this study, most vulvar cancer patients (more than three-quarters) had favorable survival outcomes at a median follow-up of 3 years post-standard treatment for vulvar cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"3 4","pages":"Article 100068"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic distal pancreatectomy: Initial experience with the Versius robotic surgical system. Stage 2a IDEAL prospective case series 机器人远端胰腺切除术：Versius机器人手术系统的初步经验。2a期IDEAL前瞻性病例系列

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100063

Francesco Lancellotti , Affan Iqbal , Jenifer Barrie , Panagiotis Stathakis , Thomas Satyadas , Rahul Deshpande , Jegatheeswaran Santhalingam , Nicola de Liguori-Carino , Aali Sheen , Ajith Kumar Siriwardena , Saurabh Jamdar

Background

Distal pancreatectomy (DP) is a well-established minimally invasive procedure. However, feasibility and technical details when using Versius robotic surgical system are still unexplored.

Method

This is a prospective stage 2a development IDEAL (Idea, Development, Exploration, Assessment and Long-term monitoring) case series. All consecutive robotic DP (RDP), including both splenectomy (DPS) and spleen-preserving DP (SPDP), were analysed. Pre- intra- and post-operative details were prospectively recorded.

Results

6 DPS and 3 SPDP were performed between May 2022 and May 2024. Conversion to open was recorded in one case. The average operating time and robot docking time were 185 min (range: 118–300) and 9.3 min (range: 3–15), respectively. No reoperation or 90-days mortality were recorded. Ports placement, instruments used, and surgical strategy are described in detail.

Conclusion

We present the first series on RDP performed by Versius robotic surgical system. The procedure is safe and feasible, and careful patient selection is required for the first cases.

远端胰腺切除术（DP）是一种公认的微创手术。然而，使用Versius机器人手术系统的可行性和技术细节仍未被探索。这是一个前瞻性的2a阶段发展的IDEAL （Idea, development, Exploration, Assessment and Long-term monitoring）案例系列。分析所有连续的机器人DP (RDP)，包括脾切除术（DPS）和保脾DP （SPDP）。术前、术中及术后的细节均进行前瞻性记录。结果在2022年5月至2024年5月间进行了6例DPS和3例SPDP。其中一例转为开放。平均操作时间185 min（范围118 ~ 300），机器人对接时间9.3 min（范围3 ~ 15）。无再手术和90天死亡率记录。详细描述了端口放置，使用的器械和手术策略。结论本文首次报道了使用Versius机器人手术系统进行RDP的病例。手术是安全可行的，在第一例病例中需要仔细选择患者。

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引用次数: 0

Pleomorphic dermal sarcoma. UK multidisciplinary team members have wide variation in opinions on management and pathways 多形性真皮肉瘤。英国多学科团队成员在管理和路径上有很大的不同

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100061

Carrie Newlands , Elizabeth Gruber , Franel Le Grange , Rajiv Anand , Simon Whitley , Stephen Keohane

Background

Pleomorphic Dermal Sarcoma (PDS) is increasing in incidence and evidence-based guidelines as to optimal management are lacking. It is unclear from guidance which cancer MDTs should be involved in the care of patients with PDS and there is anecdotally widespread variation in patient pathways and management.

Objective

To determine current pathways and opinions regarding management of PDS amongst members of relevant UK MDTs.

Methods

A survey was devised, piloted, and circulated to MDT members, via national organisations. Responses were analysed using online SurveyMonkey tools.

Results

105 consultant members of a relevant MDT responded, including 19 skin and 2 sarcoma MDT Chairs. There was widespread variation in referral pathways, with 25.7% of participants reporting no sarcoma MDT involvement in a hypothetical case of a patient with a 2.1 cm primary PDS of the scalp, with no clinically apparent regional or distant metastases (N0M0). Opinions on the correct peripheral and deep surgical excision margins (PM/DM) varied, with the majority choosing a 10 mm PM (53.3%). Taking periosteum as the deep margin was preferred by 50.5%. Histological clearance margins of at least 5 mm at the PM and at least 1 mm at the DM were preferred by 33.3% of participants and deemed to be acceptable as definitive treatment. Imaging at diagnosis and for surveillance showed wide variation, with 24.8% not offering any imaging at diagnosis, in the above case.

Conclusions

PDS pathways and clinical management have been shown to vary widely amongst UK MDT members. A modified Delphi study is proposed to develop consensus-based guidance.

背景：多形性真皮肉瘤（PDS）的发病率正在增加，缺乏循证的最佳治疗指南。从指南中还不清楚哪些癌症MDTs应该参与PDS患者的护理，而且在患者途径和管理方面存在广泛的差异。目的确定英国相关MDTs成员对PDS管理的当前途径和意见。方法通过国家组织设计、试点并向MDT成员分发了一项调查。使用在线SurveyMonkey工具对反馈进行分析。结果105名相关MDT顾问成员回应，包括19名皮肤MDT主席和2名肉瘤MDT主席。转诊途径存在广泛的差异，在一个假设的2.1厘米原发头皮PDS患者病例中，有25.7%的参与者报告没有肉瘤MDT涉及，没有临床明显的区域或远处转移（N0M0）。对正确的外周和深部手术切除边缘（PM/DM）的看法不一，大多数人选择10 mm PM（53.3%）。50.5%的人选择骨膜作为深缘。33.3%的参与者认为PM的组织学清除率至少为5 mm， DM的组织学清除率至少为1 mm，这被认为是可以接受的最终治疗。在上述病例中，诊断时的影像学和监测时的影像学差异很大，有24.8%的患者在诊断时不提供任何影像学。结论：在英国MDT成员中，spds通路和临床管理存在很大差异。提出了一种改进的德尔菲研究，以制定基于共识的指导。

{"title":"Pleomorphic dermal sarcoma. UK multidisciplinary team members have wide variation in opinions on management and pathways","authors":"Carrie Newlands , Elizabeth Gruber , Franel Le Grange , Rajiv Anand , Simon Whitley , Stephen Keohane","doi":"10.1016/j.cson.2024.100061","DOIUrl":"10.1016/j.cson.2024.100061","url":null,"abstract":"<div><h3>Background</h3><div>Pleomorphic Dermal Sarcoma (PDS) is increasing in incidence and evidence-based guidelines as to optimal management are lacking. It is unclear from guidance which cancer MDTs should be involved in the care of patients with PDS and there is anecdotally widespread variation in patient pathways and management.</div></div><div><h3>Objective</h3><div>To determine current pathways and opinions regarding management of PDS amongst members of relevant UK MDTs.</div></div><div><h3>Methods</h3><div>A survey was devised, piloted, and circulated to MDT members, via national organisations. Responses were analysed using online SurveyMonkey tools.</div></div><div><h3>Results</h3><div>105 consultant members of a relevant MDT responded, including 19 skin and 2 sarcoma MDT Chairs. There was widespread variation in referral pathways, with 25.7% of participants reporting no sarcoma MDT involvement in a hypothetical case of a patient with a 2.1 cm primary PDS of the scalp, with no clinically apparent regional or distant metastases (N0M0). Opinions on the correct peripheral and deep surgical excision margins (PM/DM) varied, with the majority choosing a 10 mm PM (53.3%). Taking periosteum as the deep margin was preferred by 50.5%. Histological clearance margins of at least 5 mm at the PM and at least 1 mm at the DM were preferred by 33.3% of participants and deemed to be acceptable as definitive treatment. Imaging at diagnosis and for surveillance showed wide variation, with 24.8% not offering any imaging at diagnosis, in the above case.</div></div><div><h3>Conclusions</h3><div>PDS pathways and clinical management have been shown to vary widely amongst UK MDT members. A modified Delphi study is proposed to develop consensus-based guidance.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"3 4","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143166219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The prognosis and adjuvant chemotherapy in KRAS mutation patients with stage I lung adenocarcinoma KRAS突变I期肺腺癌患者的预后及辅助化疗

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100069

Shangshang Ma , Kun Li , Rangrang Wang , Jiayi Qian , Yongfei Fan , Xichun Qin , Mingjun Li , Leilei Wu

Background

Adjuvant chemotherapy (ACT) remains the current first-line systemic treatment option for patients with KRAS-mutated lung adenocarcinoma (LUAD), but the response is not effective. The prognosis of ACT in patients with KRAS mutations in stage I LUAD has not yet been effectively explored.

Methods

Detailed data about patients with stage I LUAD from Shanghai Pulmonary Hospital were collected in this ambispective study. Pearson's Chi-square test, Kaplan-Meier analysis, and Cox proportional hazard models were performed in this study. The primary observational endpoint was overall survival (OS). Sensitivity analysis was performed to assess the robustness of the findings.

Results

In this study population, 10.87% (194 out of 1783) of stage I LUAD patients possessed KRAS mutations. In the KRAS-mutated cohort, 7 patients harbored EGFR L858R point mutation, 2 patients exhibited EGFR exon 19 Del mutation, 2 patients had ALK rearrangement, and 1 patient for other EGFR mutations. Patients harboring KRAS mutations had a worse OS compared to KRAS wild-type (WT) patients (5-year OS rate: 96% vs. 82%, P < 0.001). In addition, the KARS(G12C) mutation was an independent factor for poor prognosis (P < 0.001). Importantly, ACT improved survival in patients with stage IB LUAD (P = 0.02) while not improved survival in the group of stage IB patients with KRAS mutations (P = 0.31).

Conclusions

KRAS mutation could co-occur with EGFR mutation and ALK rearrangement. KRAS mutation was associated with poor prognosis in stage I LUAD patients. In addition, ACT did not improve prognosis in stage IB LUAD patients with KRAS mutations. Our findings require more research to be confirmed.

背景：辅助化疗（ACT）仍然是目前kras突变肺腺癌（LUAD）患者的一线全身治疗选择，但反应并不有效。对于KRAS突变的I期LUAD患者，ACT的预后尚未得到有效探讨。方法收集上海市肺科医院I期LUAD患者的详细资料。本研究采用Pearson卡方检验、Kaplan-Meier分析和Cox比例风险模型。主要观察终点是总生存期（OS）。进行敏感性分析以评估研究结果的稳健性。结果在本研究人群中，1783例I期LUAD患者中有194例（10.87%）具有KRAS突变。在kras突变队列中，7例患者存在EGFR L858R点突变，2例患者存在EGFR外显子19 Del突变，2例患者存在ALK重排，1例患者存在其他EGFR突变。与KRAS野生型（WT）患者相比，携带KRAS突变的患者的OS更差(5年OS率：96% vs 82%， P <；0.001)。此外，KARS（G12C）突变是预后不良的独立因素(P <；0.001)。重要的是，ACT提高了IB期LUAD患者的生存率（P = 0.02），而IB期KRAS突变患者的生存率没有提高（P = 0.31）。结论skras突变可能与EGFR突变和ALK重排同时发生。KRAS突变与I期LUAD患者预后不良相关。此外，ACT并没有改善IB期LUAD患者KRAS突变的预后。我们的发现需要更多的研究来证实。

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引用次数: 0

Relationship between expression of p53 protein in breast cancer and axillary lymph node metastasis 乳腺癌组织中p53蛋白表达与腋窝淋巴结转移的关系

Clinical Surgical Oncology

Pub Date : 2024-12-01 DOI: 10.1016/j.cson.2024.100067

Zhang Fang

Objective

To explore the expression of p53 protein in cancer tissue of breast cancer, analyze the relationship between positive rate of expression of p53 protein and axillary lymph node status.

Method

137 breast cancer patients in general hospital of PLA from June 2023 to October 2023 were selected and divided into axillary lymph node metastasis group and non-axillary lymph node metastasis group according to routine pathological outcome after surgery. Detect the situation of expression of p53 protein in cancer tissue using immunohistochemical method. The rate of expression of p53 protein between axillary lymph node metastasis group and non-axillary lymph node metastasis group were compared by χ2 test. At the same time, the relationship between the expression of p53 protein in breast cancer tissue and the age, the longest tumor diameter and tumor TNM stage was analyzed.

Result

The rate of expression of p53 protein was 60.78%, 43.02% in the axillary lymph node metastasis group and non-axillary lymph node metastasis group respectively. The difference was statistically significant (χ2 = 4.040, P = 0.044＜0.05). The expression of p53 protein in breast cancer tissue was of no relationship with age (P = 0.945＞0.05),the longest tumor diameter (P = 0.200＞0.05) and tumor TNM stage (P = 0.300 > 0.05).

Conclusion

There was a close relationship between expression of p53 protein in breast cancer tissue and axillary lymph node metastasis, and it can be regard as a predictive factor in the axillary lymph node status.

目的探讨p53蛋白在乳腺癌癌组织中的表达情况，分析p53蛋白表达阳性率与腋窝淋巴结状态的关系。方法选择2023年6月至2023年10月解放军总医院收治的乳腺癌患者137例，根据术后常规病理结果分为腋窝淋巴结转移组和非腋窝淋巴结转移组。采用免疫组化方法检测癌组织中p53蛋白的表达情况。腋窝淋巴结转移组与非腋窝淋巴结转移组p53蛋白表达率比较，采用χ2检验。同时分析乳腺癌组织中p53蛋白的表达与年龄、肿瘤最长直径、肿瘤TNM分期的关系。结果p53蛋白在腋窝淋巴结转移组和非腋窝淋巴结转移组的表达率分别为60.78%和43.02%。差异有统计学意义（χ2 = 4.040, P = 0.044<0.05）。乳腺癌组织中p53蛋白的表达与年龄（P = 0.945>0.05）、肿瘤最长直径（P = 0.200>0.05）、肿瘤TNM分期(P = 0.300 >；0.05)。结论乳腺癌组织中p53蛋白表达与腋窝淋巴结转移密切相关，可作为腋窝淋巴结状态的预测因素。

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