Surgical Oncology Insight最新文献_第3页

Intraoperative carcinoid crisis in NET operations – Eluding Dogma with current understanding NET手术中的术中类癌危象-目前理解的回避教条

Surgical Oncology Insight

Pub Date : 2025-11-21 DOI: 10.1016/j.soi.2025.100198

Lucas W. Meuchel , Rodney F. Pommier

引用次数: 0

Neoadjuvant chemotherapy in patients ≥70 with node-positive triple negative breast cancer ≥70例淋巴结阳性三阴性乳腺癌患者的新辅助化疗

Surgical Oncology Insight

Pub Date : 2025-10-23 DOI: 10.1016/j.soi.2025.100196

Anjali Chhugani , Carolyn Silverman , Brienne Donovan , Richard J. Bleicher , Melissa McShane , Austin D. Williams

Background

Neoadjuvant chemotherapy (NAC) is less frequently administered in patients > 70 years with triple negative breast cancer (TNBC) due to age-related comorbidity and fragility concerns. This study assesses trends and clinical benefit of NAC among clinically node-positive (cN+) patients.

Methods

We identified females ≥ 70 in the National Cancer Database with cN+ nonmetastatic TNBC who underwent surgery from 2012 to 2021. Surgical approach, pathologic tumor and nodal stage, trends in NAC use, and rates of pathologic complete response (pCR) were used to assess the benefit of NAC.

Results

Of 4598 patients, 2377 (51.7 %) received NAC, 1210 (26.3 %) received adjuvant chemotherapy alone (AC), and 1101 (22.0 %) received no chemotherapy. Rates of NAC increased from 29 % to 75 % (p < 0.001). NAC was more common in younger patients with larger tumors and those treated at academic institutions (p < 0.05). NAC patients were more likely to avoid axillary lymph node dissection (31 %, AC: 18 %, none: 15 %, p < 0.001). Among NAC patients, 22 % had no response to NAC, 32 % a breast pCR, 46 % nodal a pCR and 25 % pCR in both. 7 % of patients had breast pCR but remained pN+ . Overall survival (OS) did not differ between NAC and AC patients but was better than those without chemotherapy (107.6 vs. 98.2 vs. 32.6 months, respectively). Achieving breast, axillary, or total pCR was associated with improved OS in NAC patients.

Conclusion

While specific chemotherapy regimens, dose reductions, and adverse events were unable to be evaluated, clinically fit patients should be counseled on NAC as an option given the potential for clinical benefit.

新辅助化疗（NAC）较少用于>； 70岁三阴性乳腺癌（TNBC）患者，由于年龄相关的共病和脆弱性问题。本研究评估临床淋巴结阳性（cN+）患者NAC的趋势和临床获益。方法在2012年至2021年间接受手术的cN+ 非转移性TNBC患者中，我们在国家癌症数据库中筛选出≥ 70的女性。采用手术入路、病理肿瘤和淋巴结分期、NAC使用趋势和病理完全缓解率（pCR）来评估NAC的益处。结果4598例患者中，2377例（51.7 %）接受NAC， 1210例（26.3 %）单独接受辅助化疗（AC）， 1101例（22.0 %）未接受化疗。NAC的发生率从29 %增加到75 % （p <； 0.001）。NAC在较大肿瘤的年轻患者和在学术机构接受治疗的患者中更为常见（p <； 0.05）。NAC患者更有可能避免腋窝淋巴结清扫（31 %,AC: 18 %，无：15 %，p <； 0.001）。NAC患者中，22 %对NAC无反应，32 %对乳腺pCR无反应，46 %对淋巴结pCR无反应，25 %对两者均无反应。7 %的患者有乳房pCR，但仍为pN+ 。NAC和AC患者的总生存期（OS）没有差异，但优于未化疗的患者（分别为107.6个月、98.2个月和32.6个月）。获得乳房、腋窝或总pCR与NAC患者OS改善相关。结论：虽然无法评估具体的化疗方案、剂量减少和不良事件，但考虑到潜在的临床获益，临床适合的患者应建议NAC作为一种选择。

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引用次数: 0

Comparative survival analysis of gallbladder neuroendocrine carcinoma and adenocarcinoma following radical surgery: A secondary analysis of the multicenter Algerian GBC group study 胆囊神经内分泌癌和腺癌根治性手术后的比较生存分析：阿尔及利亚多中心GBC组研究的二次分析

Surgical Oncology Insight

Pub Date : 2025-10-03 DOI: 10.1016/j.soi.2025.100195

Anisse Tidjane , Chafik Bouzid , Salah Berkane , Nabil Boudjenan Serradj , Khelifa Bendjebbar , Bouabdellah Krelil , Zineddine Djilli , Allel Sahli , Rezki Touati , Redha Bouzitouna , Smail Ammari , Omar Bafdel , Zaki Boudiaf , Nacim Ikhlef , Meriem Dehal , Ramzi Graichi , Ali Benazza , Saadoun Bendjabellah , N. Bahache , Mohand Kheloufi , Kamal Bentabak

Background and objectives

Gallbladder cancer (GBC) is the most common biliary malignancy, with adenocarcinoma (GB-ADK) being predominant. Gallbladder neuroendocrine carcinoma (GB-NEC) is rare, and its prognosis after R0 surgical resection remains unclear. This study compares survival outcomes after curative surgery between GB-ADK and GB-NEC.

Methods

This retrospective, multicenter national study included patients who underwent R0 resection for GBC in Algeria (2000–2021). Demographic, clinical, pathological, and treatment-related data were analysed. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier and log-rank tests.

Results

Eleven centres participated and 1061 patients were included (1049 GB-ADK, 12 GB-NEC); incidental GBC was more frequent in the GB-ADK group (45.6 % vs. 8.3 %; p = 0.016). CEA elevation was higher in the GB-NEC group (25 % vs. 7.2 %; p = 0.020). GB-NEC exhibited more advanced stages and greater perineural/vascular invasion, though not statistically significant. Adjuvant chemotherapy was more frequently administered in the GB-NEC group (66.7 % vs. 29.2 %, p = 0.008). No significant differences were observed in OS (p = 0.222) or DFS (p = 0.269) between GB-ADK and GB-NEC groups.

Conclusion

Despite a more aggressive presentation, GB-NEC did not show worse survival than GB-ADK after curative surgery. Larger studies are needed to confirm these results.

背景与目的胆囊癌（GBC）是最常见的胆道恶性肿瘤，以腺癌（GB-ADK）为主。胆囊神经内分泌癌（GB-NEC）是罕见的，其R0手术切除后的预后尚不清楚。这项研究比较了GB-ADK和GB-NEC在根治性手术后的生存结果。方法：这项回顾性、多中心的国家研究纳入了阿尔及利亚（2000-2021年）接受R0切除术的GBC患者。对人口统计学、临床、病理和治疗相关资料进行分析。采用Kaplan-Meier和log-rank检验评估总生存期（OS）和无病生存期（DFS）。结果纳入6个中心，共纳入1061例患者（1049 GB-ADK, 12 GB-NEC）；偶发GBC在GB-ADK组更为常见（45.6% % vs. 8.3 %;p = 0.016）。GB-NEC组CEA升高较高（25 % vs. 7.2 %;p = 0.020）。GB-NEC表现出更晚期的阶段和更大的神经/血管浸润，尽管没有统计学意义。在GB-NEC组中，辅助化疗的使用频率更高（66.7 % vs 29.2 %,p = 0.008）。GB-ADK组和GB-NEC组的OS （p = 0.222）和DFS （p = 0.269）差异无统计学意义。结论尽管表现更具侵袭性，但GB-NEC在根治性手术后的生存率并不比GB-ADK差。需要更大规模的研究来证实这些结果。

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引用次数: 0

Taiwan expert consensus on the clinical integration of antibody-drug conjugates in advanced breast cancer 台湾专家共识：抗体-药物结合物治疗晚期乳腺癌

Surgical Oncology Insight

Pub Date : 2025-09-25 DOI: 10.1016/j.soi.2025.100193

Li-Chun Kao , Chih-Yi Hsu , Ming-Yang Wang , Ming-Han Yang , Chin-Sheng Hung , Guo-Shiou Liao , Kuo-Ting Lee , Wen-Ling Kuo , Meng-Ting Peng , Wei-Pang Chung , Chih-Hao Huang , Shou-Tung Chen , Chi-Cheng Huang , Yen-Shen Lu , Chun-Yu Liu

Background

Antibody–drug conjugates (ADCs) have emerged as potent targeted therapies in advanced breast cancer, offering new options across HER2-positive, HR-positive/HER2-negative, and triple-negative subtypes. To address the rapidly evolving evidence, the Taiwan Breast Cancer Society (TBCS) convened an expert panel to develop consensus guidelines for integrating ADCs into clinical practice.

Methods

A multidisciplinary panel conducted systematic literature review and iterative discussions, identifying nine key topics. They formulated 31 consensus statements, graded by level of evidence and strength of recommendation, all of which reached ≥ 85 % agreement.

Results

Trastuzumab deruxtecan (T-DXd) is recommended as the preferred second-line treatment for HER2-positive metastatic breast cancer, with T-DM1 as an alternative when T-DXd is unavailable. T-DXd retains efficacy in HER2-low disease and brain metastases. In HR-positive/HER2-negative MBC, both T-DXd and sacituzumab govitecan (SG) improve outcomes after endocrine therapy and CDK4/6 inhibitors, regardless of HER2-low (IHC 1 +/2 +) or IHC 0 status. In triple-negative breast cancer, SG offers significant survival benefit in refractory cases. There is currently no evidence supporting routine sequential use of multiple ADCs.

Conclusions

The TBCS guideline provides practical recommendations for integrating ADCs into the treatment of advanced breast cancer based on current evidence. It supports biomarker-guided agent selection across subtypes and highlights the need for continued research on sequencing strategies and optimal clinical positioning.

抗体-药物偶联物（adc）已成为晚期乳腺癌的有效靶向治疗方法，为her2阳性、hr阳性/ her2阴性和三阴性亚型提供了新的选择。为了应对快速发展的证据，台湾乳腺癌协会（TBCS）召集了一个专家小组，以制定将adc纳入临床实践的共识指南。方法一个多学科小组进行了系统的文献回顾和反复讨论，确定了9个关键主题。他们制定了31项共识声明，按证据水平和推荐强度分级，所有声明均达到≥ 85 %的一致性。结果strastuzumab deruxtecan （T-DXd）被推荐为her2阳性转移性乳腺癌的首选二线治疗，当T-DXd不可用时，T-DM1可作为替代方案。T-DXd在her2低水平疾病和脑转移中保持疗效。在hr阳性/ her2阴性的MBC中，T-DXd和sacituzumab govitecan （SG）均可改善内分泌治疗和CDK4/6抑制剂后的预后，无论her2低（IHC 1 +/2 +）或IHC 0状态。在三阴性乳腺癌中，SG在难治性病例中提供了显著的生存益处。目前没有证据支持常规顺序使用多个adc。结论：基于现有证据，TBCS指南提供了将adc纳入晚期乳腺癌治疗的实用建议。它支持生物标志物引导的跨亚型药物选择，并强调了继续研究测序策略和最佳临床定位的必要性。

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引用次数: 0

HOXA13 overexpression is associated with poor prognosis in colorectal liver metastases HOXA13过表达与结直肠肝转移患者预后不良相关

Surgical Oncology Insight

Pub Date : 2025-09-25 DOI: 10.1016/j.soi.2025.100194

David G. Su , Vadim Kurbatov , Xujun Wang , Zhaoshi Zeng , Philip B. Paty , Caroline H. Johnson , Jun Lu , Sajid A. Khan

Curative-intent hepatectomy in colorectal cancer liver metastasis (CRCLM) is guided by clinical criteria; however, molecular biomarkers may enhance prognostication. Homeobox (HOX) gene family is often dysregulated in cancer and may serve as a prognostic tool in metastatic colorectal cancer. Bulk RNA extraction was performed in frozen colorectal liver tumors (N = 39), and differentially expressed HOX genes using clinical risk scores were studied using supervised hierarchical clustering. In sum, 667 differentially expressed genes were found (p < 0.05), including multiple HOXA and HOXD family genes (p < 0.01; q<0.01). Three long non-coding RNA species (lncRNAs) were differentially expressed: HOTTIP, HOXA-AS5, and HOXD-AS2 (p < 0.01; q<0.01). HOXA13 and HOTTIP were more likely to be expressed in patients with metastatic recurrence (log-rank p = 0.004). A composite HOX score was found to be predictive of OS and RFS (log-rank p = 0.0269 and 0.0273, respectively). HOXA13, HOXD4, and HOXD8 were explored in five independent cohorts. HOX genes and their associated lncRNAs exhibit prognostic associations in patients with CRCLM and may act as biomarkers to refine clinical decision-making.

结肠直肠癌肝转移（CRCLM）的治疗目的肝切除术以临床标准为指导；然而，分子生物标志物可以提高预后。同源盒（HOX）基因家族在癌症中经常失调，可能作为转移性结直肠癌的预后工具。冷冻结直肠癌肝肿瘤（N = 39）进行大量RNA提取，并使用有监督的分层聚类方法研究使用临床风险评分的差异表达HOX基因。共发现667个差异表达基因（p <； 0.05），包括多个HOXA和HOXD家族基因（p <； 0.01;q<0.01）。HOTTIP、HOXA-AS5和HOXD-AS2三种长链非编码RNA （lncRNAs）差异表达（p <； 0.01;q<0.01）。HOXA13和HOTTIP更可能在转移性复发患者中表达（log-rank p = 0.004）。综合HOX评分可预测OS和RFS （log-rank p = 0.0269和0.0273）。在5个独立队列中研究HOXA13、HOXD4和HOXD8。HOX基因及其相关lncrna在CRCLM患者中表现出预后相关性，并可能作为生物标志物来完善临床决策。

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引用次数: 0

An overview of current immunotherapy approaches for treating gastrointestinal cancers 目前治疗胃肠道肿瘤的免疫治疗方法综述

Surgical Oncology Insight

Pub Date : 2025-09-19 DOI: 10.1016/j.soi.2025.100191

Arushi Ramaka, Arvind Rajan, Ashwin Somasundaram

Gastrointestinal (GI) cancers, account for a substantial proportion of global cancer cases and deaths, and present significant therapeutic challenges. Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has transformed the treatment landscape, and offered improved outcomes for patients presenting with various gastrointestinal malignancies. For esophageal cancer, trials like CheckMate 577, KEYNOTE 590, 811, and MATTERHORN have demonstrated improved benefit with ICIs. Pancreatic cancer, characterized by its immunologically "cold" microenvironment, has shown limited response to immunotherapy. However, strategies that combine immune checkpoint inhibitors with chemotherapy have shown some early results. In colorectal cancer, microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) tumors exhibit strong responses to ICIs, while ongoing trials aim to refine treatment for microsatellite-stable (MSS) cases. For hepatocellular carcinoma (HCC), immunotherapy combinations are regarded as a first-line treatment due to its efficacy over traditional chemotherapy. Cholangiocarcinoma (CCA) lacks pre-surgical tumor reduction options and neoadjuvant therapies, but the results of TOPAZ-1 showed that a combination of durvalumab, gemcitabine, and cisplatin improved overall survival in the advanced setting. Lastly, immunotherapy is emerging as a viable option for advanced forms of anal cancer, with trials exploring checkpoint inhibitors and adoptive cell therapies. Despite the progress, challenges such as tumor heterogeneity and immunosuppressive microenvironments necessitate ongoing research to optimize immunotherapeutic strategies.

Synopsis

Immunotherapy has revolutionized gastrointestinal cancer treatment, with immune checkpoint inhibitors showing promise in esophageal, colorectal, and hepatobiliary cancers. However, challenges including tumor heterogeneity and immunosuppressive microenvironments persist. This manuscript highlights advancements, limitations, and future strategies in integrating immunotherapy across diverse gastrointestinal malignancies, emphasizing the need for innovative approaches to optimize outcomes.

胃肠道（GI）癌症占全球癌症病例和死亡的很大比例，并提出了重大的治疗挑战。免疫疗法，特别是免疫检查点抑制剂（ICIs），已经改变了治疗前景，并为各种胃肠道恶性肿瘤患者提供了改善的结果。对于食管癌，CheckMate 577、KEYNOTE 590、811和MATTERHORN等试验都证明了使用ICIs可以改善疗效。胰腺癌的特点是其免疫“冷”微环境，对免疫治疗的反应有限。然而，将免疫检查点抑制剂与化疗相结合的策略已经显示出一些早期结果。在结直肠癌中，微卫星不稳定-高/缺陷错配修复（MSI-H/dMMR）肿瘤对ICIs表现出强烈的反应，而正在进行的试验旨在改进微卫星稳定（MSS）病例的治疗方法。对于肝细胞癌（HCC），免疫联合治疗因其优于传统化疗而被视为一线治疗。胆管癌（CCA）缺乏术前肿瘤减少选择和新辅助治疗，但TOPAZ-1的结果显示，杜伐单抗、吉西他滨和顺铂联合治疗可提高晚期患者的总生存率。最后，免疫疗法正在成为晚期肛门癌的可行选择，试验探索检查点抑制剂和过继细胞疗法。尽管取得了进展，但肿瘤异质性和免疫抑制微环境等挑战需要持续研究以优化免疫治疗策略。免疫疗法已经彻底改变了胃肠道癌症的治疗，免疫检查点抑制剂在食管癌、结直肠癌和肝胆癌中显示出前景。然而，包括肿瘤异质性和免疫抑制微环境在内的挑战仍然存在。本文强调了在多种胃肠道恶性肿瘤中整合免疫治疗的进展、局限性和未来策略，强调需要创新方法来优化结果。

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引用次数: 0

Facilitators to oncological care in foregut cancer: The patient perspective 前肠癌肿瘤护理的促进因素：患者的观点

Surgical Oncology Insight

Pub Date : 2025-09-17 DOI: 10.1016/j.soi.2025.100192

Jaspinder S. Sanghera , Michelle M. Holland , Ioannis Liapis , Rida Ahmad , Katie West , Manish Tripathi , Larry Hearld , Daniel I. Chu , Krista Mehari , Martin J. Heslin , Smita Bhatia , Annabelle L. Fonseca

Background

Foregut cancers are best treated by specialized, multidisciplinary care, often delivered, at least in part, at tertiary centers. Patient perspectives on the factors that enhance access to and adherence to cancer treatment remain underexplored. This qualitative study explores patient-reported facilitators of care at a safety-net hospital in the Southeastern United States (US).

Methods

Patients with foregut cancer receiving care at a safety-net tertiary care institution in the Southeastern US were recruited. Interviews were recorded, transcribed, and analyzed using NVivo 14 Software. Grounded theory methodology was used to identify themes and subthemes. A comprehensive codebook was established, with a high interrater reliability rate of > 90 % for all themes.

Results

Of the 30 patients interviewed, the majority were male (n = 23, 77 %) and Black (n = 18, 60 %), with an average age of 63 (IQR: 55–67). Facilitator themes were identified across four categories: (1) Individual/Interpersonal; (2) Provider/Care Team; (3) Healthcare Systems, and (4) Broader Policy. The most prevalent facilitators identified included faith and spirituality (87 %), support from immediate family (83 %), trust in the care team (90 %), and effective communication (97 %).

Conclusion

Understanding patient perspectives is essential for delivering high-quality care in foregut cancer. These facilitators should be actively promoted during the development of future interventions. An appreciation of patient beliefs, communication training for care providers, hiring necessary ancillary staff, use of written handouts, expanding financial aid services, and wider healthcare reform are all avenues to explore in the ongoing effort to improve comprehensive oncological care for patients.

背景：前肠癌最好的治疗方法是专业的、多学科的治疗，通常至少部分在三级中心进行。患者对提高获得和坚持癌症治疗的因素的看法仍未得到充分探讨。本定性研究探讨了美国东南部一家安全网医院患者报告的护理促进者。方法招募在美国东南部一家安全网三级医疗机构接受治疗的前肠癌患者。使用NVivo 14软件对访谈进行记录、转录和分析。采用扎根理论方法确定主题和副主题。建立了一个全面的码本，所有主题的判读信度均为>； 90 %。结果30例受访患者中，男性居多（n = 23,77 %），黑人居多（n = 18,60 %），平均年龄63岁（IQR: 55 ~ 67）。引导者主题分为四个类别：(1)个人/人际；(2)提供者/护理团队；(3)医疗保健系统，(4)更广泛的政策。最普遍的促进因素包括信仰和灵性（87% %）、直系亲属的支持（83% %）、对护理团队的信任（90% %）和有效的沟通（97% %）。结论了解患者的观点对提供高质量的前肠癌治疗至关重要。在制定今后的干预措施时，应积极促进这些促进因素。了解患者的信念，对护理人员进行沟通培训，雇用必要的辅助人员，使用书面讲义，扩大财政援助服务，以及更广泛的医疗改革，这些都是正在进行的努力中探索的途径，以改善对患者的综合肿瘤护理。

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引用次数: 0

The use of neoadjuvant immunotherapy may be associated with increased surgical complications In women with triple-negative breast cancer 在三阴性乳腺癌患者中，新辅助免疫治疗的使用可能与手术并发症的增加有关

Surgical Oncology Insight

Pub Date : 2025-09-08 DOI: 10.1016/j.soi.2025.100190

Danielle Graham , Ariana Kassam , Yuan Yuan , Rhea Rahim , Alisa Blumenthaler , Marissa K. Boyle , Alice Chung , Armando Giuliano , Farin Amersi

引用次数: 0

Age and muscle measures predict benefit of surgery in locally-advanced adenocarcinoma of the esophagus 年龄和肌肉测量预测局部晚期食管腺癌手术的益处

Surgical Oncology Insight

Pub Date : 2025-09-05 DOI: 10.1016/j.soi.2025.100189

V.Christian Sanderfer , Ansley B. Ricker , Alexis M. Holland , Erin E. Donahue , Reilly E. Shea , Nicholas Mullis , Sophia Bellavia , Ella Schwarzen , M.Hart Squires , Roshan S. Prabhu , Kunal C. Kadakia , Jonathan C. Salo

Background

Optimal therapy for locally-advanced adenocarcinoma (ACA) of the esophagus has been chemoradiation followed by surgery (ChemoRT + Surgery), yet the morbidity of surgery is substantial. Computed tomography (CT)-derived body composition measures and age were used to categorize patients into perioperative surgical mortality risk groups. The survival benefit of adding surgery to ChemoRT was examined after stratification by risk group.

Methods

CT scans were analyzed to calculate skeletal muscle gauge (SMG). A predictive model of 90-day surgical mortality was constructed based upon age and SMG. Patients were classified into low-risk (bottom 75 %) and high-risk (top 25 %) groups based on their predicted probability of 90-day mortality. Log-rank tests were used to compare overall survival by treatment (ChemoRT vs ChemoRT + Surgery) in both risk groups.

Results

Of 330 patients with locally-advanced ACA treated with chemoradiation, 262 (79.4 %) underwent ChemoRT + Surgery and 90-day postoperative mortality was 5.7 %. Among 247 low-risk patients, 217 (87.9 %) underwent ChemoRT + Surgery and median overall survival was longer compared to ChemoRT alone (40.6mo [95 % CI 31.4, 55.5] vs. 16.8mo [95 % CI 11.8, 29.3], p < 0.01). Among 83 high-risk patients, 45 (54.2 %) underwent ChemoRT + Surgery without a significant difference in overall survival vs ChemoRT alone (23.0mo [95 % CI 14.7, 51.1] vs. 27.4mo [95 % CI 17.2, 32.9], p = 0.60).

Conclusions

Low-risk patients with esophageal ACA have a survival benefit with ChemoRT + Surgery compared to ChemoRT alone. Conversely, we did not see a survival benefit with ChemoRT + Surgery in high-risk patients. Measurement of body composition and age identify a high-risk subset of patients who may not benefit from surgery after chemoradiation.

背景：食道局部晚期腺癌（ACA）的最佳治疗方法是化疗后手术（ChemoRT + surgery），但手术的发病率很高。使用计算机断层扫描（CT）得出的身体成分测量和年龄将患者分为围手术期死亡风险组。在危险组进行分层后，对化疗ort加手术的生存获益进行了检查。方法分析sct扫描结果，计算骨骼肌测量值（SMG）。建立基于年龄和SMG的90天手术死亡率预测模型。根据患者90天死亡率的预测概率，将患者分为低危组（最低75 %）和高危组（最高25 %）。Log-rank检验用于比较两个危险组的治疗总生存率（ChemoRT vs ChemoRT +手术）。结果330例局部晚期ACA患者接受放化疗，262例（79.4% %）接受化疗+ 手术，术后90天死亡率为5.7% %。在247名低危患者中，217名（87.9% %）接受了ChemoRT + 手术，中位总生存期比单独化疗更长（40.6个月[95 % CI 31.4, 55.5]比16.8个月[95 % CI 11.8, 29.3], p <； 0.01）。在83例高危患者中，45例（54.2 %）接受了ChemoRT + 手术，与单独化疗相比，总生存率无显著差异（23.0个月[95 % CI 14.7, 51.1]对27.4个月[95 % CI 17.2, 32.9], p = 0.60）。结论与单纯化疗相比，化疗ort + 手术对慢危食管ACA患者有生存优势。相反，我们没有看到高危患者使用ChemoRT + 手术的生存获益。身体成分和年龄的测量确定了可能无法从放化疗后手术中获益的高危患者亚群。

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引用次数: 0

Supporting the PACT Act: Top cancers diagnosed in young veterans who deployed to Iraq and Afghanistan 支持PACT法案：在被派往伊拉克和阿富汗的年轻退伍军人中诊断出的最高癌症

Surgical Oncology Insight

Pub Date : 2025-09-05 DOI: 10.1016/j.soi.2025.100188

Robert W.C. Young , James E. Duncan , Vance Y. Sohn

Introduction

In 2022, the PACT Act expanded Veterans Affairs healthcare benefits for Veterans with cancers related to toxic exposures encountered during their military service. However, evidence linking toxic exposures to cancer development remains incomplete. This study confronts this gap by identifying the most common cancers in young Veterans who served in Iraq and Afghanistan. Veteran cancer rates were compared to the National Cancer Institute’s SEER database of cancers in young adults to uncover patterns that may reveal a hidden legacy of toxic exposure.

Methods

The VA Informatics and Computing Infrastructure (VINCI) database was used to build a retrospective cohort of Veterans ages 18–39 who served in Iraq and Afghanistan and were diagnosed with cancer between 2017 and 22. The findings were compared to the 2024 SEER report on cancer incidence in young adults, ages 15–39. Data analysis was performed in Microsoft Excel.

Results

Among young male Veterans, the most diagnosed cancers were testicular (20.8 %), melanoma (13.3 %), brain tumors (9.7 %), lymphoma (9.5 %), and thyroid (8.7 %). Among young female Veterans, the most common cancers were breast (25.3 %), cervical (18.8 %), thyroid (15.8 %), melanoma (10.5 %), and brain tumors (6.9 %). Male Veterans had double the relative incidence (RI) of melanoma (13.3 % vs 6.5 % in SEER, RI 2.1), and female Veterans had almost triple the relative incidence of cervical cancer (18.8 % vs 6.6 %, RI 2.8).

Conclusions

Young Veterans who served in Iraq and Afghanistan face alarming rates of melanoma and cervical cancer. These findings may represent a broader, service-connected health crisis yet to be fully understood.

Synopsis

This study defines the top cancers diagnosed in young (ages 18–39-year-old) Veterans who deployed to Iraq and/or Afghanistan. It finds double the relative incidence of melanoma in male Veterans and nearly triple the relative incidence of cervical cancer in female Veterans.

2022年，PACT法案扩大了退伍军人事务医疗保健福利，适用于患有与服兵役期间接触有毒物质有关的癌症的退伍军人。然而，将有毒物质暴露与癌症发展联系起来的证据仍然不完整。这项研究通过确定在伊拉克和阿富汗服役的年轻退伍军人中最常见的癌症来弥补这一差距。研究人员将退伍军人的癌症发病率与美国国家癌症研究所（National cancer Institute）的SEER数据库中年轻人的癌症发病率进行了比较，以发现可能揭示有毒暴露的隐藏遗产的模式。方法采用美国退伍军人管理局信息与计算基础设施（VINCI）数据库，对2017年至22年间在伊拉克和阿富汗服役并被诊断患有癌症的18-39岁退伍军人进行回顾性研究。研究结果与2024年SEER关于15-39岁年轻人癌症发病率的报告进行了比较。数据分析在Microsoft Excel中进行。结果在年轻男性退伍军人中，诊断出最多的癌症是睾丸癌（20.8% %）、黑色素瘤（13.3% %）、脑肿瘤（9.7 %）、淋巴瘤（9.5 %）和甲状腺癌（8.7 %）。在年轻女性退伍军人中，最常见的癌症是乳腺癌（25.3% %）、宫颈癌（18.8% %）、甲状腺癌（15.8% %）、黑色素瘤（10.5 %）和脑肿瘤（6.9 %）。男性退伍军人黑色素瘤的相对发病率（RI）是前者的两倍（13.3 % vs 6.5 %,RI 2.1），而女性退伍军人宫颈癌的相对发病率几乎是前者的三倍（18.8 % vs 6.6 %,RI 2.8）。结论：在伊拉克和阿富汗服役的年轻退伍军人患黑色素瘤和宫颈癌的比例惊人。这些发现可能代表着一种更广泛的、与服务相关的健康危机尚未得到充分理解。本研究定义了在伊拉克和/或阿富汗服役的年轻（18 - 39岁）退伍军人中诊断出的最高癌症。研究发现，男性退伍军人患黑色素瘤的相对发病率是男性的两倍，女性退伍军人患宫颈癌的相对发病率是女性的近三倍。

{"title":"Supporting the PACT Act: Top cancers diagnosed in young veterans who deployed to Iraq and Afghanistan","authors":"Robert W.C. Young , James E. Duncan , Vance Y. Sohn","doi":"10.1016/j.soi.2025.100188","DOIUrl":"10.1016/j.soi.2025.100188","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022, the PACT Act expanded Veterans Affairs healthcare benefits for Veterans with cancers related to toxic exposures encountered during their military service. However, evidence linking toxic exposures to cancer development remains incomplete. This study confronts this gap by identifying the most common cancers in young Veterans who served in Iraq and Afghanistan. Veteran cancer rates were compared to the National Cancer Institute’s SEER database of cancers in young adults to uncover patterns that may reveal a hidden legacy of toxic exposure.</div></div><div><h3>Methods</h3><div>The VA Informatics and Computing Infrastructure (VINCI) database was used to build a retrospective cohort of Veterans ages 18–39 who served in Iraq and Afghanistan and were diagnosed with cancer between 2017 and 22. The findings were compared to the 2024 SEER report on cancer incidence in young adults, ages 15–39. Data analysis was performed in Microsoft Excel.</div></div><div><h3>Results</h3><div>Among young male Veterans, the most diagnosed cancers were testicular (20.8 %), melanoma (13.3 %), brain tumors (9.7 %), lymphoma (9.5 %), and thyroid (8.7 %). Among young female Veterans, the most common cancers were breast (25.3 %), cervical (18.8 %), thyroid (15.8 %), melanoma (10.5 %), and brain tumors (6.9 %). Male Veterans had double the relative incidence (RI) of melanoma (13.3 % vs 6.5 % in SEER, RI 2.1), and female Veterans had almost triple the relative incidence of cervical cancer (18.8 % vs 6.6 %, RI 2.8).</div></div><div><h3>Conclusions</h3><div>Young Veterans who served in Iraq and Afghanistan face alarming rates of melanoma and cervical cancer. These findings may represent a broader, service-connected health crisis yet to be fully understood.</div></div><div><h3>Synopsis</h3><div>This study defines the top cancers diagnosed in young (ages 18–39-year-old) Veterans who deployed to Iraq and/or Afghanistan. It finds double the relative incidence of melanoma in male Veterans and nearly triple the relative incidence of cervical cancer in female Veterans.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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