Surgical Oncology Insight最新文献_第6页

Evolving patterns of metastatic spread, treatment, and outcome for patients with oligometastatic colorectal cancer 寡转移性结直肠癌患者转移扩散、治疗和预后的演变模式

Surgical Oncology Insight

Pub Date : 2024-07-04 DOI: 10.1016/j.soi.2024.100076

Helen Pham , Sangeetha Ramanujam , Hui-Ling Yeoh , Phillip Antippa , Nezor Houli , Ben Thomson , Suzanne Kosmider , Catherine Dunn , Yat Hang To , Margaret Lee , Vanessa Wong , Susan Caird , Jeremy Shapiro , Matthew Burge , Hui-Li Wong , Brigette Ma , Stephanie Hui-Su Lim , Javier Torres , Belinda Lee , Marty Smith , Peter Gibbs

Introduction

The assessment and management of oligometastatic colorectal cancer has evolved over the last two decades. We aimed to examine trends in the presentation, management and outcomes of patients presenting with liver-only disease, given recent changed standards for baseline imaging, and evolving definitions of resectability. Patients with lung-only disease can provide a contemporaneous control group.

Methods

Prospectively maintained data from the multi-site Treatment of Recurrent and Advanced Colorectal Cancer Registry were reviewed over three consecutive periods; 2009–2013, 2014–2018, and 2019–2023. Survival outcomes were determined by Kaplan-Meier method.

Results

Of 4613 patients with metastatic colorectal cancer, median age was 66 years (interquartile range 56–76), and 2356 (51 %) patients had a single metastatic site. Compared to the earlier periods, patients diagnosed in 2019–2023, were younger, had better ECOG scores and were more likely to have three or more metastatic sites. The proportion of patients with liver-only metastases decreased over the three consecutive periods, from 32.0 % (n = 462), to 27.0 % (n = 498) to 25.9 % (n = 33), p < 0.001, however the proportion of liver-only metastases patients undergoing resection increased from 41.5 to 59.3 %, p < 0.001. The incidence and resection rate of lung-only metastases was unchanged over time.

Conclusion

The increasing number of metastatic sites and reduced number of patients with liver-only metastases is potentially explained by the increased use of FDG-PET imaging at baseline. The increased proportion of patients with liver-only disease undergoing resection may be explained by advancement in surgical techniques, improvements in systemic therapies and the evolving definition of resectable disease.

Synopsis

The pattern and treatment of metastatic colorectal cancer has evolved over the last two decades. This study examines the trends in presentation management and outcomes of patients with metastatic colorectal cancer using a multi-site database.

导言在过去二十年中，对少转移性结直肠癌的评估和管理发生了变化。鉴于基线成像标准的最新变化以及可切除性定义的不断发展，我们旨在研究单纯肝脏疾病患者的表现、管理和预后趋势。方法我们回顾了2009-2013年、2014-2018年和2019-2023年三个连续时期多站点复发和晚期结直肠癌治疗登记处的前瞻性数据。结果在4613名转移性结直肠癌患者中，中位年龄为66岁（四分位距为56-76岁），2356名患者（51%）有单一转移部位。与早期相比，2019-2023年确诊的患者更年轻，ECOG评分更高，更有可能有三个或更多转移部位。仅肝转移患者的比例在连续三个时期内有所下降，从32.0%（n = 462）到27.0%（n = 498）再到25.9%（n = 33），p <0.001，然而接受切除术的仅肝转移患者的比例从41.5%增加到59.3%，p <0.001。结论转移部位的增加和仅肝转移患者人数的减少可能是由于基线时更多地使用了 FDG-PET 成像。手术技术的进步、系统疗法的改进以及可切除疾病定义的不断发展，可能是导致接受切除术的仅肝转移患者比例增加的原因。本研究利用多站点数据库研究了转移性结直肠癌患者的治疗和预后趋势。

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引用次数: 0

Impact of irreversible electroporation on survival among patients with borderline resectable/locally advanced pancreatic cancer: A single center experience 不可逆电穿孔术对边缘可切除/局部晚期胰腺癌患者生存期的影响：单中心经验

Surgical Oncology Insight

Pub Date : 2024-07-04 DOI: 10.1016/j.soi.2024.100075

Mohammed O. Suraju , Yutao Su , Jeremy Chang , Aditi Katwala , Apoorve Nayyar , Darren M. Gordon , Scott K. Sherman , Hisakazu Hoshi , James R. Howe , Carlos H.F. Chan

Background

The use of Irreversible Electroporation (IRE) in borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) is increasing. However, its potential impact on survival has been debated. We hypothesized that addition of IRE to the conventional multimodal therapy would be associated with improved overall survival (OS) in BR/LA PDAC patients.

Methods

Among patients received neoadjuvant chemotherapy, we identified PDAC patients with BR/LA disease who underwent resection alone, resection+IRE, IRE alone, and no resection but would have been eligible for IRE. Kaplan-Meier method with Peto-Peto modified log-rank test and Cox proportional hazard were used in survival analyses.

Results

102 patients were included in the cohort – 40 resection-only (18 % LA), 13 resection+IRE (46 % LA), 14 IRE-only (93 % LA), and 35 unresected (77 % LA). Median age was 65. IRE patients had a median follow-up of 22 months [95 %CI:14–28], while for non-IRE patients it was 17 months [95 %CI:12–26]. Median age and proportion without comorbidities did not significantly differ across groups. Median OS was 30 months [95 %CI:30-NR] among patients who underwent resection+IRE, 27 months [95 %CI:23–48] for resection-only, 28 months [95 %CI:16-NR] for IRE-only, and 14 months [95 %CI:10–20] for unresected patients. In multivariable analyses, resection (HR:0.26 [95 %CI:0.13–0.54], P < 0.001), neoadjuvant chemoradiation (HR:0.50 [95 %CI:0.28–0.88], P = 0.017), and IRE (HR:0.49 [95 %CI:0.26–0.94], P = 0.03) were independently associated with decreased risk of mortality.

Conclusions

IRE may enhance survival in BR/LA PDAC patients who receive conventional multimodal therapy. Prospective studies are needed to confirm the potential benefits of IRE as an adjunct during pancreatic resection after multimodal neoadjuvant therapy for BR/LA PDAC.

Synopsis

Irreversible electroporation can be a valuable adjunct to the current multimodal therapy for treating borderline resectable and locally advanced pancreatic cancer.

背景不可逆电穿孔术（IRE）在边缘可切除（BR）和局部晚期（LA）胰腺导管腺癌（PDAC）中的应用日益增多。然而，其对存活率的潜在影响一直存在争议。在接受新辅助化疗的患者中，我们发现了患有 BR/LA 疾病的 PDAC 患者，他们分别接受了单纯切除术、切除术+IRE、单纯 IRE 以及未接受切除术但符合 IRE 治疗条件。结果102例患者被纳入队列--40例单纯切除（18% LA）、13例切除+IRE（46% LA）、14例单纯IRE（93% LA）和35例未切除（77% LA）。中位年龄为 65 岁。IRE患者的中位随访时间为22个月[95%CI:14-28]，而非IRE患者的中位随访时间为17个月[95%CI:12-26]。各组患者的中位年龄和无合并症的比例无明显差异。接受切除+IRE的患者中位OS为30个月[95 %CI:30-NR]，仅接受切除的患者为27个月[95 %CI:23-48]，仅接受IRE的患者为28个月[95 %CI:16-NR]，未接受切除的患者为14个月[95 %CI:10-20]。在多变量分析中，切除（HR:0.26 [95 %CI:0.13-0.54], P < 0.001）、新辅助化疗（HR:0.50 [95 %CI:0.28-0.88], P = 0.017）和IRE（HR:0.49 [95 %CI:0.26-0.结论IRE可提高接受常规多模式治疗的BR/LA PDAC患者的生存率。需要进行前瞻性研究，以证实 IRE 作为 BR/LA PDAC 多模式新辅助治疗后胰腺切除术的辅助手段可能带来的益处。

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引用次数: 0

A systematic review of sebaceous carcinoma of the breast from 2000–2023: A rare entity with high recurrence rates 2000-2023 年乳腺皮脂腺癌的系统回顾：复发率高的罕见病例

Surgical Oncology Insight

Pub Date : 2024-07-04 DOI: 10.1016/j.soi.2024.100074

Lauren N. Cohen , Colleen Flanagan , Amanda L. Kong , Chandler S. Cortina

Synopsis

Sebaceous carcinoma of the breast is a rare breast neoplasm with a small number of published cases. We report an updated systematic review of these cases to provide insight into the patient demographics, clinical presentation, and patient outcomes.

简介乳腺鳞状上皮癌是一种罕见的乳腺肿瘤，已发表的病例数量很少。我们对这些病例进行了最新的系统回顾，以深入了解患者的人口统计学特征、临床表现和预后。

引用次数: 0

A prospective multi-institutional trial examining the feasibility, accuracy and learning curve of fluorescence imaging for sentinel node localization in melanoma 一项前瞻性多机构试验，研究用于黑色素瘤前哨节点定位的荧光成像技术的可行性、准确性和学习曲线

Surgical Oncology Insight

Pub Date : 2024-06-27 DOI: 10.1016/j.soi.2024.100071

Colette R. Pameijer , Rogerio I. Neves , James R. Nitzkorski , Michael C. Lowe

Background

Sentinel node biopsy is a standard component of staging for patients with melanoma. Lymphoscintigraphy with technetium99 (^99mTc) is highly reliable but not patient centered, requiring a separate visit to radiology and often a painful injection. We assessed intra-operative real-time fluorescence lymphangiography as an alternative to ^99mTc for sentinel node localization in patients with extremity melanoma.

Methods

A multi-center single arm prospective trial was conducted for patients with extremity melanoma. All subjects had lymphoscintigraphy with ^99mTc prior to surgery and a dermal injection of indocyanine green in the operating room. The surgeon was blinded to the lymphoscintigraphy results and used real-time fluorescence imaging to localize the sentinel nodes. Success rate and operative times were recorded.

Results

Four surgeons enrolled 35 subjects with melanoma of the upper or lower extremity, excluding hands and feet, who met criteria for sentinel node biopsy based on NCCN guidelines. Each surgeon enrolled at least 8 subjects. The overall success rate for the first sentinel node was 83 % (29/35). The success rate varied between the axilla and groin, and between first, second and third sentinel nodes. The average time to identify the first sentinel node was 14 min, with no consistent improvement over time. There were no complications related to the ICG.

Conclusions

The success rate of sentinel node localization with indocyanine green and fluorescence imaging is high, but not high enough to use this method alone. ICG can safely replace blue dye. The learning curve for this technique is likely more than 8 patients.

Synopsis

ICG and fluorescence imaging may aid in sentinel node localization but should not replace lymphoscintigraphy with ^99mTc. ICG with fluorescence imaging can safely replace blue dye. The learning curve for this technique is at least 8 patients.

背景前哨节点活检是黑色素瘤患者分期的标准组成部分。使用锝99（99mTc）进行淋巴管造影的可靠性很高，但不是以病人为中心，需要单独到放射科就诊，而且注射时往往很痛苦。我们对四肢黑色素瘤患者术中实时荧光淋巴管造影替代 99mTc 进行前哨节点定位进行了评估。所有受试者都在手术前接受了99m锝淋巴管造影，并在手术室进行了吲哚菁绿的皮肤注射。外科医生对淋巴管造影结果是盲法，并使用实时荧光成像来定位前哨结节。结果四位外科医生共招募了35名上肢或下肢（不包括手和脚）黑色素瘤患者，他们都符合根据NCCN指南进行前哨节点活检的标准。每位外科医生至少招募了 8 名受试者。第一个前哨节点的总体成功率为 83%（29/35）。腋窝和腹股沟的成功率不同，第一个、第二个和第三个前哨结节的成功率也不同。确定第一个前哨结节的平均时间为 14 分钟，随着时间的推移没有持续性的改善。结论使用吲哚菁绿和荧光成像进行前哨节点定位的成功率很高，但还不足以单独使用这种方法。ICG 可以安全地取代蓝色染料。吲哚菁绿和荧光成像可帮助前哨节点定位，但不应取代 99mTc 淋巴闪烁成像。ICG荧光成像可以安全地取代蓝色染料。这项技术的学习曲线至少需要 8 名患者。

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引用次数: 0

Risk factors of a positive resection margin in locoregional appendix cancer and its impact on survival: The national cancer database analysis 局部阑尾癌切除边缘阳性的风险因素及其对生存的影响：国家癌症数据库分析

Surgical Oncology Insight

Pub Date : 2024-06-26 DOI: 10.1016/j.soi.2024.100072

Ekaterina Baron, Chih Ching Wu, Andrei Nikiforchin, Raquel Abengozar Mingorance, Stephanie C. Carr, Jessica A. Wernberg, Rohit Sharma

Introduction

The impact of a positive resection margin (RM+) in appendiceal cancer (AC) remains unclear, with small studies suggesting it does not worsen survival in low-grade subtypes. We aimed to evaluate RM+ rates, its risk factors, and survival outcomes across different AC histologies.

Methods

We conducted a multicenter retrospective cohort study using the National Cancer Database (2004–2019) and including stage I-III AC cases. Surgical and survival outcomes were compared between RM+ and RM- groups, with logistic regression analyzing the association of RM+ and its predictors. Subgroup analysis was performed for low/high tumor grade (LG/HG), mucinous/non-mucinous pathology (MAC/NMAC), and signet ring cell carcinoma (SRC).

Results

Among 6800 patients identified, 737 (10.8 %) had RM+, while 6063 (89.2 %) had RM-. RM+ rates varied across AC histologies: 10.9 % in LG-MAC, 17.0 % in HG-MAC, 7.8 % in LG-NMAC, 13.9 % in HG-NMAC, and 17.9 % in SRC. RM+ correlated with significantly worse survival in LG-MAC (HR 1.67), HG-MAC (HR 1.83), LG-NMAC (HR 2.04), and SRC (HR 2.37) but not in HG-NMAC after adjusting to other factors. Predictors of RM+ included pT stage, preoperative chemotherapy in LG tumors and pT stage and positive lymph nodes in HG tumors whereas more extensive resection was associated with RM- in both LG and HG.

Conclusion

RM+ worsens survival in most AC subtypes, highlighting the importance of achieving negative margins. Extensive resection, like right hemicolectomy, can improve RM- rate, but factors such as pT stage, lymph node status, and preoperative chemotherapy also affect RM+. Surgeons should prioritize achieving RM- in all AC histologies.

导言切除边缘阳性（RM+）对阑尾癌（AC）的影响仍不明确，一些小型研究表明它不会恶化低级别亚型的生存率。我们利用全国癌症数据库（2004-2019 年）开展了一项多中心回顾性队列研究，其中包括 I-III 期阑尾癌病例。比较了RM+组和RM-组的手术和生存结果，并通过逻辑回归分析了RM+与其预测因素的关联。对低/高肿瘤分级（LG/HG）、粘液性/非粘液性病理（MAC/NMAC）和标志环细胞癌（SRC）进行了亚组分析。结果在6800例已确定的患者中，737例（10.8%）为RM+，6063例（89.2%）为RM-。不同组织学的 AC RM+ 率各不相同：LG-MAC为10.9%，HG-MAC为17.0%，LG-NMAC为7.8%，HG-NMAC为13.9%，SRC为17.9%。在 LG-MAC（HR 1.67）、HG-MAC（HR 1.83）、LG-NMAC（HR 2.04）和 SRC（HR 2.37）中，RM+ 与明显较差的存活率相关，但在调整其他因素后，在 HG-NMAC 中则不相关。RM+的预测因素包括LG肿瘤的pT分期和术前化疗，以及HG肿瘤的pT分期和淋巴结阳性，而在LG和HG中，更广泛的切除与RM-有关。广泛切除（如右半结肠切除术）可提高RM-率，但pT分期、淋巴结状态和术前化疗等因素也会影响RM+。外科医生应优先考虑在所有 AC 组织学中实现 RM-。

{"title":"Risk factors of a positive resection margin in locoregional appendix cancer and its impact on survival: The national cancer database analysis","authors":"Ekaterina Baron, Chih Ching Wu, Andrei Nikiforchin, Raquel Abengozar Mingorance, Stephanie C. Carr, Jessica A. Wernberg, Rohit Sharma","doi":"10.1016/j.soi.2024.100072","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100072","url":null,"abstract":"<div><h3>Introduction</h3><p>The impact of a positive resection margin (RM+) in appendiceal cancer (AC) remains unclear, with small studies suggesting it does not worsen survival in low-grade subtypes. We aimed to evaluate RM+ rates, its risk factors, and survival outcomes across different AC histologies.</p></div><div><h3>Methods</h3><p>We conducted a multicenter retrospective cohort study using the National Cancer Database (2004–2019) and including stage I-III AC cases. Surgical and survival outcomes were compared between RM+ and RM- groups, with logistic regression analyzing the association of RM+ and its predictors. Subgroup analysis was performed for low/high tumor grade (LG/HG), mucinous/non-mucinous pathology (MAC/NMAC), and signet ring cell carcinoma (SRC).</p></div><div><h3>Results</h3><p>Among 6800 patients identified, 737 (10.8 %) had RM+, while 6063 (89.2 %) had RM-. RM+ rates varied across AC histologies: 10.9 % in LG-MAC, 17.0 % in HG-MAC, 7.8 % in LG-NMAC, 13.9 % in HG-NMAC, and 17.9 % in SRC. RM+ correlated with significantly worse survival in LG-MAC (HR 1.67), HG-MAC (HR 1.83), LG-NMAC (HR 2.04), and SRC (HR 2.37) but not in HG-NMAC after adjusting to other factors. Predictors of RM+ included pT stage, preoperative chemotherapy in LG tumors and pT stage and positive lymph nodes in HG tumors whereas more extensive resection was associated with RM- in both LG and HG.</p></div><div><h3>Conclusion</h3><p>RM+ worsens survival in most AC subtypes, highlighting the importance of achieving negative margins. Extensive resection, like right hemicolectomy, can improve RM- rate, but factors such as pT stage, lymph node status, and preoperative chemotherapy also affect RM+. Surgeons should prioritize achieving RM- in all AC histologies.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 3","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000811/pdfft?md5=bea5968875967fb0b29097f4858ba440&pid=1-s2.0-S2950247024000811-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540383","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

Increased rate of upstaging of plantar melanomas may warrant more radical treatment: Study at a single NCI-designated Cancer Center 足底黑色素瘤的上行分期率增加，可能需要更彻底的治疗：美国国家癌症研究所（NCI）指定的一家癌症中心的研究

Surgical Oncology Insight

Pub Date : 2024-06-24 DOI: 10.1016/j.soi.2024.100070

Michelle Jeffery , Vasileios Tsagkalidis , Brennan Cook , Vadim Koshenkov , Adam C. Berger

Background

Acral lentiginous melanoma holds the worst prognosis of all cutaneous melanomas. We aim to further detail the incidence of upstaging in plantar melanoma (PM) as well as identify factors associated with upstaging.

Methods

A retrospective analysis of medical records was performed of patients who underwent surgical intervention for non-metastatic primary PM at a single NCI-designated Comprehensive Cancer Center (January 2011-August 2023). The primary outcome was rate of upstaging, defined as an increase in the T-stage on final surgical pathology compared to biopsy. Clinical and pathologic staging were determined by the AJCC 8th edition. Statistical analysis included Pearson’s Chi-squared test, Fisher’s exact test, Wilcoxon rank sum test, and Kruskal-Wallis rank sum test.

Results

Forty-nine patients were identified, with an average age of 65 years (51 % male). Majority self-identified as Caucasian (55 %). Initial biopsy techniques were shave (49 %), punch (34 %) and excisional (17 %). Twenty-four patients (50 %) demonstrated upstaging. Seventy-seven percent (n = 10) of patients with clinical Tis were upstaged. Eight patients required reoperation due to upstaging, with 6 having melanoma in situ on biopsy. On multivariable logistic regression, patients with clinical Tis-T1 were more likely to be upstaged compared to T2-T3 (OR 8.75, p < 0.041). Type of biopsy, lesion size < 15 mm and positive deep margins on biopsy were not associated with risk of upstaging.

Conclusions

Our findings suggest a high incidence of upstaging of PM with no identifiable factors associated with upstaging. Patients with clinical Tis or T1 PM should undergo resection with wider margins and be strongly considered for sentinel lymph node biopsy at time of index operation.

Synopsis

In this large cohort of patients with non-metastatic primary plantar melanoma, half of the cohort was upstaged following resection. The risk was higher in patients diagnosed with Tis or T1 on biopsy compared to T2-T3. Biopsy type, lesion size < 15 mm and positive deep biopsy margins were not associated with upstaging. More radical treatment of plantar melanomas may be warranted.

背景鳞状黑色素瘤是所有皮肤黑色素瘤中预后最差的一种。我们旨在进一步详细了解足底黑色素瘤（PM）的上行分期发生率，并确定与上行分期相关的因素。方法我们对一家美国国立癌症研究院（NCI）指定的综合癌症中心（2011 年 1 月至 2023 年 8 月）中因非转移性原发性足底黑色素瘤接受手术治疗的患者的病历进行了回顾性分析。主要研究结果是上行分期率，即最终手术病理结果与活检结果相比T分期增加。临床和病理分期由 AJCC 第 8 版确定。统计分析包括皮尔逊卡方检验、费雪精确检验、Wilcoxon 秩和检验和 Kruskal-Wallis 秩和检验。大多数患者自称是白种人（55%）。最初的活检技术为刮片（49%）、打孔（34%）和切除（17%）。二十四名患者（50%）表现为上分期。在临床 Tis 患者中，77%（n = 10）的患者进行了向上分期。八名患者因上行分期而需要再次手术，其中六名患者的活检结果为原位黑色素瘤。多变量逻辑回归结果显示，与T2-T3相比，临床Tis-T1患者更有可能向上分期（OR 8.75，p <0.041）。活检类型、病变大小< 15 mm和活检深部边缘阳性与上行分期风险无关。临床表现为Tis或T1 PM的患者应接受边缘更宽的切除术，并在进行索引手术时积极考虑前哨淋巴结活检。与T2-T3相比，活检诊断为Tis或T1的患者风险更高。活检类型、病变大小< 15毫米和深部活检边缘阳性与分期上升无关。可能需要对足底黑色素瘤进行更彻底的治疗。

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引用次数: 0

Association of surgical margin on prognosis after hepatectomy for colorectal cancer liver metastases with RAS mutations RAS突变的结直肠癌肝转移灶肝切除术后手术切缘与预后的关系

Surgical Oncology Insight

Pub Date : 2024-06-24 DOI: 10.1016/j.soi.2024.100069

Takuya Tajiri, Kosuke Mima, Hiromitsu Hayashi , Yuji Miyamoto, Yuki Adachi, Takashi Ofuchi, Kosuke Kanemitsu, Toru Takematsu, Rumi Itoyama., Yuki Kitano, Shigeki Nakagawa, Hirohisa Okabe, Katsunori Imai, Hideo Baba

Background

Although outcomes of treatment for colorectal cancer liver metastases (CRLM) have improved with multidisciplinary treatment, recurrence rates after resection of liver metastases are still high. Although surgical margin (SM) is considered irrelevant in the case of R0 resection, its effectiveness is still unclear. In this study, we investigated the prognostic association of SM in CRLM according to RAS status.

Methods

Of 220 patients who had undergone initial hepatic resection for CRLM at our hospital between January 2000 and February 2020, finally, 164 remained in the study cohort. SMs (mms) were measured by macroscopic and microscopic examinations. Associations between SM, presence or absence of RAS mutations, and prognosis were analyzed using multivariate analysis with the Cox proportional hazards model.

Results

Of the 164 patients, 68 (41 %) had RAS mutations. The RAS mutation group had significantly poorer disease-free survival (DFS) (P < 0.001) and over-all survival (OS) (P < 0.001). In the RAS wild group, SM status was not significantly associated with OS or DFS, whereas in the RAS mutation group, SM< 2 mm was significantly associated with worse DFS (P = 0.014). Multivariate analysis showed that SM< 2 mm was an independent predictor of poor DFS in the RAS mutation group (HR 21.3, 95 % CI: 2.25–201.3, P = 0.008).

Conclusions

RAS mutation status is an independent predictor of poor prognosis after hepatectomy for CRLM. Especially in patients with RAS mutations, SM < 2 mm is associated with significantly worse post-hepatectomy DFS, suggesting achieving a wide SM (≥2 mm) is indicated in patients with RAS mutations

Synopsis

RAS mutation is an independent predictor of poor prognosis after hepatectomy for CRLM. Especially in patients with RAS mutations, SM < 2 mm is associated with significantly worse post-hepatectomy DFS, suggesting achieving a wide SM (≥2 mm) is indicated.

背景虽然结直肠癌肝转移（CRLM）的治疗效果在多学科治疗后有所改善，但肝转移灶切除后的复发率仍然很高。虽然手术切缘（SM）被认为与 R0 切除无关，但其有效性仍不明确。在本研究中，我们根据 RAS 状态研究了 SM 与 CRLM 预后的相关性。方法在 2000 年 1 月至 2020 年 2 月期间，我院对 220 例 CRLM 患者进行了初次肝切除术，最终有 164 例患者留在了研究队列中。通过宏观和微观检查测量了SMs（mms）。采用Cox比例危险度模型进行多变量分析，分析SM、是否存在RAS突变与预后之间的关系。RAS突变组的无病生存期（DFS）（P <0.001）和总生存期（OS）（P <0.001）明显较差。在RAS野生组中，SM状态与OS或DFS无明显相关性，而在RAS突变组中，SM< 2 mm与较差的DFS明显相关（P = 0.014）。多变量分析显示，SM< 2 mm 是 RAS 突变组 DFS 差的独立预测因子（HR 21.3，95 % CI：2.25-201.3，P = 0.008）。特别是在 RAS 突变的患者中，SM < 2 mm 与肝切除术后 DFS 明显较差相关，提示 RAS 突变患者应达到宽 SM（≥2 mm）。特别是在RAS突变的患者中，SM < 2 mm与肝切除术后DFS明显较差有关，这表明应实现宽SM（≥2 mm）。

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引用次数: 0

Travel distance does not affect overall survival in patients with appendiceal adenocarcinoma undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy 旅行距离不会影响接受细胞切除手术和腹腔热化疗的阑尾腺癌患者的总生存率

Surgical Oncology Insight

Pub Date : 2024-06-17 DOI: 10.1016/j.soi.2024.100068

Javid Sadjadi, Li Luo, Bridget Fahy, Vinay K. Rai, Sarah Popek, Lara Baste McKean, Alissa Greenbaum

Introduction

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a potentially curative approach for appendiceal cancer (AC) with peritoneal dissemination and is most often employed at tertiary referral centers. Regionalization may provide geographic barriers to care for vulnerable patients. The aim of this study was to examine the effect of travel distance on oncologic outcomes of patients with AC treated with CRS-HIPEC.

Methods

The National Cancer Database (NCDB) was reviewed from 2006 through 2020 for patients with AC who underwent CRS-HIPEC. The primary comparison variable was distance (<50 miles vs ≥ 50 miles from the CRS-HIPEC facility). Demographic and tumor characteristics were analyzed. Primary outcome was overall survival (OS). Secondary outcomes were 30-day and 90-day mortality, readmission, and length of stay (LOS).

Results

During the study period, 1703 patients met inclusion criteria, with 1000 patients travelling < 50 miles for CRS-HIPEC (59 %) and 703 travelling ≥ 50 miles (41 %). Patients who traveled ≥ 50 miles were more likely to be non-Hispanic White (p < 0.001), have annual income less than $74,062, be treated at an academic center and live in the South-Atlantic region of the United States. There was no significant difference in OS between groups (Figure 1). There were no significant differences in 30-day postoperative survival, 90-day survival, or 30-day readmission. Post-operative LOS was 8.0 versus 9.0 days (p < 0.001).

Conclusions

Travel distance ≥ 50 miles was not significantly associated with decreased OS or increased postoperative mortality, suggesting that regionalization of care does not worsen oncologic outcomes for patients with AC undergoing CRS-HIPEC.

导言：对于腹膜扩散的阑尾癌（AC），膀胱切除手术和腹腔内热化疗（CRS-HIPEC）是一种可能治愈的方法，通常在三级转诊中心采用。区域化可能会给弱势患者的治疗带来地理障碍。本研究旨在探讨旅行距离对接受 CRS-HIPEC 治疗的 AC 患者肿瘤治疗效果的影响。主要比较变量是距离（距CRS-HIPEC设施50英里与≥50英里）。对人口统计学特征和肿瘤特征进行了分析。主要结果是总生存期（OS）。结果在研究期间，1703 名患者符合纳入标准，其中 1000 名患者前往 50 英里以外的地方接受 CRS-HIPEC（占 59%），703 名患者前往≥ 50 英里以外的地方（占 41%）。行程≥50英里的患者更可能是非西班牙裔白人（p <0.001）、年收入低于74062美元、在学术中心接受治疗以及居住在美国南大西洋地区。各组间的OS无明显差异（图1）。术后30天存活率、90天存活率或30天再入院率也无明显差异。结论旅行距离≥50英里与OS下降或术后死亡率增加无明显相关性，这表明区域化治疗不会恶化接受CRS-HIPEC治疗的交流患者的肿瘤预后。

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引用次数: 0

Disaggregating U.S. Asian and Pacific Islanders: Colorectal cancer 美国亚裔和太平洋岛民分类：结直肠癌

Surgical Oncology Insight

Pub Date : 2024-06-12 DOI: 10.1016/j.soi.2024.100066

Ian Chun , Brenda Y. Hernandez , Hyeong Jun Ahn , Christina Wai

Background

Colorectal cancer remains a public health concern as the 4th most common cancer in the US. Incidence and mortality have been observed to differ between races; however, Asian and Pacific Islander ethnicities are often documented in aggregate. Recognizing that these groups are heterogeneous, this study seeks to disaggregate Native Hawaiian from the broader “Asian/Pacific Islander” group and examine disparate outcomes in colorectal cancer.

Methods

De-identified data from the Hawaii Tumor Registry was queried to evaluate colorectal cancer in the state of Hawaii. Primary outcomes were cancer stage at diagnosis, first course of therapies received, and duration of survival from diagnosis. Chi-square analyses were performed for differences in categorical variables.

Results

7943 Hawaii residents were diagnosed with colorectal cancer in 2008–2018 with 1151 (14.5 %) patients identifying as Native Hawaiian. Native Hawaiians were less likely to present with localized cancer (36.7 % vs. 41.7 %; p = 0.002) and more likely to be diagnosed with distant stage cancer compared to non-Native Hawaiians (25.2 % vs. 17.67 %; p < 0.0001) and, among those with distant metastases, more likely to receive chemotherapy (68.3 % vs. 61.1 %; p = 0.029). No significant differences were observed between races on analysis of CRC-specific mortality.

Conclusion

Significant differences exist between disaggregated Asian and Pacific Islander ethnic groups. Native Hawaiians are observed to present with more advanced cancer at the time of diagnosis in comparison to ethnicities. Disaggregating these groups reveals racial and ethnic disparities that may inform public health measures.

Synopsis

Disaggregating Asian and Native Hawaiian and Pacific Islander groups reveals disparities in colorectal cancer. Native Hawaiians presented with more advanced disease across all studied ethnic groups. No significant differences were observed in colorectal cancer specific mortality across groups.

背景直肠癌是美国第四大常见癌症，一直是公共卫生问题。据观察，不同种族之间的发病率和死亡率存在差异；然而，亚裔和太平洋岛民往往被汇总记录。认识到这些群体的异质性，本研究试图将夏威夷原住民从更广泛的 "亚洲/太平洋岛民 "群体中分离出来，并检查结直肠癌的不同结果。主要结果包括确诊时的癌症分期、接受的第一个疗程以及确诊后的存活时间。对分类变量的差异进行了卡方分析。结果2008-2018年期间，7943名夏威夷居民被诊断患有结直肠癌，其中1151名（14.5%）患者为夏威夷原住民。与非夏威夷原住民相比，夏威夷原住民患局部癌症的可能性较低（36.7% vs. 41.7%；p = 0.002），更有可能被诊断为远期癌症（25.2% vs. 17.67%；p <0.0001），在有远处转移的患者中，更有可能接受化疗（68.3% vs. 61.1%；p = 0.029）。在对 CRC 特异性死亡率的分析中，没有观察到不同种族之间存在明显差异。与其他种族相比，夏威夷原住民在确诊时癌症晚期程度更高。对这些群体进行分类揭示了种族和民族差异，可为公共卫生措施提供参考。在所有研究的族裔群体中，夏威夷原住民的病情较重。在结直肠癌特定死亡率方面，各群体之间没有发现明显差异。

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引用次数: 0

Interference with activities of daily living according to pain level after breast surgery 乳房手术后根据疼痛程度对日常生活活动的影响

Surgical Oncology Insight

Pub Date : 2024-06-09 DOI: 10.1016/j.soi.2024.100067

Kate R. Pawloski , Su Hnin , Hannah L. Kalvin , Varadan Sevilimedu , Tiana Le , Audree B. Tadros , Laurie J. Kirstein , Monica Morrow , Tracy-Ann Moo

Background

The degree to which postoperative pain interferes with activities of daily living (ADLs) after breast surgery is unclear. We assessed the effect of pain on interference and analgesic use following lumpectomy and sentinel lymph node biopsy (lump-SLNB), and mastectomy.

Methods

We retrospectively identified consecutive patients who completed ≥1 post-discharge survey(s) on postoperative days (POD) 1–5 (lump-SLNB) and 1–10 (mastectomy) from 1/2019–12/2020. The highest pain score was used to categorize none/mild and moderate/severe pain groups. Interference was reported as “none/a little”, “somewhat”, and “quite a bit/very much”. Two-sample non-parametric tests compared baseline characteristics.

Results

1067 patients underwent lump-SLNB; 1219 underwent mastectomy—436 (41%) and 857 (70%) patients reported moderate/severe pain, of whom 190 (44%) and 121 (14%) rated interference as “none/a little”, 178 (41%) and 341 (40%) as “somewhat”, and 68 (16%) and 395 (46%) as “quite a bit/very much”, respectively. Patients with moderate/severe pain more frequently reported “quite a bit/very much” interference versus those with none/mild pain (lump-SLNB: 16% versus 1.1%, p<0.001; mastectomy: 46% versus 3.8%, p<0.001). Compared to POD1, the proportion of patients with the highest degree of interference declined on each subsequent POD in both surgical cohorts. Following mastectomy, median opioid use was 2 pills overall, and 6 pills for the highest interference group.

Conclusions

Interference was more common in patients with moderate/severe pain; however, postmastectomy opioid use was low regardless of interference level. Our findings can inform expectations regarding postoperative pain, interference, and the feasibility of opioid-sparing recovery pathways.

Synopsis

Patients with moderate/severe pain after breast surgery experience more interference compared to those with none/mild pain. Postmastectomy opioid use is low, including patients reporting higher interference; most patients experience an early return to baseline function regardless of pain level.

背景乳腺手术后疼痛对日常生活活动（ADL）的干扰程度尚不清楚。我们评估了肿块切除术和前哨淋巴结活检术（肿块-SLNB）以及乳房切除术后疼痛对干扰和镇痛药使用的影响。方法我们回顾性地确定了在 2019 年 1 月至 2020 年 12 月的术后第 1-5 天（POD）（肿块-SLNB）和第 1-10 天（乳房切除术）完成≥1 次出院后调查的连续患者。最高疼痛评分用于划分无/轻度疼痛组和中度/重度疼痛组。干扰报告为 "无/有点"、"有点 "和 "相当多/非常多"。结果1067名患者接受了肿块-SLNB手术；1219名患者接受了乳房切除术-436名患者（41%）和857名患者（70%）报告了中度/重度疼痛，其中190名患者（44%）和121名患者（14%）将干扰评为 "无/有一点"，178名患者（41%）和341名患者（40%）将干扰评为 "有点"，68名患者（16%）和395名患者（46%）将干扰评为 "有点/非常严重"。与没有/轻微疼痛的患者相比，中度/重度疼痛的患者更常报告 "有点/非常严重 "的干扰（肿块-SLNB：16% 对 1.1%，p<0.001；乳房切除术：46% 对 3.8%，p<0.001）。与 POD1 相比，在两个手术组别中，干扰程度最高的患者比例在随后的每个 POD 均有所下降。乳房切除术后，阿片类药物使用量的中位数总体为 2 片，干扰程度最高的一组为 6 片。结论干扰在中度/重度疼痛患者中更为常见；然而，无论干扰程度如何，乳房切除术后阿片类药物的使用量都很低。我们的研究结果可以为人们对术后疼痛、干扰以及节省阿片类药物的恢复途径的可行性的预期提供参考。简要说明乳腺手术后中度/重度疼痛患者与无疼痛/轻度疼痛患者相比会受到更多干扰。乳房切除术后阿片类药物的使用率较低，包括报告干扰较多的患者；无论疼痛程度如何，大多数患者都能尽早恢复基线功能。

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引用次数: 0