Surgical Oncology Insight最新文献_第8页

Associations between pancreatectomy type, treatment sequence and textbook oncologic outcomes in patients with localized pancreatic adenocarcinoma 局部胰腺腺癌患者的胰腺切除术类型、治疗顺序与教科书中的肿瘤治疗效果之间的关系

Surgical Oncology Insight

Pub Date : 2024-02-09 DOI: 10.1016/j.soi.2024.100012

Mohamedraed Elshami, John B. Ammori, Jeffrey M. Hardacre, Jordan M. Winter, Lee M. Ocuin

Background

Prior studies have shown that achievement of textbook oncologic outcomes (TOO) after pancreatectomy for pancreatic adenocarcinoma (PDAC) is associated with better survival outcomes. However, the associations between TOO, procedure type, and treatment sequence has not been examined.

Methods

Patients with resected PDAC were identified within the National Cancer Database (2010–2018). We analyzed rates of TOO (defined as no 30-day readmission, no 90-day mortality, no prolonged length of stay, negative surgical margins, receipt of multi-agent chemotherapy, and nodal yield ≥12) stratified by procedure (pancreatoduodenectomy vs. distal pancreatectomy vs. total pancreatectomy) and treatment sequence (up-front surgery vs. neoadjuvant therapy).

Results

A total of 20,155 patients were identified. Patients who underwent distal pancreatectomy were less likely to have TOO compared to pancreatoduodenectomy (12.6% vs. 17.5%; OR=0.77, 95% CI: 0.68–0.88). There was no difference in TOO between patients who underwent total pancreatectomy compared to pancreatoduodenectomy (16.4% vs. 17.5%; OR=0.96, 95% CI: 0.84–1.11). Neoadjuvant chemotherapy was associated with a 5-fold increase in the odds of TOO (OR=5.07, 95% CI: 4.35–5.91). TOO was associated with improved OS regardless of surgical procedure (pancreatoduodenectomy: median OS: 33.7 vs. 20.5mo; HR=0.69, 95% CI: 0.65–0.73; distal pancreatectomy: median OS: 35.8 vs. 23.9mo; HR=0.73, 95% CI: 0.64–0.84; total pancreatectomy: median OS: 30.1 vs. 19.9mo; HR=0.69, 95% CI: 0.61–0.79).

Conclusions

The rate of TOO was lower for distal pancreatectomy as compared to pancreatoduodenectomy or total pancreatectomy. Neoadjuvant therapy was associated with higher likelihood of TOO. Regardless of pancreatectomy type, TOO was associated with improved OS.

背景先前的研究表明，胰腺腺癌（PDAC）胰腺切除术后达到教科书中的肿瘤治疗效果（TOO）与更好的生存结果相关。然而，TOO、手术类型和治疗顺序之间的关系尚未得到研究。方法在国家癌症数据库（2010-2018 年）中确定了切除 PDAC 的患者。我们分析了按手术方式（胰十二指肠切除术 vs. 远端胰腺切除术 vs. 全胰腺切除术）和治疗顺序（前期手术 vs. 新辅助治疗）分层的TOO率（定义为无30天再入院、无90天死亡率、无住院时间延长、手术切缘阴性、接受多药化疗和结节率≥12）。与胰十二指肠切除术相比，接受远端胰腺切除术的患者发生TOO的几率较低（12.6% vs. 17.5%；OR=0.77，95% CI：0.68-0.88）。与胰十二指肠切除术相比，全胰腺切除术患者的TOO没有差异（16.4% vs. 17.5%；OR=0.96，95% CI：0.84-1.11）。新辅助化疗与TOO几率增加5倍相关（OR=5.07，95% CI：4.35-5.91）。无论采用哪种手术方式，TOO都与OS的改善有关（胰十二指肠切除术：中位OS：33.7 vs. 20.5）：33.7个月 vs. 20.5个月；HR=0.69，95% CI：0.65-0.73；胰腺远端切除术：中位OS：35.8个月 vs. 23.9个月：35.8个月 vs. 23.9个月；HR=0.73，95% CI：0.64-0.84；全胰切除术：中位OS：结论与胰十二指肠切除术或全胰切除术相比，远端胰腺切除术的TOO率较低。新辅助治疗与更高的TOO可能性相关。无论采用哪种胰腺切除术，TOO都与OS的改善有关。

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引用次数: 0

Miscategorized lymph nodes in colorectal cancer: A potential pitfall of pre-surgical imaging 结直肠癌淋巴结误诊：手术前成像的潜在陷阱

Surgical Oncology Insight

Pub Date : 2024-02-09 DOI: 10.1016/j.soi.2024.100011

Muhammad O. Awiwi , Neal Bhutani , Brian K. Bednarski , Tyuyoshi Konishi , Ajaykumar C. Morani , George J. Chang , Harmeet Kaur

引用次数: 0

The prognostic role of post-operative cfDNA after resection of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis 结直肠肝切除术后 cfDNA 的预后作用

Surgical Oncology Insight

Pub Date : 2024-02-09 DOI: 10.1016/j.soi.2024.100013

Emma Vail , Patrick M. Boland , Toni Beninato , Mariam F. Eskander , Miral S. Grandhi , Haejin In , Timothy J. Kennedy , Russell C. Langan , Jason C. Maggi , Dirk F. Moore , Henry A. Pitt , Shishir K. Maithel , Brett L. Ecker

Background

Post-resection detection of cell-free DNA (cfDNA) is strongly prognostic of recurrence for patients with localized colorectal cancer (CRC). The sensitivity and specificity of this biomarker in the setting of CRC liver metastases (CRCLM) have not yet been systematically quantified.

Methods

PubMed was queried from database inception to June 2, 2023 for English-language publications reporting post-operative cfDNA status and recurrence-free survival (RFS) in patients with resected CRCLM. Weighted mean cfDNA positivity rates and RFS probabilities were utilized to estimate the sensitivity and specificity for recurrence at 1, 3 and 5 years after surgery. Recurrence risk using hazard ratios (HRs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method.

Results

Of 98 records, 10 studies (all non-randomized) were eligible, inclusive of 669 patients. The median weighted follow-up from surgical resection was 30.6 months (range 9.7–77.0 months). The mean postoperative cfDNA positivity rate was 38.5%, and cfDNA status was prognostic of RFS in 10 of 10 (100%) studies with a pooled HR of 3.11 (95% CI 2.29–4.22). Among cfDNA-positive patients, the weighted rate of recurrence was 75.0%, 92.5%, and 96.8% at 1, 3 and 5 years, respectively. Among cfDNA-negative patients, the weighted rate of recurrence was 35.7%, 59.7% and 60.7% at 1, 3 and 5 years, respectively. Sensitivity and specificity of cfDNA positivity was 67.8% and 30.0% for recurrence within 1 year, 60.9% and 15.7% for recurrence within 3 years, and 61.5% and 7.6% for recurrence within 5 years, respectively.

Conclusions

cfDNA-positivity following resection of CRCLM is highly prognostic of recurrence, which may have implications for treatment escalation strategies for this molecularly selected cohort. In contrast, recurrence was common in the cfDNA-negative cohort, cautioning against de-escalation strategies for these patients.

背景切除术后检测无细胞DNA（cfDNA）对局部结直肠癌（CRC）患者的复发有很强的预示作用。方法从数据库建立之初到2023年6月2日，在PubMed上查询了报道切除的CRCLM患者术后cfDNA状态和无复发生存率（RFS）的英文文献。利用加权平均 cfDNA 阳性率和 RFS 概率来估算术后 1、3 和 5 年复发的敏感性和特异性。采用随机效应模型和 DerSimonian-Laird 方法计算了复发风险的危险比 (HR) 和 95% CI。手术切除后的加权随访中位数为 30.6 个月（9.7-77.0 个月）。术后 cfDNA 平均阳性率为 38.5%，10 项研究中有 10 项（100%）的研究显示，cfDNA 状态是 RFS 的预后指标，汇总 HR 为 3.11（95% CI 2.29-4.22）。在 cfDNA 阳性患者中，1、3 和 5 年的加权复发率分别为 75.0%、92.5% 和 96.8%。在 cfDNA 阴性患者中，1、3 和 5 年的加权复发率分别为 35.7%、59.7% 和 60.7%。cfDNA阳性对1年内复发的敏感性和特异性分别为67.8%和30.0%，对3年内复发的敏感性和特异性分别为60.9%和15.7%，对5年内复发的敏感性和特异性分别为61.5%和7.6%。相比之下，复发在cfDNA阴性组群中很常见，因此要警惕对这些患者采取降级治疗策略。

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引用次数: 0

Hürthle cell (Oncocytic) carcinoma – Is hemithyroidectomy enough? Hürthle细胞（肿瘤细胞）癌--半胱氨酸甲状腺切除术是否足够？

Surgical Oncology Insight

Pub Date : 2024-02-04 DOI: 10.1016/j.soi.2024.100010

Taylor O. Julsrud , Trenton R. Foster , Robert A. Vierkant , Melanie L. Lyden , Travis J. McKenzie , Mabel Ryder , Benzon M. Dy

Background

Hürthle cell carcinoma (HCC) has traditionally been managed with total thyroidectomy. However, current evidence suggests a limited benefit to this approach due to the lack of radioactive iodine uptake. We sought to compare outcomes of HCC managed with hemi- (HEMI) vs. total thyroidectomy (TOTAL).

Methods

A retrospective review of 309 patients who had surgery for HCC from 2000–2019 was performed. A subcohort was selected that matched each HEMI to a paired TOTAL on age and TNM stage. Associations of clinical and pathological features with surgery type were examined using paired t-tests and exact McNemar tests. Survival and recurrence were examined using Cox regression analysis.

Results

295 patients were in the study cohort, 42 (14%) HEMI and 253 (86%) TOTAL. Of the 42 HEMI; 69% were female, median age 57 years, Tx/T1 = 16, T2/T3 = 26, nodal disease in 1 and metastatic in 1. Compared to the 42 matched TOTAL, we found no associations of surgery type with age and TNM stage. Surgery type was also not associated with gender, race, pathology or focality (p > 0.05). Over a mean follow-up of 7.0 years in the matched cohort, there were 10 recurrences (8 TOTAL, 2 HEMI), 11 deaths (5 TOTAL, 6 HEMI) and 3 deaths from HCC (3 TOTAL, 0 HEMI). There were no differences in recurrence-free survival (p = 0.065), overall survival (p = 0.806) or disease-specific survival.

Conclusion

Hemithyroidectomy is a reasonable treatment option for HCC. Extent of thyroidectomy does not affect recurrence-free survival or overall survival in our matched cohort.

Synopsis

Single institution study with 295 patients with Hürthle cell carcinoma. A case-matched cohort to control for age and stage was used to compare hemi- versus total thyroidectomy. The extent of thyroidectomy did not affect recurrence free survival or overall survival.

背景赫尔细胞癌（HCC）传统上采用全甲状腺切除术治疗。然而，目前的证据表明，由于缺乏放射性碘摄取，这种方法的获益有限。我们试图比较半甲状腺切除术（HEMI）与全甲状腺切除术（TOTAL）治疗 HCC 的效果。根据年龄和TNM分期，将每例HEMI与配对的TOTAL进行亚队列匹配。临床和病理特征与手术类型的相关性采用配对t检验和精确McNemar检验。研究队列中有 295 例患者，其中 42 例（14%）为 HEMI 型，253 例（86%）为 TOTAL 型。在 42 例 HEMI 患者中，69% 为女性，中位年龄为 57 岁，Tx/T1 = 16，T2/T3 = 26，1 例为结节性疾病，1 例为转移性疾病。与 42 例匹配的 TOTAL 患者相比，我们发现手术类型与年龄和 TNM 分期无关。手术类型也与性别、种族、病理或病灶无关（p > 0.05）。配对队列的平均随访时间为 7.0 年，其中 10 例复发（8 例总复发，2 例 HEMI），11 例死亡（5 例总复发，6 例 HEMI），3 例死于 HCC（3 例总复发，0 例 HEMI）。无复发生存率（P = 0.065）、总生存率（P = 0.806）或疾病特异性生存率均无差异。在我们的匹配队列中，甲状腺切除术的范围不会影响无复发生存率或总生存率。通过病例匹配队列对年龄和分期进行控制，比较了半甲状腺切除术和全甲状腺切除术。甲状腺切除术的范围不会影响无复发生存率或总生存率。

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引用次数: 0

Unsupervised clustering using multiple correspondence analysis reveals clinically-relevant demographic variables across multiple gastrointestinal cancers 利用多重对应分析进行无监督聚类，揭示多种胃肠道癌症中与临床相关的人口统计学变量

Surgical Oncology Insight

Pub Date : 2024-02-03 DOI: 10.1016/j.soi.2024.100009

Ryan J. Kramer , Kristen E. Rhodin , Aaron Therien , Vignesh Raman , Austin Eckhoff , Camryn Thompson , Betty C. Tong , Dan G. Blazer III , Michael E. Lidsky , Thomas D’Amico , Daniel P. Nussbaum

Objective

Patients with gastrointestinal malignancies represent a heterogenous population, even among those with similar stage and treatment pathways. Here, we used dimensionality reduction in the National Cancer Database (NCDB) to inform unsupervised clustering of patients with three gastrointestinal malignancies and examined outcomes among these computationally-derived groups.

Methods

The NCDB was queried for three cohorts of patients receiving multimodal therapy: stage II/III esophageal cancer, stage II/III gastric cancer, and stage III colon cancer. Multiple correspondence analysis (MCA), a dimensionality reduction technique well-suited for categorical variables such as demographic data in the NCDB, was performed on this cohort with variables including demographic and tumor characteristics. Principal components were analyzed to derive clusters. Outcomes for each cluster were compared using Kaplan-Meier survival methods.

Results

For esophageal (n = 11,399), gastric (n = 2033), and colon (n = 72,057) cancer, the same four variables were identified as highly representative. The principal variables were income quartile, education quartile, age quartile, and insurance type. Survival analysis demonstrated significant differences in overall survival between clusters in esophageal (p < 0.0001) and colon (p < 0.0001) cancer, but not gastric cancer (p = 0.56). Clusters defined by high income, high education, younger age, and private insurance fared better.

Conclusions

Using MCA, we identified combinations of 4 demographic variables in the NCDB with stage II/III esophageal cancer, stage II/III gastric cancer, and stage III colon cancer. These groupings had significantly different survival outcomes in colon and esophageal cancer. This work serves as proof-of-concept for the utility of unsupervised clustering for outcomes research in surgical malignancies and identifies at-risk populations.

目的胃肠道恶性肿瘤患者是一个异质性人群，即使在分期和治疗途径相似的患者中也是如此。在此，我们利用国家癌症数据库（NCDB）中的降维技术对三种胃肠道恶性肿瘤患者进行了无监督聚类，并研究了这些通过计算得出的组别之间的治疗效果。多重对应分析 (MCA) 是一种降维技术，非常适合 NCDB 中的人口统计学数据等分类变量。对主成分进行分析后得出聚类。结果对于食管癌（n = 11,399）、胃癌（n = 2033）和结肠癌（n = 72,057），同样的四个变量被确定为具有高度代表性。主要变量包括收入四分位数、教育四分位数、年龄四分位数和保险类型。生存分析表明，食管癌（p <0.0001）和结肠癌（p <0.0001）不同群组之间的总生存率存在显著差异，但胃癌（p = 0.56）不存在显著差异。结论利用 MCA，我们在国家疾病分类数据库中确定了 II/III 期食管癌、II/III 期胃癌和 III 期结肠癌的 4 个人口统计学变量组合。这些分组在结肠癌和食道癌的生存结果上有明显差异。这项工作证明了无监督聚类在外科恶性肿瘤结果研究中的实用性，并确定了高危人群。

{"title":"Unsupervised clustering using multiple correspondence analysis reveals clinically-relevant demographic variables across multiple gastrointestinal cancers","authors":"Ryan J. Kramer , Kristen E. Rhodin , Aaron Therien , Vignesh Raman , Austin Eckhoff , Camryn Thompson , Betty C. Tong , Dan G. Blazer III , Michael E. Lidsky , Thomas D’Amico , Daniel P. Nussbaum","doi":"10.1016/j.soi.2024.100009","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100009","url":null,"abstract":"<div><h3>Objective</h3><p>Patients with gastrointestinal malignancies represent a heterogenous population, even among those with similar stage and treatment pathways. Here, we used dimensionality reduction in the National Cancer Database (NCDB) to inform unsupervised clustering of patients with three gastrointestinal malignancies and examined outcomes among these computationally-derived groups.</p></div><div><h3>Methods</h3><p>The NCDB was queried for three cohorts of patients receiving multimodal therapy: stage II/III esophageal cancer, stage II/III gastric cancer, and stage III colon cancer. Multiple correspondence analysis (MCA), a dimensionality reduction technique well-suited for categorical variables such as demographic data in the NCDB, was performed on this cohort with variables including demographic and tumor characteristics. Principal components were analyzed to derive clusters. Outcomes for each cluster were compared using Kaplan-Meier survival methods.</p></div><div><h3>Results</h3><p>For esophageal (n = 11,399), gastric (n = 2033), and colon (n = 72,057) cancer, the same four variables were identified as highly representative. The principal variables were income quartile, education quartile, age quartile, and insurance type. Survival analysis demonstrated significant differences in overall survival between clusters in esophageal (p < 0.0001) and colon (p < 0.0001) cancer, but not gastric cancer (p = 0.56). Clusters defined by high income, high education, younger age, and private insurance fared better.</p></div><div><h3>Conclusions</h3><p>Using MCA, we identified combinations of 4 demographic variables in the NCDB with stage II/III esophageal cancer, stage II/III gastric cancer, and stage III colon cancer. These groupings had significantly different survival outcomes in colon and esophageal cancer. This work serves as proof-of-concept for the utility of unsupervised clustering for outcomes research in surgical malignancies and identifies at-risk populations.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000057/pdfft?md5=3c00e0283b85506b14944aa9afd3a079&pid=1-s2.0-S2950247024000057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139738128","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

Optimization of intraoperative lumpectomy specimen labeling 术中肿瘤切除术标本标记的优化

Surgical Oncology Insight

Pub Date : 2024-02-02 DOI: 10.1016/j.soi.2024.100008

Matthew J. Piotrowski , Min Yi , Carissa Le-Petross , Mediget Teshome , Henry M. Kuerer , Joanna Lee , Kelly K. Hunt , Sarah M. DeSnyder

Background

Accurate lumpectomy specimen orientation is critical as incorrect orientation may result in excision of the wrong lumpectomy margin. Our goal was to determine if specimen orientation achieved by labeling three surfaces is superior to two.

Methods

This was a prospective single-institution study including 22 breast surgical oncologists. Intraoperative labeling of either two or three surfaces of the lumpectomy specimen was based on surgeon preference. The specimen was delivered to Pathology where it was oriented by the pathology team and the surgeon then determined if the specimen was correctly oriented or if re-orientation was required. Surgeons subsequently recorded orientation technique and if re-orientation was required. Specimen weight, patient age, and BMI were recorded. Fisher’s exact test and two-sample Wilcoxon rank-sum test were used to determine p-values.

Results

Of 268 specimens, 40 (14.9%) required re-orientation. Labeling specimens on three surfaces was superior to two (22 of 195 (11.2%) versus 18 of 73 (24.6%), p = 0.01). Specimens requiring re-orientation were more likely to be heavier (36 g vs. 24 g, p = 0.02). In multivariable analysis, labeling specimens on three surfaces resulted in a 70% reduction in discordance rates between the surgeon and pathology team (OR 0.3, p = 0.001). Using mean weight of lumpectomy specimens, specimens >33 g were more likely to require reorientation (OR 2.8, p = 0.004). Age and BMI did not impact the need for re-orientation.

Conclusion

Lumpectomy specimen labeling using three surfaces was superior to two. Surgeons should routinely orient their specimens on three or more surfaces to decrease discordance rates.

背景准确的肿块切除标本定位至关重要，因为错误的定位可能导致切除错误的肿块切除边缘。我们的目标是确定标记三个表面的标本定位是否优于标记两个表面的标本定位。方法这是一项前瞻性单机构研究，包括 22 位乳腺外科肿瘤学家。术中根据外科医生的偏好对肿块切除术标本的两个或三个表面进行标记。标本被送至病理科，由病理科团队进行定向，然后由外科医生确定标本的定向是否正确或是否需要重新定向。外科医生随后记录定位技术以及是否需要重新定位。标本重量、患者年龄和体重指数均有记录。结果在 268 个标本中，有 40 个（14.9%）需要重新定向。对标本的三个表面进行标记优于对两个表面进行标记（195 例中的 22 例（11.2%）对 73 例中的 18 例（24.6%），P = 0.01）。需要重新定向的标本可能更重（36 克比 24 克，p = 0.02）。在多变量分析中，在三个表面标注标本可使外科医生和病理团队之间的不一致率降低 70%（OR 0.3，p = 0.001）。根据肿瘤切除标本的平均重量，33 克的标本更有可能需要重新定向（OR 2.8，p = 0.004）。年龄和体重指数对重新定向的需求没有影响。外科医生应定期在三个或更多表面上标注标本方向，以降低不一致率。

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引用次数: 0

Prolonged length of stay and omission of adjuvant therapy are associated with early mortality after pancreatic adenocarcinoma resection 胰腺腺癌切除术后，住院时间延长和不进行辅助治疗与早期死亡率有关

Surgical Oncology Insight

Pub Date : 2024-02-02 DOI: 10.1016/j.soi.2024.100007

Lee D. Ying , Ysabel C. Ilagan-Ying , John W. Kunstman , Nicholas Peters , Mariana Almeida , Holly Blackburn , Leah Ferrucci , Kevin Billingsley , Sajid A. Khan , Ankit Chhoda , Nithyla John , Ronald Salem , Anup Sharma , Nita Ahuja

Background

Surgical resection is the preferred treatment for non-metastatic pancreatic adenocarcinoma, but post-resection survival is highly variable. We use the National Cancer Database Participant Use Files to investigate risk factors associated with early mortality (survival less than one year) after pancreatic adenocarcinoma resection.

Methods

51,345 cases of pancreatic adenocarcinoma were identified. 16,234 had survival between three months and one year (early mortality), and 35,111 had survival greater than one year. Descriptive analyses and multivariate Cox regression models were performed to identify demographic, perioperative, and tumor biology factors associated with early mortality. A sub-analysis subsequently explored the relationship between the length of stay and chemotherapy utilization.

Results

Of the 51,345 cases of pancreatic adenocarcinoma, 16,234 had early mortality. In multivariate models adjusted for demographic, socioeconomic, facility type, tumor characteristics, and hospital risk factors, patients with early mortality also had longer lengths of stay, more unplanned readmissions. They were more likely to receive treatment at non-academic centers. Adjuvant chemotherapy utilization was lower in patients with early mortality, particularly in those with longer lengths of stay.

Conclusion

Reducing the length of stay, decreasing variability across different forms of health insurance, and increasing access to treatment at academic centers may reduce early mortality. Adjuvant chemotherapy is associated with a reduced risk of early mortality but is highly underutilized, especially in patients with prolonged hospital stays. Given that delays in receiving adjuvant chemotherapy were associated with an increased risk of early mortality, interventions to decrease perioperative complications to ensure timely access to adjuvant chemotherapy may improve survival.

背景手术切除是治疗非转移性胰腺腺癌的首选方法，但切除术后的生存率变化很大。我们利用全国癌症数据库参与者使用档案调查了与胰腺腺癌切除术后早期死亡率（生存期少于一年）相关的风险因素。其中 16,234 例的存活期在三个月到一年之间（早期死亡率），35,111 例的存活期超过一年。研究人员进行了描述性分析和多变量 Cox 回归模型，以确定与早期死亡率相关的人口学、围手术期和肿瘤生物学因素。随后进行的一项子分析探讨了住院时间与化疗使用之间的关系。在调整了人口、社会经济、医疗机构类型、肿瘤特征和医院风险因素的多变量模型中，早期死亡患者的住院时间更长，计划外再入院次数更多。他们更有可能在非学术中心接受治疗。结论缩短住院时间、减少不同形式医疗保险之间的差异以及增加在学术中心接受治疗的机会可降低早期死亡率。辅助化疗可降低早期死亡风险，但其利用率极低，尤其是对住院时间较长的患者而言。鉴于接受辅助化疗的延迟与早期死亡风险的增加有关，为减少围手术期并发症以确保及时接受辅助化疗而采取的干预措施可能会提高生存率。

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引用次数: 0

Differences in receipt of guideline-compliant care and survival for early-onset versus average-onset biliary tract cancers 早期发病与一般发病胆道癌症在接受符合指南的治疗和存活率方面的差异

Surgical Oncology Insight

Pub Date : 2024-02-01 DOI: 10.1016/j.soi.2024.100006

Mohamedraed Elshami , Jonathan J. Hue , Alexander W. Loftus , Richard S. Hoehn , John B. Ammori , Jeffrey M. Hardacre , J. Eva Selfridge , David Bajor , Amr Mohamed , Sakti Chakrabarti , Amit Mahipal , Jordan M. Winter , Lee M. Ocuin

Background

We examined differences in receipt of guideline-compliant care in patients with early-onset versus average-onset biliary tract cancers (BTC) in localized or metastatic settings. Additionally, we examined associations between guideline compliance and overall survival (OS), stratified by age of onset and clinical stage.

Methods

Patients with BTC [intrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma] were identified within the National Cancer Database (2010–2018). Early onset was defined as diagnosis at < 50 and average onset at ≥ 70 years. Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease.

Results

A total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease.

Conclusions

Early-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. Guideline compliance is associated with improved OS regardless of age of onset or clinical stage.

背景我们研究了局部或转移性胆道癌（BTC）早发患者与普通患者接受符合指南要求的治疗的差异。方法在国家癌症数据库（2010-2018 年）中确定了 BTC 患者（肝内胆管癌、胆囊腺癌、肝外胆管癌）。早期发病定义为诊断年龄为 50 岁，平均发病年龄≥ 70 岁。符合指南的治疗定义为局部疾病的手术切除和化疗，以及转移性疾病的多药化疗。结果共发现32247名患者，其中2855名患者（8.9%）为早发疾病。早发患者在发病时更有可能患有转移性疾病。早发患者更有可能在局部（OR=2.24，95% CI：1.93-2.60）和转移（OR=4.40，95% CI：3.72-5.21）情况下接受符合指南的治疗。在局部 BTC 患者中，遵守指南与早期（中位 OS：51.9 个月对 13.5 个月；HR=0.31，95% CI：0.27-0.37）和平均发病期（中位 OS：25.9 个月对 6.1 个月；HR=0.31，95% CI：0.30-0.32）疾病的 OS 改善相关。在转移性 BTC 患者中，在早期（中位 OS：10.1 个月 vs. 3.5 个月；HR=0.52，95% CI：0.43-0.62）和一般发病期（中位 OS：8.6 个月 vs. 2.2 个月；HR=0.45，95% CI：0.43-0.48）疾病中，遵循指南与 OS 改善相关。无论发病年龄或临床分期如何，遵照指南治疗都能改善患者的OS。

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引用次数: 0

Impact of diabetes mellitus and perioperative intensive blood glucose control on postoperative complications and long -term outcome in non-small cell lung cancer 糖尿病和围手术期强化血糖控制对非小细胞肺癌术后并发症和长期预后的影响

Surgical Oncology Insight

Pub Date : 2024-01-21 DOI: 10.1016/j.soi.2024.100005

Shuichi Shinohara , Ayumi Suzuki , Katsutoshi Seto , Yusuke Takahashi , Noriaki Sakakura , Takeo Nakada , Hiroaki Kuroda

Background

Diabetes mellitus (DM) is a major disease that may influence survival outcomes and the incidence of postoperative complications in patients with non-small cell lung cancer (NSCLC). However, the effects of DM on survival and postoperative complications have not yet been investigated. We aimed to elucidate the surgical outcomes and impact of perioperative intensive glucose control (IC) in patients with DM.

Methods

This study included NSCLC patients who underwent curative resection at a single institution between 2013 and 2017. DM was confirmed in patients treated by referral doctors or in those with HbA1c< 6.5 % without medication. At our institution, IC is performed in many patients with DM.

Results

A total of 854 patients were recruited: 163 in the DM and 691 in the non-DM groups. Multivariate analysis revealed DM was associated with poor recurrence-free survival (HR, 1.37; P = .046, respectively) and tended to be associated with overall survival (HR, 1.43; P = .077). The incidence of postoperative complications did not differ between the DM and non-DM groups (P = .73). However, 90-day mortality was significantly higher in the DM group (3/163 vs. 0/691, P = .007). In patients with DM, IC was independently associated with the incidence of postoperative complications (P = .042).

Conclusions

Our results suggest that DM is a prognostic predictor of poor overall survival and relapse-free survival. IC may reduce postoperative complications in patients with DM. Preoperative assessment and perioperative glycemia control for DM patients may be important for those with surgically treated NSCLC.

背景糖尿病（DM）是一种可能影响非小细胞肺癌（NSCLC）患者生存结果和术后并发症发生率的主要疾病。然而，DM 对生存和术后并发症的影响尚未得到研究。我们旨在阐明DM患者的手术结果以及围手术期强化血糖控制（IC）的影响。方法这项研究纳入了2013年至2017年期间在一家机构接受根治性切除术的NSCLC患者。转诊医生治疗的患者或HbA1c< 6.5 %且未服药的患者均证实患有DM。在我院，许多DM患者都接受了IC手术。结果共招募了854名患者：共招募了 854 名患者：163 名糖尿病组患者和 691 名非糖尿病组患者。多变量分析显示，DM 与无复发生存率低有关（HR，1.37；P = .046），与总生存率也有相关性（HR，1.43；P = .077）。DM组和非DM组的术后并发症发生率没有差异（P = .73）。然而，DM组的90天死亡率明显更高（3/163 vs. 0/691，P = .007）。在DM患者中，IC与术后并发症的发生率独立相关（P = .042）。IC可减少DM患者的术后并发症。DM患者的术前评估和围手术期血糖控制对于接受手术治疗的NSCLC患者可能非常重要。

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