Surgical Oncology Insight最新文献_第9页

Impact of clinicopathologic factors on the number of lymph nodes examined in patients with melanoma 临床病理因素对黑色素瘤患者淋巴结检查数量的影响

Surgical Oncology Insight

Pub Date : 2025-01-13 DOI: 10.1016/j.soi.2025.100123

Jason M. Lizalek, Collin E. Dougherty, Juan A. Santamaria-Barria, Bradley N. Reames, Jason Foster, Joshua M.V. Mammen

Background

Melanoma is amongst the malignancies with the greatest annual increase in incidence. The prognosis for melanoma is partially dependent on lymph node status. Staging of lymph node basins in patients without clinical evidence of lymphadenopathy is typically by sentinel lymph node (SLN) biopsy. In this study, we sought to determine factors associated with the number of sentinel lymph nodes examined.

Methods

The National Cancer Database Participant User File from 2018 to 2020 was queried for clinical node negative patients who underwent sentinel lymph node biopsy. Descriptive statistics were obtained. Stepwise negative binomial regression analysis was performed in addition to ANOVA, chi-squared and Student’s t-tests.

Results

We identified 32,516 clinically node negative patients with melanoma from 2018 to 2020 who had undergone sentinel lymph node biopsy. Using a stepwise negative binomial model, male patients had a 3.8 % increase in the number of SLNs examined compared to females, while each year of age predicted a 0.3 % decrease in the number of SLNs examined. Breslow thickness > 2 mm was associated with a 6.9 % increase in SLN examined. Primary sites with multiple potential lymphatic drainage basins including ear, lip, scalp & neck, and trunk were associated with a 55.2 %, 29.6 %, 46.6 %, 43.4 % increase in SLNs examined, respectively. The study did not identify a difference in overall survival based on the number of lymph nodes examined (p = 0.25).

Conclusion

The number of sentinel lymph nodes examined in melanoma patients is associated positively with younger age, male sex, Breslow thickness, and primary site.

Synopsis

A National Cancer Database study of sentinel lymph node biopsy yield in clinically node-negative melanoma patients showed association with age, sex, Breslow thickness, and primary site. Clinicopathologic factors were predictive of sentinel lymph node yield, indicating other influences rather than objective sentinel lymph node criteria on node biopsy.

背景：黑色素瘤是每年发病率增长最快的恶性肿瘤之一。黑色素瘤的预后部分取决于淋巴结状态。在没有淋巴结病临床证据的患者中，淋巴结池的分期通常通过前哨淋巴结（SLN）活检进行。在这项研究中，我们试图确定与前哨淋巴结检查数量相关的因素。方法查询2018 - 2020年美国国家癌症数据库参与者用户档案中接受前哨淋巴结活检的临床淋巴结阴性患者。进行描述性统计。除方差分析、卡方检验和学生t检验外，还进行逐步负二项回归分析。结果2018年至2020年，32516例临床淋巴结阴性的黑色素瘤患者接受了前哨淋巴结活检。使用逐步负二项模型，与女性相比，男性患者的sln检查数量增加了3.8 %，而每年的年龄预测sln检查数量减少了0.3 %。brreslow厚度>； 2 mm与SLN增加6.9% %相关。具有多个潜在淋巴引流盆的原发部位，包括耳朵、嘴唇、头皮和amp；颈部和躯干的sln分别增加55.2% %、29.6% %、46.6% %和43.4% %。该研究没有发现基于检查淋巴结数量的总生存率差异（p = 0.25）。结论黑色素瘤患者前哨淋巴结数目与年龄、男性、Breslow厚度、原发部位呈正相关。国家癌症数据库对临床淋巴结阴性黑色素瘤患者前哨淋巴结活检率的研究显示与年龄、性别、Breslow厚度和原发部位有关。临床病理因素可预测前哨淋巴结的产率，提示其他影响因素，而不是客观的前哨淋巴结活检标准。

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引用次数: 0

Fusobacterium nucleatum in appendiceal cancer: Prevalence and influence on the tumor immune microenvironment 阑尾癌中核梭杆菌的流行及其对肿瘤免疫微环境的影响

Surgical Oncology Insight

Pub Date : 2025-01-12 DOI: 10.1016/j.soi.2025.100122

Hyun Park , Chelsea Knotts , Rose Blodgett , Catherine R. Lewis , David L. Bartlett , Neda Dadgar , Patrick L. Wagner

Introduction

Fusobacterium nucleatum (Fn) has gained notoriety for its propensity toward mucosal invasion in acute appendicitis and its potential involvement in development or progression of colorectal cancer. We hypothesized that Fn may be linked to appendiceal cancer (AC). To explore the potential connection, we quantitatively examined the presence of Fn in appendiceal tissue across various histological diagnoses.

Methods

A total of 50 formalin-fixed paraffin-embedded tissues were obtained from archival appendectomy specimens. RNA-in situ hybridization (RNA-ISH) with an Fn-specific probe was performed, and immunohistochemical staining was performed on tumor-associated CD3 + and CD8 + lymphocytes. The digital images were analyzed using QuPath and Aperio ImageScope.

Results

RNA-ISH showed significantly higher Fn content in the appendiceal pathology with increased Fn levels in acute appendicitis, low-grade AC, and high-grade AC relative to the Fn level of a normal appendix. Also, Fn content was strongly associated with decreased CD8 + lymphocyte density within high-grade AC, but no significant association was found with CD3 + lymphocyte density and tumor grades.

Discussion

In this study, we confirmed previous reports of Fn levels within normal appendiceal tissue and acute appendicitis and extended this finding to a range of appendiceal neoplasms. The inverse relationship between Fn and CD8 + cell density within high-grade AC in our series also suggests a potential role for Fn in shaping the AC microenvironment toward an immune-suppressed or immune-excluded phenotype. Further study is planned to include larger case numbers with a wider variety of histological subtypes of AC and peritoneal metastatic lesions to enrich the understanding of the immunological and microbial microenvironment in AC for novel opportunities for targeted therapy.

导言：核分枝杆菌（Fn）因其在急性阑尾炎中的粘膜侵袭倾向及其可能参与结肠直肠癌的发生或发展而广为人知。我们假设 Fn 可能与阑尾癌（AC）有关。为了探索这种潜在的联系，我们定量检测了Fn在不同组织学诊断的阑尾组织中的存在情况。用 Fn 特异性探针进行 RNA 原位杂交（RNA-ISH），并对肿瘤相关 CD3 + 和 CD8 + 淋巴细胞进行免疫组化染色。结果RNA-ISH显示阑尾病理中的Fn含量明显增高，急性阑尾炎、低级别阑尾炎和高级别阑尾炎中的Fn含量相对于正常阑尾的Fn含量增高。此外，Fn 含量与高级别 AC 中 CD8 + 淋巴细胞密度下降密切相关，但与 CD3 + 淋巴细胞密度和肿瘤级别无明显关联。讨论在这项研究中，我们证实了之前关于正常阑尾组织和急性阑尾炎中 Fn 含量的报道，并将这一发现扩展到一系列阑尾肿瘤。在我们的系列研究中，Fn 与高级别 AC 中 CD8 + 细胞密度之间的反比关系也表明，Fn 在使 AC 微环境向免疫抑制或免疫排斥表型转变方面发挥着潜在作用。我们计划开展更多的研究，纳入更多不同组织学亚型的 AC 病例和腹膜转移病灶，以丰富对 AC 免疫学和微生物微环境的了解，从而为靶向治疗提供新的机会。

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引用次数: 0

Circulating tumor DNA predicts recurrence in patients receiving adjuvant hepatic artery infusion chemotherapy for resected colorectal liver metastases 循环肿瘤DNA预测接受辅助肝动脉输注化疗的结肠直肠癌转移患者复发

Surgical Oncology Insight

Pub Date : 2025-01-03 DOI: 10.1016/j.soi.2024.100121

Noah A. Cohen , Nazanin Khajoueinejad , Umut Sarpel , Spiros Hiotis , Parissa Tabrizian , Myron Schwartz , Benjamin J. Golas , Daniel M. Labow , Celina Ang

Objective

The role of circulating tumor DNA (ctDNA) in management of patients with colorectal cancer is evolving, however, there are no data on ctDNA monitoring in patients with resected colorectal liver metastases (CRLM) who receive adjuvant hepatic artery (HAI) chemotherapy. We report our center’s initial experience with postoperative ctDNA monitoring in patients receiving adjuvant HAI chemotherapy.

Summary background

Adjuvant HAI chemotherapy improves survival after CRLM resection. ctDNA has been shown to predict recurrence in patients with resected CRLM, however no ctDNA data are available in patients who receive adjuvant HAI chemotherapy.

Methods

All patients with CRLM who underwent surgical resection and HAI pump placement at our center were included in this study. Demographic, clinicopathologic, radiographic, and ctDNA data are reported.

Results

From 2019–2024, 13 patients with CRLM underwent surgical resection and HAI pump placement and had ctDNA testing. With median follow-up of 2.6 years (1.14–4.15), 11 (85 %) patients experienced recurrence at a median of 7.9 months (2.3–22.5). In total, 10 (77 %) patients were ctDNA-positive all of whom had radiographic evidence of recurrence. Three patients have died at the time of last follow-up.

Conclusions

After surgical resection and HAI chemotherapy, ctDNA was detectable in most patients, and was associated with radiographic recurrence in all ctDNA-positive patients. We report a high recurrence rate in this series of heavily-pretreated patients with known risk factors for recurrence.

目的循环肿瘤DNA （ctDNA）在结直肠癌患者治疗中的作用正在不断发展，然而，在接受辅助肝动脉化疗的结直肠癌肝转移（CRLM）患者中，还没有ctDNA监测的数据。我们报告本中心对接受辅助HAI化疗的患者术后ctDNA监测的初步经验。背景：辅助HAI化疗可提高CRLM切除术后的生存率。ctDNA已被证明可以预测切除的CRLM患者的复发，但在接受辅助HAI化疗的患者中没有ctDNA数据。方法所有在我中心行手术切除和HAI泵置入术的CRLM患者纳入本研究。报告了人口统计学、临床病理、放射学和ctDNA数据。结果2019-2024年，13例CRLM患者接受了手术切除和HAI泵放置，并进行了ctDNA检测。中位随访时间为2.6年（1.14-4.15年），11例（85% %）患者在中位7.9个月（2.3-22.5个月）时复发。总共有10例（77 %）患者为ctdna阳性，所有患者均有复发的影像学证据。截至最后一次随访时，已有3名患者死亡。结论在手术切除和HAI化疗后，大多数患者可检测到ctDNA，并与所有ctDNA阳性患者的放射学复发有关。我们报告了这一系列的高复发率的大量预处理患者已知的危险因素的复发。

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引用次数: 0

Real-world outcomes with T-VEC in patients with anti-PD-1 resistant in-transit disease from melanoma and Merkel cell carcinoma T-VEC治疗来自黑色素瘤和默克尔细胞癌的抗pd -1耐药转运疾病患者的实际结果

Surgical Oncology Insight

Pub Date : 2024-12-22 DOI: 10.1016/j.soi.2024.100120

David G. Su , Madeline McNamara , Margaret A. Kaszycki , Alexander E. Frey , Jeffrey J. Ishizuka , Philippos A. Costa , Thuy T. Tran , Harriet M. Kluger , James E. Clune , Sarah A. Weiss , Kelly L. Olino

Background and Objectives

Talimogene laherparepvec (T-VEC) is an intralesional cancer immunotherapy in patients with unresectable stage IIIB-IV melanoma and Merkel cell carcinoma (MCC). This study assesses T-VEC outcomes in patients with in-transit melanoma and MCC refractory to anti-PD-1 blockade.

Methods

All patients with advanced melanoma or MCC with ≥ 1 measurable lesion(s) were retrospectively evaluated from 2019 to 2023. Only those who received ICI therapy for ≥ 3 months with progression of regional metastasis prior to receiving T-VEC were included. Clinicopathologic and treatment data were reviewed.

Results

Seventeen patients underwent T-VEC therapy, consisting of thirteen melanoma and four MCC cases. Median age was 75.9 and 79.6 for melanoma and MCC cases respectively. Eleven melanoma (84 %) and three MCC (75 %) cases received extremity injections. Median number of in-transit metastatic sites for melanoma and MCC were 4 and 10; respectively, and the median number of treatment cycles per patient was five in both groups. Ten total patients responded with 8 complete responses and 2 partial responses, while five (4 melanoma; 1 MCC) had disease progression. Of seventeen patients, two discontinued T-VEC due to grade 3 + adverse events.

Conclusion

T-VEC following or in conjunction with immunotherapy exhibits tolerability and potential benefit in patients with advanced MCC and melanoma.

背景与目的alimogene laherparepvec （T-VEC）是一种用于不可切除的IIIB-IV期黑色素瘤和默克尔细胞癌（MCC）患者的瘤内肿瘤免疫疗法。本研究评估了对抗pd -1阻断难以治疗的运输中黑色素瘤和MCC患者的T-VEC结局。方法回顾性分析2019 - 2023年所有≥ 1个可测量病变的晚期黑色素瘤或MCC患者。仅包括那些在接受T-VEC之前接受ICI治疗≥ 3个月且区域转移进展的患者。回顾了临床病理和治疗资料。结果17例患者接受了T-VEC治疗，其中黑色素瘤13例，MCC 4例。黑色素瘤和MCC病例的中位年龄分别为75.9岁和79.6岁。11例黑色素瘤（84 %）和3例MCC（75 %）接受四肢注射。黑色素瘤和MCC的中位在途转移位点分别为4个和10个；两组患者的治疗周期中位数均为5个。10例患者有8例完全缓解，2例部分缓解，5例(4例黑色素瘤；1例MCC)有疾病进展。在17例患者中，2例由于3级 + 不良事件而停止T-VEC治疗。结论t - vec在免疫治疗后或联合免疫治疗对晚期MCC和黑色素瘤患者具有耐受性和潜在的益处。

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引用次数: 0

Prognostic impact of the CALLY index in patients with resectable pancreatic cancer CALLY指数对可切除胰腺癌患者预后的影响

Surgical Oncology Insight

Pub Date : 2024-12-19 DOI: 10.1016/j.soi.2024.100119

Satoshi Matsui, Yoshiyasu Kato, Katsuhisa Ohgi, Ryo Ashida, Mihoko Yamada, Shimpei Otsuka, Katsuhiko Uesaka, Teiichi Sugiura

Background

The prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index has been reported in various cancers. However, its role in pancreatic cancer remains unclear.

Methods

A cohort of 307 patients with resectable pancreatic cancer (RPC) who underwent curative surgery without neoadjuvant therapy, between July 2012 and December 2019, was analyzed. The CALLY index was defined as (albumin × lymphocytes)/ (C-reactive protein × 10⁴). The cutoff value of the CALLY index was determined according to　receiver operating characteristics analysis using survival status at 3-year follow-up. The association of the CALLY index with disease-free survival (DFS) and overall survival (OS) was investigated using univariate and multivariate analyses.

Results

The median CALLY index was 4.5, with an interquartile range of 1.4–12.3. The cutoff value of the CALLY index was set at 3.0, dividing patients into a CALLY-high group (> 3.0; n = 180) and a CALLY-low group (≤ 3.0; n = 127). The DFS and OS were significantly worse in the CALLY-low group versus the CALLY-high group (p < 0.001 and p < 0.001, respectively). Multivariate analysis, using preoperative clinicopathological variables, revealed a CALLY index ≤ 3.0 as an independent prognostic factor for DFS (hazard ratio [HR] 1.43, p = 0.041) and OS (HR 1.56, p = 0.012).

Conclusions

In RPC, survival outcomes were significantly stratified by the CALLY index = 3.0, with < 3 being a significantly poor prognostic factor for DFS and OS. The CALLY index may be useful in predicting long-term survival in patients with RPC.

术前c反应蛋白-白蛋白淋巴细胞（CALLY）指数在各种癌症中的预后意义已被报道。然而，它在胰腺癌中的作用尚不清楚。方法对2012年7月至2019年12月307例接受根治性手术且未接受新辅助治疗的可切除胰腺癌（RPC）患者进行队列分析。CALLY指数定义为（白蛋白×淋巴细胞）/ （c反应蛋白× 104）。CALLY指数的临界值根据3年随访时患者的生存状况进行操作特征分析确定。采用单因素和多因素分析研究CALLY指数与无病生存期（DFS）和总生存期（OS）的关系。结果CALLY指数中位数为4.5，四分位数范围为1.4 ~ 12.3。将CALLY指数的临界值设为3.0，将患者分为CALLY高组(>；3.0;n = 180)和CALLY-low组(≤3.0；n = 127)。低cally组的DFS和OS明显差于高cally组（p分别为 <； 0.001和p <； 0.001）。使用术前临床病理变量进行多因素分析，发现CALLY指数≤ 3.0是DFS（风险比[HR] 1.43, p = 0.041）和OS（风险比[HR] 1.56, p = 0.012）的独立预后因素。结论在RPC中，生存结果有明显的分层，CALLY指数= 3.0,<；3是DFS和OS的显著不良预后因素。CALLY指数可能有助于预测RPC患者的长期生存。

{"title":"Prognostic impact of the CALLY index in patients with resectable pancreatic cancer","authors":"Satoshi Matsui, Yoshiyasu Kato, Katsuhisa Ohgi, Ryo Ashida, Mihoko Yamada, Shimpei Otsuka, Katsuhiko Uesaka, Teiichi Sugiura","doi":"10.1016/j.soi.2024.100119","DOIUrl":"10.1016/j.soi.2024.100119","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index has been reported in various cancers. However, its role in pancreatic cancer remains unclear.</div></div><div><h3>Methods</h3><div>A cohort of 307 patients with resectable pancreatic cancer (RPC) who underwent curative surgery without neoadjuvant therapy, between July 2012 and December 2019, was analyzed. The CALLY index was defined as (albumin × lymphocytes)/ (C-reactive protein × 10<sup>4</sup>). The cutoff value of the CALLY index was determined according to　receiver operating characteristics analysis using survival status at 3-year follow-up. The association of the CALLY index with disease-free survival (DFS) and overall survival (OS) was investigated using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>The median CALLY index was 4.5, with an interquartile range of 1.4–12.3. The cutoff value of the CALLY index was set at 3.0, dividing patients into a CALLY-high group (> 3.0; n = 180) and a CALLY-low group (≤ 3.0; n = 127). The DFS and OS were significantly worse in the CALLY-low group versus the CALLY-high group (<em>p</em> < 0.001 and <em>p</em> < 0.001, respectively). Multivariate analysis, using preoperative clinicopathological variables, revealed a CALLY index ≤ 3.0 as an independent prognostic factor for DFS (hazard ratio [HR] 1.43, <em>p</em> = 0.041) and OS (HR 1.56, <em>p</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>In RPC, survival outcomes were significantly stratified by the CALLY index = 3.0, with < 3 being a significantly poor prognostic factor for DFS and OS. The CALLY index may be useful in predicting long-term survival in patients with RPC.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182587","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

Risk factors for early versus late venous thromboembolism after cytoreductive surgery and HIPEC 细胞再生手术和 HIPEC 后早期与晚期静脉血栓栓塞的风险因素

Surgical Oncology Insight

Pub Date : 2024-12-13 DOI: 10.1016/j.soi.2024.100118

Sohini Khan , Kaitlyn Kelly , Jula Veerapong , Andrew M. Lowy , Joel M. Baumgartner

Background

Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) often have extensive cancer burden, long operative times, and reduced mobility postoperatively – known risk factors for venous thromboembolism (VTE). It is unknown whether risk factors differ for early versus late VTEs post-CRS-HIPEC.

Methods

We retrospectively studied patients undergoing CRS-HIPEC from 2007 to 2021 and analyzed VTEs occurring within 60 days of surgery. VTEs ≤ postoperative day (POD) 7 were “early”; those after POD 7 were “late”. Associated risk factors were analyzed using student’s t-test, Chi-squared test, and logistic regression.

Results

By POD 60, 35 of 682 CRS-HIPEC patients (5.1 %) had VTEs – eight (22.9 %) early and 27 (77.1 %) late. All early VTEs were pulmonary emboli vs. 63 % of late VTEs (p = 0.041); five (62.5 %) early VTEs were serious (Clavien-Dindo grade ≥3) vs. two (7.4 %) late VTEs (p = 0.005). Early VTEs were associated with primary ovarian cancer (37.5 % vs. 4.2 %, p < 0.001), extensive pelvic dissection (87.5 % vs. 50.1 %, p = 0.035), PCI 31–39 (p = 0.002), OR time (558 vs. 420 min, p = 0.015), EBL (650 vs. 150 mL, p = 0.005), and intraoperative transfusion (62.5 % vs. 13.1 %, p = 0.002). Late VTEs were associated with higher Caprini score (9 vs. 8, p = 0.038), lower serum albumin (4.1 vs. 4.3, p = 0.002), PCI 31–39 (p = 0.012) and serious inpatient postoperative complications (22.2 % vs. 7.3 %, p = 0.008).

Conclusions

Severity and risk factors are markedly different for early vs. late VTEs following CRS-HIPEC. Early VTEs are more serious and associated with primary ovarian cancer and extensive cytoreduction including pelvic dissection highlighting the need for alternative prophylaxis strategies and clinical scrutiny in these populations.

背景：接受细胞减少手术和腹腔热化疗（CRS-HIPEC）的患者通常有广泛的癌症负担、较长的手术时间和术后活动能力降低——已知的静脉血栓栓塞（VTE）的危险因素。crs - hipec后早期与晚期静脉血栓形成的危险因素是否不同尚不清楚。方法回顾性研究2007年至2021年接受CRS-HIPEC的患者，分析手术60天内发生的静脉血栓栓塞。静脉血栓栓塞≤ 术后第7天（POD）为“早期”；POD 7之后的是“迟到”。相关危险因素分析采用学生t检验、卡方检验和logistic回归。结果到POD 60时，682例CRS-HIPEC患者中有35例（5.1% %）发生vte，早期8例（22.9% %），晚期27例（77.1 %）。早期静脉血栓栓塞均为肺栓塞，晚期静脉血栓栓塞63 % (p = 0.041)；早期静脉血栓栓塞5例（62.5 %）严重（Clavien-Dindo分级≥3级），晚期静脉血栓栓塞2例（7.4 %）（p = 0.005）。早期的静脉血栓栓塞与原发性卵巢癌(37.5 % 4.2 vs %,p & lt; 0.001),广泛盆腔解剖(87.5 % 50.1 vs % p = 0.035),PCI - 39 (p = 0.002),或时间(558年和420年 min, p = 0.015),电子提单(650年和150年 mL, p = 0.005),和术中输血(62.5 % 13.1 vs % p = 0.002)。晚vt Caprini分数就越(9和8,p = 0.038),降低血清白蛋白(4.1 vs 4.3, p = 0.002),PCI - 39 (p = 0.012)和严重的住院病人术后并发症(22.2 % 7.3 vs % p = 0.008)。结论CRS-HIPEC术后早期与晚期静脉血栓形成的严重程度和危险因素有显著差异。早期静脉血栓栓塞更严重，与原发性卵巢癌和广泛的细胞减少（包括盆腔夹层）有关，这突出了在这些人群中需要替代预防策略和临床检查。

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引用次数: 0

Analysis of 3144 case reports in the gastrointestinal stromal tumor literature: Identification of underappreciated demographics, clinical presentations, and biology 对胃肠道间质瘤文献中3144例病例报告的分析：鉴别被低估的人口统计学、临床表现和生物学

Surgical Oncology Insight

Pub Date : 2024-12-12 DOI: 10.1016/j.soi.2024.100117

Tannaz Ranjbarian , Mark Antkowiak , Terence M. Doherty , Yeseob Jee , Jason K. Sicklick

Objective

Gastrointestinal stromal tumors (GIST) were first described in 1998 and are now known to be the most common soft tissue sarcoma. Numerous case reports are still frequently published reporting various aspects of GIST. This prompted us to review these reports to identify common elements, changes over time, and underappreciated aspects of GIST, as well as to ask whether further exploration is truly warranted.

Methods

A search of the NCBI PubMed database from 5/1/1998–8/5/2023 identified all case reports on GIST using the terms “GIST” OR “gastrointestinal stromal tumor” AND “case report.” Publications were classified into 19 categories, subcategorized, and analyzed using descriptive statistics.

Results

A total of 4350 articles were found, with 3144 case reports representing 3348 patients included for analysis. The five most represented categories were tumor location (30.3 %), presentation (27.5 %), operative approach (12.1 %), concomitant malignancy (9.2 %), and metastatic site (8.4 %). Notable findings included rare but clinically important features such as tumor-associated paraneoplastic syndromes (0.6 %) and brain metastases (0.6 %). Additionally, 38 cases (1.2 %) were reported in neonates, infants, and children ≤ 12 years old.

Conclusions

We describe GIST case reports published over a 25-year period and classified them based upon abstract content. We were surprised to uncover an array of underappreciated aspects of GIST, speaking to the narrow but important role of publishing case reports on the novel and unusual aspects of rare diseases that would otherwise not be appreciated in larger case series or in population-based studies. Thus, we recommend judicious publication of GIST case reports, particularly those that emphasize previously unknown or unappreciated aspects of disease biology or novel approaches to management.

目的胃肠道间质瘤（GIST）于1998年首次被发现，是目前已知最常见的软组织肉瘤。许多病例报告仍然经常发表，报告GIST的各个方面。这促使我们回顾这些报告，以确定GIST的共同因素、随时间的变化和未被重视的方面，并询问是否真的有必要进行进一步的探索。方法检索1998年5月1日至2023年8月5日期间NCBI PubMed数据库，使用“GIST”或“胃肠道间质瘤”和“病例报告”等术语确定所有关于GIST的病例报告。将出版物分为19类，再分类，并使用描述性统计进行分析。结果共收录文献4350篇，纳入病例3144例，患者3348例。五个最具代表性的类别是肿瘤位置（30.3% %）、表现（27.5% %）、手术入路（12.1 %）、合并恶性肿瘤（9.2 %）和转移部位（8.4 %）。值得注意的发现包括罕见但临床上重要的特征，如肿瘤相关的副肿瘤综合征（0.6 %）和脑转移（0.6 %）。此外，38例（1.2 %）报告了新生儿，婴儿和≤ 12岁的儿童。我们描述了25年来发表的GIST病例报告，并根据摘要内容对其进行了分类。我们惊讶地发现GIST的一系列未被重视的方面，说明发表罕见疾病新颖和不寻常方面的病例报告的狭窄但重要的作用，否则在更大的病例系列或基于人群的研究中不会得到重视。因此，我们建议明智地发表GIST病例报告，特别是那些强调以前未知或未被重视的疾病生物学方面或新治疗方法的病例报告。

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引用次数: 0

Utility of tumor-informed circulating tumor DNA for detection of minimal residual disease after curative-intent therapy in localized pancreatic cancer 肿瘤信息循环肿瘤DNA在局部胰腺癌治疗后微小残留病变检测中的应用

Surgical Oncology Insight

Pub Date : 2024-12-07 DOI: 10.1016/j.soi.2024.100116

Erin M. Dickey , Mary P. Martos , Ujwal Yanala , Andres Corona , Nkiruka Ezenwajiaku , Joseph Pizzolato , Dido Franceschi , Alan S. Livingstone , Gretel Terrero , Caitlin A. Hester , Nipun B. Merchant , Jashodeep Datta , Peter J. Hosein

Introduction

Patients with localized PDAC have high recurrence rates even after curative-intent therapies. Detection of minimal residual disease (MRD) can inform prognosis and may be therapeutically actionable. Tumor-informed circulating tumor (ct)DNA has been shown to be useful for MRD detection in other cancers, but its utility in localized PDAC patients undergoing curative-intent therapy is not well established.

Methods

ctDNA samples (total 106) from 32 patients, following completion of all curative-intent therapy, were subjected to Signatera™ analysis (Natera, Inc.). Recurrence-free survival (RFS) data was calculated using Kaplan-Meier estimates. Data from three previously presented studies using the same platform were pooled for validation.

Results

In our cohort (n = 32), ctDNA positivity rate was 28.1 % (9/32) with a median follow-up time of 17.7 months (range 4–62). Median RFS was significantly lower in patients with positive ctDNA (3.6 vs. 29.0 months, p < 0.001; HR: 72.1 [8.6—604.9]). Correlation of positive ctDNA with radiographic recurrence showed a sensitivity of 47.4 % (9/19), specificity of 100 % (13/13), PPV of 100 % (9/9), and NPV of 56.5 % (13/23). In the pooled cohort (n = 172), sensitivity was 66.7 % (50/75), specificity 77.3 % (75/97), PPV 69.4 % (50/72), and NPV 75.0 % (75/100).

Conclusions

Positive tumor-informed ctDNA test shows a high specificity and PPV for radiographic recurrence and is associated with significantly worse RFS. However, sensitivity of the test remains low.

Synopsis

In patients with localized PDAC completing curative-intent therapies, tumor-informed ctDNA assessment shows high specificity for radiographic recurrence and is associated with worse RFS. However, sensitivity remains low and presents an opportunity for improved calibration of this platform.

导言局部 PDAC 患者即使接受了治愈性治疗，复发率也很高。最小残留病（MRD）的检测可为预后提供信息，并可用于治疗。肿瘤信息循环肿瘤（ct）DNA已被证明可用于其他癌症的MRD检测，但其在接受根治性治疗的局部PDAC患者中的应用尚未得到充分证实。无复发生存期（RFS）数据采用 Kaplan-Meier 估计法计算。结果在我们的队列（n = 32）中，ctDNA阳性率为28.1%（9/32），中位随访时间为17.7个月（4-62个月）。ctDNA阳性患者的中位RFS明显较低（3.6个月 vs. 29.0个月，p < 0.001; HR: 72.1 [8.6-604.9]）。ctDNA阳性与放射学复发的相关性显示，敏感性为47.4%（9/19），特异性为100%（13/13），PPV为100%（9/9），NPV为56.5%（13/23）。在汇总队列（n = 172）中，敏感性为 66.7 %（50/75），特异性为 77.3 %（75/97），PPV 为 69.4 %（50/72），NPV 为 75.0 %（75/100）。简介在完成治愈性治疗的局部 PDAC 患者中，肿瘤提示的 ctDNA 评估对放射学复发显示出较高的特异性，并与较差的 RFS 相关。然而，灵敏度仍然很低，这为改进该平台的校准提供了机会。

{"title":"Utility of tumor-informed circulating tumor DNA for detection of minimal residual disease after curative-intent therapy in localized pancreatic cancer","authors":"Erin M. Dickey , Mary P. Martos , Ujwal Yanala , Andres Corona , Nkiruka Ezenwajiaku , Joseph Pizzolato , Dido Franceschi , Alan S. Livingstone , Gretel Terrero , Caitlin A. Hester , Nipun B. Merchant , Jashodeep Datta , Peter J. Hosein","doi":"10.1016/j.soi.2024.100116","DOIUrl":"10.1016/j.soi.2024.100116","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with localized PDAC have high recurrence rates even after curative-intent therapies. Detection of minimal residual disease (MRD) can inform prognosis and may be therapeutically actionable. Tumor-informed circulating tumor (ct)DNA has been shown to be useful for MRD detection in other cancers, but its utility in localized PDAC patients undergoing curative-intent therapy is not well established.</div></div><div><h3>Methods</h3><div>ctDNA samples (total 106) from 32 patients, following completion of all curative-intent therapy, were subjected to Signatera™ analysis (Natera, Inc.). Recurrence-free survival (RFS) data was calculated using Kaplan-Meier estimates. Data from three previously presented studies using the same platform were pooled for validation.</div></div><div><h3>Results</h3><div>In our cohort (n = 32), ctDNA positivity rate was 28.1 % (9/32) with a median follow-up time of 17.7 months (range 4–62). Median RFS was significantly lower in patients with positive ctDNA (3.6 vs. 29.0 months, p < 0.001; HR: 72.1 [8.6—604.9]). Correlation of positive ctDNA with radiographic recurrence showed a sensitivity of 47.4 % (9/19), specificity of 100 % (13/13), PPV of 100 % (9/9), and NPV of 56.5 % (13/23). In the pooled cohort (n = 172), sensitivity was 66.7 % (50/75), specificity 77.3 % (75/97), PPV 69.4 % (50/72), and NPV 75.0 % (75/100).</div></div><div><h3>Conclusions</h3><div>Positive tumor-informed ctDNA test shows a high specificity and PPV for radiographic recurrence and is associated with significantly worse RFS. However, sensitivity of the test remains low.</div></div><div><h3>Synopsis</h3><div>In patients with localized PDAC completing curative-intent therapies, tumor-informed ctDNA assessment shows high specificity for radiographic recurrence and is associated with worse RFS. However, sensitivity remains low and presents an opportunity for improved calibration of this platform.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183470","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

Incidence and factors associated with heart disease in patients diagnosed with small bowel and broncho-pulmonary neuroendocrine tumors: A population-based analysis 诊断为小肠和支气管-肺神经内分泌肿瘤患者心脏病的发病率和相关因素：一项基于人群的分析

Surgical Oncology Insight

Pub Date : 2024-12-04 DOI: 10.1016/j.soi.2024.100115

Julie Hallet , Shaheeda Ahmed , Simron Singh , Sten Myrehaug , Wing C. Chan , Anna Gombay , Calvin Law

Background

Heart disease is a complication of neuroendocrine tumors (NETs). Little is known about its occurrence in all patients diagnosed with NETs. We examined the occurrence of valvular and congestive heart disease and the use of echocardiography after NETs diagnosis.

Methods

We conducted a population-based retrospective cohort study of small bowel and broncho-pulmonary NETs (2000–2019). Heart disease was defined as new congestive heart failure or valvular disease. Cumulative incidence functions (CIF with 95 %CI) of heart disease and use of echocardiography were computed accounting for the competing risk of death.

Results

Of 5735 patients with NETs, 54.1 % had small bowel primaries and 48.8 % metastatic disease. The CIF of heart disease in all patients was 10.7 % (9.8–11.7 %) at 10 years. Heart disease was more frequent for small bowel (10-year CIF 12.7 % [11.2–14.2 %]) than broncho-pulmonary (10-year CIF 9.1 % [8.0–10.3 %]) NETs. Of 1864 patients with available urinary 5HIAA data, 64.0 % had elevated results. Heart disease was more frequent with elevated serotonin (10-year CIF 13.5 % [11.3–15.9 %]). 10-year CIF for echocardiography in all patients was 64.7 % (63.3–66.1 %), and exceeded 50 % in all sub-groups. Patterns of echocardiography CIF mirrored those of heart disease.

Conclusions

Valvular and congestive heart disease occurred in 10 out of 100 patients in the 10 years after small bowel and broncho-pulmonary NETs diagnosis. Patterns of echocardiography use suggest that testing is not influenced by NET disease characteristics, with risks of under-detection in at-risk individuals.

背景心脏病是神经内分泌肿瘤（NET）的一种并发症。人们对所有确诊为NET患者的心脏疾病发生率知之甚少。我们研究了瓣膜性和充血性心脏病的发生情况，以及确诊NETs后超声心动图的使用情况。方法我们对小肠和支气管肺NETs患者进行了一项基于人群的回顾性队列研究（2000-2019年）。心脏病定义为新发充血性心力衰竭或瓣膜病。在考虑死亡竞争风险的情况下，计算了心脏病和超声心动图使用的累积发病率函数（CIF，95%CI）。结果在5735名NET患者中，54.1%为小肠原发疾病，48.8%为转移性疾病。在所有患者中，10年后心脏病的CIF为10.7%（9.8%-11.7%）。与支气管肺癌（10年CIF为9.1%[8.0-10.3%]）相比，小肠瘤（10年CIF为12.7%[11.2-14.2%]）的心脏病发病率更高。在1864名有尿液5HIAA数据的患者中，64.0%的患者尿液5HIAA结果升高。血清素升高时，心脏病的发病率更高（10年CIF为13.5% [11.3-15.9 %]）。所有患者的 10 年超声心动图 CIF 为 64.7%（63.3-66.1%），在所有亚组中均超过 50%。结论在小肠和支气管-肺NET确诊后的10年中，100名患者中有10人患有瓣膜病和充血性心脏病。超声心动图的使用模式表明，检查不受NET疾病特征的影响，但在高危人群中存在检测不足的风险。

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引用次数: 0

Role of immunotherapy in the management of primary melanoma of the vagina: A national analysis of a rare aggressive malignancy 免疫治疗在阴道原发性黑色素瘤治疗中的作用：一种罕见侵袭性恶性肿瘤的全国分析

Surgical Oncology Insight

Pub Date : 2024-12-04 DOI: 10.1016/j.soi.2024.100113

Yingjoy Li , Sarah W. Yuen , Tu Tran , Kenneth G. Linden , Warren Chow , James G. Jakowatz , Maki Yamamoto , Thuy B. Tran

Background and objectives

Primary melanoma of the vagina (PMV) is a rare, aggressive gynecological malignancy that presents significant challenges to women’s health. Despite advancements in immunotherapy (IO), the impact of IO on PMV remains unknown. This study aims to investigate prognostic factors associated with long-term survival in patients with PMV.

Methods

The National Cancer Database was queried from 2004 to 2019 to identify patients with PMV. Demographics, tumor characteristics, and treatment type were evaluated. The Kaplan Meier method was used to estimate overall survival (OS). Multivariate Cox regression analysis was performed to determine predictors of survival.

Results

Our cohort included 884 women with PMV; 16.0 % were treated with IO. There were no differences in 5-year overall survival based on pathological characteristics or receipt of IO. Surgical resection was associated with improved 5-year OS (24.4 % vs. 8.6 %, p < 0.001). Five-year OS was higher in patients who underwent lymphadenectomy (31.0 % vs. 19.4 %, p = 0.003) and who had negative surgical margins (28.0 % vs. 21.0 %, p = 0.04). Among patients who did not undergo surgery, those who received IO had nearly 2-fold higher 5-year OS, but this did not reach significance (13.7 % vs. 7.7 %, p = 0.066). On multivariable analysis, older age, nodal metastasis, and higher comorbidity were independent predictors of poor OS, while receipt of IO was not. Surgical resection was the strongest independent predictor of improved OS.

Conclusions

Surgical intervention with lymphadenectomy and negative margins was associated with prolonged survival in patients with PMV, while IO was not. Further investigation is needed to identify optimal treatment strategies for PMV.

Synopsis

In this retrospective study of patients diagnosed with primary melanoma of the vagina, immunotherapy offered limited survival benefit, regardless of curative-intent surgery. Surgical intervention with lymphadenectomy and negative margins remained the most robust predictors of improved overall survival.

背景和目的阴道原发性黑色素瘤（PMV）是一种罕见的、侵袭性的妇科恶性肿瘤，对女性健康构成重大挑战。尽管免疫疗法（IO）取得了进展，但IO对PMV的影响仍然未知。本研究旨在探讨与PMV患者长期生存相关的预后因素。方法查询2004年至2019年国家癌症数据库，以确定PMV患者。评估人口统计学、肿瘤特征和治疗类型。Kaplan Meier法估计总生存期（OS）。采用多变量Cox回归分析确定生存预测因素。结果我们的队列包括884名女性PMV患者；16.0 %给予IO治疗。基于病理特征或接受IO的5年总生存率无差异。手术切除与5年OS改善相关（24.4 % vs. 8.6 %,p <； 0.001）。接受淋巴结切除术的患者5年OS更高（31.0 % vs. 19.4 %,p = 0.003）和手术切缘阴性的患者（28.0 % vs. 21.0 %,p = 0.04）。在未接受手术的患者中，接受IO的患者的5年OS高出近2倍，但这没有达到显著性（13.7 %对7.7 %,p = 0.066）。在多变量分析中，年龄较大、淋巴结转移和较高的合并症是不良OS的独立预测因素，而接受IO则不是。手术切除是改善OS的最强独立预测因子。结论淋巴结切除和阴性切缘的手术干预与PMV患者的生存期延长有关，而IO与此无关。需要进一步的研究来确定PMV的最佳治疗策略。摘要：在这项对阴道原发性黑色素瘤患者的回顾性研究中，无论是否进行治疗目的手术，免疫治疗都能提供有限的生存益处。手术干预与淋巴结切除术和阴性切缘仍然是提高总生存率的最可靠的预测因素。

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引用次数: 0