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IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-11-01 DOI: 10.1016/S0748-7983(24)00833-3

引用次数: 0

Harnessing machine learning to predict colorectal cancer metastasis: A promising artificial intelligence frontier 利用机器学习预测结直肠癌转移：大有可为的人工智能前沿

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-11-01 DOI: 10.1016/j.ejso.2024.108493

引用次数: 0

Beyond S100B: The need for new biomarkers in stage III melanoma recurrence detection 超越 S100B：III 期黑色素瘤复发检测需要新的生物标记物。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-11-01 DOI: 10.1016/j.ejso.2024.108543

Muhammad Eeman Bhutta, Muhammad Hammad Siddique, Fasi Ur Rehman Bhutta

引用次数: 0

Significance of anatomical resection and wide surgical margin for HCC patients with MVI undergoing laparoscopic hepatectomy: A multicenter study 接受腹腔镜肝切除术的MVI HCC患者解剖学切除和宽手术切缘的意义：一项多中心研究。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-31 DOI: 10.1016/j.ejso.2024.109353

Shiye Yang , Haishun Ni , Aixian Zhang , Jixiang Zhang , Hong Zang , Zhibing Ming

Objective

To investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR).

Methods

A retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR).

Results

In the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %.

Conclusions

Anatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.

目的研究手术切除边缘和肝切除类型对预后的影响，并比较它们对接受腹腔镜肝切除术（LLR）的有或无微血管侵犯（MVI）的肝细胞癌（HCC）患者的预后意义：对320名接受腹腔镜肝切除术的HCC患者进行了回顾性分析。根据 MVI 的分级，患者被分为 M0、M1 和 M2。根据肝切除类型将患者分为解剖性切除（AR）组和非解剖性切除（NAR）组。研究人员进行了生存和Cox回归分析，以探讨AR和NAR、宽切除边缘和窄切除边缘对总生存期（OS）和复发时间（TTR）的影响：结果：在整个队列中，窄切除缘是OS和TTR的独立危险因素，而NAR不是。亚组分析显示，切除边缘窄和NAR都是MVI HCC患者OS和TTR的独立危险因素。两组（NAR-宽切除边缘和AR-窄切除边缘）M1患者的5年OS和TTR率分别为85.3%对62%和34.4%对60.2%。同样，两组（NAR-宽切除边缘和AR-窄切除边缘）M2患者的5年OS和TTR率分别为80.2%对47.9%和30.8%对64.8%：解剖性肝切除术和宽切除边缘是MVI HCC患者接受LLR的独立保护因素。然而，与解剖性肝切除术相比，宽切除边缘对预后的影响更大。

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引用次数: 0

Comparative analysis of the oncologic outcomes and risk factors for open conversion in laparoscopic surgery for non-metastatic colorectal cancer: A retrospective multicenter study 腹腔镜手术治疗非转移性结直肠癌的肿瘤学结果和开腹手术风险因素的比较分析：一项多中心回顾性研究。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-31 DOI: 10.1016/j.ejso.2024.109357

Jae Hyun Kang , Eui Myung Kim , Min Jeong Kim , Bo Young Oh , Sang Nam Yoon , Byung Mo Kang , Jong Wan Kim

Purpose

Laparoscopic colon surgery is now commonly used for colorectal cancer (CRC) resection. The objective of this study was to compare the oncologic outcomes between open conversion and laparoscopic surgery, and to identify risk factors for open conversion.

Methods

We retrospectively reviewed the medical records of patients who underwent curative resection for stage 0–III CRC at five Hallym University-affiliated hospitals between January 2011 and June 2021. The patients were divided into the conversion and laparoscopic groups according to whether laparoscopic surgery was completed.

Results

Out of 2231 patients, laparoscopic surgery was completed in 2131 patients and 100 (4.5 %) converted to open surgery. The operation time (P = 0.028) and postoperative hospital stay (P = 0.036) were longer in the conversion group than in the laparoscopic group. Overall (P = 0.022) and severe (Clavien–Dindo classification grade ≥3) (P = 0.048) complications were more frequent in the conversion group than in the laparoscopic group. The 5-year recurrence-free survival (RFS) rate was worse in the conversion group than in the laparoscopic group (P = 0.002). In the multivariable analysis, open conversion was not a prognostic factor for RFS (P = 0.082). Abdominal surgery history (P = 0.021), obstruction (P < 0.001), and T4 stage (P < 0.001) were independently associated with open conversion.

Conclusion

The conversion group had worse perioperative and oncologic outcomes. History of abdominal surgery, obstruction, and T4 stage were associated with open conversion. However, conversion itself was not associated with RFS.

目的：腹腔镜结肠手术目前已普遍用于结直肠癌（CRC）切除术。本研究旨在比较开腹手术和腹腔镜手术的肿瘤治疗效果，并确定开腹手术的风险因素：我们回顾性地查看了2011年1月至2021年6月期间在五家韩林大学附属医院接受根治性切除术的0-III期CRC患者的病历。根据是否完成腹腔镜手术将患者分为转化组和腹腔镜组：在2231名患者中，2131人完成了腹腔镜手术，100人（4.5%）转为开腹手术。与腹腔镜手术组相比，开腹手术组的手术时间（P = 0.028）和术后住院时间（P = 0.036）更长。总并发症（P = 0.022）和严重并发症（Clavien-Dindo分级≥3级）（P = 0.048）在转换组比腹腔镜组更常见。转换组的 5 年无复发生存率（RFS）低于腹腔镜组（P = 0.002）。在多变量分析中，开腹手术转换不是RFS的预后因素（P = 0.082）。腹部手术史（P = 0.021）、梗阻（P转换组的围手术期和肿瘤学预后较差。腹部手术史、梗阻和T4分期与开腹转阴有关。然而，转换本身与RFS无关。

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引用次数: 0

Mixed adenoneuroendocrine carcinomas of the appendix: Is there a survival advantage to right hemicolectomy over appendectomy? 阑尾混合性腺内分泌癌：右半结肠切除术比阑尾切除术有生存优势吗？

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-30 DOI: 10.1016/j.ejso.2024.109356

Yulong Hou, Zhenhua Tan

Background

the surgical treatment and prognostic characteristics of mixed adenoneuroendocrine carcinomas (MANEC) of the appendix are not yet available. In this study, we sought to figure out the choice of surgical approach (right hemicolectomy versus appendectomy), and explore the effect of chemotherapy on appendiceal MANEC.

Methods

patients with appendiceal MANEC from the Surveillance, Epidemiology, and End Results database (2000–2020) were stratified by gender, race, age group, tumor grade, and TNM stage. Logistic regression and Kaplan-Meier analyses relating TNM stage, grade, and receipt of right hemicolectomy (abbreviated as colectomy) to overall and cancer-specific survival were performed.

Results

455 patients with appendiceal MANEC were included, of whom 146(32 %) underwent appendectomy and 309(68 %) underwent colectomy. Patients who underwent colectomy had better cancer-specific survival (HR = 0.68, 95%CI (0.47–0.98), P = 0.041) and overall survival (HR = 0.67, 95%CI (0.48–0.93), P = 0.015) than those who underwent appendectomy alone. However, colectomy did not confer any survival advantage over appendectomy in subgroup analyses, including low-grade or high-grade tumors, T1-2N0M0 group, T3-4N0M0 group, node-positive non-metastatic tumors, and metastatic tumors. On multivariate analysis, lack of chemotherapy and high-stage (node-positive or metastatic) were associated with poorer overall survival; high-grade (grade 3–4) and high-stage were primary predictors of cancer-specific mortality. Furthermore, there was no significant association between colectomy and better survival, either overall survival or cancer specific survival, when accounting for tumor stage and grade.

Conclusions

Our study found that colectomy did not provide a survival benefit compared to appendectomy alone. Moreover, tumor stage and grade were independent determinants of cancer specific survival; chemotherapy and tumor stage were independent determinants of overall survival.

背景：阑尾混合性腺内分泌癌（MANEC）的手术治疗和预后特征尚不明确。在这项研究中，我们试图找出手术方法的选择（右半结肠切除术与阑尾切除术），并探讨化疗对阑尾MANEC的影响。方法：将监测、流行病学和最终结果数据库（2000-2020年）中的阑尾MANEC患者按性别、种族、年龄组、肿瘤分级和TNM分期进行分层。对TNM分期、分级和接受右半结肠切除术（简称结肠切除术）与总生存率和癌症特异性生存率进行了逻辑回归和卡普兰-梅耶分析：共纳入455名阑尾MANEC患者，其中146人（32%）接受了阑尾切除术，309人（68%）接受了结肠切除术。与单独接受阑尾切除术的患者相比，接受结肠切除术的患者癌症特异性生存率（HR = 0.68，95%CI (0.47-0.98)，P = 0.041）和总生存率（HR = 0.67，95%CI (0.48-0.93)，P = 0.015）更高。然而，在亚组分析中，包括低级别或高级别肿瘤、T1-2N0M0组、T3-4N0M0组、结节阳性非转移性肿瘤和转移性肿瘤，结肠切除术并不比阑尾切除术带来任何生存优势。在多变量分析中，缺乏化疗和高分期（结节阳性或转移性）与较差的总生存率有关；高级别（3-4级）和高分期是癌症特异性死亡率的主要预测因素。此外，在考虑肿瘤分期和分级的情况下，结肠切除术与总生存率或癌症特异性生存率之间没有明显的关联：我们的研究发现，与单纯阑尾切除术相比，结肠切除术并不能提高生存率。此外，肿瘤分期和分级是癌症特异性生存率的独立决定因素；化疗和肿瘤分期是总生存率的独立决定因素。

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引用次数: 0

Is liver resection still required for patients who have predictive factors for complete pathologic necrosis after downstaging treatments of locally advanced hepatocellular carcinoma? 局部晚期肝细胞癌经过降期治疗后，具有完全病理坏死预测因素的患者是否仍需进行肝脏切除？

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-28 DOI: 10.1016/j.ejso.2024.109349

Munseok Choi , Dai Hoon Han , Kyung Sik Kim , Jin Sub Choi , Beom Kyung Kim , Seung Up Kim , Jinsil Seong , Do Young Kim , Gi Hong Choi

Background

Liver resection can induce complete remission after tumor downstaging in patients with locally advanced hepatocellular carcinoma. However, additional benefits of liver resection have not been investigated in patients expected to have complete pathological necrosis (CPN) following HCC downstaging.

Methods

Between 2002 and 2019, 999 patients with locally advanced HCC underwent concurrent chemoradiotherapy (CCRT) (n = 800) or transarterial radioembolization (TARE) (n = 199). Among these patients, excluding those who underwent liver transplantation, 94 who underwent liver resection (OP group) and 867 who did not undergo surgical treatment (non-OP group) were included in this study. CPN predictive factors in the OP group were analyzed using logistic regression analysis. Long-term outcomes were compared between patients with CPN (op-CPN) and those with CPN predictive factors in the non-OP group (nop-CPNPF).

Results

Of the 94 patients in the OP group, 38 (40.4 %) had CPN (CCRT, n = 72; TARE, n = 22). In the multivariate analysis, CPN predictive factors were complete radiologic response and tumor marker responders (odds ratio [OR] 18.468, p = 0.006; OR 3.698, p = 0.045). Among the non-OP group, 21 patients were in the nop-CPNPF group. There was no difference in DFS between the nop-CPNPF and op-CPN groups (40.0 ± 18.3 vs. 60.0 ± 14.0 months, p = 0.838). The OS of the op-CPN group was not higher than that of the nop-CPNPF group (5-year OS: 39.4 % vs. 33.3 %, p = 0.328).

Conclusions

The nop-CPNPF group showed long-term outcomes similar to those of the op-CPN group, suggesting that liver resection may not provide additional benefits for long-term outcomes in patients with CPN-PF after HCC downstaging.

背景：局部晚期肝细胞癌患者在肿瘤缩小分期后，肝切除术可促使病情完全缓解。然而，对于 HCC 降期后预计会出现完全病理坏死（CPN）的患者，肝切除术的额外益处尚未得到研究：2002年至2019年期间，999名局部晚期HCC患者接受了同期化放疗（CCRT）（800人）或经动脉放射栓塞（TARE）（199人）。在这些患者中，除去接受肝移植的患者，接受肝切除术（OP 组）的患者有 94 人，未接受手术治疗（非 OP 组）的患者有 867 人。采用逻辑回归分析法对 OP 组 CPN 的预测因素进行了分析。比较了有 CPN 的患者（op-CPN）和非 OP 组有 CPN 预测因素的患者（nop-CPNPF）的长期预后：结果：在手术组的 94 名患者中，38 人（40.4%）患有 CPN（CCRT，72 人；TARE，22 人）。在多变量分析中，预测 CPN 的因素是完全放射学反应和肿瘤标志物反应者（比值比 [OR] 18.468，P = 0.006；OR 3.698，P = 0.045）。在非 OP 组中，有 21 名患者属于 nop-CPNPF 组。nop-CPNPF 组和 op-CPN 组的 DFS 没有差异（40.0 ± 18.3 个月 vs. 60.0 ± 14.0 个月，p = 0.838）。OPP-CPN组的OS并不比nop-CPNPF组高（5年OS：39.4% vs. 33.3%，p = 0.328）：结论：nop-CPNPF组的长期预后与op-CPN组相似，这表明在HCC降期后，肝切除可能不会为CPN-PF患者的长期预后带来额外的益处。

{"title":"Is liver resection still required for patients who have predictive factors for complete pathologic necrosis after downstaging treatments of locally advanced hepatocellular carcinoma?","authors":"Munseok Choi , Dai Hoon Han , Kyung Sik Kim , Jin Sub Choi , Beom Kyung Kim , Seung Up Kim , Jinsil Seong , Do Young Kim , Gi Hong Choi","doi":"10.1016/j.ejso.2024.109349","DOIUrl":"10.1016/j.ejso.2024.109349","url":null,"abstract":"<div><h3>Background</h3><div>Liver resection can induce complete remission after tumor downstaging in patients with locally advanced hepatocellular carcinoma. However, additional benefits of liver resection have not been investigated in patients expected to have complete pathological necrosis (CPN) following HCC downstaging.</div></div><div><h3>Methods</h3><div>Between 2002 and 2019, 999 patients with locally advanced HCC underwent concurrent chemoradiotherapy (CCRT) (n = 800) or transarterial radioembolization (TARE) (n = 199). Among these patients, excluding those who underwent liver transplantation, 94 who underwent liver resection (OP group) and 867 who did not undergo surgical treatment (non-OP group) were included in this study. CPN predictive factors in the OP group were analyzed using logistic regression analysis. Long-term outcomes were compared between patients with CPN (op-CPN) and those with CPN predictive factors in the non-OP group (nop-CPNPF).</div></div><div><h3>Results</h3><div>Of the 94 patients in the OP group, 38 (40.4 %) had CPN (CCRT, n = 72; TARE, n = 22). In the multivariate analysis, CPN predictive factors were complete radiologic response and tumor marker responders (odds ratio [OR] 18.468, p = 0.006; OR 3.698, p = 0.045). Among the non-OP group, 21 patients were in the nop-CPNPF group. There was no difference in DFS between the nop-CPNPF and op-CPN groups (40.0 ± 18.3 vs. 60.0 ± 14.0 months, p = 0.838). The OS of the op-CPN group was not higher than that of the nop-CPNPF group (5-year OS: 39.4 % vs. 33.3 %, p = 0.328).</div></div><div><h3>Conclusions</h3><div>The nop-CPNPF group showed long-term outcomes similar to those of the op-CPN group, suggesting that liver resection may not provide additional benefits for long-term outcomes in patients with CPN-PF after HCC downstaging.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 109349"},"PeriodicalIF":3.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Results of complete cytoreductive strategy in patients with peritoneal metastases of colorectal origin with or without extraperitoneal metastases: A bicentric analysis 对伴有或不伴有腹膜外转移的结直肠源性腹膜转移患者采用完全细胞切除策略的结果：双中心分析

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-28 DOI: 10.1016/j.ejso.2024.108788

Isabelle Sourrouille , Clément Pastier , Maximilliano Gelli , Léonor Benhaïm , Pierre Cattan , Michel Ducreux , Thomas Aparicio , Diane Goéré

Background

Increased survival can be achieved in patients with colorectal cancer peritoneal metastases (CRPM) treated with cytoreductive surgery. The benefit of this strategy remains uncertain when CRPM are associated with extraperitoneal metastases (EPM). The aim of this study was to compare short- and long-term outcomes of patients treated with CRS for CRPM, with or without EPM.

Methods

This study included 413 consecutive patients who underwent CRS for CRPM: 120 with EPM (EPM+) and 293 without (EPM-). Patients with isolated ovarian metastases were included in EPM-group (n = 83).

Results

EPM were mainly located to the liver (66 %,n = 79), retroperitoneal lymph nodes (33 %,n = 40); less frequently to the spleen (9 %,n = 12), lung (9 %,n = 10) or pleura (1 %,n = 1). Ovarian metastases were present in 126 patients (83 in EMP-, 43 in EPM+). Peritoneal carcinomatosis index (PCI) was similar in EPM- (8 [4–14]) and EPM+ (8 [3–13],p = 0.335) groups, as postoperative mortality (3 % vs 3 %,p = 1) and major morbidity rates (28 % vs 35 %,p = 0.223). Median overall survival (mOS) and disease-free survival were significantly higher in the EPM-group (58m vs 39m, and 16m vs 10m,p = 0.003). We highlighted 3 prognostic groups 1) EPM-with PCI<10 (mOS 93m), 2) EPM+ with PCI<10 (mOS 57m), 3) EPM-with 10<PCI<15 (mOS 35m) or EPM+ with 10<PCI<15 (mOS 31m) or PCI>15 regardless EPM (mOS 26m, p < 0.001).

Conclusion

Complete cytoreductive surgery seems to be feasible in patients with EPM, without increase in postoperative morbidity and mortality compared to patients without EPM. This strategy provides prolonged survival in selected patients with limited peritoneal metastases from colorectal cancer.

背景：结直肠癌腹膜转移（CRPM）患者接受囊肿切除手术治疗可提高生存率。如果结直肠癌腹膜外转移（CRPM）伴有腹膜外转移（EPM），这一策略的益处仍不确定。本研究的目的是比较接受 CRS 治疗的 CRPM 患者的短期和长期疗效，无论是否伴有 EPM：本研究纳入了 413 名连续接受 CRS 治疗的 CRPM 患者：该研究纳入了413名连续接受CRS治疗的CRPM患者：120名伴有EPM（EPM+），293名没有EPM（EPM-）。EPM组包括孤立卵巢转移的患者（n = 83）：EPM主要位于肝脏（66%，n = 79）、腹膜后淋巴结（33%，n = 40）；较少发生在脾脏（9%，n = 12）、肺部（9%，n = 10）或胸膜（1%，n = 1）。126例患者存在卵巢转移（EMP- 83例，EPM+ 43例）。腹膜癌变指数（PCI）在EPM-组（8 [4-14]）和EPM+组（8 [3-13]，P = 0.335）相似，术后死亡率（3 % vs 3 %，P = 1）和主要发病率（28 % vs 35 %，P = 0.223）也相似。EPM组的中位总生存期（mOS）和无病生存期明显高于EPM组（58米 vs 39米，16米 vs 10米，p = 0.003）。我们强调了 3 个预后组 1) EPM-有 PCI15 无 EPM 组（mOS 26m, p 结论：与没有 EPM 的患者相比，对 EPM 患者进行完全细胞剥脱手术似乎是可行的，且不会增加术后发病率和死亡率。这种策略可延长结直肠癌局限性腹膜转移患者的生存期。

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引用次数: 0

Intraperitoneal administration of a thermogel combined with an anticancer agent for the prevention of peritoneal carcinomatosis in a pig model. 在猪模型中腹膜内注射热凝胶和抗癌剂以预防腹膜癌。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-28 DOI: 10.1016/j.ejso.2024.108787

Agathe Thouvenin, Nawar Al Chirazi, Johanne Seguin, Cynthia Crocheray, Joël Poupon, Rachid Kaci, Nathalie Mignet, Vincent Boudy, Marc Pocard

Background: Surgeons may discover perioperative clinical situations associated with an increased risk of peritoneal carcinomatosis recurrence after primary resection. We developed a thermogel that can be used as a drug carrier to deliver an anticancer agent in the peritoneal cavity as a rescue solution. The spatial distribution of the thermogel and pharmacokinetics of chemotherapy have been studied in pigs. The safety of the thermogel was assessed based on the healing of bowel sutures.

Methods: Nine pigs received gel with oxaliplatin at 130 mg/200 mL (TG-Ox group), and 4 pigs received the gel alone (TG group). Digestive tract and bladder wounds were made and sutured. Pigs were sacrificed at different times after surgery to monitor the distribution of the thermogel and to detect the occurrence of bowel fistulas. Oxaliplatin plasma and tissue concentrations were determined via mass spectrometry.

Results: After 3 h, 100 % of the regions of interest were covered by the gel, 78 % were covered after 2 days, and 38 % were covered after 4 days. The thermogel delayed the release of oxaliplatin into the systemic circulation and significantly prolonged tissue impregnation. Anastomotic fistulas were observed in the TG-Ox group (10 %) versus 0 % in the TG group (p = 0.31).

Conclusions: A homogeneous distribution of the thermogel throughout the peritoneal cavity was observed, and the thermogel fulfilled its functions as a drug carrier, including ensuring safety and delaying chemotherapy delivery. Treatment-induced toxicity due to oxaliplatin was identified. The concept of a rescue solution being available in operating rooms was demonstrated.

背景：外科医生可能会发现围手术期的临床情况与原发性切除术后腹膜癌复发风险增加有关。我们开发了一种热凝胶，可用作药物载体，在腹腔内输送抗癌剂作为抢救溶液。我们在猪身上研究了热凝胶的空间分布和化疗的药代动力学。根据肠缝线的愈合情况评估了热凝胶的安全性：方法：9 头猪接受了含有 130 毫克/200 毫升奥沙利铂的凝胶（TG-Ox 组），4 头猪只接受了凝胶（TG 组）。制作并缝合消化道和膀胱伤口。猪在手术后的不同时间被处死，以监测热凝胶的分布情况并检测肠瘘的发生。通过质谱法测定奥沙利铂的血浆和组织浓度：3小时后，凝胶覆盖了100%的相关区域，2天后覆盖了78%，4天后覆盖了38%。热凝胶延缓了奥沙利铂向全身循环的释放，并显著延长了组织浸渍的时间。TG-Ox组出现吻合口瘘的比例为10%，而TG组为0%（P = 0.31）：结论：观察到热凝胶在整个腹腔内均匀分布，热凝胶实现了其作为药物载体的功能，包括确保安全和延迟化疗给药。发现了奥沙利铂引起的治疗毒性。在手术室提供抢救解决方案的概念得到了验证。

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引用次数: 0

Differences in patient- and tumor characteristics, treatment and survival between patients with screen-detected versus clinically detected colorectal peritoneal metastases 筛查发现的结直肠腹膜转移瘤与临床发现的结直肠腹膜转移瘤在患者和肿瘤特征、治疗和存活率方面的差异

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-10-25 DOI: 10.1016/j.ejso.2024.108789

L.J.K. Galanos , A. Rijken , M.A.G. Elferink , D. Boerma , A. Brandt-Kerkhof , P.R. de Reuver , J.B. Tuynman , N.F.M. Kok , P.H.J. Hemmer , W.M.U. van Grevenstein , C. Huysentruyt , F.N. van Erning , I.H.J.T. de Hingh

Introduction

Screening for colorectal cancer has been implemented to improve cancer-specific survival. This study aims to compare patient- and tumor characteristics, treatment, and survival between patients with screen-detected and clinically detected synchronous colorectal peritoneal metastases (CPM) in a Dutch population-based cohort.

Methods

Data from the Netherlands Cancer Registry (NCR) were used. Screening was performed nationwide with biennial FIT and subsequent colonoscopy if positive. Patients within the screening age (55–75 years) and diagnosed with synchronous CPM between 2014 and 2020 were included. Data from the NCR was linked to the Dutch Nationwide Pathology Databank (Palga) to identify mode of detection. Baseline characteristics and treatment were compared between screen-detected CPM patients and clinically detected CPM patients using χ₂-tests. Overall survival (OS) was compared between both groups with the log-rank test and a multivariable Cox regression analysis.

Results

Of 2,773 included patients with synchronous CPM, 197 (7 %) were detected by screening. In the screen-detected group, 56 (28 %) patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) versus 363 (14 %) in the clinically detected group (p < 0.001). Median OS was 20.0 months (IQR 9.7–51.7) in the screen-detected group versus 10.8 months (IQR 3.4–25.5) in the clinically detected group (p < 0.001). In the multivariable analysis, CPM detected through screening was associated with improved OS compared to clinically detected CPM (adjusted HR 0.68, 95%CI [0.57–0.81]).

Conclusions

Screen-detected patients with colorectal peritoneal metastases more often received treatment with curative intent and had better OS compared to clinically detected patients.

导言：为提高癌症特异性生存率，已开始实施结直肠癌筛查。本研究旨在比较荷兰人群队列中筛查发现的和临床发现的同步结直肠腹膜转移（CPM）患者的患者和肿瘤特征、治疗和生存情况。在全国范围内进行筛查，每两年进行一次 FIT 检查，如果结果呈阳性，则随后进行结肠镜检查。2014年至2020年期间，筛查年龄（55-75岁）内且确诊为同步CPM的患者被纳入其中。国家癌症研究中心的数据与荷兰全国病理数据库（Palga）相连，以确定检测方式。使用χ2检验比较了筛查出的CPM患者和临床检测出的CPM患者的基线特征和治疗情况。结果在纳入的2773名同步CPM患者中，有197人（7%）是通过筛查发现的。在筛查发现组中，有56名（28%）患者接受了细胞切除手术和腹腔内热化疗（CRS-HIPEC），而在临床发现组中，有363名（14%）患者接受了细胞切除手术和腹腔内热化疗（P< 0.001）。筛查发现组的中位 OS 为 20.0 个月（IQR 9.7-51.7），而临床发现组为 10.8 个月（IQR 3.4-25.5）（p <0.001）。在多变量分析中，与临床检测出的 CPM 相比，通过筛查检测出的 CPM 与更佳的 OS 相关（调整后 HR 0.68，95%CI [0.57-0.81]）。

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引用次数: 0