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Multidisciplinary team meeting (MDT) in cancer care: All that glitters is not gold. 癌症护理中的多学科小组会议(MDT):金无足赤,人无完人。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.ejso.2024.108751
I T Rubio, Wyld Lynda
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引用次数: 0
Surgical patterns of care of pancreatic cancer. A French population-based study. 胰腺癌的外科治疗模式。一项基于法国人口的研究。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.ejso.2024.108748
Guillaume Goebel, Valérie Jooste, Florence Molinie, Pascale Grosclaude, Anne-Sophie Woronoff, Arnaud Alves, Véronique Bouvier, Jean-Baptiste Nousbaum, Sandrine Plouvier, Leila Bengrine-Lefevre, Thomas Rabel, Anne-Marie Bouvier

Introduction: Surgical resection is the standard recommended treatment in localized pancreatic cancer. The benefit of neoadjuvant chemotherapy is still debated. The aim of this population-based study was to describe the pancreatic cancer surgical management.

Material and methods: An observational real-world study from the French Network of Cancer Registries sampled 638 pancreatic adenocarcinomas diagnosed in 2019. Characteristics of patients, tumours and recommended and administered treatments were collected. Operability of the patients and resectability of the tumours were described. A multivariate logistic regression was used to identify factors associated with the probability of having surgical resection.

Results: Among the 263 (41 %) patients with M0 pancreatic adenocarcinomas, 202 patients (77 %) were considered operable and 157 (60 %) also had a tumour considered resectable. Upfront resection was recommended for 68 % and resection after neoadjuvant chemotherapy for 32 % of these patients. Among operable patients with resectable tumour, 36 % underwent upfront R0 resection, and 15 % achieved R0 resection following neoadjuvant chemotherapy. Eventually, among M0 pancreatic adenocarcinomas, age over 80 years (OR≥80 years vs < 65 years: 0.16 [0.06-0.39], p < 0.001) and WHO performance status over 0 (OR1-2 vs 0: 0.43 [0.24-0.79], p = 0.013) decreased the odds of having resection. R0 surgical resection was achieved in 61 % of patients selected for upfront surgical recommendation, and 29 % of those selected for a prior neoadjuvant chemotherapy.

Conclusion: In a non-selected population, one-third of patients with localized pancreatic cancer had a complete R0 surgical resection. Neoadjuvant chemotherapy did not achieve a resection rate similar to that of patients selected for upfront surgical indication.

简介:手术切除是局部胰腺癌的标准推荐治疗方法:手术切除是局部胰腺癌的标准推荐治疗方法。新辅助化疗的益处仍存在争议。这项基于人群的研究旨在描述胰腺癌的手术治疗:一项来自法国癌症登记网络的真实世界观察研究对2019年确诊的638例胰腺癌进行了采样。研究收集了患者特征、肿瘤特征以及推荐和实施的治疗方法。对患者的可手术性和肿瘤的可切除性进行了描述。采用多变量逻辑回归来确定与手术切除概率相关的因素:在263名(41%)M0胰腺腺癌患者中,202名(77%)被认为可以手术,157名(60%)的肿瘤也被认为可以切除。在这些患者中,68%的患者被建议进行前期切除术,32%的患者被建议在新辅助化疗后进行切除术。在肿瘤可切除的可手术患者中,36%接受了前期R0切除术,15%在新辅助化疗后实现了R0切除。最终,在M0胰腺癌中,年龄超过80岁(OR≥80岁 vs:0.16 [0.06-0.39],p 1-2 vs:0:0.43 [0.24-0.79],p = 0.013)的患者接受切除手术的几率降低。61%选择前期手术建议的患者实现了R0手术切除,29%选择前期新辅助化疗的患者实现了R0手术切除:结论:在非选择人群中,三分之一的局部胰腺癌患者完成了R0手术切除。新辅助化疗的切除率无法达到与前期手术指征患者相似的切除率。
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引用次数: 0
Harnessing inflammatory markers to predict and prevent post-gastric surgery infections: A cost-saving approach. 利用炎症标志物预测和预防胃手术后感染:节约成本的方法。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.ejso.2024.108750
Ume Aiman, Umer Bin Shahzad
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引用次数: 0
Feasibility of intraoperative assessment of STAS in pathologic stage 1 lung adenocarcinomas in Chinese patients. 对中国患者病理分期为1期的肺腺癌进行STAS术中评估的可行性。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-08 DOI: 10.1016/j.ejso.2024.108747
FangPing Xu, ZhiHua Liu, JinHai Yan, Lixu Yan, ZhenBin Qiu, Yan Ge, ShanShan Lv, WenZhao Zhong

Background: Intraoperative assessment of tumor spread through air spaces (STAS) in early-stage lung adenocarcinomas (ADC) has been proposed to stratify patients for surgical management. However, data on the accuracy and reproducibility of detecting STAS on frozen sections (FS) and the prognostic value of STAS on FS remain limited and contradictory.

Methods: We conducted a retrospective study on the feasibility of intraoperative assessment of STAS by comparing the STAS patterns identified on FS and permanent sections from 524 patients diagnosed with pathologic stage 1 lung ADC. We also evaluated the association between STAS with patients' clinicopathological characteristics and their postoperative survival outcomes.

Results: STAS was identified in 117 out of 524 patients (22.3 %) on permanent sections. Patients with STAS identified on permanent sections experienced shorter progression-free survival (PFS; P = 0.042) and overall survival (OS; P = 0.005) compared to those without. STAS was identified in 87 out of 509 patients on FS. Patients with STAS detected on FS also had shorter PFS (P = 0.010) and OS (P < 0.001) than those without. Compared to permanent sections, STAS detection on FS yielded 66.7 % (74/111) sensitivity, 96.7 % (385/398) specificity, 85.1 % (74/87) positive predictive value, 91.2 % (385/422) negative predictive value, and 90.2 % (459/509) overall agreement. The kappa coefficient was 0.688 (P < 0.001).

Conclusions: Our results from a large series of Chinese patients with stage 1 lung ADC indicated that STAS was associated with poorer survival outcomes on both FS and permanent sections. FS is a highly specific method for assessing STAS in stage 1 lung ADC, but caution is warranted regarding false-positive results.

背景:有人建议在术中评估早期肺腺癌(ADC)肿瘤通过气隙扩散(STAS)的情况,以便对患者进行分层手术治疗。然而,有关在冰冻切片(FS)上检测 STAS 的准确性和可重复性以及 STAS 在 FS 上的预后价值的数据仍然有限且相互矛盾:我们进行了一项关于术中评估 STAS 可行性的回顾性研究,比较了从 524 例确诊为病理 1 期肺 ADC 患者的冰冻切片和永久切片上发现的 STAS 模式。我们还评估了STAS与患者临床病理特征及其术后生存结果之间的关联:结果:524 例患者中有 117 例(22.3%)在永久切片上发现了 STAS。在永久切片上发现 STAS 的患者与未发现 STAS 的患者相比,无进展生存期(PFS;P = 0.042)和总生存期(OS;P = 0.005)更短。在509例永久性切片患者中,有87例发现了STAS。在FS检查中发现STAS的患者的PFS(P = 0.010)和OS(P 结论:STAS患者的PFS(P = 0.010)和OS(P = 0.005)均较短:我们对大量中国肺部 ADC 1 期患者的研究结果表明,STAS 与 FS 和永久切片上较差的生存结果有关。FS 是评估肺 ADC 1 期 STAS 的高度特异性方法,但需要警惕假阳性结果。
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引用次数: 0
Necessity of splenectomy for antral-type scirrhous gastric cancer. 前胃鳞癌脾切除术的必要性
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-06 DOI: 10.1016/j.ejso.2024.108734
Yurina Yasui Fujisaki, Takaki Yoshikawa, Rei Ogawa, Masashi Nishino, Takeyuki Wada, Tsutomu Hayashi, Yukinori Yamagata, Masanori Tokunaga, Yusuke Kinugasa, Yasuyuki Seto

Background: Total gastrectomy with splenic hilar nodal dissection by splenectomy is frequently selected for resectable scirrhous gastric cancer (GC), irrespective of the whether it is of the antral or body type. However, whether splenectomy is necessary for antral-type scirrhous GC remains unclear.

Methods: We retrospectively reviewed the data of patients treated at National Cancer Center Hospital in Japan between 2000 and 2018. We selected patients with type IV GC in which the predominant location could be identified, who received D2 or more total gastrectomy with splenectomy, and in whom R0 or R1 resection was achieved. The therapeutic value index was evaluated by multiplying the metastatic rate of each nodal station by the five-year overall survival (OS) rate of patients with metastasis to each node.

Results: In total, 180 patients were included in this study (antral type, n = 19 [10.6 %]; body type, n = 161 [89.4 %]). Both types showed similar and frequent invasion of the greater curvature of the upper stomach. Metastasis to the splenic hilar nodes (#10) was not observed in the antral type (0/19) but was observed in the body type (35/161, 21.7 %); the difference was statistically significant (p = 0.027). The therapeutic value index of #10 was 0 in the antral type but was >7, the fourth highest, in the body type. The only nodes with an index >0 in the antral type were #4d, #3, #4sb, #6, #7, and #1.

Conclusions: Splenectomy may therefore be unnecessary for antral-type scirrhous GC.

背景:对于可切除的鳞状胃癌(GC),无论其为前胃型还是体型,通常都会选择全胃切除加脾门结节切除术。然而,对前区型淤血性胃癌是否有必要进行脾切除术仍不清楚:我们回顾性分析了 2000 年至 2018 年期间在日本国立癌症中心医院接受治疗的患者数据。我们选择了可以确定主要位置的 IV 型 GC 患者,这些患者接受了 D2 或以上的全胃切除术,同时进行了脾切除,并实现了 R0 或 R1 切除。将各结节站的转移率乘以各结节转移患者的五年总生存率(OS)来评估治疗价值指数:本研究共纳入180例患者(前体型,n = 19 [10.6%];体型,n = 161 [89.4%])。这两种类型的癌细胞都经常侵犯上胃大弯。在前胃型(0/19)中未观察到向脾门结节(#10)的转移,但在体型(35/161,21.7%)中观察到;差异有统计学意义(p = 0.027)。10 号的治疗价值指数在前列腺类型中为 0,但在身体类型中大于 7,为第四高。只有 4d、3 号、4sb、6 号、7 号和 1 号结节的治疗价值指数大于 0:结论:因此,对前区型淤血性 GC 可能不需要进行脾切除术。
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引用次数: 0
Prediction and validation of pathologic complete response for locally advanced rectal cancer under neoadjuvant chemoradiotherapy based on a novel predictor using interpretable machine learning 基于可解释机器学习的新型预测器,预测和验证新辅助化放疗下局部晚期直肠癌的病理完全反应
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-06 DOI: 10.1016/j.ejso.2024.108738
<div><h3>Background</h3><div>Precise evaluation of pathological complete response (pCR) is essential for determining the prognosis of patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (NCRT) and can offer clues for the selection of subsequent treatment strategies. Most current predictive models for pCR focus primarily on pre-treatment factors, neglecting the dynamic systemic changes that occur during neoadjuvant chemoradiotherapy, and are constrained by low accuracy and lack of integrity.</div></div><div><h3>Purpose</h3><div>This study devised a novel predictor of pCR using dynamic alterations in systemic inflammation-nutritional marker indexes (SINI) during neoadjuvant therapy and developed a machine-learning model to predict pCR.</div></div><div><h3>Methods</h3><div>Two cohorts of patients with LARC from center one from 2012 to 2017 and from center two from 2020 to 2023 were integrated for analysis. This study compared dynamic changes in blood indexes before and after neoadjuvant therapy and surgical operation. A least absolute shrinkage and selection operator (LASSO) regression analysis was conducted to mitigate collinearity and identify key indexes, constructing the SINI. Univariate and multiple logistic regression analyses were used to identify the independent risk factors associated with pCR. Additionally, 10 machine learning algorithms were employed to develop predictive models to assess risk. The hyperparameters of the machine learning models were optimized using a random search and 10-fold cross-validation. The models were assessed by examining various metrics, including the area under the receiver operating characteristic curves (AUC), the area under the precision-recall curve (AUPRC), decision curve analysis, calibration curves, and the precision and accuracy of the internal and external validation cohorts. Additionally, Shapley's additive explanations (SHAP) were employed to interpret the machine learning models.</div></div><div><h3>Results</h3><div>The study cohort comprised 677 patients from the center one and 224 patients from the center two. Six key indexes were identified, and a predictive index, SINI, was constructed. Univariate and multiple logistic regression analyses revealed that SINI, clinical T-stage, clinical N-stage, tumor size, and the distance from the anal verge were independent risk factors for pCR in patients with LARC following NCRT. The mean AUC value of the extreme gradient boosting (XGB) model in the 10-fold cross-validation of the training set was 0.877. The XGB model demonstrated superior performance in the internal and external validation sets. Specifically, in the internal test set, the XGB model achieved an AUC of 0.86, AUPRC of 0.707, accuracy of 0.82, and precision of 0.80. In the external validation set, the XGB model exhibited an AUC of 0.83, AUPRC of 0.702, accuracy of 0.81, and precision of 0.81. Additionally, the predictions generated by the XGB model were a
背景精确评估病理完全反应(pCR)对于确定接受新辅助化放疗(NCRT)的局部晚期直肠癌(LARC)患者的预后至关重要,并能为后续治疗策略的选择提供线索。目前大多数 pCR 预测模型主要关注治疗前因素,忽视了新辅助化放疗期间发生的动态系统性变化,准确性低且缺乏完整性。目的本研究利用新辅助治疗期间全身炎症-营养标志物指标(SINI)的动态变化设计了一种新型的pCR预测指标,并开发了一种机器学习模型来预测pCR。方法整合了第一中心2012年至2017年和第二中心2020年至2023年的两组LARC患者进行分析。该研究比较了新辅助治疗和手术前后血液指标的动态变化。研究采用最小绝对收缩和选择算子(LASSO)回归分析,以减少共线性并确定关键指标,从而构建 SINI。单变量和多元逻辑回归分析用于确定与 pCR 相关的独立风险因素。此外,还采用了 10 种机器学习算法来开发评估风险的预测模型。机器学习模型的超参数通过随机搜索和 10 倍交叉验证进行了优化。通过检查各种指标,包括接收者操作特征曲线下面积(AUC)、精度-召回曲线下面积(AUPRC)、决策曲线分析、校准曲线以及内部和外部验证队列的精度和准确性,对模型进行了评估。结果研究队列包括第一中心的 677 名患者和第二中心的 224 名患者。研究确定了六个关键指标,并构建了预测指标 SINI。单变量和多元逻辑回归分析表明,SINI、临床T分期、临床N分期、肿瘤大小和与肛缘的距离是NCRT后LARC患者pCR的独立危险因素。在训练集的 10 倍交叉验证中,极梯度提升(XGB)模型的平均 AUC 值为 0.877。XGB 模型在内部和外部验证集中表现出了卓越的性能。具体来说,在内部测试集中,XGB 模型的 AUC 为 0.86,AUPRC 为 0.707,准确率为 0.82,精度为 0.80。在外部验证集中,XGB 模型的 AUC 为 0.83,AUPRC 为 0.702,准确率为 0.81,精度为 0.81。本研究利用 SINI 开发并验证了 XGB 模型,用于预测 LARC 患者的 pCR。此外,基于 SINI 的机器学习模型有望准确预测可切除 LARC 患者 NCRT 后的 pCR,为个性化治疗方法提供有价值的见解。
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引用次数: 0
The preoperative recurrence score: Predicting early recurrence in peri-hilar cholangiocarcinoma 术前复发评分:预测肝周胆管癌的早期复发。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.ejso.2024.108745

Introduction

Despite advances in surgical techniques, the rate of early recurrence in perihilar cholangiocarcinoma (PCC) remains high. We sought to develop the Preoperative Recurrence Score (PRS), a model to estimate the risk of early recurrence after resection based on preoperative radiological characteristics.

Materials and methods

Data of patients who underwent surgery for PCC were retrospectively collected, and preoperative imaging was reviewed to assess tumor characteristics. A model to assess the risk of early recurrence based on preoperative radiologic characteristics was internally developed and externally validated on two cohorts of patients from two European major hepatobiliary surgery referral centers.

Results

A total of 215 patients among three different patient cohorts were included in the study. Tumor size ≥18 mm (HR 2.70, 95 % CI 1.48–4.92, p = 0.001), macroscopic portal vein involvement (HR 2.28, 95%CI 1.19–4.34, p = 0.013), hepatic arteries involvement (HR 2.44, 95%CI 1.26–4.71, p = 0.008), and presence of suspicious lymph nodes (HR 1.98, 95%CI 1.02–3.83, p = 0.043) were significantly associated with recurrence-free survival (RFS). The model showed excellent discrimination both on the internal (AUC 0.83) and external validation cohorts (external 1: AUC 0.84; external 2: AUC 0.70). High PRS was associated with worse RFS among all three cohorts, with a 1-year recurrence probability of 80.1 %, 100.0 %, and 54.2 % in the internal and external validation cohorts 1 and 2, respectively.

Conclusions

The PRS is a simple tool that can accurately assess the risk of early recurrence in patients with PCC. Up-front surgery should be carefully evaluated in patients with high PRS, as it could result in a futile resection.
导言:尽管手术技术不断进步,但肝周胆管癌(PCC)的早期复发率仍然很高。我们试图开发术前复发评分(PRS),这是一种根据术前放射学特征估算切除术后早期复发风险的模型:回顾性收集了接受PCC手术的患者数据,并回顾了术前影像学检查以评估肿瘤特征。根据术前影像学特征评估早期复发风险的模型由内部开发,并在欧洲两大肝胆外科转诊中心的两组患者中进行了外部验证:研究共纳入了三个不同患者队列中的 215 名患者。肿瘤大小≥18 mm (HR 2.70, 95 % CI 1.48-4.92, p = 0.001)、门静脉大面积受累 (HR 2.28, 95 %CI 1.19-4.34, p = 0.013)、肝动脉受累 (HR 2.44,95%CI 1.26-4.71,p = 0.008)和可疑淋巴结(HR 1.98,95%CI 1.02-3.83,p = 0.043)与无复发生存期(RFS)显著相关。该模型在内部队列(AUC 0.83)和外部验证队列(外部 1:AUC 0.84;外部 2:AUC 0.70)中均显示出极佳的区分度。在所有三个队列中,高PRS与较差的RFS相关,在内部和外部验证队列1和2中,1年复发概率分别为80.1%、100.0%和54.2%:PRS是一种能准确评估PCC患者早期复发风险的简单工具。对于PRS较高的患者,应谨慎评估前期手术,因为这可能会导致徒劳的切除。
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引用次数: 0
Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study. 肢体转移性黑色素瘤的电化学疗法治疗策略:一项欧洲回顾性队列研究的真实结果。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.ejso.2024.108740
Luca G Campana, Francesca Tauceri, Joana Bártolo, Sarah Calabrese, Joy Odili, Giulia Carrara, Victor Farricha, Dario Piazzalunga, Kriszta Bottyán, Kamal Bisarya, Matteo Mascherini, James A Clover, Serena Sestini, Maša Bošnjak, Erika Kis, Fabrizio Fantini, Piero Covarelli, Matteo Brizio, Leela Sayed, Carlo Cabula, Rosanna Careri, Tommaso Fabrizio, Klaus Eisendle, Alastair MacKenzie Ross, Hadrian Schepler, Lorenzo Borgognoni, Gregor Sersa, Sara Valpione

Background: This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM).

Methods: We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT).

Results: 452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years.

Conclusions: Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.

背景:本研究分析了电化学疗法(ECT)治疗肢体转移性黑色素瘤的策略:本研究分析了电化学疗法(ECT)对伴有肢端转移(ITM)的黑色素瘤的治疗策略:我们对国际电化学疗法实践分享网络(InspECT)内22个中心(2006-2020年)治疗的AJCC v.8 IIIB-IIID期患者进行了审计:共纳入452名患者,其中58%接受过预处理(93%有下肢ITM,44%有≤10个转移灶[中位尺寸为1.5厘米])。治疗策略包括一线电疗(145人,32%)、同时进行局部/系统治疗的电疗(163人,36%)和挽救性电疗(144人,32%)。客观反应率为 63%(完全反应 [CR],24%),再治疗后增加到 74%(CR,39%)(中位数为两次 ECT,范围为 1-8)。未接受治疗和接受过治疗的患者的 CR 率分别为 50% 和 32%(P,结论):在低负担的肢端 ITM 患者中,标准剂量博莱霉素 ECT 可产生持久的局部反应。治疗新手、肿瘤体积小、六角形电极应用、再治疗和ECT后溃疡可预测反应。CR 和同期治疗与区域控制和生存结果的改善相关。与检查点抑制剂联合治疗是安全的,但缺乏确凿的支持。
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引用次数: 0
Systematic review of cost-effectiveness studies on cervical cancer screening across Europe. 欧洲宫颈癌筛查成本效益研究的系统性回顾。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.ejso.2024.108742
Klejda Harasani, Mariela Vasileva-Slaveva, Angel Yordanov, Irina Tripac, Jean Calleja-Agius

Introduction: Cervical cancer (CC) is a type of cancer with poor prognosis when diagnosed in advanced stage with a big socioeconomic burden. The incidence rates have wide variations among European countries depending on the implementation or not of screening, vaccination programs and the human development index (HDI). Most studies on cost-effectiveness of CC screening programs are carried out in countries with a high HDI, however more recent reviews of screening approaches are coming from countries with lower HDI aiming to identify the best screening strategies. Our study aims to identify which are the currently applied and most cost-effective strategies of CC screening in Europe.

Materials and methods: This is a systematic review conducted in three different databases (PubMed, Scopus and ScienceDirect) and reported following the PRISMA guidelines. General key terms for all databases were the following: cost-effectiveness, cervical cancer, screening, Europe. We included studies in English, Italian, Spanish and Bulgarian, published in the last 25 years, reporting data on cost-effectiveness of CC screening, costs and outcome measures. The methodological quality of the articles was evaluated with a standardized tool.

Results: A total of 262 studies were identified and 22 studies were included in the final analysis. In 90.1 % of the economic studies, the new screening strategy was shown to be more cost-effective compared to the current one or compared to no screening. The optimal strategy mostly involved primary HPV testing, combined with cytology or as stand-alone screening technique. Several scenarios differing on starting age and periodicities for CC screening, combination of techniques and triage, were found to be cost-effective and below the willingness to pay (WTP) threshold. The methodology of all included studies was assessed from 10 to 11 on the JBI standardized tool and Drummond 11-point checklist.

Conclusion: Numerous cost-effective options for CC screening in different European countries were identified in this systematic review. HPV testing, with or without cytology, mainly starting at 30 years of age and repeated every 5 years or more was the most cost-effective technique. Future studies should focus on the most appropriate CC screening approach for each context and setting, also considering HPV vaccination in Europe.

导言宫颈癌(CC)是一种晚期诊断预后不良的癌症,对社会经济造成沉重负担。欧洲各国的发病率差异很大,这取决于筛查、疫苗接种计划的实施与否以及人类发展指数(HDI)。大多数关于CC筛查项目成本效益的研究都是在人类发展指数较高的国家进行的,而最近对筛查方法的审查则来自于人类发展指数较低的国家,目的是找出最佳的筛查策略。我们的研究旨在确定欧洲目前采用的最具成本效益的 CC 筛查策略:这是一项在三个不同数据库(PubMed、Scopus 和 ScienceDirect)中进行的系统性综述,并按照 PRISMA 指南进行报告。所有数据库的一般关键术语如下:成本效益、宫颈癌、筛查、欧洲。我们纳入了过去 25 年中发表的英语、意大利语、西班牙语和保加利亚语研究,这些研究报告了宫颈癌筛查的成本效益、成本和结果测量数据。我们使用标准化工具对文章的方法学质量进行了评估:结果:共确定了 262 项研究,22 项研究被纳入最终分析。在90.1%的经济学研究中,新筛查策略与当前策略相比或与不筛查相比更具成本效益。最佳策略大多涉及初级人类乳头瘤病毒检测,与细胞学检查相结合或作为独立的筛查技术。研究发现,CC 筛查的起始年龄和周期、技术组合和分流等几种方案都具有成本效益,且低于支付意愿(WTP)阈值。所有纳入研究的方法在 JBI 标准化工具和 Drummond 11 点检查表中均被评为 10 至 11 分:本系统综述确定了欧洲不同国家许多具有成本效益的CC筛查方案。主要从 30 岁开始、每 5 年或更长时间重复一次的 HPV 检测(无论是否进行细胞学检查)是最具成本效益的技术。今后的研究应侧重于针对不同情况和环境的最合适的 CC 筛查方法,同时考虑欧洲的 HPV 疫苗接种情况。
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引用次数: 0
Surgical outcomes and morbidity in open and videoendoscopic inguinal lymphadenectomy in vulvar cancer: A systematic review and metanalysis". 外阴癌开放式和视频内窥镜腹股沟淋巴结切除术的手术效果和发病率:系统回顾和荟萃分析"。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.ejso.2024.108744
Mariano Catello Di Donna, Giuseppe Cucinella, Vincenzo Giallombardo, Giuseppina Lo Balbo, Vito Andrea Capozzi, Giulio Sozzi, Natalina Buono, Letizia Borsellino, Andrea Giannini, Antonio Simone Laganà, Giovanni Scambia, Vito Chiantera

Introduction: Surgical evaluation of inguinal lymph nodes is essential to correctly guide the adjuvant treatment of vulvar cancer patients. Open inguinal lymphadenectomy (OIL) approach is the preferred route, while the videoendoscopic inguinal lymphadenectomy (VEIL) seems to be associated with better results. This meta-analysis aimed to compare the surgical outcomes of OIL vs VEIL in vulvar cancer.

Methods: The meta-analysis was conducted according to the PRISMA guideline. The search string included the following keywords: "(vulvar cancer) AND ((inguinal) OR (femoral)) AND ((lymph node dissection) OR (lymphadenectomy))". Three double-blind researchers independently extracted data.

Results: Seventeen studies were considered eligible for the analysis. Seven studies were included in the OIL group and ten studies in the VEIL group. A total of 372 groins were included in OIL group and 197 groins in VEIL group. 153 groins (41.1 %) in the OIL group and 25 groins (12.6 %) in the VEIL group developed major complications. The analysis of all lymphatic and wound complications showed that VEIL had a lower rate of lymphatic and wound complications. Estimated blood loss (p = 0.4), hospital stay (p = 0.18), time of drainage (p = 0.74), number of lymph node excised (p = 0.74) did not show significant difference between the two approaches.

Conclusions: VEIL route may be a valid alternative to OIL route with no differences in terms of surgical outcomes, except for operative time that is shorter for OIL. Future analysis of randomized controlled trials in this specific patient population are warranted to confirm these results.

导言:腹股沟淋巴结的手术评估对于正确指导外阴癌患者的辅助治疗至关重要。开放式腹股沟淋巴结切除术(OIL)是首选方法,而视频内镜腹股沟淋巴结切除术(VEIL)似乎效果更好。这项荟萃分析旨在比较OIL与VEIL在外阴癌中的手术效果:荟萃分析根据 PRISMA 指南进行。搜索字符串包括以下关键词"外阴癌)和((腹股沟)或(股))和((淋巴结清扫)或(淋巴结切除))"。三名双盲研究人员独立提取数据:有 17 项研究符合分析条件。结果:17 项研究符合分析条件,其中 7 项研究被纳入 OIL 组,10 项研究被纳入 VEIL 组。共有 372 个腹股沟被纳入 OIL 组,197 个腹股沟被纳入 VEIL 组。OIL 组中有 153 个腹股沟(41.1%)出现主要并发症,VEIL 组中有 25 个腹股沟(12.6%)出现主要并发症。对所有淋巴和伤口并发症的分析表明,VEIL 的淋巴和伤口并发症发生率较低。估计失血量(p = 0.4)、住院时间(p = 0.18)、引流时间(p = 0.74)、切除淋巴结数量(p = 0.74)在两种方法之间没有显著差异:结论:VEIL途径可能是OIL途径的有效替代方案,除了OIL途径的手术时间更短外,在手术效果方面没有差异。今后有必要对这一特定患者群体进行随机对照试验分析,以证实这些结果。
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引用次数: 0
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