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HIPEC for metastatic gastric cancer: Moving the needle towards 3-year survival 转移性胃癌的 HIPEC 治疗:向 3 年生存率迈进。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-25 DOI: 10.1016/j.ejso.2024.108790
Neal Bhutiani , Y. David Seo , Kristen A. Robinson , Michael G. White , Naruhiko Ikoma , Paul F. Mansfield , Jenny J. Li , Mariela Blum Murphy , Jaffer A. Ajani , Brian D. Badgwell

Introduction

Prior work has established hyperthermic intraperitoneal chemotherapy (HIPEC) administration as a safe treatment option for select patients with gastric adenocarcinoma and carcinomatosis. However, identifying patients who will maximally benefit from HIPEC remains unclear. This study assessed a single-institution experience with HIPEC for metastatic gastric cancer to identify variables associated with improved survival.

Methods

A database of patients treated for metastatic gastric adenocarcinoma at MD Anderson Cancer Center from 2013 to 2022 was queried for patients undergoing HIPEC as part of their treatment regimen. Patients were stratified by overall survival (OS)≥36 months or <36 months and assessed along demographic and clinicopathologic variables to identify factors associated with OS ≥ 36 months.

Results

Among 104 patients, 1,2, and 3-year OS from diagnosis was 89 %,44 %, and 18 %. Patients with OS ≥ 36 months were more likely to have moderately differentiated tumors, positive cytology only (i.e. no visible carcinomatosis), and lower peritoneal cancer index (PCI) than those with OS < 36 months (p = 0.002, p = 0.01, p = 0.001,respectively). Groups did not otherwise differ with respect to demographic parameters or treatment or pathologic details. Among patients who underwent gastrectomy, those with OS < 36 months had higher pathologic T and N category (p = 0.003 and p = 0.02, respectively). Postoperative mortality was zero in both groups among patients undergoing gastrectomy.

Conclusions

HIPEC may provide more durable survival benefit among patients with metastatic gastric cancer with moderately differentiated disease, low PCI, and positive cytology alone. Additionally, among patients who undergo gastrectomy, higher final pathologic T and N category are associated with worse survival. Trials are needed to compare 3-year OS rates in patients treated with HIPEC versus systemic therapy alone.
导言:先前的研究已经证实,对部分胃腺癌和癌肿患者来说,腹腔内热化疗(HIPEC)是一种安全的治疗方案。然而,如何确定哪些患者能从 HIPEC 中获得最大疗效仍不清楚。本研究评估了单个机构使用 HIPEC 治疗转移性胃癌的经验,以确定与提高生存率相关的变量:对2013年至2022年期间在MD安德森癌症中心接受转移性胃腺癌治疗的患者数据库进行了查询,以了解作为治疗方案一部分接受HIPEC治疗的患者情况。根据总生存期(OS)≥36 个月或结果对患者进行分层:在104名患者中,自确诊起1年、2年和3年的OS分别为89%、44%和18%。与OS≥36个月的患者相比,OS≥36个月的患者更有可能患有中度分化肿瘤、细胞学阳性(即无明显癌变)以及腹膜癌指数(PCI)较低:HIPEC可为中度分化、低PCI和仅细胞学阳性的转移性胃癌患者带来更持久的生存获益。此外,在接受胃切除术的患者中,最终病理T和N分类越高,生存率越低。需要进行试验,比较接受HIPEC治疗与单纯接受系统治疗的患者的3年生存率。
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引用次数: 0
Biobanking rare gynaecological tumours - How harmonised is data collection? 罕见妇科肿瘤生物库--数据收集的协调性如何?
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.ejso.2024.108784
Sharon O'Toole, Olga Tzortzatou, Sara Casati, James P Beirne, Charles Savona-Ventura, Miriam J Azzopardi, Rita Micallef, Jean Calleja-Agius, Bridget Ellul

Introduction: GYNOCARE, the European Network for Gynaecological Rare Cancer Research, set out to evaluate the current status of biobanks with access to rare gynaecological tumours, with a view to harmonising sample and data collection and associated consent, to facilitate collaborative cross-border research, enabling clinical trials and translational research.

Methods: Two digital surveys were formulated, one covering clinical and scientific parameters and one exploring ethical and regulatory issues around informed consent.

Results: Data were analysed for 20 common responses, from 7 European countries. Tissue was the main sample type biobanked with 63 % also banking blood. Documentation of clinical data, treatment regimens and classification systems varied. Eighty percent collected pathological information. Most biobanks were linked to medical records but only one fifth with national registries. The Information Sheet covered governance, benefits/risks, sharing (mainly for non-profit research), return of results and data protection safeguards. Only 37 % informed patients about sample and data storage, although about half stored samples for an indefinite time. Pseudonymisation and Data Protection Officer approval were the prime data safeguards. Less than half explained the difference between anonymisation and pseudonymisation. Broad consent was the norm (84 %) and 95 % granted the right to withdraw consent. Three countries have Biobank legislation.

Conclusion: These surveys provide a snapshot of the current state of biobanks and highlight divergences in the consent process and data management. More work is needed to understand what parameters are being gathered across more EU countries and thus harmonise the sample and data collection processes to facilitate cross-border research.

导言:GYNOCARE 是欧洲妇科罕见癌症研究网络(European Network for Gynaecological Rare Cancer Research),其目的是评估可获取罕见妇科肿瘤的生物库的现状,以便统一样本和数据收集及相关同意书,促进跨境合作研究,推动临床试验和转化研究:方法:制定了两项数字调查,一项涉及临床和科学参数,另一项探讨与知情同意有关的伦理和监管问题:结果:对来自 7 个欧洲国家的 20 个共同答复进行了数据分析。组织是生物银行的主要样本类型,63%的生物银行也储存血液。对临床数据、治疗方案和分类系统的记录各不相同。80%的生物库收集病理信息。大多数生物库与医疗记录相连,但只有五分之一的生物库与国家登记处相连。信息表涵盖管理、益处/风险、共享(主要用于非营利性研究)、结果返还和数据保护措施。只有 37% 的人告知患者样本和数据的储存情况,尽管约有一半的人无限期储存样本。化名和数据保护官批准是主要的数据保护措施。只有不到一半的人解释了匿名化和假名化之间的区别。广泛同意是标准做法(84%),95%的人有权撤回同意。三个国家制定了生物银行立法:这些调查提供了生物库现状的一个缩影,并强调了在同意程序和数据管理方面存在的分歧。需要做更多的工作来了解更多欧盟国家正在收集哪些参数,从而协调样本和数据收集流程,促进跨境研究。
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引用次数: 0
Ovarian cancer in children and adolescents: A unique clinical challenge. 儿童和青少年卵巢癌:独特的临床挑战。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.ejso.2024.108785
Marina Jakimovska Stefanovska, Aleksandar Celebic, Jean Calleja-Agius, Kristina Drusany Staric

Ovarian cancer in children and adolescents is rare, presenting unique diagnostic and management challenges distinct from adult cases. This paper provides a comprehensive overview of this disease, focusing on the importance of a multidisciplinary approach to care. We discuss the common presentation of ovarian malignant masses in young patients, highlighting the role of imaging and tumor markers in diagnosis. The paper delves into the surgical management of these tumors, emphasizing the importance of fertility-sparing techniques whenever possible. We explore the role of adjuvant chemotherapy, considering histological subtypes and disease stage. Furthermore, we address the good prognosis associated with early diagnosis and treatment, with survival rates exceeding 90 % in many cases. Finally, the need for long-term follow-up to monitor for potential recurrence is underscored and the long-term treatment-related effects are addressed. This review aims to guide clinicians in providing optimal care for this unique patient population, emphasizing the importance of balancing oncological control with the preservation of future fertility and quality of life.

儿童和青少年卵巢癌十分罕见,在诊断和管理方面面临着有别于成人病例的独特挑战。本文全面概述了这种疾病,重点强调了多学科治疗方法的重要性。我们讨论了年轻患者卵巢恶性肿块的常见表现,强调了影像学和肿瘤标志物在诊断中的作用。本文深入探讨了这些肿瘤的手术治疗,强调了尽可能采用保全生育技术的重要性。考虑到组织学亚型和疾病分期,我们探讨了辅助化疗的作用。此外,我们还探讨了早期诊断和治疗带来的良好预后,许多病例的生存率超过 90%。最后,我们强调了长期随访以监测潜在复发的必要性,并探讨了与治疗相关的长期影响。本综述旨在指导临床医生为这一特殊患者群体提供最佳治疗,强调在肿瘤控制与保留未来生育能力和生活质量之间取得平衡的重要性。
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引用次数: 0
Exploring the protein signature of endometrial cancer: A comprehensive review through diverse samples and mass spectrometry-based proteomics. 探索子宫内膜癌的蛋白质特征:通过不同样本和基于质谱的蛋白质组学进行全面回顾。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.ejso.2024.108783
Oyku Su Yildirim, Pelin Yildiz, Abdullah Karaer, Jean Calleja-Agius, Sureyya Ozcan

Endometrial cancer (EC) is increasing incidence among women, and it constitutes a health problem for women globally. An important aspect of EC management involves the use of protein biomarkers for early detection and monitoring. Protein biomarkers allow the identification of high-risk patients, the detection of the disease in its early stages, and the assessment of treatment responses. Mass spectrometry (MS)-based proteomics offers robust analytical techniques and a comprehensive understanding of proteins. Proteomics methods allow scientists to investigate both the quantities and functions of proteins. Thus, it provides valuable insights into how proteins are altered under different conditions. This review summarizes recent advances in MS-based proteomic biomarker discovery for EC, focusing on different sample types and MS-based techniques used in clinical studies. The review emphasized in detail the most commonly used key sources such as blood, urine, vaginal fluids and tissue. Furthermore, MS-based proteomics techniques such as untargeted, targeted, sequential window acquisition of all theoretical mass spectra (SWATH-MS) and mass spectrometry imaging used in the discovery and validation/validation phases were evaluated. This review highlights the importance of biomarker discovery and clinical translation to improve diagnostic and therapeutic outcomes in EC. It aims to provide a comprehensive overview of MS-based proteomics in EC, guiding future research and clinical applications.

子宫内膜癌(EC)在妇女中的发病率越来越高,已成为全球妇女的一个健康问题。子宫内膜癌治疗的一个重要方面是利用蛋白质生物标记物进行早期检测和监测。通过蛋白质生物标记物可以识别高危患者,在疾病早期阶段进行检测,并评估治疗反应。基于质谱(MS)的蛋白质组学提供了强大的分析技术和对蛋白质的全面了解。通过蛋白质组学方法,科学家可以研究蛋白质的数量和功能。因此,它为了解蛋白质在不同条件下如何发生变化提供了宝贵的见解。本综述总结了基于 MS 的欧共体蛋白质组生物标志物发现的最新进展,重点介绍了临床研究中使用的不同样本类型和基于 MS 的技术。综述详细强调了血液、尿液、阴道分泌物和组织等最常用的关键来源。此外,还评估了基于质谱的蛋白质组学技术,如非靶向、靶向、所有理论质谱的顺序窗口采集(SWATH-MS)以及在发现和验证/确认阶段使用的质谱成像技术。本综述强调了生物标记物发现和临床转化对改善心血管疾病诊断和治疗效果的重要性。它旨在全面概述基于 MS 的蛋白质组学在心血管疾病中的应用,为未来的研究和临床应用提供指导。
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引用次数: 0
Prognostic factors in patients with pathological T3N0M0 gastric cancer: A multi-institutional, retrospective study (YCOG2202). 病理 T3N0M0 胃癌患者的预后因素:一项多机构回顾性研究(YCOG2202)。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.ejso.2024.108782
Hiroki Kondo, Sho Sato, Chikara Kunisaki, Yusaku Tanaka, Kei Sato, Jun Kimura, Takashi Kosaka, Hidetaka Andrew Ono, Hirochika Makino, Hirotoshi Akiyama, Itaru Endo

Aim: Gastric cancer is one of the leading causes of cancer-related mortalities worldwide. According to the pathological TNM classification, T3N0M0, Stage IIA gastric cancer has been excluded from the S-1 adjuvant chemotherapy trials. Thus, the clinical impact of S-1 adjuvant chemotherapy in patients with pathological T3N0M0 cancer and the associated prognostic factors have not been elucidated. Consequently, we determined the prognostic factors in patients with pathological T3N0M0 gastric cancer and the efficacy of adjuvant chemotherapy.

Methods: From 2007 to 2018, 205 patients diagnosed with pathological T3N0M0 gastric cancer were enrolled at seven institutions. Recurrence-free and overall survival rates were evaluated. Univariate and multivariate survival analyses for recurrence-free and overall survival were performed, using the Cox proportional hazards model.

Results: The 5-year recurrence-free and overall survival rates were 84.7 % and 81.4 %, respectively. Although there was no difference in overall survival, multivariate analysis identified positive venous invasion as an independent risk factor for recurrence (p = 0.007, hazard ratio = 3.851). Adjuvant chemotherapy had no impact on both recurrence free and overall survival. However, the 5-year overall survival rates in the sub-cohort that completed adjuvant chemotherapy with S-1 were higher than those in the sub-cohort that did not complete the treatment (p = 0.019).

Conclusion: The prognosis of patients with pathological T3N0M0 gastric cancer was relatively favorable. However, adjuvant chemotherapy was not identified as an independent risk factor and patients with venous invasion were at a high risk of recurrence. Therefore, a large-scale multi-institutional prospective study evaluating the efficacy of adjuvant chemotherapy for high risk pT3N0M0 is required.

目的:胃癌是导致全球癌症相关死亡的主要原因之一。根据病理 TNM 分类,T3N0M0、IIA 期胃癌被排除在 S-1 辅助化疗试验之外。因此,S-1 辅助化疗对病理 T3N0M0 癌症患者的临床影响及相关预后因素尚未阐明。因此,我们确定了病理T3N0M0胃癌患者的预后因素和辅助化疗的疗效:2007年至2018年,7家机构共纳入205名确诊为病理T3N0M0胃癌的患者。评估了无复发生存率和总生存率。采用Cox比例危险模型对无复发生存率和总生存率进行单变量和多变量生存分析:结果:5 年无复发生存率和总生存率分别为 84.7% 和 81.4%。虽然总生存率没有差异,但多变量分析发现静脉侵犯阳性是导致复发的独立风险因素(p = 0.007,危险比 = 3.851)。辅助化疗对无复发生存率和总生存率均无影响。然而,完成S-1辅助化疗的亚组的5年总生存率高于未完成治疗的亚组(p = 0.019):结论:病理T3N0M0胃癌患者的预后相对较好。结论:病理类型为 T3N0M0 的胃癌患者预后相对较好,但辅助化疗并不是一个独立的风险因素,而且有静脉侵犯的患者复发风险较高。因此,需要进行大规模的多机构前瞻性研究,评估辅助化疗对高风险 pT3N0M0 的疗效。
{"title":"Prognostic factors in patients with pathological T3N0M0 gastric cancer: A multi-institutional, retrospective study (YCOG2202).","authors":"Hiroki Kondo, Sho Sato, Chikara Kunisaki, Yusaku Tanaka, Kei Sato, Jun Kimura, Takashi Kosaka, Hidetaka Andrew Ono, Hirochika Makino, Hirotoshi Akiyama, Itaru Endo","doi":"10.1016/j.ejso.2024.108782","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108782","url":null,"abstract":"<p><strong>Aim: </strong>Gastric cancer is one of the leading causes of cancer-related mortalities worldwide. According to the pathological TNM classification, T3N0M0, Stage IIA gastric cancer has been excluded from the S-1 adjuvant chemotherapy trials. Thus, the clinical impact of S-1 adjuvant chemotherapy in patients with pathological T3N0M0 cancer and the associated prognostic factors have not been elucidated. Consequently, we determined the prognostic factors in patients with pathological T3N0M0 gastric cancer and the efficacy of adjuvant chemotherapy.</p><p><strong>Methods: </strong>From 2007 to 2018, 205 patients diagnosed with pathological T3N0M0 gastric cancer were enrolled at seven institutions. Recurrence-free and overall survival rates were evaluated. Univariate and multivariate survival analyses for recurrence-free and overall survival were performed, using the Cox proportional hazards model.</p><p><strong>Results: </strong>The 5-year recurrence-free and overall survival rates were 84.7 % and 81.4 %, respectively. Although there was no difference in overall survival, multivariate analysis identified positive venous invasion as an independent risk factor for recurrence (p = 0.007, hazard ratio = 3.851). Adjuvant chemotherapy had no impact on both recurrence free and overall survival. However, the 5-year overall survival rates in the sub-cohort that completed adjuvant chemotherapy with S-1 were higher than those in the sub-cohort that did not complete the treatment (p = 0.019).</p><p><strong>Conclusion: </strong>The prognosis of patients with pathological T3N0M0 gastric cancer was relatively favorable. However, adjuvant chemotherapy was not identified as an independent risk factor and patients with venous invasion were at a high risk of recurrence. Therefore, a large-scale multi-institutional prospective study evaluating the efficacy of adjuvant chemotherapy for high risk pT3N0M0 is required.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108782"},"PeriodicalIF":3.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638444","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
Residual microcalcifications after neoadjuvant systemic therapy for early breast cancer: Implications for surgical planning and long-term outcomes 早期乳腺癌新辅助系统治疗后的残留微钙化:对手术规划和长期疗效的影响
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.ejso.2024.108781
Joel Allotey , Vinita Ruparel , Anna McCallum , Karendeep Somal , Louise Simpson , Gaurav Gupta , Gerald Lip , Ravi Sharma , Yazan Masannat
Residual microcalcifications on mammograms after neoadjuvant chemotherapy (NACT) pose a challenge in surgical decision-making. This single-centre retrospective review of all patients who had NACT for breast cancer over five years, evaluated the relationship between pathological complete response and residual microcalcifications, controlling for tumour size, nodal stage, grade, and receptor status, as well as the impact of residual microcalcifications on recurrence and survival. There was no significant association between pathological complete response (pCR) and residual microcalcifications (p = 0.763). We computed hazard ratios (HR) for Time to recurrence (TTR) and overall survival (OS) which were both not significant, with HR = 2.599, [0.290, 23.264], p = 0.393 and HR = 1.362 [0.123, 15.062], p = 0.801 respectively. The predictive and prognostic significance of residual microcalcifications remains to be proven. The surgical excision of these lesions should be considered based on individual patient risk.
新辅助化疗(NACT)后乳房X光片上残留的微小钙化给手术决策带来了挑战。这项单中心回顾性研究对五年来所有接受新辅助化疗的乳腺癌患者进行了评估,在控制肿瘤大小、结节分期、分级和受体状态的情况下,评估了病理完全反应与残留微小钙化之间的关系,以及残留微小钙化对复发和生存的影响。病理完全反应(pCR)与残留微小钙化之间无明显关联(p = 0.763)。我们计算了复发时间(TTR)和总生存率(OS)的危险比(HR),结果均不显著,分别为 HR = 2.599 [0.290, 23.264], p = 0.393 和 HR = 1.362 [0.123, 15.062], p = 0.801。残留微钙化的预测和预后意义仍有待证实。应根据患者的个体风险考虑手术切除这些病灶。
{"title":"Residual microcalcifications after neoadjuvant systemic therapy for early breast cancer: Implications for surgical planning and long-term outcomes","authors":"Joel Allotey ,&nbsp;Vinita Ruparel ,&nbsp;Anna McCallum ,&nbsp;Karendeep Somal ,&nbsp;Louise Simpson ,&nbsp;Gaurav Gupta ,&nbsp;Gerald Lip ,&nbsp;Ravi Sharma ,&nbsp;Yazan Masannat","doi":"10.1016/j.ejso.2024.108781","DOIUrl":"10.1016/j.ejso.2024.108781","url":null,"abstract":"<div><div>Residual microcalcifications on mammograms after neoadjuvant chemotherapy (NACT) pose a challenge in surgical decision-making. This single-centre retrospective review of all patients who had NACT for breast cancer over five years, evaluated the relationship between pathological complete response and residual microcalcifications, controlling for tumour size, nodal stage, grade, and receptor status, as well as the impact of residual microcalcifications on recurrence and survival. There was no significant association between pathological complete response (pCR) and residual microcalcifications (p = 0.763). We computed hazard ratios (HR) for Time to recurrence (TTR) and overall survival (OS) which were both not significant, with HR = 2.599, [0.290, 23.264], p = 0.393 and HR = 1.362 [0.123, 15.062], p = 0.801 respectively. The predictive and prognostic significance of residual microcalcifications remains to be proven. The surgical excision of these lesions should be considered based on individual patient risk.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 108781"},"PeriodicalIF":3.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560972","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
Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions 在术中检测乳腺病变时,对非放射性种子和导线引导定位进行生态统计比较。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.ejso.2024.108779
Stefan Lukac , Elena Leinert , Thorsten Kühn , Davut Dayan , Florian Ebner , Kerstin Pfister , Henning Schäffler , Kristina Veselinovic , Wolfang Janni , Michael Hiete , Visnja Fink

Background

The current standard for the preoperative marking of non-palpable breast lesions is wire guided localization (WGL) which is associated with logistical efforts and patient discomfort. Non-radioactive seeds (NRS) recently challenged the use of WGL; but do they provide a better alternative from a logistical and environmental perspective?

Methods

WGL standard was compared with NRS available in Germany: Magseed®, Pintuition®, SAVI SCOUT ® and LOCalizer™ on a logistical and carbon-footprinting basis. In the logistical analysis the number of patient contacts with the healthcare system for lesion localization/removal and the number of breast punctures were evaluated in two different clinical scenarios (primary surgery and secondary surgery after neoadjuvant treatment). The carbon footprints of WGL and NRS (with exception of LOCalizer) were assessed based on their material compositions and operating energy in a streamlined approach.

Results

Application of NRS reduces the number of contacts by 33.3 % (2 vs. 3) in primary, by 50 % (2 vs. 4) in secondary surgery, and the number of breast punctures by 33.3 % (2 vs.3). Annual Germany-wide material- and energy-based carbon footprints of NRS (1.6–3.2 tons CO2eq) are significantly lower in comparison to WGL (10.3 tons CO2eq). The implementation of NRS would lead to a CO2eq reduction by around 79 % compared to WGL.

Conclusions

The use of NRS for the localization of non palpable breast lesions is more favorable from the environmental and logistical perspective, when compared to WGL with possible benefits for patients, healthcare providers and the environment.
背景:目前术前标记不可触及的乳腺病变的标准是线引导定位(WGL),这与后勤工作和患者不适有关。最近,非放射性种子(NRS)的使用对 WGL 提出了挑战;但从后勤和环境角度来看,它们是否提供了更好的替代方法?将 WGL 标准与德国现有的 NRS 进行比较:Magseed®、Pintuition®、SAVI SCOUT ® 和 LOCalizer™ 在物流和碳足迹基础上进行了比较。在后勤分析中,对两种不同的临床情况(初次手术和新辅助治疗后的二次手术)进行了评估,评估了患者为病灶定位/切除而与医疗系统接触的次数以及乳腺穿刺的次数。根据 WGL 和 NRS(LOCalizer 除外)的材料成分和运行能耗,以简化的方法对其碳足迹进行了评估:结果:使用 NRS 后,初次手术的接触次数减少了 33.3%(2 次对 3 次),二次手术的接触次数减少了 50%(2 次对 4 次),乳房穿刺次数减少了 33.3%(2 次对 3 次)。与 WGL(10.3 吨 CO2eq)相比,NRS 在全德国范围内的年度材料和能源碳足迹(1.6-3.2 吨 CO2eq)明显降低。与 WGL 相比,实施 NRS 可减少约 79% 的二氧化碳当量:结论:与 WGL 相比,从环境和物流角度来看,使用 NRS 对非触诊性乳腺病变进行定位更为有利,可为患者、医疗服务提供者和环境带来益处。
{"title":"Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions","authors":"Stefan Lukac ,&nbsp;Elena Leinert ,&nbsp;Thorsten Kühn ,&nbsp;Davut Dayan ,&nbsp;Florian Ebner ,&nbsp;Kerstin Pfister ,&nbsp;Henning Schäffler ,&nbsp;Kristina Veselinovic ,&nbsp;Wolfang Janni ,&nbsp;Michael Hiete ,&nbsp;Visnja Fink","doi":"10.1016/j.ejso.2024.108779","DOIUrl":"10.1016/j.ejso.2024.108779","url":null,"abstract":"<div><h3>Background</h3><div>The current standard for the preoperative marking of non-palpable breast lesions is wire guided localization (WGL) which is associated with logistical efforts and patient discomfort. Non-radioactive seeds (NRS) recently challenged the use of WGL; but do they provide a better alternative from a logistical and environmental perspective?</div></div><div><h3>Methods</h3><div>WGL standard was compared with NRS available in Germany: Magseed®, Pintuition®, SAVI SCOUT ® and LOCalizer™ on a logistical and carbon-footprinting basis. In the logistical analysis the number of patient contacts with the healthcare system for lesion localization/removal and the number of breast punctures were evaluated in two different clinical scenarios (primary surgery and secondary surgery after neoadjuvant treatment). The carbon footprints of WGL and NRS (with exception of LOCalizer) were assessed based on their material compositions and operating energy in a streamlined approach.</div></div><div><h3>Results</h3><div>Application of NRS reduces the number of contacts by 33.3 % (2 vs. 3) in primary, by 50 % (2 vs. 4) in secondary surgery, and the number of breast punctures by 33.3 % (2 vs.3). Annual Germany-wide material- and energy-based carbon footprints of NRS (1.6–3.2 tons CO<sub>2</sub>eq) are significantly lower in comparison to WGL (10.3 tons CO<sub>2</sub>eq). The implementation of NRS would lead to a CO<sub>2</sub>eq reduction by around 79 % compared to WGL.</div></div><div><h3>Conclusions</h3><div>The use of NRS for the localization of non palpable breast lesions is more favorable from the environmental and logistical perspective, when compared to WGL with possible benefits for patients, healthcare providers and the environment.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 108779"},"PeriodicalIF":3.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma. 术前评估自发性门静脉分流作为肝细胞癌肝脏切除术后肝功能衰竭的预测指标。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.ejso.2024.108778
Gianluca Rompianesi, Ho-Seong Han, Giuseppe Fusai, Santiago Lopez-Ben, Marcello Maestri, Giorgio Ercolani, Marcello Di Martino, Rafael Diaz-Nieto, Benedetto Ielpo, Alejandro Perez-Alonso, Nolitha Morare, Margarida Casellas, Anna Gallotti, Angela de la Hoz Rodriguez, Fernando Burdio, Federico Ravaioli, Pietro Venetucci, Emanuela Lo Bianco, Arianna Ceriello, Roberto Montalti, Roberto Ivan Troisi

Background: Post-hepatectomy liver failure (PHLF) can significantly compromise outcomes, especially in cirrhotic patients. The identification of accurate and non-invasive pre-operative predictors is of paramount importance to appropriately stratify patients according to their estimated risk and select the best treatment strategy.

Materials and methods: Consecutive patients undergoing liver resection for HCC on cirrhosis between 1-2015 and 12-2020 at 10 international Institutions were enrolled and their pre-operative CT scans were evaluated for the presence of spontaneous portosystemic shunts (SPSS) to identify predictors of PHLF and develop a nomogram.

Results: The analysis of the CT scans identified SPSS in 74 patients (17.4 %). PHLF was developed in 27 out of 425 cases (6.4 %), with grades B/C observed in 17 patients (4 %). At the multivariable analysis, the presence of SPSS resulted an independent risk factor for all-grades PHLF (OR 6.83, 95%CI 2.39-19.51, p < 0.001) and clinically significant PHLF development (OR 7.92, 95%CI 2.03-30.85, p = 0.003) alongside a patient's age ≥74 years, a pre-operative platelets count <106x103/μL, a multiple-segments liver resection, and an intraoperative blood loss ≥1200 mL. The 30- and 90-days mortality in patients with and without SPSS resulted 2.7 % vs 0.3 % (p = 0.024) and 5.4 % vs 1.1 % (p = 0.014). The accuracy of SPSS in predicting PHLF development was 0.847 (95%n CI 0.809-0.880). The internally validated nomogram showed excellent performance in predicting grades B/C PHLF (c-statistic = 0.933 (95%CI 0.888-0.979)).

Conclusion: The pre-operative presence of SPSS assessed on the pre-operative imaging proved to be a valuable radiological biomarker able to predict PHLF development in patients undergoing liver resection for HCC.

背景:肝切除术后肝功能衰竭(PHLF)会严重影响预后,尤其是肝硬化患者。要根据患者的估计风险对其进行适当分层并选择最佳治疗策略,识别准确的非侵入性术前预测指标至关重要:纳入了2015年1月1日至2020年12月12日期间在10家国际机构接受肝硬化HCC肝切除术的连续患者,并对其术前CT扫描进行了评估,以确定是否存在自发性门静脉分流(SPSS),从而确定PHLF的预测因素并制定提名图:结果:CT 扫描分析发现 74 例患者(17.4%)存在自发性门静脉分流(SPSS)。在 425 例患者中有 27 例(6.4%)出现 PHLF,其中 17 例患者(4%)为 B/C 级。在多变量分析中,SPSS 的存在是所有等级 PHLF 的独立危险因素(OR 6.83,95%CI 2.39-19.51,P 3/μL,多段肝切除,术中失血量≥1200 mL)。有 SPSS 和无 SPSS 患者的 30 天和 90 天死亡率分别为 2.7% vs 0.3%(P = 0.024)和 5.4% vs 1.1%(P = 0.014)。SPSS 预测 PHLF 发展的准确率为 0.847(95%n CI 0.809-0.880)。内部验证的提名图在预测 B/C 级 PHLF 方面表现出色(c 统计量 = 0.933 (95%CI 0.888-0.979)):结论:术前成像中评估的 SPSS 是一种有价值的放射生物标志物,能够预测因 HCC 而接受肝切除术的患者 PHLF 的发展情况。
{"title":"Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma.","authors":"Gianluca Rompianesi, Ho-Seong Han, Giuseppe Fusai, Santiago Lopez-Ben, Marcello Maestri, Giorgio Ercolani, Marcello Di Martino, Rafael Diaz-Nieto, Benedetto Ielpo, Alejandro Perez-Alonso, Nolitha Morare, Margarida Casellas, Anna Gallotti, Angela de la Hoz Rodriguez, Fernando Burdio, Federico Ravaioli, Pietro Venetucci, Emanuela Lo Bianco, Arianna Ceriello, Roberto Montalti, Roberto Ivan Troisi","doi":"10.1016/j.ejso.2024.108778","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108778","url":null,"abstract":"<p><strong>Background: </strong>Post-hepatectomy liver failure (PHLF) can significantly compromise outcomes, especially in cirrhotic patients. The identification of accurate and non-invasive pre-operative predictors is of paramount importance to appropriately stratify patients according to their estimated risk and select the best treatment strategy.</p><p><strong>Materials and methods: </strong>Consecutive patients undergoing liver resection for HCC on cirrhosis between 1-2015 and 12-2020 at 10 international Institutions were enrolled and their pre-operative CT scans were evaluated for the presence of spontaneous portosystemic shunts (SPSS) to identify predictors of PHLF and develop a nomogram.</p><p><strong>Results: </strong>The analysis of the CT scans identified SPSS in 74 patients (17.4 %). PHLF was developed in 27 out of 425 cases (6.4 %), with grades B/C observed in 17 patients (4 %). At the multivariable analysis, the presence of SPSS resulted an independent risk factor for all-grades PHLF (OR 6.83, 95%CI 2.39-19.51, p < 0.001) and clinically significant PHLF development (OR 7.92, 95%CI 2.03-30.85, p = 0.003) alongside a patient's age ≥74 years, a pre-operative platelets count <106x10<sup>3</sup>/μL, a multiple-segments liver resection, and an intraoperative blood loss ≥1200 mL. The 30- and 90-days mortality in patients with and without SPSS resulted 2.7 % vs 0.3 % (p = 0.024) and 5.4 % vs 1.1 % (p = 0.014). The accuracy of SPSS in predicting PHLF development was 0.847 (95%n CI 0.809-0.880). The internally validated nomogram showed excellent performance in predicting grades B/C PHLF (c-statistic = 0.933 (95%CI 0.888-0.979)).</p><p><strong>Conclusion: </strong>The pre-operative presence of SPSS assessed on the pre-operative imaging proved to be a valuable radiological biomarker able to predict PHLF development in patients undergoing liver resection for HCC.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108778"},"PeriodicalIF":3.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568145","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
Reply to: Enhancing vulvar cancer care: Integrating biomarkers and AI for better outcomes. 答复加强外阴癌护理:整合生物标记物和人工智能,提高疗效。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.ejso.2024.108775
Mario Preti, Luigino Dal Maso, Stefano Guzzinati, Lauro Bucchi
{"title":"Reply to: Enhancing vulvar cancer care: Integrating biomarkers and AI for better outcomes.","authors":"Mario Preti, Luigino Dal Maso, Stefano Guzzinati, Lauro Bucchi","doi":"10.1016/j.ejso.2024.108775","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108775","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108775"},"PeriodicalIF":3.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497169","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
Survival prediction of colorectal liver metastases underwent surgical resection after neoadjuvant chemotherapy: Tumor response combined with the genetic and morphological evaluation score. 新辅助化疗后手术切除结直肠肝转移瘤的生存预测:肿瘤反应结合基因和形态学评估评分。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-21 DOI: 10.1016/j.ejso.2024.108777
Yu-Ming Su, Ke-Min Jin, Hong-Wei Wang, Yan-Yan Wang, Xiao-Luan Yan, Kun Wang, Juan Li, Da Xu, Bao-Cai Xing

Introduction: Neoadjuvant chemotherapy is becoming routine for colorectal liver metastasis (CRLM) in patients with high risks of recurrence or in whom resection is difficult. This retrospective study aimed to establish a modified survival prediction model for patients with CRLM who underwent hepatectomy after neoadjuvant chemotherapy.

Materials and methods: A total of 619 patients who received neoadjuvant chemotherapy followed by hepatectomy between 2006 and 2021 were included and divided into training and validation groups at a ratio of 2:1. The model was established in training group and validated in validation group. Chemotherapy response was integrated into the genetic and morphological evaluation (GAME) score as a new NeoGAME model, with assigned points based on the hazard ratio in the multivariate Cox regression. The NeoGAME score grouping cutoff was divided using X-tile, and the predictive power was compared with that of traditional models.

Results: The 5-year overall survival were significantly different in the NeoGAME low-risk (0-2 points), medium-risk (3-4 points) and high-risk (≥5 points) groups (training group, P < 0.001; validation group, P = 0.0012). The area under the curve in predicting 5-year survival was 0.67 and 0.66 for the training and validation groups, respectively. Time-dependent receiver operating characteristic curve showed better discrimination ability of NeoGAME than the GAME score in predicting 5-year survival.

Conclusions: The newly established NeoGAME score can predict survival more precisely for patients with CRLM receiving neoadjuvant chemotherapy. Moreover, the model offers a useful tool for assessing tumor behavior and selecting a benefiting population for liver resection.

简介:对于复发风险高或切除困难的结直肠肝转移(CRLM)患者,新辅助化疗已成为常规治疗方法。这项回顾性研究旨在为接受新辅助化疗后进行肝切除术的 CRLM 患者建立一个改良的生存预测模型:纳入2006年至2021年期间接受新辅助化疗后进行肝切除术的619例患者,按2:1的比例分为训练组和验证组。模型在训练组建立,在验证组验证。将化疗反应纳入基因和形态学评价(GAME)评分,作为一个新的NeoGAME模型,并根据多变量Cox回归的危险比进行赋分。用X-tile划分NeoGAME评分分组,并与传统模型的预测能力进行比较:结果:NeoGAME低风险组(0-2分)、中风险组(3-4分)和高风险组(≥5分)的5年总生存率均有明显差异(训练组,P 结论:NeoGAME评分的预测能力与传统模型的预测能力相近:新建立的 NeoGAME 评分能更准确地预测接受新辅助化疗的 CRLM 患者的生存率。此外,该模型还是评估肿瘤行为和选择肝切除术受益人群的有用工具。
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