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51.2 ESSO Announcements

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2025.109605

引用次数: 0

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IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/S0748-7983(25)00043-5

引用次数: 0

Reply to: Comment on Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis 回复：局部进展期直肠癌根治性切除吻合后保护性造口逆转漏损相关因素分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109507

Miao-Ling Tsai, Been-Ren Lin

引用次数: 0

Development of a modified nutritional index model based on nutritional status and sarcopenia to predict long-term survival and chemotherapy benefits in elderly patients with advanced gastric cancer 基于营养状况和肌肉减少症的改良营养指数模型的发展，以预测老年晚期胃癌患者的长期生存和化疗获益。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109503

Ju Wu , Ze-Ning Huang , Xing-Qi Zhang , Shuang-Shuang Hou , Jia-Bin Wang , Qi-Yue Chen , Ping Li , Jian-Wei Xie , Chang-Ming Huang , Jian-Xian Lin , Chao-Hui Zheng

Background

Elderly patients with advanced gastric cancer have poor prognoses. This study aims to develop a prediction model for long-term survival after radical surgery and to identify patients who may benefit from chemotherapy.

Methods

Data from 555 elderly patients with advanced gastric cancer admitted to two medical centers from 2009 to 2018 were retrospectively analyzed. Sarcopenia was combined with the Controlling Nutritional Status (CONUT) score to create a modified nutritional index (mCONUT). Cox regression analyses were used to develop a novel nomogram prediction model (mCNS) that combined mCONUT, pN, and tumor size, and its performance was further verified both internally and externally.

Results

Multivariate Cox analysis revealed that tumor size, pN, and mCONUT were independent prognostic risk factors for overall survival (OS). The mCNS model showed good fit and high predictive value (AUC: training set 0.711; validation set 0.707), outperforming the pTNM model (p < 0.05). To further investigate the association between the model and adjuvant chemotherapy, we categorized the model into two risk groups: a high-risk group and a low-risk group. Further analysis revealed that, in the low-risk group, the OS and recurrence-free survival(RFS) for patients receiving adjuvant chemotherapy was significantly better than that of those who did not receive chemotherapy (p = 0.047,p = 0.019). In the high-risk group, this result was not observed (p = 0.120, p = 0.053).

Conclusion

The mCNS model has high predictive value in predicting long-term survival of elderly patients with advanced gastric cancer. Patients with mCNS-L were able to benefit from chemotherapy after laparoscopic radical gastrectomy.

背景：老年晚期胃癌患者预后较差。本研究旨在建立根治性手术后长期生存的预测模型，并确定可能受益于化疗的患者。方法：回顾性分析2009 - 2018年两家医疗中心收治的555例老年晚期胃癌患者的资料。骨骼肌减少症与控制营养状态（CONUT）评分相结合，形成改良营养指数（mCONUT）。采用Cox回归分析建立了一种结合mCONUT、pN和肿瘤大小的新型nomogram预测模型（mCNS），并进一步从内部和外部验证其性能。结果：多因素Cox分析显示，肿瘤大小、pN和mCONUT是影响总生存期（OS）的独立预后危险因素。mCNS模型拟合良好，具有较高的预测值(AUC：训练集0.711；验证集0.707)，优于pTNM模型(p结论：mCNS模型对预测老年晚期胃癌患者的长期生存具有较高的预测价值。mCNS-L患者能够从腹腔镜根治性胃切除术后的化疗中获益。

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引用次数: 0

Impact of obesity on outcomes following surgery for gastric adenocarcinoma: A European multi-institutional study 肥胖对胃腺癌手术后预后的影响：一项欧洲多机构研究

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109518

Ophélie Bacoeur-Ouzillou , Thibault Voron , Céline Lambert , David Fuks , Guillaume Piessen , Gilles Manceau , Jérome Guiramand , Denis Pezet , Caroline Gronnier , Johan Gagnière

Introduction

The impact of overweight and obesity on pathological outcomes, complications, and oncologic outcomes following surgery for gastric adenocarcinoma has been poorly reported in Western populations. This study aimed to better understand the impact of overweight and obesity on both surgical and oncological outcomes in patients who underwent surgery for gastric cancer.

Methods

Data were retrospectively collected from a multi-institutional European database. 1589 patients underwent surgery for gastric adenocarcinoma between 2007 and 2017. Patients were divided into three groups according to their body mass index (BMI): 722 normoponderal patients (45.4 %), 585 overweight patients (36.8 %), and 282 obese patients (17.7 %).

Results

The tumor stage, administration of perioperative chemotherapy, number of harvested lymph nodes, and reoperation rates were similar. Tumor location differed between the groups, with more distal locations in normoponderal patients than in overweight patients (51.4 % vs. 44.1 %, p = 0.04). Surgical complications were more frequent in obese patients than in normoponderal patients (34.8 % vs. 24.2 %, p = 0.005), and severe postoperative complications too. The medical complication rate was higher in overweight and obese patients (31.5 % and 32.6 % vs. 24.1 %, p = 0.003). There was no difference in the overall survival.

Conclusions

Obesity was not related to tumor stage, pre- or intraoperative strategies, or survival in patients undergoing surgery for gastric adenocarcinoma. However, postoperative morbidity increases in patients with obesity. Surgery for gastric adenocarcinoma should be proposed for all patients and should be performed as usual, regardless of their BMI. However, obese patients should be counseled regarding the higher risk of postoperative complications.

在西方人群中，超重和肥胖对胃腺癌手术后病理结果、并发症和肿瘤学结果的影响报道很少。本研究旨在更好地了解超重和肥胖对胃癌手术患者手术和肿瘤预后的影响。方法：回顾性收集来自欧洲多机构数据库的数据。2007年至2017年期间，1589名患者接受了胃腺癌手术。根据体重指数（BMI）将患者分为3组：正常体重722例（45.4%），超重585例（36.8%），肥胖282例（17.7%）。结果：两组肿瘤分期、围手术期化疗、淋巴结清扫数、再手术率相似。肿瘤的位置在两组之间存在差异，正常颞叶患者的远端位置多于超重患者（51.4%比44.1%,p = 0.04）。肥胖患者手术并发症发生率高于正常对照组（34.8%比24.2%,p = 0.005），且术后并发症严重。超重和肥胖患者的并发症发生率较高（31.5%和32.6%比24.1%,p = 0.003）。总体存活率没有差异。结论：肥胖与胃腺癌手术患者的肿瘤分期、术前或术中策略或生存无关。然而，肥胖患者的术后发病率增加。胃腺癌的手术应建议所有患者，并应照常进行，无论其BMI如何。然而，肥胖患者应被告知术后并发症的风险较高。

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引用次数: 0

Economic evaluation of palliative gastrointestinal surgery for advanced cancer patients with malignant bowel obstruction: A systematic review 姑息性胃肠手术治疗晚期癌症合并恶性肠梗阻的经济评价：一项系统综述。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109490

Xinyi Casuarine Low , Jun Jie Lee , Yewei Xie , Si Min Jolene Wong , Nicholas Graves

Background

Palliative surgery reduces debilitating symptoms attributable to cancer, and the intent is to improve health-related quality of life. Malignant bowel obstruction is a common indication. Despite positive clinical outcomes, there is a shortage of economic evaluation evidence to support wider adoption of palliative surgery.

Aim

The aim of this review is to summarize the existing economic evaluation literature for palliative gastrointestinal surgery for advanced cancer patients with malignant bowel obstruction.

Methods

The Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and systematic literature searches were performed using PubMed, Medline, EMBASE and Cochrane. English-language studies comparing cost outcomes of palliative gastrointestinal surgery for malignant bowel obstruction between January 2000 and April 2024 were considered. The Consolidated Health Economic Evaluation Reporting Standards 2022 were used to assess the quality of reporting, and Risk of Bias in Model-based Economic Evaluations was used to examine potential risk of bias of included studies.

Results

A total of nine papers were included, with five reporting cost outcomes only and four were full economic evaluations. Methods used, and the conditions included were heterogenous. There was a lack of consistency in methods and reporting deficits relative to the CHEERS 2022 guideline. Multiple potential sources of bias were detected.

Conclusions

The quality of economic evaluations is quite poor. Heterogeneity among studies limits the ability to compare and generalise findings. Future research should strive to standardize methodologies, improve reporting practices, and develop more robust, high-quality economic evaluations that can better inform decision-making in palliative gastrointestinal surgery for malignant bowel obstruction.

背景：姑息性手术可减少癌症引起的衰弱症状，目的是改善与健康相关的生活质量。恶性肠梗阻是常见的适应症。尽管有积极的临床结果，但缺乏经济评估证据来支持姑息性手术的广泛采用。目的：本综述的目的是总结现有姑息性胃肠手术治疗晚期癌症合并恶性肠梗阻的经济评价文献。方法：遵循PRISMA （Systematic Reviews and meta - analysis）指南的首选报告项目，使用PubMed、Medline、EMBASE和Cochrane进行系统文献检索。英语研究比较了2000年1月至2024年4月期间恶性肠梗阻的姑息性胃肠手术的成本结果。采用《综合卫生经济评价报告标准2022》评估报告质量，采用基于模型的经济评价中的偏倚风险检查纳入研究的潜在偏倚风险。结果：共纳入9篇论文，其中5篇仅报告成本结果，4篇是全面的经济评估。所采用的方法和条件都是异质的。与干杯2022指南相比，方法和报告缺陷缺乏一致性。发现了多个潜在的偏倚来源。结论：经济评价质量较差。研究之间的异质性限制了比较和概括研究结果的能力。未来的研究应努力标准化方法，改进报告实践，并开发更可靠、高质量的经济评估，以便更好地为恶性肠梗阻姑息性胃肠道手术的决策提供信息。

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引用次数: 0

Outcomes of intraperitoneal chemotherapy for the treatment of gastric cancer with peritoneal metastasis: A comprehensive systematic review and meta-analysis 腹腔化疗治疗胃癌伴腹膜转移的结果：一项全面的系统回顾和荟萃分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109499

Piers R. Boshier , Nicholas Tekkis , Alice Baggaley , Henry D. Robb , Guillaume Lafaurie , Geert Simkens , Magnus Nilsson , George B. Hanna , Russell Petty

Background

Peritoneal metastasis is common in gastric cancer and linked to poor survival. Treatment of peritoneal metastasis with intraperitoneal chemotherapy has become an accepted practice in some centres. This systematic review and meta-analysis intends to provide a comprehensive evaluation of published evidence for the use of intraperitoneal chemotherapy is gastric cancer patients with peritoneal metastasis.

Methods

A systematic literature search for studies reporting the use of intraperitoneal chemotherapy for the treatment gastric cancer with macroscopic peritoneal metastasis was performed up until June 2024. Studies were not eligible for inclusion if they described the use of intraperitoneal chemotherapy solely as an adjunct to gastrectomy or cytoreductive surgery. Pooled- and meta-analysis was used to summarise study outcomes.

Results

Fifty-three studies reporting the outcomes of 2446 gastric cancer patients who received intraperitoneal chemotherapy for the treatment of peritoneal metastasis, were included. Three principal methods of intraperitoneal chemotherapy administration were described: catheter based (normothermic) intraperitoneal chemotherapy (n = 28); pressurised intraperitoneal aerosolised chemotherapy (n = 14), and; hyperthermic intraperitoneal chemotherapy (n = 11). The proportion of patients with complete peritoneal disease regression after receiving intraperitoneal chemotherapy was 27 % (95%CI, 14–41). Median overall survival determined was 16.4 months (95%CI, 14.4–18.4). Meta-analysis of data from eight studies comparing combined intraperitoneal and systemic chemotherapy with systemic chemotherapy alone identified a survival benefit for patients receiving intraperitoneal chemotherapy (Hazard ratio 0.57 [95%CI, 0.48–0.67],P < 0.001).

Conclusion

Despite variation in published treatment approaches and a lack of evidence from well-designed clinical trials, intraperitoneal chemotherapy may be considered safe and in selected circumstances efficacious.

背景：腹膜转移在胃癌中很常见，且与生存率低有关。腹腔内化疗治疗腹膜转移已成为一些中心接受的做法。本系统综述和荟萃分析旨在对已发表的证据进行综合评价，以支持胃癌腹膜转移患者使用腹腔化疗。方法：系统检索截至2024年6月腹腔内化疗治疗胃癌伴肉眼腹膜转移的相关文献。如果研究仅将腹腔化疗作为胃切除术或细胞减少手术的辅助手段，则不符合纳入标准。合并和荟萃分析用于总结研究结果。结果：纳入53项研究，报告了2446例接受腹腔化疗治疗腹膜转移的胃癌患者的预后。本文描述了三种主要的腹腔化疗方法：基于导管的（常温）腹腔化疗（n = 28）；加压腹腔内雾化化疗（n = 14）；腹腔内高温化疗（n = 11）。接受腹腔化疗后腹膜疾病完全消退的患者比例为27% （95%CI, 14-41）。确定的中位总生存期为16.4个月（95%CI, 14.4-18.4）。8项比较腹腔联合全身化疗与单独全身化疗的研究数据的荟萃分析发现，接受腹腔化疗的患者的生存获益（风险比0.57 [95%CI, 0.48-0.67]，P）。结论：尽管已发表的治疗方法存在差异，且缺乏精心设计的临床试验的证据，但腹腔化疗可能被认为是安全的，在某些情况下是有效的。

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引用次数: 0

Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients 通过图像引导下经皮引流预测和管理细胞减少手术和腹膜内高温化疗后的腹腔内收集：1313例患者的5年经验。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109495

Ahmed Saeed, Camran Nesari, Victoria Evans, Kandiah Chandrakumaran, Thomas Desmond Cecil, Brendan John Moran, Faheez Mohamed

Introduction

Intraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy.

Aim

To identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD.

Method

A retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed.

Results

Intraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106.

In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis.

IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds.

Conclusion

Intraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.

简介：腹腔内收集（IACs）是细胞减缩手术（CRS）和腹腔内高温化疗（HIPEC）后常见的现象。炎症生物标志物和营养指数（NI）可以预测IACs。影像引导下经皮引流（IGPD）是治疗IACs的一种替代方法。目的：确定预测CRS和HIPEC后IACs的因素，并回顾IGPD后的结果。方法：回顾性分析2018年1月至2022年3月期间，从国家转诊中心前瞻性收集的数据，包括接受CRS和HIPEC治疗并接受IGPD治疗的IACs患者。比较倾向评分匹配的病例，评估IACs的预测。回顾了IGPD的成果。结果：1313例患者中有106例（8.0%）出现腹腔积液，101/106行IGPD，在超声或CT引导下。5/106需要剖腹手术。在接受IGPD的患者中，术前和术后CRP和中性粒细胞显著升高，而术前和术后白蛋白和NI显著低于倾向评分匹配的对照组。在多变量分析中，术后CRP和中性粒细胞计数以及术前和术后白蛋白和mGPS被确定为独立预测因子。IGPD改善了94%的临床状况。15/106（14.8%）的IAC病因为吻合口漏，最常见的是左膈下积液（24/101,24%）。主要并发症4例，IGPD置入期间膀胱穿孔2例，引流后出血2例。结论：CRS和HIPEC术后腹腔内收集物可通过炎症标志物和营养指数进行预测。及时使用IGPD可获得良好的结果，避免了剖腹手术的需要。

{"title":"Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients","authors":"Ahmed Saeed, Camran Nesari, Victoria Evans, Kandiah Chandrakumaran, Thomas Desmond Cecil, Brendan John Moran, Faheez Mohamed","doi":"10.1016/j.ejso.2024.109495","DOIUrl":"10.1016/j.ejso.2024.109495","url":null,"abstract":"<div><h3>Introduction</h3><div>Intraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy.</div></div><div><h3>Aim</h3><div>To identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD.</div></div><div><h3>Method</h3><div>A retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed.</div></div><div><h3>Results</h3><div>Intraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106.</div><div>In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis.</div><div>IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds.</div></div><div><h3>Conclusion</h3><div>Intraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109495"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767550","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

Major pathologic response as a prognostic surrogate in esophageal squamous cell carcinoma patients receiving neoadjuvant chemotherapy/chemoimmunotherapy: A multi-center cohort study 主要病理反应作为食管鳞状细胞癌患者接受新辅助化疗/化疗免疫治疗的预后指标：一项多中心队列研究

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109500

Zhinuan Hong , Shuhan Xie , Hui Xu , Sunkui Ke , Wenyi Liu , Shijie Huang , Shuchen Chen , Jinbiao Xie , Jinxin Xu , Mingqiang Kang

Purpose

To determine the prognostic and survival surrogate value of major pathologic response (MPR) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemotherapy/chemoimmunotherapy(nCT/nICT) and surgery.

Method

A retrospective multi-center study cohort study enrolled 305 ESCC patients who underwent neoadjuvant chemotherapy/chemoimmunotherapy followed by esophagectomy. Endpoints included recurrence-free survival (RFS), locoregional recurrence-free survival(L-RFS), distant metastasis-free survival(D-MFS), and recurrence patterns. The Cox regression analysis and Harrell's C-index were used to analyze survival differences and surrogate endpoints. The Kaplan-Meier method was used for the subgroup analysis in two subgroups(the patients receiving nICT and patients receiving nCT) and the prognostic value analysis of adjuvant therapy in non-MPR and MPR patients.

Result

Of the 305 patients, 105 achieved MPR, demonstrating a significantly improved RFS (P value < 0.001), L-RFS (P value < 0.001), and D-MFS (P value = 0.003). MPR was identified as an independent risk factor for RFS(HR:0.415, 95%CI:[0.227, 0.759], P value = 0.004) and demonstrated equal predictive capacity to be a surrogate of survival endpoints with T stage and N stage(Harrell's C-index: 0.613). In subgroup analysis, patients with MPR showed better survival outcomes in subgroups that received neoadjuvant chemoimmunotherapy (P value = 0.012) and neoadjuvant chemotherapy(P value < 0.001). Additionally, adjuvant therapy did not confer additional survival benefits to both MPR and non-MPR patients. Compared with patients who achieved MPR, non-MPR patients exhibited a higher recurrence rate, although the recurrence sites were similar between the two groups.

Conclusion

MPR can serve as an independent prognostic factor and a surrogate of survival endpoints in ESCC patients undergoing nCT/nICT. Besides, as a potential indicator for postoperative management, MPR can provide reference basis and evidence support in clinical practice.

目的：确定接受新辅助化疗/免疫治疗（nCT/nICT）和手术的食管鳞状细胞癌（ESCC）患者主要病理反应（MPR）的预后和生存替代价值：一项回顾性多中心队列研究共纳入了305名接受新辅助化疗/化学免疫疗法和食管切除术的ESCC患者。研究终点包括无复发生存期（RFS）、无局部复发生存期（L-RFS）、无远处转移生存期（D-MFS）和复发模式。采用 Cox 回归分析和 Harrell's C 指数分析生存率差异和替代终点。采用 Kaplan-Meier 法对两个亚组（接受 nICT 的患者和接受 nCT 的患者）进行亚组分析，并对非 MPR 和 MPR 患者辅助治疗的预后价值进行分析：结果：在 305 例患者中，有 105 例达到了 MPR，RFS 明显改善（P 值结论：MPR 可作为独立的预后指标：在接受 nCT/nICT 治疗的 ESCC 患者中，MPR 可作为独立的预后因素和生存终点的替代指标。此外，作为术后管理的潜在指标，MPR 还能为临床实践提供参考依据和证据支持。

{"title":"Major pathologic response as a prognostic surrogate in esophageal squamous cell carcinoma patients receiving neoadjuvant chemotherapy/chemoimmunotherapy: A multi-center cohort study","authors":"Zhinuan Hong , Shuhan Xie , Hui Xu , Sunkui Ke , Wenyi Liu , Shijie Huang , Shuchen Chen , Jinbiao Xie , Jinxin Xu , Mingqiang Kang","doi":"10.1016/j.ejso.2024.109500","DOIUrl":"10.1016/j.ejso.2024.109500","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the prognostic and survival surrogate value of major pathologic response (MPR) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemotherapy/chemoimmunotherapy(nCT/nICT) and surgery.</div></div><div><h3>Method</h3><div>A retrospective multi-center study cohort study enrolled 305 ESCC patients who underwent neoadjuvant chemotherapy/chemoimmunotherapy followed by esophagectomy. Endpoints included recurrence-free survival (RFS), locoregional recurrence-free survival(L-RFS), distant metastasis-free survival(D-MFS), and recurrence patterns. The Cox regression analysis and Harrell's C-index were used to analyze survival differences and surrogate endpoints. The Kaplan-Meier method was used for the subgroup analysis in two subgroups(the patients receiving nICT and patients receiving nCT) and the prognostic value analysis of adjuvant therapy in non-MPR and MPR patients.</div></div><div><h3>Result</h3><div>Of the 305 patients, 105 achieved MPR, demonstrating a significantly improved RFS (P value < 0.001), L-RFS (P value < 0.001), and D-MFS (P value = 0.003). MPR was identified as an independent risk factor for RFS(HR:0.415, 95%CI:[0.227, 0.759], P value = 0.004) and demonstrated equal predictive capacity to be a surrogate of survival endpoints with T stage and N stage(Harrell's C-index: 0.613). In subgroup analysis, patients with MPR showed better survival outcomes in subgroups that received neoadjuvant chemoimmunotherapy (P value = 0.012) and neoadjuvant chemotherapy(P value < 0.001). Additionally, adjuvant therapy did not confer additional survival benefits to both MPR and non-MPR patients. Compared with patients who achieved MPR, non-MPR patients exhibited a higher recurrence rate, although the recurrence sites were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>MPR can serve as an independent prognostic factor and a surrogate of survival endpoints in ESCC patients undergoing nCT/nICT. Besides, as a potential indicator for postoperative management, MPR can provide reference basis and evidence support in clinical practice.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109500"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794601","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

Treatment-sequencing before and after index hepatectomy with either synchronous or metachronous colorectal liver metastasis: Comparison of recurrence risk, repeat hepatectomy and overall survival in a population-derived cohort 同步或异时性结直肠癌肝转移的指数肝切除术前后的治疗序列：在人群来源的队列中，复发风险、重复肝切除术和总生存率的比较

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109540

Torhild Veen , Arezo Kanani , Claudia Zaharia , Dordi Lea , Kjetil Søreide

Background

Treatment of colorectal cancer liver metastasis (CRLM) includes several options with impact on the patient journey and may depend on presentation and patient characteristics. The aim of the study was to investigate how treatment sequencing in index hepatectomy for synchronous or metachronous CRLM may potentially impact treatment pathways and oncological outcomes.

Methods

An observational cohort study (ACROBATICC; NCT0176813) of patients having surgery for CRLM. Patient and tumour characteristics, treatment and recurrence patterns were recorded. Recurrence-free (RFS) and overall survival (OS) analyzed by Kaplan-Meier method (log-rank test).

Results

The study included 132 patients, median age 67 yrs, 69 % men and 55 % had synchronous CRLM. Overall, 65 (50 %) received neoadjuvant chemotherapy, 45 (63 %) in synchronous and 20 (33 %) in metachronous CRLM (odds ratio, OR 0.30 95%CI 0.15–0.62; p < 0.001). Patient- and tumour characteristics did not differ except number of metastases (synchronous CRLM median 2 (range 1–4) vrs metachronous median 1 (1–2), respectively; p < 0.001). Some 99 (75 %) patients relapsed, 38 % had liver-recurrence. Repeat hepatectomy was performed in one-third, with equal rates between synchronous or metachronous CRLM. Median OS of all patients was 68 months, for a difference of 24 months between synchronous and metachronous CRLM (59 and 83 months, respectively; p = 0.334). RFS survival did not differ between groups.

Conclusion

Pre-operative chemotherapy was given twice as often for patients with synchronous CRLM who also had more metastases and more frequently rectal primaries. Liver recurrence rates, repeat hepatecomy and overall survival was comparable between groups. Intrinsic cancer biology needs to be better investigated to provide better outcomes.

背景：结直肠癌肝转移（CRLM）的治疗包括几种影响患者旅程的选择，可能取决于表现和患者特征。该研究的目的是研究同步或非同步CRLM的指数肝切除术的治疗顺序如何潜在地影响治疗途径和肿瘤预后。方法：观察性队列研究(ACROBATICC；NCT0176813)为接受CRLM手术的患者。记录患者和肿瘤特征、治疗和复发模式。Kaplan-Meier法（log-rank检验）分析无复发（RFS）和总生存期（OS）。结果：该研究包括132例患者，中位年龄67岁，69%为男性，55%为同步CRLM。总体而言，65例（50%）接受了新辅助化疗，同步化疗45例（63%），非同步化疗20例（33%）(优势比，OR 0.30 95%CI 0.15-0.62；结论：同步CRLM患者术前化疗的频率是其他患者的两倍，这些患者也有更多的转移和更频繁的直肠原发。两组间肝脏复发率、重复肝切除术和总生存率具有可比性。内在的癌症生物学需要更好的研究，以提供更好的结果。

{"title":"Treatment-sequencing before and after index hepatectomy with either synchronous or metachronous colorectal liver metastasis: Comparison of recurrence risk, repeat hepatectomy and overall survival in a population-derived cohort","authors":"Torhild Veen , Arezo Kanani , Claudia Zaharia , Dordi Lea , Kjetil Søreide","doi":"10.1016/j.ejso.2024.109540","DOIUrl":"10.1016/j.ejso.2024.109540","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of colorectal cancer liver metastasis (CRLM) includes several options with impact on the patient journey and may depend on presentation and patient characteristics. The aim of the study was to investigate how treatment sequencing in index hepatectomy for synchronous or metachronous CRLM may potentially impact treatment pathways and oncological outcomes.</div></div><div><h3>Methods</h3><div>An observational cohort study (ACROBATICC; NCT0176813) of patients having surgery for CRLM. Patient and tumour characteristics, treatment and recurrence patterns were recorded. Recurrence-free (RFS) and overall survival (OS) analyzed by Kaplan-Meier method (log-rank test).</div></div><div><h3>Results</h3><div>The study included 132 patients, median age 67 yrs, 69 % men and 55 % had synchronous CRLM. Overall, 65 (50 %) received neoadjuvant chemotherapy, 45 (63 %) in synchronous and 20 (33 %) in metachronous CRLM (odds ratio, OR 0.30 95%CI 0.15–0.62; p < 0.001). Patient- and tumour characteristics did not differ except number of metastases (synchronous CRLM median 2 (range 1–4) vrs metachronous median 1 (1–2), respectively; p < 0.001). Some 99 (75 %) patients relapsed, 38 % had liver-recurrence. Repeat hepatectomy was performed in one-third, with equal rates between synchronous or metachronous CRLM. Median OS of all patients was 68 months, for a difference of 24 months between synchronous and metachronous CRLM (59 and 83 months, respectively; p = 0.334). RFS survival did not differ between groups.</div></div><div><h3>Conclusion</h3><div>Pre-operative chemotherapy was given twice as often for patients with synchronous CRLM who also had more metastases and more frequently rectal primaries. Liver recurrence rates, repeat hepatecomy and overall survival was comparable between groups. Intrinsic cancer biology needs to be better investigated to provide better outcomes.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109540"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812325","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