Journal of Surgical Oncology最新文献

Background: Despite adequate discussion and counseling in the office, inadequate health literacy or language barriers may make it difficult to follow instructions from a physician and access necessary resources. This may negatively impact survival outcomes. Most healthcare materials are written at a 10th grade level, while many patients read at an 8th grade level. Hispanic Americans comprise about 25% of the US patient population, while only 6% of physicians identify as bilingual.

Questions/purpose: (1) Does ChatGPT 3.5 provide appropriate responses to frequently asked patient questions that are sufficient for clinical practice and accurate in English and Spanish? (2) What is the comprehensibility of the responses provided by ChatGPT 3.5 and are these modifiable?

Methods: Twenty frequently asked osteosarcoma patient questions, evaluated by two fellowship-trained musculoskeletal oncologists were input into ChatGPT 3.5. Responses were evaluated by two independent reviewers to assess appropriateness for clinical practice, and accuracy. Responses were graded using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level test (FKGL). The responses were then input into ChatGPT 3.5 for a second time with the following command "Make text easier to understand". The same method was done in Spanish.

Results: All responses generated were appropriate for a patient-facing informational platform. There was no difference in the Flesch Reading Ease Score between English and Spanish responses before the modification (p = 0.307) and with the Flesch-Kincaid grade level (p = 0.294). After modification, there was a statistically significant difference in comprehensibility between English and Spanish responses (p = 0.003 and p = 0.011).

Conclusion: In both English and Spanish, none of the ChatGPT generated responses were found to be factually inaccurate. ChatGPT was able to modify responses upon follow-up with a simplified command. However, it was shown to be better at improving English responses than equivalent Spanish responses.

Circulating tumor cells (CTCs) are tumor cells that detach from the primary tumor site and enter the bloodstream. They hold significant value for the early detection, diagnosis, and treatment of tumors. CTC detection methods can be classified into in vivo and in vitro techniques. Compared to traditional tumor detection methods, CTC detection causes less harm to the body and allows for earlier identification of malignant tumors, thereby enabling timely treatment and improving patient survival rates. In recent years, CTC detection has been widely used to assess the effectiveness of tumor immunotherapy. Dynamic monitoring of CTCs can help optimize clinical treatment strategies. This review summarizes the latest in vivo and in vitro detection methods for CTCs and discusses their applications in immunotherapy for various common tumors, aiming to provide better guidance and support for clinical practice.

Background: The Pre-EMPT study aimed to determine if structured exercise could reduce length of stay, post-operative complications and improve fitness and health-related quality of life (HQRL) in patients undergoing neoadjuvant chemotherapy (NAC) and oesophagectomy.

Methods: A prospective non-randomised trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal adenocarcinoma. Length of hospital stay and post-operative complications were recorded. Cardiopulmonary exercise testing (CPEX), body composition analyses, lymphocyte levels and HRQL questionnaires were performed at multiple time points.

Results: Median length of stay was similar in both groups. There were 6 versus 11 complications observed (intervention vs control p = 0.086). Cardio-pulmonary fitness (VO2peak) declined after NAC, but less in the intervention group (intervention -13.54% vs control -21.40%, p = 0.02). Body composition improved in the intervention group (FMi/FFMi -5.5% intervention, 10.7% control p = 0.043). Performance, cognitive, sleep and emotional function scores improved following NAC in the intervention group. Lymphocyte subsets increased in the intervention group compared to the control group after chemotherapy (p = 0.034). Chemotherapy response was improved in the intervention group (p = 0.022).

Conclusion: A structured exercise programme may mitigate cardiopulmonary deconditioning, reduce sarcopenia and offset lymphopenia, during chemotherapy, in patients undergoing NAC and oesophagectomy.

Perioperative chemotherapy has emerged as a critical component in managing resectable colorectal liver metastases (CRLM), aiming to improve long-term survival, although data supporting its use remains controversial. This narrative review explores the current state of perioperative chemotherapy in patients with resectable CRLM, focusing on its role in different oncological risk categories. The review highlights ongoing controversies, such as optimal patient selection and the role of post- versus preoperative treatment in specific scenarios.

Background and objectives: Identification of colorectal cancer (CRC) patients at high risk of recurrence could be of substantial clinical use. We evaluated the association of ctDNA status, using a tumor-informed assay, with recurrence-free survival (RFS).

Methods: Stage III CRC patients were enrolled between 2016 and 2020. Tumor tissue and serial (every 3 months for years 1-3, biannually for years 4-5) blood samples were collected. Utilizing whole-exome sequencing and selection of 50-200 variants for tumor informed assays, ctDNA status was determined using plasma cell-free DNA.

Results: Of 137 patients enrolled, 124 with 1029 ctDNA results were included in the analyses. Median follow-up was 4.8 years. Plasma ctDNA status was strongly associated with risk of recurrence during the surveillance period (hazard ratio (HR) 49.6, 95% CI: 16.6-148.3; p < 0.0001), and at the postsurgical (HR 9.6, 95% CI: 3.2-29.5) and postdefinitive therapy timepoints (HR: 16.7, 95% CI: 6.9-40.3). The estimated 3-year RFS for ctDNA positive and ctDNA negative patients were, respectively, 54.5% and 96.1% after surgery, and 18.2% and 90.0% after definitive therapy. Multivariable analysis indicated ctDNA but not CEA was strongly prognostic for recurrence.

Conclusions: Our tumor-informed ctDNA assay was strongly prognostic for recurrence in patients with stage III colorectal cancer at all timepoints.