Journal of Surgical Oncology最新文献

Background and Objectives

Sarcopenia adversely affects clinical outcomes in patients with cancer. Studies indicate that sarcopenia significantly predicts chemotherapy-induced dose-limiting toxicities, including early discontinuation, delay, and dose-reduction, in patients with colorectal, esophageal, digestive, hepatocellular, and renal cancers. The Strength, Assistance for walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire is a simple and effective tool for sarcopenia screening. Adjuvant chemotherapy is the standard treatment for advanced (Stages II/III) colorectal cancer (CRC). Predicting chemotherapy discontinuation could help improve oncologic outcomes. This study aimed to evaluate the correlation between the SARC-F score and chemotherapy discontinuation.

Methods

This study included 139 patients with CRC who underwent surgery between July 2016 and June 2023, received adjuvant chemotherapy and completed the SARC-F questionnaire before surgery. The SARC-F includes five items, each scored from 0 to 2. Patients were divided into two groups based on optimal SARC-F cutoff value. Treatment discontinuation was analyzed using a logistic regression model.

Results

Patients were categorized into high-SARC-F (n = 18) and low-SARC-F (n = 121) groups. Patients in the high-SARC-F group were older (p < 0.001), had higher rates of hypertension (p = 0.001) and diabetes mellitus (p = 0.017), elevated preoperative C-reactive protein levels (p < 0.001), and a higher incidence of treatment discontinuation (p = 0.010). Univariate and multivariate analyses identified a high SARC-F score as an independent risk factor for chemotherapy discontinuation (odds ratio 3.905, 95% confidence interval 1.100–13.867).

Conclusions

Our findings indicate that the SARC-F score reflects sarcopenia characteristics and can predict adjuvant chemotherapy discontinuation in patients with CRC.

Background and Objectives

The safety of omitting radiotherapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC) remains controversial. This study investigates the safety of omitting RT after BCS.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search of PubMed, Web of Science, EMBASE, and the Cochrane Library to identify eligible randomized controlled trials (RCTs). The primary outcomes were local recurrence (LR) and overall survival (OS), while secondary outcomes included distant metastasis (DM), disease-free survival (DFS), and disease-specific survival (DSS). The analysis was conducted using hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

A total of 14 RCTs involving 11 977 early-stage BC patients who underwent BCS were included in this meta-analysis. Compared with patients who received RT, those who omitted RT had a significantly higher LR (HR = 2.76; p < 0.001), but no significant difference was observed in OS between the two groups (HR = 1.05; p = 0.208). The DFS was significantly better in the RT group than in the no-RT group (HR = 1.29; p = 0.001). No significant differences were observed between the two groups in DM (HR = 0.96; p = 0.729) or DSS (HR = 1.03; p = 0.754). Subgroup analyses revealed that omitting RT was associated with a higher LR across different follow-up periods, age stratifications, and types of BC invasiveness, but no significant impact on OS was found.

Conclusions

This study found that in patients with early-stage BC, omitting RT after BCS increased the LR compared with the RT group, but did not affect the OS.

Trial Registration: PROSPERO (CRD420250655104).

Objective

To evaluate the utility of the Social Vulnerability Index (SVI) in understanding disparities in breast cancer screening, incidence, and mortality.

Background

Despite major advances in breast cancer detection and treatment, significant disparities persist—particularly among socioeconomically and geographically vulnerable populations. The SVI, developed by the CDC, is a composite index that captures community-level vulnerability across multiple social domains and may serve as a tool to identify and address inequities in cancer care.

Methods

This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024616874). PubMed, Scopus, and Embase were searched for studies examining associations between SVI and breast cancer outcomes. Studies were evaluated using the Newcastle-Ottawa Scale or appropriate Cochrane tools. Meta-analyses were performed where applicable.

Results

Fifteen studies were included. Seven studies examined screening; a pooled meta-analysis (n = 3) showed reduced screening in high-SVI areas (pooled OR: 0.55, 95% CI: 0.24–1.26; I² = 99%). Four studies reported reduced incidence in high-SVI populations, likely reflecting underdiagnosis. Five studies demonstrated increased mortality in high-SVI populations, with ORs ranging from 1.09 to 2.84. Other studies addressed comorbidities, access to care, and disease subtypes.

Conclusion

The SVI is a valuable, multidimensional tool for characterizing and addressing disparities in breast cancer outcomes, with implications for public health interventions and policy.

BACKGROUND

Emerging data support the use of neoadjuvant treatment (NAT), particularly immunotherapy in microsatellite instability–high (MSI-H) tumors. We evaluate national trends in NAT utilization for clinical T4b colon cancers and its association with overall survival, with a focus on MSI-H tumors.

METHODS

We conducted a retrospective cohort study using the National Cancer Database (2010–2022) evaluating patients with non-metastatic clinical T4b colonic adenocarcinoma who underwent colectomy. The primary outcome measures were trends in NAT utilization and overall survival.

RESULTS

Among 8862 patients with clinical T4b colon cancer, NAT utilization increased over time, peaking at 28% in the most recent quartile. NAT recipients were more likely younger, healthier, and to be treated at academic centers. NAT was associated with higher R0 resection rates (83% vs 77%, p < 0.001) and significantly longer mean overall survival (105 vs 80 months, p < 0.001).

Among MSI-H patients (11% of the cohort), 15% received NAT. Immunotherapy use increased steadily, surpassing chemotherapy in 2022. Patients receiving neoadjuvant immunotherapy +/− chemotherapy demonstrated superior survival to chemotherapy alone (106 vs 85 months, p < 0.001).

CONCLUSIONS

Neoadjuvant therapy use has increased nationally, with a notable rise in immunotherapy for MSI-H tumors. Neoadjuvant treatment, particularly immunotherapy, is associated with significant overall survival benefit.

Background and Objectives

The prognostic differences between subcutaneous leiomyosarcoma and dermal leiomyosarcoma are not well defined due to limited cohort sizes and insufficient follow-up in prior studies. This study aimed to investigate the clinicopathological features of subcutaneous and dermal leiomyosarcoma and estimate their 10-year rates of metastasis, local recurrence, and overall survival. Additionally, we propose standardized follow-up recommendations.

Methods

All patients diagnosed with cutaneous leiomyosarcoma in Denmark from 1980 to 2022 were included. The prognosis was estimated using age- and sex-standardized stratified cause-specific Cox-regression with all-cause mortality as competing risk.

Results

We included 196 patients with subcutaneous leiomyosarcoma and 465 with dermal leiomyosarcoma. The 10-year local recurrence rate was similar in patients with subcutaneous leiomyosarcoma (15%) and dermal leiomyosarcoma (11%, p = 0.13). However, patients with subcutaneous leiomyosarcoma had a significantly higher 10-year risk of metastasis (25%), primarily observed in grade 2 and 3 tumors, compared with dermal leiomyosarcoma (2.7%), p < 0.001, and a lower 10-year-overall survival (56% vs. 64%), p = 0.02.

Conclusions

Grade 2 and 3 subcutaneous leiomyosarcoma should be classified as a high-risk sarcoma with a substantial risk of metastasis and poor overall survival, necessitating follow-up that includes both clinical examinations and PET/CT or CT of the thorax for 5 years to detect both locoregional and distant metastases. Dermal leiomyosarcoma should be considered a low-risk sarcoma due to its low risk of metastasis and moderate risk of local recurrence, suggesting that the follow-up can focus on clinical examinations for 4 years as the 10-year risk of local recurrence is < 1% after this time point.

Objective

To evaluate the impact of delayed esophagectomy on the overall survival of esophageal cancer patients undergoing esophagectomy after CROSS.

Methods

A retrospective analysis was done of a prospective database of esophagectomy patients who underwent CROSS therapy and esophagectomy from May 2016 to January 2020. Preoperative characteristics, postoperative adverse events, recurrence rates, and survival rates were compared between patients who underwent surgery within 60 days of CROSS completion versus > 60 days.

Results

In total, 197 patients were included; 137 underwent surgery within 60 days (standard group, SG) versus 60 at > 60 days (delayed group, DG). Median time to surgery was 43 versus 76 days for the SG and DG groups. Median follow-up was 60 months. No differences were observed for gender, race, home state, Eastern Cooperative Oncology Group score, and tumor characteristics. DG patients were older; had higher Charlson Comorbidity Scores; and more history of myocardial infarction, stroke, and smoking, all p ≤ 0.05. DG had increased odds of major postoperative adverse events (odds ratio 2.26, 95% confidence interval 1.11–4.20). Overall survival and recurrence were similar.

Conclusion

Following CROSS, a delay in esophagectomy beyond 60 days was not associated with worse recurrence or overall survival despite increased comorbidities and postoperative events.

Background

Breast conservation surgery (BCS) has not been a widely adopted treatment in early breast cancer despite its oncological outcomes similar to mastectomy. In emerging economies, BCS rates are < 40% compared to > 70% in the West. Hence, this study was undertaken to describe factors influencing the underutilization of BCS.

Methods

A prospective longitudinal study was conducted between September 2019 and December 2021 on patients with biopsy-proven early breast cancer eligible for BCS. The choice of surgery (mastectomy vs. breast conservation) by patients was recorded at initial diagnosis and staging. A predesigned structured questionnaire was used to identify the factors associated with their choice of mastectomy. The patients received multiple counseling sessions by the operating surgeon(s), and the choice of surgery was recorded again. Factors associated with the choice of surgery were identified and evaluated by univariate or multivariate logistic regression.

Results

Out of 238 consecutive patients operated on in the study period, 84 met eligibility criteria and were recruited. At the time of initial diagnosis and staging, 13 (15.5%) patients wanted BCS. After multiple counseling sessions, finally, 75 (89.3%) opted for BCS; however, 9 (10.7%) still wanted mastectomy. The factors influencing the choice of mastectomy were fear of outcome (90% of patients), followed by family influence (35%), radiation-related factors (30%), personal factors (25%), and surgery-related factors (25%).

Conclusions

Systematic counseling by the treating team markedly improved breast conservation acceptance rates from 15.5% to 89.3%. Fear of outcome is the major factor influencing the choice of mastectomy over BCS in early breast cancer patients suitable for BCS.

Background and Methods

Surgical esophagectomy is falsely regarded as contributing little survival in resectable, early-stage disease in favor of nonsurgical treatment with definitive chemoradiation (dCR). We examine surgery in treatment by evaluating large-scale trends in mortality. The SEER database was queried for esophageal cancer patients from 2004 to 2020. Total of 59 754; 19 806 squamous and 34 484 adenocarcinoma. The primary outcome was the hazard ratio for overall survival defined as time from diagnosis-to-death. Differences between patients were assessed using χ² tests for categorical variables and t-tests for continuous variables. Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models.

Results

A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. In every category, the risk of mortality was higher in dCR compared to CRS.

Conclusions

Surgery combined with chemoradiation, and/or surgery alone, confers a significant survival benefit over dCR in resectable patients.

Discussion

Surgery should be considered early in medically fit patients with operable disease.