Journal of Surgical Oncology最新文献

Background: Biliary tract cancers (BTCs) represent distinct biological and genomic entities. Anatomic and geographic heterogeneity in genomic profiling of BTC subtypes, genomic co-alterations, and their impact on long-term outcomes are not well defined.

Methods: Genomic data to characterize alterations among patients with BTCs were derived from the AACR GENIE registry (v15.1) and other genomic data sets. Patterns of mutational co-occurrence, frequency of co-alterations, and their impact on long-term outcomes among BTC patients were examined.

Results: Alterations in IDH1 and FGFR2 genes were mostly noted among intrahepatic cholangiocarcinoma (iCCA) samples, TP53, ERBB2/HER2, and SMAD4 mutations were more frequent among gallbladder cancer (GBC) samples while extrahepatic cholangiocarcinoma (eCCA) more commonly harbored KRAS mutations (all Q < 0.001). Alterations in IDH1 and FGFR2 genes were more frequent among iCCA samples from Western vs. Eastern populations, while KRAS, SMAD4, and ERBB2 mutations were more commonly observed among Eastern populations(all Q < 0.05). FGFR2 gene was frequently co-mutated with BAP1 (log2OR: 1.55, Q < 0.001), while IDH1 gene was commonly co-mutated with PBRM1 (log2OR: 1.09, Q < 0.001). Co-alteration rate among patients with IDH1-mutant iCCAs, FGFR2-rearranged iCCAs, KRAS-mutant eCCA, and HER2-mutant GBCs were 80.8%, 85.2%, 76.7%, and 100%, respectively. Among patients with iCCA and FGFR2 fusions/rearrangements, harboring co-alterations in the TP53 pathway or PI3K pathway correlated with worse overall survival (OS), while patients with IDH1-mutant iCCA had worse OS when harboring co-alterations in the cell cycle pathway.

Conclusions: Marked genomic heterogeneity exists among patients with BTCs based on anatomic and geographic location. The overwhelming majority of BTC patients with clinically significant mutations had concurrent genomic co-alterations. The current study highlights the molecular complexity of BTCs with multiple alterations that commonly co-exist and could potentially be targeted to treat BTCs.

Background and methods: Colorectal cancer (CRC) treatment can influence health-related quality of life (HRQOL). This study examined HRQOL among older adults undergoing CRC treatment, and the conditional effects of race, ethnicity, and primary language. We conducted a retrospective cohort study of Medicare Advantage enrollees ≥ 65 years old who completed the Medicare Health Outcomes Survey (MHOS) (2016-2020). The exposure group answered "Yes" to the current CRC treatment and the control group answered "No." The primary outcomes were physical component summary (PCS) and mental component summary (MCS) scores. Conditional effects by race and ethnicity were analyzed using interaction terms.

Results: Among 184 486 adults, 676 (0.4%) reported current CRC treatment. Those receiving treatment had significantly lower PCS scores (β coefficient -1.98, p < 0.001) and lower MCS scores (β coefficient -0.81, p = 0.018), compared to nontreatment. In the treatment group, Hispanic respondents and Spanish speakers had higher PCS scores (β coefficient 1.96, p = 0.019 and 3.19, p = 0.023, respectively), and respondents identifying as American Indian or Alaska Native had higher MCS scores (β coefficient 8.72, p = 0.016).

Conclusion: Individuals receiving CRC treatment exhibit worse HRQOL. Outcomes differed by race and ethnicity. This study suggests the need to invest in targeted interventions to improve overall HRQOL during treatment for CRC.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) of the body/tail is notably different than PDAC in the head of the pancreas. Surgery plus chemotherapy is known to improve outcomes for all PDAC. The sequence of this therapy is well studied in head cancers yet has never been evaluated systematically in relation to distal pancreatectomy (DP).

Methods: Patients receiving DP for PDAC and who received chemotherapy were included. Patients were compared receiving neoadjuvant systemic therapy (NAST) only, adjuvant (AST) only, both NAST + AST, and who received total neoadjuvant therapy (TNT), defined as > 24 weeks NAST before DP. PSM was performed 1:1 between AST and each other group creating quadruplets of patients for analysis. Matching factors were determined by multivariate cox-regression analysis of factors independently affecting survival. Survival was considered from diagnosis and from surgery to account for potential biases.

Results: In total, 4677 patients were selected with 400 (8.6%) receiving TNT, 536 (11.5%) NAST, 3235 (69.2%) AST, and 506 (10.8%) NAST + AST. A total of 341 quadruplets were selected after PSM. There were no differences in comorbidities, T/N-stage, retrieved or positive lymph nodes, and margin status after matching. Kaplan-Meier analysis showed no difference in median OS between the matched treatment groups (33.71 ± 2.07 vs. 35.22 ± 1.62 vs. 32.53 ± 3.31 vs. 37.88 ± 1.90, respectively; log-rank p = 0.464). Five-year OS was not different between the groups (21% vs. 18% vs. 20% vs. 25%, respectively; p = 0.501).

Conclusion: The sequence of chemotherapy and surgery did not impact survival in distal PDAC. Providers should tailor an individualized approach designed to maximize the chance of completing both treatments.

Background and objectives: IO has transformed cancer management, but its adoption in advanced cancer patients varies by tumor type. With more Stage IV patients undergoing surgery, understanding site-specific outcomes in these challenging patients is essential. We aimed to evaluate IO use and survival trends for Stage IV cancer patients across high-incidence cancers in the US.

Methods: Patients diagnosed with Stage IV prostate, breast, melanoma, colorectal, renal, bladder, lung, or pancreas cancer were identified from the National Cancer Database (2004-2020). Cochrane-Armitage test and Kaplan-Meier methods assessed IO and overall survival across three periods: 2004-2010, 2011-2015, and 2016-2020.

Results: Among 1 425 731 Stage IV cancer patients, most had lung (50.0%), pancreas (12.5%), and breast cancer (9.3%), while the least had melanoma (2.2%). From periods 1 to 3, IO use increased from 1.0% to 24.6%, notably in melanoma (9.5% to 58.5%, p < 0.001). Melanoma exhibited the greatest survival gains (median survival: 7.1 to 14.9 months). Absolute increases in 3-year overall survival rates ranged from 3.4% in pancreas (1.7% to 5.1%) to 21.4% in melanoma (15.7% to 37.1%).

Conclusions: Utilization of IO is tumor-site specific and associated with improved survival rates for Stage IV cancer, with varied success across types. Variations in receipt highlight ongoing challenges to ensure equitable adoption.

Background: Household-level factors may also influence the risk of new persistent opioid use (NPOU). We sought to assess the risk of NPOU among individuals with household exposure to substance abuse.

Methods: Opioid-naïve individuals who underwent oncological procedures were identified using the IBM MarketScan database. Multivariable regression equations were used to assess the association between household exposure to substance abuse and NPOU.

Results: Among 10 557 individuals 4.9% (n = 520) had a family history of substance abuse. Patients with a family history of substance abuse were more likely to use opioids during the perioperative (85.0% vs. 78.8%) and postoperative periods (40.2% vs. 34.1%) (both p < 0.05). Moreover, perioperative (300 MME [IQR: 450-200] vs. 250 MME [IQR: 150-435]) and postoperative (525 MME [IQR: 1348-225] vs. 350 MME [IQR: 150-850]) opioid dose was also higher among patients with a family history of substance abuse (both p < 0.001). On multivariate analysis, patients with family history of substance abuse had 37% (OR 1.37, 95% CI 1.07-1.75) higher odds of NPOU.

Conclusion: Among opioid-naïve individuals undergoing oncological procedures, a family history of substance abuse is associated with NPOU. Patients should be screened for household-level factors before prescribing opioids for perioperative use.

Introduction: Triple-negative breast cancer (TNBC) has a prevalence of 12%-24% in the Hispanic population. Previous research has demonstrated that disparities in healthcare access significantly influence patient outcomes. We aimed to compare the clinicopathological characteristics and outcomes of Hispanic females with TNBC living in Latin America (HPLA) to the Hispanic population in the United States (HPUS).

Methods: We evaluated two retrospective cohorts: patients diagnosed with TNBC at the Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru, during 2000-2015, and HPUS patients with TNBC from the Surveillance, Epidemiology, and End Results Program (SEER).

Results: A total of 2007 HPLA and 8457 HPUS patients were included. The HPLA patients were younger and more frequently lived in nonmetropolitan areas. HPLA had higher T and N (p < 0.001) stages. HPLA patients were more likely to present with Stage III disease (51.6% vs. 20.8%), while Stage IV presentations were similar 6.6% vs. 6.8%. HPLA patients with Stages I and II more frequently underwent mastectomy compared to HPUS (56.2 vs. 48.0%). HPLA patients received neoadjuvant chemotherapy (p < 0.001), adjuvant chemotherapy (p < 0.001), and radiotherapy (p < 0.001) more often. While early breast cancer stages had similar overall survival (OS) rates for both populations, HPLA patients had worse 5-year OS rates compared to HPUS patients in Stages III (39.9% vs. 52.3%, p < 0.001) and IV (4.6% vs. 10.7%, p < 0.001).

Conclusions: Hispanic females living in Latin America were more frequently diagnosed with advanced stages of TNBC and more often underwent mastectomy, even in early-stage disease. When analyzing advanced stages, HPLA had worse OS rates compared to HPUS.

Background and objectives: Little is known about the relationship between neoadjuvant chemotherapy (NAC) and perioperative morbidity for patients undergoing combined resection of rectal cancer and sLM. The purpose of this study is to determine the impact of NAC on 30-day morbidity for patients who undergo combined resection of primary rectal cancer and sLM.

Materials and methods: A retrospective cohort study of patients undergoing combined resection of primary rectal cancer and sLM between 2016 and 2020 at participating NSQIP hospitals. Multivariate logistic regression models were used to assess the relationship between NAC and 30-day morbidity rates.

Results: Among 878 patients who underwent combined resection of primary rectal cancer and sLM, 672 (76.54%) received NAC. There were no significant differences in the rates of 30-day overall morbidity between patients who received NAC and those who did not (37.65% vs. 37.68%, p = 0.95). On adjusted analysis, there was no association between receipt of NAC and rates of overall morbidity (adjusted OR = 1.10, 95% CI 0.78-1.56, p = 0.95).

Conclusions: The receipt of NAC does not appear to be associated with increased perioperative morbidity in patients undergoing combined resection of primary rectal cancer and sLM.

Background and objectives: Gastric adenocarcinoma (GA) is commonly treated with open or minimally invasive surgery (MIS). The preferred surgical approach remains unclear. This study sought to assess utilization over time, compare complication rates by surgical approach, and identify predictors of experiencing complications.

Methods: Patients who underwent GA resection from 2016 to 2022 were identified in the American College of Surgeons National Surgical Quality Improvement Program and compared based on receipt of open gastrectomy versus MIS. Complication rates were compared with χ² tests. Predictors of experiencing complications or receiving MIS were assessed using multivariable Poisson regressions with robust variance.

Results: Out of 4,429 patients, most underwent open gastrectomy versus MIS (84.2% vs. 15.9%). MIS uptake did not increase. Open gastrectomy patients experienced more major complications (18.5% vs. 13.1%), higher perioperative mortality (1.53% vs. 0.57%), and longer hospital stays (7 vs. 5 days) compared to MIS patients (all p values < 0.01). MIS patients had a decreased risk of experiencing any complications (RR: 0.7, 95% CI: 0.5-0.8). Non-white patients were less likely to receive MIS.

Conclusions: MIS is associated with a decreased risk of experiencing complications compared to open gastrectomy for GA, yet its utilization has plateaued. Sociodemographic predictors of receipt of MIS indicate potential disparities in accessing certain treatments.

Summary: The preferred surgical approach for gastric cancer is unclear. This analysis of the American College of Surgeons National Surgical Quality Improvement Program compared complication rates of open gastrectomy with minimally invasive surgery (MIS). MIS was associated with a decreased risk of experiencing complications, yet utilization has plateaued.