Journal of Surgical Oncology最新文献

Background: Metastatic disease in the humerus presents with severe pain, compromised upper extremity function, and impending or completed pathologic fractures. Prophylactic fixation can improve quality of life, yet little is known about the variability in negotiated payor rates for this procedure, which may influence surgical decision making. The objective of this study was to examine factors associated with variations in negotiated payor rates for prophylactic fixation of the proximal humerus.

Methods: A cross-sectional analysis of negotiated payor rates for current procedural terminology (CPT) code 23491 (prophylactic fixation of the proximal humerus) was conducted using data from the Turquoise Health database. Hospital size was categorized by total bed capacity; payor classes included commercial, Medicare Advantage, managed Medicaid, veterans' affairs, workers' compensation, dual Medicare-Medicaid, exchange plans, and self-pay. Rural-Urban Commuting Area (RUCA) codes, Area Deprivation Index (ADI), and median household income were used to characterize regional factors. Statistical analyses were conducted in R version 4.2.3.

Results: A total of 88,858 negotiated payor rates were evaluated. The average negotiated payor rate in the sample was $11,088. Hospitals with a bed capacity of 1,000-1,500 had the highest mean rates (a +$577 difference from the 0-100 bed reference group, p < 0.0001), whereas mid-sized hospitals (300-500 beds) had significantly lower rates (-$220 difference, p < 0.0001). Workers' compensation yielded the highest rates, exceeding self-pay by $11,620 (p < 0.0001). Metropolitan hospitals, on average, had lower rates than non-metropolitan hospitals ($575 difference, p < 0.0001). Median household income was associated with a clinically insignificant increase in rates ($0.005 per dollar, p < 0.0001), while ADI showed no significant effect.

Conclusions: Substantial variability in negotiated payor rates for prophylactic fixation of the humerus was evident across hospital sizes, payor types, and geographic contexts. These findings underscore the importance of transparent negotiations and value-based reimbursement frameworks to ensure equitable, cost-effective access to orthopaedic oncology care.

Background and objectives: Primary tumor size is a key prognostic factor in osteosarcoma, but quantitative risk estimates and optimal thresholds remain undefined. We quantified the size-survival relationship in high-grade osteosarcoma.

Methods: We analyzed 1,807 high-grade osteosarcoma patients from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021) using Cox regression, systematic threshold testing (40-150 mm with multiple testing corrections), and propensity score matching at the AJCC 80 mm threshold.

Results: Each 10 mm increase in tumor size was associated with a 6.6% increased hazard of death after adjusting for age, sex, tumor site, surgery, radiation, and chemotherapy (Hazard ratio [HR] = 1.066, p < 0.001; adjusted C-index = 0.694). Binary AJCC staging demonstrated limited mortality discrimination (34.4% vs 44.4%, 10-percentage-point spread), while three-tier soft tissue sarcoma (STS)-adapted staging revealed a 21-percentage-point mortality gradient (26.6% to 47.7%) with superior adjusted discrimination (C-index = 0.695 vs 0.680, p < 0.001). All tested thresholds demonstrated significant associations, with no single optimal cutpoint identified. Polynomial testing indicated a linear relationship (p = 0.334). Propensity score matching at the AJCC 8 cm threshold of 666 patient pairs confirmed the effect (HR = 1.443, 95%-confidence interval: 1.214-1.715, p < 0.001). Polynomial testing indicated a linear relationship (p = 0.253).

Conclusion: Tumor size demonstrates a continuous dose-response relationship with survival. Three-tier STS staging outperforms binary AJCC classification for risk stratification.

Introduction: Early-onset pancreatic cancer (EOPC), defined as pancreatic ductal adenocarcinoma (PDAC) diagnosed at or before age 50, is an increasingly recognized clinical entity with a rising incidence. Despite advancements in treatment, socioeconomic status (SES) disparities have impacted access to care and survival. This study examined the relationship between SES and survival in EOPC.

Methods: Data from the National Cancer Database (2004-2022) were analyzed for patients diagnosed with EOPC. SES was determined using a composite measure incorporating education and income levels and was categorized into four quartiles. Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling were used to assess survival differences across the SES groups.

Results: A total of 10,729 patients with EOPC were included, with 24.0% in the low SES group, 29.9% in mid-low SES, 30.3% in mid-high SES, and 15.8% in high SES. Higher SES was associated with increased access to multimodal therapy, including neoadjuvant and adjuvant chemotherapy, radiation, and surgical resection (p < 0.001). Private insurance coverage was significantly higher in the high-SES group (81.1% vs. 50.2% in the low-SES group, p < 0.001). Multivariable Cox regression showed that patients in the high-SES group had a significantly lower risk of mortality (HR = 0.71, 95% CI: 0.54-0.83; p = 0.033). The median survival increased from 9 months in the low SES group to 12 months in the high SES group (p < 0.001). Kaplan-Meier analysis showed that survival differences by SES were most pronounced in advanced-stage disease, particularly in stage III (p = 0.017) and stage IV (p < 0.001) cancers.

Conclusion: Lower SES was consistently linked to worse EOPC survival, particularly in advanced stages. Addressing SES-related disparities through targeted interventions and healthcare policy reforms could improve outcomes across all disease stages. Further research into the unique tumor biology and molecular characteristics of EOPC is needed to better understand how SES influences disease progression and treatment response.

Background: Advances in orthopedic oncology have significantly improved outcomes following extremity tumor resections; however, complications like nonunion, hardware failure, and radiation-induced fractures can occur after orthopedic fixation. While the vascularized fibula-free flap (FFF) is well-established in primary reconstructions, its effectiveness as a salvage option is not well described. We report our 25-year experience with the use of FFF in salvage extremity reconstruction.

Methods: This retrospective case series included patients undergoing extremity salvage with FFF after failure of primary oncologic reconstructions from 1995 to 2021. Demographics, surgical indications, reconstructive details, functional outcomes, complications, and Musculoskeletal Tumor Society (MSTS) scores were analyzed.

Results: Fifteen patients (ages 6-71 years) met inclusion criteria, which included nine humeral and six femoral reconstructions, with an average follow-up of 6.7 years. Indications for salvage were radiation-induced fracture (n = 6), nonunion (n = 3), allograft fracture (n = 3), and hardware failure (n = 3). The median interval between the initial surgery for tumor resection and FFF for limb salvage was 4 years 3 months (mean: 9 years, range: 10 months to 29.3 years). All lower-extremity reconstructions achieved full weight-bearing without pain. Upper-extremity reconstructions resulted in full functional restoration in six patients and minor functional deficits in three. Bony union of fibula flap was achieved in 78.5% patients. Reoperation were performed in 4 patients for wound issues (n = 2) and hardware removal (n = 2).

Conclusion: FFF is a reliable and effective option for management of oncologic-related complications of the extremities. It can avoid amputations and improve limb function.

Background: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide. Despite advances in surgery and adjuvant therapy, recurrence after curative resection remains a major challenge, and current surveillance tools such as carcinoembryonic antigen (CEA) and imaging lack sensitivity for detecting minimal residual disease (MRD). Circulating microRNAs (miRNAs) have emerged as promising biomarkers due to their stability in plasma and disease-specific expression profiles.

Objective: This study aimed to evaluate the clinical relevance of four circulating cell-free miRNAs-miR-155, miR-221, miR-34a, and miR-143-for monitoring tumor clearance following surgery in CRC patients.

Methods: Plasma samples were obtained from CRC patients at multiple perioperative time points and compared with samples from healthy controls. Expression levels of the selected miRNAs were quantified using real-time PCR, normalized to cel-miR-39, and analyzed in relation to clinicopathological features. Dynamic postoperative changes and diagnostic performance were assessed, including ROC curve analysis.

Results: Circulating miR-155 and miR-221 were significantly upregulated in CRC patients compared with controls, whereas the tumor suppressor miRNAs miR-34a and miR-143 were markedly downregulated. Postoperative samples showed progressive normalization of these markers, though variability persisted in a subset of patients. The combined four-miRNA panel achieved excellent diagnostic accuracy (AUC = 0.999), outperforming CEA in distinguishing CRC from controls. No independent predictive effect of individual miRNAs was demonstrated in multivariate models, but biologically consistent trends were observed.

Conclusion: Circulating miR-155, miR-221, miR-34a, and miR-143 demonstrate dynamic early postoperative changes and hold promise as minimally invasive biomarkers of short-term tumor clearance after colorectal cancer surgery. While the combined panel shows strong diagnostic performance at baseline, longer-term prospective studies with multi-year follow-up are required to establish their role in recurrence surveillance alongside established markers such as CEA and ctDNA.