World Journal of Surgical Oncology最新文献

Background: Sentinel lymph node biopsy (SLNB) guided by indocyanine green is an innovative technique with a high detection rate in breast cancer; however, Latin American reports are scarce. This study describes the first series of patients in Peru who underwent this technique and evaluates the relationships between clinicopathological factors and lymph node positivity.

Methods: A retrospective study was conducted on breast cancer patients who underwent SLNB guided by indocyanine green between 2021 and 2024. Clinical and pathological variables were analyzed, and their associations with lymph node positivity were evaluated via bivariate and multivariate statistical tests.

Results: Sixty-nine patients were analyzed, and a detection rate of 100% was achieved with the indocyanine green technique. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.9% (CI: 90.8%-99.9%), 97.3% (CI: 92.1%-99.9%), 96.9% (CI: 90.8%-99.9%), and 97.3% (CI: 92.0 - 99.9%), respectively, with 95% confidence intervals (CIs). SLN positivity was significantly associated with a larger preoperative ultrasound tumor size (25.4 ± 9.0 vs. 20.7 ± 9.2 mm; p = 0.018), pT stage (65.6% vs. 37.8%; p = 0.023), and the presence of lymphovascular invasion (p < 0.001). No significant differences were found in terms of age, body mass index, menopausal status, comorbidities, laterality, or histological grade.

Conclusions: Tumor size, pT stage, and lymphovascular invasion were the main predictors of lymph node positivity in this Peruvian cohort. This study constitutes the first Peruvian series evaluating indocyanine green-guided SLNB, providing relevant evidence for its implementation in Latin America and supporting its use as a safe and effective technique for the treatment of breast cancer.

Background: 30 to 70% of patients with positive sentinel lymph nodes (SLNs) in early breast cancer do not develop non-SLN metastases. They are exposed to the potential complications and sequelae of axillary lymph node dissection (ALND) without gaining additional therapeutic benefit. Therefore, a prediction model for non-SLN metastasis is needed. We identified the anatomical location of metastatic SLNs as a key factor for predicting non-SLN status.

Methods: We retrospectively identified 1,717 consecutive patients who underwent SLN biopsy; 481 SLN-positive patients treated from 2009 to 2019 underwent completion ALND and formed the development cohort, and 113 SLN-positive patients treated from 2020 to 2022 served as a temporal validation cohort. A multivariable logistic regression model was developed and presented as a nomogram. Performance was assessed by discrimination and calibration, and clinical utility by decision curve analysis. The Memorial Sloan Kettering Cancer Center (MSKCC) and Shanghai Cancer Hospital (SCH) models were evaluated for comparison.

Results: Multivariate analysis revealed eight independent predictors of non-SLN metastasis: metastatic SLN location, tumor size, multifocality, lymphovascular invasion, extracapsular extension, number of positive and negative SLNs, and size of SLN metastasis. The nomogram based on these variables achieved high discrimination in both the training (AUC = 0.830) and validation (AUC = 0.785) cohorts. In the temporal validation cohort, discrimination was higher than the MSKCC model (AUC= 0.690; P = 0.033) and numerically higher than the SCH model (AUC = 0.716; P = 0.088). At prespecified false-negative rate targets, the model identified 0.9%, 23.0%, and 27.4% of patients as candidates for omitting completion ALND under FNR thresholds of 0%, <5%, and <10%, respectively, and yielded a higher net benefit than the comparator models across clinically relevant risk thresholds. The model also maintained performance in patients with ≥3 positive SLNs (AUC = 0.843).

Conclusions: Metastatic SLN location relative to the ICBN is a novel anatomical predictor of non-SLN metastasis. A nomogram incorporating this variable demonstrated good discrimination and clinical utility in a single-center cohort with temporal validation; prospective multicenter validation with standardized ICBN assessment is warranted before broader implementation.

Background: Hemicorporectomy is an exceptionally rare and radical procedure reserved for highly selected patients with locally advanced pelvic malignancies without distant metastasis. Dedifferentiated sacral chordoma represents an aggressive histological subtype that may preclude conventional en bloc resection due to extensive local invasion. In such extraordinary circumstances, hemicorporectomy may be considered as a last-resort surgical strategy.

Case presentation: A 67-year-old male patient was diagnosed with a dedifferentiated sacral chordoma exhibiting extensive invasion of pelvic organs and retroperitoneal extension up to the L4 level, without distant metastasis. Following multidisciplinary evaluation, curative-intent hemicorporectomy was deemed the only feasible treatment option. The procedure was performed in a single-stage anterior-to-posterior approach, incorporating contemporary reconstructive techniques, including urinary diversion and an anterolateral thigh musculocutaneous flap. Pathological examination confirmed dedifferentiated chordoma with clear surgical margins. The postoperative period was complicated by wound-related issues requiring surgical debridement and an episode of pulmonary edema. Despite these complications, the patient achieved functional stabilization, including independent sitting and wheelchair mobilization. At six months, pulmonary metastases were detected, and palliative care was initiated. The patient died nine months after surgery due to pulmonary complications.

Conclusions: This case highlights that hemicorporectomy, though associated with significant morbidity, remains a viable curative or palliative option in carefully selected patients with locally advanced pelvic tumors. When performed with meticulous planning and multidisciplinary coordination, the procedure can provide meaningful short-term survival, symptom relief, and quality-of-life improvement in otherwise untreatable cases.

Background: Gallbladder cancer (GBC) is a highly aggressive malignancy of the digestive system with a poor prognosis. Therefore, the development of effective targeted therapeutic strategies is critical for improving survival outcomes in patients with GBC. Erb-B2 receptor tyrosine kinase 2 (ERBB2) is a proto-oncogene whose overexpression or mutation has been closely linked to the initiation and progression of various cancers.

Methods: Whole-exome sequencing (WES) was performed on tumor tissue from a patient with advanced GBC who underwent conversion surgery following combination therapy with the multi-targeted tyrosine kinase inhibitor anlotinib and the PD-1 immune checkpoint inhibitor camrelizumab, to identify potential genomic alterations associated with treatment response. Transcriptomic profiling was conducted in cell lines transfected with plasmids encoding either wild-type ERBB2 or the I655V mutant. Western blot analysis was used to assess activation of the downstream PI3K-AKT and MAPK-ERK signaling pathways and to measure PD-L1 expression levels. Bioinformatic analyses were employed to predict the structural and functional consequences of the ERBB2 I655V mutation.

Results: WES revealed that the ERBB2 I655V mutation may be associated with therapeutic response. Mechanistically, the I655V substitution resides within the GG4-like motif of the ERBB2 transmembrane domain and may alter the transmembrane dimerization interface, potentially promoting heterodimer formation with other ErbB family members and leading to enhanced downstream signaling. Transcriptome sequencing and in vitro experiments demonstrated that the ERBB2 I655V mutation constitutively activates ERBB2, resulting in sustained activation of the PI3K-AKT and MAPK-ERK pathways. This subsequently upregulates PD-L1 expression and contributes to an immunosuppressive tumor microenvironment, which may underline the observed clinical response to combined targeted and immunotherapy.

Conclusions: The ERBB2 I655V mutation may be associated with improved treatment response to immunotherapy in gallbladder cancer.