World Journal of Surgical Oncology最新文献

Background: This study aims to evaluate the efficacy and safety of camrelizumab in combination with chemotherapy as a second-line treatment for patients with locally advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC).

Methods: In this retrospective, single-center observational study, we collected medical records of patients with locally advanced, recurrent, or metastatic ESCC who received either camrelizumab combined with chemotherapy or chemotherapy alone as second-line treatment between July 1, 2019, and May 31, 2023. We evaluated short-term efficacy, including overall response rate (ORR) and disease control rate (DCR), as well as survival outcomes, including progression-free survival (PFS) and overall survival (OS). Safety was also assessed. Additionally, factors influencing OS in ESCC patients were analyzed.

Results: A total of 60 patients with locally advanced, recurrent, or metastatic ESCC were included, with 30 receiving camrelizumab combined with chemotherapy and 30 receiving chemotherapy alone as second-line treatment. There were no statistically significant differences in ORR (33.33% vs. 13.33%) and DCR (73.33% vs. 56.67%) between the combination therapy and chemotherapy-alone groups (P > 0.05). However, the median PFS was significantly longer in the combination therapy group compared to the chemotherapy group (4.7 months vs. 3.4 months, P = 0.048). Additionally, the median OS was significantly improved in the combination therapy group compared to the chemotherapy group (11.7 months vs. 6.5 months, P = 0.003). Age and history of radical surgery were significantly associated with OS in patients receiving camrelizumab combined with chemotherapy as second-line treatment (P < 0.05).

Conclusion: Second-line treatment with camrelizumab combined with chemotherapy is well-tolerated and associated with favorable oncological outcomes in patients with locally advanced, recurrent, or metastatic ESCC. Furthermore, younger patients and those who have undergone radical surgery may derive greater benefit from camrelizumab combined with chemotherapy as a second-line treatment.

Background: Metastasis from Renal cell carcinoma at presentation is seen in nearly one fifth of the patients and commonly occur to lung, bone and liver. Synchronous vaginal and cervical metastasis is extremely rare. Several pathways have been proposed of which blood reflux from left renal vein to ovarian vein is most plausible. The prognosis is usually very poor as they are often associated with disseminated metastasis.

Case presentation: A 55-year-old women presented with post-menopausal vaginal bleeding, on examination a smooth mass occupying the vagina and obscuring the view of cervix with normal mucosa was found. Biopsy and Immunohistochemistry showed it to be renal cell carcinoma. Further investigations lead to identification of left renal mass with pulmonary, vaginal and cervical metastasis. Patient was started on Pazopanib 800 mg PO per day, and was lost to follow-up.

Conclusion: Vaginal metastasis presenting as post-menopausal bleeding is one of the rarest presentation of renal cell carcinoma with only 3 cases reported in literature before this. Metastatic tumors to the vagina are more common than primary tumors and are mostly from cervix, endometrium and ovary. A high index of suspicion and through examination and investigation is the key to correct diagnosis and management.

Background: Non-small cell lung cancer (NSCLC) transforming to small cell lung cancer (SCLC) is one of the mechanisms of resistance to tyrosine kinase inhibitors (TKIs). Cases of NSCLC transforming into SCLC have been discovered. However, we lack concentrated data on the characteristics of this population and the transformed SCLC to aid our insight of the biology and clinical value of NSCLC transforming with positive.

Methods: We systematically reviewed the published literatures and summarized the pathological and clinical characteristics, and the prognosis, of published cases.

Results: 140 patients with lung adenocarcinoma (LUAD) were included in this study, with a median age of 56.8 years. The median time from the first diagnosis of LUAD transforming to SCLC (ttSCLC) was 20.0 months. The median overall survival (mOS) after the diagnosis of SCLC was 11.0 months (95% CI, 7.41 to 14.59 months). In the univariate analysis, ever smoking (either former or current) was a promising predictor of a shorter ttSCLC (HR, 1.73; 95% CI, 1.14 to 2.62; P = 0.010). TKIs therapy administered as a second line and beyond treatment was related to a significant delay in SCLC onset compared to first-line therapy (HR, 0.62; 95% CI, 0.40 to 0.96; P = 0.031). The median progression-free survival (mPFS) on first-line platinum plus etoposide after the conversion to SCLC was 3.0 months. Female appeared to be related to worse outcomes after transformation of SCLC.

Conclusion: Transformed SCLC exhibited poor response to primary SCLC classic chemotherapy and immunotherapy. It carries a worse prognosis. Exploring novel therapeutic strategies for transformed SCLC is imperative.

Background: We aim to investigate the impact of visceral fat area (VFA) on the prognosis of patients following radical gastric resection and develop a nomogram prediction model to forecast the prognosis of gastric cancer patients.

Methods: We retrospectively analyzed 156 patients who underwent laparoscopic radical gastrectomy for distal gastric cancer in the 900th hospital of the Joint Logistics Support Force from April 2018 to April 2020. We collected the CT image data and clinicopathological data one week prior to the operation and then used software to calculate the VFA, dividing it into two groups: a low VFA group (n = 71) and a high VFA group (n = 85). We compared the clinicopathological characteristics and early postoperative complications of the two groups. The Pearson χ² test was used to analyze the correlation between body mass index (BMI) and VFA. We used the Kaplan-Meier method to draw the survival curve, analyzed the independent risk factors affecting the prognosis of gastric cancer patients using univariate and multivariate Cox regression models, and established a nomogram model for patient prognosis prediction.

Results: The results of CT showed that VFA value was (95.89 ± 41.40) cm², and body mass index (BMI) was positively correlated with VFA value (r = 0.291, P < 0.001). The ROC curve shows that VFA can predict the prognosis of patients with gastric cancer significantly better than BMI (AUC = 0.826 vs. AUC = 0.707, P = 0.016). The incidence of incision fat liquefaction, pancreatic fistula, and abdominal infection in the high VFA group was higher than that in the low VFA group (P < 0.05). We followed up with all patients for 0.5-48.5 months, with a median follow-up time of 30 months. We used the Kaplan-Meier method to draw the survival curve. The results showed that the overall survival rate of patients in the high VFA group was significantly higher than that in the low VFA group (χ² = 38.208, P < 0.001), and the high BMI group was significantly higher than that in the low BMI group (χ² = 29.767, P < 0.001). Age, the degree of differentiation, complications after surgery, VFA, ASA grading, and TNM staging were all found to have independent effects on the prognosis of gastric cancer patients (Multivariate Cox regression analysis). Multivariate Cox regression analysis led to the construction of a nomogram prediction model for the total survival of gastric cancer patients. Its internal verification C-index was 0.881 (95% CI: 0.852-0.910), and the calibration chart showed good consistency.

Conclusions: Age, differentiation degree, postoperative complications, VFA, ASA grading, and TNM staging are independent influencing factors for the prognosis of patients with gastric cancer. The constructed nomogram has excellent prediction accuracy and is helpful to evaluate the prognosis of patients.

Introduction: Patients who achieve the textbook outcome (TO) present an uneventful postoperative course. Obtaining TO has also been related to better survival in oncological patients. Information about TO in patients with peritoneal carcinomatosis from ovarian cancer who undergo surgery is very scarce. Our objective was investigate TO in patients with carcinomatosis of ovarian origin who underwent interval surgery with or without HIPEC (TOOC) and its impact on survival.

Methods: A multicenter study was performed between 2010 and 2015. Inclusion criteria were > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The criteria to establish TOOC were no major complications, no mortality, non-prolonged stay (p75:10 days), complete cytoreduction (CC-0), and no readmission.

Results: 365 patients were included, and TOOC was achieved in 204 (55.9%) patients. CC-0 cytoreduction was obtained in 312(85.5%). 7 patients (1.9%) died. 71 (19.5%) presented major complications (≥ IIIa). The readmission rate was 9.3%, and 24.9% of the patients presented a prolonged stay. The parameter with most significant negative impact on achieving TOOC was length of stay. Multivariate analysis confirmed postsurgical PCI, age, HIPEC, and time of surgery in minutes as an independent factor of TOOC. Survival analysis showed that patients who achieved TOOC had better overall survival (41 months (24.5- 67) versus 27 months (14-48.2) (p < 0.0001).

Conclusion: TO is an easy and valuable management tool for evaluating and comparing results obtained at different centers after surgery for peritoneal carcinomatosis of locally advanced ovarian cancer. Achieving TOOC benefits overall survival.

Background: The significance of the controlling nutritional status (CONUT) score in predicting the prognostic outcomes of diffuse large B-cell lymphoma (DLBCL) has been widely explored, with conflicting results. Therefore, the present meta-analysis aimed to identify the prognostic significance of the CONUT in DLBCL by aggregating current evidence.

Methods: The Web of Science, PubMed, Embase, CNKI and Cochrane Library databases were searched for articles from inception to October 15, 2024. The prognostic value of CONUT for DLBCL was analyzed by determining the pooled hazard ratios (HRs) with 95% confidence intervals (CIs). The Newcastle-Ottawa Scale (NOS) was used to analyze study quality.

Results: Eight studies including 2687 cases were included in this work. The NOS scores of these studies were 7-9 (median, 8), demonstrating high quality. Our analyses revealed that an elevated CONUT score significantly predicted poor overall survival (OS) (HR = 1.63, 95%CI = 1.29-2.05, p < 0.001) and inferior progression-free survival (PFS) (HR=1.22, 95%CI = 1.12-1.33, p < 0.001) in patients with DLBCL. Further, the elevated CONUT score showed a significant correlation with the following clinicopathological factors in DLBCL: Ann Arbor stage III-IV, Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 2-4, presence of extranodal disease, ≥high intermediate National Comprehensive Cancer Network International Prognostic Index (NCCN IPI), presence of B symptoms, elevated lactose dehydrogenase (LDH) levels, and presence of bone marrow infiltration.

Conclusions: An increased CONUT score was dramatically associated with poor OS and PFS in patients with DLBCL, as well as with clinicopathological characteristics representing DLBCL tumor development.

Objective: To investigate the relationship of pretreatment of circulating tumor cells (CTCs) and cervical lymph node metastasis (LNM) (central LNM (CLNM) and lateral LNM (LLNM)) in papillary thyroid carcinoma (PTC) patients with ≤ 55 years old.

Methods: Clinicopathological data (CTCs level, Hashimoto's thyroiditis, thyroid function, multifocal, tumor size, invaded capsule, clinical stage, and LNM) of 588 PTC patients with ≤ 55 years old were retrospectively collected. The relationship of CLNM, LLNM and the clinical features of patients was analyzed. Univariate and multivariate logistic regression analyses were used to evaluate the relationship between the CTCs and CLNM, LLNM.

Results: There were 273(46.4%) and 89(15.1%) patients with CLNM and LLNM, respectively. Patients with CLNM had higher proportions of multifocality, tumor size > 1 cm, invaded capsule, and positive CTCs level than those without (all p < 0.05). Patients with LLNM had higher proportions of multifocality, tumor size > 1 cm, and invaded capsule than those without (all p < 0.05). Logistic regression analysis showed that multifocality (odds ratio (OR): 1.821, 95% confidence interval (CI): 1.230-2.698, p = 0.003), tumor size > 1 cm (OR: 3.444, 95% CI: 2.296-5.167, p < 0.001), invaded capsule (OR: 1.699, 95% CI: 1.167-2.473, p = 0.006), and positive CTCs level (OR: 1.469, 95% CI: 1.019-2.118, p = 0.040) were independently associated with CLNM; and multifocality (OR: 2.373, 95% CI: 1.389-4.052, p = 0.002), tumor size > 1 cm (OR: 5.344, 95% CI: 3.037-9.402, p < 0.001), and invaded capsule (OR: 2.591, 95% CI: 1.436-4.674, p = 0.002) were independently associated with LLNM.

Conclusions: Preoperative CTCs positive was associated with CLNM in PTC patients with ≤ 55 years old, but not LLNM.

Objective: This study aimed to compare the expression of lymphoid enhancer factor 1 (LEF1) and β-catenin in basal cell adenoma (BA), desmoid-type fibromatosis (DF), and pancreatic solid pseudopapillary neoplasm (SPN) to evaluate their diagnostic utility in tumors associated with the WNT/β-catenin signaling pathway harboring the mutation of CTNNB1 gene 3 exon.

Methods: Eighty tumor patients, including 26 BAs, 30 DFs, and 24 SPNs, were analyzed. Immunohistochemical staining was identified positive (nuclear staining of LEF1 and β-catenin in > 50% of tumor cells). The diagnostic rate of LEF1 alone, β-catenin alone, and their combination were compared for each tumor type and all patients.

Results: Compared to β-catenin, when LEF1 alone was used for diagnosis, the diagnostic rate increased by 46.16% for BA, 16.67% for SPN, and 11.25% for all patients, but decreased by 23.34% for DF. The combined use of β-catenin and LEF1 significantly increased the diagnostic ratio in BA (46.16%), SPN (16.67%), and all patients (21.25%), but only marginally in DF (3.33%). In terms of all WNT pathway tumors with CTNNB1 gene mutation encompassed by our study, statistical analysis revealed no significant difference between LEF1 alone and β-catenin alone. However, their combined application was highly significant (P = 0.001) .

Conclusion: While β-catenin is commonly used as a marker for WNT pathway tumors, its variable expression and localization can be challenging for diagnosis. Our study emphasizes the importance of LEF1 as a complementary marker to β-catenin in diagnosing BA, DF, SPN, and other WNT pathway tumors activated by exon 3 CTNNB1 gene mutation. The combined use of LEF1 and β-catenin enhances diagnostic accuracy and may help the identification of these tumor types.

Background: Extraskeletal osteosarcoma (ESOS) is a rare kind of sarcoma with a low preoperative diagnosis and a poor prognosis. ESOS arising from abdominal mesentery is extremely rare. Increasing diagnostic methods and standardizing treatment protocols are crucial issues of ESOS.

Case presentation: We report the case of a 52-year-old female ESOS patient. She had a history of ovarian carcinoma (stage IIIC) surgery two years before, with five cycles of chemotherapy. A mass was found during postoperative examinations. A R0 surgical resection was performed. Post-operational pathological report plus intra-surgery findings supported a diagnosis of ESOS. She is still alive 10 months post-operationally, with routine blood and radiographical examinations.

Conclusion: Enhancing awareness of this extremely rare disease together with advancements in diagnostic methods will hopefully enable earlier recognition and initiation of treatment. Protocols for standardizing treatments require a larger multi-center collaboration and more data analysis.