World Journal of Surgical Oncology最新文献

Background: No studies on neoadjuvant chemotherapy for gastric cancer (GC) with T4b stage were reported. This study aimed to assess the effectiveness of neoadjuvant chemotherapy using DCS regimen (docetaxel, cisplatin, and S-1) for GC with T4b stage.

Methods: Forty-three patients diagnosed GC with surgical or clinical T4b stage received three or four preoperative cycles of DCS therapy followed by gastrectomy and lymphadenectomy between Jan-2018 and Dec-2022. Short-tern outcomes including tumor response, completion of neoadjuvant chemotherapy, toxicity and adverse events, rate of treatment-related death, R0 resection, rate of complete adjuvant chemotherapy and short-term surgical results were investigated. The oncologic outcomes comprised 3-year OS and 3-year disease-free survival (DFS).

Results: A total of 43 patients with T4b gastric cancer were included in the analysis. Among them, twenty-five patients underwent gastrectomy and lymphadenectomy. The completion rate of neoadjuvant chemotherapy was 88.4%, including 4 cycles of 51.2% and 3 cycles of 37.2%. The disease-control and clinical response rate were 88.4% and 58.1%, respectively. During preoperative chemotherapy, grade 3/4 neutropenia occurred in 20.9%, anemia in 13.9%, hyponatremia in 4.8%, and vomiting in 2.3%. Pathologic complete response was achieved in 8.0%. After surgery, no patient experienced severe complications (Clavien Dindo > = 3). The R0 resection rate was 72.0% and the rate of complete adjuvant chemotherapy was 83.3%. The 3-year OS and DFS rates were 49% and 38%, respectively.

Conclusions: Neoadjuvant chemotherapy with DCS regimen demonstrated a high tolerance, high tumor response rate, high complete adjuvant chemotherapy rate and satisfactory 3-year survival outcomes. Three- or four-course of preoperative DCS regimen is a promising approach for GC with T4b stage.

Objective: The primary objective of this study was to identify the risk of metastasis to lymph nodes above the inferior mesenteric artery (IMA) in endometrioid-type endometrial cancer (EC) and the factors that influence metastasis.

Methods: The study included patients who had been operated on for endometrioid-type EC in three gynecological oncology centers between 2007 and 2023. The supramesenteric lymph node (SM-LN) is the region between the left renal vein and the IMA, whereas the inframesenteric lymph node (IM-LN) is the region between the IMA and the aortic bifurcation, as determined by the level of the IMA.

Results: The study sample comprised 412 patients. The median number of lymph nodes excised per patient was 58. The median count was 37 for pelvic lymph nodes, 21 for para-aortic lymph nodes, 8 for IM-LN, and 13 for SM-LN. In the univariate analysis, the factors that were found to be statistically significant in determining SM-LN metastasis included tumor size, depth of myometrial invasion, uterine serosal invasion, lymphovascular space invasion (LVSI), cervical invasion, peritoneal cytology, adnexal metastasis, omental metastasis, non-nodal extrauterine metastasis, pelvic lymph node metastasis, and IM-LN metastasis. In the multivariate analysis, SM-LN metastasis was independently associated with tumor size, LVSI, pelvic lymph node metastasis, and IM-LN metastasis.

Conclusion: In conclusion, in cases of intermediate-high risk EC, it is important to know that the disease spreads to SM-LN in 7.3% of patients. The efficacy of postoperative adjuvant treatment may be inadequate due to a lack of information regarding the SM-LN region.

Background: The systemic inflammatory response index (SIRI) is calculated via the following formula: SIRI = monocyte count × neutrophil count/lymphocyte count. The value of the SIRI in predicting the prognosis of gastric cancer (GC) remains controversial. This study revealed the precise effect of the SIRI in predicting GC prognosis through a meta-analysis.

Methods: The ability of the SIRI to predict GC prognosis was evaluated by calculating combined hazard ratios (HRs) and 95% confidence intervals (CIs). Furthermore, the combined odds ratios (ORs) and 95% CIs were determined to analyze the associations between the SIRI and the clinicopathological characteristics of patients with GC.

Results: Seven publications on a total of 1763 cases were included in this study. The SIRI threshold was between 0.58 and 1.35, and the median value was 0.85. Our pooled findings revealed that a higher SIRI was significantly linked with poor overall survival (OS) (HR = 1.87, 95% CI = 1.59-2.20, p < 0.001) and disease-free survival (DFS; HR = 1.88, 95% CI = 1.50-2.36, p < 0.001) in GC patients. However, the SIRI did not exhibit a significant association with sex (OR = 1.98, 95% CI = 0.82-4.75, p = 0.126), surgery type (OR = 0.96, 95% CI = 0.61-1.51, p = 0.847), tumor differentiation (OR = 0.75, 95% CI = 0.54-1.06, p = 0.099), or TNM stage (OR = 1.25, 95% CI = 0.34-4.62, p = 0.743) in patients with GC.

Conclusions: An elevated SIRI was significantly associated with unfavorable OS and DFS in patients with GC. Thus, the SIRI is a reliable biomarker for predicting GC prognosis in clinical practice.

Background: Post-radiation fractures (PRF) are a recognised complication of radiation treatment for soft tissue sarcomas. They have a low incidence and typically occur up to 5 years following treatment, more commonly affecting the pelvis, ribs and femur. Due to radiation-induced changes in bone, PRFs typically require more complicated intervention compared to post-trauma fractures, however, limited literature exists, particularly in regards to mid-shaft femoral PRFs. We report a case of a mid-shaft femoral PRF managed with a modified onlay free vascularised fibular grafting (FVFG).

Case presentation: A 40-year-old male with a history of left quadriceps clear cell sarcoma successfully treated with wide local excision, chemotherapy and radiotherapy 18 years prior presented with a displaced oblique pathological fracture of his left femoral shaft. He was initially treated operatively with intramedullary nailing, however, repeat imaging at the one-year post-operative review demonstrated persistent hypotrophic non-union of the fracture. 16 months following the initial fracture, the patient underwent further surgical intervention with implantation of a modified onlay FVFG to the anterior aspect of the distal femur without nail removal. One-year post-revision, the patient was pain-free with normal mobility and imaging of both the graft and fracture site demonstrated complete union.

Conclusion: Despite their operative complexity, we suggest that FVFGs should be considered for treating non-union of mid-shaft femoral PRFs due to their ability to promote healing and bone union in irradiated bone. Here we describe an original technique of a modified onlay FVFG which can be used in PRFs, and we have put this technique in the context of the current literature in FVFG.

Objective: Neoadjuvant immunochemotherapy has been a promising choice for patients with locally advanced non-small cell cancer (NSCLC). However, whether neoadjuvant immunochemotherapy impacted the subsequent surgical or pathological outcomes of patients with pulmonary lymphoepithelioma-like carcinoma (PLELC) remains relatively unknown. This study aimed to evaluate the safety and efficacy of neoadjuvant immunochemotherapy in PLELC patients.

Methods: A retrospective study was conducted on patients who received neoadjuvant immunochemotherapy in combination with chemotherapy followed by surgery between 2019 and 2022. The clinical records of the patients were analyzed.

Results: Among the 31 patients with PLELC who underwent neoadjuvant immunochemotherapy followed by surgery, 18 patients (58.0%) experienced tumor downstaging. Nineteen patients (61.5%) achieved a partial response, 2 patients (6.4%) achieved a complete response, and 2 (6.4%) exhibited progressive disease. Pathological evaluation of resected specimens revealed that 8 (25.8%) patients achieved major pathological response (MPR), and 2 (6.4%) pathological complete response (PCR). The mean disease-free survival (DFS) was 17.4 months, which was not significantly different from the value in lung squamous cell carcinoma (LSQ) patients (15.1 months, P = 0.54)).

Conclusion: Neoadjuvant immunochemotherapy is a safe and effective approach to reduce the extent of tumor, render unresectable to resectable, and offer an opportunity to receive modified surgery, which may be a promising strategy for patients with PLELC.

Background: Preoperative biliary drainage (PBD) for selected patients with severe juandice has been shown to improve clinical conditions for pancreaticoduodenectomy (PD) and reduce the risk of post-pancreatectomy hemorrhage (PPH). However, the determination of an optimal end-point for PBD remains unclear. The aim of this research is to introduce the concept of goal-oriented biliary drainage, which may serve as a reasonable target and identify the optimal surgery time window.

Methods: The clinical data of 194 patients diagnosed with pancreatic cancer and obstructive jaundice were retrospectively analyzed. Serological laboratory examinations including total bilirubin (TBIL) within one week before PBD and PD were recorded and labeled as TBIL-pre and TBIL-post respectively. PBD and PD were performed by experienced medical teams. PPH with grade B and C were enrolled.

Results: TBIL-post less than 93.0µmol/L (sensitivity 83.78%, specificity 72.61%) or TBIL decay more than 68.5% (sensitivity 86.49%, specificity 69.43%) identified through ROC curves and multivariate analysis were independent protective factors for reducing the risk of PPH (OR 0.234 and 0.191 retrospectively, P<0.05) and were established as PBD goals. The Kaplan-Meier curves demonstrated the median time to achieve both PBD goals was 3 weeks. Additionally, the proportion of patients achieving both goals failed to increase with the PBD duration over 6 weeks (P > 0.05). The proportion of TBIL-post ≤ 93.0µmol/L (70.8% vs. 51.1%, P<0.05) and TBIL decay ≥ 68.5% (67.0% vs. 50.0%, P<0.05) were higher in EBS group than those in PTCD group.

Conclusion: A goal-oriented PBD with the target of TBIL ≤ 93.0µmol/L or TBIL decay ≥ 68.5% can reduce the morbidity of PPH. In general conditions, PBD duration within 3 weeks would be sufficient, while exceeding the duration beyond 6 weeks could not provide additional benefits. Both EBS and PTCD are safe and EBS is more recommended due to its superior performance in achieving the goals.

Background: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rare and highly malignant primary tumor characterized by the loss of SMARCA4 expression. Despite advancements in oncology, diagnosing and treating SMARCA4-UT remain significant clinical challenges.

Case demonstration: A 67-year-old male with a history of smoking presented to the hospital with complaints of abdominal distention and pain lasting for more than four days. Abdominal computed tomography (CT) revealed a high-density mass measuring approximately 41 × 37 mm in the right lower quadrant. Additionally, chest CT identified a high-density mass measuring 63 × 48 mm in the upper lobe of the right lung. The patient underwent partial small bowel resection, and postoperative pathological examination confirmed a diagnosis of SMARCA4-UT originating in the small mesentery. Unfortunately, the patient succumbed to respiratory failure 21 days after the diagnosis.

Conclusion: SMARCA4-UT is an exceedingly rare and aggressive undifferentiated tumor. This case highlights a presentation of SMARCA4-UT with abdominal pain and distention as initial symptoms. Clinicians should consider SMARCA4-UT in middle-aged or elderly male patients with a history of smoking who present with large masses. Comprehensive chest imaging is essential to exclude the thoracic primary disease in such cases.

Purpose: Although 18 F-FDG-PET/CT is helpful in defining many types of cancer, localized prostate cancer should not be treated with this technique. This study describes the use of multi-parametric MRI (mpMRI) to characterize incidental 18 F-FDG uptake in the prostate.

Methods and materials: While 18 F-FDG-PET/CT is useful for characterizing a variety of cancers, it is not advised for prostate cancer that is localized. This work investigates the use of mpMRI to describe incidental 18 F-FDG uptake in the prostate.mpMRI included T2-weighted (T2W), dynamic contrast enhancement (DCE), and apparent diffusion coefficient (ADC) sequences. Patients were classified according to PI-RADS (Prostate Imaging Reporting and Data System) version 2.1 by an experienced uroradiologist, and 18 F-FDG-PET was evaluated to determine whether the area of involvement on CT had a counterpart in mpMRI. A biopsy was performed on 30 of the 92 patients. These patients' maximum standardized uptake values (SUVmax) 6 < and ≥ 6, PS(PSA) density 0.15 < and ≥ 0.15, PSA level, uptake pattern (focal involvement/diffuse involvement), and PI-RADS scores were compared. P < .05 was considered statistically significant. Logistic regression was used to analyze PI-RADS score groups age, PSA, PSA density and SUVmax.

Results: In the study, 92 patients with incidental 18 F-FDG-PET/CT prostate uptake were examined. Median age was 66, PSA median was 3.6 ng/ml (range: 0-3198 ng/ml). Notably, in 70.6% of cases, PET/CT uptake didn't correlate with mp-MRI findings. Among PI-RADS 3-4-5 patients (29.3%), there was a correlation. Biopsies in 30 patients revealed 43.3% benign, 56.7% malignant. Significant differences between benign and malignant cases were observed in PSA density, PI-RADS scores, and PSA levels (p < .05), while SUVmax and uptake pattern were not significant. In multivariate logistic regression analysis, PI-RADS score groups were found to be independent risk factors for predicting malignancy.

Conclusions: Our study showed that incidental 18 F-FDG-PET/CT prostate uptake was detected and that high PSA density values, PI-RADS scores, and PSA values, such as in routine patients, and not PET-CT findings such as SUVmax and uptake pattern, were more predictive of malignancy.

Background/objectives: This study aimed to evaluate the safety, efficacy, and long-term outcomes of S-1-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable or borderline-resectable pancreatic ductal adenocarcinoma (PDAC).

Methods: This retrospective study included patients with PDAC who underwent S-1-based NACRT at our institute between 2010 and 2017.

Results: Forty patients were included in the study, including 15 (37.5%) with resectable PDAC and 25 (62.5%) with borderline-resectable PDAC. The NACRT completion and resection rates were 85.0% (n = 34) and 67.5% (n = 27), respectively. Several grade 3 adverse events were observed, including leukopenia (25.0%), anorexia (17.5%), neutropenia (10.0%), thrombocytopenia (7.5%), febrile neutropenia (2.5%), elevated aspartate aminotransferase/alanine aminotransferase (2.5%) levels, and hyponatremia (2.5%). The R0 resection rate was 70.4% (n = 19/27) in patients who underwent pancreatectomy. Grades 1, 2, and 3 according to the College of American Pathologists grading system were observed in 1 (3.7%), 12 (44.4%), and 14 (51.9%) patients, respectively. Over a median follow-up period of 32.9 months (interquartile range, 9.1-68.0), the 1-, 3-, and 5-year OS rates were 81.4%, 45.5%, and 30.3%, respectively, in the intention-to-treat analysis. In the curative-intent surgery cohort (n = 27), the 1-, 3-, and 5-year OS rates were 88.9%, 48.2%, and 37.0%, respectively.

Conclusions: S-1-based NACRT is safe and yields acceptable long-term outcomes for patients with resectable or borderline-resectable PDAC.