World Journal of Surgical Oncology最新文献

Background: To assess the clinical utility of PCA3 in the diagnostic accuracy, the correlation between PCA3 and biopsy or pathological characteristics and the performance of PCA3 to reduce the unnecessary biopsies in Chinese population.

Methods: A prospective study including patients with indication of prostate biopsies from 4 centers was conducted. All patients underwent PCA3 urine tests and prostate biopsies. The PCA3 score was analyzed by PCA3 gene expression Detection Kit (Fluorescent RT-PCR) (York biotech, Cat.#YDM-B01, China). Base model (clinical information) and PCA3 model (PCA3 scores and clinical information) were constructed via multivariate logistic regression. Discrimination, calibration and decision curve analysis were evaluated.

Results: In 1117 patients, 587 men with positive biopsy results had higher median PCA3 scores than those with negative biopsy results (p < 0.001). PCA3 scores had a greater area under the curve (AUC) than tPSA, %fPSA and PSAD in all PSA levels or PSA gray zone (4-10 ng/ml). Men with biopsy Gleason score < 7 had lower median PCA3 scores than those with Gleason score ≥ 7 (p = 0.016). In radical prostatectomy specimens, PCA3 scores were significantly associated with high-grade PCa (p = 0.002) and EAU biochemical recurrence risk (p = 0.044), but not extracapsular extension (p = 0.072), seminal vesicle invasion (p = 0.482) and T stage (p = 0.457). Regression analysis showed that the AUC increased from 0.806 (base model) to 0.873 (PCA3 model). PCA3 model with cutoff 0.15 could reduce 35.3% prostate biopsies and delay 5.8% high-grade PCa.

Conclusions: PCA3 had a better diagnosis accuracy than tPSA, %fPSA and PSAD. PCA3 was a significantly independent predictor for risk stratification, suggesting that PCA3 could provide incremental value to reduce unnecessary prostate biopsies.

Objective: Postoperative venous thromboembolism (VTE) is a potentially life-threatening complication. This study aimed to develop a predictive model to identify independent risk factors and estimate the likelihood of VTE in patients undergoing surgery for cervical cancer.

Methods: We conducted a retrospective cohort study involving 1,174 patients who underwent surgery for cervical carcinoma between 2019 and 2022. The cohort was randomly divided into training and validation sets at 7:3. Univariate and multivariate logistic regression analyses were used to determine the independent factors associated with VTE. The results of the multivariate logistic regression were used to construct a nomogram. The nomogram's performance was assessed via the concordance index (C-index) and calibration curve. Additionally, its clinical utility was assessed through decision curve analysis (DCA).

Results: The predictive nomogram model included factors such as age, pathology type, FIGO stage, history of chemotherapy, the neutrophil-lymphocyte ratio (NLR), fibrinogen degradation products (FDP), and D-dimer levels. The model demonstrated robust discriminative power, achieving a C-index of 0.854 (95% CI: 0.799-0.909) in the training cohort and 0.757 (95% CI: 0.657-0.857) in the validation cohort. Furthermore, the nomogram showed excellent calibration and clinical utility, as evidenced by the calibration curve and decision curve analysis (DCA) results.

Conclusions: We developed a high-performance nomogram that accurately predicts the risk of VTE in cervical cancer patients undergoing surgery, providing valuable guidance for thromboprophylaxis decision-making.

Background: TFE3-translocation renal cell carcinoma (TFE3-tRCC), a distinct subtype of kidney cancer characterized by Xp11.2 translocations, involving TFE3 fusion with various partner genes, lacks effective treatments and prognostic biomarkers for advanced stages. This study aimed to unravel the pathogenic mechanisms and uncover novel therapeutic targets.

Methods: The transcriptional characterization of TFE3-tRCC was conducted by RNA sequencing on 14 untreated primary TFE3-tRCC patients. The relative mRNA and protein levels were detected using qRT-PCR and Western blot, respectively. The location of ASPL-TFE3 fusion protein was analyzed by immunofluorescence. MTT and colony formation assays were used to detect cell proliferation. Annexin V/PI staining was used to evaluate cell apoptosis. Transwell assays were used to evaluate in vitro cell migration and invasion.

Results: In TFE3-tRCC patients, GSTP1 expression was upregulated. ASPL-TFE3 cell models revealed that the ASPL-TFE3 fusion protein translocates to the nucleus, contributing to tumorigenesis. Notably, GSTP1 was transcriptionally activated by chimeric TFE3. Treatment with GSTP1-targeting siRNA or the GSTP1 inhibitor Ezatiostat effectively inhibited tumor growth and induced apoptosis in TFE3-tRCC cells. Furthermore, GSTP1 was found to drive TFE3-tRCC progression via modulation of the JNK signaling pathway.

Conclusion: Upregulation of GSTP1 mediated by chimeric TFE3 promotes TFE3-tRCC progression by targeting JNK signaling pathway, which underscore the potential of GSTP1 as a promising therapeutic target for TFE3-tRCC.

Aim: The aim of this study was to introduce the Esophagus-Sparing Anastomotic Narrowing Revision (ESANR) technique for the intraoperative management of anastomotic narrowing and to conduct a literature review to provide an algorithm for the management of narrowing and strictures that may develop secondary to esophagojejunostomy.

Methods: Three patients with anastomotic narrowing during esophagojejunostomy were analyzed between September 2019 and June 2024. The anastomotic narrowing was detected by intraoperative gastroscopy after reconstruction. The ESANR technique was performed for the management of anastomotic narrowing. We conducted a systematic search of PubMed, Embase, and Web of Science databases for studies published up to June 2024 related to the treatment of anastomotic stricture. Data on the number of patients, sex, age, type of anastomosis, treatment, and outcomes were collected.

Results: The ESANR technique proved effective for the management of anastomotic narrowing in patients who underwent esophagojejunostomy during gastric cancer surgery. No anastomotic stricture or leakage was found following ESANR, and all three patients recovered without complications. 12 studies with a total of 174 patients were analyzed. The management of anastomotic stricture, which included Balloon Dilation (BD), Endoscopic Incision Therapy (EIT), stent placement, Endoscopic combination therapy (Needle-Knife stricturotomy NKS, Balloon Dilation with Triamcinolone Injection TAC), and re-do laparoscopic esophagojejunostomy.

Conclusions: In conclusion, the ESANR technique demonstrates potential advantages in addressing anastomotic narrowing in esophagojejunostomy. However, further clinical data and analyses are necessary to verify its effectiveness and establish robust statistical support.

Background: There is ongoing debate surrounding the optimal therapeutic strategy for hepatocellular carcinoma (HCC) patients achieving complete response (CR) after conversion therapy. This meta-analysis compares the prognostic outcomes of non-surgery strategies with hepatectomy.

Methods: The systematic searches were conducted up to April 11, 2024, across PubMed, Embase, Web of Science, and the Cochrane Library, analyzing progression-free survival (PFS) and overall survival (OS). Subgroup analyses were conducted based on whether patients achieved a clinical CR or a radiologic CR, as well as the regimen of non-surgery strategy employed.

Results: Six studies with 481 patients were identified. Non-surgery strategy was linked to significantly worse PFS compared to hepatectomy (hazard ratio [HR] = 2.15; 95% confidence interval [CI], 1.60 to 2.90). However, there was not a notable difference in OS between the two groups (HR = 1.35; 95% CI, 0.93 to 1.96). Subgroup analysis showed that for patients with clinical CR, there were no notable differences in both PFS and OS. Conversely, patients with radiologic CR experienced significantly worse PFS and OS when treated with non-surgery strategy.

Conclusions: Non-surgery strategy might provide comparable outcomes to hepatectomy for HCC patients with clinical CR, as opposed to those with radiologic CR. Further research is needed to confirm these results.

Introduction: Although the Tumor-Node-Metastasis (TNM) staging system is widely used for staging lung squamous cell carcinoma (LSCC), the TNM system primarily emphasizes tumor size and metastasis, without adequately considering lymph node involvement. Consequently, incorporating lymph node metastasis as an additional prognostic factor is essential for predicting outcomes in LSCC patients.

Methods: This retrospective study included patients diagnosed with LSCC between 2004 and 2018 and was based on data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The primary endpoint of the study was cancer-specific survival (CSS), and demographic characteristics, tumor characteristics, and treatment regimens were incorporated into the predictive model. The study focused on the value of indicators related to pathological lymph node testing, including the lymph node ratio (LNR), regional node positivity (RNP), and lymph node examination count (RNE), in the prediction of cancer-specific survival in LSCC. A prognostic model was established using a multivariate Cox regression model, and the model was evaluated using the C index, Kaplan-Meier, the Akaike information criterion (AIC), decision curve analysis (DCA), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and the predictive efficacy of different models was compared.

Results: A total of 14,200 LSCC patients (2004-2018) were divided into training and validation cohorts. The 10-year CSS rate was approximately 50%, with no significant survival differences between cohorts (p = 0.8). The prognostic analysis revealed that models incorporating LNR, RNP, and RNE demonstrated superior performance over the TNM model. The LNR and RNP models demonstrated better model fit, discrimination, and reclassification, with AUC values of 0.695 (training) and 0.665 (validation). The RNP and LNR models showed similar predictive performance, significantly outperforming the TNM and RNE models. Calibration curves and decision curve analysis confirmed the clinical utility and net benefit of the LNR and RNP models in predicting long-term CSS for LSCC patients, highlighting their value in clinical decision-making.

Conclusion: This study confirms that RNP status is an independent prognostic factor for CSS in LSCC, with predictive efficacy comparable to LNR, with both models enhancing survival prediction beyond TNM staging.

Background: The equivalence between left upper lobectomy (LUL) and left upper tri-segmentectomy (LUTS) for stage I left upper non-small cell lung cancer (NSCLC) remains unclear. This study compares the perioperative and oncological outcomes of LUL and LUTS in this patient population.

Methods: This study included patients who underwent LUL or LUTS at West China Hospital of Sichuan University and Sichuan ShangJin Hospital between August 2018 and November 2023. Patients with tumors located at least 2 cm from the lingular segment were included. Propensity score matching (PSM) addressed baseline imbalances between groups. Perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), lung cancer-specific survival (LCSS), and subgroup analyses were assessed.

Results: A total of 1019 patients were included (LUL: 524; LUTS: 495) with a median follow-up of 4.8 years (IQR: 2.5-8.1). Compared to LUL, LUTS was associated with significantly shorter operative times (103 vs. 120 min, p = 0.001), reduced postoperative drainage volume at 3 days (335 vs. 485 ml, p = 0.001) and total (360 vs. 530 ml, p = 0.001), lower conversion to thoracotomy rates (1.0% vs. 3.4%, p = 0.009), and fewer postoperative complications (9.9% vs. 14.9%, p = 0.016). No significant differences were observed in 5-year OS (86.7% vs. 85.4%, HR: 0.96; 95% CI: 0.66-1.39; p = 0.821), 5-year RFS (78.4% vs. 75.3%, HR: 0.85; 95% CI: 0.63-1.13; p = 0.258), or 5-year LCSS (90.2% vs. 91.3%, HR: 0.99; 95% CI: 0.62-1.57; p = 0.956) between the two groups.

Conclusion: For stage I left upper NSCLC, LUTS, while preserving adequate surgical margins, achieves superior perioperative and comparable oncological outcomes to LUL.

Objective: To explore the relationship between vessel invasion (VI) and clinicopathological features and prognosis in patients with gastric cancer (GC).

Methods: A total of 3600 cases of patients with GC who underwent radical gastrectomy in gastrointestinal surgery department of the First Affiliated Hospital of Naval Medical University from June 2014 to June 2019 were retrospectively analyzed, and filtering them based on specific inclusion and exclusion criteria. To reduce the possibility of selection bias about the impact of VI, patients were divided into two groups according to the presence or absence of it, and performed a one-to-one propensity score matching (PSM), resulting in 724 patients in each group. In the analysis of data from 3,205 GC patients was employed to examine inter-group variations in VI positivity across diverse clinicopathological factors. Both univariate and multivariate Cox regression models were applied to investigate the correlation between clinicopathological factors and prognosis. The findings were further illustrated through the plotting of Kaplan-Meier survival curves.

Results: 3205 patients were included in this study, of which 989 (30.9%) were VI-positive and 2216 (69.1%) were VI-negative. VI-positive group was found to be significantly associated with age, body mass index (BMI), pTNM stage, tumor location, perineural invasion (PI), Lauren classfication and tumor deposit (TD) (P < .05), but not with gender or basic disease. VI-positive patients had a worse survival than VI-negative patients before (P < .001) and after (P = .007) PSM matching. The Kaplan-Meier survival curve after PSM illustrated that patients with VI had a 5-year survival rate of 58.03%, whereas patients without VI had a higher rate at 66.25%. Further, multivariate analysis after matching demonstrated that VI was an independent risk factor for prognosis (P = .030).

Conclusion: VI is associated with multiple pathological factors and serves as an independent risk factor affecting the prognosis of GC.

Background: The combination of immunotherapy and chemotherapy has demonstrated an enhancement in progression-free survival (PFS) for individuals with advanced and metastatic triple-negative breast cancer (TNBC) when compared to the use of chemotherapy alone. Nevertheless, the extent to which different subgroups of metastatic TNBC patients experience this benefit remains uncertain.

Objectives: Our objective was to conduct subgroup analyses to more precisely identify the factors influencing these outcomes.

Materials and methods: The PubMed database was searched until Dec 2023 for studies that compared PD-1 checkpoint inhibitors plus chemotherapy (ICT) with chemotherapy (CT) alone. The primary outcome of interest was progression-free survival (PFS). Review Manager (RevMan) version 5.4. was used for the data analysis.

Results: Four randomized controlled trials (RCTs) comprising 2468 advanced and metastatic TNBC were included in this systematic review and meta-analysis. PFS surge with combined therapy was observed in White (HR 0.80 [0.70, 0.91], p = 0.0007) and Asian ethnicities (HR 0.73 [0.58, 0.93], p = 0.01) but not in Blacks (HR 0.72 [0.42, 1.24], p = 0.24). Overall, patients with distant metastasis demonstrated to derive the PFS benefit from additional immunotherapy (HR 0.87 [0.77, 0.99], p = 0.03); however, metastasis to individual distant site was associated with failure to achieve any treatment difference (Bone: HR 0.79 [0.41, 1.52], p = 0.49; Lung: HR 0.85 [0.70, 1.04], p = 0.11; Liver: HR 0.80 [0.64, 1.01], p = 0.06). While number of metastases > 3 also showed to impact the PFS advantage (HR 0.89 [0.69, 1.16], p = 0.39). While patients, regardless of prior chemotherapy, experienced a notable enhancement in PFS with ICT (Overall: HR 0.79 [0.71, 0.88], p < 0.0001; Yes: HR 0.87 [0.76, 1.00], p = 0.05; No: HR 0.67 [0.56, 0.80], p < 0.00001), those previously exposed to chemotherapy exhibited a significantly smaller PFS advantage compared to those without prior chemotherapy, as evidenced by a significant subgroup difference (Test for subgroup difference: P = 0.02, I2 = 82.2%). Patients lacking PD-L1 expression also failed to achieve any additional benefit from immunotherapy (PD-L1-: HR 0.95 [0.81, 1.12]; p = 0.54; PD-L1+: HR 0.73 [0.64, 0.85], p < 0.0001). Age, ECOG status, and presentation with de novo metastasis/recurrent shown no impact on IT-associated PFS advantage.

Conclusions: Patient- and treatment- related factors such as ethnicity, distant metastases, number of metastases (> 3), previous exposure to chemotherapy and PD-L1 expression, seem to influence or restrict the advantage in progression-free survival associated with the addition of immunotherapy to chemotherapy, as opposed to chemotherapy alone, in patients with advanced and metastatic TNBC. Larger studies are warranted to validate these outcomes.

Background: Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.

Methods: The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.

Results: A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).

Conclusions: Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.