World Journal of Surgical Oncology最新文献

Background: Emotional distress (ED), characterized by symptoms of depression and anxiety, is highly prevalent in patients with breast cancer. Although retrospective studies suggest an association between ED and adverse cancer outcomes, findings from prospective studies remain inconsistent.

Objective: This prospective observational study aimed to investigate the association between emotional distress and long-term survival outcomes in patients with breast cancer following curative surgery.

Methods: A total of 159 patients with breast cancer were enrolled. Baseline levels of emotional distress were assessed using standardized scales. Patients were prospectively followed for up to 7 years to monitor overall survival (OS) and progression-free survival (PFS). Inverse probability of treatment weighting (IPTW) was employed to adjust the baseline confounders.

Results: The unadjusted 7-year OS and PFS rates in patients with ED were numerically lower than those without ED (OS: 78.5% vs. 93.7%; PFS: 76.9% vs. 89.3%). After adjustment using IPTW, emotional distress was independently associated with lower OS (adjusted HR = 6.52, 95% CI: 1.78-23.89, P = 0.005) and PFS (adjusted HR = 3.73, 95% CI: 1.19-11.71, P = 0.024).

Conclusion: This study provides prospective evidence that emotional distress is associated with reduced survival and an increased risk of disease progression in breast cancer patients following curative surgery. These findings highlight the importance of integrating psychological assessment and supportive care into routine oncologic management.

Background: Distant metastases are the leading cause of death for patients with differentiated thyroid cancer (DTC), and surgery and radioactive iodine (RAI) therapy are effective treatments for them. However, there remains a large proportion of patients with poor prognoses, and there exists no consensus on whether systemic chemotherapy or beam radiation should be administrated to improve their prognoses.

Method: The clinicopathology information of patients with metastatic DTC (mDTC) was retrospectively collected and analyzed. A nomogram was created to predict their prognosis and divided patients into high- and low-risk groups, and the external validation was performed.

Results: The Cox regression showed that sex, age, metastatic sites, surgery, and radiotherapy were independent influencing factors affecting OS. Fine-gray competing risk analysis showed that age, T-stage, N-stage, metastatic sites, and radiotherapy were independent risk factors for TCSD. The nomogram we constructed proved to be effective and robust with high efficiency, with C-indexes of 0.785 (95% CI = 0.752-0.813) and 0.794 (95%CI = 0.766-0.831) on the train and test sets, respectively. mDTC patients were further classified into high- and low-risk groups based on the prediction of nomogram, those in the high-risk group had significantly worse OS and higher TCSD than those in the low-risk group (P < 0.001), and chemotherapy significantly improved OS and reduced TCSD for patients in the high-risk group, whereas local beam radiation did not provide any survival benefit. In the external validation dataset, the 1-, 3-, and 5-year AUC values of the model ranged from 0.833 to 0.873, which further proved the efficiency of our model.

Conclusion: This study developed an accurate prognostic model for patients with mDTC, which may be applicable in future clinical practice for prognosis and death prediction. For high-risk patients, as predicted by nomogram, systemic chemotherapy was the recommended therapy option for them.

Background: Primary leiomyosarcoma (LMS) of the colon is an exceptionally rare malignancy, accounting for less than 0.1% of colorectal cancers. Because of its rarity and nonspecific presentation, preoperative diagnosis is challenging, and optimal management strategies remain undefined.

Case presentation: A 47-year-old woman with no prior medical history underwent screening colonoscopy, which revealed a 2.5-cm ulcerative mass in the proximal descending colon. Biopsies performed twice, including a follow-up examination one month later, showed only chronic inflammation. Computed tomography demonstrated eccentric wall thickening with minimal pericolic infiltration, raising suspicion for malignancy. The patient underwent laparoscopic radical en bloc resection of the splenic flexure and descending colon with D2 lymphadenectomy, followed by stapled colo-colic anastomosis. Histopathology revealed a 4.2 × 3.5 cm spindle-cell tumor with high cellularity, moderate pleomorphism, > 100 mitoses/50 HPF, and invasion extending to the subserosal layer. Immunohistochemistry showed positivity for smooth muscle actin and desmin, and negativity for CD34, CD117, DOG-1, and S-100. The Ki-67 index was 70-80%. Resection margins and all 13 lymph nodes were negative. The postoperative course was uneventful, and the patient remains disease-free at 11 months.

Conclusion: Colonic LMS is a rare and aggressive tumor that often evades preoperative diagnosis, especially when biopsies are inconclusive. Surgical resection with negative margins is the mainstay of treatment, and close surveillance is essential due to the high risk of recurrence.

Background: Conventional open surgery (OP) is effective and simple for treating papillary thyroid cancer (PTC), but the excessive separation of band strap muscles causes discomfort in the anterior cervical region and a long scar, which may impair the patient's life quality and beauty. Gasless endoscopic surgery via subclavicular approach (ESSA) may provide a better alternative.

Methods: The prospective data of 90 PTC patients who underwent ESSA or OP (45:45) in hemithyroidectomy and central neck dissection (CND) in our center from March 2022 to August 2023 were analyzed. Safety indicator incidence of complications, efficiency indicator No. lymph nodes (LNs) of CND, postoperative recurrence of central neck LNs indicated by Ultrasound (US) at 6 months, postoperative functions of the anterior cervical region and cosmetic satisfaction were recorded as the primary endpoints.

Results: The ESSA group had no significant differences with the OP group in baseline data, complications, No. LNs (9.04 ± 4.58 vs. 9.87 ± 4.89, p = 0.413) and metastatic LNs (1.60 ± 2.79 vs.1.69 ± 2.50, p = 0.874) of CND. The two groups had no postoperative recurrence of central neck LNs indicated by ultrasound (US) at 6 months. The ESSA group exhibited better functionally sensitive and motional outcomes in the anterior cervical region compared to the OP group (P = 0.0217 and P = 0.008), and had higher cosmetic satisfaction than the OP group (P < 0.001).

Conclusion: Compared with OP, ESSA is equally safe and effective, but more cosmetic and conducive to preserving functions of the anterior cervical region. ESSA can be considered an alternative approach to OP in hemithyroidectomy and CND.

Background: Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), is an aggressive malignancy and the most prevalent subtype of lymphoma both globally and in Malaysia. This study aimed to assess the clinical course, treatment response to the R-CHOP regimen (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone), and survival outcomes of patients diagnosed with DLBCL at a tertiary care center.

Methods: A retrospective analysis was conducted on patients diagnosed with de novo DLBCL between 2015 and 2020. Demographic profiles, clinical features, treatment information, and outcomes were systematically collected and evaluated.

Results: A total of 202 patients were analyzed, with a median age of 58 years (interquartile range: 20). The majority were male (58.4%). The median follow-up period was 50.1 months (interquartile range: 64.6). All patients received at least one cycle of the R-CHOP regimen. Following chemotherapy, 6.9% of patients underwent radiotherapy as a consolidative approach. A complete response was achieved in 57.9% of cases. The three-year overall survival (OS) and progression-free survival (PFS) rates were 60.9% and 58.4%, respectively. Patients with higher International Prognostic Index scores demonstrated significantly poorer OS and PFS than those with lower scores (p < 0.0001 for both). The presence of B symptoms was also associated with inferior OS and PFS (p = 0.047 and 0.044, respectively). Furthermore, hypoalbuminemia (serum albumin < 35 g/L) emerged as an independent prognostic indicator linked to reduced OS in multivariate analysis (p = 0.0040).

Conclusions: This study provides key insights into the clinical characteristics and treatment outcomes of Malaysian patients with DLBCL managed with the R-CHOP regimen. Age, presence of B symptoms, disease stage, baseline serum albumin, and lactate dehydrogenase levels were identified as significant prognostic markers that may help predict survival in newly diagnosed DLBCL cases. Larger, prospective trials with prolonged follow-up are necessary to validate these findings.

Introduction: Triple-Negative Breast Cancer (TNBC) is characterized by high heterogeneity and therapeutic limitations, creating an urgent need for quantifiable and readily accessible prognostic markers to optimize risk stratification. Although the baseline values of inflammatory indices are associated with prognosis, the dynamic remodeling process of the immune-inflammatory response after surgery has not been sufficiently explored. This study innovatively introduces the linear slope to quantify the annual rate of change in postoperative inflammatory indices, aiming to construct a prognostic model that integrates dynamic trends.

Methods: This retrospective study included 296 patients with TNBC who underwent adjuvant chemotherapy following surgery. The primary endpoints of the study were disease-free survival (DFS) and breast cancer-specific survival (BCSS). Inflammatory values were log2-transformed, multicollinearity was assessed using the variance inflation factor (VIF), and multivariable Cox proportional hazards regression models were utilized to assess disease-free survival and breast cancer-specific survival. These were integrated with time-dependent receiver operating characteristic (ROC) curves, bootstrap internal evaluation, and SHAP (SHapley Additive exPlanations) for interpreting the predictive model.

Result: The conventional Cox model demonstrated that T stage, N stage, histological grade, lymphovascular invasion(LVI), and perineural invasion(PNI) were independent prognostic factors for both DFS and BCSS (p < 0.05). The time-dependent model revealed that the dynamic changes in log2(SIRI) held significant prognostic value, which was reflected in the contribution value of SIRI in the SHAP. Time-dependent ROC curves showed that the model's predictive performance at 5 and 6 years was superior to that of the traditional model, although the calibration curve suggested the presence of overestimation. The decision curve analysis curve supported its clinical utility within the common threshold range of 0.1-0.3.

Conclusion: The time-dependent model effectively quantified the dynamic evolution of postoperative inflammation. The prognostic model integrating it with tumor staging significantly improved the accuracy of prognosis prediction in TNBC.