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Transition to Targeted Therapies Improved the Prognosis and Increased the Utilization of Medical Treatments among Patients with Synchronous Metastatic Renal Cell Cancer. 向靶向治疗的过渡改善了同步转移性肾细胞癌患者的预后并增加了药物治疗的利用率。
IF 1.5 Q2 Medicine Pub Date : 2021-08-12 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5237695
Lauri Laru, Hanna Ronkainen, Markku H Vaarala

Since the introduction of targeted therapies (TTs) for metastatic renal cell cancer (mRCC) in 2005, a limited amount of epidemiological data on efficacy of modern drug therapies for synchronous mRCC has been published. We present a comprehensive nationwide cohort including all cases of primarily metastasized renal cell cancer among adults diagnosed between 2005 and 2010, based on data from the Finnish Cancer Registry and patient records from treating hospitals. Applied treatment protocols and survival outcomes were analyzed. A total of 977 patients were included in the analysis; 499 patients were diagnosed between 2005 and 2007 and 478 patients were diagnosed between 2008 and 2010. The median overall survival (OS) was 8.80 months (95% confidence interval (CI): 7.60-10.02). The median OS of the patients diagnosed at the latter era was significantly better (11.1; 95% CI: 8.8-13.4 vs. 7.0; 95% CI: 5.7-8.3 months, p ≤ 0.001). A total number of 524 (53.8%) patients received drug therapy. Altogether, TTs including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors (mTORi), and vascular endothelial growth factor inhibitor covered 331 (63.2%) of first-line treatments, whereas interferon and its combinations with chemotherapy were used for 186 (35.5%) patients. The median OS rates for TT and interferon as first-line therapy groups were 19.9 (16.9-22.8) and 14.9 (12.3-17.4) months, respectively. The OS for patients who did not receive drug therapy after cytoreductive nephrectomy was dismal. We found that the OS estimate of mRCC patients in Finland has improved since the introduction of tyrosine kinase inhibitors. However, the prognosis remains poor for frail, elderly patients with an impaired performance status.

自2005年针对转移性肾细胞癌(mRCC)引入靶向治疗(tt)以来,关于现代药物治疗同步mRCC疗效的流行病学数据有限。基于芬兰癌症登记处的数据和治疗医院的患者记录,我们提出了一个全面的全国队列研究,包括2005年至2010年间诊断的所有成人原发性转移性肾细胞癌病例。分析应用的治疗方案和生存结果。共有977例患者被纳入分析;2005年至2007年期间诊断出499名患者,2008年至2010年期间诊断出478名患者。中位总生存期(OS)为8.80个月(95%可信区间(CI): 7.60-10.02)。后一时期诊断的患者的中位OS明显更好(11.1;95% CI: 8.8-13.4 vs. 7.0;95% CI: 5.7-8.3个月,p≤0.001)。共524例(53.8%)患者接受药物治疗。总的来说,包括酪氨酸激酶抑制剂、哺乳动物雷帕霉素靶点抑制剂(mTORi)和血管内皮生长因子抑制剂在内的TTs治疗覆盖了331例(63.2%)一线治疗,而干扰素及其联合化疗用于186例(35.5%)患者。TT和干扰素作为一线治疗组的中位OS率分别为19.9(16.9-22.8)和14.9(12.3-17.4)个月。对于细胞减减性肾切除术后未接受药物治疗的患者,OS是令人沮丧的。我们发现芬兰mRCC患者的OS估计自引入酪氨酸激酶抑制剂以来有所改善。然而,对于身体虚弱、表现不佳的老年患者,预后仍然很差。
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引用次数: 1
Survival Benefit of Intervention Treatment in Advanced Anaplastic Thyroid Cancer. 晚期间变性甲状腺癌介入治疗的生存获益。
IF 1.5 Q2 Medicine Pub Date : 2021-06-03 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5545127
Pornthep Kasemsiri, Pimpika Chaisakgreenon, Patravoot Vatanasapt, Supawan Laohasiriwong, Watchareeporn Teeramatwanich, Cattleya Thongrong, Teeraporn Ratanaanekchai, Surapol Suetrong

Background: The management of anaplastic thyroid cancer (ATC) is controversial; thus, proper treatment and prognostic factors should be investigated.

Objectives: To compare the survival outcomes of the intervention and palliative treatment in ATC patients.

Methods: A hospital-based retrospective study was conducted at a single tertiary university hospital. The medical record charts were retrieved from November 20, 1987, to December 31, 2016. The final follow-up ended by December 31, 2017. The patients' demographic data, laboratory data, clinical presentation, and treatment modality results were analyzed.

Results: One hundred twenty-one records were analyzed with a one-year overall survival rate of 3.5% (median survival time: 77 days); however, 16 cases had insufficient data to classify staging and treatment modalities. Therefore, 105 ATC patients (37 with stage IVa, 39 with stage IVb, and 29 with stage IVc disease) were included with a one-year overall survival rate of 4.0% (median survival time of 82 days). Intervention treatment allowed longer median survival times (p < 0.05) and a better survival rate (p < 0.05). Among the interventional treatment groups, postoperative chemoradiation yielded the longest median survival time (187 days) and the highest survival rate (20%) (p < 0.05). The intervention modality allowed a better median survival time at all stages, particularly in stage IVa (p < 0.05). Unfavorable prognostic factors were adjusted for in a multiple Cox regression model showing that significant factors included age ≥65 years (hazard ratio HR: 2.57), palliative treatment (HR: 1.85), and leukocytosis ≥10,000 cells/mm3 (HR: 2.76).

Conclusions: Intervention treatment provided a better survival outcome in all stages, particularly in stage IVa, with a significantly better median survival time. Among interventional treatments, postoperative chemoradiation led to the longest survival rate, suggesting that this treatment should be considered in ATC patients with resectable tumors and no poor prognostic factors, such as older age and leukocytosis.

背景:间变性甲状腺癌(ATC)的治疗存在争议;因此,应研究适当的治疗和预后因素。目的:比较干预与姑息治疗对ATC患者的生存结局。方法:在一所三级大学医院进行回顾性研究。病历图检索时间为1987年11月20日至2016年12月31日。最后的随访于2017年12月31日结束。分析患者的人口学资料、实验室资料、临床表现和治疗方式结果。结果:121例患者1年总生存率为3.5%(中位生存时间为77天);然而,16例病例没有足够的数据来划分分期和治疗方式。因此,纳入105例ATC患者(IVa期37例,IVb期39例,IVc期29例),一年总生存率为4.0%(中位生存时间为82天)。干预治疗中位生存期延长(p < 0.05),生存率提高(p < 0.05)。在介入治疗组中,术后放化疗的中位生存时间最长(187天),生存率最高(20%)(p < 0.05)。干预方式在所有阶段的中位生存时间更长,特别是在IVa阶段(p < 0.05)。在多重Cox回归模型中调整了不利的预后因素,结果显示显著因素包括年龄≥65岁(危险比HR: 2.57)、姑息治疗(危险比HR: 1.85)和白细胞数量≥10,000个细胞/mm3(危险比HR: 2.76)。结论:干预治疗在所有阶段提供了更好的生存结果,特别是在IVa阶段,中位生存时间显着提高。在介入治疗中,术后放化疗生存率最长,提示对于可切除肿瘤且无高龄、白细胞增多等不良预后因素的ATC患者,应考虑采用放化疗。
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引用次数: 2
Correlation between Prognostic Factors and the Histopathological Response to Neoadjuvant Chemotherapy in Osteosarcoma: A Retrospective Study. 骨肉瘤预后因素与新辅助化疗组织病理反应的相关性:一项回顾性研究。
IF 1.5 Q2 Medicine Pub Date : 2021-04-26 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8843325
Yogi Prabowo, Iwan Setiawan, Achmad Fauzi Kamal, Evelina Kodrat, Muhammad Luqman Labib Zufar
Background Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients' survival and follow-up information. Results We reviewed 64 patients within 5–65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender (p = 0.012), age (p = 0.029), symptom duration (p = 0.004), and tumor enlargement after neoadjuvant chemotherapy (p < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. Conclusions Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.
背景:结合新辅助化疗和辅助化疗的多模式治疗是提高骨肉瘤总生存率的标准治疗方案。然而,关于影响新辅助化疗后组织病理反应的预后因素的数据有限。患者和方法。我们回顾性地回顾了2008年至2018年间本中心诊断为骨肉瘤的患者。我们根据性别、年龄、肿瘤大小、诊断部位和分期、转移部位、手术类型、坏死率(基于Huvos分级系统)和新辅助化疗周期数对患者进行了特征分类。我们将对新辅助化疗的反应分为Huvos 1级和2级患者的不良反应和Huvos 3级和4级患者的良好反应。我们还记录了患者的生存和随访信息。结果:我们回顾了64例5-65岁的患者,以男性为主(62.5%)。股骨远端是骨肉瘤最常见的部位(53.1%)。根据Huvos分级系统,15例(23.4%)患者对新辅助化疗反应良好,49例(76.6%)患者对新辅助化疗反应不良。基于多因素分析,性别(p = 0.012)、年龄(p = 0.029)、症状持续时间(p = 0.004)、新辅助化疗后肿瘤增大(p 20岁= 1分,女性= 1分,症状持续时间> 12周= 1分,新辅助化疗后肿瘤增大= 2分)。该评分系统将患者分为两组,总分大于2分预测新辅助化疗反应较差。结论:年龄、性别、症状持续时间、肿瘤大小是影响骨肉瘤患者新辅助化疗组织病理反应的预后特征。
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引用次数: 7
Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Experience in Peritoneal Carcinomatosis: Single-Center Analysis of 180 Cases. 180例腹膜癌减胞术及围手术期腹腔内化疗的经验分析。
IF 1.5 Q2 Medicine Pub Date : 2021-04-22 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8851751
Kursat Karadayi, Meric Emre Bostanci, Murat Can Mollaoglu, Ufuk Karabacak

Background: In peritoneal carcinomatosis (PC), increased life span and disease-free survival times are shown in patients with hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (SRC). In this study, our main objective was to present our experience of performing SRC and perioperative intraperitoneal chemotherapy (HIPEC and EPIC) on patients with PC, in light of the literature.

Methods: Demographic data, follow-up results, peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CCR) score, and morbidity and mortality rates of 180 patients treated with SRC + HIPEC + EPIC for PC at the Department of Surgical Oncology at Sivas Cumhuriyet University between January 2008 and July 2020 were analyzed retrospectively.

Results: Distribution of 180 PC cases according to primary organs included 53 ovarian, 39 colorectal, 33 stomach, 25 primary peritoneum, 10 uterus, 10 tuba, five soft tissue, and five appendix originated carcinoma. The average PCI of the cases detected preoperatively was 21 (5-30). Completeness of cytoreduction scores of CCR-0 in 102 cases, CCR-1 in 67 cases, CCR-2 in eight cases, and CCR-3 in three cases was obtained. Median operation time was 300 (200-540) minutes. Perioperative morbidity rate was 47.0%, and perioperative mortality rate was 13.5%.

Conclusion: The peritonectomy procedure is a difficult, long-lasting, troublesome intervention, but it is the most important treatment option with acceptable morbidity and mortality rates in patients selected for PC treatment in experienced centers.

背景:在腹膜癌(PC)中,在细胞减少手术(SRC)后进行高温腹腔化疗(HIPEC)和术后早期腹腔化疗(EPIC)的患者的寿命和无病生存时间增加。在这项研究中,我们的主要目的是根据文献介绍我们对PC患者进行SRC和围手术期腹腔内化疗(HIPEC和EPIC)的经验。方法:回顾性分析2008年1月至2020年7月在西vas Cumhuriyet大学外科肿瘤科接受SRC + HIPEC + EPIC治疗的180例PC患者的人口统计学资料、随访结果、腹膜癌指数(PCI)、细胞减少完整性(CCR)评分、发病率和死亡率。结果:180例PC按原发器官分布:卵巢53例,结直肠39例,胃33例,腹膜25例,子宫10例,气管10例,软组织5例,阑尾5例。术前发现患者PCI平均为21次(5 ~ 30次)。获得102例CCR-0、67例CCR-1、8例CCR-2、3例CCR-3细胞减少评分的完全性。中位手术时间300(200-540)分钟。围手术期发病率47.0%,死亡率13.5%。结论:腹膜切除术是一项困难、持久、麻烦的干预措施,但在经验丰富的中心,它是选择PC治疗的患者中发病率和死亡率可接受的最重要的治疗方案。
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引用次数: 6
Comparison of IORT (Radical and Boost Dose) and EBRT in Terms of Disease-Free Survival and Overall Survival according to Demographic, Pathologic, and Biological Factors in Patients with Breast Cancer. 根据乳腺癌患者的人口学、病理和生物学因素,IORT(根治和增强剂量)和EBRT在无病生存期和总生存期方面的比较
IF 1.5 Q2 Medicine Pub Date : 2021-04-16 eCollection Date: 2021-01-01 DOI: 10.1155/2021/2476527
Solmaz Hashemi, Seyedmohammadreza Javadi, Mohammad Esmaeil Akbari, Hamidreza Mirzaei, Seied Rabi Mahdavi

Background: The standard treatment for breast cancer is breast-conserving surgery (BCS) with radiotherapy. If external beam radiation therapy (EBRT) can be safely replaced with intraoperative radiotherapy (IORT), it will help patients to save their breast and to have equivocal or better results in DFS and overall survival (OS).

Methods: A total of 2022 patients with breast cancer treated during 6 years were enrolled in the current study. A total of 657, 376, and 989 patients received EBRT, radical, and boost dose by IORT, respectively, according to the IRIORT consensus protocol. The primary endpoint was recurrence and death. The secondary endpoint was the role of variables in recurrence and death.

Results: With a mean follow-up of 34.5 and 40.18 months for the IORT and EBRT groups, respectively, there was a significant difference in DFS between electron boost and X-ray boost groups (P=0.037) and the electron radical group compared with EBRT (P=0.025), but there was no significant difference between other boost and radical groups in DFS and OS.

Conclusions: IORT can be a preferred treatment modality because of its noninferior outcomes, and in some special conditions, it has superior outcomes compared to EBRT, particularly in delivering radical dose with IORT.

背景:乳腺癌的标准治疗是保乳手术(BCS)加放疗。如果外束放射治疗(EBRT)可以安全地取代术中放疗(IORT),将有助于患者保存乳房,并在DFS和总生存期(OS)方面取得模棱两可或更好的结果。方法:本研究共纳入2022例6年内接受治疗的乳腺癌患者。根据IORT共识协议,共有657,376和989名患者分别接受了EBRT,根治和增强剂量IORT。主要终点是复发和死亡。次要终点是复发和死亡变量的作用。结果:IORT组和EBRT组的平均随访时间分别为34.5个月和40.18个月,与EBRT组相比,电子增强组和x射线增强组的DFS (P=0.037)和电子自由基组的DFS和OS (P=0.025)差异有统计学意义,而其他增强组和自由基组的DFS和OS差异无统计学意义。结论:IORT因其良好的预后而成为首选的治疗方式,在某些特殊情况下,与EBRT相比,IORT的预后更好,特别是在提供根治剂量方面。
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引用次数: 5
How Can a Multidisciplinary Approach Improve Prognosis of Soft-Tissue Sarcomas of Extremities? 多学科联合治疗如何改善四肢软组织肉瘤的预后?
IF 1.5 Q2 Medicine Pub Date : 2021-03-24 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8871557
Asmae Mazti, Mohamed El Idrissi, Abdelhalim El Ibrahimi, Mustapha El Maaroufi, Ghizlane El Koubaiti, Touria Bouhafa, Samira El Fakir, Samia Arifi, Abdelmajid Mrini, Laila Chbani

Soft-tissue sarcomas are malignant tumors that require good management within specialized centers. Our study aims to assess the benefit of handling these kinds of tumors using the Multidisciplinary Meeting (MDM) approach. The current paper details this approach through a prospective study that has lasted for 42 months in the HASSAN II University Hospital Center, Fez, Morocco. During this research work, 116 cases were selected with an average age of 53 years. In 95.7% of the cases, it was found that the lower limb was the most frequent tumor type (78.4%). Also, ninety-two (92) patients (79.3%) have had a prior biopsy. Ninety-nine (99) patients (85.3%) have received a magnetic resonance imaging scan (MRI) before surgery. Sixty-three (63) patients were operated on, including R0 resection used for 37 patients, R1 used for 21 patients, and R2 used for five patients. As a result, liposarcomas were the most frequent type (30.1%), followed by synovial sarcomas (14.6%), leiomyosarcomas (9.5%), ewing sarcoma (8.6), and undifferentiated pleomorphic sarcomas (7.7%). In addition, neoadjuvant chemotherapy was used for 36 patients. The other 22 patients received adjuvant chemotherapy and/or radiotherapy. The overall survival rate was 60.56 months, which proves a significant improvement, thanks to the multidisciplinary meeting approach. Conclusion. The conducted investigation has shown that using MDM for managing soft-tissue sarcomas of extremities improves the patients' survival rate. Moreover, results have proven MDM might allow optimal treatment regarding less local recurrence and metastasis.

软组织肉瘤是恶性肿瘤,需要在专门的中心进行良好的治疗。我们的研究旨在评估使用多学科会议(MDM)方法处理这类肿瘤的益处。本文通过一项在摩洛哥非斯的哈桑二世大学医院中心持续42个月的前瞻性研究详细介绍了这种方法。本研究共选取116例,平均年龄53岁。在95.7%的病例中,发现下肢是最常见的肿瘤类型(78.4%)。此外,92例(79.3%)患者既往有活检。99例(85.3%)患者在手术前接受了磁共振成像扫描(MRI)。共手术63例,其中R0切除37例,R1切除21例,R2切除5例。结果,脂肪肉瘤是最常见的类型(30.1%),其次是滑膜肉瘤(14.6%)、平滑肌肉瘤(9.5%)、尤文氏肉瘤(8.6)和未分化多形性肉瘤(7.7%)。另外,36例患者接受了新辅助化疗。其余22例患者接受辅助化疗和/或放疗。总生存率为60.56个月,由于多学科会议的方法,这证明了显着的改善。结论。研究表明,使用MDM治疗四肢软组织肉瘤可提高患者的生存率。此外,研究结果表明,MDM可以减少局部复发和转移,从而实现最佳治疗。
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引用次数: 2
From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review. 从诊断到管理;残端阑尾炎粘液囊肿,一种罕见的外科疾病:文献回顾。
IF 1.5 Q2 Medicine Pub Date : 2021-02-11 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8816643
Syed Muhammad Ali, Mohannad Al-Tarakji, Fakhar Shahid, Amjad Salah Qabani, Amjad Ali Shah, Khalid Ahmed, Muhammad Burhan Khan, Inamullah

Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.

阑尾粘液囊肿是指粘液物质在阑尾腔内的堆积。虽然术语不精确,因为它不能区分良性和恶性的性质,但术前识别是必要的,因为在手术处理过程中粘液的溢出会导致严重的并发症,如腹膜假性粘液瘤。阑尾残端出现黏液囊肿,即阑尾发炎器官手术切除后的残余组织,是一种极为罕见的现象,文献中报道的病例并不多。在这篇综述中,我们讨论了所有在英语文献中报道的病例。
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引用次数: 3
Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer. 腹腔镜与开放式结肠系膜全切除术治疗右结肠癌。
IF 1.5 Q2 Medicine Pub Date : 2021-02-02 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8859879
Ali Zedan, Essam Elshiekh, Mohamed I Omar, Mohamad Raafat, Salah M Khallaf, Haisam Atta, Marwa T Hussien
Results The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266). Conclusions In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.
结果:LCME组平均手术时间明显长于OCME组,平均术中出血量较少。在LCME组中,有4例患者(8.3%)需要转换。腹腔镜较开放入路淋巴结清扫数增加(分别为39.81±16.74比32.65±12.28,P=0.010)。腹腔镜入路与术后首次放屁的时间间隔较短,与术后液体和正常饮食的时间间隔较短有关。LCME组术后住院时间明显缩短。LCME组的并发症发生率(14.7%)略低于OCME组(27.2%)(P=0.252)。LCME组3年OS与OCME组相似(分别为78.2% vs. 63.2%, P值= 0.423)。腹腔镜组3年DFS(74.5%)高于开放组(60.0%),但差异无统计学意义(P值= 0.266)。结论:总之,如果有外科医生的专业知识,腹腔镜CME右半结肠切除术在技术上是可行和安全的。LCME具有与开放手术治疗II期或III期结肠癌患者相当的长期肿瘤预后(复发和生存)。
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引用次数: 8
Critical Analysis of Stage IV Epithelial Ovarian Cancer Patients after Treatment with Neoadjuvant Chemotherapy followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). IV期上皮性卵巢癌患者接受新辅助化疗后细胞减少手术和腹腔热化疗(CRS/HIPEC)的关键分析。
IF 1.5 Q2 Medicine Pub Date : 2020-12-16 eCollection Date: 2020-01-01 DOI: 10.1155/2020/1467403
Carlos A Munoz-Zuluaga, Armando Sardi, Michelle Sittig, Vadim Gushchin, Mary C King, Carol Nieroda, Felipe Lopez-Ramirez, Teresa P Diaz-Montes

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients.

Methods: Advanced EOC from 2015-2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed. Perioperative factors were assessed. Overall survival (OS) and progression-free survival (PFS) were analyzed by stage.

Results: Twenty-seven FIGO stage IIIC (n = 12) and IV (n = 15) patients were reviewed. Median NACT cycles were 3 and 4, respectively. Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV. SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively. Median organ resections were 6 and 7, respectively. Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality. Median time to adjuvant chemotherapy was 53 and 74 days, respectively (p=0.007). SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV (p=0.269). SIII 1-year PFS was 54%; median PFS: 12 months. SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months (p=0.944).

Conclusion: Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.

背景:新辅助化疗(NACT)后的细胞减少手术和腹腔内高温化疗(CRS/HIPEC)有望成为IIIC期(SIII)上皮性卵巢癌(EOC)的初始治疗方法;然而,IV期(SIV)的结果很少被报道。我们评估了与SIII患者相比,NACT + CRS/HIPEC治疗新诊断的SIV EOC的经验和结果。方法:回顾2015-2018年因疾病不可切除或表现不佳而采用NACT(卡铂/紫杉醇)治疗的晚期EOC,并随访CRS/HIPEC。评估围手术期因素。分阶段分析总生存期(OS)和无进展生存期(PFS)。结果:回顾了27例FIGO IIIC期(n = 12)和IV期(n = 15)患者。中位NACT周期分别为3和4。nact后,SIII患者的91%、91%和100%以及SIV患者的85%、92%和71%的网膜结块、腹水和胸腔积液减少/消除。SIII/SIV中位PCI分别为21和20,分别获得92%和100%的完全细胞减少(≤0.25 cm)。中位器官切除分别为6例和7例。III/IV级手术并发症为0% SIII和23% SIV,无住院死亡率。辅助化疗的中位时间分别为53天和74天(p=0.007)。SIII的1年和2年OS分别为100%和83%,SIV的87%和76% (p=0.269)。SIII 1年PFS为54%;中位PFS: 12个月。SIV 1年和2年PFS分别为47%和23%;中位PFS: 12个月(p=0.944)。结论:选择最初诊断和不可切除的SIV EOC的结果与NACT + CRS/HIPEC后的SIV EOC相似。SIV EOC可能受益于CRS/HIPEC,进一步的研究应该探索这种治疗方法。
{"title":"Critical Analysis of Stage IV Epithelial Ovarian Cancer Patients after Treatment with Neoadjuvant Chemotherapy followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC).","authors":"Carlos A Munoz-Zuluaga,&nbsp;Armando Sardi,&nbsp;Michelle Sittig,&nbsp;Vadim Gushchin,&nbsp;Mary C King,&nbsp;Carol Nieroda,&nbsp;Felipe Lopez-Ramirez,&nbsp;Teresa P Diaz-Montes","doi":"10.1155/2020/1467403","DOIUrl":"https://doi.org/10.1155/2020/1467403","url":null,"abstract":"<p><strong>Background: </strong>Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients.</p><p><strong>Methods: </strong>Advanced EOC from 2015-2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed. Perioperative factors were assessed. Overall survival (OS) and progression-free survival (PFS) were analyzed by stage.</p><p><strong>Results: </strong>Twenty-seven FIGO stage IIIC (<i>n</i> = 12) and IV (<i>n</i> = 15) patients were reviewed. Median NACT cycles were 3 and 4, respectively. Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV. SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively. Median organ resections were 6 and 7, respectively. Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality. Median time to adjuvant chemotherapy was 53 and 74 days, respectively (<i>p</i>=0.007). SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV (<i>p</i>=0.269). SIII 1-year PFS was 54%; median PFS: 12 months. SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months (<i>p</i>=0.944).</p><p><strong>Conclusion: </strong>Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1467403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38767730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Inadvertent Inguinal Sarcoma Excision during Hernia Surgery: Outcomes, Gender Analysis, and Prevention. 疝气手术中不慎腹股沟肉瘤切除:结果、性别分析和预防。
IF 1.5 Q2 Medicine Pub Date : 2020-12-07 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8374790
Joshua M Lawrenz, James P Norris, Marcus C Tan, Eric T Shinohara, John J Block, Elizabeth J Davis, Vicki L Keedy, Jennifer L Halpern, Ginger E Holt, Herbert S Schwartz

Introduction: Inadvertent excision of a soft tissue sarcoma during hernia surgery is a preventable clinical scenario that leads to unnecessary patient morbidity. Prior series are few, which only include male patients with little focus on prevention. The purpose of this study is to report the presenting features and outcomes of both male and female patients who underwent inadvertent inguinal sarcoma excision during hernia surgery.

Methods: A retrospective analysis of a single sarcoma referral center identified 33 patients who were referred for definitive treatment. Patients were divided into three clinically relevant groups based on intraoperative diagnosis, sex, and location of the mass relative to the inguinal ligament. T-tests and Fisher's exact tests were performed to compare continuous and categorical variables, respectively. Kaplan-Meier modeling was performed to assess sarcoma-specific survival.

Results: Females were younger (47 years vs. 61 years, p=0.003) and had smaller sarcomas (6.7 cm vs. 11 cm, p=0.012) compared to males. Only two sarcomas (2/33, 6%) were <4 cm in size. The majority of sarcomas in females were above the inguinal ligament (12/14, 86%). Twenty-nine (88%) underwent definitive R0 excision. The mean number of surgeries per patient was three (range 1-13), with nineteen (58%) patients requiring flap reconstruction and six (18%) requiring vascular bypass. Five patients locally recurred (15%) at a mean of 38 months after definitive excision (range 5-128 months). Overall sarcoma-specific disease-free survival was 64%, with no difference between males (80 ± 11%) and females (59 ± 17%) (p=0.885). Mean follow-up was 75 months (range 5-212).

Conclusion: This is the second largest study regarding inadvertent inguinal sarcoma excision and the first to include females. When a suspected hernia is >4 cm, irreducible, firm, and is growing, especially in females, consider obtaining preoperative advanced three-dimensional imaging (CT or MRI) that can differentiate a neoplasm from a hernia.

简介:在疝气手术中不慎切除软组织肉瘤是一种可预防的临床情况,导致不必要的患者发病率。以前的系列很少,只包括男性患者,很少关注预防。本研究的目的是报告在疝手术中不慎切除腹股沟肉瘤的男性和女性患者的表现特征和结果。方法:回顾性分析单个肉瘤转诊中心确定了33例转诊患者进行最终治疗。根据术中诊断、性别和肿块相对于腹股沟韧带的位置,将患者分为三个临床相关组。分别进行t检验和Fisher精确检验来比较连续变量和分类变量。采用Kaplan-Meier模型评估肉瘤特异性生存。结果:与男性相比,女性更年轻(47岁对61岁,p=0.003),肉瘤更小(6.7 cm对11 cm, p=0.012)。只有2例肉瘤(2/ 33,6 %)p=0.885)。平均随访75个月(范围5-212)。结论:这是关于无意中腹股沟肉瘤切除的第二大研究,也是第一个包括女性的研究。当疑似疝> 4cm,不可缩小,坚固且正在生长时,尤其是女性,应考虑术前进行先进的三维成像(CT或MRI),以区分肿瘤和疝。
{"title":"Inadvertent Inguinal Sarcoma Excision during Hernia Surgery: Outcomes, Gender Analysis, and Prevention.","authors":"Joshua M Lawrenz,&nbsp;James P Norris,&nbsp;Marcus C Tan,&nbsp;Eric T Shinohara,&nbsp;John J Block,&nbsp;Elizabeth J Davis,&nbsp;Vicki L Keedy,&nbsp;Jennifer L Halpern,&nbsp;Ginger E Holt,&nbsp;Herbert S Schwartz","doi":"10.1155/2020/8374790","DOIUrl":"https://doi.org/10.1155/2020/8374790","url":null,"abstract":"<p><strong>Introduction: </strong>Inadvertent excision of a soft tissue sarcoma during hernia surgery is a preventable clinical scenario that leads to unnecessary patient morbidity. Prior series are few, which only include male patients with little focus on prevention. The purpose of this study is to report the presenting features and outcomes of both male and female patients who underwent inadvertent inguinal sarcoma excision during hernia surgery.</p><p><strong>Methods: </strong>A retrospective analysis of a single sarcoma referral center identified 33 patients who were referred for definitive treatment. Patients were divided into three clinically relevant groups based on intraoperative diagnosis, sex, and location of the mass relative to the inguinal ligament. <i>T</i>-tests and Fisher's exact tests were performed to compare continuous and categorical variables, respectively. Kaplan-Meier modeling was performed to assess sarcoma-specific survival.</p><p><strong>Results: </strong>Females were younger (47 years vs. 61 years, <i>p</i>=0.003) and had smaller sarcomas (6.7 cm vs. 11 cm, <i>p</i>=0.012) compared to males. Only two sarcomas (2/33, 6%) were <4 cm in size. The majority of sarcomas in females were above the inguinal ligament (12/14, 86%). Twenty-nine (88%) underwent definitive R0 excision. The mean number of surgeries per patient was three (range 1-13), with nineteen (58%) patients requiring flap reconstruction and six (18%) requiring vascular bypass. Five patients locally recurred (15%) at a mean of 38 months after definitive excision (range 5-128 months). Overall sarcoma-specific disease-free survival was 64%, with no difference between males (80 ± 11%) and females (59 ± 17%) (<i>p</i>=0.885). Mean follow-up was 75 months (range 5-212).</p><p><strong>Conclusion: </strong>This is the second largest study regarding inadvertent inguinal sarcoma excision and the first to include females. When a suspected hernia is >4 cm, irreducible, firm, and is growing, especially in females, consider obtaining preoperative advanced three-dimensional imaging (CT or MRI) that can differentiate a neoplasm from a hernia.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8374790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
期刊
International Journal of Surgical Oncology
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