Indian Journal of Surgical Oncology最新文献

This study aimed to assess the expression of Gata-3 and Il-4 by verifying the presence of Th2 responses in carcinoma lesions under different clinical conditions. Sixty specimens comprising 30 oral tongue squamous cell carcinomas (OTSCCs) and 30 lower lip squamous cell carcinomas (LLSCCs) were randomly selected for the study. Gata-3 was quantified in parenchymal and stromal cells and Il-4 was semi-quantitatively analyzed. The highest Gata-3 ⁺ expressions in LLSCC cases were detected in the total parenchyma (p: 0.000), total stroma (p: 0.000), and total parenchyma/stroma (p: 0.000). Concerning Il-4, higher concentrations were detected in the parenchyma (p: 0.000) in LLSCC cases, while higher concentrations were observed in the stroma (p: 0.000) and in the parenchyma/stroma (p: 0.004) in OTSCC cases. Significant associations between Gata-3 and Il-4 were detected according to the OTSCC region in comparison with LLSCC cases. A higher number of immunolabelled cells for Gata-3 was observed in LLSCCs, suggesting greater Gata-3 expression in less aggressive lesions, potentially reducing the likelihood of tumor invasion and metastasis. Furthermore, higher Il-4 expressions were noted in OTSCC stroma, evidencing not only a higher response (Th2) in this tumor microenvironment but also suggesting that the lower amounts of Il-4 detected in LLSCCs may be associated with a neoplastic growth inhibition mechanism. These findings corroborate the more aggressive OTSCC behavior in comparison with LLSCCs and emphasize the important role of this cytokine and its application in the fight against cancer.

Oral squamous cell carcinoma is the most common malignancy in the head and neck region. The DOI and PNI are important prognostic factors. DOI greater than 4 mm is also used as an indication for elective neck node dissection. FDG-PET/CT is now used in head and neck cancers for the delineation of the primary tumor, detection of regional nodal metastases, distant metastases, and second primary tumors. In our study, we have tried to show the correlation between preoperative FDG uptake values and postoperative histopathological parameters such as DOI and PNI. Two hundred eighty-four patients with OSCC who presented to us underwent whole-body FDG-PET/CT in addition to the routine evaluation. The patients underwent surgeries for the primary lesion and neck dissection. DOI data was segregated into ≤ 4 mm and > 4 mm. PNI was segregated into positive and negative. ROC was plotted to know the cutoff point of SUVmax in predicting DOI and PNI. For predicting the DOI > 4 mm, the cutoff point for SUVmax was 8.88 with a specificity of 76.4 and sensitivity of 69.8 (Youden's index - .660), area under the curve 0.771, and p value of 0.001. For predicting the presence of PNI, the cutoff point for SUVmax was 13.33 with sensitivity of 49.4 and specificity of 70.8. Preoperative FDG PET/CT can predict the depth of invasion in lesions that appear to be less than 4 mm clinically and help in decisions regarding elective neck dissections. Although the sensitivity and specificity of FDG PET/CT in predicting PNI are low but SUVmax above 13.33 can be considered a poor prognostic factor, considering the possibility of PNI positivity. FDG-PET/CT should not only be used for the diagnosis of distant metastases and identification of second primary. It can also be used for the identification of poor prognostic factors such as DOI and PNI.

Due to controversial results, the clinical impact of sex in pancreatic cancer has not been fully clarified. We aimed to investigate the clinical significance of sex in patients with pancreatic cancer in this study. A total of 334 pancreatic cancer patients were assessed retrospectively. Of 334 patients, 109 (32.6%) were women. The distribution of sex according to stages was identical: 52 of 154 patients (33.8%) had metastatic disease, 39 of 122 patients (32.0%) had locally advanced disease, and 18 of 58 patients (31.0%) had local disease (p = 0.9). No significant effect of any clinical variable on sex was observed in all stages, but women had higher serum LDH levels than men in metastatic disease (57.1 vs 20.5%, p = 0.009). Overall survival rates of patients in all stages were similar between sexes; the median overall survival rates in women vs. men were 5.5 vs. 4.35 months, respectively, in patients with metastatic disease (p = 0.2); 9.9 vs. 8.9 months, respectively in patients with locally advanced disease (p = 0.6); and 20.05 vs 17.8 months, respectively, in patients with local disease (p = 0.09). In conclusion, no effect of sex on survival was found in pancreatic cancer patients.

Lung cancer radiotherapy is a complex treatment modality, heavily influenced by tumor motion and the shifting positions of organs at risk (OARs) during the respiratory cycle. This study proposes a personalized radiotherapy planning approach that incorporates respiratory dynamics by utilizing 4D CT imaging. The method integrates advanced segmentation techniques, motion tracking, and optical flow algorithms to track tumor displacement and the relative positions of OARs throughout different respiratory phases. Initially, segmentation is performed using a modified ResNet-50 architecture, tailored to delineate the lungs, tumors, and critical structures accurately. This architecture is enhanced by replacing the last layers with specialized ones to improve resolution and boundary delineation. To address the dynamic nature of respiratory motion, motion tracking algorithms are used to monitor and predict tumor displacement in real time. Additionally, optical flow techniques are employed to assess and compensate for inter-phase motion. For each respiratory phase, segmented slices are reconstructed in 3D using the marching cube algorithm, providing a detailed, continuous representation of the anatomical structures involved. The optimal respiratory phase for treatment is determined by analyzing tumor and OAR movement, ensuring minimal radiation exposure to healthy tissues while maximizing tumor irradiation. This approach has objectified that the choice of the ideal phase varies from one patient to another, depending on tumor size, location, and the proximity of organs at risk. The system is designed to automatically identify this optimal phase, enhancing the accuracy and effectiveness of radiotherapy and leading to improved patient outcomes.

The rising incidence of differentiated thyroid cancer (DTC), particularly papillary thyroid carcinoma (PTC), has sparked interest in de-escalating surgical management to reduce morbidity while maintaining oncological safety. While total thyroidectomy remains the standard of care, hemithyroidectomy has emerged as a potential alternative for low- to moderate-risk PTC. This study evaluates the feasibility and oncological outcomes of hemithyroidectomy compared to total thyroidectomy in a tertiary care center in Northern India. This observational study included 214 patients diagnosed with PTC between 2010 and 2015. Patients were divided into two groups: 107 underwent hemithyroidectomy, and 107 underwent total thyroidectomy. The groups were matched for age, gender, tumor size, and ATA risk stratification. Primary outcomes included disease-free survival (DFS), structural recurrence, and all-cause mortality over 1, 5, and 10 years. Statistical analysis was performed to compare outcomes between the two groups. The mean age at diagnosis was 41.72 ± 5.2 years in the hemithyroidectomy group and 40.6 ± 5.2 years in the total thyroidectomy group (p = 0.47). Tumor size (1.67 ± 0.37cm vs. 1.78 ± 0.30, p = 0.073) and ATA risk stratification (low risk: 65 vs. 61, p = 0.57; intermediate risk: 42 vs. 46, p = 0.57) were comparable. Structural recurrence rates at 1, 5, and 10 years were similar between groups with no statistically significant difference (p = 0.166). The 5-year DFS rates were 95.00% (hemithyroidectomy) and 97.10% (total thyroidectomy), while the 10-year DFS rates were 93.45% and 96.26%, respectively. Hemithyroidectomy demonstrates comparable oncological safety to total thyroidectomy in low- to selected moderate-risk PTC, which include patients with microscopic extra thyroidal extension and microscopic capsular & vascular invasion, supporting its role as a conservative surgical option. Strict adherence to follow-up protocols is essential to detect and manage recurrence promptly. Careful patient selection and individualized treatment planning are critical to achieving optimal outcomes in the era of surgical de-escalation for thyroid cancer.

The American College of Radiology (ACR) created the Breast Imaging Reporting and Data System, or BI-RADS, to standardize the way radiologists report mammography, ultrasound, and MRI findings. This study aimed to compare the diagnostic accuracy of combined mammography and sonography with that of mammography alone in differentiating malignant from benign breast masses. This 3-year, hospital-based cross-sectional study included female patients presenting with breast lumps. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were calculated with histopathology as the gold standard. This study evaluated 590 female patients with breast lumps (mean age 46.3 years), identifying 330 benign and 260 malignant cases. Fibroadenoma and invasive ductal carcinoma were the most common diagnoses. Patient age and body mass index (BMI) were significantly correlated with diagnosis, with an increased incidence of malignancy in the older and higher BMI groups, unlike fertility status; and, crucially, combining mammography with ultrasonography significantly enhanced breast lesion detection. This combined approach increased the sensitivity from 94.62% to 99.23% and the specificity from 86.67% to 90.91%. Consequently, both the PPV (84.83% to 89.58%) and NPV (95.33% to 99.34%) improved, resulting in an overall increase in diagnostic accuracy from 90.17% to 94.58%. This study revealed that combining mammography and sonography significantly improves the diagnostic accuracy for palpable breast masses, especially in differentiating between benign and malignant lesions. Integrating both imaging techniques into standard practice will lead to early diagnosis of malignant lesions and help avoid unnecessary biopsies for benign lesions.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02432-3.

Locally advanced rectal cancer (LARC) poses a significant treatment challenge, as conventional chemo-radiotherapy (CRT) frequently results in poor rates of pathological complete response (pCR) and distant metastasis. Total neoadjuvant chemotherapy followed by surgery may have the potential to improve overall outcomes and are coming onto clinical practice. This study aims to compare the efficacy and safety of TNT (Arm A) versus conventional CRT (Arm-B) in achieving pCR and distant metastasis in both the arms. It is an open-labelled randomized controlled trial. Total 172 patients were enrolled in the trial having histologically confirmed LARC (stages T3-T4 or any T stage with lymph node involvement) from June 2021 to June 2023. Patients were randomized to either Arm-A (n = 87) or Arm-B (n = 85). This interim analysis was conducted after two-thirds of the target sample had completed 1-year follow-up. The patients in the Arm A received preoperative radiotherapy with concurrent capecitabine followed by three cycles of capecitabine plus oxaliplatin (CapOx) while those on Arm B received radiotherapy with concurrent capecitabine only followed by 6 cycles of adjuvant CapOx. The primary objective was pCR, being no residual tumor cells (ypT0N0) in the resection specimen. Secondary endpoints were tumor regression score (TRG), circumferential resection margin (CRM) positivity, radicality of the resection margin, local recurrence and distant metastasis, and safety profile. In the interim analysis, which included 150 patients with 75 in each group, pCR was observed in 16.2% of Arm A and 17.4% of Arm-B (p > 0.05). There was no difference in tumor regression scores between the groups. Nonetheless, the TNT group significantly suffered less with distant metastasis at 1 year (6 vs.16 cases; p = 0.040). Local recurrence, CRM positive, or resection margin status did not show any relative difference. There were no significant adverse effects reported in both groups, and toxicity was moderate. This interim analysis suggests that while pCR is comparable in both the groups, TNT may offer superior systemic control by reducing distant metastasis. The findings also suggests the potential of TNT as a preferred treatment strategy in patients with LARC, though completion of the study and a long term follow-up is required to confirm its benefits. Clinical Trials Registry of India: CTRI/2021/05/033642.

This article focuses on a simple but crucial instrument used in every surgical procedure: the Scalpel. The first step of any surgery is making an incision on the operative site, which opens the way for the surgeon to explore tissue spaces, identify structures, and proceed with the operation. For centuries, surgeons around the world have operated based on the medical systems of their time, aided by available instruments, equipment, and trained paramedical staff-all united in their shared commitment to alleviating human suffering. The history of medicine spans over 3,000 years, from prehistoric times through the Babylonian era, the Arabic period, the Enlightenment, and into the Modern Digital Age. Despite many advancements, the Scalpel remains the First instrument that a surgeon reaches for, to begin an operation. This article delves into the history, significance, and role of the Scalpel, observing how it has withstood the test of time and continues to be indispensable despite the rise of high-tech surgical procedure. Observation is the key to identify the relationship of Surgeon and Scalpel, an inseparable one.

Oral cancer affects millions of people with a high mortality rate throughout the world. Increasing evidences have demonstrated that mircoRNAs (miRNAs) play crucial roles in the modulation of tumour growth and progression, whereas the functional role of miR-539 and miR-6824 in oral cancer is not well established. The mitogen-activated protein kinase (MAPK) pathway has a master control role in various cancer-related biological processes as cell growth, proliferation, differentiation, migration, and apoptosis. Mitogen-activated protein kinase 1, also known as MAP2K1, was verified as the target of miR-539 and miR-6824. In our present study, we sought to explore biological role of miR-539 and miR-6824 in OSCC progression and for better specificity and efficiency; stem-loop primers followed by real-time polymerase chain reaction have been determined. The expression level of miR-539 and miR-6824 expression was downregulated in OSCC tissues (p value = 0.00) (p value = 0.269) and OLP tissues (p value = 0.006) (p value = 0.054). Significant upregulation of MAP2K1 gene was noted in the OLP (p value = 0.034) and OSCC (p value = 0.01), specimens compared with healthy controls. Significant positive correlations were observed between miR-539 and miR-6824 (p value = 0.05). Receiver operating characteristic (ROC) curve analysis was performed to assess the sensitivity and specificity of miRNAs as diagnostic biomarkers and result showed area under the ROC curve (AUC) of map2k1 was 0.92, has_miR_539 the area under ROC curve (AUC) was of 0.982 (p = 0.0001) and has_miR_6824 was 1.000 (p < 0.0001). This study provides the first evidence of the miR-539 and miR-6824 role in oral cancer and suggests a potential therapeutic target and prognostic predictor for oral cancer.

Breast cancer is the commonest cancer among Indian women as it is globally. Margin status post lumpectomy remains an important predictor of local recurrence after breast conserving surgery. We set out to investigate the positive predictive value of intra operative frozen section analysis in a tertiary cancer center in North East India. Retrospective data from all women who underwent breast conserving Surgery (BCS) from 2017 to 2022 was included. Frozen section analysis reports were compared against final pathology reports. Comparison was in regard to margin status. Two hundred ten women underwent BCT, and mean age was 49.5 years. The sensitivity and specificity of frozen section was 92.5% (86.2-95.64% 95% CI) and 99.8% (62.23-99.9% 95% CI) respectively. The PPV and NPV was 94.8% (87.09-99.86% 95% CI) and 99.8% (95.53-99.9% 95 CI). Our analysis showed an accuracy of 99.63% (95.22-99.96%, 95% CI). We concluded that frozen section analysis is accurate and has a high positive predictive value and negative predictive value for margin status in breast conserving surgery.