Surgical Oncology-Oxford最新文献

Background: Human epidermal growth factor receptor type2 (HER2)-low breast cancer has emerged as a clinically relevant subtype with novel HER2-targeted therapies. This study aimed to investigate the clinicopathological features and prognostic implications of HER2-low status in patients with early breast cancer undergoing long-term follow-up.

Methods: We retrospectively analyzed patients with HER2-negative early breast cancer who underwent surgery between 2003 and 2022. We investigated clinicopathological factors associated with HER2-low status and the clinical impacts of HER2-low/zero status on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) according to hormone receptor (HR) status using univariate and multivariate analyses.

Results: Among 3663 patients with early breast cancer, we identified 2519 HER2-negative patients (HER2-low 57%, HER2-zero 28%). HER2-low status was associated with high estrogen-receptor (ER) positivity (Allred score 8) and less mucinous histology, but there was no association with progesterone receptor (PgR) expression. HER2-low status also tended to be associated with pre/perimenopausal status and higher nuclear grade (≥2), but not with tumor size or lobular/metaplastic type. Pathological complete response rates after neoadjuvant chemotherapy were comparable between HER2-low (18.9%) and HER2-zero (21.6%), with no survival differences. HER2 status (low vs. zero) was not significantly associated with DFS, DDFS, or OS, and had no prognostic impact in patients with either HR-positive or -negative disease.

Conclusion: HER2-low breast cancer was characterized by distinct biological features, including high ER positivity (especially Allred score 8) without PgR association, but did not confer a prognostic advantage over HER2-zero disease. HER2-low status may reflect biological heterogeneity that could be relevant when interpreting treatment response rather than serving as an independent prognostic marker.

Background: Medial-to-lateral (ML) approach is the standard technique in laparoscopic surgery for left-sided colon cancer. However, it can be technically challenging; such as in patients with intra-abdominal adhesions or during splenic flexure mobilization. To overcome these difficulties, we adopted a cranial-to-caudal (CC) approach as an alternative technique. This study aimed to compare the CC and ML approaches in terms of short-term clinical and mid-term oncological outcomes.

Methods: Patients performed laparoscopic surgery for left-sided colon cancer between October 2018 and November 2022 were retrospectively analyzed. Patients were classified into two groups. The primary outcome was the length of the resected specimen. Secondary outcomes were pathological parameters, perioperative outcomes, recurrence-free survival (RFS) and overall survival (OS).

Results: Seventy-four patients were included (ML, n = 39; CC, n = 35). The CC group had longer specimen lengths compared with the ML group (32.9 ± 6.8 cm vs 28.9 ± 6.4 cm; p = 0.022), and longer proximal margin (11.8 ± 3.3 cm vs 9.9 ± 2.3 cm; p = 0.004). Lymph node yield was also higher in the CC group (26.4 ± 8.7 vs 22.3 ± 6.5; p = 0.033). On multivariable analysis, specimen length was independently associated with lymph node yield (β = 0.73; 95% CI, 0.47-1.20; p < 0.001). During a mean follow-up of 44 months, RFS (88.6% vs 89.7%; p = 0.84) and OS (88.6% vs 87.2%; p = 0.67) were similar between the groups.

Conclusions: In laparoscopic surgery for left-sided colon cancer, the CC approach yielded longer resected specimens and more lymph node counts compared with the ML approach, but did not improve oncologic outcomes.

Background: Primary hepatic neuroendocrine tumors (PHNETs) are rare neoplasms with limited population-level data to guide treatment. We evaluated clinical, pathologic, and treatment factors associated with surgical intervention and survival using a contemporary national cohort.

Methods: Patients diagnosed with PHNETs from 2000 to 2021 were identified within the Surveillance, Epidemiology, and End Results (SEER) database. Demographic, tumor, and treatment characteristics were analyzed. Multivariable logistic regression identified predictors of surgical resection. Kaplan-Meier and Cox models evaluated overall survival (OS) and cause-specific survival (CSS).

Results: A total of 669 patients met inclusion criteria. Surgical resection was performed in 16.4 % of cases. Compared with localized disease, regional disease was associated with significantly lower odds of surgery (OR 0.25, 95 % CI: 0.14-0.45). Ten-year OS was 21.8 % for localized, 12.5 % for regional, and 4.8 % for distant disease (p < 0.001). Well differentiated tumors were associated with superior 5- and 10-year OS and CSS compared to poorly differentiated tumors (p < 0.001). Among patients with localized or regional disease, surgical resection was associated with a 10-year OS of 44.9 % versus 9.2 % without surgery (p < 0.001). On multivariable analysis, poorly differentiated histology (HR 2.69, 95 % CI: 1.93-3.77) and larger tumor size (HR 1.01, 95 % CI: 1.00-1.01) were associated with increased mortality, while surgical resection remained protective (HR 0.23, 95 % CI: 0.15-0.37).

Conclusions: Surgical resection is associated with significantly improved survival in patients with localized or regional PHNETs. Tumor grade, stage, and size remain key prognostic factors in this rare malignancy.

Background: Numerous blood-based markers have been proposed as potential predictors of malignancy, not only in thyroid but also in various cancer types. This study aimed to evaluate the diagnostic utility of these markers for predicting malignancy in indeterminate thyroid nodules.

Method: After literature review, we identified a set of markers potentially useful for predicting malignancy. Age, gender, nodule size, platelet count, mean platelet volume, platelet distribution width, lymphocyte/monocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet large cell ratio, immature granulocyte, thyroid-stimulating hormone, thyroglobulin, thyroglobulin-antibody and thyroid peroxidase-antibody levels were prospectively collected from patients who underwent thyroidectomy at our institution. The relationship between these markers and malignancy in indeterminate nodules was evaluated.

Results: Among 1392 patients who underwent thyroidectomy between March-2021 and June-2024, 225 were operated for indeterminate thyroid nodules. In these patients, both nodule size ≥4 cm and serum thyroglobulin levels were found to be significantly associated with malignancy in univariate analysis (p < 0.05). ROC curve analysis identified a Tg cut-off value of 299 ng/mL. In multivariate analysis, when a nodule size threshold of 4 cm and a Tg cut-off of 299 ng/mL were applied, the significance of Tg as an independent predictor of malignancy became more pronounced.

Conclusion: The relationship between nodule size and malignancy is known, but elevated thyroglobulin levels have been found to be an independent risk factor for malignancy in indeterminate nodules. Although it needs to be generalized with more data, it is an inexpensive and simple diagnostic test that could guide us in patients with indeterminate cytologic findings.