Pub Date : 2024-12-01Epub Date: 2024-03-07DOI: 10.1016/j.suronc.2024.102057
Austin Yu, Linus Lee, Thomas Yi, Michael Fice, Rohan K Achar, Sarah Tepper, Conor Jones, Evan Klein, Neil Buac, Nicolas Lopez-Hisijos, Matthew W Colman, Steven Gitelis, Alan T Blank
Purpose: Machine learning (ML) models have been used to predict cancer survival in several sarcoma subtypes. However, none have investigated extremity leiomyosarcoma (LMS). ML is a powerful tool that has the potential to better prognosticate extremity LMS.
Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of histologic extremity LMS (n = 634). Patient, tumor, and treatment characteristics were recorded, and ML models were developed to predict 1-, 3-, and 5-year survival. The best performing ML model was externally validated using an institutional cohort of extremity LMS patients (n = 46).
Results: All ML models performed best at the 1-year time point and worst at the 5-year time point. On internal validation within the SEER cohort, the best models had c-statistics of 0.75-0.76 at the 5-year time point. The Random Forest (RF) model was the best performing model and used for external validation. This model also performed best at 1-year and worst at 5-year on external validation with c-statistics of 0.90 and 0.87, respectively. The RF model was well calibrated on external validation. This model has been made publicly available at https://rachar.shinyapps.io/lms_app/ CONCLUSIONS: ML models had excellent performance for survival prediction of extremity LMS. Future studies incorporating a larger institutional cohort may be needed to further validate the ML model for LMS prognostication.
{"title":"Development and external validation of a machine learning model for prediction of survival in extremity leiomyosarcoma.","authors":"Austin Yu, Linus Lee, Thomas Yi, Michael Fice, Rohan K Achar, Sarah Tepper, Conor Jones, Evan Klein, Neil Buac, Nicolas Lopez-Hisijos, Matthew W Colman, Steven Gitelis, Alan T Blank","doi":"10.1016/j.suronc.2024.102057","DOIUrl":"10.1016/j.suronc.2024.102057","url":null,"abstract":"<p><strong>Purpose: </strong>Machine learning (ML) models have been used to predict cancer survival in several sarcoma subtypes. However, none have investigated extremity leiomyosarcoma (LMS). ML is a powerful tool that has the potential to better prognosticate extremity LMS.</p><p><strong>Methods: </strong>The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of histologic extremity LMS (n = 634). Patient, tumor, and treatment characteristics were recorded, and ML models were developed to predict 1-, 3-, and 5-year survival. The best performing ML model was externally validated using an institutional cohort of extremity LMS patients (n = 46).</p><p><strong>Results: </strong>All ML models performed best at the 1-year time point and worst at the 5-year time point. On internal validation within the SEER cohort, the best models had c-statistics of 0.75-0.76 at the 5-year time point. The Random Forest (RF) model was the best performing model and used for external validation. This model also performed best at 1-year and worst at 5-year on external validation with c-statistics of 0.90 and 0.87, respectively. The RF model was well calibrated on external validation. This model has been made publicly available at https://rachar.shinyapps.io/lms_app/ CONCLUSIONS: ML models had excellent performance for survival prediction of extremity LMS. Future studies incorporating a larger institutional cohort may be needed to further validate the ML model for LMS prognostication.</p>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":" ","pages":"102057"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.suronc.2024.102168
Patrick Soldath , Philip Ryom , René Horsleben Petersen
Background
To compare short-term mortality and long-term overall survival between sleeve lobectomy and pneumonectomy for centrally located non-small cell lung cancer (NSCLC).
Methods
We retrospectively reviewed patients who had been radically resected for NSCLC by sleeve lobectomy with or without pulmonary arterioplasty at our institution between 2009 and 2023. We then propensity score-matched the patients with pneumonectomy counterparts from a national registry and compared their 30- and 90-day mortality and long-term overall survival before and after matching. The mortality was compared using independence tests and the overall survival using Kaplan-Meier estimates and the log-rank test.
Results
The study included 109 sleeve lobectomy patients and 315 pneumonectomy patients, of whom 60 patients from each group were matched. The 30- and 90-day mortality was similar between both the unmatched and matched groups (unmatched: 3.7 % vs 5.1 % and 5.5 % vs 9.2 %; matched: 5.0 % vs 6.7 % and 5.0 % vs 12 %. All p-values >0.05). The overall survival was longer in both the unmatched and matched sleeve lobectomy patients (unmatched: hazard ratio [HR] 0.52, 95 % confidence interval [CI] 0.37–0.73, p < 0.001; matched HR 0.55, 95 % CI 0.34–0.90, p = 0.018). The 5-year overall survival was 68 % and 49 % for the unmatched sleeve lobectomy and pneumonectomy patients, respectively, and 61 % and 42 % for the matched ones.
Conclusions
Sleeve lobectomy yields non-inferior short-term mortality and superior long-term overall survival compared with pneumonectomy and should be the resection of choice for centrally located NSCLC when feasible.
比较袖状肺叶切除术和全肺切除术治疗中心位置非小细胞肺癌（NSCLC）的短期死亡率和长期总生存率。方法回顾性分析2009年至2023年在我院行非小细胞肺癌套筒肺叶切除术合并或不合并肺动脉成形术的患者。然后，我们对全国登记的肺切除术患者进行倾向评分匹配，并比较匹配前后的30天和90天死亡率和长期总生存率。使用独立检验比较死亡率，使用Kaplan-Meier估计和log-rank检验比较总生存率。结果本研究纳入套筒肺叶切除术患者109例，全肺切除术患者315例，两组各匹配60例。未匹配组和匹配组的30天和90天死亡率相似(未匹配组：3.7% vs 5.1%和5.5% vs 9.2%；匹配：5.0% vs 6.7%, 5.0% vs 12%。p值均为>；0.05)。未配对和配对袖叶切除术患者的总生存时间更长(未配对：风险比[HR] 0.52, 95%可信区间[CI] 0.37-0.73, p <；0.001;匹配HR 0.55, 95% CI 0.34-0.90, p = 0.018)。未匹配的袖状肺叶切除术和全肺切除术患者的5年总生存率分别为68%和49%，匹配的患者的5年总生存率分别为61%和42%。结论与全肺切除术相比，套筒肺叶切除术短期死亡率不低于全肺切除术，长期总生存率高于全肺切除术，在可行的情况下，应作为中心位置非小细胞肺癌的首选切除术。
{"title":"Long-term survival after sleeve lobectomy versus pneumonectomy for non-small cell lung cancer","authors":"Patrick Soldath , Philip Ryom , René Horsleben Petersen","doi":"10.1016/j.suronc.2024.102168","DOIUrl":"10.1016/j.suronc.2024.102168","url":null,"abstract":"<div><h3>Background</h3><div>To compare short-term mortality and long-term overall survival between sleeve lobectomy and pneumonectomy for centrally located non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients who had been radically resected for NSCLC by sleeve lobectomy with or without pulmonary arterioplasty at our institution between 2009 and 2023. We then propensity score-matched the patients with pneumonectomy counterparts from a national registry and compared their 30- and 90-day mortality and long-term overall survival before and after matching. The mortality was compared using independence tests and the overall survival using Kaplan-Meier estimates and the log-rank test.</div></div><div><h3>Results</h3><div>The study included 109 sleeve lobectomy patients and 315 pneumonectomy patients, of whom 60 patients from each group were matched. The 30- and 90-day mortality was similar between both the unmatched and matched groups (unmatched: 3.7 % vs 5.1 % and 5.5 % vs 9.2 %; matched: 5.0 % vs 6.7 % and 5.0 % vs 12 %. All p-values >0.05). The overall survival was longer in both the unmatched and matched sleeve lobectomy patients (unmatched: hazard ratio [HR] 0.52, 95 % confidence interval [CI] 0.37–0.73, p < 0.001; matched HR 0.55, 95 % CI 0.34–0.90, p = 0.018). The 5-year overall survival was 68 % and 49 % for the unmatched sleeve lobectomy and pneumonectomy patients, respectively, and 61 % and 42 % for the matched ones.</div></div><div><h3>Conclusions</h3><div>Sleeve lobectomy yields non-inferior short-term mortality and superior long-term overall survival compared with pneumonectomy and should be the resection of choice for centrally located NSCLC when feasible.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102168"},"PeriodicalIF":2.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-23DOI: 10.1016/j.suronc.2024.102169
A Hamadalnile, M Mariathasan, Mahmud Riad, A G Patel, S Atkinson, A A Prachalias, P Srinivasan, L Jiao, R H Bhogal, K Menon, C Schneider
Background: During the Covid-19 pandemic cancer surgery was severely affected due to relocation of healthcare resources and the resulting restructuring of cancer pathways. Although this potentially affected rapidly progressing malignancies like pancreatic cancer the most, little is known about long-term outcomes following pancreatectomy.
Materials and methods: Survival data from two pancreatic surgery centres in the UK was analysed with patients being compared across pre-pandemic (C19-) and intra-pandemic (C19+) groups. Demographic, pathological and surgical pathway parameters were evaluated with multivariate analysis and propensity score matching.
Results: Out of 123 patients, 60 had surgery during the pandemic. The main strategy to reduce disruptions to pancreatic surgery was relocation of services to private sector facilities without emergency medicine departments. Although time to surgery was delayed by almost 20 days during the pandemic, there were no significant differences in overall survival at 22 months vs. 24 months or disease free survival at 15 months vs. 16 months for the C19+ and C19- groups, respectively. Adjuvant chemotherapy, Charlson comorbidity score, tumour stage and resection margin status were found to be independent predictors for overall survival whereas only adjuvant chemotherapy and Charlson comorbidity score were predictive of disease free survival.
Conclusion: This article provides a template for the effective restructuring of pancreatectomy pathways during a pandemic with associated lockdowns and provides the first evidence that the quality of outcomes can be maintained in this difficult environment. It is hoped that these results will provide a framework for addressing surgical oncology challenges in future pandemics.
{"title":"Delayed surgery during the Covid-19 pandemic did not affect long-term outcomes of pancreatic adenocarcinoma.","authors":"A Hamadalnile, M Mariathasan, Mahmud Riad, A G Patel, S Atkinson, A A Prachalias, P Srinivasan, L Jiao, R H Bhogal, K Menon, C Schneider","doi":"10.1016/j.suronc.2024.102169","DOIUrl":"https://doi.org/10.1016/j.suronc.2024.102169","url":null,"abstract":"<p><strong>Background: </strong>During the Covid-19 pandemic cancer surgery was severely affected due to relocation of healthcare resources and the resulting restructuring of cancer pathways. Although this potentially affected rapidly progressing malignancies like pancreatic cancer the most, little is known about long-term outcomes following pancreatectomy.</p><p><strong>Materials and methods: </strong>Survival data from two pancreatic surgery centres in the UK was analysed with patients being compared across pre-pandemic (C19-) and intra-pandemic (C19+) groups. Demographic, pathological and surgical pathway parameters were evaluated with multivariate analysis and propensity score matching.</p><p><strong>Results: </strong>Out of 123 patients, 60 had surgery during the pandemic. The main strategy to reduce disruptions to pancreatic surgery was relocation of services to private sector facilities without emergency medicine departments. Although time to surgery was delayed by almost 20 days during the pandemic, there were no significant differences in overall survival at 22 months vs. 24 months or disease free survival at 15 months vs. 16 months for the C19+ and C19- groups, respectively. Adjuvant chemotherapy, Charlson comorbidity score, tumour stage and resection margin status were found to be independent predictors for overall survival whereas only adjuvant chemotherapy and Charlson comorbidity score were predictive of disease free survival.</p><p><strong>Conclusion: </strong>This article provides a template for the effective restructuring of pancreatectomy pathways during a pandemic with associated lockdowns and provides the first evidence that the quality of outcomes can be maintained in this difficult environment. It is hoped that these results will provide a framework for addressing surgical oncology challenges in future pandemics.</p>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"102169"},"PeriodicalIF":2.3,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.suronc.2024.102170
E. Raimond , C. Ambroise , Y. Kerbage , L. Ouldamer , S. Bendifallah , X. Carcopino , M. Koskas , P.A. Bolze , V. Lavoué , T. Gauthier , O. Graesslin , A. Fauconnier , C. Huchon , Francogyn Group
Introduction
Vulvar cancer is a rare cancer, it most often affects older women, with tumours of more advanced size and stage than in younger patients. The first-line treatment for vulvar cancer is surgery. Current European and American guidelines recommend negative histological margins. As tumor size is greater in older patients, the aim of this study was to assess the impact of patient age on surgical excision margins in squamous cell carcinomas of the vulva.
Material and method
This was a retrospective multicenter observational study. A descriptive analysis of the population was performed and a univariate analysis was performed according to patient age. Survival data were plotted using the Kaplan-Meier method and compared using a log rank test. Survival was analyzed using a Cox model to calculate the Hazard Ratio.
Results
Among the 547 patients included, there were 206 patients <65 years and 341 ≥ 65 years, including 135 ≥ 80 years. Median postoperative histological lesion size and interquartile range was greater in patients ≥65 years (30 mm [18–45] versus 26 mm [14–34], p < 0.001). Patients ≥65 years of age more often benefited from radical total vulvectomy (n = 103 (28.8 %) versus n = 44 (20.4 %), p = 0.03). However, negative surgical excision margins were identical between the 2 groups (n = 180 (87.4 %) versus n = 286 (83.9 %), p = 0.21). Revision surgery was performed more frequently in patients <65 years. Recurrence-free survival was better in patients aged <65 years (HR = 0.60; CI95 % (0.45–0.82), p = 0.001).
Conclusion
Despite larger tumour size, age is not a factor influencing the achievement of negative excision margins in squamous cell carcinomas of the vulva, at the cost of more radical surgery.
{"title":"Impact of age on surgical excision margins for vulvar squamous cell carcinomas: A multicenter study by the francogyn group","authors":"E. Raimond , C. Ambroise , Y. Kerbage , L. Ouldamer , S. Bendifallah , X. Carcopino , M. Koskas , P.A. Bolze , V. Lavoué , T. Gauthier , O. Graesslin , A. Fauconnier , C. Huchon , Francogyn Group","doi":"10.1016/j.suronc.2024.102170","DOIUrl":"10.1016/j.suronc.2024.102170","url":null,"abstract":"<div><h3>Introduction</h3><div>Vulvar cancer is a rare cancer, it most often affects older women, with tumours of more advanced size and stage than in younger patients. The first-line treatment for vulvar cancer is surgery. Current European and American guidelines recommend negative histological margins. As tumor size is greater in older patients, the aim of this study was to assess the impact of patient age on surgical excision margins in squamous cell carcinomas of the vulva.</div></div><div><h3>Material and method</h3><div>This was a retrospective multicenter observational study. A descriptive analysis of the population was performed and a univariate analysis was performed according to patient age. Survival data were plotted using the Kaplan-Meier method and compared using a log rank test. Survival was analyzed using a Cox model to calculate the Hazard Ratio.</div></div><div><h3>Results</h3><div>Among the 547 patients included, there were 206 patients <65 years and 341 ≥ 65 years, including 135 ≥ 80 years. Median postoperative histological lesion size and interquartile range was greater in patients ≥65 years (30 mm [18–45] versus 26 mm [14–34], p < 0.001). Patients ≥65 years of age more often benefited from radical total vulvectomy (n = 103 (28.8 %) versus n = 44 (20.4 %), p = 0.03). However, negative surgical excision margins were identical between the 2 groups (n = 180 (87.4 %) versus n = 286 (83.9 %), p = 0.21). Revision surgery was performed more frequently in patients <65 years. Recurrence-free survival was better in patients aged <65 years (HR = 0.60; CI95 % (0.45–0.82), p = 0.001).</div></div><div><h3>Conclusion</h3><div>Despite larger tumour size, age is not a factor influencing the achievement of negative excision margins in squamous cell carcinomas of the vulva, at the cost of more radical surgery.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102170"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Standard gastrectomy with D2 lymph node (LN) dissection for gastric cancer involves peripancreatic lymphadenectomy [1]. This technically demanding procedure requires meticulous dissection within the dissectable layers of connective tissue, while identifying and preserving the pancreas [2]. Our previous study demonstrated the proficiency of Eureka, a surgical artificial intelligence (AI) system, in recognizing both connective tissue and the pancreas [3,4]. Dual highlighting of these structures is expected to reduce surgeon stress by aiding in anatomical identification, thereby ensuring safer and more accurate surgery.
Methods
Connective tissue and the pancreas were highlighted by the surgical AI system in surgical videos on no. 6 (infrapyloric LNs), no. 8 (LNs along the common hepatic artery), and no. 13 (LNs on the posterior surface of the pancreatic head) dissection. These videos were specifically selected as surgeons encountered difficulty in distinguishing the dissectable layers and the pancreatic process.
Results
All videos showed variations of pancreatic morphologies that differed in size and shape. The AI system consistently highlighted the pancreatic process even during initial exploration. Furthermore, it recognized connective tissue, which delineated the appropriate layers for dissection.
Conclusions
The surgical AI system accurately demonstrated dual highlighting of the pancreatic process and connective tissues. Although there are challenges for clinical application, this system can be a valuable tool for anatomical guidance and recognition during surgery, potentially leading to safer and better outcomes.
{"title":"The potential of AI-assisted gastrectomy with dual highlighting of pancreas and connective tissue","authors":"Tatsuro Nakamura, Yasunori Kurahashi, Yoshinori Ishida, Hisashi Shinohara","doi":"10.1016/j.suronc.2024.102171","DOIUrl":"10.1016/j.suronc.2024.102171","url":null,"abstract":"<div><h3>Background</h3><div>Standard gastrectomy with D2 lymph node (LN) dissection for gastric cancer involves peripancreatic lymphadenectomy [<span><span>1</span></span>]. This technically demanding procedure requires meticulous dissection within the dissectable layers of connective tissue, while identifying and preserving the pancreas [<span><span>2</span></span>]. Our previous study demonstrated the proficiency of Eureka, a surgical artificial intelligence (AI) system, in recognizing both connective tissue and the pancreas [<span><span>3</span></span>,<span><span>4</span></span>]. Dual highlighting of these structures is expected to reduce surgeon stress by aiding in anatomical identification, thereby ensuring safer and more accurate surgery.</div></div><div><h3>Methods</h3><div>Connective tissue and the pancreas were highlighted by the surgical AI system in surgical videos on no. 6 (infrapyloric LNs), no. 8 (LNs along the common hepatic artery), and no. 13 (LNs on the posterior surface of the pancreatic head) dissection. These videos were specifically selected as surgeons encountered difficulty in distinguishing the dissectable layers and the pancreatic process.</div></div><div><h3>Results</h3><div>All videos showed variations of pancreatic morphologies that differed in size and shape. The AI system consistently highlighted the pancreatic process even during initial exploration. Furthermore, it recognized connective tissue, which delineated the appropriate layers for dissection.</div></div><div><h3>Conclusions</h3><div>The surgical AI system accurately demonstrated dual highlighting of the pancreatic process and connective tissues. Although there are challenges for clinical application, this system can be a valuable tool for anatomical guidance and recognition during surgery, potentially leading to safer and better outcomes.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102171"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.suronc.2024.102166
Ji Hoon Kim
{"title":"Laparoscopic subsegmentectomy 5 for deeply located hepatocellular carcinoma surrounded by major portal pedicles and middle hepatic vein","authors":"Ji Hoon Kim","doi":"10.1016/j.suronc.2024.102166","DOIUrl":"10.1016/j.suronc.2024.102166","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102166"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.suronc.2024.102167
Danielle Lavy , Michal Shimonovitz , Daniel Keidar , Anton Warshavsky , Yonatan Lessing , Adam Abu-Abeid , Schlomo Schneebaum , Mor Miodovnik , Eran Nizri
Introduction
Sentinel lymph node biopsy (SLNB) is a key procedure in the staging and management of melanoma. Traditionally, it is performed using a dual-mapping technique combining a radioactive isotope (RI) and blue dye (BD). Fluorescence-guided surgery with indocyanine green (ICG) has emerged as an alternative tracer, offering potential advantages in real-time visualization and operative efficiency. This study compares the efficacy of RI + ICG with RI + BD in SLNB for melanoma.
Methods
We conducted a retrospective cohort study at a single center, including 311 patients who underwent SLNB for melanoma. Patients were divided into two groups: RI + BD (n = 227, January 2010–August 2022) and RI + ICG (n = 84, August 2022–February 2024). SLN detection rates, positive SLN rates, operative times, and postoperative complications were compared between the two groups.
Results
Both groups were clinically and pathologically comparable. SLN detection rates were 100 % in the RI + BD group and 98.8 % in the RI + ICG group (p = 0.1). The median number of lymph nodes resected was lower in the RI + ICG group as compared to the RI + BD group (p = 0.047). While positive SLN rates were higher in the RI + ICG group (9.5 % vs. 6.2 %), this difference was not statistically significant (p = 0.3). ICG alone could not identify all the positive SLN. Postoperative complications, including seroma, did not differ significantly between groups.
Conclusions
ICG-guided SLNB is comparable to BD-guided SLNB in terms of detection rate and SLN positivity, although it can not be used alone to identify all positive SLNBs. ICG-based fluorescence imaging is a promising technique that may enhance surgical efficiency in melanoma management.
{"title":"ICG-guided sentinel lymph node biopsy in melanoma is as effective as blue dye: A retrospective analysis","authors":"Danielle Lavy , Michal Shimonovitz , Daniel Keidar , Anton Warshavsky , Yonatan Lessing , Adam Abu-Abeid , Schlomo Schneebaum , Mor Miodovnik , Eran Nizri","doi":"10.1016/j.suronc.2024.102167","DOIUrl":"10.1016/j.suronc.2024.102167","url":null,"abstract":"<div><h3>Introduction</h3><div>Sentinel lymph node biopsy (SLNB) is a key procedure in the staging and management of melanoma. Traditionally, it is performed using a dual-mapping technique combining a radioactive isotope (RI) and blue dye (BD). Fluorescence-guided surgery with indocyanine green (ICG) has emerged as an alternative tracer, offering potential advantages in real-time visualization and operative efficiency. This study compares the efficacy of RI + ICG with RI + BD in SLNB for melanoma.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at a single center, including 311 patients who underwent SLNB for melanoma. Patients were divided into two groups: RI + BD (n = 227, January 2010–August 2022) and RI + ICG (n = 84, August 2022–February 2024). SLN detection rates, positive SLN rates, operative times, and postoperative complications were compared between the two groups.</div></div><div><h3>Results</h3><div>Both groups were clinically and pathologically comparable. SLN detection rates were 100 % in the RI + BD group and 98.8 % in the RI + ICG group (p = 0.1). The median number of lymph nodes resected was lower in the RI + ICG group as compared to the RI + BD group (p = 0.047). While positive SLN rates were higher in the RI + ICG group (9.5 % vs. 6.2 %), this difference was not statistically significant (p = 0.3). ICG alone could not identify all the positive SLN. Postoperative complications, including seroma, did not differ significantly between groups.</div></div><div><h3>Conclusions</h3><div>ICG-guided SLNB is comparable to BD-guided SLNB in terms of detection rate and SLN positivity, although it can not be used alone to identify all positive SLNBs. ICG-based fluorescence imaging is a promising technique that may enhance surgical efficiency in melanoma management.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102167"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-08DOI: 10.1016/j.suronc.2024.102160
Cristian Mantilla Rosa , Aparna Vancheswaran , Charlotte E. Ariyan
This review explores T-cell immunotherapy for melanoma, highlighting immune checkpoint inhibitors (anti-CTLA-4, anti-PD-1, anti-LAG-3), tumor-infiltrating lymphocytes (TILs), and emerging therapies that engineer T cells with specific receptors or T-cell receptors, such as CAR-T and TCR cells, and RNA vaccines. We discuss the history of T-cell immunotherapy, mechanisms of action, and future directions for improving patient outcomes.
本综述探讨了黑色素瘤的T细胞免疫疗法，重点介绍免疫检查点抑制剂（抗CTLA-4、抗PD-1、抗LAG-3）、肿瘤浸润淋巴细胞（TILs）以及具有特异性受体或T细胞受体的新兴疗法，如CAR-T和TCR细胞以及RNA疫苗。我们将讨论 T 细胞免疫疗法的历史、作用机制以及改善患者预后的未来方向。
{"title":"T-cell immunotherapy for melanoma","authors":"Cristian Mantilla Rosa , Aparna Vancheswaran , Charlotte E. Ariyan","doi":"10.1016/j.suronc.2024.102160","DOIUrl":"10.1016/j.suronc.2024.102160","url":null,"abstract":"<div><div>This review explores T-cell immunotherapy for melanoma, highlighting immune checkpoint inhibitors (anti-CTLA-4, anti-PD-1, anti-LAG-3), tumor-infiltrating lymphocytes (TILs), and emerging therapies that engineer T cells with specific receptors or T-cell receptors, such as CAR-T and TCR cells, and RNA vaccines. We discuss the history of T-cell immunotherapy, mechanisms of action, and future directions for improving patient outcomes.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102160"},"PeriodicalIF":2.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1016/j.suronc.2024.102162
Teodora Dumitra , Mark B. Faries
The initial route of metastasis for many cancers, including melanoma, is via regional lymphatic channels. This fact, recognized more than a century ago, has spurred tremendous interest in the optimal method of assessing and treating lymph nodes and eventually led to the development of lymphatic mapping and sentinel lymph node (SLN) biopsy. The potential utility of nodal treatment includes providing the most accurate staging or prognostic information and removing early metastases in order to halt the cascade of metastatic spread in an effort to save the patient's life. In the past, pathologic assessment of regional lymph nodes required removal of all regional nodes, a procedure that results in moderate levels of short and long-term morbidity. SLN biopsy allows not only a minimally invasive method of nodal assessment, but one more accurate than full node dissection as it permits more intensive pathologic scrutiny of the tissue. The question of the therapeutic effect of SLN biopsy has been a subject of much controversy. There is clear evidence that SLN biopsy improves relapse-free survival in melanoma, but its effect on melanoma-specific and overall survival remains less clear.
{"title":"Melanoma sentinel lymph node biopsy in the modern era","authors":"Teodora Dumitra , Mark B. Faries","doi":"10.1016/j.suronc.2024.102162","DOIUrl":"10.1016/j.suronc.2024.102162","url":null,"abstract":"<div><div>The initial route of metastasis for many cancers, including melanoma, is via regional lymphatic channels. This fact, recognized more than a century ago, has spurred tremendous interest in the optimal method of assessing and treating lymph nodes and eventually led to the development of lymphatic mapping and sentinel lymph node (SLN) biopsy. The potential utility of nodal treatment includes providing the most accurate staging or prognostic information and removing early metastases in order to halt the cascade of metastatic spread in an effort to save the patient's life. In the past, pathologic assessment of regional lymph nodes required removal of all regional nodes, a procedure that results in moderate levels of short and long-term morbidity. SLN biopsy allows not only a minimally invasive method of nodal assessment, but one more accurate than full node dissection as it permits more intensive pathologic scrutiny of the tissue. The question of the therapeutic effect of SLN biopsy has been a subject of much controversy. There is clear evidence that SLN biopsy improves relapse-free survival in melanoma, but its effect on melanoma-specific and overall survival remains less clear.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102162"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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