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Sustained high neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy predicts worse prognosis in patients after esophagectomy for esophageal squamous cell carcinoma 新辅助化疗期间持续高中性粒细胞与淋巴细胞比值预示食管鳞癌切除术后患者预后较差
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-12-02 DOI: 10.1016/j.suronc.2025.102335
Keita Takahashi, Masami Yuda, Yoshitaka Ishikawa, Takanori Kurogochi, Akira Matsumoto, Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Fumiaki Yano, Ken Eto

Purpose

The contribution of the trend of neutrophil-to-lymphocyte ratio (NLR) values during neoadjuvant chemotherapy (NAC) remains poorly understood in patients with esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to clarify the influence of sustained-high-NLR during NAC on the prognosis of ESCC patients undergoing curative esophagectomy after NAC.

Methods

This study analyzed 108 ESCC patients. Patients were divided into four groups as the remained-low-NLR group, the elevated-NLR group, the decreased-NLR group, and the sustained-high-NLR group according to the NLR levels before and after NAC. After that, the backgrounds and perioperative factors were compared among the four groups. Finally, Independent prognostic factors were identified.

Results

The overall survival (OS) was significantly different among the four groups (p = 0.02) and relapse-free survival (RFS) tended to be different among the groups (p = 0.08), with the sustained-high-NLR group having the poorest survival. In a multivariate analysis for OS and RFS, sustained-high-NLR was a significant adverse prognostic factor (p < 0.01; HR, 3.16; 95 % CI, 1.38–7.22 and p = 0.01; HR, 2.45; 95 % CI, 1.22–4.93, respectively).

Conclusions

Consistently elevated NLR during NAC was correlated with an unfavorable prognosis in patients who underwent NAC followed by esophagectomy for ESCC. Additionally, sustainedly high NLR may be a useful biomarker for adjuvant nivolumab.
目的对食管鳞状细胞癌(ESCC)患者新辅助化疗(NAC)期间中性粒细胞与淋巴细胞比值(NLR)值变化趋势的贡献尚不清楚。因此,本研究旨在阐明NAC期间持续高nlr对ESCC患者NAC后行根治性食管切除术预后的影响。方法对108例ESCC患者进行分析。根据NAC前后NLR水平将患者分为维持低NLR组、升高NLR组、降低NLR组和持续高NLR组。比较四组患者的背景及围手术期因素。最后,确定独立的预后因素。结果4组患者总生存期(OS)差异有统计学意义(p = 0.02),无复发生存期(RFS)差异有统计学意义(p = 0.08),其中持续高nlr组生存期最差。在OS和RFS的多变量分析中,持续高nlr是显著的不良预后因素(p < 0.01; HR, 3.16; 95% CI, 1.38-7.22和p = 0.01; HR, 2.45; 95% CI, 1.22-4.93)。结论NAC期间NLR持续升高与行NAC后食管切除术的ESCC患者预后不良相关。此外,持续高NLR可能是辅助纳武单抗的有用生物标志物。
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引用次数: 0
Clinically significant delayed gastric emptying after multivisceral resection for retroperitoneal sarcoma: A retrospective cohort study 腹膜后肉瘤多脏器切除后显著的胃排空延迟:一项回顾性队列研究。
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-12-02 DOI: 10.1016/j.suronc.2025.102336
Dorian Yarih Garcia-Ortega , Luis Antonio Bonilla-Salado , Ana Paulina Meléndez-Fernández , Sylvia Veronica Villavicencio-Valencia , Diyitzia Rosario Irineo-Cerecedo , Cherilynn Martinez-Valdovinos , David Aarón Bujanda-Sandoval , Kuauhyama Luna-Ortiz

Background

Delayed gastric emptying (DGE) is an underrecognized but clinically impactful complication following multivisceral resection (MVR) for retroperitoneal sarcoma (RPS). This study aimed to determine the incidence, risk factors, and postoperative morbidity of clinically significant DGE in a Latin American tertiary referral sarcoma center.

Methods

We conducted a retrospective cohort study of adult patients with primary or recurrent RPS who underwent MVR between January 2020 and December 2024. DGE was defined and graded according to ISGPS criteria, with grades B–C considered clinically significant. Multivariable logistic regression identified independent predictors for DGE. Clinical outcomes were compared by DGE status.

Results

Among 142 patients who underwent MVR, the incidence of clinically significant DGE was 8.6 %. Independent risk factors included tumor size >22 cm (OR 2.25; 95 % CI 1.12–4.50; p = 0.023), dedifferentiated liposarcoma histology (OR 3.52; 95 % CI 1.12–11.01; p = 0.031), and multifocal disease (OR 2.78; 95 % CI 1.03–7.49; p = 0.044). DGE was associated with a prolonged hospital stay (22 vs. 10.5 days, p < 0.001) and a higher rate of ICU admission (9.3 % vs. 2.7 %, p = 0.034). No significant associations were found with major complications or reoperation.

Conclusions

Clinically significant DGE is an infrequent but high-impact complication after MVR for RPS. Tumor-related features such as large size, high-grade histology, and multifocality contribute to its development. Early identification and standardized perioperative strategies may help reduce the incidence and clinical burden of this condition. These findings provide essential data from a historically underrepresented region and support efforts to optimize postoperative recovery in complex sarcoma surgery.
背景:胃排空延迟(DGE)是腹膜后肉瘤(RPS)多脏器切除术(MVR)后未被充分认识但具有临床影响的并发症。本研究旨在确定拉丁美洲三级转诊肉瘤中心临床显著DGE的发病率、危险因素和术后发病率。方法:我们对2020年1月至2024年12月期间接受MVR治疗的原发性或复发性RPS成年患者进行了回顾性队列研究。DGE根据ISGPS标准定义和分级,B-C级被认为具有临床意义。多变量逻辑回归确定了DGE的独立预测因子。根据DGE状态比较临床结果。结果:142例MVR患者中,有临床意义的DGE发生率为8.6%。独立危险因素包括肿瘤大小>22 cm (OR 2.25; 95% CI 1.12-4.50; p = 0.023)、去分化脂肪肉瘤组织学(OR 3.52; 95% CI 1.12-11.01; p = 0.031)和多灶性疾病(OR 2.78; 95% CI 1.03-7.49; p = 0.044)。DGE与延长住院时间相关(22天vs 10.5天)。结论:临床显著的DGE是RPS MVR术后少见但影响较大的并发症。肿瘤的相关特征,如体积大、组织学分级高、多灶性是其发展的原因。早期识别和标准化的围手术期策略可能有助于减少这种情况的发生率和临床负担。这些发现为历史上代表性不足的地区提供了重要数据,并支持优化复杂肉瘤手术术后恢复的努力。
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引用次数: 0
Identification of TRACP 5b as a local recurrence biomarker in giant cell tumor of bone 骨巨细胞瘤局部复发标志物TRACP 5b的鉴定
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-19 DOI: 10.1016/j.suronc.2025.102331
Yu Toda, Koichi Ogura, Shintaro Iwata, Eisuke Kobayashi, Shuhei Osaki, Suguru Fukushima, Akira Kawai

Background

Giant cell tumor of bone (GCTB) has a high potential for local recurrence after surgical treatment. It is characterized by the histological proliferation of osteoclast-like multinucleated giant cells. Tartrate-resistant acid phosphatase 5b (TRACP5b) is a reliable serum marker of bone resorption. This study aimed to investigate the impact of TRACP5b levels on the local recurrence of GCTB following surgical treatment.

Methods

We retrospectively analyzed data from 47 primary GCTB patients who underwent serum TRACP5b testing and surgical treatment between 2015 and 2022. We statistically evaluated the correlation between TRACP5b levels and clinical characteristics. Patients were stratified into two groups based on TRACP5b levels, and the association between TRACP5b and local recurrence was assessed across various clinical parameters.

Results

The mean TRACP5b level in male patients (2062 ± 2289 mU/dL) was significantly higher than in female patients (976 ± 487 mU/dL; p = 0.048). A moderate positive correlation was observed between tumor size and TRACP5b levels (r = 0.586, p < 0.001). Gender, tumor location (trunk, lower extremity, and upper extremity), tumor size, and TRACP5b levels were significantly associated with local recurrence-free survival (p values were 0.037, 0.0006, 0.048, and 0.004, respectively).

Conclusions

This study identified preoperative TRACP5b levels as a prognostic factor for local recurrence in GCTB patients, highlighting its potential utility in risk stratification and personalized management.
背景骨巨细胞瘤(GCTB)在手术治疗后有很高的局部复发可能性。其特点是破骨细胞样多核巨细胞的组织学增生。抗酒石酸酸性磷酸酶5b (TRACP5b)是一种可靠的骨吸收血清标志物。本研究旨在探讨TRACP5b水平对GCTB手术后局部复发的影响。方法回顾性分析2015年至2022年47例接受血清TRACP5b检测和手术治疗的原发性GCTB患者的资料。我们统计评估TRACP5b水平与临床特征的相关性。根据TRACP5b水平将患者分为两组,并通过各种临床参数评估TRACP5b与局部复发之间的关系。结果男性患者的平均TRACP5b水平(2062±2289 mU/dL)显著高于女性患者(976±487 mU/dL, p = 0.048)。肿瘤大小与TRACP5b水平呈正相关(r = 0.586, p < 0.001)。性别、肿瘤位置(躯干、下肢和上肢)、肿瘤大小和TRACP5b水平与局部无复发生存率显著相关(p值分别为0.037、0.0006、0.048和0.004)。结论本研究确定术前TRACP5b水平是GCTB患者局部复发的预后因素,强调其在风险分层和个性化管理中的潜在效用。
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引用次数: 0
Surgical management of breast cancer liver metastases: what indications and results in 2025? A narrative review 乳腺癌肝转移的手术治疗:2025年的适应证和结果?叙述性回顾
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-19 DOI: 10.1016/j.suronc.2025.102330
Lucia Paiano , René Adam , Nicolas Golse
Breast cancer liver metastases (BCLM) have historically been treated with chemotherapy and supportive care, and long-term survival in stage IV breast cancer remains rare despite advances in systemic therapies such as chemotherapy, hormonal and targeted therapies. Since the 2000s, many trials comparing surgery and systemic therapy have improved our understanding of the management of BCLM. Prognostic factors influencing outcome include disease-free interval from primary tumor, hormone receptor status, metastatic burden and tumor biology. Molecular profiling (e.g. BRCA1/2, PIK3CA, HER2, ESR1) has further refined the response to systemic therapy, enabling personalized treatment strategies. Recent evidence highlights the prognostic impact of surgery in combination with systemic therapy in highly selected patients, with a 5-year survival rate reaching 53 %. Optimal surgical candidates may include patients with small (<5 cm), solitary or easily resectable metastases, stable disease on neoadjuvant therapy and favorable tumor biology. However, preoperative imaging often underestimates tumor burden, leading to resection cancellation in ∼20 % of cases. Unlike colorectal liver metastases, BCLM rarely become resectable after systemic therapy, which is primarily aimed at disease control and reducing recurrence risk. Non-surgical interventions, including radiofrequency or microwave ablation and radioembolization, are typically reserved for patients who are ineligible for surgery due to frailty, comorbidities or challenging tumor locations. Multidisciplinary planning remains essential to optimize treatment, integrating systemic advances, tumor biology and surgical feasibility to improve long-term outcomes in the management of BCLM.
乳腺癌肝转移(BCLM)历来都是通过化疗和支持性治疗来治疗的,尽管化疗、激素和靶向治疗等系统性治疗取得了进展,但IV期乳腺癌的长期生存率仍然很低。自2000年代以来,许多比较手术和全身治疗的试验提高了我们对BCLM治疗的理解。影响预后的因素包括原发肿瘤无病期、激素受体状态、转移负荷和肿瘤生物学。分子分析(如BRCA1/2、PIK3CA、HER2、ESR1)进一步完善了对全身治疗的反应,实现了个性化的治疗策略。最近的证据强调了在高度选定的患者中,手术联合全身治疗对预后的影响,其5年生存率达到53%。最佳的手术候选者可能包括小(< 5cm),孤立或易于切除的转移,新辅助治疗稳定的疾病和良好的肿瘤生物学。然而,术前成像往往低估了肿瘤负荷,导致约20%的病例切除取消。与结直肠肝转移不同,BCLM在接受全身治疗后很少可以切除,其主要目的是控制疾病和降低复发风险。非手术干预,包括射频或微波消融和放射栓塞,通常用于因虚弱,合并症或肿瘤位置挑战性而不适合手术的患者。多学科规划对于优化治疗仍然至关重要,整合系统进展、肿瘤生物学和手术可行性,以改善BCLM管理的长期结果。
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引用次数: 0
Strategies of the management of pulmonary metastases in children with Ewing sarcoma- single institution experience of 137 patients 儿童尤文氏肉瘤肺转移的治疗策略- 137例患者的单院经验
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-19 DOI: 10.1016/j.suronc.2025.102334
Krzysztof Bronowicki, Justyna Antoniuk-Majchrzak, Iwona Malesza, Tomasz Walenta, Agnieszka Szymborska, Anna Raciborska

Background

The role of pulmonary metastasectomy in pediatric Ewing sarcoma remains controversial, with significant treatment selection bias complicating the interpretation of retrospective series.

Objective

To evaluate treatment outcomes in isolated pulmonary metastases (PM) using propensity score analysis to control for selection bias.

Methods

Retrospective analysis of 137 patients with pulmonary metastases (85 isolated PM, 52 PM with extrapulmonary metastases) treated between 1998 and 2024. Primary comparison focused on thoracotomy alone versus radiotherapy alone in isolated PM patients with primary tumor surgery (n = 30). Propensity score matching was performed to address selection bias.

Results

Patients with isolated PM had superior overall survival compared to those with extrapulmonary disease (median OS: 111 vs 66 months, p < 0.001). In isolated PM patients with primary tumor surgery, direct comparison between thoracotomy alone and radiotherapy alone revealed superior survival with surgical resection (median OS: 125 vs 38 months, p = 0.009).
Stratified analysis by chemotherapy response demonstrated that thoracotomy benefit was primarily evident in patients with poor histologic response (≤10 % viable cells, median OS: 56 vs 27 months, p = 0.017), while patients with good response showed similar outcomes regardless of local treatment approach (p = 0.104).
After propensity score matching and multivariable adjustment for age and gender, the apparent benefit of thoracotomy was maintained in direct treatment comparisons, though overall comparison against all non-surgical treatments showed no significant difference (HR 0.75, p = 0.343), highlighting the importance of appropriate treatment comparisons and patient selection.

Conclusions

Thoracotomy may benefit carefully selected isolated PM patients, particularly those with poor response to chemotherapy. However, significant selection bias complicates the interpretation of retrospective surgical series. The benefit appears limited to specific clinical scenarios rather than representing a general therapeutic advantage. Future studies should focus on developing standardized selection criteria and prospective validation of treatment algorithms.
背景肺转移切除术在儿童尤文氏肉瘤中的作用仍然存在争议,明显的治疗选择偏倚使回顾性研究的解释复杂化。目的评价孤立性肺转移瘤(PM)的治疗效果,采用倾向评分分析控制选择偏倚。方法回顾性分析1998 ~ 2024年收治的137例肺转移患者的临床资料,其中分离性PM 85例,合并肺外转移的PM 52例。最初的比较集中在孤立性PM患者原发肿瘤手术单独开胸与单独放疗(n = 30)。进行倾向评分匹配以解决选择偏差。结果孤立性PM患者的总生存期优于肺外疾病患者(中位生存期:111个月vs 66个月,p < 0.001)。在原发肿瘤手术的孤立性PM患者中,直接比较单独开胸和单独放疗显示手术切除的生存率更高(中位生存期:125个月vs 38个月,p = 0.009)。化疗反应的分层分析表明,开胸手术的益处主要体现在组织学反应差的患者(活细胞≤10%,中位生存期:56 vs 27个月,p = 0.017),而反应良好的患者无论采用何种局部治疗方法,其结果都相似(p = 0.104)。经过倾向评分匹配和年龄和性别的多变量调整后,尽管与所有非手术治疗的总体比较没有显着差异(HR 0.75, p = 0.343),但在直接治疗比较中,开胸手术仍然有明显的优势,这突出了适当的治疗比较和患者选择的重要性。结论谨慎选择孤立的PM患者,特别是对化疗反应较差的患者,开胸手术可能会受益。然而,明显的选择偏倚使回顾性手术系列的解释复杂化。这种益处似乎仅限于特定的临床情况,而不是代表一般的治疗优势。未来的研究应侧重于制定标准化的选择标准和治疗算法的前瞻性验证。
{"title":"Strategies of the management of pulmonary metastases in children with Ewing sarcoma- single institution experience of 137 patients","authors":"Krzysztof Bronowicki,&nbsp;Justyna Antoniuk-Majchrzak,&nbsp;Iwona Malesza,&nbsp;Tomasz Walenta,&nbsp;Agnieszka Szymborska,&nbsp;Anna Raciborska","doi":"10.1016/j.suronc.2025.102334","DOIUrl":"10.1016/j.suronc.2025.102334","url":null,"abstract":"<div><h3>Background</h3><div>The role of pulmonary metastasectomy in pediatric Ewing sarcoma remains controversial, with significant treatment selection bias complicating the interpretation of retrospective series.</div></div><div><h3>Objective</h3><div>To evaluate treatment outcomes in isolated pulmonary metastases (PM) using propensity score analysis to control for selection bias.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 137 patients with pulmonary metastases (85 isolated PM, 52 PM with extrapulmonary metastases) treated between 1998 and 2024. Primary comparison focused on thoracotomy alone versus radiotherapy alone in isolated PM patients with primary tumor surgery (n = 30). Propensity score matching was performed to address selection bias.</div></div><div><h3>Results</h3><div>Patients with isolated PM had superior overall survival compared to those with extrapulmonary disease (median OS: 111 vs 66 months, p &lt; 0.001). In isolated PM patients with primary tumor surgery, direct comparison between thoracotomy alone and radiotherapy alone revealed superior survival with surgical resection (median OS: 125 vs 38 months, p = 0.009).</div><div>Stratified analysis by chemotherapy response demonstrated that thoracotomy benefit was primarily evident in patients with poor histologic response (≤10 % viable cells, median OS: 56 vs 27 months, p = 0.017), while patients with good response showed similar outcomes regardless of local treatment approach (p = 0.104).</div><div>After propensity score matching and multivariable adjustment for age and gender, the apparent benefit of thoracotomy was maintained in direct treatment comparisons, though overall comparison against all non-surgical treatments showed no significant difference (HR 0.75, p = 0.343), highlighting the importance of appropriate treatment comparisons and patient selection.</div></div><div><h3>Conclusions</h3><div>Thoracotomy may benefit carefully selected isolated PM patients, particularly those with poor response to chemotherapy. However, significant selection bias complicates the interpretation of retrospective surgical series. The benefit appears limited to specific clinical scenarios rather than representing a general therapeutic advantage. Future studies should focus on developing standardized selection criteria and prospective validation of treatment algorithms.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102334"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693723","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}
引用次数: 0
Relationship between preoperative inflammatory status and survival in patients undergoing curative surgery for colorectal cancer 结直肠癌根治性手术患者术前炎症状态与生存的关系
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-19 DOI: 10.1016/j.suronc.2025.102332
Valerio Argiolas , Simona Deidda , Mirko Armas, Luigi Zorcolo, Angelo Restivo

Introduction

Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. While TNM staging remains the cornerstone for prognostic stratification, growing evidence highlights the role of systemic inflammation and nutritional status in influencing oncologic outcomes. This study aimed to evaluate the prognostic significance of preoperative immunonutritional indices in patients undergoing curative resection for stage I–III CRC.

Methods

This retrospective cohort study included 616 patients treated between January 2013 and December 2021 at a single tertiary center. Preoperative indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation score (SIS)—were calculated from routine blood tests performed within four weeks prior to surgery. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier curves and Cox proportional hazard models.

Results

After a median follow-up of 61.3 months, 185 deaths (30.0 %) and 74 recurrences (12.0 %) were recorded. All indices demonstrated significant associations with five-year OS and DFS in univariate analysis. In multivariate analysis, PLR>176.9 (HR 1.43; 95 % CI 1.06–1.94; p = 0.02) and LMR≤3 (HR 1.46; 95 % CI 1.8–1.99; p = 0.01) were independently associated with worse OS. For DFS, significant independent predictors of adverse outcomes included NLR>2.95 (HR 1.58; 95 % CI 1.15–2.15; p = 0.004), PLR>176.9 (HR 1.65; 95 % CI 1.20–2.26; p = 0.002), LMR≤3 (HR 1.57; 95 % CI 1.14–2.15; p = 0.006), SII>529.6 (HR 1.46, 95 % CI 1.07–1.99; p = 0.02), and SIS 1–2 (HR 1.43, 95 % CI 1.03–2.06; p = 0.04).

Conclusion

Preoperative immunonutritional indices are independent prognostic markers in nonmetastatic colorectal cancer. Their integration with standard staging system could enhance risk stratification and guide personalized treatment.
结直肠癌(CRC)是世界范围内癌症相关发病率和死亡率的主要原因。虽然TNM分期仍然是预后分层的基础,但越来越多的证据强调了全身性炎症和营养状况在影响肿瘤预后方面的作用。本研究旨在评估术前免疫营养指标对I-III期结直肠癌根治性切除术患者预后的意义。方法本回顾性队列研究纳入了2013年1月至2021年12月在单一三级中心接受治疗的616例患者。术前指标-中性粒细胞与淋巴细胞比率(NLR),血小板与淋巴细胞比率(PLR),淋巴细胞与单核细胞比率(LMR),全身免疫炎症指数(SII),预后营养指数(PNI)和全身炎症评分(SIS) -通过术前四周内进行的常规血液检查计算。使用Kaplan-Meier曲线和Cox比例风险模型估计总生存期(OS)和无病生存期(DFS)。结果中位随访61.3个月,死亡185例(30.0%),复发率74例(12.0%)。在单变量分析中,所有指标均与5年OS和DFS有显著相关性。在多因素分析中,PLR> = 176.9 (HR 1.43; 95% CI 1.06-1.94; p = 0.02)和LMR≤3 (HR 1.46; 95% CI 1.8-1.99; p = 0.01)与OS较差独立相关。对于DFS,不良结局的重要独立预测因子包括NLR>;2.95 (HR 1.58; 95% CI 1.15-2.15; p = 0.004)、PLR>176.9 (HR 1.65; 95% CI 1.20-2.26; p = 0.002)、LMR≤3 (HR 1.57; 95% CI 1.14-2.15; p = 0.006)、SII>529.6 (HR 1.46, 95% CI 1.07-1.99; p = 0.02)和SIS 1-2 (HR 1.43, 95% CI 1.03-2.06; p = 0.04)。结论术前免疫营养指标是判断非转移性结直肠癌预后的独立指标。与标准分期系统相结合,可加强风险分层,指导个体化治疗。
{"title":"Relationship between preoperative inflammatory status and survival in patients undergoing curative surgery for colorectal cancer","authors":"Valerio Argiolas ,&nbsp;Simona Deidda ,&nbsp;Mirko Armas,&nbsp;Luigi Zorcolo,&nbsp;Angelo Restivo","doi":"10.1016/j.suronc.2025.102332","DOIUrl":"10.1016/j.suronc.2025.102332","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. While TNM staging remains the cornerstone for prognostic stratification, growing evidence highlights the role of systemic inflammation and nutritional status in influencing oncologic outcomes. This study aimed to evaluate the prognostic significance of preoperative immunonutritional indices in patients undergoing curative resection for stage I–III CRC.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 616 patients treated between January 2013 and December 2021 at a single tertiary center. Preoperative indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation score (SIS)—were calculated from routine blood tests performed within four weeks prior to surgery. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier curves and Cox proportional hazard models.</div></div><div><h3>Results</h3><div>After a median follow-up of 61.3 months, 185 deaths (30.0 %) and 74 recurrences (12.0 %) were recorded. All indices demonstrated significant associations with five-year OS and DFS in univariate analysis. In multivariate analysis, PLR&gt;176.9 (HR 1.43; 95 % CI 1.06–1.94; <em>p</em> = 0.02) and LMR≤3 (HR 1.46; 95 % CI 1.8–1.99; p = 0.01) were independently associated with worse OS. For DFS, significant independent predictors of adverse outcomes included NLR&gt;2.95 (HR 1.58; 95 % CI 1.15–2.15; <em>p</em> = 0.004), PLR&gt;176.9 (HR 1.65; 95 % CI 1.20–2.26; <em>p</em> = 0.002), LMR≤3 (HR 1.57; 95 % CI 1.14–2.15; p = 0.006), SII&gt;529.6 (HR 1.46, 95 % CI 1.07–1.99; <em>p</em> = 0.02), and SIS 1–2 (HR 1.43, 95 % CI 1.03–2.06; <em>p</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>Preoperative immunonutritional indices are independent prognostic markers in nonmetastatic colorectal cancer. Their integration with standard staging system could enhance risk stratification and guide personalized treatment.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102332"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579487","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}
引用次数: 0
Reconsidering upfront surgery for resectable pancreatic ductal adenocarcinoma: The role of risk stratification and neoadjuvant chemotherapy 重新考虑可切除胰腺导管腺癌的前期手术:风险分层和新辅助化疗的作用
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-19 DOI: 10.1016/j.suronc.2025.102333
Yoshitaro Shindo , Hidenori Takahashi , Hiroto Matsui , Yukio Tokumitsu , Masao Nakajima , Yuta Kimura , Mitsuo Nishiyama , Yusaku Watanabe , Shinobu Tomochika , Yuki Nakagami , Ryouichi Tsunedomi , Michihisa Iida , Tatsuya Ioka , Hiroaki Nagano

Background

The optimal treatment strategy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains controversial. In this study, we aimed to evaluate the impact of neoadjuvant chemotherapy (NAC) using gemcitabine plus nab-paclitaxel (GnP) or modified FOLFIRINOX (mFFX) compared with upfront surgery (UFS) in patients with R-PDAC.

Methods

This retrospective cohort study included 125 patients diagnosed with R-PDAC at a single institution between 2010 and 2022. The patients were divided into UFS (n = 57) and NAC (n = 68) groups. Survival outcomes, perioperative factors, and prognostic variables were analyzed. Subgroup analysis was performed based on high-risk features, defined as elevated carcinoembryonic antigen (CEA) levels >6 ng/mL and tumor size ≥25 mm.

Results

No significant differences were observed in overall survival (OS) and progression-free survival (PFS) between the entire UFS and NAC groups. However, in patients with high-risk features, NAC significantly improved OS compared with UFS (median survival 29.0 months vs. 10.6 months, respectively; P < 0.0001). NAC was associated with reduced intraoperative blood loss and a lower lymph node positivity rate without increasing postoperative morbidity or mortality.

Conclusions

While NAC did not universally improve survival outcomes in R-PDAC, it significantly benefitted patients with poor prognostic indicators. These findings support a selective approach to NAC based on biological risk stratification rather than anatomical criteria alone. Future prospective studies are warranted to validate these observations and optimize individualized treatment strategies.
背景:可切除胰导管腺癌(R-PDAC)的最佳治疗策略仍存在争议。在这项研究中,我们旨在评估吉西他滨联合nab-紫杉醇(GnP)或改良FOLFIRINOX (mFFX)的新辅助化疗(NAC)与术前手术(UFS)对R-PDAC患者的影响。方法本回顾性队列研究纳入了2010年至2022年在一家机构诊断为R-PDAC的125例患者。将患者分为UFS组(n = 57)和NAC组(n = 68)。分析生存结果、围手术期因素和预后变量。根据癌胚抗原(CEA)水平升高≤6 ng/mL和肿瘤大小≥25 mm的高危特征进行亚组分析。结果UFS组和NAC组的总生存期(OS)和无进展生存期(PFS)无显著差异。然而,在具有高危特征的患者中,与UFS相比,NAC显著改善了OS(中位生存期分别为29.0个月和10.6个月;P < 0.0001)。NAC与术中出血量减少和淋巴结阳性率降低相关,但未增加术后发病率或死亡率。结论:虽然NAC不能普遍改善R-PDAC患者的生存结果,但它能显著改善预后指标较差的患者。这些发现支持基于生物学风险分层而不是单独的解剖学标准的NAC选择性方法。未来的前瞻性研究有必要验证这些观察结果并优化个体化治疗策略。
{"title":"Reconsidering upfront surgery for resectable pancreatic ductal adenocarcinoma: The role of risk stratification and neoadjuvant chemotherapy","authors":"Yoshitaro Shindo ,&nbsp;Hidenori Takahashi ,&nbsp;Hiroto Matsui ,&nbsp;Yukio Tokumitsu ,&nbsp;Masao Nakajima ,&nbsp;Yuta Kimura ,&nbsp;Mitsuo Nishiyama ,&nbsp;Yusaku Watanabe ,&nbsp;Shinobu Tomochika ,&nbsp;Yuki Nakagami ,&nbsp;Ryouichi Tsunedomi ,&nbsp;Michihisa Iida ,&nbsp;Tatsuya Ioka ,&nbsp;Hiroaki Nagano","doi":"10.1016/j.suronc.2025.102333","DOIUrl":"10.1016/j.suronc.2025.102333","url":null,"abstract":"<div><h3>Background</h3><div>The optimal treatment strategy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains controversial. In this study, we aimed to evaluate the impact of neoadjuvant chemotherapy (NAC) using gemcitabine plus nab-paclitaxel (GnP) or modified FOLFIRINOX (mFFX) compared with upfront surgery (UFS) in patients with R-PDAC.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 125 patients diagnosed with R-PDAC at a single institution between 2010 and 2022. The patients were divided into UFS (n = 57) and NAC (n = 68) groups. Survival outcomes, perioperative factors, and prognostic variables were analyzed. Subgroup analysis was performed based on high-risk features, defined as elevated carcinoembryonic antigen (CEA) levels &gt;6 ng/mL and tumor size ≥25 mm.</div></div><div><h3>Results</h3><div>No significant differences were observed in overall survival (OS) and progression-free survival (PFS) between the entire UFS and NAC groups. However, in patients with high-risk features, NAC significantly improved OS compared with UFS (median survival 29.0 months vs. 10.6 months, respectively; P &lt; 0.0001). NAC was associated with reduced intraoperative blood loss and a lower lymph node positivity rate without increasing postoperative morbidity or mortality.</div></div><div><h3>Conclusions</h3><div>While NAC did not universally improve survival outcomes in R-PDAC, it significantly benefitted patients with poor prognostic indicators. These findings support a selective approach to NAC based on biological risk stratification rather than anatomical criteria alone. Future prospective studies are warranted to validate these observations and optimize individualized treatment strategies.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102333"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579572","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}
引用次数: 0
Risk factors for postoperative malignant progression of lower-grade gliomas: a systematic review and meta-analysis 低级别胶质瘤术后恶性进展的危险因素:系统回顾和荟萃分析。
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-12 DOI: 10.1016/j.suronc.2025.102327
Zhengmao Ge , Guyu Jin , Hongkang Wang , Shimin Wang , Xiaowei Fei , Shuyang Li , Lei Zhang , Xiaofan Jiang , Yanyu Zhang

Objectives

The primary aim was to evaluate the risk factors for postoperative malignant progression of lower-grade glioma (LGG) in patients.

Data sources

PubMed, EMBASE, Web of Science and Cochrane Library were searched from database inception to August 2024.

Eligibility criteria

Quantitative and original studies reporting risk factors for postoperative malignant progression of LGGs were included.

Results

17 observational studies with 3810 glioma patients met the inclusion criteria. Factors including advanced age (HR 1.011, p = 0.042), contrast enhancement (HR 1.540, p = 0.001), rapid expanding speed (HR 4.525, p < 0.001), location in insular lobe (HR 1.514, p = 0.020), eloquence involved (HR 2.413, p < 0.001) and corpus callosum involved (HR 1.695, p = 0.002) were identified as risk factors of postoperative malignant progression of LGGs. High Karnofsky Performance Status (KPS) score (HR 0.955, p = 0.001), oligodendroglioma (HR 0.603, p < 0.001), oligoastrocytoma (HR 0.693, p = 0.016), isocitrate dehydrogenase (IDH) mutation (HR 0.406, p = 0.004), 1p19q codeletion (HR 0.534, p < 0.001), O6-methylguanine-DNA methyltransferase promoter (MGMTP) methylation (HR 0.539, p = 0.007), resection operation (HR 0.277, p < 0.001) and high extent of resection (EOR) (HR 0.972, p = 0.038) were identified as factors that decreased the risk of postoperative malignant progression of LGGs.

Conclusion

This review identified multiple factors associated with the risk of postoperative malignant progression of LGGs, with moderate to high certainty of evidence supporting several key risk and protective factors. Surgeons should be aware of these factors and consider implementing more active treatment and surveillance measures for high-risk patients to improve prognosis.
目的:主要目的是评估低级别胶质瘤(LGG)患者术后恶性进展的危险因素。数据来源:PubMed、EMBASE、Web of Science、Cochrane Library检索自建库至2024年8月。入选标准:纳入报告lgg术后恶性进展危险因素的定量和原始研究。结果:17项观察性研究3810例胶质瘤患者符合纳入标准。影响因素包括高龄(HR 1.011, p = 0.042)、对比增强(HR 1.540, p = 0.001)、扩张速度快(HR 4.525, p 6-甲基鸟嘌呤- dna甲基转移酶启动子(MGMTP)甲基化(HR 0.539, p = 0.007)、切除手术(HR 0.277, p)。结论:本研究确定了与LGGs术后恶性进展风险相关的多个因素,其中一些关键风险和保护因素的证据具有中等至高的确定性。外科医生应意识到这些因素,并考虑对高危患者实施更积极的治疗和监测措施,以改善预后。
{"title":"Risk factors for postoperative malignant progression of lower-grade gliomas: a systematic review and meta-analysis","authors":"Zhengmao Ge ,&nbsp;Guyu Jin ,&nbsp;Hongkang Wang ,&nbsp;Shimin Wang ,&nbsp;Xiaowei Fei ,&nbsp;Shuyang Li ,&nbsp;Lei Zhang ,&nbsp;Xiaofan Jiang ,&nbsp;Yanyu Zhang","doi":"10.1016/j.suronc.2025.102327","DOIUrl":"10.1016/j.suronc.2025.102327","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary aim was to evaluate the risk factors for postoperative malignant progression of lower-grade glioma (LGG) in patients.</div></div><div><h3>Data sources</h3><div>PubMed, EMBASE, Web of Science and Cochrane Library were searched from database inception to August 2024.</div></div><div><h3>Eligibility criteria</h3><div>Quantitative and original studies reporting risk factors for postoperative malignant progression of LGGs were included.</div></div><div><h3>Results</h3><div>17 observational studies with 3810 glioma patients met the inclusion criteria. Factors including advanced age (HR 1.011, p = 0.042), contrast enhancement (HR 1.540, p = 0.001), rapid expanding speed (HR 4.525, p &lt; 0.001), location in insular lobe (HR 1.514, p = 0.020), eloquence involved (HR 2.413, p &lt; 0.001) and corpus callosum involved (HR 1.695, p = 0.002) were identified as risk factors of postoperative malignant progression of LGGs. High Karnofsky Performance Status (KPS) score (HR 0.955, p = 0.001), oligodendroglioma (HR 0.603, p &lt; 0.001), oligoastrocytoma (HR 0.693, p = 0.016), isocitrate dehydrogenase (IDH) mutation (HR 0.406, p = 0.004), 1p19q codeletion (HR 0.534, p &lt; 0.001), O<sup>6</sup>-methylguanine-DNA methyltransferase promoter (MGMTP) methylation (HR 0.539, p = 0.007), resection operation (HR 0.277, p &lt; 0.001) and high extent of resection (EOR) (HR 0.972, p = 0.038) were identified as factors that decreased the risk of postoperative malignant progression of LGGs.</div></div><div><h3>Conclusion</h3><div>This review identified multiple factors associated with the risk of postoperative malignant progression of LGGs, with moderate to high certainty of evidence supporting several key risk and protective factors. Surgeons should be aware of these factors and consider implementing more active treatment and surveillance measures for high-risk patients to improve prognosis.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102327"},"PeriodicalIF":2.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534854","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}
引用次数: 0
The impact of the timing of adjuvant treatment initiation in patients with upfront resection of pancreatic cancer 胰腺癌前期切除术患者开始辅助治疗时机的影响
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-10 DOI: 10.1016/j.suronc.2025.102329
Sydney McManus , Aimée Galatas , Sarah Hemelt , Sanchit Sachdeva , Kevin Sullivan , Bolni Marius Nagalo , Denise Danos , Omeed Moaven

Introduction

This study evaluates the association between timing of adjuvant chemotherapy and overall survival in resectable pancreatic ductal adenocarcinoma (PDAC). It also examines whether the adoption of modern chemotherapy regimens in recent years has influenced this relationship, reflecting evolving treatment practices.

Methods

Cases of resectable primary invasive PDAC were identified using the National Cancer Database (NCDB). Overall survival (OS) was visualized using Kaplan Meier survival plots and Cox proportional hazard models. Covariat adjustment and propensity score matched cohort were analyzed. The matched cohort was analyzed with Cox proportional hazard models and logistic models.

Results

31,949 patients were included in the study. 26.4 % received no chemotherapy, 66.4 % received chemotherapy within 12 weeks, and 7.2 % received chemotherapy after 12 weeks. There was significant improvement in mOS. Between 2015 and 2019, there was a significant difference in OS for patients receiving chemotherapy within 12 weeks, compared to >12 weeks.

Conclusion

While adjuvant chemotherapy in patients with resectable PDAC is associated with improved OS compared to no adjuvant therapy, it is worth considering that those who are well enough to receive chemotherapy inherently have better prognoses. Importantly, the survival association persists regardless of the timing of chemotherapy initiation, suggesting that late administration of adjuvant chemotherapy may still be beneficial in appropriately selected patients.
本研究评估了可切除胰导管腺癌(PDAC)的辅助化疗时间与总生存期之间的关系。它还研究了近年来现代化疗方案的采用是否影响了这种关系,反映了不断发展的治疗实践。方法采用美国国家癌症数据库(NCDB)对可切除的原发性侵袭性PDAC病例进行鉴定。采用Kaplan Meier生存图和Cox比例风险模型可视化总生存期(OS)。分析协变量调整和倾向评分匹配的队列。采用Cox比例风险模型和logistic模型对匹配队列进行分析。结果31,949例患者纳入研究。26.4%的患者未接受化疗,66.4%的患者在12周内接受化疗,7.2%的患者在12周后接受化疗。mOS有显著改善。2015年至2019年期间,12周内接受化疗的患者的OS与12周内接受化疗的患者相比有显著差异。结论虽然可切除PDAC患者的辅助化疗与无辅助治疗相比可改善OS,但值得考虑的是,那些足够健康接受化疗的患者本身具有更好的预后。重要的是,无论化疗开始的时间如何,生存相关性仍然存在,这表明在适当选择的患者中,晚期辅助化疗可能仍然有益。
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引用次数: 0
SCOUT® radar localization of non-palpable breast carcinomas versus traditional wire-based localization: a single center retrospective comparison 非可触及乳腺癌的SCOUT®雷达定位与传统导线定位:单中心回顾性比较
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2025-11-10 DOI: 10.1016/j.suronc.2025.102324
Åse Florholmen-Kjær , Rica Mortensen , Vegard Heimly Brun

Purpose

Breast-conserving therapy requires a secure method to localize non-palpable lesions. The traditional and simple metal wire localization (WL) is challenged by more advanced and costly techniques that may have several advantages. We report the first European direct comparison between WL and SCOUT® Radar Localization (RL) comparing oncological and logistical benefits of implementing the new method in the treatment of non-palpable breast carcinomas including in situ lesions.

Methods

We retrospectively analyzed 150 breast cancer surgeries performed immediately before and after WL was replaced by RL in our unit. The last 50 wire-guided surgeries were compared to the initial 50 radar-guided surgeries (cohort I, implementation phase) and to the subsequent 50 radar-guided surgeries (cohort II, routine phase).

Results

All lesions and markers were successfully removed in all groups. No procedure-specific complications were registered. Of the 50 patients in the WL group, 8 % needed redo surgery due to positive margins, compared to 4 % in the RL groups (not statistically different). The histological margin was similar between the groups. The median time consumption during surgery was reduced by 26.5 min after establishing the radar localization method (p = 0.022). The resected tissue corresponded better with the marked area in the breast in the RL group (p = 0.026), as evaluated by a more central placement of the marker.

Conclusions

Radar localization of breast carcinomas is safe for women with non-palpable breast carcinomas including in situ lesions. The method reduces time consumption in the operating room and may give better surgical precision.
目的:保乳治疗需要一种安全的方法来定位不可触及的病变。传统和简单的金属丝定位(WL)正受到更先进和昂贵的技术的挑战,这些技术可能具有一些优势。我们报告了欧洲首次直接比较WL和SCOUT®雷达定位(RL),比较实施新方法治疗非可触及乳腺癌(包括原位病变)的肿瘤学和后勤效益。方法:我们回顾性分析了我们单位150例乳腺癌手术在WL被RL取代之前和之后立即进行的手术。将最后50例导线引导手术与最初的50例雷达引导手术(队列I,实施阶段)和随后的50例雷达引导手术(队列II,常规阶段)进行比较。结果:各组病变及标志物均成功切除。未发现手术并发症。在WL组的50例患者中,8%的患者因边缘阳性而需要重做手术,而RL组的这一比例为4%(无统计学差异)。两组间的组织学边缘相似。建立雷达定位方法后,手术中位耗时缩短26.5 min (p = 0.022)。RL组切除的组织与乳房标记区域的对应性更好(p = 0.026),通过标记更中心的位置来评估。结论:乳腺癌的雷达定位对于包括原位病变在内的非可触性乳腺癌是安全的。该方法减少了手术时间,提高了手术精度。
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引用次数: 0
期刊
Surgical Oncology-Oxford
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