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}
Pub Date : 2024-11-02DOI: 10.1016/j.suronc.2024.102161
Regis R. Paulinelli , Ana F.F. Goulart , Horacio Mendoza Santos , Barbara A. Barbosa , Ana-Luisa F. Silva , Luiz-Fernando J. Ribeiro , Ruffo Freitas-Junior
Introduction
We present a new technique, the bilobed lateral artery perforator-based flap, for breast-conserving surgery of large central tumors or nearby, combining Zymany's bilobed flap and a Lateral Intercostal Perforator (LICAP) flap, and its 10-year outcomes.
Materials and methods
We studied 37 patients with malignant breast tumors near or involving the central skin, without ptosis or desire to correct it, who avoided mastectomy with this modified bilobed flap from 2013 to 2022. The same surgeon operated on them in different institutions. This research project was approved by our ethical committee (n. 2.322.212).
Results
The mean age was 57.17 (±12.60) years. The mean specimen weight was 74.32 (±25.84)g, and the mean tumor size was 40.35 (±15.81) mm. Fourteen (37.84 %) tumors were larger than 5 cm and one was multicentric. Thirty-two (86.49 %) patients had invasive ductal carcinomas. Nipple areola complex was removed in 19 (51.35 %) cases due to clinical involvement, and immediately reconstructed in two cases with contralateral free grafting. Twenty-one (56.76 %) patients received neoadjuvant chemotherapy. Three (8.11 %) patients had immediate contralateral mastopexy. Radiotherapy was indicated in all cases. There were 3 (8.11 %) minor complications, one positive margin, and no surgical revisions. In a mean follow-up of 39.97 (±29.43) months, there were no local recurrences, 2 metastasis, and one death. Satisfaction and aesthetic results were good or excellent in most cases.
Conclusions
The new technique enabled breast conservation, with high rates of free margins, high levels of satisfaction, few complications in women with large central tumors on small breasts with limited ptosis.
{"title":"Bilobed lateral artery perforator-based flap for partial breast reconstruction – Technique description and results from a ten-year cohort","authors":"Regis R. Paulinelli , Ana F.F. Goulart , Horacio Mendoza Santos , Barbara A. Barbosa , Ana-Luisa F. Silva , Luiz-Fernando J. Ribeiro , Ruffo Freitas-Junior","doi":"10.1016/j.suronc.2024.102161","DOIUrl":"10.1016/j.suronc.2024.102161","url":null,"abstract":"<div><h3>Introduction</h3><div>We present a new technique, the bilobed lateral artery perforator-based flap, for breast-conserving surgery of large central tumors or nearby, combining Zymany's bilobed flap and a Lateral Intercostal Perforator (LICAP) flap, and its 10-year outcomes.</div></div><div><h3>Materials and methods</h3><div>We studied 37 patients with malignant breast tumors near or involving the central skin, without ptosis or desire to correct it, who avoided mastectomy with this modified bilobed flap from 2013 to 2022. The same surgeon operated on them in different institutions. This research project was approved by our ethical committee (n. 2.322.212).</div></div><div><h3>Results</h3><div>The mean age was 57.17 (±12.60) years. The mean specimen weight was 74.32 (±25.84)g, and the mean tumor size was 40.35 (±15.81) mm. Fourteen (37.84 %) tumors were larger than 5 cm and one was multicentric. Thirty-two (86.49 %) patients had invasive ductal carcinomas. Nipple areola complex was removed in 19 (51.35 %) cases due to clinical involvement, and immediately reconstructed in two cases with contralateral free grafting. Twenty-one (56.76 %) patients received neoadjuvant chemotherapy. Three (8.11 %) patients had immediate contralateral mastopexy. Radiotherapy was indicated in all cases. There were 3 (8.11 %) minor complications, one positive margin, and no surgical revisions. In a mean follow-up of 39.97 (±29.43) months, there were no local recurrences, 2 metastasis, and one death. Satisfaction and aesthetic results were good or excellent in most cases.</div></div><div><h3>Conclusions</h3><div>The new technique enabled breast conservation, with high rates of free margins, high levels of satisfaction, few complications in women with large central tumors on small breasts with limited ptosis.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102161"},"PeriodicalIF":2.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631597","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 : 2024-11-01DOI: 10.1016/j.suronc.2024.102163
Laura M. Nicolais , Timothy L. Fitzgerald
The rarity and lack of Level I Evidence compromise our ability to care for patients with gallbladder cancer.
Methods
NCDB cohort study of with resected Stage Groups IB-IVA gallbladder adenocarcinoma between 2004 and 2018. Patients were included.
Results
8484 patients were included, median survival was 29.8 (CI 28.6–31.2); Stage IB: 67.0, Stage II: 36.6, and Stage III/IVA 18.4 months. A survival benefit was noted for surgery beyond cholecystectomy (Stage IB 105 vs. 36 months, HR 0.56, p < 0.001; Stage II 56 vs. 20 months, HR 0.72, p < 0.001; and Stage III/IVA 23.8 vs. 9.9 months, HR 0.67, p < 0.001) and chemoradiotherapy (Stage IB 102 vs. 64.8, HR 0.87, CI 0.62–1.23, p = 0.4; ' Stage II 49 vs. 33.5 months, HR 0.78, CI 0.68–0.91, p = 0.002; and Stage III/IVA 31 vs. 12.2 HR 0.60, CI 0.52–0.70, p < 0.001). Adjuvant chemotherapy improved survival in Stage III/IVA (20 vs. 12.2 months, HR 0.74, p < 0.001) but not Stage II and trend toward harm in Stage IB. A nomogram with created with these data.
Conclusion
Surgery beyond cholecystectomy provides a benefit to all. Adjuvant chemotherapy (Stage III and IVA) benefits and chemoradiotherapy (II, III, and IVA) only patients with higher stage disease.
{"title":"Individualizing care for patients with gallbladder cancer","authors":"Laura M. Nicolais , Timothy L. Fitzgerald","doi":"10.1016/j.suronc.2024.102163","DOIUrl":"10.1016/j.suronc.2024.102163","url":null,"abstract":"<div><div>The rarity and lack of Level I Evidence compromise our ability to care for patients with gallbladder cancer.</div></div><div><h3>Methods</h3><div>NCDB cohort study of with resected Stage Groups IB-IVA gallbladder adenocarcinoma between 2004 and 2018. Patients were included.</div></div><div><h3>Results</h3><div>8484 patients were included, median survival was 29.8 (CI 28.6–31.2); Stage IB: 67.0, Stage II: 36.6, and Stage III/IVA 18.4 months. A survival benefit was noted for surgery beyond cholecystectomy (Stage IB 105 vs. 36 months, HR 0.56, p < 0.001; Stage II 56 vs. 20 months, HR 0.72, p < 0.001; and Stage III/IVA 23.8 vs. 9.9 months, HR 0.67, p < 0.001) and chemoradiotherapy (Stage IB 102 vs. 64.8, HR 0.87, CI 0.62–1.23, p = 0.4; ' Stage II 49 vs. 33.5 months, HR 0.78, CI 0.68–0.91, p = 0.002; and Stage III/IVA 31 vs. 12.2 HR 0.60, CI 0.52–0.70, p < 0.001). Adjuvant chemotherapy improved survival in Stage III/IVA (20 vs. 12.2 months, HR 0.74, p < 0.001) but not Stage II and trend toward harm in Stage IB. A nomogram with created with these data.</div></div><div><h3>Conclusion</h3><div>Surgery beyond cholecystectomy provides a benefit to all. Adjuvant chemotherapy (Stage III and IVA) benefits and chemoradiotherapy (II, III, and IVA) only patients with higher stage disease.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102163"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578630","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 : 2024-10-28DOI: 10.1016/j.suronc.2024.102159
Marie Magana , Sebastien Vergez , Benjamin Verillaud , Renaud Garrel , Diane Evrard , François Mouawad , Ludovic de Gabory , Nicolas Fakhry , Franck Jegoux , Olivier Malard , Christine Bach , Pierre Philouze , Karine Aubry , Olivier Mauvais , Antoine Moya Plana , Jean Paul Marie , Bertrand Baujat , Sarah Atallah
Background and objectives
Salivary gland Secretory Carcinoma (SC), characterized by Skalova in 2010 is a rare tumor studied within the REFCOR (French Network of experts on Rare Head and Neck Cancers). We conducted a prospective multicentric cohort study of 108 SC cases in the REFCOR database up to July 2021, analyzing diagnostic, therapeutic, and survival data.
Methods
Data was collected prospectively from diagnosis to the last update. Each patient had two histological readings including one by a REFCORpath pathologist, and all cases underwent molecular testing to confirm diagnosis. Statistical analyses were performed using R software.
Results
MRI was not contributive to malignancy diagnosis. After 2 histological readings, 79 % of patients were diagnosed, with 21 % requiring molecular testing to confirm diagnosis. Surgical treatment typically involved tumor excision and lymph node dissection. The tumor exhibited low lymph node involvement, with 95 % of patients being cN0, and no nodal metastases post-dissection. Five-year overall survival and recurrence-free survival were 91.4 % {95 % CI (0.84–1)} and 89 % {95 % CI (0.81; 0.98)} respectively, indicating a favorable prognosis.
Conclusions
SC is a rare and newly recognized tumor, with generally favorable outcomes. Our cohort, among the largest to date, provides valuable insights. Future research should refine treatment guidelines.
{"title":"Natural history of salivary gland secretory carcinoma: A REFCOR study.","authors":"Marie Magana , Sebastien Vergez , Benjamin Verillaud , Renaud Garrel , Diane Evrard , François Mouawad , Ludovic de Gabory , Nicolas Fakhry , Franck Jegoux , Olivier Malard , Christine Bach , Pierre Philouze , Karine Aubry , Olivier Mauvais , Antoine Moya Plana , Jean Paul Marie , Bertrand Baujat , Sarah Atallah","doi":"10.1016/j.suronc.2024.102159","DOIUrl":"10.1016/j.suronc.2024.102159","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Salivary gland Secretory Carcinoma (SC), characterized by Skalova in 2010 is a rare tumor studied within the REFCOR (French Network of experts on Rare Head and Neck Cancers). We conducted a prospective multicentric cohort study of 108 SC cases in the REFCOR database up to July 2021, analyzing diagnostic, therapeutic, and survival data.</div></div><div><h3>Methods</h3><div><em>Data was</em> collected prospectively from diagnosis to the last update. Each patient had two histological readings including one by a REFCORpath pathologist, and all cases underwent molecular testing to confirm diagnosis. Statistical analyses were performed using R software.</div></div><div><h3>Results</h3><div>MRI was not contributive to malignancy diagnosis. After 2 histological readings, 79 % of patients were diagnosed, with 21 % requiring molecular testing to confirm diagnosis. Surgical treatment typically involved tumor excision and lymph node dissection. The tumor exhibited low lymph node involvement, with 95 % of patients being cN0, and no nodal metastases post-dissection. Five-year overall survival and recurrence-free survival were 91.4 % {95 % CI (0.84–1)} and 89 % {95 % CI (0.81; 0.98)} respectively, indicating a favorable prognosis.</div></div><div><h3>Conclusions</h3><div>SC is a rare and newly recognized tumor, with generally favorable outcomes. Our cohort, among the largest to date, provides valuable insights. Future research should refine treatment guidelines.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102159"},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561209","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 : 2024-10-11DOI: 10.1016/j.suronc.2024.102155
Neel Patel , Joseph O. Werenski , Marcos R. Gonzalez , Marilee J. Clunk , Meagan R. McCadden , Alexis Richard , Ivan Chebib , Yin P. Hung , G. Petur Nielsen , Santiago A. Lozano-Calderon
Introduction
The percentage of tumor necrosis is a crucial prognostic factor in osteosarcoma. Many studies adopt a 90 % cutoff based on osteoblastic osteosarcoma, but these findings are generalized to all conventional subtypes, including chondroblastic osteosarcoma. We sought to answer these questions: (1) Is tumor necrosis ≥90 % associated with better overall survival (OS) and disease-free survival (DFS) in osteoblastic and chondroblastic osteosarcoma? (2) Does the osteosarcoma subtype impact tumor necrosis? (3) Does the osteosarcoma subtype in “good” responders (tumor necrosis ≥90 %) affect OS and DFS?.
Materials and methods
We conducted a retrospective study of 156 patients with osteoblastic and chondroblastic osteosarcoma treated at our institution. All patients received a standardized chemotherapy protocol and underwent surgery with the goal of achieving negative margins (R0 resection). Propensity-score matching was performed to adjust for potential confounders. Kaplan-Meier survival analysis and Cox proportional hazards modeling were performed.
Results
Patients with osteoblastic osteosarcoma and tumor necrosis ≥90 % had higher 5- and 10-year OS and DFS compared to those with necrosis <90 %. In chondroblastic osteosarcoma, a trend towards higher OS and DFS was seen in patients with tumor necrosis ≥90 %; this, however, was not significant. Chondroblastic osteosarcoma was not a risk factor for either tumor necrosis <90 % (p = 0.89) or tumor necrosis <70 % (p = 0.57). Patients with osteoblastic or chondroblastic osteosarcoma that were deemed “good” responders (tumor necrosis ≥90 %) had similar OS and DFS at the 5- and 10-year marks.
Conclusion
Conventional osteosarcoma subtype was not a risk factor for “poor” response. Survival outcomes (OS and DFS) were similar for osteoblastic and chondroblastic osteosarcoma with good response to chemotherapy.
{"title":"Tumor necrosis drives prognosis in osteosarcoma: No difference in chemotherapy response and survival between chondroblastic and osteoblastic osteosarcoma","authors":"Neel Patel , Joseph O. Werenski , Marcos R. Gonzalez , Marilee J. Clunk , Meagan R. McCadden , Alexis Richard , Ivan Chebib , Yin P. Hung , G. Petur Nielsen , Santiago A. Lozano-Calderon","doi":"10.1016/j.suronc.2024.102155","DOIUrl":"10.1016/j.suronc.2024.102155","url":null,"abstract":"<div><h3>Introduction</h3><div>The percentage of tumor necrosis is a crucial prognostic factor in osteosarcoma. Many studies adopt a 90 % cutoff based on osteoblastic osteosarcoma, but these findings are generalized to all conventional subtypes, including chondroblastic osteosarcoma. We sought to answer these questions: (1) Is tumor necrosis ≥90 % associated with better overall survival (OS) and disease-free survival (DFS) in osteoblastic and chondroblastic osteosarcoma? (2) Does the osteosarcoma subtype impact tumor necrosis? (3) Does the osteosarcoma subtype in “good” responders (tumor necrosis ≥90 %) affect OS and DFS?.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective study of 156 patients with osteoblastic and chondroblastic osteosarcoma treated at our institution. All patients received a standardized chemotherapy protocol and underwent surgery with the goal of achieving negative margins (R0 resection). Propensity-score matching was performed to adjust for potential confounders. Kaplan-Meier survival analysis and Cox proportional hazards modeling were performed.</div></div><div><h3>Results</h3><div>Patients with osteoblastic osteosarcoma and tumor necrosis ≥90 % had higher 5- and 10-year OS and DFS compared to those with necrosis <90 %. In chondroblastic osteosarcoma, a trend towards higher OS and DFS was seen in patients with tumor necrosis ≥90 %; this, however, was not significant. Chondroblastic osteosarcoma was not a risk factor for either tumor necrosis <90 % (p = 0.89) or tumor necrosis <70 % (p = 0.57). Patients with osteoblastic or chondroblastic osteosarcoma that were deemed “good” responders (tumor necrosis ≥90 %) had similar OS and DFS at the 5- and 10-year marks.</div></div><div><h3>Conclusion</h3><div>Conventional osteosarcoma subtype was not a risk factor for “poor” response<strong>.</strong> Survival outcomes (OS and DFS) were similar for osteoblastic and chondroblastic osteosarcoma with good response to chemotherapy.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102155"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445297","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 : 2024-10-10DOI: 10.1016/j.suronc.2024.102157
Yusuke Fujita , Koya Hida , Daisuke Nishizaki , Yoshiro Itatani , Shigeki Arizono , Takashi Akiyoshi , Eisuke Asano , Toshiyuki Enomoto , Takeshi Naitoh , Kazutaka Obama , Japan Society of Laparoscopic Colorectal Surgery
Purpose
Neoadjuvant chemoradiotherapy (nCRT) is employed for the local control of locally advanced rectal cancer; however, its prognostic impact is limited and often impairs pelvic organ function. Therefore, careful patient selection is essential. This study aimed to investigate the impact of nCRT on relapse-free survival (RFS) by stratifying patients according to MRI detected circumferential resection margin (mrCRM) or extramural vascular invasion (mrEMVI), as the ability of MRI findings to identify patients who will have beneficial outcomes from nCRT is uncertain.
Methods
We retrospectively analyzed patients with clinical stage II–III lower rectal cancer who underwent surgical resection with or without nCRT between 2010 and 2011 at 69 hospitals in Japan. The impact of nCRT on RFS was evaluated using multivariable Cox regression models in the entire cohort and in subgroups stratified by mrCRM or mrEMVI status.
Results
In the entire cohort (nCRT, n = 172; surgery alone, n = 503), nCRT showed a trend toward improved RFS, although the difference was not statistically significant (HR, 0.74; 95 % CI, 0.54–1.03; P = 0.074). Among mrCRM-negative and mrEMVI-negative patients, there were no significant differences in RFS between the nCRT and surgery-alone groups. Among mrCRM-positive patients, nCRT tended to improve the RFS (HR, 0.70; 95 % CI, 0.46–1.06; P = 0.089). Among mrEMVI-positive patients, nCRT significantly prolonged the RFS (HR, 0.62; 95 % CI, 0.38–1.00; P = 0.048).
Conclusions
Compared to surgery alone, nCRT did not significantly improve RFS in the overall population but significantly improved RFS in mrEMVI-positive patients.
{"title":"Neoadjuvant chemoradiotherapy is associated with prolonged relapse free survival in patient with MRI-detected extramural vascular invasion (mrEMVI) positive rectal cancer: A multicenter retrospective cohort study in Japan","authors":"Yusuke Fujita , Koya Hida , Daisuke Nishizaki , Yoshiro Itatani , Shigeki Arizono , Takashi Akiyoshi , Eisuke Asano , Toshiyuki Enomoto , Takeshi Naitoh , Kazutaka Obama , Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1016/j.suronc.2024.102157","DOIUrl":"10.1016/j.suronc.2024.102157","url":null,"abstract":"<div><h3>Purpose</h3><div>Neoadjuvant chemoradiotherapy (nCRT) is employed for the local control of locally advanced rectal cancer; however, its prognostic impact is limited and often impairs pelvic organ function. Therefore, careful patient selection is essential. This study aimed to investigate the impact of nCRT on relapse-free survival (RFS) by stratifying patients according to MRI detected circumferential resection margin (mrCRM) or extramural vascular invasion (mrEMVI), as the ability of MRI findings to identify patients who will have beneficial outcomes from nCRT is uncertain.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with clinical stage II–III lower rectal cancer who underwent surgical resection with or without nCRT between 2010 and 2011 at 69 hospitals in Japan. The impact of nCRT on RFS was evaluated using multivariable Cox regression models in the entire cohort and in subgroups stratified by mrCRM or mrEMVI status.</div></div><div><h3>Results</h3><div>In the entire cohort (nCRT, n = 172; surgery alone, n = 503), nCRT showed a trend toward improved RFS, although the difference was not statistically significant (HR, 0.74; 95 % CI, 0.54–1.03; P = 0.074). Among mrCRM-negative and mrEMVI-negative patients, there were no significant differences in RFS between the nCRT and surgery-alone groups. Among mrCRM-positive patients, nCRT tended to improve the RFS (HR, 0.70; 95 % CI, 0.46–1.06; P = 0.089). Among mrEMVI-positive patients, nCRT significantly prolonged the RFS (HR, 0.62; 95 % CI, 0.38–1.00; P = 0.048).</div></div><div><h3>Conclusions</h3><div>Compared to surgery alone, nCRT did not significantly improve RFS in the overall population but significantly improved RFS in mrEMVI-positive patients.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102157"},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445310","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 : 2024-10-09DOI: 10.1016/j.suronc.2024.102156
Alison C. Coogan , Paige A. Blinn , Ethan M. Ritz , Alan Tan , Lilia Lunt , Rachel Akers , Cristina O'Donoghue
Background
There is limited data examining potential disparities in the receipt of immunotherapy among patients with stage III melanoma.
Methods
We performed a retrospective cohort review using the National Cancer Database (NCDB) including adult patients with stage III melanoma between 2004 and 2017. We compared receipt of immunotherapy based on demographic and socioeconomic factors for patients diagnosed 2004–2014 and 2016–2017, before and after FDA approval of immune checkpoint blockade.
Results
12,099 patients were included. The proportion of stage III patients who received immunotherapy significantly increased over time, from 24.0 % in 2004–2014 to 43.7 % in 2016–2017 (p < 0.001). There was a significant difference in patients who receive immunotherapy based on age (p < 0.001), insurance (p < 0.001), facility location (p < 0.001).On multivariable analysis, increased odds of immunotherapy receipt were found in patients with diagnosis in 2016–2017 (adjusted odds ratio (aOR) 3.3, 95 % CI 2.9–3.7), younger age (65–80 years aOR 0.43, 95 % CI 0.35–0.52), Hispanic ethnicity (aOR 1.5, 95 % CI 1.1–2.1), and private insurance (not insured aOR 0.67, 95 % CI 0.52–0.85).
Conclusions
Although narrowing, gaps persist in the receipt of immunotherapy after FDA approval. Understanding disparities in the receipt of immunotherapy will aid in understanding barriers to treatment and ensuring patients have equitable access to advanced care.
背景目前研究III期黑色素瘤患者接受免疫疗法的潜在差异的数据有限。方法我们利用美国国家癌症数据库（NCDB）进行了一项回顾性队列研究，纳入了2004年至2017年间的III期黑色素瘤成年患者。我们比较了 2004-2014 年和 2016-2017 年确诊的患者在 FDA 批准免疫检查点阻断疗法之前和之后根据人口统计学和社会经济因素接受免疫疗法的情况。随着时间的推移，接受免疫治疗的 III 期患者比例明显增加，从 2004-2014 年的 24.0% 增加到 2016-2017 年的 43.7%（p <0.001）。根据年龄（p <0.001）、保险（p <0.001）、医疗机构所在地（p <0.001），接受免疫治疗的患者存在明显差异。经多变量分析发现，2016-2017年确诊的患者接受免疫治疗的几率增加（调整后的几率比（aOR）为3.3，95 % CI 2.9-3.7）、年龄较小（65-80 岁 aOR 0.43，95 % CI 0.35-0.52）、西班牙裔（aOR 1.5，95 % CI 1.1-2.1）和私人保险（未保险 aOR 0.67，95 % CI 0.52-0.85）。了解接受免疫疗法方面的差距将有助于了解治疗障碍，并确保患者能够公平地获得先进的医疗服务。
{"title":"The impact of demographics and socioeconomic status on the receipt of immunotherapy for stage III melanoma","authors":"Alison C. Coogan , Paige A. Blinn , Ethan M. Ritz , Alan Tan , Lilia Lunt , Rachel Akers , Cristina O'Donoghue","doi":"10.1016/j.suronc.2024.102156","DOIUrl":"10.1016/j.suronc.2024.102156","url":null,"abstract":"<div><h3>Background</h3><div>There is limited data examining potential disparities in the receipt of immunotherapy among patients with stage III melanoma.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort review using the National Cancer Database (NCDB) including adult patients with stage III melanoma between 2004 and 2017. We compared receipt of immunotherapy based on demographic and socioeconomic factors for patients diagnosed 2004–2014 and 2016–2017, before and after FDA approval of immune checkpoint blockade.</div></div><div><h3>Results</h3><div>12,099 patients were included. The proportion of stage III patients who received immunotherapy significantly increased over time, from 24.0 % in 2004–2014 to 43.7 % in 2016–2017 (p < 0.001). There was a significant difference in patients who receive immunotherapy based on age (p < 0.001), insurance (p < 0.001), facility location (p < 0.001).On multivariable analysis, increased odds of immunotherapy receipt were found in patients with diagnosis in 2016–2017 (adjusted odds ratio (aOR) 3.3, 95 % CI 2.9–3.7), younger age (65–80 years aOR 0.43, 95 % CI 0.35–0.52), Hispanic ethnicity (aOR 1.5, 95 % CI 1.1–2.1), and private insurance (not insured aOR 0.67, 95 % CI 0.52–0.85).</div></div><div><h3>Conclusions</h3><div>Although narrowing, gaps persist in the receipt of immunotherapy after FDA approval. Understanding disparities in the receipt of immunotherapy will aid in understanding barriers to treatment and ensuring patients have equitable access to advanced care.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102156"},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434105","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 : 2024-10-04DOI: 10.1016/j.suronc.2024.102153
Paola Solis- Pazmino , Camila Pazmino , Orly Termeie , Kristina La , Eduardo Pilatuna , Belen Tite , Luis Figueroa , Magno Guarconi , Jon Harrison , Yosef Nasseri , Joshua Ellenhorn , Brendan C. Visser
Background
The presence of ovarian-type stroma defines mucinous cystic neoplasm (MCN). Criteria for surgical resection differ between current consensus guidelines (IAP, AGA, and Europe). This meta-analysis aims to describe pre-surgical clinical parameters that predict malignant transformation of MCN of the pancreas.
Methods
A systematic review and meta-analysis of articles published from 2006 to the time of manuscript authorship in December 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus.
Results
17 studies were identified and included 1058 patients with MCN treated with pancreatectomy. The mean cohort age was 48.2 years (standard deviation [SD] ± 7.9) with an expected female predominance (96 %). The presenting symptom for most was abdominal pain (55.6 %), however, nearly 20 % of patients were asymptomatic. Most patients were treated with distal pancreatectomy (70.5 %), and the mean tumor size was 45 mm. The rate of invasive cancer was 13.8 %. Cysts with mural nodules had a higher risk of developing invasive tumors than those that did not (OR 26.47, 95%CI 12.57–55.74, p < 0.001, I2:0 %). Other clinical factors such as the presence of intramural calcifications or an elevated serum CA 19–9 (>37U/mL) were not predictive of malignancy.
Conclusion
The present meta-analysis did not clarify establishing reliable predictors for malignant transformation other than mural modularity, which may represent tumors that have already undergone transformation. It may be used as a criterion in treatment decision-making.
{"title":"Predictors of malignant transformation in mucinous pancreatic cystic neoplasm: A systemic review and meta-analysis","authors":"Paola Solis- Pazmino , Camila Pazmino , Orly Termeie , Kristina La , Eduardo Pilatuna , Belen Tite , Luis Figueroa , Magno Guarconi , Jon Harrison , Yosef Nasseri , Joshua Ellenhorn , Brendan C. Visser","doi":"10.1016/j.suronc.2024.102153","DOIUrl":"10.1016/j.suronc.2024.102153","url":null,"abstract":"<div><h3>Background</h3><div>The presence of ovarian-type stroma defines mucinous cystic neoplasm (MCN). Criteria for surgical resection differ between current consensus guidelines (IAP, AGA, and Europe). This meta-analysis aims to describe pre-surgical clinical parameters that predict malignant transformation of MCN of the pancreas.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of articles published from 2006 to the time of manuscript authorship in December 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus.</div></div><div><h3>Results</h3><div>17 studies were identified and included 1058 patients with MCN treated with pancreatectomy. The mean cohort age was 48.2 years (standard deviation [SD] ± 7.9) with an expected female predominance (96 %). The presenting symptom for most was abdominal pain (55.6 %), however, nearly 20 % of patients were asymptomatic. Most patients were treated with distal pancreatectomy (70.5 %), and the mean tumor size was 45 mm. The rate of invasive cancer was 13.8 %. Cysts with mural nodules had a higher risk of developing invasive tumors than those that did not (OR 26.47, 95%CI 12.57–55.74, p < 0.001, I2:0 %). Other clinical factors such as the presence of intramural calcifications or an elevated serum CA 19–9 (>37U/mL) were not predictive of malignancy.</div></div><div><h3>Conclusion</h3><div>The present meta-analysis did not clarify establishing reliable predictors for malignant transformation other than mural modularity, which may represent tumors that have already undergone transformation. It may be used as a criterion in treatment decision-making.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102153"},"PeriodicalIF":2.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424875","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 : 2024-10-03DOI: 10.1016/j.suronc.2024.102154
Johanna Kelley , Gabriella Smith , Meng Yao , Laura Chambers , Robert DeBernardo
Objective
The objective of this research is to compare the ability of mFI5 to the mFI11 to predict frailty, postoperative complications, discharge location for patients with ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) at time of cytoreductive surgery.
Methods
This is a single-institution retrospective study in patients with advanced (Stage III, IV) or recurrent ovarian cancer treated with surgical cytoreduction with HIPEC. Logistic regression was used to evaluate frailty as well as factors associated with moderate to severe Accordion postoperative complications and discharge to home. Correlation was calculated between mFI5 and mFI11.
Results
Of 141 patients who received HIPEC between 2010 and 2020, 23 patients were classified as frail (mFI5 score ≥2), while 118 were not frail. Frail patients were significantly older with mean age 65.9 compared to non-frail patients who had mean age of 59.1 (p = 0.005), as well as a higher Charlston Comorbidity Index (p < 0.001), and more renal disease (p = 0.025), hypothyroidism (p = 0.005), and hyperlipidemia (p = 0.004). mFI5 and mFI11 scores for frailty were highly correlated (spearman rho 0.98, p < 0.001). Frail patients were more likely to be discharged to a skilled nursing facility (22.7 %) vs. 6.8 % of non-frail patients, or require home services (18.2 % vs 8.5 %, p = 0.025). On multivariable logistic regression, frail patients were more likely to experience moderate or higher Accordion postoperative complications (OR 3.08, p = 0.024).
Conclusions
The mFI5, a simpler tool than the mFI11, is also highly associated with postoperative complications and need for postoperative services in patients with ovarian cancer undergoing HIPEC at time of cytoreductive surgery.
{"title":"The modified 5-factor frailty index predicts postoperative outcomes in patients with ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy","authors":"Johanna Kelley , Gabriella Smith , Meng Yao , Laura Chambers , Robert DeBernardo","doi":"10.1016/j.suronc.2024.102154","DOIUrl":"10.1016/j.suronc.2024.102154","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this research is to compare the ability of mFI5 to the mFI11 to predict frailty, postoperative complications, discharge location for patients with ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) at time of cytoreductive surgery.</div></div><div><h3>Methods</h3><div>This is a single-institution retrospective study in patients with advanced (Stage III, IV) or recurrent ovarian cancer treated with surgical cytoreduction with HIPEC. Logistic regression was used to evaluate frailty as well as factors associated with moderate to severe Accordion postoperative complications and discharge to home. Correlation was calculated between mFI5 and mFI11.</div></div><div><h3>Results</h3><div>Of 141 patients who received HIPEC between 2010 and 2020, 23 patients were classified as frail (mFI5 score ≥2), while 118 were not frail. Frail patients were significantly older with mean age 65.9 compared to non-frail patients who had mean age of 59.1 (p = 0.005), as well as a higher Charlston Comorbidity Index (p < 0.001), and more renal disease (p = 0.025), hypothyroidism (p = 0.005), and hyperlipidemia (p = 0.004). mFI5 and mFI11 scores for frailty were highly correlated (spearman rho 0.98, p < 0.001). Frail patients were more likely to be discharged to a skilled nursing facility (22.7 %) vs. 6.8 % of non-frail patients, or require home services (18.2 % vs 8.5 %, p = 0.025). On multivariable logistic regression, frail patients were more likely to experience moderate or higher Accordion postoperative complications (OR 3.08, p = 0.024).</div></div><div><h3>Conclusions</h3><div>The mFI5, a simpler tool than the mFI11, is also highly associated with postoperative complications and need for postoperative services in patients with ovarian cancer undergoing HIPEC at time of cytoreductive surgery.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102154"},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401900","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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