Annals of Surgical Oncology最新文献

Background: Cachexia index (CXI) is a recently proposed biomarker reflecting the cachectic condition, including inflammation, sarcopenia and nutritional status, of patients with various malignancies. We evaluated its prognostic impact in patients undergoing esophagectomy for esophageal cancer (EC).

Methods: A total of 378 patients were retrospectively reviewed. CXI was calculated as skeletal muscle index × serum albumin level/neutrophil-to-lymphocyte ratio. The sex-specific lowest quartile defined the Low-CXI group. Univariate and multivariate Cox proportional hazards models were applied to identify independent prognostic factors for overall survival (OS) and disease-free survival (DFS).

Results: The low-CXI group was significantly associated with older age (P < 0.001), more severe comorbidity (P = 0.001), and more advanced pathological stage (P = 0.032). Patients in the low-CXI group had poorer OS and DFS than those in the high-CXI group (both P < 0.001). Multivariate analysis revealed that low-CXI was independently associated with poor OS (P = 0.002) and DFS (P = 0.002). In the cause-specific survival analyses, low-CXI was a predictor of deaths from non-EC-related causes. Subdivision into pathological stage (pStage) 0-I and II/III revealed that significant survival differences according to CXI were observed in both pStage 0-I (P = 0.045 for OS, and 0.029 for DFS) and pStage II/III (P < 0.001 for OS, and 0.002 for DFS) patients.

Conclusions: Low-CXI was independently associated with poor OS and DFS in patients undergoing surgery for EC, in both early- and advanced-stage patients. Furthermore, CXI may also be useful for predicting non-EC-related mortality.

Purpose: Despite the growing incidence of small renal tumors, adoption of percutaneous biopsy remains limited because of concerns about oncologic safety. Lack of robust long-term outcome data further contributes to clinical hesitation regarding routine use. We evaluated the impact of preoperative renal mass biopsy (RMB) on upstaging and recurrence in patients with cT1 renal cell carcinoma (RCC) undergoing definitive surgery.

Methods: Retrospective cohort study of 386 consecutive patients who underwent preoperative RMB and 772 propensity score-matched controls who proceeded directly to surgery for cT1 RCC between 2004 and 2022 were compared for recurrence-free survival (RFS) using Kaplan-Meier analysis and Cox proportional hazards regression, and upstaging to perinephric fat invasion by multivariable logistic regression.

Results: Analytical cohort comprised 882 (76.2%) T1a and 276 (23.8%) T1b patients, with 684 (59.1%) after partial nephrectomy and 474 (40.9%) after radical nephrectomy. During a median follow-up of 58 months (interquartile range 39-77), RFS showed no statistically significant difference (5Y RFS 96.7% vs. 97.8%, p = 0.35). Multivariable analysis confirmed RMB was not associated with recurrence (hazard ratio = 0.71, 95% confidence interval 0.34-1.46, p = 0.35). Independent predictors of recurrence included tumor size, nuclear grade, high nephrometry E score and perinephric fat invasion. Likewise, RMB was not associated with upstaging to perinephric fat invasion (odds ratio 1.64, 95% confidence interval 0.78-3.36, p = 0.182). On multivariable analysis, nephrometry E score was the only significant predictor of perinephric fat invasion.

Conclusion: Preoperative biopsy in T1 RCC was not associated with adverse oncologic outcomes, affirming its safety and supporting its utility in the management planning of patients with small renal masses.