Annals of Surgical Oncology最新文献

Background: Thoracoscopic sublobar resection is emerging as a main treatment option for early-stage non-small cell lung cancer (NSCLC). This study aimed to determine whether distinct early post-discharge pain trajectories could be identified in patients with stage IA NSCLC undergoing thoracoscopic sublobar resection.

Methods: The data were collected from a longitudinal prospective observational cohort (CN-PRO-Lung 3). Pain severity was rated using a 0-10 scale, with assessments conducted before surgery and daily after discharge for up to 30 days. Post-discharge pain trajectories were identified using the latent class mixed model. Potential risk factors associated with different pain trajectory were explored, including preoperative clinical characteristics, body composition metrics derived from chest computed tomography, surgical methods, and postoperative clinical outcomes.

Results: A total of 439 patients were selected in the trajectory analysis. One trajectory comprised 65 patients (14.8%, unrecovered group) who experienced persistent moderated post-discharge pain, while the other comprised 374 patients (85.2%, recovered group) with mild post-discharge pain and a declining trend. The independent predictors for the unrecovered post-discharge pain trajectory included the subcutaneous fat index (odds ratio [OR] 1.031, 95% confidence interval [CI] 1.007-1.055, p = 0.010), preoperative pain severity (OR 1.428, 95% CI 1.102-1.851, p = 0.007), and hospital stay (OR 1.166, 95% CI 1.012-1.345, p = 0.034).

Conclusions: Patients with stage IA NSCLC undergoing thoracoscopic sublobar resection had two different early post-discharge pain trajectories. The higher subcutaneous fat index, more severe preoperative pain level, and longer hospital stay were associated with the unrecovered post-discharge pain.

Background: T-cell exhaustion (Tex) represents a distinct immunological state characterized by the progressive functional deterioration of T cells under persistent antigenic stimulation. In recent years, the field of Tex research has attracted considerable attention, accompanied by a dramatic surge in related scientific literature. This study employed bibliometric methods to conduct a comprehensive analysis of Tex-related publications.

Methods: The scientific literature focusing on Tex published between 2005 and 2024 was retrieved from the Web of Science Core Collection. For comprehensive bibliometric evaluation, tools including CiteSpace, VOSviewer, and online websites were used to construct visual networks, including co-authorship, co-citation, and co-occurrence analysis. Quantitative assessment of research output and impact was performed through multiple metrics.

Results: The analysis included a total of 2831 publications. The data fitting analysis indicated an exponential growth in the number of publications per year. Regarding research contributions, the United States and China have consistently demonstrated their leading positions. Among academic institutions and individual researchers, Harvard University has emerged as the most productive organization. Reference analysis showed that chimeric antigen receptor (CAR) T-cell therapy is one of the fields that attract greatest attention in the current Tex research. Keyword analysis revealed that cancer was the most studied disease in this area, followed by hepatocellular carcinoma and HIV. Analysis of high-frequency keywords also found that current research focuses on the field centered around immunotherapy and immune checkpoint inhibitors, functional status of T cells and the mechanisms underlying Tex, tumor microenvironment, prognosis and biomarkers, and the role of Tex in specific diseases. In addition, in the coming years, several key areas will remain at the forefront of scientific exploration. These include machine learning, pan-cancer, programmed death-1 blockade, scRNA-seq, immune tolerance, VISTA, immunotherapy resistance, exosome, chronic inflammation, gene editing, triple-negative breast cancer, tumor microenvironment, solid tumors, multiple myeloma, and extracellular vesicles.

Conclusions: This research represents the inaugural effort to perform an extensive bibliometric evaluation of literature focusing on Tex between 2005 and 2024. The findings derived from this analysis offer a credible resource for scholars aiming to swiftly grasp essential insights and emerging trends, as well as future hotspots within this domain.

Background: Postmastectomy autologous reconstruction (PMAR) is an important component of comprehensive breast cancer care. Previous research has suggested the existence of sociodemographic disparities in complications after immediate PMAR. The objective of this study was to examine the impact of sociodemographic and clinical factors on immediate PMAR postoperative outcomes.

Methods: We performed a retrospective cohort study of adult patients undergoing PMAR in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2016-2021). Postmastectomy autologous reconstruction included deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutaneous (TRAM), and latissimus dorsi (LD) flaps. Primary outcomes were inpatient postoperative complications and readmissions within 30 and 90 days. Data elements were abstracted by using ICD-10 codes and comorbidities defined by using the Elixhauser classification. Univariate and multivariate analyses were performed.

Results: We identified 3537 women admitted for PMAR. 483 (13.7%) patients experienced complications 30 days postsurgery. An additional 46 patients (15%) experienced complications within 90 days. A total of 224 patients (6.3%) were readmitted within 30 days, and 368 (10.4%) were readmitted within 90 days. Patients living in smaller metropolitan areas or with four or more comorbidities had significantly increased odds of complications. Patients with Medicaid, Medicare, or two or more comorbidities were significantly more likely to experience hospital length of stay ≥7 days. Residing in smaller metropolitan areas, having two or more comorbidities, or having Medicare were associated with increased odds of 30-day and 90-day readmission.

Conclusions: Disparities exist in outcomes after PMAR in patients with public insurance, residing in smaller metropolitan areas, and with multiple comorbidities. These findings should be further evaluated to assess validity and determine generalizability.

Background: Despite treatment advancements, esophageal cancer survival remains poor due to high recurrence rates. Early detection of recurrence may allow for timely treatment and improved outcomes. This study evaluated recurrence patterns and detection methods using different imaging surveillance strategies after esophagectomy.

Methods: A retrospective study reviewed patients who underwent esophagectomy for cancer at a high-volume National Cancer Institute (NCI)-designated comprehensive cancer center from 2007 to 2019. Postoperative surveillance followed a protocol based on the CROSS trial incorporating routine computed tomography (CT) imaging and clinical exams. Statistical analyses included independent t tests for continuous variables and chi-square tests for categorical variables. Times to recurrence and survival were calculated using Kaplan-Meier and compared by the log-rank test. Multivariate analysis used binary logistic regression.

Results: Among 368 patients, 302 (82.1 %) received neoadjuvant chemoradiation. Recurrence occurred for 140 (38 %) patients, with more than 80 % of the recurrences detected within 2 years after surgery. In a multivariate analysis, lymphovascular invasion and clinical stage 3 disease were associated with recurrence. Clinically driven imaging discovered 61 (43.6 %) of the 140 recurrence cases, whereas routine surveillance imaging identified 77 (55 %) of the cases. The median time to recurrence was 9.4 months. The patients whose recurrence was detected through routine surveillance had a longer survival than those whose recurrence was detected by clinically driven imaging (median survival, 29.3 vs 17.7 months, respectively; p < 0.05).

Conclusions: The incidence of early recurrence is high after trimodality therapy (CROSS regimen) for esophageal cancer. Routine imaging surveillance combined with clinical examination as a surveillance protocol is necessary for early detection and timely treatment.

Background: Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a novel, minimally invasive method of delivering intraperitoneal chemotherapy with promising peritoneal disease control in ovarian cancer.

Methods: This US multicenter prospective phase I trial (NCT04329494) evaluated the safety and efficacy of PIPAC cisplatin 10.5 mg/m² and doxorubicin 2.1 mg/m² (PIPAC-CD) every 6 weeks in ovarian cancer at three US centers. Primary endpoints were dose-limiting toxicities and adverse events. Secondary endpoints included response according to RECIST (Response Evaluation Criteria in Solid Tumors) criteria, laparoscopic peritoneal carcinomatosis index, histologic peritoneal regression grading score, progression-free survival (PFS), and overall survival (OS).

Results: In total, 15 patients were enrolled. The median prior lines of therapy was 3 (range 1-10). The PIPAC completion rate (≥2 PIPACs) was 86.7%. A total of 76.9% of patients had extraperitoneal disease at baseline. One patient discontinued treatment for toxicity because of deterioration of her baseline Eastern Cooperative Oncology Group 2 performance status. There was one grade 3 abdominal pain, one grade 3 anorexia, and no grade 4 or 5 adverse events. Laparoscopic best response (peritoneal carcinomatosis index) and histologic response (peritoneal regression grading score) occurred in 30.8% and 46.2%, respectively. Radiologic best response (RECIST) was 6.7%, with one partial response and a stable disease rate of 26.7%. Median PFS and OS were 2.3 months (95% confidence interval 1.7-3.2) and 17.1 months (95% confidence interval 5.6-not reached), respectively (n=15).

Conclusions: PIPAC-CD is feasible, safe, and well tolerated at academic US centers. OS and PFS were limited in patients with heavily pretreated ovarian carcinoma who underwent PIPAC-CD. Future trials should focus on optimizing PIPAC drug combinations and determining optimal patient selection criteria for ovarian cancer.