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Letter to the Editors: Concerning "Nodal Surgery for Patients ≥ 70 Undergoing Mastectomy for DCIS? Choose Wisely" by Elissa C. Dalton et al. 致编辑的信:关于 Elissa C. Dalton 等人撰写的 "因 DCIS 而接受乳房切除术的≥70 岁患者的结节手术?明智选择",作者 Elissa C. Dalton 等人。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-21 DOI: 10.1245/s10434-024-16061-7
Jialin Zhao, Qingli Zhu, Li Peng, Song Fang
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引用次数: 0
Clinical Outcomes in Patients with Early Stage Node-Negative HER2-Positive Breast Cancer Receiving Upfront Surgery or Neoadjuvant Systemic Therapy. 接受前期手术或新辅助系统疗法的早期结节阴性 HER2 阳性乳腺癌患者的临床疗效。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-27 DOI: 10.1245/s10434-024-16087-x
Natasha Muppidi, Taiwo Adesoye, Min Yi, Susie X Sun, Mariana Chavez-MacGregor, Puneet Singh, Meghan Karuturi, Nina Tamirisa, Kelly K Hunt, Mediget Teshome

Background: HER2-positive breast cancer is traditionally treated with neoadjuvant systemic therapy (NST), but optimal treatment sequencing is less clear in patients with small tumors. We investigated clinicopathologic and oncologic outcomes in early stage HER2-positive breast cancer.

Patients and methods: An institutional database was queried to identify patients with cT1-2 (≤ 3 cm) N0M0, HER2-positive breast cancer treated from 2015 to 2020 and compared upfront surgery and NST cohorts. Logistic regression was performed to identify factors predicting upstaging. Survival outcomes by group were compared using log-rank tests.

Results: Of 256 patients identified, 170 (66.4%) received upfront surgery and 86 (33.6%) NST. The NST cohort was younger and had more cT2 and grade 3 tumors and negative sentinel nodes. There was no significant difference in type of breast surgery or receipt of axillary lymphadenectomy. After upfront surgery, 4 (2.4%) patients had upstaging to pT > 3 cm and 18 (10.6%) to pN1-3. No factors predicted upstaging. After NST, 47 (54.7%) achieved pathologic complete response and 3 (3.5%) had upstaging to ypN1-3 with older age (OR 1.08, p = 0.004) and hormone receptor-positive status (OR 7.07, p = 0.002) identified as predictors. At median follow-up of 3.55 years, 10 (3.9%) patients had recurrence and 5 (2.0%) patients died. There were no significant differences in oncologic outcomes between groups.

Conclusions: Patients with cT1-2 (≤ 3 cm)N0 HER2-positive breast cancer selected for NST have higher-risk disease. Low rates of pathologic upstaging were observed with no difference in surgical treatments and overall excellent oncologic outcomes in both groups. These findings may guide decision-making regarding treatment sequencing for patients with early stage HER2-positive disease.

背景:HER2阳性乳腺癌传统上采用新辅助全身治疗(NST),但小肿瘤患者的最佳治疗顺序尚不明确。我们研究了早期HER2阳性乳腺癌的临床病理学和肿瘤学结果:我们查询了一个机构数据库,以确定2015年至2020年接受治疗的cT1-2(≤3厘米)N0M0、HER2阳性乳腺癌患者,并比较了前期手术和NST队列。进行了逻辑回归以确定预测上行分期的因素。使用对数秩检验比较了各组的生存结果:在确定的 256 名患者中,170 人(66.4%)接受了前期手术,86 人(33.6%)接受了 NST。NST组患者更年轻,cT2和3级肿瘤以及前哨结节阴性者更多。乳腺手术类型和腋窝淋巴结切除术的接受情况没有明显差异。前期手术后,有4名(2.4%)患者的pT>3厘米,18名(10.6%)患者的pN1-3升高。没有任何因素可预测肿瘤的分期。NST 后,47 例(54.7%)患者获得了病理完全反应,3 例(3.5%)患者的分期上升至 ypN1-3,年龄较大(OR 1.08,p = 0.004)和激素受体阳性状态(OR 7.07,p = 0.002)被认为是预测因素。中位随访 3.55 年,10 例(3.9%)患者复发,5 例(2.0%)患者死亡。两组患者的肿瘤治疗结果无明显差异:结论:cT1-2(≤ 3 厘米)N0 HER2 阳性乳腺癌患者选择 NST 的风险较高。两组患者的病理分期率较低,手术治疗效果无差异,总体肿瘤预后良好。这些发现可为早期HER2阳性患者的治疗排序决策提供指导。
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引用次数: 0
Conversion Surgery After Chemotherapy Plus Nivolumab as the First-Line Treatment for Unresectable Advanced or Recurrent Gastric Cancer and a Biomarker Study Using the Gustave Roussy Immune Score: A Multicenter Study. 化疗加 Nivolumab 作为不可切除的晚期或复发性胃癌一线治疗后的转换手术以及使用 Gustave Roussy 免疫评分的生物标志物研究:一项多中心研究。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-03 DOI: 10.1245/s10434-024-16161-4
Nobuhiro Nakazawa, Makoto Sohda, Nobuhiro Hosoi, Takayoshi Watanabe, Yuji Kumakura, Toshiki Yamashita, Naritaka Tanaka, Kana Saito, Akiharu Kimura, Kengo Kasuga, Kenji Nakazato, Daisuke Yoshinari, Hisashi Shimizu, Yasunari Ubukata, Hisashi Hosaka, Akihiko Sano, Makoto Sakai, Hiroomi Ogawa, Ken Shirabe, Hiroshi Saeki

Background: There are few reports on conversion surgery (CS) after chemotherapy plus nivolumab as a first-line treatment in patients with unresectable advanced or recurrent gastric cancer (GC). This multicenter study was conducted to analyze real-world data on CS after chemotherapy plus nivolumab as a first-line treatment and to identify predictive biomarkers.

Methods: This multicenter study included 104 patients who received chemotherapy plus nivolumab as primary treatment for unresectable advanced recurrent GC from 12 institutes. We investigated and analyzed patient characteristics and blood test data in the presence or absence of CS, the relationship between the Gustave Roussy Immune Score (GRIm-s) and CS, and the characteristics of CS cases.

Results: CS was performed in 12 patients (11.5%). Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was significantly better in patients who underwent CS (p < 0.0001). There were no CS cases with high-risk GRIm-s (0%), however there were 22 non-CS cases (23.9%). No high-risk GRIm-s cases were converted to CS. Minimally invasive surgery was performed in 50.0% of the cases, with R0 resection in all cases and only one case of urinary retention (Grade II) as a postoperative complication, indicating a good postoperative short-term outcome. There were two cases of postoperative recurrence (16.7%), both of which were grade 1b.

Conclusions: The short-term postoperative results of CS after chemotherapy plus nivolumab as the first-line treatment for GC were acceptable in this study. There were no high-risk GRIm-s cases among those who underwent CS, suggesting that the GRIm-s may be a predictor of CS.

背景:关于不可切除的晚期或复发性胃癌(GC)患者化疗加尼伐单抗一线治疗后的转换手术(CS)的报道很少。本项多中心研究旨在分析化疗加尼伐单抗一线治疗后转化手术的实际数据,并确定预测性生物标志物:这项多中心研究纳入了来自12家机构的104名接受化疗+nivolumab一线治疗的不可切除的晚期复发性胃癌患者。我们调查并分析了有无CS的患者特征和血液检测数据、Gustave Roussy免疫评分(GRIm-s)与CS之间的关系以及CS病例的特征:结果:12名患者(11.5%)进行了CS。东部合作肿瘤学组表现状态(ECOG-PS)明显优于接受 CS 的患者(p 结论:GRIm-s 与 CS 的关系非常密切:在本研究中,化疗加 nivolumab 作为 GC 一线治疗后进行 CS 的术后短期效果是可以接受的。接受CS治疗的患者中没有高危GRIm-s病例,这表明GRIm-s可能是CS的预测指标。
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引用次数: 0
Maximizing Postoperative Success in NSCLC: The Critical Role of Multidisciplinary Collaboration. 最大限度地提高 NSCLC 术后成功率:多学科协作的关键作用。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-14 DOI: 10.1245/s10434-024-16234-4
Rongrui Zhao, Xinyue Ma, Jiacui Zhang
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引用次数: 0
The Prognostic Significance of Nativity, Enclave Residence, and Socioeconomic Status Among Hispanic Patients with Hepatocellular Carcinoma. 西班牙裔肝细胞癌患者的祖籍、飞地居住地和社会经济地位的预后意义。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-21 DOI: 10.1245/s10434-024-15761-4
Zachary A Whitham, Nicole M Nevarez, Rong Rong, Gloria Chang, Cecilia G Ethun, Matthew R Porembka, John C Mansour, Sam C Wang, Patricio M Polanco, Herbert J Zeh, Nicole E Rich, Amit G Singal, Adam C Yopp

Background: Residence in ethnic enclaves and nativity are both associated with survival in Hispanic patients with cancer, although their prognostic significance in patients with hepatocellular carcinoma (HCC) is unknown. We aimed to determine the association between nativity, neighborhood socioeconomic status (nSES), and ethnic enclave residency with overall survival in Hispanic patients with HCC.

Methods: Hispanic patients diagnosed with HCC from 2004 to 2017 were identified in the Texas Cancer Registry. Existing indices were applied to tract-level 2000 US Census data to measure enclave residence and nSES. Enclaves were defined by seven measures. Multivariable Cox proportional hazard models were used to evaluate the association between nativity, enclave residency, and nSES with survival.

Results: Among 9496 Hispanic patients with HCC, 2283 (24%) were foreign-born. Compared with US-born Hispanic patients, foreign-born Hispanic patients were less likely to present with localized HCC (45.3% vs. 48.8%, p = 0.03) and less likely to receive HCC treatment (53.9% vs. 47.6%, p < 0.001); however, foreign-born Hispanic patients had lower mortality in adjusted models (adjusted hazard ratio [aHR] 0.86, 95% confidence interval [CI] 0.79-0.93). Neighborhood SES, but not enclave residence, was also associated with overall survival. Compared with those in low nSES non-enclaves, Hispanic patients in high nSES neighborhoods, with either enclave (aHR 0.80, 95% CI 0.72-0.88) or non-enclave (aHR 0.89, 95% CI 0.80-0.98) residence status and low nSES enclaves (aHR 0.93, 95% CI 0.86-0.98) had improved survival.

Conclusion: In Hispanic patients with HCC, foreign birthplace and higher nSES, but not enclave residence, are associated with improved survival. Additional research on intersectionality between ethnicity, nativity, and neighborhood context is warranted.

背景:在西班牙裔癌症患者中,居住在民族飞地和本土性都与生存有关,但它们对肝细胞癌(HCC)患者的预后意义尚不清楚。我们旨在确定西班牙裔 HCC 患者的原籍地、邻里社会经济地位(nSES)和飞地居住地与总生存率之间的关系。方法:在德克萨斯州癌症登记处确定了 2004 年至 2017 年诊断为 HCC 的西班牙裔患者。将现有指数应用于2000年美国人口普查数据的区级,以衡量飞地居住地和nSES。飞地由七种测量方法定义。采用多变量考克斯比例危险模型评估原籍、飞地居住地和nSES与生存的关系:在9496名患有HCC的西班牙裔患者中,有2283人(24%)在国外出生。与美国出生的西语裔患者相比,外国出生的西语裔患者出现局部 HCC 的几率较低(45.3% 对 48.8%,P = 0.03),接受 HCC 治疗的几率也较低(53.9% 对 47.6%,P 结论:在西语裔 HCC 患者中,外国出生的西语裔患者存活率较高:在患有 HCC 的西班牙裔患者中,外国出生地和较高的 nSES(而非飞地居住地)与生存率的提高有关。有必要对种族、出生地和社区环境之间的交叉性进行进一步研究。
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引用次数: 0
ASO Author Reflections: Anatomic Resection for Intrahepatic Cholangiocarcinoma: Should it be the Standard? ASO 作者的思考:肝内胆管癌的解剖切除:是否应作为标准?
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-29 DOI: 10.1245/s10434-024-16309-2
Luca Viganò, Giuseppe Maria Ettorre, Giammauro Berardi
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引用次数: 0
National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer. 乳腺癌乳房切除术后入院与在家康复的全国模式。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI: 10.1245/s10434-024-16107-w
Leah S Kim, Miranda S Moore, Eric Schneider, Joseph Canner, Haripriya Ayyala, Judy Chen, Pavan Anant, Elena Graetz, Melanie A Lynch, Gregory Zanieski, Alyssa Gillego, Monica G Valero, Ellie M Proussaloglou, Elizabeth R Berger, Mehra Golshan, Rachel A Greenup, Tristen S Park

Background: We examined national patterns of care and perioperative outcomes for women after mastectomy, comparing home recovery (HR) with hospital admission.

Patients and methods: Using Martketscan data (2017-2019), women ≥ 18 years old who underwent mastectomy ± reconstruction were identified and classified as either home recovery (same calendar day discharge) or hospital admission (stays > 1 calendar day). Comorbidities and receipt of chemo/immunotherapy 6 months prior to surgery and post-surgical 30-day complications were measured. Logistic regression calculated the odds of any complication by encounter type, adjusting for age, accompanying lymph node (LN) procedure, reconstruction, neoadjuvant chemo- and/or immunotherapy, and select comorbidities.

Results: Of 11,789 mastectomy encounters (N = 11,659 women), 4751 (40%) cases utilized HR while 7038 (60%) had hospital admission. HR patients were older (53.6 years old vs. 51.8 years old) with lower rates of reconstruction (60.2 vs. 74.5%, p < 0.001). Rates of neoadjuvant chemotherapy (19.6 vs. 20.9%, p = 0.099) and immunotherapy (3.6 vs. 3.9%, p = 0.445) were similar between groups. Complication rates were lower among HR patients with fewer postoperative hematomas (0.6 vs. 1.3%, p < 0.001) and decreased wound complications (8.5 vs. 9.8%, p = 0.019). In a multivariable analysis, the odds of any complication were approximately 20% lower for HR patients compared with admission patients (aOR 0.81, 95% CI 0.72-0.91, p < 0.001). Unplanned emergency room visits were similar between groups (6.7 vs. 7.2%, p = 0.374); yet fewer hospital re-admissions (2.5 vs. 3.5%, p = 0.003) occurred in women recovering at home.

Conclusion: HR is a safe option compared with in-hospital admission for clinically appropriate women after mastectomy as they are less likely to experience postoperative complications, emergency department (ED) visits, or hospitalization.

背景:我们研究了全国乳房切除术后妇女的护理模式和围手术期结果,比较了家庭康复(HR)和入院治疗:利用Martketscan数据(2017-2019年),确定了接受乳房切除术(±重建)的≥18岁女性,并将其分类为家庭康复(同一日历日出院)或入院(住院时间>1日历日)。对合并症、术前 6 个月接受化疗/免疫治疗以及术后 30 天并发症进行了测量。逻辑回归计算了不同类型并发症的发生几率,并对年龄、伴随的淋巴结(LN)手术、重建、新辅助化疗和/或免疫治疗以及选定的合并症进行了调整:在 11789 例乳房切除术中(N = 11659 名女性),4751 例(40%)使用了 HR,7038 例(60%)入院治疗。HR患者年龄较大(53.6岁对51.8岁),重建率较低(60.2%对74.5%,P 结论:与住院治疗相比,HR 是适合乳房切除术后临床妇女的安全选择,因为她们不太可能出现术后并发症、急诊科就诊或住院治疗。
{"title":"National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer.","authors":"Leah S Kim, Miranda S Moore, Eric Schneider, Joseph Canner, Haripriya Ayyala, Judy Chen, Pavan Anant, Elena Graetz, Melanie A Lynch, Gregory Zanieski, Alyssa Gillego, Monica G Valero, Ellie M Proussaloglou, Elizabeth R Berger, Mehra Golshan, Rachel A Greenup, Tristen S Park","doi":"10.1245/s10434-024-16107-w","DOIUrl":"10.1245/s10434-024-16107-w","url":null,"abstract":"<p><strong>Background: </strong>We examined national patterns of care and perioperative outcomes for women after mastectomy, comparing home recovery (HR) with hospital admission.</p><p><strong>Patients and methods: </strong>Using Martketscan data (2017-2019), women ≥ 18 years old who underwent mastectomy ± reconstruction were identified and classified as either home recovery (same calendar day discharge) or hospital admission (stays > 1 calendar day). Comorbidities and receipt of chemo/immunotherapy 6 months prior to surgery and post-surgical 30-day complications were measured. Logistic regression calculated the odds of any complication by encounter type, adjusting for age, accompanying lymph node (LN) procedure, reconstruction, neoadjuvant chemo- and/or immunotherapy, and select comorbidities.</p><p><strong>Results: </strong>Of 11,789 mastectomy encounters (N = 11,659 women), 4751 (40%) cases utilized HR while 7038 (60%) had hospital admission. HR patients were older (53.6 years old vs. 51.8 years old) with lower rates of reconstruction (60.2 vs. 74.5%, p < 0.001). Rates of neoadjuvant chemotherapy (19.6 vs. 20.9%, p = 0.099) and immunotherapy (3.6 vs. 3.9%, p = 0.445) were similar between groups. Complication rates were lower among HR patients with fewer postoperative hematomas (0.6 vs. 1.3%, p < 0.001) and decreased wound complications (8.5 vs. 9.8%, p = 0.019). In a multivariable analysis, the odds of any complication were approximately 20% lower for HR patients compared with admission patients (aOR 0.81, 95% CI 0.72-0.91, p < 0.001). Unplanned emergency room visits were similar between groups (6.7 vs. 7.2%, p = 0.374); yet fewer hospital re-admissions (2.5 vs. 3.5%, p = 0.003) occurred in women recovering at home.</p><p><strong>Conclusion: </strong>HR is a safe option compared with in-hospital admission for clinically appropriate women after mastectomy as they are less likely to experience postoperative complications, emergency department (ED) visits, or hospitalization.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Oncologic and Perioperative Outcomes of Robot-Assisted Versus Conventional Laparoscopy for the Treatment of Clinically Uterine-Confined High-Grade Adenocarcinoma. 机器人辅助腹腔镜手术与传统腹腔镜手术治疗临床子宫局限性高级别腺癌的肿瘤学和围手术期结果。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-24 DOI: 10.1245/s10434-024-16029-7
Christian Dagher, Yu Hui Lim, Yukio Sonoda, Lila Marshall, Kara Long Roche, Elizabeth Jewell, Dennis S Chi, Ginger Gardner, Vance Broach, Jennifer J Mueller, Nadeem R Abu-Rustum, Mario M Leitao

Objective: The aim of this study was to compare oncologic and perioperative outcomes of robot-assisted laparoscopy (RA) and conventional laparoscopy (LSC) in apparent clinically uterine-confined, high-grade adenocarcinoma.

Methods: A retrospective review was conducted to identify patients with newly diagnosed high-grade uterine adenocarcinoma treated at our institution between 1 January 2009 and 30 June 2021. Exclusion criteria included bulky extrauterine disease, no lymph node assessment, or synchronous tumors. Clinicopathologic details were obtained from medical records. Postoperative complications were classified using the Memorial Sloan Kettering Cancer Center Surgical Secondary Events system, and statistical analysis was performed using appropriate tests.

Results: Of 901 patients identified, 748 (83%) underwent RA and 153 (17%) underwent LSC. Median age was 65 years (range 25-92) and median body mass index was 30 kg/m2 (range 15-60). Overall, 650 patients (72%) had 2009 International Federation of Obstetrics and Gynecology (FIGO) stage I disease. Forty-one patients (4.6%) converted to laparotomy-26 (3.5%) from RA versus 15 (9.8%) from LSC (p = 0.02). Postoperative complications occurred in 81 patients (9.0%), with no significant differences in type or rate between groups. Median operative time was 192 mins (range 88-936) for RA versus 168 mins (range 90-372) for LSC (p = 0.002). Median follow-up was 52 months (range 1-163) for RA and 66 months (range 7-165) for LSC. Four-year progression-free survival (PFS) and disease-specific survival (DSS) were similar between groups. Multivariate analysis showed stage, histology, peritoneal cytology, and lymphovascular invasion predicated a decrease in PFS and DSS.

Conclusions: RA demonstrated comparable oncologic outcomes to LSC in patients with high-grade endometrial carcinoma, with no significant difference in postoperative complications or long-term survival.

研究目的本研究旨在比较机器人辅助腹腔镜(RA)和传统腹腔镜(LSC)治疗明显的临床子宫局限性高级别腺癌的肿瘤学和围手术期疗效:本院对2009年1月1日至2021年6月30日期间新确诊的高级别子宫腺癌患者进行了回顾性研究。排除标准包括巨大子宫外疾病、未进行淋巴结评估或同步肿瘤。临床病理资料来自医疗记录。术后并发症采用纪念斯隆-凯特琳癌症中心外科次要事件系统进行分类,并采用适当的检验方法进行统计分析:在确定的901例患者中,748例(83%)接受了RA手术,153例(17%)接受了LSC手术。中位年龄为 65 岁(25-92 岁不等),中位体重指数为 30 公斤/平方米(15-60 公斤/平方米不等)。总体而言,650 名患者(72%)的疾病处于 2009 年国际妇产科联盟(FIGO)I 期。41名患者(4.6%)转为开腹手术--26名(3.5%)来自RA,15名(9.8%)来自LSC(P = 0.02)。81名患者(9.0%)发生了术后并发症,两组患者的并发症类型和发生率无明显差异。RA的中位手术时间为192分钟(范围88-936),而LSC为168分钟(范围90-372)(P = 0.002)。RA的中位随访时间为52个月(1-163个月),LSC为66个月(7-165个月)。两组患者的四年无进展生存期(PFS)和疾病特异性生存期(DSS)相似。多变量分析表明,分期、组织学、腹腔细胞学和淋巴管侵犯预示着PFS和DSS的下降:结论:在高级别子宫内膜癌患者中,RA的肿瘤治疗效果与LSC相当,术后并发症和长期生存率没有显著差异。
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引用次数: 0
Hepatic Resection as the Primary Treatment Method for Hepatocellular Carcinoma After Orthotopic Liver Transplantation. 将肝切除术作为原位肝移植后肝细胞癌的主要治疗方法
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-22 DOI: 10.1245/s10434-024-16085-z
Abraham J Matar, Kailey M Oppat, Frances J Bennett, Emilie A K Warren, Chase J Wehrle, Zhihao Li, Luckshi Rajendran, Zachary P Rokop, Chandrashekhar Kubal, Ben E Biesterveld, David P Foley, Mayumi Maeda, Mindie H Nguyen, Beth Elinoff, Abhinav Humar, Dimitrios Moris, Debra Sudan, John Klein, Juliet Emamaullee, Vatche Agopian, Parsia A Vagefi, Shukri H A Dualeh, Christopher J Sonnenday, Gonzalo Sapisochin, Federico N Aucejo, Shishir K Maithel

Background: Liver transplantation (LT) is the treatment of choice for end-stage liver disease and certain malignancies such as hepatocellular carcinoma (HCC). Data on the surgical management of de novo or recurrent tumors that develop in the transplanted allograft are limited. This study aimed to investigate the perioperative and long-term outcomes for patients undergoing hepatic resection for de novo or recurrent tumors after liver transplantation.

Methods: The study enrolled adult and pediatric patients from 12 centers across North America who underwent hepatic resection for the treatment of a solid tumor after LT. Perioperative outcomes were assessed as well as recurrence free survival (RFS) and overall survival (OS) for those undergoing resection for HCC.

Results: Between 2003 and 2023, 54 patients underwent hepatic resection of solid tumors after LT. For 50 patients (92.6 %), resection of malignant lesions was performed. The most common lesion was HCC (n = 35, 64.8 %), followed by cholangiocarcinoma (n = 6, 11.1 %) and colorectal liver metastases (n = 6, 11.1 %). The majority of the 35 patients underwent resection of HCC did not receive any preoperative therapy (82.9 %) or adjuvant therapy (71.4 %), with resection their only treatment method for HCC. During a median follow-up period of 50.7 months, the median RFS was 21.5 months, and the median OS was 49.6 months.

Conclusion: Hepatic resection following OLT is safe and associated with morbidity and mortality rates that are comparable to those reported for patients undergoing resection in native livers. Hepatic resection as the primary and often only treatment modality for HCC following LT is associated with acceptable RFS and OS and should be considered in well selected patients.

背景:肝移植(LT)是治疗终末期肝病和某些恶性肿瘤(如肝细胞癌)的首选方法。有关移植异体中出现的新发或复发肿瘤的手术治疗数据十分有限。本研究旨在调查肝移植后因新发或复发肿瘤而接受肝切除术的患者的围手术期和长期疗效:该研究招募了来自北美 12 个中心的成人和儿童患者,他们在肝移植后接受了肝切除术以治疗实体瘤。结果:2003年至2023年期间,54名患者接受了肝移植手术,其中有3名患者在术后复发:2003年至2023年间,54名患者在LT术后接受了实体瘤肝切除术。50名患者(92.6%)接受了恶性病灶切除术。最常见的病变是肝癌(35 例,占 64.8%),其次是胆管癌(6 例,占 11.1%)和结直肠肝转移瘤(6 例,占 11.1%)。在接受 HCC 切除术的 35 名患者中,大多数未接受任何术前治疗(82.9%)或辅助治疗(71.4%),切除术是他们治疗 HCC 的唯一方法。中位随访期为50.7个月,中位RFS为21.5个月,中位OS为49.6个月:结论:OLT 后的肝切除术是安全的,其发病率和死亡率与接受原位肝切除术的患者相当。肝切除术作为LT术后HCC的主要治疗方式,通常也是唯一的治疗方式,可获得可接受的RFS和OS,经过严格筛选的患者应考虑进行肝切除术。
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引用次数: 0
Hepatic and Overall Progression-Free Survival After Percutaneous Hepatic Perfusion (PHP) as First-Line or Second-Line Therapy for Metastatic Uveal Melanoma. 经皮肝灌注 (PHP) 作为转移性葡萄膜黑色素瘤的一线或二线疗法后的肝脏和总体无进展生存期。
IF 3.4 2区 医学 Q2 ONCOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-22 DOI: 10.1245/s10434-024-16039-5
Helana Ghali, Michelle M Dugan, Shaliz Aflatooni, Aleena Boby, Danielle K DePalo, José Laborde, Junsung Choi, Altan F Ahmed, Jonathan S Zager

Background: Uveal melanoma often metastasizes to the liver, portending a poor prognosis. Melphalan/hepatic delivery system (HDS) via percutaneous hepatic perfusion (PHP) is a minimally invasive means of circulating high-dose chemotherapy through the affected liver. This study evaluated melphalan/HDS use as either first-line or second-line treatment to guide treatment sequencing.

Patients and methods: A retrospective review included patients with hepatic-dominant metastatic uveal melanoma who underwent melphalan/HDS treatment via PHP from 2008 to 2023.

Results: A total of 30 patients were identified; 53.3% female, with a median age of 63.5 years (37-78 years). Median follow-up time was 14.5 months. First-line therapies included melphalan/HDS (n = 17), liver-directed (n = 7), and immunotherapy (n = 6). Second-line therapies included melphalan/HDS (n = 6), immunotherapy (n = 5), and liver-directed (n = 3). Median hepatic progression-free survival (hPFS) for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 17.6/8.8/9.2 months, respectively (P = 0.002). Median hPFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was not reached/14.7/7.5 months, respectively (P < 0.001). Median overall PFS for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 15.4/8.8/9.2 months, respectively (P = 0.04). Median overall PFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was 22.2/14.7/7.5 months, respectively (P = 0.001).

Conclusions: Melphalan/HDS via PHP for metastatic uveal melanoma to the liver was found to have significantly improved hPFS and overall PFS when used as first-line therapy compared with immunotherapy or liver-directed therapy. PHP continued to demonstrate improved hPFS and PFS when used as second-line therapy compared with second-line immunotherapy or liver-directed therapy.

背景:葡萄膜黑色素瘤常转移至肝脏,预后较差。通过经皮肝灌注(PHP)的美法仑/肝脏给药系统(HDS)是一种通过受影响肝脏循环高剂量化疗的微创方法。本研究评估了美法仑/HDS作为一线或二线治疗的使用情况,以指导治疗排序:回顾性研究纳入了2008年至2023年期间通过PHP接受美法仑/HDS治疗的肝转移性葡萄膜黑色素瘤患者:共发现30例患者,53.3%为女性,中位年龄为63.5岁(37-78岁)。中位随访时间为 14.5 个月。一线疗法包括美法仑/HDS(17 例)、肝脏导向疗法(7 例)和免疫疗法(6 例)。二线疗法包括美法仑/HDS(6例)、免疫疗法(5例)和肝脏导向疗法(3例)。一线美法仑/HDS、免疫疗法和肝脏导向疗法的中位肝脏无进展生存期(hPFS)分别为17.6/8.8/9.2个月(P = 0.002)。二线美罗啡/HDS、免疫疗法和肝脏导向疗法的中位生存期分别为14.7/7.5个月(P<0.001)。一线美法仑/HDS、免疫疗法和肝脏导向疗法的中位总生存时间分别为15.4/8.8/9.2个月(P = 0.04)。二线美法仑/HDS、免疫疗法和肝脏导向疗法的中位总生存期分别为22.2/14.7/7.5个月(P = 0.001):通过PHP治疗转移至肝脏的葡萄膜黑色素瘤的美法仑/HDS,与免疫疗法或肝脏导向疗法相比,作为一线疗法可显著改善hPFS和总PFS。与二线免疫疗法或肝脏导向疗法相比,PHP 作为二线疗法时的 hPFS 和 PFS 继续得到改善。
{"title":"Hepatic and Overall Progression-Free Survival After Percutaneous Hepatic Perfusion (PHP) as First-Line or Second-Line Therapy for Metastatic Uveal Melanoma.","authors":"Helana Ghali, Michelle M Dugan, Shaliz Aflatooni, Aleena Boby, Danielle K DePalo, José Laborde, Junsung Choi, Altan F Ahmed, Jonathan S Zager","doi":"10.1245/s10434-024-16039-5","DOIUrl":"10.1245/s10434-024-16039-5","url":null,"abstract":"<p><strong>Background: </strong>Uveal melanoma often metastasizes to the liver, portending a poor prognosis. Melphalan/hepatic delivery system (HDS) via percutaneous hepatic perfusion (PHP) is a minimally invasive means of circulating high-dose chemotherapy through the affected liver. This study evaluated melphalan/HDS use as either first-line or second-line treatment to guide treatment sequencing.</p><p><strong>Patients and methods: </strong>A retrospective review included patients with hepatic-dominant metastatic uveal melanoma who underwent melphalan/HDS treatment via PHP from 2008 to 2023.</p><p><strong>Results: </strong>A total of 30 patients were identified; 53.3% female, with a median age of 63.5 years (37-78 years). Median follow-up time was 14.5 months. First-line therapies included melphalan/HDS (n = 17), liver-directed (n = 7), and immunotherapy (n = 6). Second-line therapies included melphalan/HDS (n = 6), immunotherapy (n = 5), and liver-directed (n = 3). Median hepatic progression-free survival (hPFS) for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 17.6/8.8/9.2 months, respectively (P = 0.002). Median hPFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was not reached/14.7/7.5 months, respectively (P < 0.001). Median overall PFS for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 15.4/8.8/9.2 months, respectively (P = 0.04). Median overall PFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was 22.2/14.7/7.5 months, respectively (P = 0.001).</p><p><strong>Conclusions: </strong>Melphalan/HDS via PHP for metastatic uveal melanoma to the liver was found to have significantly improved hPFS and overall PFS when used as first-line therapy compared with immunotherapy or liver-directed therapy. PHP continued to demonstrate improved hPFS and PFS when used as second-line therapy compared with second-line immunotherapy or liver-directed therapy.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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Annals of Surgical Oncology
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