Annals of Surgical Oncology最新文献

Background: This study was conducted to determine the use of C-reactive protein (CRP) levels in drainage fluid as an alternative indicator of clinically relevant postoperative pancreatic fistulas (CR-POPFs) following pancreaticoduodenectomy (PD). Reportedly, serum CRP levels are associated with CR-POPFs. Drainage fluid following PD is used to diagnose a pancreatic fistula, removing the need for blood sampling. However, the significance of CRP in drainage fluid remains unclear.

Methods: In this retrospective study, we reviewed consecutive patients who underwent PD at Hiroshima University between April 2014 and October 2021. Clinical factors for CR-POPFs were analyzed, and serum and drain CRP levels were measured during the first 4 days after surgery.

Results: Among the 384 patients enrolled, 58 (15.1%) developed CR-POPFs. Serum and drain CRP levels on postoperative days (PODs) 2, 3, and 4 were significantly associated with CR-POPFs. Receiver operating characteristic analysis indicated that CRP levels on POD 4 most precisely predicted CR-POPFs, with area under the curve values of 0.820 and 0.803 for serum and drain CRP levels, respectively. Additionally, these two factors exhibited a strong positive correlation (p<0.001, r=0.814). Multivariate analysis revealed that drain CRP level ≥6.5 mg/dL on POD 4 independently predicted CR-POPFs (odds ratio 4.95; 95% confidence interval 2.27-10.81; p<0.001) with a negative predictive value of 95.6%.

Conclusions: Drain CRP level on POD 4 is a strong predictive factor for CR-POPFs and may be an alternate criterion to serum CRP levels after PD.

Background: Endocrine prevention is a well-established preventative strategy for women with high-risk lesions (HRL). The objective of the study was to evaluate factors associated with endocrine prevention adherence in this patient population.

Patients and methods: We performed a retrospective cohort study of all women referred for atypical ductal and lobular hyperplasia (ADH/ALH) and lobular carcinoma in situ (LCIS) between 2019 and 2025. Data pertaining to eligibility, initiation, and adherence to endocrine prevention were extracted with univariate analyses performed to evaluate factors associated with adherence.

Results: Among 200 female patients with HRL, 112 (56%) had ADH, 72 (36%) had ALH, and 16 (8%) had classical LCIS. The median age was 55 years (IQR 50-62 years), with 126 (63%) patients accepting a prescription for endocrine prevention. Low-dose tamoxifen was the most common regimen prescribed (65.1%), compared with regular-dose tamoxifen (13.5%), raloxifene (16.7%), and aromatase inhibitors (4.8%). At a median follow-up of 37 months (IQR 18-49 months), 83 of 126 women (65.9%) initiated endocrine prevention and 72 (57.1%) remained adherent. Age (67.7% 51-60 years versus 47.1% < 50 years, p = 0.046), family history of breast cancer (71.0% vs. 52.6%, p = 0.048), and awareness of endocrine prevention (75.0% vs. 52.0%, p = 0.03) were significantly associated with adherence. Of 50 patients who initiated tamoxifen 5 mg, 46 (92%) remained adherent, and of 13 women who completed at least 3 years of therapy, 9 (69.2%) elected to complete a total 5 year course of low-dose tamoxifen.

Conclusions: Adherence to endocrine prevention is high in women who initiate medication, with few discontinuing due to side effects.