Annals of Surgical Oncology最新文献

Introduction: Oncologic outcome data on women with neither SLNB nor radiation are limited. We evaluated recurrence and survival in older women with early stage, ER+/HER2 negative breast cancer who underwent lumpectomy without SLNB or radiation.

Patients and methods: Women treated for breast cancer from 2014 to 2022 were identified in a local tumor registry. Inclusion criteria were women 65 years and older, tumor size ≤ 5 cm, ER+ > 10%, HER2- invasive breast cancers treated with lumpectomy without SLNB or radiation. The Kaplan-Meier method was used to estimate curves for mortality and recurrence.

Results: A total of 116 women met inclusion criteria. Median age at time of surgery was 76 (IQR: 72-80) years. The majority of patients were white (85%). Most patients had a T1 tumor (85%) and ductal histology (78%). In total, 107 patients (92%) initiated adjuvant endocrine therapy with median therapy duration of 4.2 years. Of the 116 patients, 7 developed recurrence (6.0%). Of the seven recurrences, all were initially locoregional: six in breast and one axillary. Three women with recurrence underwent mastectomy (5 year mastectomy-free survival 97.4%).

Discussion: Locoregional recurrence was rare at a median follow up of over 5 years with simultaneous omission of SLNB and radiation in older women with early stage ER+, HER2- breast tumors. Death from non cancer causes was more common, highlighting the competing risks in this population. These findings support the oncologic safety of this approach in well selected patients-older women with low risk tumors.

Background: Hepatic arterial infusion (HAI) oxaliplatin represents a promising treatment option in patients with unresectable liver-only colorectal metastases (CRLM).

Methods: In this randomized phase II study, we evaluated the efficacy of an intensification strategy based on HAI oxaliplatin combined with systemic chemotherapy (sys-CT) as a salvage treatment in patients with CRLM still unresectable after first-line induction sys-CT. The primary objective was conversion to resection/ablation (CTR). A real-life retrospective cohort of consecutive patients treated with HAI oxaliplatin + sys-CT in the same setting was also analyzed.

Results: The study was stopped prematurely because of slow enrollment. Among 26 patients (13 men [50%]; median age 60 years) enrolled in 2018-2021, 11 were randomized in arm A (HAI + sys-CT, percutaneously placed catheters) and nine in arm B (sys-CT). CRLM were synchronous in 89% of patients, and 55% had RAS mutations. The CTR was 64% (7/11) in arm A and 22% (2/9) in arm B (odds ratio 0.16; 95% confidence interval 0.02-1.2; p = 0.09). Objective tumor response was 80% (8/10) in arm A and 11% (1/9) in arm B. Median overall survival was not reached in arm A versus 16.6 months in arm B (p = 0.008). Progression-free survival was significantly longer in arm A (12.6 vs. 4.37 months, p = 0.002). In the retrospective cohort of 35 patients, objective tumor response and CTR were 64% and 34%, respectively. Overall, HAI-related toxicity was manageable.

Conclusions: Because the number of enrolled patients was lower than expected, our study could not confirm that salvage HAI combined with sys-CT improved CTR and survival outcomes compared with Sys-CT alone. However, these encouraging exploratory results warrant further prospective studies.

Trial registration: ClinicalTrials.gov, (NCT03164655). Trial registration date: 11th May 2017. https://clinicaltrials.gov/ct2/show/NCT03164655.

Background: Benefit of splenic hilar lymph nodes (group n°10 or LN10 according to the Japanese gastric cancer association classification) harvesting during total gastrectomy for cancer is still debated, especially because of both uncertain positive impact on oncologic outcomes and reported increased intra- and postoperative morbidity. Our aim was to investigate the real value of LN10 harvesting in total gastrectomy.

Methods: Data were analyzed from the ADENOKGAST multi-institutional retrospective database, conducted between 2007 and 2017. A propensity score analysis was performed using the inverse probability of treatment weighting method. Preoperative factors for recurrence were analyzed in univariate and multivariate models to create a risk score (proportional to Odds Ratios), allowing two groups of patients to be distinguished: low and high risk for recurrence. Survivals were studied using Kaplan-Meier methods and Cox models.

Results: 514 patients were analyzed. Patients who underwent LN10 harvesting (LN10+) (n=84) or not (LN10-) (n=430) were compared. 30-day severe postoperative morbidity (p=0.7) and 90-day postoperative mortality (p=0.3) were similar. Mean length of hospital stay was slightly increase in LN10+ patients (19.7 vs 20.6 days; p=0.03). Recurrence rates (36% vs 40%; p=0.7) and recurrence location (OR=1.2; p=0.85) were similar, as well as both overall survival (OS) (HR=0.84; IC95=[0.44;1.58]; p=0.6) and recurrence-free survival (RFS) (HR=1.1; IC95=[0.64;1.91]; p=0.7). Among patients with high risk for recurrence, there was no benefit neither on OS nor RFS of LN10 harvesting.

Conclusions: LN10 harvesting did not improve neither OS nor RFS following total gastrectomy for gastric cancer, even in patients with high risk for recurrence.

Background: This study aimed to assess perioperative safety and long-term survival after hepatopancreatoduodenectomy (HPD) by performing a systematic review and single-arm meta-analysis of studies published since 2005. The HPD procedure is a high-risk but potentially curative treatment for advanced bile duct and gallbladder cancers. Although perioperative outcomes have improved over time, an updated synthesis of contemporary evidence remains limited.

Methods: The PubMed, Embase, and Web of Science databases were systematically searched to identify studies published between January 2005 and March 2025. Eligible studies reported outcomes of HPD for bile duct or gallbladder cancers. Pooled estimates for morbidity, 90 day mortality, R0 resection, and 5 year overall survival (OS) rates were calculated using random- or common-effects models. Risk of bias was assessed using the ROBINS-I tool.

Results: This meta-analysis included 18 studies involving 707 patients. The pooled morbidity rate was 0.64 (95% confidence interval [CI, 0.53-0.74), and the 90 day mortality rate was 0.10 (95% CI, 0.05-0.20). The R0 resection rate was 0.79 (95% CI, 0.76-0.82), and the 5 year OS was 0.32 (95% CI, 0.28-0.37). Subgroup analyses showed better perioperative outcomes for gallbladder cancer but superior long-term survival for bile duct cancer.

Conclusions: The HPD procedure offers an acceptable perioperative risk and favorable long-term survival for selected patients, particularly those with bile duct cancer. In contrast, the lack of long-term survival benefit of HPD for gallbladder cancer supports the prevailing view that HPD should not be routinely recommended for this indication. These findings provide contemporary benchmarks and may inform refinement of surgical indication criteria for HPD.

Background: Pancreatic ductal adenocarcinoma (PDAC) lacks consistent biomarkers to monitor treatment response and predict survival. Metabolically active extracellular vesicles (EVs) carrying tumor-specific KRAS mutations offer promise as disease-specific biomarkers.

Patients and methods: Informed by genomic profiling of tumor tissue, plasma samples were prospectively collected from 44 patients, with confirmed KRAS-mutated PDAC, undergoing neoadjuvant therapy (NAT) followed by surgery between 2019 and 2021. Samples were obtained at diagnosis, post-NAT, and 1 month post surgery. EVs were isolated using lipid nanoprobe technology, and EV-associated KRAS mutations were detected using droplet digital polymerase chain reaction (ddPCR). Patients were grouped on the basis of temporal changes in EV-associated KRAS mutation allele frequency (MAF): no KRAS detected (ND), decreasing MAF (DD), and increasing MAF (ID).

Results: Among 44 patients, 29 (65.9%) were ND, 8 (18.2%) DD, and 7 (15.9%) ID. Detectable EV-associated KRAS MAF was found in 21%, 30%, and 50% of patients with stages I, II, and III PDAC. No significant differences were noted in demographic or clinical variables (p > 0.05). The ND group had the longest restricted mean disease-free survival (rmDFS: 31.2 months), followed by DD (27.8 months) and ID (9.8 months; p = 0.010). Similarly, restricted mean overall survival (rmOS) was longest in the ND (40.3 months), followed by DD (35.7 months) and ID (17.7 months; p = 0.012). On multivariable analysis, increasing EV-KRAS MAF (ID group) independently predicted inferior rmDFS [hazard ratio (HR): 6.14; p = 0.001] and rmOS (HR: 6.95; p = 0.002).

Conclusions: Temporal increase of EV-KRAS MAF is a significant predictor of reduced DFS and OS in PDAC. Integrating EV-KRAS mutation allele frequency dynamics analysis with current biomarkers such as carbohydrate antigen 19-9 (CA19-9) could improve treatment monitoring and survival prognostication.

Introduction: The MD Anderson Symptom Inventory (MDASI) is a well-established, validated patient-reported outcome survey that assesses cancer patient symptom burden for use in clinical care and research. Multiple MDASI modules have been developed and validated to tailor the survey to specific cancer/treatment types. We validated an MDASI survey specific to surgical patients with upper gastrointestinal (UGI) cancers (MDASI-UGI-Surg), including pancreatic and gastroesophageal cancers, and which is designed to capture dynamic changes in symptom burden in the perioperative period.

Methods: Following qualitative interviews and expert panel feedback, the MDASI-UGI-Surg module was developed and validated in 169 consecutive patients undergoing major surgical resection for UGI cancer. Surveys were administered preoperatively as well as 3, 7, 14, 21, and 28 days postoperatively, and again 24 hours later to measure test-retest reliability. Outcome measures were validity and reliability.

Results: A total of 145 patients enrolled were deemed evaluable (6 patients withdrew, 18 operations were cancelled/aborted). Disease sites included 42 (28.97%) esophagus, 27 (18.62%) stomach, and 76 (52.41%) pancreas. Cronbach alpha was 0.79 and 0.92 for symptoms severity items and interference items, respectively. Known-group validity was supported by the ability of MDASI-UGI-Surg to detect significant differences in symptom and interference levels according to performance status. Test-retest reliability was confirmed with intraclass correlation (0.76 to 0.89). Composite scores for core, module, and interference items were not significantly different between patients from the three disease sites of interest.

Conclusions: The MDASI-UGI-Surg is a new, psychometrically validated tool that can be used to capture dynamic changes in symptom burden in UGI cancer patients.

Background: Osteosarcoma is a malignant bone tumor primarily composed of interstitial cells; there is an urgent need to develop effective treatments to improve patient prognosis. Traditional Chinese medicine offers a promising direction for research. This study explores the inhibitory effects and mechanisms of eupatilin on osteosarcoma, as well as the feasibility of using exosomes loaded with eupatilin in the treatment of osteosarcoma.

Methods: The cell counting kit-8 (CCK-8) assay was utilized to determine the optimal experimental concentration of eupatilin and assess its effect on cell proliferation. Cell apoptosis, migration, and invasion were evaluated through flow cytometry, wound healing assay, transwell assay, and colony formation assay. The expression of neighbor of BRCA1 gene 2 (NBR2), microRNA-129-5p (miR-129-5p), and FKBP prolyl isomerase 11 (FKBP11) were assessed using real-time quantitative polymerase chain reaction and Western blot. Extracellular exosomes from bone marrow mesenchymal stem cells were extracted via ultracentrifugation. Exosomes overexpressing miR-129-5p were obtained by transfecting the stem cells, and exosomes loaded with eupatilin were prepared through co-incubation. The inhibitory effects of different exosome treatments were observed.

Results: Cytological experiments demonstrated that eupatilin significantly enhances the apoptosis rate of osteosarcoma cells, suppresses cell viability, and markedly diminishes the capacities for colony formation, migration, and invasion. PCR and WB analyses revealed that the expression levels of NBR2, FKBP11 gene, and protein were notably reduced, whereas the expression level of miR-129-5p was significantly elevated. Exosome-based therapy exhibited a pronounced inhibitory effect on osteosarcoma cells.

Conclusion: Eupatilin exerts a reliable inhibitory effect on osteosarcoma cells through the NBR2/miR-129-5p/FKBP11 regulatory axis. Exosomes can effectively carry both eupatilin and miR-129-5p, enhancing their therapeutic efficacy.

Background: Solitary pulmonary nodules in postoperative pancreatic cancer patients pose a diagnostic challenge in distinguishing primary lung cancer (PLC) from pulmonary metastasis (PM). KRAS mutation analysis is a potential tool for distinguishing these entities.

Methods: A retrospective study of 17 patients who underwent pulmonary resection after pancreatic cancer surgery was conducted. Paired pancreatic and pulmonary tumor samples were analyzed for KRAS mutations. PDX1 expression was assessed by immunohistochemistry. Preoperative clinical factors were evaluated using KRAS mutation-based classification as the reference.

Results: KRAS mutations were discordant between pancreatic and pulmonary tumors in nine patients (53%), leading to a diagnosis of PLC. KRAS G12R concordance was observed in three cases, confirming PM. Five cases with KRAS G12D or G12V concordance could not be definitively classified. KRAS mutation analysis identified more PLC cases than pathological diagnosis. PDX1 expression was found in both PM and some PLC cases, as well as in lung invasive mucinous adenocarcinoma cases without pancreatic cancer history, limiting its diagnostic value. Lymphovascular invasion in the pancreatic tumor was significantly associated with PM.

Conclusions: KRAS mutation analysis of both pancreatic tumor and lung tumor is useful for distinguishing solitary pulmonary nodules in postoperative pancreatic cancer patients. KRAS mutation analysis identified PLC more frequently than conventional pathological diagnosis.