Annals of Surgical Oncology最新文献

Introduction: Elderly patients with early gastric cancer exhibit a relatively shorter life expectancy and lower recurrence risk, prompting consideration of whether the regular follow-up strategy should apply to this demographic. This study was designed to determine the effect of routine postoperative follow-up on the elderly patients, specifically those pathologically diagnosed with stage I gastric cancer.

Methods and materials: This retrospective analysis was conducted at a single tertiary center and enrolled patients aged ≥ 75 years who underwent curative gastrectomy for stage I gastric cancer between January of 2007 and December of 2016. The patients were divided into routine and nonroutine follow-up groups, depending on whether the recommended follow-up examinations (endoscopy, CT, and blood tests) were complete. Propensity score matching was performed to compare the overall survival (OS) and disease-specific survival (DSS) between the two study groups.

Results: Among 385 patients enrolled, 301 (78.2%) were routine and 84 (21.8%) were nonroutine follow-up patients. After propensity score matching, each study group consisted of 83 patients. There was no significant difference in OS (85.5% vs. 83.1%, p = 0.47) and DSS (98.6% vs. 98.3%, p = 0.57) between the two study groups. There were six (1.5%) recurrences in the entire cohort: four in the routine and two in the nonroutine follow-up group.

Conclusions: Regular follow-up of elderly patients with stage I gastric cancer did not significantly impact the OS and DSS rates.

Background: The Dutch breast cancer guideline recommends surveillance for classic lobular carcinoma in situ (LCIS), unless there is a discrepancy with mammographic findings, and surgery for pleomorphic and non-classic LCIS.

Objective: The aim of this study was to assess adherence to the guideline in daily practice, as well as the surgery rate, risk of upstaging, and events during follow-up.

Methods: Selection of patients from a nationwide cohort diagnosed between 2011 and 2020. Patients with a history of in situ or invasive breast cancer or concomitant atypical ductal hyperplasia were excluded. Analyses comprised univariable analysis.

Results: Of 1178 diagnoses, 1018 (86%) were classic LCIS, 129 (11%) were pleomorphic LCIS, and 31 (3%) were non-classic (florid or unspecified non-classic) LCIS. Surgery was performed in 323 patients. The surgery rate for classic LCIS was 19%, 83% for pleomorphic LCIS, and 84% for non-classic LCIS. The upstage rate for both classic and pleomorphic LCIS was 32%, and 31% for non-classic LCIS. LCIS was upstaged in 103 patients (32%); 24 (7%) to DCIS and 79 (25%) to invasive breast cancer. Follow-up of the 859 non-operated patients showed fewer than 4% with ipsilateral DCIS or invasive breast cancer.

Conclusion: The surgery rates for classic, pleomorphic, and non-classic LCIS indicate that the guideline is well adhered to in daily practice. Given the high upstage rates and low number of subsequent DCIS and invasive breast cancer events in patients with classic LCIS, these patients appear to be well-selected for surgery versus surveillance. The results support the recommendation to operate on patients with pleomorphic/non-classic LCIS.

Background: The American Joint Committee on Cancer (AJCC) 8th edition TNM staging manual, which provided ypTNM for patients undergoing neoadjuvant therapy (NAT), has not been comparatively assessed against pTNM for prognosis in pancreatic cancer. This study aimed to compare the prognosis between ypTNM and pTNM stages.

Patients and methods: Clinicopathological data from 586 patients who underwent pancreatic cancer surgery at a tertiary center between 2018 and 2022 were analyzed to compare survival outcomes between ypTNM and pTNM stages and identify prognostic factors.

Results: The analysis included 541 patients (100 ypTNM, 441 pTNM). Significant differences in overall survival (OS) were observed among patients stratified by TNM stage (p < 0.001). However, no significant difference in OS was found between the ypTNM and pTNM groups (2-year survival rate (YSR): 76.8% vs. 66.7%, p = 0.094). Subgroup analysis by stage I (82.4% vs. 76.2%, p = 0.577) and II (68.8% vs. 61.6%, p = 0.715), and III (53.0% vs. 49.8%, p = 0.596) revealed similar survival rates. Multivariate analysis identified factors associated with OS: age > 65 years (HR 1.763, p < 0.001), CA19-9 > 150 U/mL (HR 1.439, p = 0.014), preoperative biliary drainage (HR 1.405, p = 0.029), pathologic T2 stage (HR 1.961, p = 0.004) and T3/4 stage (HR 2.830, p < 0.001) versus T0/1 stage, lymphovascular invasion (HR 2.220, p < 0.001), and adjuvant treatment (HR 0.251, p < 0.001).

Conclusions: This study confirms comparable survival outcomes between ypTNM and pTNM stages in surgically resected pancreatic cancer, affirming the applicability of the TNM staging system after NAT. The results highlight the utility of TNM staging in guiding therapeutic decisions for patients undergoing NAT.

Background: To improve the prognosis of clinically resectable type 4 or large type 3 gastric cancer (GC), we performed a phase I/II study of neoadjuvant-radiotherapy combined with S-1 plus cisplatin.

Patients and methods: Phase I, with a standard 3 + 3 dose-escalation design, was performed to define the recommended phase II dose. Efficacy and safety were evaluated in phase II. The three dose levels were as follows: level 0, S-1 60 mg/m² on days 1-14 plus cisplatin 60 mg/m² on day 1; level 1, S-1 80 mg/m² on days 1-14 plus cisplatin 60 mg/m² on day 1; and level 2, S-1 80 mg/m² on days 1-14 and 22-35, plus cisplatin 60 mg/m² on days 1 and 22. The starting dose was level 1. Radiotherapy was delivered at a total dose of 40 Gy in fractions for 4 weeks.

Results: A total of six patients were enrolled in the phase I study. Dose-limiting toxicity was observed at level 2; level 1 was established as the recommended phase II dose. In phase II, 20 patients were enrolled from November 2012 to April 2018. Grade 3/4 leukopenia and nonhematologic adverse events occurred in 35% and 5% of the patients, respectively. In total, 19 patients underwent the protocol surgery; 2 (10.5%) achieved a pathological complete response. There were no treatment-related deaths; 3- and 5-year overall survival rates were 70.0 and 50.0%, respectively.

Conclusions: Neoadjuvant chemoradiotherapy with S-1 plus cisplatin is a safe and promising treatment for clinically resectable type 4 or large type 3 GC.