Annals of Surgical Oncology最新文献

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: Bilateral risk-reducing mastectomies (RRMs) have been proven to decrease the risk of breast cancer in patients at high risk owing to family history or having pathogenic genetic mutations. However, few resources with consolidated data have detailed the patient experience following surgery. This systematic review features patient-reported outcomes for patients with no breast cancer history in the year after their bilateral RRM.

Methods: The databases MEDLINE, Embase, and Scopus were used to identify studies. Studies were then evaluated by multiple authors, and their quality was assessed by using the Methodological Index for Non-Randomized Studies score.

Results: Our search identified 1858 unique studies, of which 11 met our inclusion criteria. Only two of these studies included patients who did not receive postmastectomy reconstruction. The included studies were either retrospective cohort studies or prospective studies. General satisfaction with the outcome of RRM and the decision to undergo RRM was high across many of the studies, with low levels of regret. There was also a noticeable trend of improved psychosocial outcomes following RRM. For postoperative sexual well-being, body image, aesthetic satisfactions, and somatosensory function, there were a mix of positive and negative outcomes.

Conclusions: The patients who elected to manage their breast cancer risk with bilateral RRM (mostly with reconstruction) tend to be satisfied with their decision and the surgical outcomes. This may be related to decreased cancer-related anxiety. Postmastectomy psychosocial well-being tends to improve while physical health after surgery varies by patient.