Annals of Surgical Oncology最新文献

Background: Breast phyllodes tumors (PT) are classified as benign, borderline, or malignant, primarily based on histological features, but lack reliable biomarkers for grading. Our aim is to find a protein marker to improve the accuracy of PT grading.

Methods: We analyzed formalin-fixed paraffin-embedded (FFPE) samples of fibroadenoma (FA) and PT using quantitative proteomics to screen the protein marker S100A8, confirmed its role in PT grading via immunohistochemistry, and examined its correlation with clinicopathological features.

Results: Quantitative proteomics studies showed that the differential proteins between FA and PT primarily involve calcium ion binding, including S100A8, FKBP10, MMP9, SPARC, and MMP14. Meanwhile, the proteomic studies showed a statistically significant increase in the expression of S100A8 in malignant PT compared with benign PT. Immunohistochemical validation showed that S100A8 was predominantly expressed in the nucleus and cytoplasm of stromal cells in malignant PT. The expression level of S100A8 in stromal cells demonstrated a positive correlation with PT categories (p < .001), as well as with Ki67 expression (p < .001).

Conclusions: To the best of our knowledge, this study is the first to demonstrate the integration of S100A8 and Ki67 expression in stromal cells with histological characteristics aids in grading PT.

Background: Conditional survival (CS) estimates offer valuable prognostic insights for both clinicians and patients who have already survived a period following diagnosis. This study aimed to evaluate how survival outcomes evolve over time in patients with early-stage nonsmall cell lung cancer (NSCLC) and constructed a personalised CS-nomogram to provide dynamic prognostic predictions.

Methods: Patients with early-stage NSCLC diagnosed between 2004 and 2015 were identified from the Surveillance Epidemiology End Results (SEER) registry. The Aalen-Johansen estimator was used to estimate cancer-specific survival (CSS). LASSO regression were used to identify key prognostic factors. Multivariable Cox regression was used to construct the CS-nomogram. The model performance was evaluated in terms of discrimination, calibration, and clinical utility.

Results: The findings indicated that the 5-year conditional survival rate exhibited an enhancement from an initial 66.1% to 87.6% among patients who had survived for a period of five years. The CS-nomogram demonstrated strong predictive performance, with concordance indices of 0.745 (95% CI: 0.742-0.748) and 0.751 (95% CI: 0.749-0.753) on the training and validation cohorts, respectively. The calibration curves exhibited a high degree of alignment with the ideal reference line, the AUC values for predictions from 1 to 10 years demonstrated stability, and decision curve analysis revealed a high net benefit, indicative of the model's superior performance.

Conclusions: The CS-nomogram offered dynamic and individualised prognostic assessments to support the long-term prognosis management.

Background: This study aimed to investigate outcome for patients affected by primary retroperitoneal sarcomas (RPS) treated over time at a single large referral institution.

Methods: The study included all consecutive patients with primary, localized, adult-type soft tissue sarcoma of the retroperitoneum observed and treated at the authors' institution from January 2002 to December 2021. The primary endpoint was overall survival (OS). The secondary endpoints were crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM), and post-recurrence OS. Based on the date of primary surgery, the patients were divided in two groups (2002-2011 and 2012-2021).

Results: The study identified 872 patients: 244 treated between 2002 and 2011 (early cohort) and 628 treated between 2012 and 2021 (recent cohort). The median follow-up period was 77.1 months (interquartile range [IQR], 41.7-115.4): 136.7 months (IQR, 118.1-166.4 months) for the early cohort and 59.5 months (IQR, 34.1-88.9 months) for the recent cohort. At the multivariable analysis, the patients in the recent cohort had significantly better OS. The early cohort had a 5 year OS of 61.7% (95% CI, 55.9-68.2%) and a 10 year OS of 47.7% (95% CI, 41.7-54.6%), whereas the recent cohort had a 5 year OS of 78.8% (95% CI, 75.1-82.6%) and a 10 year OS of 64.0% (95% CI, 57.8-70.8%). The recent cohort had fewer distant metastases (hazard ratio [HR], 1.50; 95% CI, 1.06-2.11; p = 0.022) and a similar rate of local recurrences (HR, 1.31; 95% CI, 0.97-1.76; p = 0.080). The 30 month post-recurrence OS was 41.9% (95% CI, 34.5-50.9%) in the early cohort and 65.9% (95% CI, 59.5-72.9%) in the recent cohort (p < 0.001).

Conclusions: Management of RPS in the recent years has resulted in prolonged OS. These findings establish new standards for historical comparisons of emerging strategies.

Background: The 2024 Kyoto guidelines for the management of intraductal mucinous neoplasms (IPMNs) build on previous guidelines that consider worrisome features (WF) and high-risk stigmata (HRS) to recommend surveillance or resection. These new guidelines have not yet been validated.

Methods: Patients undergoing pancreatectomy for an IPMN at an academic medical center between 2012 and 2023 were included. IPMNs were categorized as low-grade dysplasia (LGD), high-grade dysplasia (HGD), or invasive carcinoma (IC). Preoperative imaging was used to determine HRS and WF in accordance with the 2024 Kyoto guidelines. We compared IPMNs with LGD to those with HGD or IC using univariate analyses and evaluated logistic regression models with c-statistics.

Results: Of 211 patients, 84 (40%) had LGD, 49 (23%) had HGD, and 78 (37%) had IC. Among HRS, obstructive jaundice (p = 0.004), pancreatic duct ≥ 10 mm (p < 0.001), and suspicious or positive cytology (p < 0.001) were significantly associated with HGD/IC. An increasing number of HRS were associated with higher rates of HGD/IC. Among WFs, an abrupt change in the caliber of pancreatic duct with distal pancreatic atrophy (p = 0.001) and cystic growth ≥ 2.5 mm/year (p = 0.033) were significantly associated with higher rates of HGD/IC. Increasing numbers of WFs were also associated with higher rates of HGD/IC. The 2024 Kyoto model showed improved discrimination (area under the curve [AUC] = 0.849) compared with the 2017 Fukuoka model (AUC=0.780, p = 0.06).

Conclusion: The risk of HGD/IC in IPMNs increased in a stepwise fashion as the number of WFs increased. The 2024 guidelines represent an advancement over the 2017 guidelines, notably with the inclusion of suspicious cytology as an HRS.

Introduction: The aim of this study was to examine differences in breast cancer presentation, management, and outcomes between sexual and gender minority (SGM) patients and cisgender heterosexual women (CHW).

Methods: A prospective institutional database was reviewed to identify patients who had surgical management for clinical stage 0-III breast cancer from 2016 to 2023. SGM patients were identified as those who had self-documented in the medical record as lesbian, gay, bisexual, transgender, nonbinary, queer, intersex, asexual, nonbinary, or pansexual. Descriptive statistics were used to compare characteristics of SGM patients and CHW.

Results: Among 5346 patients, 5204 (97.3%) identified as CHW and 142 (2.7%) identified as SGM. There were no differences in presenting symptoms, stage, grade, or subtype between groups. SGM patients were more likely to be diagnosed under the age of 50 (38.7% SGM vs. 30.0% CHW, p=0.03) and to undergo mastectomy (42.6% SGM vs. 34.3% CHW, p=0.04). Among those undergoing mastectomy, SGM patients were less likely to have reconstruction (53.3% vs. 73.2%, p<0.01). Rates of adjuvant radiation and systemic therapy were similar. At a median follow-up of 30 months, there were no differences in the rate of invasive disease recurrence (0.8% SGM vs. 1.3% CHW, p=0.66).

Conclusions: SGM and CHW patients with breast cancer treated in a tertiary cancer center had similar breast cancer presentation, treatment, and outcomes. SGM patients were less likely to undergo breast conservation and reconstruction after mastectomy, suggesting that SGM identity may play a role in preference for type of local therapy.