Annals of Surgical Oncology最新文献

Background: Approximately 25% of patients with stage III colorectal cancer experience liver metastasis after radical resection; however, there is currently a lack of methods to predict liver metastasis. This study aims to develop and validate a pathomics nomogram to predict liver metastasis in patients with stage III colorectal cancer.

Methods: A total of 318 enrolled patients were divided into three cohorts: a training cohort (n = 139), a validation cohort (n = 69), and an external cohort (n = 110). A competitive risk nomogram was established by the pathomics signature and clinicopathological characteristics and assessed by calibration, discrimination, and clinical usefulness.

Results: A significant correlation between the pathomics signature and liver metastasis in stage III colorectal cancer was found. Multivariate Fine-Gray analysis indicated that preoperative carcinoembryonic antigen level, postoperative chemotherapy, and pathomics signature were independent predictors of liver metastasis. A competitive risk nomogram was developed to predict liver metastasis in patients with stage III colorectal cancer. The predicting nomogram shows good discrimination and calibration, with C-indexes of 0.811 (95% confidence interval [CI] 0.651-0.971), 0.759 (95% CI 0.531-0.987), and 0.845 (95% CI 0.641-0.999), with area under the receiver operating characteristic (AUROC) curves at 5 years of 0.833 (95% CI 0.742-0.925), 0.760 (95% CI 0.652-0.893), and 0.812 (95% CI 0.692-0.931) in the training, validation, and external cohorts, respectively. Compared with the clinicopathological nomogram, the nomogram combined with the pathomics signature had better performance (AUROC 0.823 [95% CI 0.764-0.881] vs. 0.678 [95% CI 0.606-0.751]; p < 0.001).

Conclusions: The pathomics signature is a predictive indicator for liver metastasis in patients with stage III colorectal cancer, and the integrated nomogram can be used to predict liver metastasis better than the clinicopathological nomogram alone.

Background: Appendiceal epithelial tumors are rare and encompass a broad set of adenocarcinoma histologies, including mucinous (mAC), colonic-type (cAC), and goblet cell (GCA) adenocarcinomas. It has previously been reported that nodal disease predicted recurrence in patients with nonmetastatic appendiceal adenocarcinomas, supporting diagnostic laparoscopy with right hemicolectomy for staging and assessment for risk of recurrence. In this update, we sought to identify predictors of nodal disease on initial diagnostic pathology in nonmetastatic adenocarcinomas.

Methods: Patients with nonmetastatic appendiceal adenocarcinoma at a single institution from 1994 to 2020 were included. Clinicopathologic characteristics that predict recurrence and lymph node metastasis were analyzed. Workup included staging laparoscopy with right hemicolectomy, seriel imaging and biochemical monitoring.

Results: A total of 147 patients with mAC (18%), cAC (22%), and GCAs (59%) were included. After median follow-up of 53 months, 23 (16%) patients recurred, most commonly in the peritoneal cavity (17/23, 74%). Recurrence rates were higher among node-positive patients (59% vs. 5%, P < 0.001). Nodal disease was more common in mAC (27%) and cAC (37%) than in GCA (11%); however, adenocarcinoma grade was not associated with nodal involvement.

Conclusions: Nodal metastasis was more common in mAC and cAC compared with GCA and was the only significant predictor of recurrence in appendix cancer.

Introduction: The study was designed to evaluate the efficacy and safety of hyperthermic intrathoracic chemotherapy (HITHOC) as an adjuvant treatment for thymic epithelial tumors, including thymomas and thymic carcinomas.

Methods: A systematic review of PubMed, Embase, and Cochrane Library databases was conducted from inception to July 30, 2024. The analysis included retrospective studies and case series involving patients undergoing cytoreductive surgery combined with HITHOC for thymomas. The treatment effects for binary endpoints were assessed using proportion rates with 95% confidence intervals (CIs). Statistical analyses were performed using R software.

Results: Fifteen studies comprising 248 patients were included. The mean age of patients was 56 years. Thymomas represented 92% of cases, thymic carcinomas 7%, and other thymic neoplasms 1%. Operative mortality was 2.42% (95% CI 1.09-5.28), and overall mortality was 8.32% (95% CI 4.25-15.65). The disease recurrence rate was 25.99% (95% CI 14.04-43.02). The incidence of pneumonia was 1.96% (95% CI 0.45-8.16), and acute kidney injury (AKI) was 2.83% (95% CI 0.94-8.20).

Conclusions: The combination of cytoreductive surgery with HITHOC in patients with thymomas resulted in low operative and overall mortality, as well as low rates of AKI. However, the high recurrence rate presents a challenge for long-term disease control. This study provides the most up-to-date evidence on the safety and efficacy of HITHOC for thymomas, contributing valuable insights for clinical practice.

Trial registration: International Prospective Register of Systematic Reviews; No.: CRD42024566953; URL: https://www.crd.york.ac.uk/prospero/ .