Chinese clinical oncology最新文献

Oncoplastic breast surgery (OBS) has undergone significant advancement in recent decades, transforming breast cancer (BC) treatment by facilitating increased rates of breast-conserving surgery (BCS) through volume displacement techniques and enabling immediate reconstruction via volume replacement following mastectomy. This approach has demonstrably improved cosmetic outcomes and health-related quality of life metrics for patients undergoing oncological intervention. The progression of surgical methodology from Halsted's radical mastectomy to contemporary oncoplastic techniques constitutes a fundamental paradigm shift in surgical approach. Meta-analyses and prospective cohort studies have established that oncoplastic techniques maintain oncological safety when compared with conventional BCS and mastectomy, demonstrating comparable local recurrence (LR) rates and disease-free survival (DFS) outcomes. Multiple classification systems for oncoplastic procedures have been established based on quantifiable metrics including percentage of breast volume resected, surgical complexity indices, and technical approach parameters, providing evidence-based frameworks for clinical decision-making. The breast surgeon currently functions as the critical nexus in multidisciplinary treatment of BC, integrating optimized surgical techniques with multimodal treatment protocols, particularly systemic therapeutic agents. The implementation of neoadjuvant chemotherapy (NCT) regimens has expanded the indications for breast conservation in cases previously requiring mastectomy, leading to the development of the "extreme oncoplasty" concept for selected patients. Nevertheless, significant implementation barriers persist globally, predominantly related to educational infrastructure limitations and the absence of standardized oncoplastic surgical training curricula for breast surgeons. Diverse training methodologies have emerged internationally, including simulation-based learning, subspecialty fellowships, and curricular integration in surgical residency programs, though outcome-based standardization remains elusive. This non-systematic review analyzes the developmental trajectory of breast cancer surgery, examining the evolution and validation of oncoplastic techniques, standardized classification systems, applications in challenging clinical scenarios, and the current status of surgical education, emphasizing the pivotal role of professional societies in developing evidence-based educational initiatives to broaden access to these advanced surgical techniques.

Background: Radical resection remains the mainstay of treatment for patients with hilar cholangiocarcinoma (HCCA), however, the scope of resection remains controversial. This study investigates the influence of tumor infiltration length along the mucosa and submucosa of the bile duct on curative resection.

Methods: The clinical and pathological data of 31 HCCA patients who underwent en bloc and extended liver resection in the Department of Biliary-Pancreatic Surgery of Sun Yat-sen Memorial Hospital from January 2020 to December 2021 were retrospectively analyzed. First, the gross tumor boundary and bile duct resection margin were marked with ink before the specimen was fixed in formalin solution. Subsequently, the specimens were embedded and sectioned longitudinally along the bile duct. Finally, the length of tumor invasion was calculated according to the marked macroscopic and microscopic boundaries. SPSS statistical software was used for statistical analysis.

Results: The average infiltration length in the proximal bile duct mucosa and submucosa were 8.5±5.2 and 8.6±4.9 mm, while the average infiltration length in the distal bile duct mucosa and submucosa were 12.8±7.5 and 11.5±7.2 mm, respectively. The accuracy of the Bismuth-Corlette classification for type III lesions was 68.4% (13/19).

Conclusions: Imaging examinations may underestimate the extent of HCCA growth along the bile duct. The R0 resection rate can be increased by extended hepatectomy including more than half of the liver volume.

Background: Bone metastasis in prostate cancer (PCa) has been considered a significant determinant of both patient survival and quality of life. However, the factors contributing to the incidence of bone metastasis remain unidentified. This study primarily aims to elucidate the risk factors associated with bone metastasis in individuals diagnosed with PCa.

Methods: A total of 177 patients who had undergone radical prostatectomy at our institution were included in the analysis. These patients were categorized into two groups based on the results of whole-body bone emission computed tomography (ECT) scanning: the bone metastasis group and the non-bone metastasis group. Univariate and multivariate logistic regression analyses were conducted to determine the independent risk factors for bone metastasis. Additionally, receiver operating characteristic (ROC) curves were employed to compare the diagnostic efficacy of the clinical variables. Additional data from the Surveillance, Epidemiology, and End Results (SEER) database, consisting of 96,497 patients, were analyzed for external validation.

Results: The findings indicated that among the diagnosed patients with PCa, 18.64% (33/177) exhibited bone metastasis. Through multivariate logistic regression analysis, it was determined that prostate-specific antigen (PSA), Gleason score, percentage of monocyte (M%), and N stage were identified as independent risk factors for bone metastasis in PCa. The study found that the sensitivities for PSA and Gleason score were 66.67% and 69.70%, respectively, while the specificities were 85.42% and 65.97%, respectively. Additionally, the analysis of data from the SEER database confirmed that both PSA, Gleason score and N stage were independent risk factors. Furthermore, the Chi-squared test revealed a positive correlation between the primary histological grade and the rate of bone metastasis.

Conclusions: The present study ascertained that PSA, Gleason score and N stage served as prognostic indicators for bone metastasis in PCa. The investigation of the significance of M% and the primary histological grade in the diagnosis of bone metastasis in PCa warranted further exploration.

Background: Among the pancreatic cystic neoplasia, the mucinous cystic neoplasia (MCN) is less-well understood as these are a much rarer to come by and a poorly described cyst entity. Notably, the MCNs have previously been thought to almost exclusively develop in females, with few reports of MCN in males. Here we present a case of male MCN together with a systematic review of the disparities in sex-dependent prevalence and malignancy risk as found in the literature.

Methods: A systematic review and meta-analysis were conducted on pre-existing literature to assess the incidence and malignancy rates of MCN in male and female patients. The study protocol was prospectively registered on PROSPERO (CRD42024606793). A comprehensive search of PubMed, Embase, MEDLINE and Web of Science was performed covering all studies published from January 2014 to August 2024.

Results: The study included 51 studies with a total of 3,519 patients. Prevalence rates show a marked predominance of MCN in female patients at 84.5% [95% confidence interval (CI): 80.5-87.9%], while malignancy rates are significantly higher in male patients with MCN 47.2% (95% CI: 26.1-69.3%) compared to females at 16.6% (95% CI: 6.4-36.6%).

Conclusions: Among all studies reporting on MCN, the systematic review of accumulated data found an overall prevalence of 14.2% in males, but with an almost 50% risk of malignancy rate in males compared to females.

Malignant duodenal obstruction is a common issue affecting up to 20% of patients with advanced gastrointestinal malignancies. Distal duodenal obstruction (DDO) poses unique surgical challenges, such as the need to drain the stomach and the proximal portions of the duodenum. The traditional approach, gastrojejunostomy, may not be as effective for relieving DDO, as gastrojejunostomy does not necessarily drain the duodenum. In this situation, a duodenojejunostomy could be more advantageous due to its ability to provide dual (stomach and duodenal) drainage. Here we present a case of a 75-year-old female with distal (D4) duodenal obstruction due to metastatic duodenal adenocarcinoma. Despite being previously treated with a gastrojejunostomy stent at an outside hospital, the patient presented with recurrent malignant DDO for which a robotic-assisted trans-mesocolic duodenojejunostomy was performed. This approach leverages the duodenal drainage ability of duodenojejunal bypass and the advantages of the minimally invasive robotic approach, resulting in effective and efficient relief of the obstruction. The patient's postoperative course was characterized by minimal postoperative pain, rapid resumption of solid intake, and early re-initiation of chemotherapy, underscoring the potential of this technique. This innovative surgical technique has notable clinical implications for patients in need of palliation from distal duodenal or proximal jejunal obstruction.

Background and objective: Non-inferiority (NI) study is a popular randomized controlled trial design that aims to demonstrate whether a test treatment, considering its auxiliary benefits, is not unacceptably worse compared to a standard active control treatment. There is extensive work in the literature that discusses NI trials' merits, issues, and how certain clinical and statistical challenges can be addressed. Here, we are aimed to provide a narrative review of NI studies in terms of its design considerations, potential issues, and corresponding solutions from the perspectives of biostatisticians.

Methods: We conducted a wide literature search on clinical and statistical methodology papers related to NI trials.

Key content and findings: In the "Fundamentals of NI study" section, we start from the formulation of the margin and the NI hypothesis test and then focus on the underlying two fundamental assumptions (the constancy assumption and assay sensitivity). We present experts and regulatory agencies' opinions on how certain statistical issues of NI studies are caused and how they could be addressed. We focus on key aspects of NI studies, which include formulations of an NI hypothesis test, definition of NI margins, determining historical evidence of the active control drug, checking assay sensitivity and constancy assumption, etc. We also briefly touch on topics such as comparisons between the fixed-margin method and the synthesis method for NI evaluation, analysis principle in presence of treatment non-adherence, Bayesian design of NI studies, and restricted mean survival time (RMST) as a measure for designing NI studies. Figures and examples are given throughout the article to better illustrate ideas.

Conclusions: We believe that NI design, with its issues addressed by appropriate statistical and clinical considerations, still plays a pivotal role in clinical research by improving patients' experience and alleviating healthcare inequalities.

Background: Eccrine poroma (EP) is a benign cutaneous neoplasm that originates from the acrosyringium of the eccrine sweat duct. EP can be found on any skin area with sweat glands and typically occurs on the palmoplantar areas. They usually present as solitary, asymptomatic, well-circumscribed, smooth or verrucous papules or nodules that range in color from skin-colored to red or brown. However, some cases may be difficult to diagnose clinically, especially when the distribution and morphology are not typical. The periungual region represents an uncommon localization for these neoplasms and can easily be misdiagnosed.

Case description: Here, we present a rare case of a 52-year-old man who presented with a 2-year history of a painless, slowly growing, erythematous nodule on the lateral nail fold of his right toe. The lesion was initially suspected to be an amelanotic melanoma, but histopathological revealed a tumor composed of broad anastomosing bands of cuboidal cells with eosinophilic cytoplasm and round nuclei within the dermis, confirmed to be an EP. After complete surgical excision of the lesion with 1 mm margins, the wound healed well and there was no recurrence or metastasis after 12 months of follow-up.

Conclusions: EPs in the periungual region are exceedingly rare. Their presentation and atypical appearance can lead to misdiagnosis and missed opportunities for early treatment. Clinicians should be aware of this possibility and perform biopsies of any suspicious periungual lesion to ensure timely and appropriate management.