Surgical Oncology Insight最新文献

{"title":"Comparative survival analysis of gallbladder neuroendocrine carcinoma and adenocarcinoma following radical surgery: A secondary analysis of the multicenter Algerian GBC group study","authors":"Anisse Tidjane ,&nbsp;Chafik Bouzid ,&nbsp;Salah Berkane ,&nbsp;Nabil Boudjenan Serradj ,&nbsp;Khelifa Bendjebbar ,&nbsp;Bouabdellah Krelil ,&nbsp;Zineddine Djilli ,&nbsp;Allel Sahli ,&nbsp;Rezki Touati ,&nbsp;Redha Bouzitouna ,&nbsp;Smail Ammari ,&nbsp;Omar Bafdel ,&nbsp;Zaki Boudiaf ,&nbsp;Nacim Ikhlef ,&nbsp;Meriem Dehal ,&nbsp;Ramzi Graichi ,&nbsp;Ali Benazza ,&nbsp;Saadoun Bendjabellah ,&nbsp;N. Bahache ,&nbsp;Mohand Kheloufi ,&nbsp;Kamal Bentabak","doi":"10.1016/j.soi.2025.100195","DOIUrl":"10.1016/j.soi.2025.100195","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Gallbladder cancer (GBC) is the most common biliary malignancy, with adenocarcinoma (GB-ADK) being predominant. Gallbladder neuroendocrine carcinoma (GB-NEC) is rare, and its prognosis after R0 surgical resection remains unclear. This study compares survival outcomes after curative surgery between GB-ADK and GB-NEC.</div></div><div><h3>Methods</h3><div>This retrospective, multicenter national study included patients who underwent R0 resection for GBC in Algeria (2000–2021). Demographic, clinical, pathological, and treatment-related data were analysed. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier and log-rank tests.</div></div><div><h3>Results</h3><div>Eleven centres participated and 1061 patients were included (1049 GB-ADK, 12 GB-NEC); incidental GBC was more frequent in the GB-ADK group (45.6 % vs. 8.3 %; <em>p</em> = 0.016). CEA elevation was higher in the GB-NEC group (25 % vs. 7.2 %; <em>p</em> = 0.020). GB-NEC exhibited more advanced stages and greater perineural/vascular invasion, though not statistically significant. Adjuvant chemotherapy was more frequently administered in the GB-NEC group (66.7 % vs. 29.2 %, p = 0.008). No significant differences were observed in OS (p = 0.222) or DFS (p = 0.269) between GB-ADK and GB-NEC groups.</div></div><div><h3>Conclusion</h3><div>Despite a more aggressive presentation, GB-NEC did not show worse survival than GB-ADK after curative surgery. Larger studies are needed to confirm these results.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taiwan expert consensus on the clinical integration of antibody-drug conjugates in advanced breast cancer","authors":"Li-Chun Kao ,&nbsp;Chih-Yi Hsu ,&nbsp;Ming-Yang Wang ,&nbsp;Ming-Han Yang ,&nbsp;Chin-Sheng Hung ,&nbsp;Guo-Shiou Liao ,&nbsp;Kuo-Ting Lee ,&nbsp;Wen-Ling Kuo ,&nbsp;Meng-Ting Peng ,&nbsp;Wei-Pang Chung ,&nbsp;Chih-Hao Huang ,&nbsp;Shou-Tung Chen ,&nbsp;Chi-Cheng Huang ,&nbsp;Yen-Shen Lu ,&nbsp;Chun-Yu Liu","doi":"10.1016/j.soi.2025.100193","DOIUrl":"10.1016/j.soi.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Antibody–drug conjugates (ADCs) have emerged as potent targeted therapies in advanced breast cancer, offering new options across HER2-positive, HR-positive/HER2-negative, and triple-negative subtypes. To address the rapidly evolving evidence, the Taiwan Breast Cancer Society (TBCS) convened an expert panel to develop consensus guidelines for integrating ADCs into clinical practice.</div></div><div><h3>Methods</h3><div>A multidisciplinary panel conducted systematic literature review and iterative discussions, identifying nine key topics. They formulated 31 consensus statements, graded by level of evidence and strength of recommendation, all of which reached ≥ 85 % agreement.</div></div><div><h3>Results</h3><div>Trastuzumab deruxtecan (T-DXd) is recommended as the preferred second-line treatment for HER2-positive metastatic breast cancer, with T-DM1 as an alternative when T-DXd is unavailable. T-DXd retains efficacy in HER2-low disease and brain metastases. In HR-positive/HER2-negative MBC, both T-DXd and sacituzumab govitecan (SG) improve outcomes after endocrine therapy and CDK4/6 inhibitors, regardless of HER2-low (IHC 1 +/2 +) or IHC 0 status. In triple-negative breast cancer, SG offers significant survival benefit in refractory cases. There is currently no evidence supporting routine sequential use of multiple ADCs.</div></div><div><h3>Conclusions</h3><div>The TBCS guideline provides practical recommendations for integrating ADCs into the treatment of advanced breast cancer based on current evidence. It supports biomarker-guided agent selection across subtypes and highlights the need for continued research on sequencing strategies and optimal clinical positioning.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HOXA13 overexpression is associated with poor prognosis in colorectal liver metastases","authors":"David G. Su ,&nbsp;Vadim Kurbatov ,&nbsp;Xujun Wang ,&nbsp;Zhaoshi Zeng ,&nbsp;Philip B. Paty ,&nbsp;Caroline H. Johnson ,&nbsp;Jun Lu ,&nbsp;Sajid A. Khan","doi":"10.1016/j.soi.2025.100194","DOIUrl":"10.1016/j.soi.2025.100194","url":null,"abstract":"<div><div>Curative-intent hepatectomy in colorectal cancer liver metastasis (CRCLM) is guided by clinical criteria; however, molecular biomarkers may enhance prognostication. Homeobox (HOX) gene family is often dysregulated in cancer and may serve as a prognostic tool in metastatic colorectal cancer. Bulk RNA extraction was performed in frozen colorectal liver tumors (N = 39), and differentially expressed <em>HOX</em> genes using clinical risk scores were studied using supervised hierarchical clustering. In sum, 667 differentially expressed genes were found (<em>p</em> &lt; 0.05), including multiple <em>HOXA</em> and <em>HOXD</em> family genes (<em>p</em> &lt; 0.01; <em>q</em>&lt;0.01). Three long non-coding RNA species (lncRNAs) were differentially expressed: <em>HOTTIP</em>, <em>HOXA-AS5</em>, and <em>HOXD-AS2</em> (<em>p</em> &lt; 0.01; <em>q</em>&lt;0.01). <em>HOXA13</em> and <em>HOTTIP</em> were more likely to be expressed in patients with metastatic recurrence (log-rank <em>p</em> = 0.004). A composite HOX score was found to be predictive of OS and RFS (log-rank <em>p</em> = 0.0269 and 0.0273, respectively). <em>HOXA13</em>, <em>HOXD4</em>, and <em>HOXD8</em> were explored in five independent cohorts. <em>HOX</em> genes and their associated lncRNAs exhibit prognostic associations in patients with CRCLM and may act as biomarkers to refine clinical decision-making.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of current immunotherapy approaches for treating gastrointestinal cancers","authors":"Arushi Ramaka,&nbsp;Arvind Rajan,&nbsp;Ashwin Somasundaram","doi":"10.1016/j.soi.2025.100191","DOIUrl":"10.1016/j.soi.2025.100191","url":null,"abstract":"<div><div>Gastrointestinal (GI) cancers, account for a substantial proportion of global cancer cases and deaths, and present significant therapeutic challenges. Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has transformed the treatment landscape, and offered improved outcomes for patients presenting with various gastrointestinal malignancies. For esophageal cancer, trials like CheckMate 577, KEYNOTE 590, 811, and MATTERHORN have demonstrated improved benefit with ICIs. Pancreatic cancer, characterized by its immunologically \"cold\" microenvironment, has shown limited response to immunotherapy. However, strategies that combine immune checkpoint inhibitors with chemotherapy have shown some early results. In colorectal cancer, microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) tumors exhibit strong responses to ICIs, while ongoing trials aim to refine treatment for microsatellite-stable (MSS) cases. For hepatocellular carcinoma (HCC), immunotherapy combinations are regarded as a first-line treatment due to its efficacy over traditional chemotherapy. Cholangiocarcinoma (CCA) lacks pre-surgical tumor reduction options and neoadjuvant therapies, but the results of TOPAZ-1 showed that a combination of durvalumab, gemcitabine, and cisplatin improved overall survival in the advanced setting. Lastly, immunotherapy is emerging as a viable option for advanced forms of anal cancer, with trials exploring checkpoint inhibitors and adoptive cell therapies. Despite the progress, challenges such as tumor heterogeneity and immunosuppressive microenvironments necessitate ongoing research to optimize immunotherapeutic strategies.</div></div><div><h3>Synopsis</h3><div>Immunotherapy has revolutionized gastrointestinal cancer treatment, with immune checkpoint inhibitors showing promise in esophageal, colorectal, and hepatobiliary cancers. However, challenges including tumor heterogeneity and immunosuppressive microenvironments persist. This manuscript highlights advancements, limitations, and future strategies in integrating immunotherapy across diverse gastrointestinal malignancies, emphasizing the need for innovative approaches to optimize outcomes.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators to oncological care in foregut cancer: The patient perspective","authors":"Jaspinder S. Sanghera ,&nbsp;Michelle M. Holland ,&nbsp;Ioannis Liapis ,&nbsp;Rida Ahmad ,&nbsp;Katie West ,&nbsp;Manish Tripathi ,&nbsp;Larry Hearld ,&nbsp;Daniel I. Chu ,&nbsp;Krista Mehari ,&nbsp;Martin J. Heslin ,&nbsp;Smita Bhatia ,&nbsp;Annabelle L. Fonseca","doi":"10.1016/j.soi.2025.100192","DOIUrl":"10.1016/j.soi.2025.100192","url":null,"abstract":"<div><h3>Background</h3><div>Foregut cancers are best treated by specialized, multidisciplinary care, often delivered, at least in part, at tertiary centers. Patient perspectives on the factors that enhance access to and adherence to cancer treatment remain underexplored. This qualitative study explores patient-reported facilitators of care at a safety-net hospital in the Southeastern United States (US).</div></div><div><h3>Methods</h3><div>Patients with foregut cancer receiving care at a safety-net tertiary care institution in the Southeastern US were recruited. Interviews were recorded, transcribed, and analyzed using NVivo 14 Software. Grounded theory methodology was used to identify themes and subthemes. A comprehensive codebook was established, with a high interrater reliability rate of &gt; 90 % for all themes.</div></div><div><h3>Results</h3><div>Of the 30 patients interviewed, the majority were male (n = 23, 77 %) and Black (n = 18, 60 %), with an average age of 63 (IQR: 55–67). Facilitator themes were identified across four categories: (1) Individual/Interpersonal; (2) Provider/Care Team; (3) Healthcare Systems, and (4) Broader Policy. The most prevalent facilitators identified included faith and spirituality (87 %), support from immediate family (83 %), trust in the care team (90 %), and effective communication (97 %).</div></div><div><h3>Conclusion</h3><div>Understanding patient perspectives is essential for delivering high-quality care in foregut cancer. These facilitators should be actively promoted during the development of future interventions. An appreciation of patient beliefs, communication training for care providers, hiring necessary ancillary staff, use of written handouts, expanding financial aid services, and wider healthcare reform are all avenues to explore in the ongoing effort to improve comprehensive oncological care for patients.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of neoadjuvant immunotherapy may be associated with increased surgical complications In women with triple-negative breast cancer","authors":"Danielle Graham ,&nbsp;Ariana Kassam ,&nbsp;Yuan Yuan ,&nbsp;Rhea Rahim ,&nbsp;Alisa Blumenthaler ,&nbsp;Marissa K. Boyle ,&nbsp;Alice Chung ,&nbsp;Armando Giuliano ,&nbsp;Farin Amersi","doi":"10.1016/j.soi.2025.100190","DOIUrl":"10.1016/j.soi.2025.100190","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and muscle measures predict benefit of surgery in locally-advanced adenocarcinoma of the esophagus","authors":"V.Christian Sanderfer ,&nbsp;Ansley B. Ricker ,&nbsp;Alexis M. Holland ,&nbsp;Erin E. Donahue ,&nbsp;Reilly E. Shea ,&nbsp;Nicholas Mullis ,&nbsp;Sophia Bellavia ,&nbsp;Ella Schwarzen ,&nbsp;M.Hart Squires ,&nbsp;Roshan S. Prabhu ,&nbsp;Kunal C. Kadakia ,&nbsp;Jonathan C. Salo","doi":"10.1016/j.soi.2025.100189","DOIUrl":"10.1016/j.soi.2025.100189","url":null,"abstract":"<div><h3>Background</h3><div>Optimal therapy for locally-advanced adenocarcinoma (ACA) of the esophagus has been chemoradiation followed by surgery (ChemoRT + Surgery), yet the morbidity of surgery is substantial. Computed tomography (CT)-derived body composition measures and age were used to categorize patients into perioperative surgical mortality risk groups. The survival benefit of adding surgery to ChemoRT was examined after stratification by risk group.</div></div><div><h3>Methods</h3><div>CT scans were analyzed to calculate skeletal muscle gauge (SMG). A predictive model of 90-day surgical mortality was constructed based upon age and SMG. Patients were classified into low-risk (bottom 75 %) and high-risk (top 25 %) groups based on their predicted probability of 90-day mortality. Log-rank tests were used to compare overall survival by treatment (ChemoRT vs ChemoRT + Surgery) in both risk groups.</div></div><div><h3>Results</h3><div>Of 330 patients with locally-advanced ACA treated with chemoradiation, 262 (79.4 %) underwent ChemoRT + Surgery and 90-day postoperative mortality was 5.7 %. Among 247 low-risk patients, 217 (87.9 %) underwent ChemoRT + Surgery and median overall survival was longer compared to ChemoRT alone (40.6mo [95 % CI 31.4, 55.5] vs. 16.8mo [95 % CI 11.8, 29.3], p &lt; 0.01). Among 83 high-risk patients, 45 (54.2 %) underwent ChemoRT + Surgery without a significant difference in overall survival vs ChemoRT alone (23.0mo [95 % CI 14.7, 51.1] vs. 27.4mo [95 % CI 17.2, 32.9], p = 0.60).</div></div><div><h3>Conclusions</h3><div>Low-risk patients with esophageal ACA have a survival benefit with ChemoRT + Surgery compared to ChemoRT alone. Conversely, we did not see a survival benefit with ChemoRT + Surgery in high-risk patients. Measurement of body composition and age identify a high-risk subset of patients who may not benefit from surgery after chemoradiation.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting the PACT Act: Top cancers diagnosed in young veterans who deployed to Iraq and Afghanistan","authors":"Robert W.C. Young ,&nbsp;James E. Duncan ,&nbsp;Vance Y. Sohn","doi":"10.1016/j.soi.2025.100188","DOIUrl":"10.1016/j.soi.2025.100188","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022, the PACT Act expanded Veterans Affairs healthcare benefits for Veterans with cancers related to toxic exposures encountered during their military service. However, evidence linking toxic exposures to cancer development remains incomplete. This study confronts this gap by identifying the most common cancers in young Veterans who served in Iraq and Afghanistan. Veteran cancer rates were compared to the National Cancer Institute’s SEER database of cancers in young adults to uncover patterns that may reveal a hidden legacy of toxic exposure.</div></div><div><h3>Methods</h3><div>The VA Informatics and Computing Infrastructure (VINCI) database was used to build a retrospective cohort of Veterans ages 18–39 who served in Iraq and Afghanistan and were diagnosed with cancer between 2017 and 22. The findings were compared to the 2024 SEER report on cancer incidence in young adults, ages 15–39. Data analysis was performed in Microsoft Excel.</div></div><div><h3>Results</h3><div>Among young male Veterans, the most diagnosed cancers were testicular (20.8 %), melanoma (13.3 %), brain tumors (9.7 %), lymphoma (9.5 %), and thyroid (8.7 %). Among young female Veterans, the most common cancers were breast (25.3 %), cervical (18.8 %), thyroid (15.8 %), melanoma (10.5 %), and brain tumors (6.9 %). Male Veterans had double the relative incidence (RI) of melanoma (13.3 % vs 6.5 % in SEER, RI 2.1), and female Veterans had almost triple the relative incidence of cervical cancer (18.8 % vs 6.6 %, RI 2.8).</div></div><div><h3>Conclusions</h3><div>Young Veterans who served in Iraq and Afghanistan face alarming rates of melanoma and cervical cancer. These findings may represent a broader, service-connected health crisis yet to be fully understood.</div></div><div><h3>Synopsis</h3><div>This study defines the top cancers diagnosed in young (ages 18–39-year-old) Veterans who deployed to Iraq and/or Afghanistan. It finds double the relative incidence of melanoma in male Veterans and nearly triple the relative incidence of cervical cancer in female Veterans.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in surgical treatment of stage IV melanoma: A SEER database study.","authors":"Orly N Farber, Yu-Jen Chen, George Molina, Olivia Monton, Elizabeth J Lilley","doi":"10.1016/j.soi.2025.100176","DOIUrl":"10.1016/j.soi.2025.100176","url":null,"abstract":"<p><strong>Introduction: </strong>Immunotherapy for advanced melanoma has improved survival outcomes and changed the surgical management of this disease. Prior work demonstrated no difference in rates of resection for stage IV melanoma after the introduction of immunotherapy. However, prior data were limited by shorter study durations and by only examining distant resections. As such, we sought to expand this work by examining longitudinal trends in both primary and distant resections for patients with advanced melanoma in the years after immunotherapy approvals.</p><p><strong>Methods: </strong>This retrospective cohort study used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to capture adult patients diagnosed with stage IV cutaneous melanoma between 2004 and 2020. We identified the annual percentage of patients who underwent surgical resections.</p><p><strong>Results: </strong>Of the 10,632 case records included, significantly fewer patients underwent surgical resection in the post-immunotherapy era (2011-2020) as compared to the pre-immunotherapy era (2004-2013) (50.4 % vs. 59.6 %, p < 0.0001). In our interrupted time series, we found a significant decline in the rate of all surgical resections in the post-immunotherapy era, decreasing by 0.97 % per year (p < 0.0001). There were significant decreases in the rates of both primary and distant resections in the post-immunotherapy era. For primary resections alone, we observed a significant level of change with annual rates of surgery declining by 5.1 % (p = 0.014) after 2011.</p><p><strong>Conclusions: </strong>This study confirms that a significant - albeit declining - proportion of patients with stage IV melanoma undergo both primary and distant resections in the post-immunotherapy era.</p><p><strong>Synopsis: </strong>Since the initial approval of immunotherapy to treat advanced melanoma in 2011, the role of surgical care for melanoma has evolved. This study examined trends in the utilization of surgery for patients with stage IV melanoma before and after 2011. We identified patients diagnosed with stage IV melanoma between 2004 and 2020 (N = 10,632) from the Surveillance, Epidemiology, and End Results database. Using an interrupted time series analysis, we compared the proportion of patients who underwent either primary or distant surgical resections in the pre- and post-immunotherapy eras (59.6 % vs. 50.4 %, respectively; p < 0.0001). There was a significant decline in the rate of all surgical resections in the post-immunotherapy era, decreasing by 0.97 % per year (p < 0.0001). These results highlight diminishing but still robust surgical treatment of stage IV melanoma since the introduction of immunotherapy.</p>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissecting the PRADO (Personalized Response-driven ADjuvant cOmbination therapy) trial in melanoma for surgical oncologists; safety and feasibility of surgical de-escalation after neo-adjuvant immunotherapy for macroscopic stage III melanoma","authors":"Charlotte M.C. Oude Ophuis ,&nbsp;Alexander C.J. van Akkooi","doi":"10.1016/j.soi.2025.100186","DOIUrl":"10.1016/j.soi.2025.100186","url":null,"abstract":"<div><div>The Personalized Response-directed surgery and Adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma (PRADO trial) is an international, multicenter, single arm, non-randomized prospective phase 2 trial that investigated neoadjuvant immunotherapy (ipi-nivo) in patients with macroscopic stage III melanoma. Depending on tumor response after index lymph node resection (ILN), patients were offered follow up only (major pathologic response, MPR ≤10 % viable melanoma); therapeutic lymph node dissection (TLND) without adjuvant therapy (partial pathologic response, pPR; 11–50 % viable tumor cells), and finally, TLND + /- adjuvant radiotherapy to the nodal field, followed by adjuvant systemic therapy (pathologic non response (pNR; &gt;50 % viable tumor cells), and switch to BRAF/MEK inhibition in case of a BRAF V600 mutation. Primary endpoints were confirmation of pathologic response rate (pRR) of the ipi-nivo; to investigate whether TLND can be safely omitted in patients achieving MPR, with the hypothesis that MPR is durable and transcends the need for TLND. Results showed that MPR could be achieved 61 % of patients and TLND could safely be omitted in these patients with significantly lower surgical morbidity and better QoL, with durable DFS and DMFS at 2 years. Summarizing, the PRADO trial showed that in macroscopic stage III melanoma 2 doses of neoadjuvant ipi-nivo leads to a high MPR rate and suggests TLND can be safely omitted in favor of ILN. Validation of this concept will follow in MSLT-3.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}