Surgical Oncology Insight最新文献

{"title":"Circulating tumor DNA predicts recurrence in patients receiving adjuvant hepatic artery infusion chemotherapy for resected colorectal liver metastases","authors":"Noah A. Cohen ,&nbsp;Nazanin Khajoueinejad ,&nbsp;Umut Sarpel ,&nbsp;Spiros Hiotis ,&nbsp;Parissa Tabrizian ,&nbsp;Myron Schwartz ,&nbsp;Benjamin J. Golas ,&nbsp;Daniel M. Labow ,&nbsp;Celina Ang","doi":"10.1016/j.soi.2024.100121","DOIUrl":"10.1016/j.soi.2024.100121","url":null,"abstract":"<div><h3>Objective</h3><div>The role of circulating tumor DNA (ctDNA) in management of patients with colorectal cancer is evolving, however, there are no data on ctDNA monitoring in patients with resected colorectal liver metastases (CRLM) who receive adjuvant hepatic artery (HAI) chemotherapy. We report our center’s initial experience with postoperative ctDNA monitoring in patients receiving adjuvant HAI chemotherapy.</div></div><div><h3>Summary background</h3><div>Adjuvant HAI chemotherapy improves survival after CRLM resection. ctDNA has been shown to predict recurrence in patients with resected CRLM, however no ctDNA data are available in patients who receive adjuvant HAI chemotherapy.</div></div><div><h3>Methods</h3><div>All patients with CRLM who underwent surgical resection and HAI pump placement at our center were included in this study. Demographic, clinicopathologic, radiographic, and ctDNA data are reported.</div></div><div><h3>Results</h3><div>From 2019–2024, 13 patients with CRLM underwent surgical resection and HAI pump placement and had ctDNA testing. With median follow-up of 2.6 years (1.14–4.15), 11 (85 %) patients experienced recurrence at a median of 7.9 months (2.3–22.5). In total, 10 (77 %) patients were ctDNA-positive all of whom had radiographic evidence of recurrence. Three patients have died at the time of last follow-up.</div></div><div><h3>Conclusions</h3><div>After surgical resection and HAI chemotherapy, ctDNA was detectable in most patients, and was associated with radiographic recurrence in all ctDNA-positive patients. We report a high recurrence rate in this series of heavily-pretreated patients with known risk factors for recurrence.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182588","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":"Real world experience with omission of therapeutic lymph node dissection in clinical stage III malignant melanoma treated with checkpoint or kinase inhibition systemic therapy","authors":"Michael J. Kirsch ,&nbsp;Elliott J. Yee ,&nbsp;Patrick Hosokawa ,&nbsp;William Robinson ,&nbsp;Theresa Medina ,&nbsp;Luke Mantle ,&nbsp;John Blair Hamner ,&nbsp;Martin D. McCarter ,&nbsp;Camille L. Stewart","doi":"10.1016/j.soi.2025.100131","DOIUrl":"10.1016/j.soi.2025.100131","url":null,"abstract":"<div><h3>Background</h3><div>Management of clinical stage III melanoma, which historically was treated with surgical therapeutic lymph node dissection (TLND), has changed significantly due to the introduction of effective systemic therapies including immune checkpoint and BRAF/MEK inhibitors. We asked how surgical interventions changed progression free survival and overall survival in this population.</div></div><div><h3>Methods</h3><div>The Flatiron Health electronic health records database for Advanced Melanoma was queried for patients with clinical stage III melanoma treated between 2018 and 2022 with systemic therapy. Patients were stratified by receipt of TLND.</div></div><div><h3>Results</h3><div>There were 533 patients with clinical stage III melanoma treated with systemic therapy identified; 235 (44.1 %) underwent TLND prior to systemic therapy, 17 (3.2 %) underwent TLND after receipt of systemic therapy, and 281 (52.7 %) received systemic therapy alone and did not have surgery. There were 38.1 % (n = 203) who experienced disease progression at 2 years. Patients in the no surgery group had the best 2-year progression free survival (67.3 %) compared to the upfront surgery (58.3 %) and surgery after systemic therapy groups (23.5 %, p = 0.001), and there was no difference in 2-year overall survival (82.2 % vs 80.0 % vs 82.3 %, p = 0.81). These findings persisted on multivariable analysis.</div></div><div><h3>Conclusions</h3><div>In this modern era dataset, more than half of patients with clinical stage III melanoma were treated with systemic therapy alone, despite guideline recommendations for TLND. They had superior progression free survival and similar overall survival compared to those also treated with potentially morbid surgery. Randomized data are needed to evaluate appropriate omission of surgery in this patient population.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474673","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":"Utility of tumor-informed circulating tumor DNA for detection of minimal residual disease after curative-intent therapy in localized pancreatic cancer","authors":"Erin M. Dickey ,&nbsp;Mary P. Martos ,&nbsp;Ujwal Yanala ,&nbsp;Andres Corona ,&nbsp;Nkiruka Ezenwajiaku ,&nbsp;Joseph Pizzolato ,&nbsp;Dido Franceschi ,&nbsp;Alan S. Livingstone ,&nbsp;Gretel Terrero ,&nbsp;Caitlin A. Hester ,&nbsp;Nipun B. Merchant ,&nbsp;Jashodeep Datta ,&nbsp;Peter J. Hosein","doi":"10.1016/j.soi.2024.100116","DOIUrl":"10.1016/j.soi.2024.100116","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with localized PDAC have high recurrence rates even after curative-intent therapies. Detection of minimal residual disease (MRD) can inform prognosis and may be therapeutically actionable. Tumor-informed circulating tumor (ct)DNA has been shown to be useful for MRD detection in other cancers, but its utility in localized PDAC patients undergoing curative-intent therapy is not well established.</div></div><div><h3>Methods</h3><div>ctDNA samples (total 106) from 32 patients, following completion of all curative-intent therapy, were subjected to Signatera™ analysis (Natera, Inc.). Recurrence-free survival (RFS) data was calculated using Kaplan-Meier estimates. Data from three previously presented studies using the same platform were pooled for validation.</div></div><div><h3>Results</h3><div>In our cohort (n = 32), ctDNA positivity rate was 28.1 % (9/32) with a median follow-up time of 17.7 months (range 4–62). Median RFS was significantly lower in patients with positive ctDNA (3.6 vs. 29.0 months, p &lt; 0.001; HR: 72.1 [8.6—604.9]). Correlation of positive ctDNA with radiographic recurrence showed a sensitivity of 47.4 % (9/19), specificity of 100 % (13/13), PPV of 100 % (9/9), and NPV of 56.5 % (13/23). In the pooled cohort (n = 172), sensitivity was 66.7 % (50/75), specificity 77.3 % (75/97), PPV 69.4 % (50/72), and NPV 75.0 % (75/100).</div></div><div><h3>Conclusions</h3><div>Positive tumor-informed ctDNA test shows a high specificity and PPV for radiographic recurrence and is associated with significantly worse RFS. However, sensitivity of the test remains low.</div></div><div><h3>Synopsis</h3><div>In patients with localized PDAC completing curative-intent therapies, tumor-informed ctDNA assessment shows high specificity for radiographic recurrence and is associated with worse RFS. However, sensitivity remains low and presents an opportunity for improved calibration of this platform.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183470","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":"Optimal surveillance for detecting sarcoma lung metastasis – A systematic review","authors":"Neha Malik,&nbsp;Kate Krause,&nbsp;Emily Z. Keung,&nbsp;Heather G. Lyu,&nbsp;Heather Lillemoe,&nbsp;Christopher Scally,&nbsp;Keila Torres,&nbsp;Kelly Hunt,&nbsp;Mary Austin,&nbsp;Christina L. Roland","doi":"10.1016/j.soi.2025.100124","DOIUrl":"10.1016/j.soi.2025.100124","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate diagnosis of lung metastasis for patients with soft tissue sarcoma (STS) can impact overall survival, but there is considerable variability in imaging utilized to detect metastasis. Chest x-ray (CXR) or computer tomography (CT) scan of the chest are the most common studies in current practice.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed. Databases were searched from inception to January 3, 2024. Articles were reviewed to determine if CXR or CT chest was associated with improved overall or recurrence-free survival in patients with STS. Articles were also reviewed for data on cost-effectiveness of CXR versus CT chest. The quality of evidence was assessed by the Critical Appraisal Skills Programme.</div></div><div><h3>Results</h3><div>259 abstracts were screened, and twenty-seven studies were selected for full-text review. Nine studies met all inclusion criteria. Seven studies included data on survival or recurrence rates and four included data on the cost of imaging modality. The seven studies all had conflicting results on the impact of CXR versus chest CT on survival and recurrence. The four studies that looked at cost found that CXR was more cost-effective, but in certain patients, screening with chest CT could be cost-effective.</div></div><div><h3>Conclusion</h3><div>The literature defining the optimal surveillance method for lung metastases for patients with STS is limited. Most of the studies had a low quality of evidence due to study design and significant risk of bias. Randomized controlled trials are needed to further understand the best imaging modality for lung metastasis surveillance in this patient population.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183475","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":"Analysis of 3144 case reports in the gastrointestinal stromal tumor literature: Identification of underappreciated demographics, clinical presentations, and biology","authors":"Tannaz Ranjbarian ,&nbsp;Mark Antkowiak ,&nbsp;Terence M. Doherty ,&nbsp;Yeseob Jee ,&nbsp;Jason K. Sicklick","doi":"10.1016/j.soi.2024.100117","DOIUrl":"10.1016/j.soi.2024.100117","url":null,"abstract":"<div><h3>Objective</h3><div>Gastrointestinal stromal tumors (GIST) were first described in 1998 and are now known to be the most common soft tissue sarcoma. Numerous case reports are still frequently published reporting various aspects of GIST. This prompted us to review these reports to identify common elements, changes over time, and underappreciated aspects of GIST, as well as to ask whether further exploration is truly warranted.</div></div><div><h3>Methods</h3><div>A search of the NCBI PubMed database from 5/1/1998–8/5/2023 identified all case reports on GIST using the terms “GIST” OR “gastrointestinal stromal tumor” AND “case report.” Publications were classified into 19 categories, subcategorized, and analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>A total of 4350 articles were found, with 3144 case reports representing 3348 patients included for analysis. The five most represented categories were tumor location (30.3 %), presentation (27.5 %), operative approach (12.1 %), concomitant malignancy (9.2 %), and metastatic site (8.4 %). Notable findings included rare but clinically important features such as tumor-associated paraneoplastic syndromes (0.6 %) and brain metastases (0.6 %). Additionally, 38 cases (1.2 %) were reported in neonates, infants, and children ≤ 12 years old.</div></div><div><h3>Conclusions</h3><div>We describe GIST case reports published over a 25-year period and classified them based upon abstract content. We were surprised to uncover an array of underappreciated aspects of GIST, speaking to the narrow but important role of publishing case reports on the novel and unusual aspects of rare diseases that would otherwise not be appreciated in larger case series or in population-based studies. Thus, we recommend judicious publication of GIST case reports, particularly those that emphasize previously unknown or unappreciated aspects of disease biology or novel approaches to management.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183469","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":"Fusobacterium nucleatum in appendiceal cancer: Prevalence and influence on the tumor immune microenvironment","authors":"Hyun Park ,&nbsp;Chelsea Knotts ,&nbsp;Rose Blodgett ,&nbsp;Catherine R. Lewis ,&nbsp;David L. Bartlett ,&nbsp;Neda Dadgar ,&nbsp;Patrick L. Wagner","doi":"10.1016/j.soi.2025.100122","DOIUrl":"10.1016/j.soi.2025.100122","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Fusobacterium nucleatum</em> (<em>Fn</em>) has gained notoriety for its propensity toward mucosal invasion in acute appendicitis and its potential involvement in development or progression of colorectal cancer. We hypothesized that <em>Fn</em> may be linked to appendiceal cancer (AC). To explore the potential connection, we quantitatively examined the presence of <em>Fn</em> in appendiceal tissue across various histological diagnoses.</div></div><div><h3>Methods</h3><div>A total of 50 formalin-fixed paraffin-embedded tissues were obtained from archival appendectomy specimens. RNA-in situ hybridization (RNA-ISH) with an <em>Fn</em>-specific probe was performed, and immunohistochemical staining was performed on tumor-associated CD3 + and CD8 + lymphocytes. The digital images were analyzed using QuPath and Aperio ImageScope.</div></div><div><h3>Results</h3><div>RNA-ISH showed significantly higher <em>Fn</em> content in the appendiceal pathology with increased <em>Fn</em> levels in acute appendicitis, low-grade AC, and high-grade AC relative to the Fn level of a normal appendix. Also, <em>Fn</em> content was strongly associated with decreased CD8 + lymphocyte density within high-grade AC, but no significant association was found with CD3 + lymphocyte density and tumor grades.</div></div><div><h3>Discussion</h3><div>In this study, we confirmed previous reports of <em>Fn</em> levels within normal appendiceal tissue and acute appendicitis and extended this finding to a range of appendiceal neoplasms. The inverse relationship between <em>Fn</em> and CD8 + cell density within high-grade AC in our series also suggests a potential role for <em>Fn</em> in shaping the AC microenvironment toward an immune-suppressed or immune-excluded phenotype. Further study is planned to include larger case numbers with a wider variety of histological subtypes of AC and peritoneal metastatic lesions to enrich the understanding of the immunological and microbial microenvironment in AC for novel opportunities for targeted therapy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183474","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":"Superparamagnetic tracer and paramagnetic seed for marking of sentinel lymph nodes and index metastatic nodes before neoadjuvant chemotherapy to facilitate subsequent sentinel lymph node biopsy and targeted axillary dissection in breast cancer patients: A feasibility study","authors":"Kian Chin ,&nbsp;Roger Olofsson Bagge ,&nbsp;Nushin Mirzaei ,&nbsp;Anikó Kovács ,&nbsp;Henrik Leonhardt ,&nbsp;Pontus Zaar ,&nbsp;Andreas Karakatsanis ,&nbsp;Eirini Pantiora ,&nbsp;Staffan Eriksson ,&nbsp;Maria Ekholm ,&nbsp;Alastair Thompson ,&nbsp;Peter Barry ,&nbsp;Michael Boland ,&nbsp;Vivian Man ,&nbsp;Ava Kwong ,&nbsp;Fredrik Wärnberg","doi":"10.1016/j.soi.2024.100114","DOIUrl":"10.1016/j.soi.2024.100114","url":null,"abstract":"<div><h3>Background/objective</h3><div>Axillary staging after neoadjuvant chemotherapy (NACT) is associated with low detection and high false negative rates for sentinel lymph node biopsies (SLNB). The optimal method for lymphatic mapping is not determined. The aim was to study the feasibility of pre-marking axillary lymph nodes before NACT with a paramagnetic approach, utilizing superparamagnetic iron oxide nanoparticles (SPIO) and paramagnetic seeds (Magseed®).</div></div><div><h3>Methods</h3><div>Eighty patients with clinically node negative (cN0) and node positive (cN+) breast cancers were included. All had SPIO injected before and technetium-99m (Tc⁹⁹^m) after NACT. The index metastatic nodes (Index-met) were pre-marked with Magseed®⁾. Primary endpoint was SLN and Index-met detection per patient. Secondary endpoints were concordance and reversed concordance of tracers.</div></div><div><h3>Results</h3><div>Thirty-nine cN0 and 37 cN+ patients who underwent SLNB and targeted axillary dissections (TAD) were eligible for analyses. The overall SLN detection with SPIO and Tc⁹⁹^m were: 65/76 (86 %) vs. 60/76 (79 %), (95 % CI for difference between tracers 1 %-12 %, p = 0.01) respectively. The overall concordance and reversed concordance were 84/106 (79 %) vs. 84/193 (49 %), (95 % CI 21 %-39 %, p &lt; 0.001) respectively. Detection of Index-met with Magseed® and Tc⁹⁹^m were 36/37 (97 %) vs. 20/36 (56 %), (95 % CI 27 %-59 %, p &lt; 0.001) respectively. The median number of nodes retrieved with SPIO and Tc⁹⁹^m were 2 (IQR 1–3) and 1 (IQR 1–2) (p &lt; 0.001), respectively.</div></div><div><h3>Conclusions</h3><div>It was feasible to perform axillary staging by pre-marking the relevant lymph nodes using a paramagnetic approach before NACT. Notably, a large proportion of SPIO marked lymph nodes were different from those marked by Tc⁹⁹^m.</div></div><div><h3>Synopsis</h3><div>This study investigated using a paramagnetic approach for axillary nodal mapping <em>before</em> neoadjuvant chemotherapy comparing to a conventional mapping performed after chemotherapy. The results indicated feasibility of the paramagnetic method which also identified a different group of lymph nodes. However, these results require a further validation with a larger study.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182391","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":"Prognostic factors for patients with T2/T3 gallbladder cancer: Does extent of resection matter?","authors":"Stacy Goins ,&nbsp;Kristen E. Rhodin ,&nbsp;Austin M. Eckhoff ,&nbsp;Michela Fabricius ,&nbsp;Allison N. Martin ,&nbsp;Daniel P. Nussbaum ,&nbsp;Garth Herbert ,&nbsp;Kevin N. Shah ,&nbsp;Sabino Zani ,&nbsp;Dan G. Blazer ,&nbsp;Peter J. Allen ,&nbsp;Michael E. Lidsky","doi":"10.1016/j.soi.2025.100126","DOIUrl":"10.1016/j.soi.2025.100126","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder cancer (GBC) portends a poor prognosis, and guidelines recommend radical cholecystectomy for patients with T1b and greater disease. We evaluated prognostic factors for T2 and T3 GBC among a contemporary cohort.</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was queried for patients with resected pathologic T2 and T3 GBC from 2004 to 2018. Patients were stratified by extent of resection: simple (SC) vs radical cholecystectomy (RC). Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods.</div></div><div><h3>Results</h3><div>Altogether, 10,107 patients (6426 [63.6 %] T2; 3681 [36.4 %] T3) were identified: 2203 (21.8 %) underwent SC and 7904 (78.2 %) RC. Patients with SC were more likely to have T2 disease, negative nodes, and positive margins. Tumor grade, node positivity, margin positivity, and T3 stage were associated with greater mortality. Treatment at an academic center and receipt of adjuvant chemotherapy were associated with improved survival. Extent of surgical resection was not associated with OS in unadjusted and adjusted analyses (adjusted HR 0.98, 95 % CI 0.92–1.05, p = 0.62).</div></div><div><h3>Discussion</h3><div>Outcomes for patients with resected T2 and T3 GBC remain poor, though these retrospective data suggest RC is not associated with better OS. Multidisciplinary management and prospective investigation are needed to advance outcomes and facilitate selection of patients who may benefit from radical resection.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298665","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":"Role of immunotherapy in the management of primary melanoma of the vagina: A national analysis of a rare aggressive malignancy","authors":"Yingjoy Li ,&nbsp;Sarah W. Yuen ,&nbsp;Tu Tran ,&nbsp;Kenneth G. Linden ,&nbsp;Warren Chow ,&nbsp;James G. Jakowatz ,&nbsp;Maki Yamamoto ,&nbsp;Thuy B. Tran","doi":"10.1016/j.soi.2024.100113","DOIUrl":"10.1016/j.soi.2024.100113","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Primary melanoma of the vagina (PMV) is a rare, aggressive gynecological malignancy that presents significant challenges to women’s health. Despite advancements in immunotherapy (IO), the impact of IO on PMV remains unknown. This study aims to investigate prognostic factors associated with long-term survival in patients with PMV.</div></div><div><h3>Methods</h3><div>The National Cancer Database was queried from 2004 to 2019 to identify patients with PMV. Demographics, tumor characteristics, and treatment type were evaluated. The Kaplan Meier method was used to estimate overall survival (OS). Multivariate Cox regression analysis was performed to determine predictors of survival.</div></div><div><h3>Results</h3><div>Our cohort included 884 women with PMV; 16.0 % were treated with IO. There were no differences in 5-year overall survival based on pathological characteristics or receipt of IO. Surgical resection was associated with improved 5-year OS (24.4 % vs. 8.6 %, p &lt; 0.001). Five-year OS was higher in patients who underwent lymphadenectomy (31.0 % vs. 19.4 %, p = 0.003) and who had negative surgical margins (28.0 % vs. 21.0 %, p = 0.04). Among patients who did not undergo surgery, those who received IO had nearly 2-fold higher 5-year OS, but this did not reach significance (13.7 % vs. 7.7 %, p = 0.066). On multivariable analysis, older age, nodal metastasis, and higher comorbidity were independent predictors of poor OS, while receipt of IO was not. Surgical resection was the strongest independent predictor of improved OS.</div></div><div><h3>Conclusions</h3><div>Surgical intervention with lymphadenectomy and negative margins was associated with prolonged survival in patients with PMV, while IO was not. Further investigation is needed to identify optimal treatment strategies for PMV.</div></div><div><h3>Synopsis</h3><div>In this retrospective study of patients diagnosed with primary melanoma of the vagina, immunotherapy offered limited survival benefit, regardless of curative-intent surgery. Surgical intervention with lymphadenectomy and negative margins remained the most robust predictors of improved overall survival.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183217","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":"Impact of clinicopathologic factors on the number of lymph nodes examined in patients with melanoma","authors":"Jason M. Lizalek,&nbsp;Collin E. Dougherty,&nbsp;Juan A. Santamaria-Barria,&nbsp;Bradley N. Reames,&nbsp;Jason Foster,&nbsp;Joshua M.V. Mammen","doi":"10.1016/j.soi.2025.100123","DOIUrl":"10.1016/j.soi.2025.100123","url":null,"abstract":"<div><h3>Background</h3><div>Melanoma is amongst the malignancies with the greatest annual increase in incidence. The prognosis for melanoma is partially dependent on lymph node status. Staging of lymph node basins in patients without clinical evidence of lymphadenopathy is typically by sentinel lymph node (SLN) biopsy. In this study, we sought to determine factors associated with the number of sentinel lymph nodes examined.</div></div><div><h3>Methods</h3><div>The National Cancer Database Participant User File from 2018 to 2020 was queried for clinical node negative patients who underwent sentinel lymph node biopsy. Descriptive statistics were obtained. Stepwise negative binomial regression analysis was performed in addition to ANOVA, chi-squared and Student’s t-tests.</div></div><div><h3>Results</h3><div>We identified 32,516 clinically node negative patients with melanoma from 2018 to 2020 who had undergone sentinel lymph node biopsy. Using a stepwise negative binomial model, male patients had a 3.8 % increase in the number of SLNs examined compared to females, while each year of age predicted a 0.3 % decrease in the number of SLNs examined. Breslow thickness &gt; 2 mm was associated with a 6.9 % increase in SLN examined. Primary sites with multiple potential lymphatic drainage basins including ear, lip, scalp &amp; neck, and trunk were associated with a 55.2 %, 29.6 %, 46.6 %, 43.4 % increase in SLNs examined, respectively. The study did not identify a difference in overall survival based on the number of lymph nodes examined (p = 0.25).</div></div><div><h3>Conclusion</h3><div>The number of sentinel lymph nodes examined in melanoma patients is associated positively with younger age, male sex, Breslow thickness, and primary site.</div></div><div><h3>Synopsis</h3><div>A National Cancer Database study of sentinel lymph node biopsy yield in clinically node-negative melanoma patients showed association with age, sex, Breslow thickness, and primary site. Clinicopathologic factors were predictive of sentinel lymph node yield, indicating other influences rather than objective sentinel lymph node criteria on node biopsy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183473","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}