Surgical Oncology-Oxford最新文献

{"title":"Lymphocyte-to-monocyte, platelet-to-albumin and platelet-to-lymphocyte ratios as prognostic biomarkers for neoadjuvant treatment response in rectal cancer patients","authors":"V. Făgărășan ,&nbsp;V. Bințințan ,&nbsp;R. Seicean ,&nbsp;A. Caziuc ,&nbsp;R. AIlioaie ,&nbsp;G. Făgărășan ,&nbsp;A. Ilie-Ene ,&nbsp;G. Dindelegan ,&nbsp;C. Căinap","doi":"10.1016/j.suronc.2024.102126","DOIUrl":"10.1016/j.suronc.2024.102126","url":null,"abstract":"<div><h3>Introduction</h3><p>Systemic inflammatory response (SIR) indicators are an emerging category of serum biomarkers with significant potential as prognostic and predictive factors in various types of cancers The primary focus of our study was to determine the prognostic value of the lymphocyte-to-monocyte ratio (LMR), platelet-to-albumin ratio (PLR) and platelet-to-albumin ratio (PAR) in evaluating the response to neoadjuvant treatment for patients with rectal cancer.</p></div><div><h3>Materials and methods</h3><p>We included 99 consecutive patients with rectal cancer which were admitted for surgery in our institution after completing a standard neoadjuvant radio-chemotherapy regimen. Several hematologic parameters, including LMR, PAR and PLR, were calculated by collecting and analyzing blood samples preoperatively. Cases were divided into groups using ROC curve analysis to determine optimal cutoff values for each of the investigated parameters. Treatment response was assessed through histopathological analysis of the resected specimens.</p></div><div><h3>Results</h3><p>PLR values over 215.2 were correlated with the presence of lymph node metastasis. A similar correlation was observed between PAR values over 41.89 and lymph node positivity. A significant correlation was observed between the presence of tumor budding on histopathological analysis and high-PAR values. A statistically significant correlation between a high PLR and a good response to neoadjuvant treatment was determined.</p></div><div><h3>Conclusions</h3><p>High PLR values may be associated with a more favorable treatment response to neoadjuvant radio-chemotherapy. A high PAR may be associated with unfavorable histopathological characteristics. Further studies on these readily available biomarkers are required in order to validate their clinical utility.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102126"},"PeriodicalIF":2.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S096074042400094X/pdfft?md5=90de88041625739cb58473a7fbde57d1&pid=1-s2.0-S096074042400094X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular markers of proliferation, DNA repair, and immune infiltration defines high-risk subset of resectable retroperitoneal sarcomas","authors":"Nathan D. Seligson ,&nbsp;Yan W. Asmann ,&nbsp;Tariq Almerey ,&nbsp;Yaquelin Coll Zayas ,&nbsp;Mark A. Edgar ,&nbsp;Steven Attia ,&nbsp;Keith L. Knutson ,&nbsp;Sanjay P. Bagaria","doi":"10.1016/j.suronc.2024.102125","DOIUrl":"10.1016/j.suronc.2024.102125","url":null,"abstract":"<div><h3>Introduction</h3><p>For retroperitoneal sarcomas (RPS), aggressive surgical resection offers the only chance for a cure; however, 5-year survival remains below 65%. Therefore, there is a critical need to identify drivers of poor clinical outcomes.</p></div><div><h3>Materials and methods</h3><p>To identify biomarkers of tumors likely to recur following curative intent resection, we performed genomic and transcriptomic sequencing for 47 and 34 patients, respectively, with non-metastatic RPS at a single, high-volume sarcoma center.</p></div><div><h3>Results</h3><p>At the DNA level, alterations in <em>TERT</em> were associated with poor disease-free survival (DFS) and overall survival (OS). Increased RNA expression of gene sets related to growth signaling and DNA repair were associated with poor DFS and OS. Infiltration of CD8⁺ T-Cells and activated dendritic cells were associated with poor DFS and OS.</p></div><div><h3>Conclusion</h3><p>These findings may help to better identify and treat non-metastatic, high-risk RPS.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102125"},"PeriodicalIF":2.3,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer-related lymphedema: A critical review on recent progress","authors":"Nasrin Sharifi ,&nbsp;Sarfraz Ahmad","doi":"10.1016/j.suronc.2024.102124","DOIUrl":"10.1016/j.suronc.2024.102124","url":null,"abstract":"<div><p>Lymphedema is a chronic and debilitating condition characterized by an abnormal buildup of protein-rich fluid in the interstitial tissue, leading to the development of edema and tissue structural alterations. Breast cancer-related lymphedema (BCRL) remains a significant healthcare burden because it can develop within days and up to 11-years after the surgery. Specifically, axillary lymph node dissection leads to 30–50 % upper limb lymphedema, which involves the accumulation of protein-rich fluid. In this article, we provide a comprehensive/critical overview of post-mastectomy lymphedema, focusing on key aspects as diagnosis, prevention, and treatment methods. Beginning with clinical condition, the article explores the pathophysiology and risk factors associated with post-mastectomy lymphedema. It further delves into various diagnostic modalities available, highlighting the importance of early detection for optimal management of BCRL. We also examine preventive strategies, emphasizing the role of patient education, lifestyle modifications, and proactive measures in reducing the risk of lymphedema development. In terms of treatment, the article covers a wide array of interventions ranging from conservative approaches like manual lymphatic drainage and compression therapy to surgical techniques such as lymph node transfer and lymphaticovenular anastomosis. Thus, through a comprehensive synthesis of current evidence and clinical practices updates, the review aims to guide healthcare professionals in delivering preventive and effective care while improving outcomes for individuals affected by post-mastectomy lymphedema.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102124"},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative appendiceal histology grade and Pseudomyxoma peritonei grade offers a solution to avoid right hemicolectomy during cytoreductive surgery and HIPEC","authors":"Richard Ghandour ,&nbsp;Armelle Bardier ,&nbsp;Mathilde Wagner ,&nbsp;Brice Malgras ,&nbsp;Rachid Kaci ,&nbsp;Solène Doat ,&nbsp;Marc Pocard","doi":"10.1016/j.suronc.2024.102123","DOIUrl":"10.1016/j.suronc.2024.102123","url":null,"abstract":"<div><h3>Introduction &amp; objectives</h3><p>Treatment of PMP consists of appendectomy, cytoreductive surgery (CRS) and HIPEC. Right-sided hemicolectomy is necessary only when PMP is high grade, given the lymphatic invasion risk. To date, no single preoperative factor was identified as predictive of PMP grade.</p></div><div><h3>Materials &amp; methods</h3><p>Preoperative factors of a prospective cohort study on PMP were retrospectively analyzed, in order to identify situations linked with high or low grade appendiceal PMP. The main outcome was PMP grade on definitive histology after CRS.</p></div><div><h3>Results</h3><p>n = 105. In univariate analysis, the grade of the appendiceal tumor, systematically reviewed in an expert center, showed an OR of 25.00 (95 % CI: 3.30–189.27; p = 0.001) and an NPV of 93.75 [85.36, 100]. Peritoneal biopsy demonstrated an OR of 19.80 (95 % CI: 2.30–170.71; p = 0.002) and a PPV of 90 [71.41, 100]. In multivariate analysis, these two factors remained significantly associated with PMP grade.</p></div><div><h3>Conclusion</h3><p>Whenever appendiceal tumor is low grade on preoperative histology, the colon has to be spared unless completeness of CRS is compromised, which is a high-grade feature in fact. In case of high grade appendiceal tumor and/or peritoneal biopsy, right-sided hemicolectomy is warranted. If no histology is available preoperatively, adapt to intraoperative lesions as no preoperative factors seem to be predictive.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102123"},"PeriodicalIF":2.3,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of malignancy for treatment direction in patients with nonfunctioning adrenal incidentaloma","authors":"Jongwon Jung ,&nbsp;Byung-Chang Kim ,&nbsp;Douk Kwon ,&nbsp;Won Woong Kim ,&nbsp;Yu-mi Lee ,&nbsp;Kye Jin Park ,&nbsp;Seung Hun Lee ,&nbsp;Ki-Wook Chung ,&nbsp;Tae-Yon Sung","doi":"10.1016/j.suronc.2024.102122","DOIUrl":"10.1016/j.suronc.2024.102122","url":null,"abstract":"<div><h3>Background</h3><p>Adrenal incidentalomas (AI) are predominantly nonfunctional and benign, and their detection and differential diagnosis are aided by computed tomography (CT). A nonfunctioning adrenal incidentaloma (NFAI) usually requires regular follow-up; however, adrenalectomy may be necessary in certain patients. This study aimed to evaluate prognostic predictors to guide the treatment approach for AIs.</p></div><div><h3>Methods</h3><p>This retrospective, single-center study involved patients diagnosed with NFAI from January 2000 to December 2020. Patients were divided into surgery and observation groups. A subgroup analysis compared malignant and benign adenoma within the surgery group.</p></div><div><h3>Results</h3><p>A total of 307 patients were included, with 127 in the surgery group and 180 in the observation group. The surgery group displayed distinct morphological and malignant potential features in CT scans more frequently than the observational group did. The malignant subgroup exhibited more irregular borders on CT, and a higher number of patients with absolute washout under 60 % and relative washout under 40 % compared with the benign adenoma subgroup. Interestingly, within the surgery group, the mean tumor size was &lt;4 cm for the both malignant and benign adenoma subgroups.</p></div><div><h3>Conclusions</h3><p>Characterizing NFAI is important for appropriate treatment, as not all AIs have a favorable prognosis. CT findings associated with malignant potential, such as Hounsfield unit and washout values, were useful in determining the need for surgical treatment. However, the conventional criterion of a 4-cm size threshold for surgery was not a reliable malignancy predictor. Surgical resection should be considered for specific patient groups to ensure proper treatment over mere observation.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102122"},"PeriodicalIF":2.3,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radioactive iodine ablation therapy reduces the risk of recurrent disease in pediatric differentiated thyroid carcinoma","authors":"Eman Toraih ,&nbsp;Alyssa Webster ,&nbsp;Eric Pineda ,&nbsp;Dylan Pinion ,&nbsp;Lily Baer ,&nbsp;Emily Persons ,&nbsp;Marcela Herrera ,&nbsp;Mohammad Hussein ,&nbsp;Emad Kandil","doi":"10.1016/j.suronc.2024.102120","DOIUrl":"10.1016/j.suronc.2024.102120","url":null,"abstract":"<div><h3>Background</h3><p>While radioactive iodine (RAI) therapy in older adults with differentiated thyroid carcinoma (DTC) reduces recurrence, data in pediatrics remain limited. We conducted a meta-analysis to quantify outcomes and recurrence risk with RAI versus thyroidectomy alone in the pediatric population.</p></div><div><h3>Methods</h3><p>Systematic literature review identified 34 retrospective studies including 2913 DTC patients under age 22 years (published 2005–2023). Meta-analysis calculated pooled rates of disease persistence and recurrence. Relative risk ratios compared odds of recurrence with RAI versus no RAI.</p></div><div><h3>Results</h3><p>Patients had mean age 14.7 years (95 % CI, 14.2–15.2) and were 75.9 % female (95 % CI, 73.8–78.1 %). Majority (90.2 %) received RAI. Pooled persistence rate was 30.3 % (95 % CI, 21.7–39.5 %); higher with RAI (31.5 %; 95 % CI, 22.4–41.3 %) than no RAI (4.5 %; 95 % CI, 0.0–18.7 %) (OR 3.28; 95 % CI,1.82–5.91; <em>p</em> &lt; 0.001). Recurrence rate was 8.97 % (95 % CI, 4.78–14.3 %). Those with RAI had 53.1 % lower recurrence risk versus no RAI (RR 0.47; 95 % CI, 0.27–0.82; <em>p</em> = 0.007). Median follow-up was 7.2 years (95 % CI, 5.8–8.5 years), with no association between follow-up duration and recurrence (r = −0.053; <em>p</em> = 0.80).</p></div><div><h3>Conclusions</h3><p>RAI therapy as an adjunct to thyroidectomy is associated with a significantly lower risk of long-term recurrence in pediatric DTC. These findings advocate for the use of RAI in preventing recurrence among high-risk pediatric patients with DTC.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102120"},"PeriodicalIF":2.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0960740424000884/pdfft?md5=5cace831bce1f904f8d97ea8774e45e1&pid=1-s2.0-S0960740424000884-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of long-standing lymphopenia after radiation therapy on survival in rectal cancer","authors":"Viacheslav Soyfer ,&nbsp;Eli Lugovoy ,&nbsp;Alla Nikolaevski-Berlin ,&nbsp;Yasmin Korzets ,&nbsp;Albert Schlocker ,&nbsp;Orit Gutfeld ,&nbsp;Inna Ospovat ,&nbsp;Uri Amit ,&nbsp;Tatiana Rabin ,&nbsp;Yasmin Filomena Natan-Oz ,&nbsp;Leor Zach ,&nbsp;Ofer Merimsky ,&nbsp;Ravit Geva ,&nbsp;Sharon Peles ,&nbsp;Ido Wolf","doi":"10.1016/j.suronc.2024.102119","DOIUrl":"10.1016/j.suronc.2024.102119","url":null,"abstract":"<div><h3>Background</h3><p>Lymphopenia and high neutrophil-to-lymphocyte ratio are known negative prognostic factors in rectal cancer. Until recently, however, lymphopenia was regarded as a minor sequela following radiation therapy (RT). The immune system's influence on rectal cancer treatment outcomes led us to evaluate the impact of lymphopenia at various time points, before, during, and following radiotherapy. We hypothesized that chronic lymphopenia following radiotherapy might negatively influence the survival of patients, and pre-treatment lymphopenia may be predictive of poor outcomes.</p></div><div><h3>Methods</h3><p>This retrospective study involved 110 patients treated for rectal cancer between 2015 and 2019. The oncological outcomes are defined as alive without disease (AWOD), alive with disease (AWD), and death. These outcome probabilities tested against variables of lymphopenia before RT, during RT, and at several post-RT follow-up time points.</p></div><div><h3>Results</h3><p>At the end of the study, 69 patients were AWOD (63 %), 13 were AWD (12 %) and 28 had died (25 %). Treatment results were assessed with according level of lymphocytes measured one year following RT: 35 out of 39 patients (89.7 %) with normal values were AWOD. In 65 patients with sustained lymphopenia, 52 % were AWOD, 18.5 % AWD and 29 % died. A similar difference was found at all time-points up to 2 years following RT (p &lt; 0.004).</p><p>The results of our study shows that pre-existing lymphopenia (prior to RT) is associated with a 3 times greater chance of death compared to patients with normal lymphocyte levels prior to RT. The PFS significantly affected by lymphopenia at all time-points after RT. An NLR of more than 4 was associated with a 3-time higher risk of recurrence than lower NLR scores (p = 0.0054).</p></div><div><h3>Conclusion</h3><p>Our results support the relevance of lymphopenia and NLR in the prognosis of rectal cancer. We believe this is the first study showing a negative correlation between sustained lymphopenia and OS following RT.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102119"},"PeriodicalIF":2.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0960740424000872/pdfft?md5=92f40612cc847acdeed41ed0926ebe88&pid=1-s2.0-S0960740424000872-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does adding sacroiliac (type IV) resection to periacetabular (type II) resection increase complications or provide worse clinical outcomes? An institutional experience and systematic review","authors":"Rajko S. Vucicevic,&nbsp;Athan G. Zavras,&nbsp;Michael P. Fice,&nbsp;Charles Gusho,&nbsp;Austin Yu,&nbsp;Steven Gitelis,&nbsp;Alan T. Blank,&nbsp;Jonathan A. Myers,&nbsp;Matthew W. Colman","doi":"10.1016/j.suronc.2024.102116","DOIUrl":"10.1016/j.suronc.2024.102116","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objectives&lt;/h3&gt;&lt;p&gt;Internal hemipelvectomy is a limb sparing procedure most commonly indicated for malignant bone and soft tissue tumors of the pelvis. Partial resection and pelvic reconstruction may be challenging for orthopedic oncologists due to late presentation, high tumor burden, and complex anatomy. Specifically, wide resection of tumors involving the periacetabular and sacroiliac (SI) regions may compromise adjacent vital neurovascular structures, impair wound healing, or limit functional recovery. We aimed to present a series of patients treated at our institution who underwent periacetabular internal hemipelvectomy (Type II) with or without sacral extension (Type IV) in combination with a systematic review to investigate postoperative complications, functional outcomes, and implant and patient survival following pelvic tumor resection via Type II hemipelvectomy with or without Type IV resection.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;p&gt;A surgical registry of consecutive patients treated with internal hemipelvectomy for primary or secondary pelvic bone tumors at our institution since 1994 was retrospectively reviewed. All type II resection patients were stratified into two separate cohorts, based on whether or not periacetabular resection was extended beyond the SI joint to include the sacrum (Type IV), as per the Enneking and Dunham classification. Patient demographics, operative parameters, complications, and oncological outcomes were collected. Categorical and continuous variables were compared with Pearson's chi square or Fisher's exact test and the Mann-Whitney &lt;em&gt;U&lt;/em&gt; test, respectively. Literature review according to PRISMA guidelines queried studies pertaining to patient outcomes following periacetabular internal hemipelvectomy. The search strategy included combinations of the key words “internal hemipelvectomy”, “pelvic reconstruction”, “pelvic tumor”, and “limb salvage”. Pooled data was compared using Pearson's chi square. Statistical significance was established as p &lt; 0.05.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 76 patients were treated at our institution with internal hemipelvectomy for pelvic tumor resection, of whom 21 had periacetabular resection. Fifteen patients underwent Type II resection without Type IV involvement, whereas six patients had combined Type II/IV resection. There were no significant differences between groups in operative time, blood loss, complications, local recurrence, postoperative metastasis, or disease mortality. Systematic review yielded 69 studies comprising 929 patients who underwent internal hemipelvectomy with acetabular resection. Of these, 906 (97.5 %) had only Type II resection while 23 (2.5 %) had concomitant Type II/IV resection. While overall complication rates were comparable, Type II resection alone produced significantly fewer neurological complications when compared to Type II resection with sacral extension (3.9 % vs. 17.4 %, p = 0.001). No si","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102116"},"PeriodicalIF":2.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy leads to improved overall survival in patients undergoing resection for Undifferentiated pleomorphic sarcoma","authors":"Sarah C. Tepper ,&nbsp;Linus Lee ,&nbsp;Michael P. Fice ,&nbsp;Conor M. Jones ,&nbsp;Neil Buac ,&nbsp;Gayathri Vijayakumar ,&nbsp;Dian Wang ,&nbsp;Matthew W. Colman ,&nbsp;Steven Gitelis ,&nbsp;Alan T. Blank","doi":"10.1016/j.suronc.2024.102118","DOIUrl":"10.1016/j.suronc.2024.102118","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Undifferentiated pleomorphic sarcoma (UPS) is a frequent subtype within the heterogeneous group of soft tissue sarcomas (STS). The use of radiotherapy (RT) has become an important component of a multimodal approach to treating STS. Key studies have demonstrated that the addition of RT improves rates of local control in STS, though the effect on overall survival (OS) is less clear. Furthermore, there is very limited and conflicting evidence regarding effect of RT on overall survival in UPS. The purposes of this investigation were to examine the association between RT and OS in UPS patients undergoing surgical resection and to determine independent prognostic indicators of OS in this patient population.</p></div><div><h3>Methods</h3><p>This was a retrospective review of patients who underwent surgical treatment for primary UPS from 1993 to 2021. Associations between RT and OS were analyzed with Kaplan-Meier curves and log-rank testing. Cox proportional hazards regression analysis was used to determine independent prognostic factors of OS.</p></div><div><h3>Results</h3><p>One hundred and fourteen patients who underwent surgical resection of primary UPS were included in the study. Ninety-six (84.2 %) patients received RT perioperatively. Use of RT was associated with improved OS on log-rank testing (hazard ratio (HR) 0.20; 95 % confidence interval (CI) 0.11–0.36; p &lt; 0.001). On multivariate analysis, RT was an independent predictor of improved OS (HR 0.18; 95 % CI 0.09–0.39; p &lt; 0.001) while metastasis at presentation (HR 4.82; 95 % CI 2.26–10.27; p &lt; 0.001) and older age (HR 1.92; 95 % CI 1.20–3.36; p = 0.02) were predictive of decreased OS. Use of RT was not significantly associated with a lower rate of local recurrence in our cohort (p = 0.49).</p></div><div><h3>Conclusions</h3><p>Use of RT in combination with surgery was an independent prognostic indicator of improved overall survival in UPS patients. Older age and metastasis at presentation were associated with worse overall survival. Based on this and other available studies, treatment for UPS should involve limb-sparing resection when feasible with RT to ensure optimal survival.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"56 ","pages":"Article 102118"},"PeriodicalIF":2.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debulking hepatectomy for colorectal liver metastasis: Analysis of risk factors for progression free survival","authors":"","doi":"10.1016/j.suronc.2024.102056","DOIUrl":"10.1016/j.suronc.2024.102056","url":null,"abstract":"<div><h3>Background</h3><p>The study explores the role of liver debulking surgery<span> in cases of unresectable colorectal liver metastases (CRLM), challenging the traditional notion that surgery is not a valid option in such scenarios.</span></p></div><div><h3>Materials and methods</h3><p>Patients with advanced but resectable disease who underwent surgery with a curative intent (Group I) and those with advanced incompletely resectable disease who underwent a “debulking” hepatectomy (Group II) were compared.</p></div><div><h3>Results</h3><p>There was no difference in the intra-operative and post-operative results between the two groups. The 3-year and 5-year OS rates were 69% and 47% for group 1 vs 64% and 35% for group 2 respectively (p = 0.14). The 3-year and 5-year PFS rates were 32% and 21% for group 1 vs 12% and 8% for group 2 respectively (p = 0.009). Independent predictors of PFS in the debulking group were bilobar metastases (HR = 2.70; p = 0.02); the presence of extrahepatic metastasis (HR = 2.65, p = 0.03) and the presence of more than 9 metastases (HR = 2.37; p = 0.04). Iterative liver surgery for CRLM was a significant protective factor (HR = 0.34, p = 0.04).</p></div><div><h3>Conclusion</h3><p>An aggressive palliative surgical approach may offer a survival benefit for selected patients with unresectable CRLM, without increasing the morbidity. The decision for surgery should be made on a case-by-case basis.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"55 ","pages":"Article 102056"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}