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1.
Hung-Wen Lai Ren-Hung Huang Yu-Ting Wu Chih-Jung Chen Shou-Tung Chen Ying-Jen Lin Dar-Ren Chen Chih-Wei Lee Hwa-Koon Wu Hui-Yu Lin Shou-Jen Kuo 《European journal of surgical oncology》2018,44(11):1725-1735
Background
To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer.Methods
Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer.Results
Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P < 0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio (OR) = 2.165, 95% CI = 1.253–4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR = 0.530, 95% CI = 0.332–0.842) and reoperation (OR = 0.302, 95% CI = 0.119–0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer.Conclusions
Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision. 相似文献2.
Gregory E. Ekatah Arran K. Turnbull Laura M. Arthur Jeremy Thomas Christine Dodds J. Michael Dixon 《European journal of surgical oncology》2017,43(11):2029-2035
Introduction
Ductal Carcinoma in situ (DCIS) represents 5% of symptomatic and 20–30% of screen detected cancers. Breast conserving surgery (BCS) ± radiotherapy is performed in over 70% of women with DCIS. What constitutes an adequate margin for BCS remains unclear.Methods
A single institution follow up study has been conducted of 466 patients with pure DCIS treated by BCS between 2000 and 2010 of whom 292 received whole breast radiotherapy and 167 did not. Patients were selected for radiotherapy based on perceived risk of in breast tumour recurrence (IBTR). Distance to nearest radial margin was measured; 10 patients had a margin width of <1 mm, 94 had widths of 1–2 mm and 362 had widths of >2 mm. There was no association of margin width and the use of radiotherapy.Results
At a median follow up of 7.2 years there were 44 IBTR (27 DCIS and 17 invasive). There was no evidence that margin widths >2 mm resulted in a lower rate of IBTR than margin widths of 1–2 mm. The actuarial IBTR rates at 5 and 10 years for margins of 1–2 mm were 9.0% (95% CI ± 5.9%) and 9.0% (95% CI ± 5.9%) respectively and for margins of >2 mm were 8.0% (95% CI ± 3.9%) and 13.0% (95% CI ± 3.9%) respectively. Odds Ratio for IBTR 1–2 mm vs >2 mm was 0.839 (95% CI 0.392–1.827) p = 0.846. In a multivariate analysis only DCIS size predicted for IBTR (HR 2.73 p < 0.0001).Conclusion
1 mm appears a sufficient margin width for BCS in DCIS irrespective of whether patients receive radiotherapy. 相似文献3.
Anthony J. Maxwell Karen Clements Bridget Hilton David J. Dodwell Andrew Evans Olive Kearins Sarah E. Pinder Jeremy Thomas Matthew G. Wallis Alastair M. Thompson 《European journal of surgical oncology》2018,44(4):429-435
Background
The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear.Methods
Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed.Results
Eighty-nine women with DCIS diagnosed 1998–2010 were identified. The median age at diagnosis was 75 (range 44–94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12–180) months. Twenty-nine women (33%) developed invasive breast cancer after a median interval of 45 (12–144) months. 14/29 (48%) with high grade, 10/31 (32%) with intermediate grade and 3/17 (18%) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048).Conclusions
High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial. 相似文献4.
Sung-Hsin Kuo Chiao Lo Yu-Hsuan Chen Huang-Chun Lien Wen-Hung Kuo Ming-Yang Wang Yi-Hsuan Lee Chiun-Sheng Huang 《Clinical breast cancer》2018,18(6):441-450.e2
Purpose
To identify whether a certain group of breast ductal carcinoma-in-situ (DCIS) patients can be treated with breast-conserving surgery (BCS) alone; to analyze the clinicopathologic features of DCIS and tamoxifen administration in patients treated with BCS who developed ipsilateral breast tumor recurrence (IBTR).Patients and Methods
Data for 375 women with breast DCIS who underwent BCS at our institute between June 2003 and October 2010 were analyzed. The patients were divided into different categories according to the recurrence risk predicted using the California/Van Nuys Prognostic Index (USC/VNPI) score (4-6, 7-9, and 10-12), Eastern Cooperative Oncology Group (ECOG) E5194 criteria, or combined risk features with USC/VNPI score and ECOG E5194 criteria. The IBTR and disease-free survival (DFS) rates were calculated by the Kaplan-Meier method. The prognostic effects of age, tumor size, tumor grade, margin width, estrogen receptor status, USC/VNPI score, low-risk characteristics, and tamoxifen use were evaluated by log-rank tests.Results
Of the patients, 168 were treated with breast irradiation after BCS and 207 were not. The patients who were treated with radiotherapy (RT) tended to be younger (< 40 years), to have higher USC/VNPI scores (7-9), and to meet the ECOG E5194 non–cohort 1 criteria. The 7-year risk of IBTR was 6.2% (n = 11) in the patients who received irradiation and 9.0% (n = 22) in those who did not. DFS rates were better in the patients who underwent RT than in those who did not (93.3% vs. 88.5%, P = .056). Among the patients who underwent BCS alone, age ≥ 40 years, margin width > 10 mm, USC/VNPI scores 4-6, ECOG E5194 cohort 1 criteria, estrogen receptor–positive status, and tamoxifen use predicted lower IBTR and better DFS rates. In the multivariate analysis, combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1 criteria) were identified as an independent prognostic factor of lower IBTR (P = .028) and better DFS (P = .005).Conclusion
RT reduces the risk of IBTR after BCS for DCIS of the breast. Patients with combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1 criteria) may be adequately treated with BCS alone. 相似文献5.
Jianyang Wang Shulian Wang Yu Tang Hao Jing Guangyi Sun Jing Jin Yueping Liu Yongwen Song Weihu Wang Hui Fang Hua Ren Zihao Yu Yexiong Li 《Clinical breast cancer》2018,18(5):e975-e984
Background
To investigate the superiority of breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy alone for patients with stage I breast cancer in a real-world setting.Patients and Methods
The data from patients with histologically confirmed stage I breast cancer treated from 1999 to 2014 were retrospectively reviewed. The association of outcomes with the choice of treatment (BCS plus RT vs. mastectomy) was evaluated using multivariable proportional hazards regression and further confirmed using propensity score matching methods.Results
Of 6137 eligible patients in the present study, 1296 underwent BCS plus RT and 4841 underwent mastectomy plus axillary lymph node dissection without RT (mastectomy group). Multivariate analysis revealed that BCS plus RT was related to similar locoregional recurrence-free survival but greater distant metastasis-free survival (P = .003) and overall survival (P = .036) compared with mastectomy. For the 1252 pairs of patients matched using propensity score matching, the BCS plus RT groups enjoyed significantly greater 5-year overall survival (99.1% vs. 96.1%; P = .001), distant metastasis-free survival (97.0% vs. 92.2%; P < .001), and disease-free survival (95.3% vs. 90.2%; P = .001) compared with the mastectomy group.Conclusion
BCS plus RT provided better outcomes than mastectomy for eligible patients with stage I breast cancer and should be offered as a preferred treatment option. 相似文献6.
Si-Qi Qiu Monique D. Dorrius Steven J. de Jongh Liesbeth Jansen Jakob de Vries Carolien P. Schröder Guo-Jun Zhang Elisabeth G.E. de Vries Bert van der Vegt Gooitzen M. van Dam 《European journal of surgical oncology》2018,44(11):1708-1713
Purpose
Around 15%–30% of patients receiving breast-conserving surgery (BCS) for invasive breast carcinoma or ductal carcinoma in situ (DCIS) need a reoperation due to tumor-positive margins at final histopathology. Currently available intraoperative surgical margin assessment modalities all have specific limitations. Therefore, we aimed to assess the feasibility and accuracy of micro-computed tomography (micro-CT) as a novel method for intraoperative margin assessment in BCS.Methods
Lumpectomy specimens from 30 consecutive patients diagnosed with invasive breast cancer or DCIS were imaged using a micro-CT. Margin status was assessed on micro-CT images by two investigators who were blinded to the final histopathological margin status. The micro-CT margin status was compared with the histopathological margin status.Results
The margin status could be assessed by micro-CT in 29 out of 30 patients. Of these, nine patients had a positive tumor margin and 20 a negative tumor margin at final histopathology. Margin status evaluation by micro-CT took always less than 15 min. The margin status in 25 patients was correctly predicted by micro-CT. There were four false-negative predictions. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of micro-CT in margin status prediction were 86%, 56%, 100%, 100% and 83%, respectively. With micro-CT, the positive margin rate could potentially have been reduced from 31% to 14%.Conclusions
Whole lumpectomy specimen micro-CT scanning is a promising technique for intraoperative margin assessment in BCS. Intraoperative quick feedback on the margin status could potentially lead to a reduction in the number of reoperations. 相似文献7.
Hannah Lui Park Jenny Chang Gagandeep Lal Krustina Lal Argyrios Ziogas Hoda Anton-Culver 《Clinical breast cancer》2018,18(2):e179-e185
Background
Although it is known that the risk of a second breast cancer event among young women diagnosed with ductal carcinoma in situ (DCIS) is higher than in older women, the effect of current treatment options on long-term outcomes in this subgroup of women remains poorly defined. We aimed to evaluate national treatment trends and determine their effect on second breast cancer risk and overall survival among young women diagnosed with DCIS.Materials and Methods
Surveillance, Epidemiology, and End Results data from 1998 to 2011 were used to analyze 3648 DCIS patients younger than age 40 years.Results
Among all treatment options, breast-conserving surgery (BCS) with radiation therapy (BCS + RT) was the most prevalent (36.1%) followed by mastectomy (MTX) without contralateral prophylactic MTX (CPM; 25.8%), BCS alone (22.2%), and MTX with CPM (15.8%). Risk of a second ipsilateral event was > 5-fold and > 2-fold lower within 2 years and 5 years of initial DCIS diagnosis, respectively, in women who received BCS + RT compared with BCS alone; and overall survival was 3-fold higher in women who received BCS + RT. However, MTX with or without CPM did not show an increase in overall survival compared with BCS + RT. In addition, although the percentage of young women who receive MTX with CPM has increased in recent years, MTX with CPM did not show an increased benefit in survival compared with MTX without CPM.Conclusion
The results of our study suggest that more aggressive treatments do not offer survival benefits over BCS + RT; thus, clinical treatment options in young women with DCIS should be carefully considered. 相似文献8.
C.M.S. Hassing T.F. Tvedskov N. Kroman T.L. Klausen J.B. Drejøe J.F. Tvedskov T.-L. Lambine H. Kledal G. Lelkaitis L. Langhans 《European journal of surgical oncology》2018,44(5):725-730
Background
Radioactive seed localisation (RSL) is a preoperative localisation method using a small titanium seed containing iodine-125. The method is increasingly applied for localising non-palpable lesions in the treatment of breast cancer. We believe that RSL has the potential to be used in various surgical specialties. The aim of this feasibility study was to test RSL as a preoperative localisation of non-palpable lymph nodes.Methods
Between November 24, 2015 and October 26, 2016, 15 patients with suspicious lymph nodes on imaging were included in the study. The lymph nodes were located in the axillary region (n = 9), the head and neck region (n = 5) and the inguinal region (n = 1). The seeds were placed in the centre of the lymph node, in the capsule or just outside the capsule guided by ultrasound. During surgery, incision and localisation of the lymph nodes were performed based on the auditory signal of the gamma probe. After excision, lymph nodes including iodine seeds were sent for pathologic examination and the seeds were returned to the Department of Nuclear Medicine.Results
The non-palpable lymph nodes were all successfully marked using ultrasound. The lymph nodes were successfully localised and excised during surgery, and the procedure was performed without complications in the majority of the cases.Conclusion
Localisation of suspicious non-palpable lymph nodes using RSL is feasible. RSL may ease the surgical procedure, minimise trauma to the surrounding tissue and ultimately benefit the patient. Future prospective studies are necessary to determine the further use of RSL within different surgical specialties. 相似文献9.
Purpose
In this proof-of-concept study, we proposed 3-D–printed mold–guided breast-conserving surgery (BCS) in breast cancer patients.Patients and Methods
Pathologically confirmed and eligible breast cancer patients received magnetic resonance imaging examinations before BCS. The information on the shape, size, and location of the tumor relative to the nipple was extracted and analyzed. We used a 3-D printing technique to produce a mold to guide BCS for breast cancer patients.Results
We performed 3-D–printed mold–guided BCS in 8 breast cancer patients. All of the patients had negative surgical margins, confirmed by intraoperative and postoperative pathologic examinations.Conclusion
The 3-D–printed mold–guided BCS approach is a feasible way to achieve negative surgical margins. A prospective designed cohort study, with more patients included and a longer follow-up, is needed to further confirm its long-term oncologic safety. 相似文献10.
D. Pukancsik P. Kelemen M. Újhelyi E. Kovács N. Udvarhelyi N. Mészáros I. Kenessey T. Kovács M. Kásler Z. Mátrai 《European journal of surgical oncology》2017,43(2):303-310
Background
Breast-conserving surgery (BCS) is considered the standard treatment for early-stage breast cancer. However, fair to poor cosmetic outcomes following conventional BCS have been observed in as many as one-third of cases. The aim of this study was to determine the critical tumor-to-breast volume ratio for each quadrant of the breast beyond which conventional BCS would no longer offer acceptable cosmetic and functional results or satisfactory quality of life for the patient.Methods
A prospective cohort study was performed between December 2011 and December 2013 involving 350 patients younger than 70 years with early-stage unifocal (T ≤ 30 mm) breast cancer who underwent wide excision and axillary sentinel lymph node biopsy followed by whole-breast irradiation. Using validated panels and software (the Breast Cancer Treatment Outcome Scale [BCTOS], EORTC Cancer Quality of Life Questionnaire number C30-BR23, and Breast Cancer Conservative Treatment – cosmetic results [BCCT.core] software), quality of life and aesthetic and functional parameters and their changes in correlation to the percentage of breast volume excised were statistically analyzed.Results
The maximum percentages of breast volume that were resectable by conventional BCS without resulting in unacceptable aesthetic and functional outcomes or decreased quality of life were 18–19% in the upper-outer quadrant (p < 0.0001), 14–15% in the lower-outer quadrant (p < 0.0001), 8–9% in the upper-inner quadrant (p < 0.0001), and 9–10% in the lower-inner quadrant (p < 0.0001).Conclusion
Aided by the calculated cut-off values for each breast quadrant, breast surgeons might render more objective decisions regarding performing conventional BCS, using oncoplastic techniques or choosing mastectomy with immediate reconstruction. 相似文献11.
E.L. Vos J. Gaal C. Verhoef K. Brouwer C.H.M. van Deurzen L.B. Koppert 《European journal of surgical oncology》2017,43(10):1846-1854
Background
Re-excision after breast conserving surgery (BCS) for invasive breast cancer (IBC) can be omitted for focally positive margins in the Netherlands, but this guideline is not routinely followed. Focally positive and extensively positive margins have rarely been studied separately and compared to negative margins regarding clinicopathological predictors, residual disease incidence, and local recurrence.Methods
All females with BCS for Tis-T3, without neo-adjuvant chemotherapy between 2005 and 2014 at one university hospital were included. Clinicopathological and follow-up information was collected from electronic patient records. Index tumor samples from all patients with re-excision were reviewed by one pathologist. Margins were classified as negative (≥2 mm width), close (<2 mm width), focally positive (≤4 mm length of tumor touching inked margin), or extensively positive (>4 mm length).Results
From 499 patients included, 212 (43%) had negative, 161 (32%) had close, 59 (12%) had focally positive, and 67 (13%) had extensively positive margins. Increasingly involved margins were associated with lobular type, tumor size, and adjacent DCIS in IBC patients and lesion size in purely DCIS patients. In IBC patients, 17%, 49%, and 77% had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 55%, 50%, and 70% respectively. In purely DCIS patients, 26 (65%), 13 (87%), and 16 (94%) had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 39%, 46%, and 90% respectively.Conclusion
Incidence of residual disease after focally positive margins was not different from close margins, but was significantly higher after extensively positive margins. We recommend quantifying extent of margin involvement in all pathology reports. 相似文献12.
Anne Oberguggenberger Verena Meraner Monika Sztankay Anja Hilbert Michael Hubalek Bernhard Holzner Eva Gamper Georg Kemmler Teresa Baumgartner Isabelle Lackinger Barbara Sperner-Unterweger Barbara Mangweth-Matzek 《Clinical breast cancer》2018,18(1):38-44
Purpose
Health behavior (HB) has been identified as contributing to breast cancer (BC) disease outcome. The present study was subjected to gain more in-depth insight into breast cancer survivors' (BCS) HB and its associations with patient quality of life (QOL) outcome. We investigated HB focusing on eating disturbances comparing the latter with a reference population sample (PS).Materials and Methods
The research cohort included 303 BCS completing a comprehensive patient-reported-outcome assessment on HB (eating disturbances, exercise, substance use) and QOL. Data from an age- and education-matched reference PS (n = 303) on eating disturbances were included.Results
Overall, 30% of BCS were overweight; 11.7% of BCS (2-11 years after diagnosis, mean = 5.2 years) reported eating disturbances compared with 5% of PS (P < .05). Approximately three-fourths of BCS indicated they exercise regularly, one-fourth smoke regularly, and 30% consume alcohol. Lower consumption of analgesics and tranquilizers, higher frequency of exercise, lower eating concern (EDE-Q), younger age, and lower body mass index were significant predictors for better physical QOL. Lower eating and shape concern were next to age-identified predictive for better psychological QOL.Discussion
Obesity and eating disturbances are a considerable HB problem in women with a history of BC. Considering that HB is predictive for long-term QOL in BCS, routine counseling on HB should be integrated into survivorship care to increase patient education and contribute to behavioral changes. 相似文献13.
Michael Co Gary M. Tse Clement Chen Jiannan Wei Ava Kwong 《Clinical breast cancer》2018,18(3):e421-e425
Introduction
Phyllodes tumor (PT) is an uncommon fibroepithelial tumor of the breast showing predominately proliferation of the stromal component. The presence of ductal carcinoma in situ (DCIS) or invasive ductal carcinoma is rare, with only a few cases reported in the literature.Methods
A retrospective review of a prospectively maintained database was performed. Patients who were treated for PT in 5 hospitals in Hong Kong and Shenzhen, China over a period of 20 years (1997-2016) were evaluated. All pathology slides were reported by specialist pathologists. Patients with coexisting ductal carcinoma were identified.Results
A total of 557 patients were included in this cohort; 363 (65.2%) patients had benign PT, 130 (23.3%) had borderline PT, and 64 (11.5%) had malignant PT. There were 6 (1.1%) patients with coexisting ductal carcinoma in the PT; 5 were DCIS and 1 was invasive ductal carcinoma. The median age was 46.5 years (range, 25-54 years). Ductal carcinoma occurred more frequently in malignant PT than in benign or borderline PT (4.7% vs. 0.6%; P = .02). However, malignant PT was not associated with higher DCIS grade (P = .1). All patients underwent surgery with clear resection margins. After a median follow-up interval of 70 months (range, 2-101 months), all patients remained disease- and recurrence-free.Conclusion
We report 6 additional uncommon cases of ductal carcinoma complicating PT. The presence of ductal carcinoma was not adverse prognosticator as these are usually incidental and situated within the harboring PT. 相似文献14.
Naoki Hayashi Hiroko Tsunoda Eriko Abe Mari Kikuchi Katsutoshi Enokido Koichiro Tsugawa Koyu Suzuki Seigo Nakamura 《Breast cancer (Tokyo, Japan)》2012,19(2):131-137
Background
It is very important to excise ductal carcinoma in situ (DCIS) with sufficient margins to prevent local recurrence. We describe the experience of ultrasonography (US)-guided and/or mammography (MMG)-guided breast conserving surgery (BCS) for DCIS.Methods
In this retrospective study, we considered 87 consecutive lesions of 86 patients treated with US- and/or MMG-guided BCS between January and December 2006.Results
The mean age of the 86 patients was 50.0 years (range 28–80 years). Preoperative mapping was performed using US alone for 49 lesions without microcalcifications and using US and MMG for 38 lesions with microcalcifications. Eighty-one (93.1%) of the 87 lesions were diagnosed as non-comedo type or mixed type, and 6 lesions (6.9%) were diagnosed as comedo type of DCIS. Sixty-five lesions (74.8%) were diagnosed as negative margins, 15 lesions (17.2%) as close margins, and 7 lesions (8.0%) as positive margins. Three lesions (3.4%) without microcalcifications that were mapped using US alone underwent additional resection in a second operation. The maximum tumor size was correlated with margin status (p = 0.043).Conclusion
Thus US- and/or MMG-guided BCS is a reliable method for treating patients with DCIS regardless of histopathological type and offers the advantage of being noninvasive and nonstressful for patients.15.
Steffen Kahlert Theresa M. Kolben Elisa Schmoeckel Bastian Czogalla Anna Hester Tom Degenhardt Cordula Kempf Sven Mahner Nadia Harbeck Thomas Kolben 《European journal of surgical oncology》2018,44(9):1318-1323
Purpose
The purpose of this study was the evaluation of risk factors for local recurrence after breast conserving surgery (BCS) with special focus on the impact of residual disease in specimens of simultaneous additional excisions (AE) from the tumor cavity on patients' outcome in patients with negative final margin status after one-step BCS.Methods
This study was designed as a single center retrospective cohort study. Patients with primary non-metastatic breast cancer treated by one-step BCS with pathologically confirmed negative resection status between 1990 and 2006 were included. Ipsilateral breast tumor recurrence (IBTR) and overall survival (OS) were evaluated by Kaplan-Meier-estimates. A multivariate Cox proportional hazards regression model was used to identify potential independent prognostic factors associated with the risk of IBTR.Results
A total of 1081 patients were included in this analysis. Simultaneous additional excisions were performed in 79.4% of patients (tumor positive: 12.2%). Median follow-up after primary diagnosis was 124 months. The IBTR rate after 15 years was significantly higher in the group with tumor positive AE (no AE (10.2%) vs. AE tumor positive (27.5%) p = 0.002; AE tumor negative (14.0%) vs. AE tumor positive (27.5%) p = 0.008). The OS rate did not differ significantly between groups. Multivariate analysis revealed residual cancer in AE being associated with a significantly increased relative risk of IBTR of 2.0 (p = 0.014).Conclusion
In the current analysis residual disease in simultaneous additional excisions was associated with an increased risk for IBTR despite negative final margin status. This should be considered in the overall therapeutic concept. 相似文献16.
Judith Stift Alexandra Graf Christoph Schwarz Dietmar Tamandl Patrick Starlinger Merima Herac Andrea Beer Friedrich Wrba Martin Bodingbauer Klaus Kaczirek Stefan Stremitzer 《European journal of surgical oncology》2018,44(1):139-147
Background
The value of microscopic biliary and perineural invasion as prognostic biomarkers in patients with resectable colorectal liver metastases (CLM) who undergo neoadjuvant chemotherapy and liver resection is still unclear. This retrospective study was performed to elucidate this issue.Methods
Histologic slides of resected CLM of patients who underwent neoadjuvant bevacizumab-based chemotherapy and liver resection were investigated with respect to biliary and perineural invasion. Presence of invasion was correlated with radiologic and histologic response, recurrence-free survival (RFS) and overall survival (OS).Results
One hundred forty-one patients were enrolled. There was a significant association between biliary and perineural invasion, respectively (P = 0.001). Moreover, both biliary and perineural invasion were associated with bilobar metastatic spread and higher number of metastases, while perineural invasion was also associated with a higher Fong score. No significant association was found with response. In univariable analysis, biliary and perineural invasion were associated with shorter RFS (median 10.1 vs. 13.5 months, HR 2.09, P = 0.010 and 7.6 vs. 14.0, HR 2.23, P = 0.001, respectively). Biliary invasion was also associated with shorter OS (median 32.8 months vs. not reached, HR 2.78, P = 0.010), however these results did not remain significant in multivariable analysis.Conclusions
In patients with resectable colorectal liver metastases undergoing neoadjuvant bevacizumab-based chemotherapy and liver resection, biliary and perineural invasion are associated with higher tumor load but may not be prognostic biomarkers. 相似文献17.
Jean Lubrano Philippe Bachelier François Paye Yves Patrice Le Treut Laurence Chiche Antonio Sa-Cunha Olivier Turrini Benjamin Menahem Guy Launoy Jean-Robert Delpero 《European journal of surgical oncology》2018,44(7):1078-1082
Background
Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy.Methods
The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well.Results
Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001).Conclusions
Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence. 相似文献18.
M. Davaadorj Y. Saito Y. Morine T. Ikemoto S. Imura C. Takasu S. Yamada T. Hiroki M. Yoshikawa M. Shimada 《European journal of surgical oncology》2017,43(2):344-350
Aims
Secreted Frizzled-Related Protein-1 (SFRP1) is a well-known negative regulator of the wingless type (Wnt)-β-catenin pathway and its inactivation plays an important role in the development and progression of many cancers. In this study, we aimed to determine the clinical significance of SFRP1 expression in intrahepatic cholangiocarcinoma (IHCC) and to define the relationship to Wnt-β-catenin pathway.Methods
Fifty IHCC patients who had liver resection were enrolled in this study. SFRP1 protein expression was examined by immunohistochemistry in tumor tissues. The patients were divided into two groups: SFRP1 positive (n = 30) and negative (n = 20). Clinicopathological characteristics were analyzed.Results
SFRP1 significantly correlated with curability (Cur A, B vs. C, p = 0.029); and recurrent pattern (intrahepatic vs. extrahepatic, p = 0.010). The negative SFRP1 group had significantly poorer prognosis, and 5-year survival rates were 8.1% of the negative SFRP1 group and 44.6% of the positive SFRP1 group, respectively. Moreover, the disease-free survival rate in the negative SFRP1 group was significantly poorer (p < 0.001). Multivariate analysis revealed that loss of SFRP1served as an independent prognostic factor in IHCC for both overall (HR, 2.923; 95% CI, 1.30–6.56; p = 0.009) and disease-free (HR, 2.631; 95% CI, 1.31–5.27; p = 0.006) survival. In addition, SFRP1 expression negatively correlated to β-catenin expression (p = 0.005).Conclusions
Those results suggested that the loss of SFRP1 could be a poor prognostic factor for IHCC, through the Wnt-β-catenin pathway. 相似文献19.
A.C. Currie A. Brigic S. Thomas-Gibson N. Suzuki M. Moorghen J.T. Jenkins O.D. Faiz R.H. Kennedy 《European journal of surgical oncology》2017,43(11):2044-2051
Background
Previous attempts at sentinel lymph node (SLN) mapping in colon cancer have been compromised by ineffective tracers and the inclusion of advanced disease. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping in T1/T2 clinically staged colonic malignancy.Methods
Consecutive patients with clinical T1/T2 stage colon cancer underwent endoscopic peritumoral submucosal injection of indocyanine green (ICG) for fluorescence detection of SLN using a near-infrared (NIR) camera. All patients underwent laparoscopic complete mesocolic excision surgery. Detection rate and sensitivity of the NIR-ICG technique were the study endpoints.Results
Thirty patients mean age = 68 years [range = 38–80], mean BMI = 26.2 (IQR = 24.7–28.6) were studied. Mesocolic sentinel nodes (median = 3/patient) were detected by fluorescence within the standard resection field in 27/30 patients. Overall, ten patients had lymph node metastases, with one of these patients having a failed SLN procedure. Of the 27 patients with completed SLN mapping, nine patients had histologically positive lymph nodes containing malignancy. 3/9 had positive SLNs with 6 false negatives. In five of these false negative patients, tumours were larger than 35 mm with four also being T3/T4.Conclusion
ICG mapping with NIR fluorescence allowed mesenteric detection of SLNs in clinical T1/T2 stage colonic cancer.20.
Daniel Perez Nathaniel Melling Matthias Biebl Matthias Reeh Julia-Kristin Baukloh Jameel Miro Adam Polonski Jakob R. Izbicki Belinda Knoll Johann Pratschke Felix Aigner 《European journal of surgical oncology》2018,44(2):237-242