Delayed adjuvant hormonal therapy and its impact on mortality in women with breast cancer

Adjuvant hormonal therapy (HT) is important for the management of hormone‐sensitive breast cancer. However, the timeliness for adjuvant HT and the consequences of delayed initiation of treatment have not been analyzed. The purpose of this study was to characterize delays to HT and assess the impact on clinical outcomes. The study cohort consisted of female patients with invasive ductal and/or lobular, hormone receptor‐positive breast cancer diagnosed between 2010 and 2015. Initiation of HT >6 months (180 days) after surgery was defined as delayed. Patients receiving chemotherapy were excluded from the study cohort. Multivariable logistic regression modeling was performed to establish associations between delayed HT and demographic, facility, and clinical factors. Survival analysis was performed using the Kaplan‐Meier estimation and Cox proportional hazards regression to evaluate overall survival. Of 179 590 women assessed in the National Cancer Database, 3.2% had a delay in the initiation of adjuvant HT. Positive demographic‐related risk factors were younger age, ethnic minority groups, and multiple comorbidities. Clinical factors significantly associated with delayed initiation of adjuvant HT were high‐grade tumor, larger tumor size, greater lymph node involvement, having an unplanned readmission within 30 days of surgery, and positive final surgical margins. Adjusted survival analysis showed a survival disadvantage of delayed initiation of HT. Risk factors for delayed initiation of HT specific to demographic and clinical characteristics were identified. Delayed initiation of HT was associated with a survival detriment.     

Does use of axillary ultrasound in clinically node‐negative patients receiving neo‐adjuvant systemic therapy for breast cancer lead to surgical overtreatment?

Increased use of neo‐adjuvant chemotherapy (NAC) for breast cancer has raised uncertainty regarding staging of the axilla, particularly for patients with a clinically negative axillary physical examination (PE). We sought to determine whether axillary ultrasound (AUS) prior to NAC to identify occult nodal disease is beneficial in patients with a clinically negative examination by evaluating the difference in nodal burden on final pathology in those with abnormal vs normal AUS. A retrospective review of an institutional cancer registry identified patients who underwent NAC for breast cancer and had a pretreatment AUS. Differences in the number of positive lymph nodes (PLN) in patients with a normal axillary PE and abnormal vs normal AUS prior to NAC were determined. A total of 120 patients who received NAC had a negative axillary PE prior to treatment. Fifty‐three had an abnormal AUS and biopsy‐proven lymph node (LN) involvement. In patients with an abnormal AUS, median number of PLNs at surgery was 1 vs 0 for those with a normal AUS (mean difference of 2.12, P < .0001). Of those patients with an abnormal AUS and biopsy‐proven LN involvement, 87% underwent axillary lymph node dissection (ALND) and nearly half had no PLN on final pathology (N = 23, 43%). Patients with a clinically negative axilla and an abnormal AUS were more likely to have PLN at the time of surgery. However, almost half of those patients had no residual LN involvement. Routine AUS prior to NAC may lead to more extensive surgical management of the axilla.     

The application of platelet‐rich plasma for skin graft enrichment: A meta‐analysis

Existing evidence demonstrated that the role of platelet‐rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%‐8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13‐0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11‐0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta‐analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.     

ⅠB~ⅢA期非小细胞肺癌患者手术切除+辅助化疗后阿特珠单抗治疗的临床研究评价

1文献来源Felip E,Altorki N,Zhou C,et al.Adjuvant atezolizumab after adjuvant chemotherapy in resected stageⅠB-ⅢA non-small-cell lung cancer(IMpower010):A randomised,multicentre,open-label,phase 3 trial[J].Lancet,2021,398(10308):1344-1357.2证据水平1b。3背景约50%新确诊的非小细胞肺癌(non-small-cell lung cancer,NSCLC)患者为局限性(Ⅰ期或Ⅱ期)或局部晚期(Ⅲ期)。     

日本早期胃癌治疗现状及发展趋势

微创、保胃、保功能与个体化已成为日本早期胃癌治疗的显著特色。内镜治疗的适应证与根治性评价体系进一步完善。在外科治疗方面,对于无淋巴结转移的病例,推荐D1+淋巴结清扫;对可疑或明确淋巴结转移者,行D2淋巴结清扫。尽管早期胃癌的微创手术已广泛用于临床,但基于现有临床研究,第6版日本《胃癌治疗指南》对微创手术的适应证仍较谨慎,对于临床I期病例,腹腔镜远端胃切除术获强推荐,但腹腔镜近端胃切除术、全胃切除术及机器人手术仅为弱推荐。前哨淋巴结活检结合淋巴引流区清扫、双镜联合手术有望进一步缩小胃切除与淋巴结清扫范围。保留幽门的胃切除术及近端胃切除术开展日益广泛,获指南弱推荐,近端胃切除术的消化道重建推荐食管残胃吻合、双通道吻合或间置空肠,但临床主流是双肌瓣吻合、改良食管胃侧壁吻合（mSOFY）及双通道吻合。早期胃癌手术建议保留大网膜,对迷走神经的保留仍具有一定争议。基于现有证据,无论有无淋巴结转移,早期胃癌均不推荐术后辅助治疗。今后,早期胃癌的治疗将更加精准,微无创、保胃、重功能及个体化的特点将更加显著。