Residual disease

残留病
  • 文章类型: Journal Article
    卵巢癌仍然是最致命的妇科恶性肿瘤。所有高级浆液性卵巢癌(HGSOC)的一半在修复双链DNA断裂方面具有同源重组缺陷(HRD),并且是接受PARP抑制剂维持治疗的候选者。虽然从医学的角度来看,关于患者的治疗指导的文献很多,HRD状态对手术前景的影响相对有限.在这次审查中,我们考虑了具有BRCA1/2突变和/或HRD状态的晚期卵巢癌的临床和生物学特征,特别是它们对手术治疗和药物-手术顺序的影响.讨论了根据一线和复发性环境中分子测试的结果修改手术适应症的方法。
    Ovarian carcinoma remains the most lethal gynaecologic malignancy. Half of all high-grade serous ovarian cancers (HGSOCs) have a homologous recombination deficiency (HRD) with regard to the repair of double-strand DNA breaks and are candidate to receive maintenance treatment with PARP inhibitors. While a wealth of literature exists regarding the therapeutic guidance of patients from a medical standpoint, the influence of the HRD status on the surgical outlook has been comparatively limited. In this review, the clinical and biological features of advanced ovarian cancers with BRCA1/2 mutation and/or HRD status are considered with particular reference to their impact on the surgical management and on the medico-surgical sequence. The modification of the surgical indications according to the results of molecular testing in first-line and recurrent settings are discussed.
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  • 文章类型: Journal Article
    本研究旨在阐明治疗前中性粒细胞与淋巴细胞比率(NLR)对局部晚期乳腺癌(LABC)新辅助化疗(NAC)反应的预后作用。由于当前可用数据中的结果相互矛盾,本研究的重点是评估治疗前NLR与达到病理完全缓解(pCR)率和生存结局之间的相关性.对于目前的研究,数据来自在费萨尔国王专科医院和研究中心(利雅得,沙特阿拉伯)在2005年至2014年期间从前瞻性BC数据库中获得并进行了分析。根据使用接收器工作特征曲线确定的最佳NLR截止值,将患者分为两组。进行Logistic回归分析以评估与pCR相关的变量,和Cox回归分析用于评估与生存结局相关的变量.发现低治疗前NLR组(≤2.2)表现出更高的实现pCR的可能性(优势比,2.59;95%CI,1.52-4.38;P<0.001),随着更高的5年无病生存率(DFS)[75.8vs.64.9%;危险比(HR),0.69;95%CI,0.50-0.94;P=0.02]和5年总生存率(OS;90.3vs.81.9;HR,0.62;95%CI,0.39-0.98;P=0.04)与高NLR组(>2.2)相比。亚组分析显示,观察到的生存结果的显著性是由三阴性BC(TNBC)亚组驱动的。观察到残留TNBC疾病和高治疗前NLR的患者5年DFS较低(44.4vs.75.0%;P=0.02)和5年OS(55.9vs.84.5%;P=0.055)与残留TNBC疾病和低NLR的患者相比。最后,本研究的数据表明,治疗前NLR可以作为LABC患者NAC后pCR和生存结局的可行独立预后因素,特别是TNBC患者。
    The present study aimed to clarify the prognostic role of the pre-treatment neutrophil-to-lymphocyte ratio (NLR) for the response to neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC). Due to conflicting results in currently available data, the specific focus of the present study was on evaluating the associations between the pre-treatment NLR and the rate of achieving a pathological complete response (pCR) and survival outcomes. For the present study, data from a cohort of 465 consecutive patients with LABC who underwent NAC at King Feisal Specialist Hospital and Research Center (Riyadh, Saudi Arabia) between 2005 and 2014 were obtained from a prospective BC database and analyzed. Patients were stratified into two groups based on an optimal NLR cut-off determined using the receiver operating characteristic curve. Logistic regression analyses were conducted to assess variables associated with pCR, and Cox regression analyses were used to assess variables associated with survival outcomes. The low pre-treatment NLR group (≤2.2) was found to exhibit a higher likelihood of achieving a pCR (odds ratio, 2.59; 95% CI, 1.52-4.38; P<0.001), along with higher 5-year disease-free survival (DFS) [75.8 vs. 64.9%; hazard ratio (HR), 0.69; 95% CI, 0.50-0.94; P=0.02] and 5-year overall survival (OS; 90.3 vs. 81.9; HR, 0.62; 95% CI, 0.39-0.98; P=0.04) rates compared with those in the high NLR group (>2.2). Sub-group analysis revealed that the observed significance in survival outcomes was driven by the triple-negative BC (TNBC) subgroup. Patients with residual TNBC disease and a high pre-treatment NLR were observed to have lower 5-year DFS (44.4 vs. 75.0%; P=0.02) and 5-year OS (55.9 vs. 84.5%; P=0.055) rates compared with those with residual TNBC disease and a low NLR. To conclude, data from the present study suggest that the pre-treatment NLR can serve as a viable independent prognostic factor for pCR following NAC in patients with LABC and for survival outcomes, particularly for patients with TNBC.
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  • 文章类型: Journal Article
    背景:浆液性卵巢癌(SOC)的原发性减瘤手术的最佳结果受靠近直肠的原发性卵巢肿瘤或转移灶的影响很大。
    目的:探讨影响卵巢原发肿瘤术后残余或靠近直肠的转移灶的危险因素。
    方法:收集并回顾性分析了来自A机构(培训和测试组)的164例符合SOC的患者和来自B机构(外部验证组)的36例符合SOC的患者的临床和MRI数据。临床资料包括年龄、血清碳水化合物抗原125(CA-125),人附睾蛋白4和中性粒细胞与淋巴细胞比率(NLR)。磁共振成像(MRI)数据包括卵巢质量分布,卵巢肿块的最大直径,卵巢肿块特征,原发性卵巢肿瘤或转移性病变的直肠浸润程度,和大量的腹水。采用多因素logistic回归建立模型。
    结果:通过单变量和多变量逻辑回归,CA-125(P=0.024,比值比[OR]=3.798,95%置信区间[CI]=1.24-13.32),NLR(P=0.037,OR=3.543,95%CI=1.13~12.72),原发性卵巢肿瘤或转移灶的直肠浸润程度(P<0.001,OR=37.723,95%CI=7.46-266.88)被筛选为独立预测因子。训练中模型的曲线值下的面积,test,和外部验证组分别为0.860,0.764和0.778.
    结论:基于T1加权双回波MRI的临床-放射学模型可用于非侵入性预测术后残余卵巢肿瘤或接近SOC的转移。
    BACKGROUND: The optimal primary debulking surgery outcome of serous ovarian carcinoma (SOC) is greatly affected by primary ovarian neoplasm or metastatic lesion close to the rectum.
    OBJECTIVE: To study the risk factors affecting postoperative residual primary ovarian neoplasm or metastatic lesion close to the rectum of SOC.
    METHODS: The clinical and MRI data of 164 patients with SOC eligible from institution A (training and test groups) and 36 patients with SOC eligible from institution B (external validation group) were collected and retrospectively analyzed. The clinical data included age, serum carbohydrate antigen 125 (CA-125), human epididymis protein 4, and neutrophil-to-lymphocyte ratio (NLR). Magnetic resonance imaging (MRI) data included ovarian mass distribution, maximum diameter of ovarian mass, ovarian mass features, degree of rectal invasion of the primary ovarian neoplasm or metastatic lesion, and amount of ascites. A model was established using multivariate logistic regression.
    RESULTS: By univariate and multivariate logistic regressions, CA-125 (P = 0.024, odds ratio [OR] = 3.798, 95% confidence interval [CI] = 1.24-13.32), NLR (P = 0.037, OR = 3.543, 95% CI = 1.13-12.72), and degree of rectal invasion of the primary ovarian neoplasm or metastatic lesion (P < 0.001, OR = 37.723, 95% CI = 7.46-266.88) were screened as independent predictors. The area under the curve values of the model in the training, test, and external validation groups were 0.860, 0.764, and 0.778, respectively.
    CONCLUSIONS: The clinical-radiological model based on T1-weighted dual-echo MRI can be used non-invasively to predict postoperative residual ovarian neoplasm or metastasis close to SOC in the rectum.
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  • 文章类型: Journal Article
    癌细胞异质性和治疗抗性主要来自代谢和转录适应。但是人们对它们之间的联系知之甚少。这里,我们证明,在黑色素瘤中,癌症干细胞标记醛脱氢酶1A3(ALDH1A3)与细胞核中的乙酰辅酶A(CoA)合成酶2(ACSS2)形成酶促伙伴关系,以将高葡萄糖代谢通量与神经c(NC)谱系和葡萄糖代谢基因的乙酰组蛋白H3修饰偶联。重要的是,我们表明乙醛是乙酰组蛋白H3修饰的代谢物来源,为这种高挥发性和毒性的代谢物提供生理功能。在斑马鱼黑色素瘤残留病模型中,BRAF抑制剂治疗后出现ALDH1高亚群,用ALDH1自杀抑制剂靶向这些药物,硝呋嗪,延迟或防止BRAF抑制剂耐药复发。我们的工作表明,ALDH1A3-ACSS2偶联直接协调核乙醛-乙酰-CoA代谢与特定的基于染色质的基因调控,并代表了黑色素瘤的潜在治疗脆弱性。
    Cancer cellular heterogeneity and therapy resistance arise substantially from metabolic and transcriptional adaptations, but how these are interconnected is poorly understood. Here, we show that, in melanoma, the cancer stem cell marker aldehyde dehydrogenase 1A3 (ALDH1A3) forms an enzymatic partnership with acetyl-coenzyme A (CoA) synthetase 2 (ACSS2) in the nucleus to couple high glucose metabolic flux with acetyl-histone H3 modification of neural crest (NC) lineage and glucose metabolism genes. Importantly, we show that acetaldehyde is a metabolite source for acetyl-histone H3 modification in an ALDH1A3-dependent manner, providing a physiologic function for this highly volatile and toxic metabolite. In a zebrafish melanoma residual disease model, an ALDH1-high subpopulation emerges following BRAF inhibitor treatment, and targeting these with an ALDH1 suicide inhibitor, nifuroxazide, delays or prevents BRAF inhibitor drug-resistant relapse. Our work reveals that the ALDH1A3-ACSS2 couple directly coordinates nuclear acetaldehyde-acetyl-CoA metabolism with specific chromatin-based gene regulation and represents a potential therapeutic vulnerability in melanoma.
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  • 文章类型: Journal Article
    目的:对于接受新辅助化疗(NAC)治疗的可手术的三阴性乳腺癌(TNBC),临床预后和术后决策完全依赖于病理完全缓解(pCR)与否.我们评估了NAC后pCR或残留疾病(RD)患者的表现程度是否进一步影响了总生存期(OS)。
    方法:从2010年至2019年的国家癌症数据库中确定了接受NAC的I-III期TNBC患者。使用Kaplan-Meier方法和Cox比例风险回归进行单变量和多变量分析,通过疾病程度评估总生存期。
    结果:共有35,598名患者符合纳入标准,和11,967达到pCR。十年OS为88.5%,按cT和cN类别划分。最佳10年OS见于cT1-2,cN0患者(90.9%),而在cT3-4,cN2-3疾病患者中最差(72.0%)。共有23,631例患者发生RD。十年OS为60.1%,按cT和cN类别划分。在cT1-2,cN0患者中观察到最佳的10年OS(73.0%),在cT3-4,cN2-3疾病患者中最差(36.3%)。值得注意的是,与cT1-2cN0和RD患者相比,cT3-4,cN2-3疾病在诊断和pCR时的OS明显较差(aHR1.30,95%置信区间1.03-1.63,p=0.03)。
    结论:在TNBC患者中,出现时的疾病程度与OS的预后无关,与对NAC的反应无关。即使在pCR的情况下,晚期患者的OS也较差。需要进一步的研究来评估这些患者是否应该考虑额外的辅助治疗策略。
    OBJECTIVE: For operable triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy (NAC), clinical prognostication and postoperative decision-making relies exclusively on whether a pathologic complete response (pCR) is achieved or not. We evaluated whether extent of disease at presentation further influenced overall survival (OS) among patients with pCR or with residual disease (RD) following NAC.
    METHODS: Patients with stage I-III TNBC who underwent NAC were identified from the National Cancer Database from 2010 to 2019. Overall survival was assessed by disease extent using the Kaplan-Meier method and Cox proportional hazards regression for univariate and multivariable analysis.
    RESULTS: A total of 35,598 patients met inclusion criteria, and 11,967 achieved pCR. Ten-year OS was 88.5% and varied by cT and cN category at presentation. Best 10-year OS was seen in patients with cT1-2, cN0 (90.9%) and was worst in those with cT3-4, cN2-3 disease (72.0%). A total of 23,631 patients had RD. Ten-year OS was 60.1% and varied by cT and cN category at presentation. Best 10-year OS was seen in patients with cT1-2, cN0 (73.0%) and was worst in those with cT3-4, cN2-3 disease (36.3%). Notably, OS was significantly poorer for patients with cT3-4, cN2-3 disease at diagnosis and pCR versus those with cT1-2 cN0 and RD (aHR 1.30, 95% confidence interval 1.03-1.63, p = 0.03).
    CONCLUSIONS: Among patients with TNBC, extent of disease at presentation was prognostic for OS independently of response to NAC. Patients with advanced stage at presentation had poorer OS even in the context of pCR. Further investigation is needed to evaluate whether additional adjuvant therapy strategies should be considered for these patients.
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  • 文章类型: Journal Article
    背景:胆囊切除术后的偶发胆囊癌(IGBC)构成胆囊癌诊断的重要部分。提倡重新探索以优化疾病清除并提高生存率。残留疾病(RD)与劣质肿瘤结局的一致性提示对再切除作为IGBC自然史中的修饰因子的作用进行了严格的检查。
    方法:纳入2012年至2022年诊断为胆囊癌的所有患者。采用弹性网络正则化回归模型对IGBC组中RD的高风险预测因子进行了分析。根据切除边缘和RD评估生存结果。
    结果:在接受IGBC再探查的181例患者中,133(73.5%)拥有RD,48人(26.5%)没有证据。弹性网络模型,利用选定的λ=0.029,确定与RD风险相关的六个系数:胆囊切除术的抽吸(0.141),肝肿瘤起源(1.852),重新探索时间>8周(1.879),正边距状态(2.575),较高的T阶段(1.473),和低分化肿瘤(2.241)。此外,研究显示,无RD证据的IGBC患者的中位总生存期为44个月(CI38-60),与RD患者的31个月(23-42)相比(p<0.001)。
    结论:再切除显示RD的发生率很高(73.5%),与较差的生存结果显着相关。术前识别高风险特征提供了可靠的生物学疾病概况。这有助于对可能从再切除中受益的患者进行战略预选,强调有必要对那些具有不利特征的患者进行量身定制的化疗以巩固结果。
    BACKGROUND: Incidental Gallbladder Cancer (IGBC) following cholecystectomy constitutes a significant portion of gallbladder cancer diagnoses. Re-exploration is advocated to optimize disease clearance and enhance survival rates. The consistent association of residual disease (RD) with inferior oncologic outcomes prompts a critical examination of re-resection\'s role as a modifying factor in the natural history of IGBC.
    METHODS: All patients diagnosed with gallbladder cancer between 2012 and 2022 were included. An elastic net regularized regression model was employed to profile high-risk predictors of RD within the IGBC group. Survival outcomes were assessed based on resection margins and RD.
    RESULTS: Among the 181 patients undergoing re-exploration for IGBC, 133 (73.5 %) harbored RD, while 48 (26.5 %) showed no evidence. The elastic net model, utilizing a selected λ = 0.029, identified six coefficients associated with the risk of RD: aspiration from cholecystectomy (0.141), hepatic tumor origin (1.852), time to re-exploration >8 weeks (1.879), positive margin status (2.575), higher T stage (1.473), and poorly differentiated tumors (2.241). Furthermore, the study revealed a median overall survival of 44 months (CI 38-60) for IGBC patients with no evidence of RD, compared to 31 months (23-42) for those with RD (p < 0.001).
    CONCLUSIONS: Re-resection revealed a high incidence of RD (73.5 %), significantly correlating with poorer survival outcomes. The preoperative identification of high-risk features provides a reliable biological disease profile. This aids in strategic preselection of patients who may benefit from re-resection, underscoring the need to consolidate outcomes with tailored chemotherapy for those with unfavorable characteristics.
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  • 文章类型: Journal Article
    乳腺癌患者新辅助化疗(NAC)后的残留疾病预测结果比病理完全缓解更差。基于残留肿瘤的解剖部位的不同预后影响尚未得到很好的研究。
    该研究旨在评估NAC后具有不同残留肿瘤部位的乳腺癌患者的无病生存期(DFS),并开发出预测这些患者1至3年DFS的列线图。
    一项回顾性队列研究。
    NAC后953例淋巴结阳性乳腺癌患者的回顾性分析。患者分为三组:乳腺残留病(RDB),淋巴结残留病(RDN),以及两者的残留病(RDBN)。组间比较DFS。以7:3的比例将患者分为训练集和验证集。分析了DFS的预后因素,以建立列线图预测模型。
    RDB患者的3年DFS优于94.6%,RDN为85.2%,RDBN为81.8%(p<0.0001)。临床T分期,N级,分子亚型,在单因素和多因素分析中,术后pN分期与DFS独立相关.结合临床肿瘤淋巴结转移(TNM)分期的列线图,分子亚型,病理反应表现出良好的辨别力(C指数0.748训练,0.796验证队列),和校准。
    残留病的位置具有预后意义,节点残差预测较差的DFS。经验证的列线图使个性化DFS预测能够指导治疗决策。
    了解乳腺癌治疗后残留肿瘤位置对预后的影响接受新辅助化疗后,手术前缩小肿瘤的治疗方法,一些乳腺癌患者可能仍有残留的肿瘤细胞。我们的研究重点是这些剩余肿瘤的位置-无论是在乳房中,淋巴结,或两者-影响癌症在未来1至3年内不复发的可能性。这种可能性被称为“无病生存”(DFS)。我们分析了953例接受新辅助化疗但仍有残留肿瘤的乳腺癌患者的数据。通过比较肿瘤保留在不同位置的患者的DFS,我们发现残留肿瘤的具体位置显著影响患者的长期健康和康复。此外,我们开发了一种称为“列线图”的预测工具,以帮助医生和患者评估未来1至3年内癌症复发的风险。这个工具考虑了各种因素,如肿瘤的大小和类型,以及化疗后残留肿瘤的位置和程度。我们的研究为了解乳腺癌治疗后复发的风险提供了新的见解。这项工作不仅增强了我们对乳腺癌管理的理解,而且还有助于为将来的患者制定更个性化和有效的治疗策略。
    UNASSIGNED: Residual disease after neoadjuvant chemotherapy (NAC) in breast cancer patients predicts worse outcomes than pathological complete response. Differing prognostic impacts based on the anatomical site of residual tumors are not well studied.
    UNASSIGNED: The study aims to assess disease-free survival (DFS) in breast cancer patients with different residual tumor sites following NAC and to develop a nomogram for predicting 1- to 3-year DFS in these patients.
    UNASSIGNED: A retrospective cohort study.
    UNASSIGNED: Retrospective analysis of 953 lymph node-positive breast cancer patients with residual disease post-NAC. Patients were categorized into three groups: residual disease in breast (RDB), residual disease in lymph nodes (RDN), and residual disease in both (RDBN). DFS compared among groups. Patients were divided into a training set and a validation set in a 7:3 ratio. Prognostic factors for DFS were analyzed to develop a nomogram prediction model.
    UNASSIGNED: RDB patients had superior 3-year DFS of 94.6% versus 85.2% for RDN and 81.8% for RDBN (p < 0.0001). Clinical T stage, N stage, molecular subtype, and postoperative pN stage were independently associated with DFS on both univariate and multivariate analyses. Nomogram integrating clinical tumor-node-metastasis (TNM) stage, molecular subtype, pathological response demonstrated good discrimination (C-index 0.748 training, 0.796 validation cohort), and calibration.
    UNASSIGNED: The location of residual disease has prognostic implications, with nodal residuals predicting poorer DFS. The validated nomogram enables personalized DFS prediction to guide treatment decisions.
    Understanding the impact of residual tumor location on prognosis after breast cancer treatment After receiving neoadjuvant chemotherapy, a treatment to shrink tumors before surgery, some breast cancer patients may still have residual tumor cells. Our study focuses on how the location of these remaining tumors – whether in the breast, lymph nodes, or both – affects the likelihood of the cancer not returning within the next 1 to 3 years. This likelihood is known as ‘disease-free survival’ (DFS). We analyzed data from 953 breast cancer patients who underwent neoadjuvant chemotherapy and still had residual tumors. By comparing DFS among patients with tumors remaining in different locations, we discovered that the specific location of the residual tumor significantly impacts the patient’s long-term health and recovery. Additionally, we developed a predictive tool called a ‘nomogram’ to help doctors and patients assess the risk of cancer recurrence in the next 1 to 3 years. This tool considers various factors such as the size and type of the tumor, as well as the location and extent of the residual tumor after chemotherapy. Our research offers new insights into understanding the risk of recurrence after breast cancer treatment. This work not only enhances our comprehension of breast cancer management but also aids in devising more personalized and effective treatment strategies for patients in the future.
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  • 文章类型: Journal Article
    目的:保留乳头乳房切除术(NSM)后的缺血性并发症可以通过2阶段手术得到改善,其中首先进行乳头乳晕复合体(NAC)的血运重建和有或没有淋巴结分期手术的肿块切除术(1S),在完成NSM(2S)前几周。我们报告了与2SNSM中残留癌的存在有关的程序之间的时间间隔。
    方法:确定了2015年至2022年接受2SNSM的乳腺癌女性。进行患者水平和乳房水平分析。介绍时的临床分期,注意到1S时的病理分期和2S时的残留病。残留疾病被分类为微观(1-2毫米),最小(3-10毫米),和中等(>10毫米)。
    结果:59例患者(108个乳房)接受了2SNSM。所有患者的1和2S之间的中位时间间隔为34天:浸润性癌前期手术为31天,前期DCIS手术为41天,接受新辅助治疗的患者为31天。在6周内完成NSM,分析了72%的乳房。在1S病理学上有浸润性癌的53例乳房中,35%(19/53)没有残留浸润性疾病,24.5%(13/53)在最终2S没有残留浸润性或原位癌。在50名接受过前期手术的女性中,16人(32%)在2SNSM发现残留浸润性癌,其中9例患病小于或等于1cm。
    结论:浸润性癌症在1S手术中被完全切除了65%的乳房。残留疾病很小,在2S时只有一例升级。缺血性乳房切除术皮瓣并发症的减少抵消了两阶段手术的增加时间。
    OBJECTIVE: Ischemic complications after nipple-sparing mastectomy (NSM) can be ameliorated by 2-stage procedures wherein devascularization of the nipple-areolar complex (NAC) and lumpectomy with or without nodal staging surgery is performed first (1S), weeks prior to a completion NSM (2S). We report the time interval between procedures in relation to the presence of residual carcinoma at 2S NSM.
    METHODS: Women with breast cancer who received 2S NSM from 2015 to 2022 were identified. Both patient level and breast level analyses were conducted. Clinical staging at presentation, pathologic staging at 1S and residual disease at 2S pathology are noted. Residual disease was classified as microscopic (1-2 mm), minimal (3-10 mm), and moderate (> 10 mm).
    RESULTS: 59 patients (108 breasts) underwent 2S NSM. The median time interval between 1 and 2S for all patients was 34 days: 31 days for upfront surgery invasive cancer, 41 days for upfront DCIS surgery and 31 days for those receiving neoadjuvant therapy. Completion NSM was performed within 6 weeks for 72% of the breasts analyzed. Of the 53 breasts with invasive cancer on 1S pathology, 35% (19/53) had no residual invasive disease and 24.5% (13/53) had neither residual invasive nor in situ carcinoma on final 2S. Among the 50 women who had upfront surgery, 16 (32%) had residual invasive cancer found at 2S NSM, 9 of which had less than or equal to 1 cm disease.
    CONCLUSIONS: Invasive cancers were completely resected during 1S procedure in 65% of breasts. Residual disease was minimal and there was only one case of upstaging at 2S. Added time of two-stage surgery is offset by a reduction in ischemic mastectomy flap complications.
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  • 文章类型: Journal Article
    目的:本研究的目的是研究原发性切除手术(PDS)后开始化疗(TTC)的时间是否会影响晚期上皮性卵巢/输卵管/原发性腹膜癌(EOC)的相对生存率(RS)。
    方法:全国基于人群的EOCFIGOIIIC-IV期女性研究,2008-2018年在瑞典妇科癌症质量登记册中注册,用PDS和化疗治疗。TTC分为;≤21天,22-28天,29-35天,36-42天和>42天。使用Pohar-Perme对净生存率的估计来估计相对生存率(RS)。通过泊松回归模型估计超额死亡率比率(EMRR)的多变量分析。
    结果:总计,包括1694名妇女。中位年龄为65.0岁。年龄较大且无残留病的TTC>42天比0-21天更常见。5年的RS为37.9%,TTC组之间没有差异。在R0(无残留疾病)队列中(n=806),TTC≤21天(91.6%)和22-28天(91.4%)的2年RS高于TTC>42天(79.1%)。TTC>42天(EMRR2.33,p=0.026),与TTC0-21天相比,FIGOIV期(EMRR1.83,p=0.007)和非浆液性组织学(EMRR4.20,p<0.001)与2年更差的超额死亡率相关,在R0队列中。在FIGOIV期的R0队列中,TTC与2年生存率相关,而在IIIC期则不相关。残留病变患者的TTC与RS无关。
    结论:对于整个队列,第四阶段,非浆液形态和残留病,但不是TTC,影响5年相对生存率。然而,对于PDS后无残留疾病的患者,TTC时间越长,2年生存率越差.
    The aim of the study was to investigate if time to start chemotherapy (TTC) after primary debulking surgery (PDS) impacted relative survival (RS) in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer (EOC).
    Nationwide population-based study of women with EOC FIGO stages IIIC-IV, registered 2008-2018 in the Swedish Quality Register for Gynecologic Cancer, treated with PDS and chemotherapy. TTC was categorized into; ≤21 days, 22-28 days, 29-35 days, 36-42 days and > 42 days. Relative survival (RS) was estimated using the Pohar-Perme estimate of net survival. Multivariable analyses of excess mortality rate ratios (EMRRs) were estimated by Poisson regression models.
    In total, 1694 women were included. The median age was 65.0 years. Older age and no residual disease were more common in TTC >42 days than 0-21 days. The RS at 5-years was 37.9% and did not differ between TTC groups. In the R0 (no residual disease) cohort (n = 806), 2-year RS was higher in TTC ≤21 days (91.6%) and 22-28 days (91.4%) than TTC >42 days (79.1%). TTC >42 days (EMRR 2.33, p = 0.026), FIGO stage IV (EMRR 1.83, p = 0.007) and non-serous histology (EMRR 4.20, p < 0.001) were associated with 2-year worse excess mortality compared to TTC 0-21 days, in the R0 cohort. TTC was associated with 2-year survival in the R0 cohort in FIGO stage IV but not in stage IIIC. TTC was not associated with RS in patients with residual disease.
    For the entire cohort, stage IV, non-serous morphology and residual disease, but not TTC, influenced 5-year relative survival. However, longer TTC was associated with a poorer 2-year survival for those without residual disease after PDS.
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  • 文章类型: Journal Article
    手术切除的目标是完全切除癌症;有一个系统来描述完成的程度是有用的。这是由残留肿瘤(R)分类捕获的,这与TNM分类是分开的,TNM分类描述了独立于治疗的癌症的解剖范围。传统的R分类将R0指定为完全切除,R1是宏观上完整的切除,但手术边缘有微观肿瘤,R2是留下大肿瘤的切除术。对于肺癌,另一个类别包括残留肿瘤的存在不确定的情况。本文是对有关这些R类别及其描述符的证据的全面审查,重点关注2000年以后发表的研究,并对潜在的混杂因素进行调整。完整之间的一贯歧视,不确定,和不完全切除证实了总生存率。关于特定描述符的证据通常有些有限,并且仅部分一致;尽管如此,数据表明保留所有描述符,但要澄清以解决歧义。基于这篇综述,建议第9版肺癌分期分类的R分类保留相同的总体框架和描述符,用更精确的描述符定义。这些改进应该有助于应用以及进一步的研究。
    BACKGROUND: The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain.
    METHODS: This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders.
    RESULTS: Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities.
    CONCLUSIONS: On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.
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