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European Journal of Cardio-thoracic... Jun 2024
A prospective multicentre cohort study of colorectal lung metastasectomy with a nested randomized controlled trial: the key points from the pulmonary metastasectomy in colorectal cancer study.
Topics: Humans; Colorectal Neoplasms; Lung Neoplasms; Metastasectomy; Prospective Studies; Pneumonectomy; Randomized Controlled Trials as Topic
PubMed: 38873790
DOI: 10.1093/ejcts/ezae216 -
Academic Radiology Jun 2024The role of lactate dehydrogenase A (LDHA) expression in differentiated thyroid cancer (DTC), especially in radioiodine-refractory DTC, remains unclear. The aim of this...
RATIONALE AND OBJECTIVES
The role of lactate dehydrogenase A (LDHA) expression in differentiated thyroid cancer (DTC), especially in radioiodine-refractory DTC, remains unclear. The aim of this study was to analyse the relationships and the prognostic value of LDHA, glycolysis, and radioactive iodine (RAI) avidity in DTC.
METHODS
DTC patients who underwent F-FDG PET/CT and subsequent total thyroidectomy or metastasectomy were enroled. The expression levels of LDHA, glucose transporters (Glut) and Ki67 proteins in tumour tissue were measured using immunohistochemistry. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of F-FDG PET/CT were measured. A radioiodine whole body scan was used to determine lesion radioiodine avidity.
RESULTS
69 patients with DTC were enroled in this study, including 37 women (53.6%) and 32 men (46.4%), with a median age of 52 years (11 to 77 years). Regarding the pathological category, papillary thyroid cancer was documented in 50 patients (72.5%), while follicular and poorly differentiated thyroid cancer were found in 12 patients (17.4%) and seven patients (10.1%), respectively. Distant metastases were observed in 27 (39.1%) patients; 34 (49.3%) were classified as stage I, 16 (23.2%) as stage II, and 3 (4.3%) and 16 (23.2%) patients in stages III and IV, respectively. LDHA expression levels were correlated with Glut3 expression levels (r = 0.395, P = 0.003) and SUVmax (r = 0.408, P = 0.002). The median LDHA expression and lesion SUVmax of the RAI avidity group were lower than those of the non-RAI avidity group (200 vs. 285, P = 0.036; 3.06 vs. 8.38, P = 0.038, respectively). Elevated SUVmax (P = 0.004), MTV (P = 0.014), TLG (P = 0.001) and LDHA expression (P = 0.048) led to shorter time to progression (TTP); Cox regression analysis revealed that TLG (HR: 4.773, P = 0.047) was an independent prognostic factor of TTP.
CONCLUSION
Elevated LDHA is correlated with increased glucose metabolism, decreased radioiodine avidity, and accelerated disease progression. Moreover, F-FDG PET/CT acting as "in vivo pathology" is an excellent predictor of DTC prognosis.
PubMed: 38866688
DOI: 10.1016/j.acra.2024.04.033 -
Advances in Clinical and Experimental... Jun 2024Individuals with metastatic gastric cancer (MGC) are incurable and have a poor prognosis. To date, surgical resection with curative intent is the only treatment...
BACKGROUND
Individuals with metastatic gastric cancer (MGC) are incurable and have a poor prognosis. To date, surgical resection with curative intent is the only treatment providing hope for a cure, but the role of surgical resection is still controversial.
OBJECTIVES
To assess the effects of gastrectomy compared to non-resection on MGC patient survival.
MATERIAL AND METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to October 10, 2023. Primary outcomes were 1-, 2-, 3-, and 5-year overall survival (OS), OS, and OS time.
RESULTS
Forty-six studies with 7,152 MGC patients were included. Compared to MGC patients receiving no resection, MGC patients with gastrectomy had significantly improved 1-year OS (pooled relative risk (RR):1.90, 95% confidence intervals (95% CIs): 1.50, 2.41), 2-year OS (pooled RR: 2.23, 95% CI: 1.40, 3.53), 3-year OS (pooled RR: 6.09, 95% CI: 3.12, 11.87), 5-year OS (pooled RR: 4.30, 95% CI: 1.35, 13.74), and reduced risk of death (pooled hazard ratio (HR): 0.49, 95% CI: 0.37, 0.65). Gastrectomy combined with metastasectomy or not also revealed similar results regarding OS and risk of death. Additionally, OS time was significantly longer in patients receiving gastrectomy than patients not receiving resection (pooled weighted mean difference (WMD): 6.06, 95% CI: 1.36, 10.760). No significant difference in postoperative morbidity was detected between the patients receiving gastrectomy and patients not receiving resection (pooled RR: 2.54, 95% CI: 0.13, 51.39).
CONCLUSION
Gastrectomy, with or metastasectomy, may provide MGC patients with survival benefits.
PubMed: 38860711
DOI: 10.17219/acem/184268 -
Cureus May 2024Liver resection poses many challenges for the anesthesiologist, including intraoperative hemodynamic instability, postoperative pain, and risk of coagulopathy. We report...
Liver resection poses many challenges for the anesthesiologist, including intraoperative hemodynamic instability, postoperative pain, and risk of coagulopathy. We report a case of epidural hematoma after epidural catheter removal, following a minor liver single metastasectomy. The main purpose of this case report is to bring to light the false security provided by traditional coagulation parameters and whether further investigation should be considered in selected cases, before handling neuraxial catheters. Alterations in coagulation after a partial hepatectomy remain poorly understood; thus, we believe that additional hemostatic values such as viscoelastic testing might be considered to better assess these patients.
PubMed: 38854343
DOI: 10.7759/cureus.59879 -
Clinical Nuclear Medicine Jun 2024Although PSMA-targeted PET imaging is predominantly used for prostate carcinoma (PC), it has also been reported for thyroid carcinoma (TC). A 77-year-old man had a liver...
Although PSMA-targeted PET imaging is predominantly used for prostate carcinoma (PC), it has also been reported for thyroid carcinoma (TC). A 77-year-old man had a liver metastasectomy for poorly differentiated TC, which had elevated 18F-FDG uptake. Two years later, he was diagnosed with acinar-type modified Gleason score of 7 (3 + 4) PC. Four years later, he had metastatic liver lesions that had no radioactive iodine and 18F-FDG avidity. These lesions were 68Ga-PSMA avid, and the biopsy confirmed TC metastasis. This case emphasizes the importance of 68Ga-PSMA-based imaging in poorly differentiated TC and pathological confirmation for lesions that were 68Ga-PSMA-positive.
PubMed: 38847784
DOI: 10.1097/RLU.0000000000005299 -
Clinical Case Reports Jun 2024Palliative surgical resection of extra-calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and...
KEY CLINICAL MESSAGE
Palliative surgical resection of extra-calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and preventing associated morbidity. Careful surgical planning, including selective preoperative embolization and controlled resection around critical structures such as the sagittal sinus, is essential for successful outcomes. Cranioplasty with Titanium mesh and bone cement post-resection can provide symptomatic relief, better cosmesis, and overall improved quality of life.
ABSTRACT
Renal cell carcinomas are aggressive tumors with distant systemic disease. The calvarium appears to be an unusual and rare site for distant metastasis. The treatment modalities are challenging and out of the normal realm for the management of these tumors. We report a case of a 63-year-old woman with a previous history of nephrectomy who presented with symptoms of severe headaches, and swelling of bi-frontal and bi-parietal scalp regions due to multifocal extracalvarial disease. Preoperative bilateral superficial temporal artery embolization was performed to control the intraoperative bleeding. Surgical technique has been described with the critical steps involved, and a literature review has been conducted. Palliative tumor resection surgery was performed to improve the patient's quality of life as well as to confirm the histopathological diagnosis. Gross total resection of the extracalvarial metastatic tumor was achieved. Biopsy confirmed renal cell tumor with the clear cell subtype. The patient recovered well from her surgery with slow healing of the scalp wound. At 6-month follow-up, no recurrence of the extracalvarial disease was observed on serial imaging. Extracalvarial metastasis is a rare presentation in renal cell carcinoma. Considering the inherent radioresistant nature of the tumor, palliative surgical resection can be offered to control the metastatic spread, relieve agonizing pain symptoms, and to improve the quality of life. Preoperative embolization helps to decrease intraoperative blood loss. Moreover, palliative surgical resection of extracalvarial diseases helps to treat the metastasis as well as avoiding the associated morbidity that may occur if left untreated.
PubMed: 38845800
DOI: 10.1002/ccr3.8967 -
The Annals of Thoracic Surgery Jun 2024In advanced osteosarcoma, the lung is the most frequent site of distant metastasis, with metastasectomy often utilized for local control. The influence of pulmonary...
BACKGROUND
In advanced osteosarcoma, the lung is the most frequent site of distant metastasis, with metastasectomy often utilized for local control. The influence of pulmonary resection margin length on outcomes for osteosarcoma has not been well explored. We sought to evaluate the impact of margin length relative to tumor size on local recurrence and survival in lung-limited metastatic osteosarcoma.
METHODS
Patients with metastatic osteosarcoma who underwent lung resection between 2000-2020 were identified from a single institution. Clinicopathologic variables were collected. Margin length-to-tumor size ratio (MTR) was calculated per nodule and classified relative to MTR of 0.5. The primary outcome was development of local recurrence per nodule. Multivariate logistic regression was used to investigate covariates.
RESULTS
142 patients with 689 nodules met inclusion criteria, with mean age of 35.6 years (IQR 20.9-46.6). Patients were predominantly male (n=87, 61.3%) and White (n=106, 72.5%). Most nodules (n=644, 93.5%) were resected via thoracotomy. Mean tumor size was 0.8 cm (IQR 0.5-1.70), with average margin length of 0.3 cm (IQR 0.1-0.7). Among all nodules, 299 (43.4%) had MTR > 0.5. Systemic therapy was received by 94 patients (66.2%) preoperatively and 100 patients (70.4%) postoperatively. Importantly, we found that MTR >0.5 conferred a protective effect against recurrence (HR: 0.67, 95% CI: 0.52-0.87, p=0.003).
CONCLUSIONS
In resected pulmonary metastatic osteosarcoma, margin length greater than half the size of the pulmonary nodule is associated with lower incidence of local recurrence, with implications for subsequent need for additional therapy and disease-free state, meriting attentive intraoperative consideration.
PubMed: 38839027
DOI: 10.1016/j.athoracsur.2024.05.023 -
European Journal of Cancer (Oxford,... May 2024The safety profile of adjuvant pembrolizumab was evaluated in a pooled analysis of 4 phase 3 clinical trials.
BACKGROUND
The safety profile of adjuvant pembrolizumab was evaluated in a pooled analysis of 4 phase 3 clinical trials.
METHODS
Patients had completely resected stage IIIA, IIIB, or IIIC melanoma per American Joint Committee on Cancer, 7th edition, criteria (AJCC-7; KEYNOTE-054); stage IIB or IIC melanoma per AJCC-8 (KEYNOTE-716); stage IB, II, or IIIA non-small cell lung cancer per AJCC-7 (PEARLS/KEYNOTE-091); or postnephrectomy/metastasectomy clear cell renal cell carcinoma at increased risk of recurrence (KEYNOTE-564). Patients received adjuvant pembrolizumab 200 mg (2 mg/kg up to 200 mg for pediatric patients) or placebo every 3 weeks for approximately 1 year. Adverse events (AEs) were summarized for patients who received ≥ 1 dose of treatment.
RESULTS
Data were pooled from 4125 patients treated with pembrolizumab (n = 2060) or placebo (n = 2065). Median (range) duration of treatment was 11.1 months (0.0-18.9) with pembrolizumab and 11.2 months (0.0-18.1) with placebo. Treatment-related AEs occurred in 78.6 % (1620/2060) of patients in the pembrolizumab group (grade 3-5, 16.3 % [336/2060]) and 58.7 % (1212/2065) in the placebo group (grade 3-5, 3.5 % [72/2065]). Immune-mediated AEs (e.g. adrenal insufficiency, hypophysitis, and thyroiditis) occurred in 36.2 % (746/2060) of patients in the pembrolizumab group (grade 3-5, 8.6 % [177/2060]) and 8.4 % (174/2065) in the placebo group (grade 3-5, 1.1 % [23/2065]). Of patients with ≥ 1 immune-mediated AE or infusion reaction, systemic corticosteroids were required for 35.2 % (268/761) and 20.2 % (39/193) of patients in the pembrolizumab and placebo groups, respectively.
CONCLUSIONS
Adjuvant pembrolizumab demonstrated a manageable safety profile that was comparable to prior reports in advanced disease.
PubMed: 38838446
DOI: 10.1016/j.ejca.2024.114146 -
European Journal of Cardio-thoracic... Jun 2024
Topics: Humans; Lung Neoplasms; Metastasectomy; Retrospective Studies; Europe; Pneumonectomy
PubMed: 38833677
DOI: 10.1093/ejcts/ezae224 -
BMC Pediatrics Jun 2024Osteosarcoma is the most common primary malignant bone tumour in children and adolescents. Lungs are the most frequent and often the only site of metastatic disease. The...
BACKGROUND
Osteosarcoma is the most common primary malignant bone tumour in children and adolescents. Lungs are the most frequent and often the only site of metastatic disease. The presence of pulmonary metastases is a significant unfavourable prognostic factor. Thoracotomy is strongly recommended in these patients, while computed tomography (CT) remains the gold imaging standard. The purpose of our study was to create tools for the CT-based qualification for thoracotomy in osteosarcoma patients in order to reduce the rate of useless thoracotomies.
METHODS
Sixty-four osteosarcoma paediatric patients suspected of lung metastases on CT and their first-time thoracotomies (n = 100) were included in this retrospective analysis. All CT scans were analysed using a compartmental evaluation method based on the number and size of nodules. Calcification and location of lung lesions were also analysed. Inter-observer reliability between two experienced radiologists was assessed. The CT findings were then correlated with the histopathological results of thoracotomies. Various multivariate predictive models (logistic regression, classification tree and random forest) were built and predictors of lung metastases were identified.
RESULTS
All applied models proved that calcified nodules on the preoperative CT scan best predict the presence of pulmonary metastases. The rating of the operated lung on the preoperative CT scan, dependent on the number and size of nodules, and the total number of nodules on this scan were also found to be important predictors. All three models achieved a relatively high sensitivity (72-92%), positive predictive value (81-90%) and accuracy (74-79%). The positive predictive value of each model was higher than of the qualification for thoracotomy performed at the time of treatment. Inter-observer reliability was at least substantial for qualitative variables and excellent for quantitative variables.
CONCLUSIONS
The multivariate models built and tested in our study may be useful in the qualification of osteosarcoma patients for metastasectomy through thoracotomy and may contribute to reducing the rate of unnecessary invasive procedures in the future.
Topics: Humans; Osteosarcoma; Thoracotomy; Lung Neoplasms; Adolescent; Child; Retrospective Studies; Male; Female; Bone Neoplasms; Tomography, X-Ray Computed
PubMed: 38831258
DOI: 10.1186/s12887-024-04858-0