BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ...BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.展开更多
Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of...Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of a new approach, cytoreductive surgery with peritonectomy procedures together with hyperthermic intraperitoneal chemotherapy and/or early postoperative intraperitoneal chemotherapy to treat peritoneal carcinomatosis, many research groups contributed with promising results using this procedure being up to date this strategy the only one that has shown curative benefits on colorectal peritoneal carcinomatosis achieving reported overall survival rates up to 64 mo and fiveyear survival rates up to 51%. The aim of this paper is to expose an updated overview of the therapeutic possibilities of these procedures in colorectal peritoneal metastases in the same way that our Unit of Oncologic Surgery has performed since 1997 with more than four hundred procedures.展开更多
Ovarian carcinoma is one of three gynecological neoplasms. It typically develops as an insidious disease, with few warning signs or symptoms, because the ovary is situated at a deep part of the pelvic cavity. Advanced...Ovarian carcinoma is one of three gynecological neoplasms. It typically develops as an insidious disease, with few warning signs or symptoms, because the ovary is situated at a deep part of the pelvic cavity. Advanced ovarian carcinoma （AOC） is highly malignant, so the prognosis of the patients is poor. Initial debulking surgery, followed by chemotherapy, is currently the main therapeutic choice for AOC. During operations, efforts should be made to excise the tumor and minimize the residual lesion, so as to achieve the optimal cytoreduction and improve the prognosis. As a feasible therapeutic regimen for the patients with primary unresectable AOC, neoadjuvant chemotherapy can improve the surgical condition and can increase the optimality of cytoreduction. It is important therefore to evaluate the feasibility of surgical treatment and make a proper selection of the primary treatment plan and neoadjuvant chemotherapy, so as to enhance the optimality of surgery and to avoid unnecessary exploratory laparotomy. At present, methods of feasibility evaluation for optimal cytoreduction of AOC are as follows： 1） radiography, i.e., CT, PET and MRI scanning; 2） CA-125 value; 3） laparoscopic exploration; 4） other tumor markers such as p53. However, any method lacks the ability to cover all the predicting factors influencing the outcome of cytoreduction, and to evaluatethe surgery across the board. Searching for new methods and combining two or more procedures to evaluate the feasibility of cytoreduction may increase the optimality, reduce the residual focus, prolong survival time and improve the prognosis. In this study, recent advances in evaluation of the feasibility for optimal cytoreduction and the selection of neoadjuvant chemotherapeutic regimens were reviewed.展开更多
<strong>Objective:</strong><span style="font-family:Verdana;"> Complete resectability of all visualized tumor implants at debulking surgery for advanced epithelial ovarian cancer is confirm...<strong>Objective:</strong><span style="font-family:Verdana;"> Complete resectability of all visualized tumor implants at debulking surgery for advanced epithelial ovarian cancer is confirmed to be the s</span><span style="font-family:""><span style="font-family:Verdana;">ingle most important prognostic factor. This study aims</span><b> </b><span style="font-family:Verdana;">to develop </span><span style="font-family:Verdana;">preoperative</span><span style="font-family:Verdana;"> predicting score based on clinical, biological, and radiological criteria of epithelial ovarian cancer to assess the feasibility of complete cytoreduction. </span><b><span style="font-family:Verdana;">Study Design: </span></b><span style="font-family:Verdana;">A retrospective record-based study. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">The study was conducted upon 50 consecutive patients managed for epithelial ovarian cancer with FIGO stage III. Patients’ data were collected from records of the Gyne-Oncology Clinic of El Shatby University Maternity Hospital affiliated </span><span style="font-family:Verdana;">to</span><span style="font-family:Verdana;"> Alexandria University. </span><b><span style="font-family:Verdana;">Results:</span></b></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Many parameters were significantly associated with completeness of resectability in univariate analysis;including age, BMI, CA125, albumin, pre-albumin, PCI, mesenteric, and right copula of diaphragm affection by CT scan (</span><span style="font-family:Verdana;">p value</span><span style="font-family:Verdana;"> < 0</span></span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">05). A 100-point predictability score was developed, 10 for BMI ≥</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">35 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">, 25 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for Pre albumin < 14.5 mg/dl, 35 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for mesenteric affection, and 30 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for </span><span style="font-family:Verdana;">affection</span><span style="font-family:Verdana;"> of Rt. </span><span style="font-family:Verdana;">copula</span><span style="font-family:Verdana;"> of </span><span style="font-family:Verdana;">diaphragm</span><span style="font-family:Verdana;">. The overall accuracy of the score was 92%. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> In advanced ovarian cancer, pre-operative predicting score (including clinical, biological, and radiological criteria) can be used as a roadmap for </span><span style="font-family:Verdana;">prediction</span><span style="font-family:Verdana;"> of </span><span style="font-family:Verdana;">feasibility</span><span style="font-family:Verdana;"> of complete resectability. However, more research is needed on larger sample sizes.</span></span>展开更多
Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains deba...Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains debatable.We aimed to evaluate pre-HSCT strategies by comparing the endpoints related to disease control between advanced MDS patients with pre-HSCT cytoreduction and those with best supportive care.Methods:We described 228 consecutive advanced MDS patients who received HSCT from a haploidentical donor(HID,n=162)or matched related donor(MSD,n=66)with uniform myeloablative conditioning regimens between January 2015 and December 2018.Of these 228 patients,131(57.5%)were treated exclusively with pre-HSCT best supportive care(BSC),49(22.5%)were given HMA,and 48(21.1%)received both IC and HMA.Propensity score-matching analysis,multivariate analyses,and subgroup analyses were performed to elucidate the impact of pre-HSCT strategies on transplant outcomes.Results:The 3-year relapse-free survival(RFS)rates were 78.2% and 70.0% for the BSC and cytoreduction cohorts(P=0.189)and were 78.2%,66.7%,and 73.2% for the BSC,HMA,and HMA+IC groups,respectively(P=0.269).A propensity score-matching analysis confirmed that the 3-year RFS rates were 81.9%,87.5%,and 66.9% for BSC,cytoreduction complete remission(CR),and cytoreduction non-CRgroups,respectively(P=0.051).Multivariate analyses demonstrated that pre-HSCT cytoreduction,older patient age,monosomal karyotype,and interval between diagnosis and HSCT were poor prognostic factors for RFS.In the subgroup analyses,BSC was associated with longer RFS compared to cytoreduction among the younger patients,those with international prognostic scoring system intermediate-2/high risk at diagnosis,and those with intermediate/poor cytogenetics.Conclusions:Different pre-HSCT therapies did not yield discrepant post-HSCT outcomes.No benefit in terms of post-HSCT outcomes were correlated with pre-HSCT cytoreduction in advanced MDS even for cytoreduction CR patients.Early referral to HSCT is essential for advanced MDS patients.展开更多
The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte rati...The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.展开更多
BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperiton...BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.展开更多
BACKGROUND Pseudomyxoma peritonei(PMP)is a distinct form of peritoneal malignancy characterized by diffuse intra-abdominal gelatinous ascites,with an estimated incidence of 1-3 per 1000000.PMP is predominantly seconda...BACKGROUND Pseudomyxoma peritonei(PMP)is a distinct form of peritoneal malignancy characterized by diffuse intra-abdominal gelatinous ascites,with an estimated incidence of 1-3 per 1000000.PMP is predominantly secondary to appendiceal mucinous neoplasms,with rarer origins including the ovaries,colon,and urachus.However,PMP originating from small intestine is extremely rare.CASE SUMMARY A 60-year-old male patient presented with anorexia and abdominal distension.Computed tomography revealed the presence of abdominopelvic effusions and multiple intra-abdominal space-occupying lesions.Ultrasound-guided aspiration indicated that the aspirated tissue was mucinous.Exploratory laparoscopy and tissue biopsy identified diffuse tumor nodules in peritoneum,omentum,pelvic region,intestinal walls,and mesentery.Histopathological analysis of the resected tumors confirmed the presence of mucinous adenocarcinoma,but the primary lesion was difficult to determine.The patient was referred to our center for further treatment and underwent cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)under general anesthesia.The intraoperative peritoneal cancer index was 30.The surgery lasted 8 hours,with a blood loss of about 600 mL.A complete cytoreduction(CCR0)was achieved.No serious complications occurred after surgery,and the patient’s condition was good during the telephone follow-up.Postoperative pathology confirmed the diagnosis of small intestinal mucinous adenocarcinoma at proximal jejunum,which was complicated by high-grade PMP.CONCLUSIONPMP originating from small intestine is an exceptionally rare entity that exhibits non-specific clinical features. Thepreferred treatment is CRS + HIPEC.展开更多
BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents si...BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury(AKI).Identifying perioperative risk factors plays a critical role in preserving renal function.AIM To evaluate postoperative renal outcomes in patients with PC who underwent CRS+HIPEC.METHODS Patients who underwent CRS+HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study.Demographic data,preoperative estimated glomerular filtration rate,HIPEC agents used(cisplatin,mitomycin C,oxaliplatin),intraoperative fluid management,vasopressor use,and postoperative creatinine levels were recorded.AKI was defined according to the 2012 Kidney Disease:Improving Global Outcomes criteria.Independent predictors were identified through multivariate logistic regression analysis.RESULTS AKI developed in 61 of 445 patients(13.7%).Among them,62.0%were stage I,24.6%were stage II,and 13.1%were stage III.The highest AKI rate was observed in the cisplatin group(21.4%),with lower rates in the oxaliplatin group(9.6%)and the mitomycin C group(6.5%).Independent risk factors included cisplatin use[odds ratio(OR)=2.8;95%confidence interval:1.6-4.9;P<0.001),intraoperative fluid administration<6000 mL(OR=2.1;P=0.02),vasopressor requirement(OR=1.9;P=0.03),and preoperative estimated glomerular filtration rate<75 mL/minute/1.73 m2(OR=2.3;P=0.01).AKI was associated with a prolonged hospital stay.Three patients(0.7%)progressed to chronic kidney disease.CONCLUSION Independent risk factors such as cisplatin use,inadequate fluid replacement,vasopressor requirement,and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS+HIPEC.展开更多
Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectom...Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.展开更多
Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during a...Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.展开更多
Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that del...Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that delayed CN might have benefits for the survival of the patients.We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy(TT).Methods:A literature search was conducted in PubMed,EMBASE,EBSCOhost,MedRxiv,and Scopus.We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival(OS)of upfront CN with deferred CN in patients with advanced RCC undergoing TT.Meta-analysis was carried out using Review Manager v5.4 software.The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error,presented using the forest plot with 95%confidence interval.Results:Four studies were analyzed quantitatively.Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT(hazard ratio 0.50,95%confidence interval 0.40–0.64,p<0.001).Conclusion:The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC.However,more research is needed to fully understand the role,optimal timing,and sequencing of TT and CN in the treatment of advanced RCC.展开更多
BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and ga...BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.展开更多
Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although t...Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.展开更多
BACKGROUND: Curable outcome of unresectable hepato- cellular carcinoma ( HCC) was seldom encountered in the past. This study was designed to assess the role of down- staging followed by resection ( downstaging-resecti...BACKGROUND: Curable outcome of unresectable hepato- cellular carcinoma ( HCC) was seldom encountered in the past. This study was designed to assess the role of down- staging followed by resection ( downstaging-resection) in the improvement of prognosis of unresectable HCC. METHODS: During the period of 1958-2003 , a total of 1085 patients were verified surgically to be unresectable. Of these patients, 139 received downstaging-resection, with a rate of 84.2% for coexisting cirrhosis and a median tumor diame- ter of 11.1 cm. Resection of the right lobe, hepatic hilum and bilateral cancer accounted for 97. 8% of the patients. Downstaging including hepatic artery ligation ( HAL) + he- patic artery chemo-infusion ( HAI ) was performed in 65.5% of the patients, HAL + HAI + radiotherapy/radioim- munotherapy in 29. 5%, and HAL or HAI alone in 5.0%. Retrospective analysis was made of the survival of patients with unresectable HCC, downstaging-resection rate and treatment pattern. RESULTS: In the 139 patients with downstaging-resection, the median interval between the first and second operation was 7.2 months and the 5-year survival rate calculated from the first operation was 48. 7%. In the 1085 patients with un- resectable HCC, their 5-year survival was 0% in the period of 1958-1973, 11.5% in the period of 1974-1988 and 19.3% in the period of 1989-2003. These figures were correlated with the increasing downstaging-resection rate from 0%, 9.0% to 15.6%, and the increasing percentage of triple or double combination treatment from 32.2%, 60.4% to 69.7%. The 5-year survival in triple treatment group was 24. 9%, double treatment 15.2%, and single treatment only 10.9%, which was also correlated with the downstaging-re- section rate of 34.6%, 16.2% and 1.8% respectively. CONCLUSIONS: Downstaging-resection plays a role in improving prognosis of unresectable HCC. Triple and double treatments provide a higher downstaging-resection rate and may result in better prognosis.展开更多
Objective： Human epididymis protein 4（HE4） is a promising biomarker of epithelial ovarian cancer（EOC）. But its role in assessing the primary optimal debulking（OD） of EOC remains unknown. The purpose of this stu...Objective： Human epididymis protein 4（HE4） is a promising biomarker of epithelial ovarian cancer（EOC）. But its role in assessing the primary optimal debulking（OD） of EOC remains unknown. The purpose of this study is to elucidate the ability of preoperative HE4 in predicting the primary cytoreductive outcomes in advanced EOC, tubal or peritoneal carcinoma.Methods： We reviewed the records of 90 patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at the Department of Obstetrics and Gynecology of Peking University People＇s Hospital between November 2005 and October 2010. Preoperative serum HE4 and CA125 levels were detected with EIA kit. A receiver operating characteristic（ROC） curve was used to determine the most useful HE4 cut-off value. Logistic regression analysis was performed to identify significant preoperative clinical characteristics to predict optimal primary cytoreduction.Results： OD was achieved in 47.7%（43/48） of patients. The median preoperative HE4 level for patients with OD vs. suboptimal debulking was 423 and 820 pmol/L, respectively（P〈0.001）. The areas under the ROC curve for HE4 and CA125 were 0.716 and 0.599, respectively（P=0.080）. The most useful HE4 cut-off value was 473 pmol/L. Suboptimal cytoreduction was obtained in 66.7%（38/57） of cases with HE4 ≥473 pmol/L compared with only 27.3%（9/33） of cases with HE4 〈473 pmol/L. At this threshold, the sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） for diagnosing suboptimal debulking were 81%, 56%, 67%, and 73%, respectively. Logistic regression analysis showed that the patients with HE4 ≥473 pmol/L were less likely to achieve OD（odds ratio =5.044, P=0.002）.Conclusions： Preoperative serum HE4 may be helpful to predict whether optimal cytoreductive surgery could be obtained or whether extended cytoreduction would be needed by an interdisciplinary team.展开更多
Epithelial ovarian cancer (EOC) is the second most common genital malignancy in women and is the most lethal gynecological malignancy,with an estimated five-year survival rate of 39%.Despite efforts to develop an effe...Epithelial ovarian cancer (EOC) is the second most common genital malignancy in women and is the most lethal gynecological malignancy,with an estimated five-year survival rate of 39%.Despite efforts to develop an effective ovarian cancer screening method,60% of patients still present with advanced disease.Comprehensive management using surgical cytoreduction to decrease the tumor load to aminimum,and intraperitoneal chemotherapy to eliminate microscopic disease on peritoneal surface,has the potential to greatly improve quality of life and to have an impact on survival in ovarian cancer patients.Despite achieving clinical remission after completion of initial treatment,most patients (60%) with advanced EOC will ultimately develop recurrent disease or show drug resistance;the eventual rate of curability is less than 30%.Given the poor outcome of women with advanced EOC,it is imperative to continue to explore novel therapies.展开更多
Although multiple options for the treatment of liver tumors have often been described in the past, including liver resection, radiofrequency ablation with or without hepatic pump insertion, laparoscopic liver resectio...Although multiple options for the treatment of liver tumors have often been described in the past, including liver resection, radiofrequency ablation with or without hepatic pump insertion, laparoscopic liver resection and the use of chemotherapy, the potential of immunotherapy and gene manipulation is still largely unexplored.Immunological therapy by gene manipulation is based on the interaction between virus-based gene delivery systems and dendritic cells. Using viruses as vectors, it is possible to transduce dendritic cells with genes encoding tumor-associated antigens, thus inducing strong humoral and cellular immunity against the antigens themselves.Both chemotherapy and radiation therapy have the disadvantage of destroying healthy cells, thus causing severe side-effects. We need more precisely targeted therapies capable of killing cancer cells while sparing healthy cells. Our goal is to establish a new treatment for solid liver tumors based on the concept of cytoreduction,and propose an innovative algorithm.展开更多
One hundred years ago, the first patients with lung cancer have been reported （1）. Since then long term survival in patients with lung cancer remains disappointing, and this is not only due to the delayed diagnosis ...One hundred years ago, the first patients with lung cancer have been reported （1）. Since then long term survival in patients with lung cancer remains disappointing, and this is not only due to the delayed diagnosis but also to the dismal survival of the 70%-75% inoperable patients.展开更多
Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients(about 70%) present with an advanced International Federat...Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients(about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy(CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease(RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefi t of surgery. It's still undefi ned how the intrinsic features of the tumor make intra-abdominal implants easier to remove.Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the defi nition of RD is not universal. A unique and defi nitive defi nition is needed.展开更多
基金Supported by a Research Fund from Dankook University in 2024,No.R202400759.
文摘BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.
文摘Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of a new approach, cytoreductive surgery with peritonectomy procedures together with hyperthermic intraperitoneal chemotherapy and/or early postoperative intraperitoneal chemotherapy to treat peritoneal carcinomatosis, many research groups contributed with promising results using this procedure being up to date this strategy the only one that has shown curative benefits on colorectal peritoneal carcinomatosis achieving reported overall survival rates up to 64 mo and fiveyear survival rates up to 51%. The aim of this paper is to expose an updated overview of the therapeutic possibilities of these procedures in colorectal peritoneal metastases in the same way that our Unit of Oncologic Surgery has performed since 1997 with more than four hundred procedures.
文摘Ovarian carcinoma is one of three gynecological neoplasms. It typically develops as an insidious disease, with few warning signs or symptoms, because the ovary is situated at a deep part of the pelvic cavity. Advanced ovarian carcinoma （AOC） is highly malignant, so the prognosis of the patients is poor. Initial debulking surgery, followed by chemotherapy, is currently the main therapeutic choice for AOC. During operations, efforts should be made to excise the tumor and minimize the residual lesion, so as to achieve the optimal cytoreduction and improve the prognosis. As a feasible therapeutic regimen for the patients with primary unresectable AOC, neoadjuvant chemotherapy can improve the surgical condition and can increase the optimality of cytoreduction. It is important therefore to evaluate the feasibility of surgical treatment and make a proper selection of the primary treatment plan and neoadjuvant chemotherapy, so as to enhance the optimality of surgery and to avoid unnecessary exploratory laparotomy. At present, methods of feasibility evaluation for optimal cytoreduction of AOC are as follows： 1） radiography, i.e., CT, PET and MRI scanning; 2） CA-125 value; 3） laparoscopic exploration; 4） other tumor markers such as p53. However, any method lacks the ability to cover all the predicting factors influencing the outcome of cytoreduction, and to evaluatethe surgery across the board. Searching for new methods and combining two or more procedures to evaluate the feasibility of cytoreduction may increase the optimality, reduce the residual focus, prolong survival time and improve the prognosis. In this study, recent advances in evaluation of the feasibility for optimal cytoreduction and the selection of neoadjuvant chemotherapeutic regimens were reviewed.
文摘<strong>Objective:</strong><span style="font-family:Verdana;"> Complete resectability of all visualized tumor implants at debulking surgery for advanced epithelial ovarian cancer is confirmed to be the s</span><span style="font-family:""><span style="font-family:Verdana;">ingle most important prognostic factor. This study aims</span><b> </b><span style="font-family:Verdana;">to develop </span><span style="font-family:Verdana;">preoperative</span><span style="font-family:Verdana;"> predicting score based on clinical, biological, and radiological criteria of epithelial ovarian cancer to assess the feasibility of complete cytoreduction. </span><b><span style="font-family:Verdana;">Study Design: </span></b><span style="font-family:Verdana;">A retrospective record-based study. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">The study was conducted upon 50 consecutive patients managed for epithelial ovarian cancer with FIGO stage III. Patients’ data were collected from records of the Gyne-Oncology Clinic of El Shatby University Maternity Hospital affiliated </span><span style="font-family:Verdana;">to</span><span style="font-family:Verdana;"> Alexandria University. </span><b><span style="font-family:Verdana;">Results:</span></b></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Many parameters were significantly associated with completeness of resectability in univariate analysis;including age, BMI, CA125, albumin, pre-albumin, PCI, mesenteric, and right copula of diaphragm affection by CT scan (</span><span style="font-family:Verdana;">p value</span><span style="font-family:Verdana;"> < 0</span></span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">05). A 100-point predictability score was developed, 10 for BMI ≥</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">35 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">, 25 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for Pre albumin < 14.5 mg/dl, 35 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for mesenteric affection, and 30 </span><span style="font-family:Verdana;">point</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> for </span><span style="font-family:Verdana;">affection</span><span style="font-family:Verdana;"> of Rt. </span><span style="font-family:Verdana;">copula</span><span style="font-family:Verdana;"> of </span><span style="font-family:Verdana;">diaphragm</span><span style="font-family:Verdana;">. The overall accuracy of the score was 92%. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> In advanced ovarian cancer, pre-operative predicting score (including clinical, biological, and radiological criteria) can be used as a roadmap for </span><span style="font-family:Verdana;">prediction</span><span style="font-family:Verdana;"> of </span><span style="font-family:Verdana;">feasibility</span><span style="font-family:Verdana;"> of complete resectability. However, more research is needed on larger sample sizes.</span></span>
基金partly supported by grants from the National Key Research and Development Program of China(2019YFC0840606)from the Ministry of Science and TechnologyNational Natural Science Foundation of China(Grant No.82070189&81770189&81621001&81530046)+4 种基金Peking University Clinical Scientist Program(BMU2019LCKXJ003)the Fundamental Research Funds for the Central Universitiesthe Science and Technology Project of Guangdong Province of China(Grant No.2016B030230003)the project of health collaborative innovation of Guangzhou city(no.201704020214)Beijing Municipal Science&Technology Commission(No.Z191100006619054).
文摘Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains debatable.We aimed to evaluate pre-HSCT strategies by comparing the endpoints related to disease control between advanced MDS patients with pre-HSCT cytoreduction and those with best supportive care.Methods:We described 228 consecutive advanced MDS patients who received HSCT from a haploidentical donor(HID,n=162)or matched related donor(MSD,n=66)with uniform myeloablative conditioning regimens between January 2015 and December 2018.Of these 228 patients,131(57.5%)were treated exclusively with pre-HSCT best supportive care(BSC),49(22.5%)were given HMA,and 48(21.1%)received both IC and HMA.Propensity score-matching analysis,multivariate analyses,and subgroup analyses were performed to elucidate the impact of pre-HSCT strategies on transplant outcomes.Results:The 3-year relapse-free survival(RFS)rates were 78.2% and 70.0% for the BSC and cytoreduction cohorts(P=0.189)and were 78.2%,66.7%,and 73.2% for the BSC,HMA,and HMA+IC groups,respectively(P=0.269).A propensity score-matching analysis confirmed that the 3-year RFS rates were 81.9%,87.5%,and 66.9% for BSC,cytoreduction complete remission(CR),and cytoreduction non-CRgroups,respectively(P=0.051).Multivariate analyses demonstrated that pre-HSCT cytoreduction,older patient age,monosomal karyotype,and interval between diagnosis and HSCT were poor prognostic factors for RFS.In the subgroup analyses,BSC was associated with longer RFS compared to cytoreduction among the younger patients,those with international prognostic scoring system intermediate-2/high risk at diagnosis,and those with intermediate/poor cytogenetics.Conclusions:Different pre-HSCT therapies did not yield discrepant post-HSCT outcomes.No benefit in terms of post-HSCT outcomes were correlated with pre-HSCT cytoreduction in advanced MDS even for cytoreduction CR patients.Early referral to HSCT is essential for advanced MDS patients.
文摘The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.
文摘BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.
基金Supported by 2024 Aerospace Center Hospital Scientific Research Fund,No.YN202410.
文摘BACKGROUND Pseudomyxoma peritonei(PMP)is a distinct form of peritoneal malignancy characterized by diffuse intra-abdominal gelatinous ascites,with an estimated incidence of 1-3 per 1000000.PMP is predominantly secondary to appendiceal mucinous neoplasms,with rarer origins including the ovaries,colon,and urachus.However,PMP originating from small intestine is extremely rare.CASE SUMMARY A 60-year-old male patient presented with anorexia and abdominal distension.Computed tomography revealed the presence of abdominopelvic effusions and multiple intra-abdominal space-occupying lesions.Ultrasound-guided aspiration indicated that the aspirated tissue was mucinous.Exploratory laparoscopy and tissue biopsy identified diffuse tumor nodules in peritoneum,omentum,pelvic region,intestinal walls,and mesentery.Histopathological analysis of the resected tumors confirmed the presence of mucinous adenocarcinoma,but the primary lesion was difficult to determine.The patient was referred to our center for further treatment and underwent cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)under general anesthesia.The intraoperative peritoneal cancer index was 30.The surgery lasted 8 hours,with a blood loss of about 600 mL.A complete cytoreduction(CCR0)was achieved.No serious complications occurred after surgery,and the patient’s condition was good during the telephone follow-up.Postoperative pathology confirmed the diagnosis of small intestinal mucinous adenocarcinoma at proximal jejunum,which was complicated by high-grade PMP.CONCLUSIONPMP originating from small intestine is an exceptionally rare entity that exhibits non-specific clinical features. Thepreferred treatment is CRS + HIPEC.
文摘BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury(AKI).Identifying perioperative risk factors plays a critical role in preserving renal function.AIM To evaluate postoperative renal outcomes in patients with PC who underwent CRS+HIPEC.METHODS Patients who underwent CRS+HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study.Demographic data,preoperative estimated glomerular filtration rate,HIPEC agents used(cisplatin,mitomycin C,oxaliplatin),intraoperative fluid management,vasopressor use,and postoperative creatinine levels were recorded.AKI was defined according to the 2012 Kidney Disease:Improving Global Outcomes criteria.Independent predictors were identified through multivariate logistic regression analysis.RESULTS AKI developed in 61 of 445 patients(13.7%).Among them,62.0%were stage I,24.6%were stage II,and 13.1%were stage III.The highest AKI rate was observed in the cisplatin group(21.4%),with lower rates in the oxaliplatin group(9.6%)and the mitomycin C group(6.5%).Independent risk factors included cisplatin use[odds ratio(OR)=2.8;95%confidence interval:1.6-4.9;P<0.001),intraoperative fluid administration<6000 mL(OR=2.1;P=0.02),vasopressor requirement(OR=1.9;P=0.03),and preoperative estimated glomerular filtration rate<75 mL/minute/1.73 m2(OR=2.3;P=0.01).AKI was associated with a prolonged hospital stay.Three patients(0.7%)progressed to chronic kidney disease.CONCLUSION Independent risk factors such as cisplatin use,inadequate fluid replacement,vasopressor requirement,and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS+HIPEC.
文摘Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.
文摘Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.
文摘Objective:Stage Ⅳ renal cell carcinoma(RCC)is associated with a significant decrease in survival rates.Cytoreductive nephrectomy(CN)is one of the treatments for stage Ⅳ RCC.However,there are studies showing that delayed CN might have benefits for the survival of the patients.We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy(TT).Methods:A literature search was conducted in PubMed,EMBASE,EBSCOhost,MedRxiv,and Scopus.We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival(OS)of upfront CN with deferred CN in patients with advanced RCC undergoing TT.Meta-analysis was carried out using Review Manager v5.4 software.The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error,presented using the forest plot with 95%confidence interval.Results:Four studies were analyzed quantitatively.Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT(hazard ratio 0.50,95%confidence interval 0.40–0.64,p<0.001).Conclusion:The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC.However,more research is needed to fully understand the role,optimal timing,and sequencing of TT and CN in the treatment of advanced RCC.
文摘BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.
文摘Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.
文摘BACKGROUND: Curable outcome of unresectable hepato- cellular carcinoma ( HCC) was seldom encountered in the past. This study was designed to assess the role of down- staging followed by resection ( downstaging-resection) in the improvement of prognosis of unresectable HCC. METHODS: During the period of 1958-2003 , a total of 1085 patients were verified surgically to be unresectable. Of these patients, 139 received downstaging-resection, with a rate of 84.2% for coexisting cirrhosis and a median tumor diame- ter of 11.1 cm. Resection of the right lobe, hepatic hilum and bilateral cancer accounted for 97. 8% of the patients. Downstaging including hepatic artery ligation ( HAL) + he- patic artery chemo-infusion ( HAI ) was performed in 65.5% of the patients, HAL + HAI + radiotherapy/radioim- munotherapy in 29. 5%, and HAL or HAI alone in 5.0%. Retrospective analysis was made of the survival of patients with unresectable HCC, downstaging-resection rate and treatment pattern. RESULTS: In the 139 patients with downstaging-resection, the median interval between the first and second operation was 7.2 months and the 5-year survival rate calculated from the first operation was 48. 7%. In the 1085 patients with un- resectable HCC, their 5-year survival was 0% in the period of 1958-1973, 11.5% in the period of 1974-1988 and 19.3% in the period of 1989-2003. These figures were correlated with the increasing downstaging-resection rate from 0%, 9.0% to 15.6%, and the increasing percentage of triple or double combination treatment from 32.2%, 60.4% to 69.7%. The 5-year survival in triple treatment group was 24. 9%, double treatment 15.2%, and single treatment only 10.9%, which was also correlated with the downstaging-re- section rate of 34.6%, 16.2% and 1.8% respectively. CONCLUSIONS: Downstaging-resection plays a role in improving prognosis of unresectable HCC. Triple and double treatments provide a higher downstaging-resection rate and may result in better prognosis.
基金supported by Natural Science Foundation of China(NSFC-81172454)the Specialized Research Fund for Doctoral Program of Higher Education(SRFDR-20100001110079)
文摘Objective： Human epididymis protein 4（HE4） is a promising biomarker of epithelial ovarian cancer（EOC）. But its role in assessing the primary optimal debulking（OD） of EOC remains unknown. The purpose of this study is to elucidate the ability of preoperative HE4 in predicting the primary cytoreductive outcomes in advanced EOC, tubal or peritoneal carcinoma.Methods： We reviewed the records of 90 patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at the Department of Obstetrics and Gynecology of Peking University People＇s Hospital between November 2005 and October 2010. Preoperative serum HE4 and CA125 levels were detected with EIA kit. A receiver operating characteristic（ROC） curve was used to determine the most useful HE4 cut-off value. Logistic regression analysis was performed to identify significant preoperative clinical characteristics to predict optimal primary cytoreduction.Results： OD was achieved in 47.7%（43/48） of patients. The median preoperative HE4 level for patients with OD vs. suboptimal debulking was 423 and 820 pmol/L, respectively（P〈0.001）. The areas under the ROC curve for HE4 and CA125 were 0.716 and 0.599, respectively（P=0.080）. The most useful HE4 cut-off value was 473 pmol/L. Suboptimal cytoreduction was obtained in 66.7%（38/57） of cases with HE4 ≥473 pmol/L compared with only 27.3%（9/33） of cases with HE4 〈473 pmol/L. At this threshold, the sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） for diagnosing suboptimal debulking were 81%, 56%, 67%, and 73%, respectively. Logistic regression analysis showed that the patients with HE4 ≥473 pmol/L were less likely to achieve OD（odds ratio =5.044, P=0.002）.Conclusions： Preoperative serum HE4 may be helpful to predict whether optimal cytoreductive surgery could be obtained or whether extended cytoreduction would be needed by an interdisciplinary team.
文摘Epithelial ovarian cancer (EOC) is the second most common genital malignancy in women and is the most lethal gynecological malignancy,with an estimated five-year survival rate of 39%.Despite efforts to develop an effective ovarian cancer screening method,60% of patients still present with advanced disease.Comprehensive management using surgical cytoreduction to decrease the tumor load to aminimum,and intraperitoneal chemotherapy to eliminate microscopic disease on peritoneal surface,has the potential to greatly improve quality of life and to have an impact on survival in ovarian cancer patients.Despite achieving clinical remission after completion of initial treatment,most patients (60%) with advanced EOC will ultimately develop recurrent disease or show drug resistance;the eventual rate of curability is less than 30%.Given the poor outcome of women with advanced EOC,it is imperative to continue to explore novel therapies.
文摘Although multiple options for the treatment of liver tumors have often been described in the past, including liver resection, radiofrequency ablation with or without hepatic pump insertion, laparoscopic liver resection and the use of chemotherapy, the potential of immunotherapy and gene manipulation is still largely unexplored.Immunological therapy by gene manipulation is based on the interaction between virus-based gene delivery systems and dendritic cells. Using viruses as vectors, it is possible to transduce dendritic cells with genes encoding tumor-associated antigens, thus inducing strong humoral and cellular immunity against the antigens themselves.Both chemotherapy and radiation therapy have the disadvantage of destroying healthy cells, thus causing severe side-effects. We need more precisely targeted therapies capable of killing cancer cells while sparing healthy cells. Our goal is to establish a new treatment for solid liver tumors based on the concept of cytoreduction,and propose an innovative algorithm.
文摘One hundred years ago, the first patients with lung cancer have been reported （1）. Since then long term survival in patients with lung cancer remains disappointing, and this is not only due to the delayed diagnosis but also to the dismal survival of the 70%-75% inoperable patients.
文摘Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients(about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy(CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease(RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefi t of surgery. It's still undefi ned how the intrinsic features of the tumor make intra-abdominal implants easier to remove.Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the defi nition of RD is not universal. A unique and defi nitive defi nition is needed.
