Tumor Diameter Research Articles

Boric acid impedes glioblastoma growth in a rat model: insights from multi-approach analysis

Limited advancements in managing malignant brain tumors have resulted in poor prognoses for glioblastoma (GBM) patients. Standard treatment involves surgery, radiotherapy, and chemotherapy, which lack specificity and damage healthy brain tissue. Boron-containing compounds, such as boric acid (BA), exhibit diverse biological effects, including anticancer properties. This study aimed to examine whether boron supplementation, as BA, can inhibit glioblastoma growth in a xenograft animal model. Using MRI-based tumor size measurement, survival rates, hematological, clinical biochemistry analyses, and genotoxicity parameters, we assessed the impact of BA. Histopathological, immunohistochemical, and immunofluorescence examinations were also conducted. All BA doses (3.25, 6.5, and 13 mg kg−1 b.w.) extended survival compared to GBM controls after 14 days, with a dose-dependent anti-GBM effect observed in MRI analyses. BA treatment improved hematological (WBC and PLT counts) and biochemical parameters (LDL-C, CREA, and ALP). Histopathological examination revealed a significant reduction in tumor diameter with 6.5 and 13 mg kg−1 BA. Immunohistochemical and immunofluorescence staining showed modulation of intracytoplasmic Ki67, cytoplasmic CMPK2, and GFAP expressions in tumor cells post-BA treatment. Additionally, BA did not increase micronuclei formations, indicating its non-genotoxic nature. In conclusion, targeting tumor suppressor networks with boron demonstrates significant therapeutic potential for GBM treatment.

Risk scoring system for evaluating pathological upstaging after radical nephroureterectomy for upper tract urothelial carcinoma: A multicenter study in Japan.

Accurate preoperative staging of upper tract urothelial carcinoma is often difficult. Therefore, we aimed to investigate the preoperative factors associated with pathological upstaging in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and to develop a risk-scoring system to assess pathological upstaging. This retrospective study enrolled 386 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinical tumor stage 4, clinical node +, and those who received neoadjuvant chemotherapy were excluded from the study. The association between preoperative patient factors and pathological upstaging was analyzed. Statistical analyses included the t-test, chi-squared test, and logistic regression analysis. Of the 386 patients, 32 were excluded. Finally, 354 patients were included in this study, of whom 87 (24.6%) were pathologically upstaged. Hydronephrosis, positive urine cytology result, and maximum tumor diameter <30 mm were associated with upstaging. We developed a risk scoring system in which the score was the sum of the number of applicable items for three factors: hydronephrosis, positive urine cytology result, and maximum tumor size <30 mm. The probabilities of ureteral cancer upstaging were 0%, 8.3%, 29.5%, and 50.0% for scores of 0, 1, 2, and 3, respectively. Hydronephrosis, urine cytology, and maximum tumor diameter were associated with pathological upstaging. Our risk-scoring system may be useful in predicting pathological upstaging, especially in patients with ureteral cancer.

Prenatally Diagnosed Cardiac Tumors and Tuberous Sclerosis Complex: A Single-Center Experience

Background/Objectives: Cardiac rhabdomyoma (CR), the most frequently occurring fetal cardiac tumor, is often an early marker of tuberous sclerosis complex (TSC). This study evaluates outcomes of fetuses with prenatally diagnosed cardiac tumors managed at a single tertiary center. Methods: Medical records of fetuses diagnosed with cardiac tumors between 2009 and 2024 were retrospectively reviewed. Results: Sixteen cases were identified, with a median follow-up of 6.7 years. TSC was confirmed in 14 cases (88%). Multiple tumors were observed in 13 cases (81%), while 3 cases (19%) had solitary tumors (19%). Both non-TSC cases involved solitary tumors. Cardiac complications (arrhythmias, conduction disorders, and hemodynamic abnormalities) occurred in 38% of cases prenatally and 69% postnatally, with larger tumor diameters significantly associated with complications (p = 0.02). No fetal hydrops or mortality occurred; however, one child died at age five due to a seizure. Postnatal tumor regression occurred in 56% of cases and complete regression in 38% by a median age of 2.3 years (range: 0.6–4.4). One tumor remained stable. Brain MRI revealed TSC-related changes in all TSC-affected patients except one, who had a developmental brain anomaly. Most TSC patients experienced epilepsy (71%) and developmental delays. Conclusion: While CRs are typically benign and regress spontaneously, their strong association with TSC highlights the importance of early diagnosis and family counseling. TSC-related epilepsy and psychomotor delays significantly impair the quality of life. Early mTOR inhibitor therapy offers promise in mitigating TSC-related complications and improving outcomes.

Prognostic Modeling of Overall Survival in Glioblastoma Using Radiomic Features Derived from Intraoperative Ultrasound: A Multi-Institutional Study

Background: Accurate prognostic models are essential for optimizing treatment strategies for glioblastoma, the most aggressive primary brain tumor. While other neuroimaging modalities have demonstrated utility in predicting overall survival (OS), intraoperative ultrasound (iUS) remains underexplored for this purpose. This study aimed to evaluate the prognostic potential of iUS radiomics in glioblastoma patients in a multi-institutional cohort. Methods: This retrospective study included patients diagnosed with glioblastoma from the multicenter Brain Tumor Intraoperative (BraTioUS) database. A single 2D iUS slice, showing the largest tumor diameter, was selected for each patient. Radiomic features were extracted and subjected to feature selection, and clinical data were collected. Using a fivefold cross-validation strategy, Cox proportional hazards models were built using radiomic features alone, clinical data alone, and their combination. Model performance was assessed via the concordance index (C-index). Results: A total of 114 patients met the inclusion criteria, with a mean age of 56.88 years, a median OS of 382 days, and a median preoperative tumor volume of 32.69 cm3. Complete tumor resection was achieved in 51.8% of the patients. In the testing cohort, the combined model achieved a mean C-index of 0.87 (95% CI: 0.76–0.98), outperforming the radiomic model (C-index: 0.72, 95% CI: 0.57–0.86) and the clinical model (C-index: 0.73, 95% CI: 0.60–0.87). Conclusions: Intraoperative ultrasound relies on acoustic properties for tissue characterization, capturing unique features of glioblastomas. This study demonstrated that radiomic features derived from this imaging modality have the potential to support the development of survival models.

Downstaging of hepatocellular carcinoma before liver transplantation: Results from a national multi-center prospective cohort study.

Patients with hepatocellular carcinoma (HCC) meeting UNOS-downstaging (DS) criteria have excellent post-liver transplantation (LT) outcomes. Studies on HCC beyond UNOS-DS criteria ("All-comers" (AC)) have been limited by small sample size and short follow-up time, prompting this analysis. 326 patients meeting UNOS-DS and 190 meeting AC criteria from 9 LT centers across 5 UNOS regions were enrolled from 2015 to 2023 and prospectively followed. Competing risk analysis and Kaplan-Meier method were used to evaluate downstaging and LT outcomes, and Fine-and-Gray and Cox models were used to identify predictors of outcomes. AC and UNOS-DS had similar median alpha-fetoprotein (15 vs. 12ng/mL;p=0.08), MELD (9 vs. 9;p=0.52), and Child-Pugh (A vs. A;p=0.30). At 2 years from first local regional therapy, 82% of UNOS-DS and 66% of AC were successfully downstaged (p<0.001). In AC, DS rates were 72% for tumor number plus diameter of largest lesion<10, 51% for sum 10-12, and 39% for sum>12 (p=0.01). Y-90 achieved higher DS success than transarterial chemoembolization (TACE) in AC (74% vs. 65%;p<0.001). 48% of UNOS-DS and 40% of AC underwent LT (p=0.10). 5-year post-LT survival was similar between UNOS-DS and AC (74% vs. 72%;p=0.77), although 5-year post-LT recurrence was higher in AC (30% vs. 14%;p=0.02). Despite higher HCC recurrence and lower ITT survival in AC, post-LT survival was comparable between UNOS-DS and AC. Y-90 attained higher DS success than TACE in AC. LT after downstaging is feasible in AC, though defining an upper limit in tumor burden may be necessary.

Prognostic and Predictive Values of F-18 FDG PET/CT Volumetric Parameters in Small Cell Lung Cancer

Introduction: Volumetric parameters of the 18F-FDG PET/CT can contribute to the treatment decision in high risk patients. In the present study, we aimed to examine the predictive, prognostic, and clinical value of PET/CT by using the two volumetric parameters: metabolic tumor volume (MTV) and total lesion glycolysis (TLG), SUVmax to concurrently evaluate survival data in patients diagnosed with small cell lung cancer (SCLC). Methods: 244 patients with SCLC, who underwent 18F-FDG PET/CT imaging for staging purpose were enrolled. Primary tumor SUVmax, MTV (40-70%) and TLG (40-70%) obtained from PET/CT were documented. Results: All lesions (n=244) showed 18F-FDG uptake, mean SUVmax of 19.74±8.71 [range (min – max) = 3.80 - 58.80]. SUVmax was significantly higher in tumors with diameters &gt; 2 cm compared to those with diameters ≤ 2 cm (p=0.000). The mean survival time was significantly shorter in patients with tumor diameter greater than 2 cm, locoregional LN involvement, distant nodal metastasis, or distant organ metastasis (p=0.019, p

Efficacy and learning curve of 69 cases of robot-assisted resection of retroperitoneal benign tumors

Objectives: To explore the efficacy of robotic-assisted retroperitoneal benign tumor resection and to analyze its learning curve. Methods: This is a retrospective case series study. The data of patients who underwent robotic-assisted retroperitoneal benign tumor resection from August 2015 to February 2023 at the Department of Retroperitoneal Tumor Surgery was analyzed retrospectively. There were 24 males and 45 females, with an age of (46.3±10.6) years (range: 19 to 76 years). The perioperative data, postoperative pathological results, and follow-up data were recorded. The cumulative sum (CUSUM) method was used to analyze the robotic system setup time and operative time to plot the learning curve. A linear regression model was applied to determine the best-fit curve, selecting the model with the highest R² value. Based on the vertex of the learning curve for surgical time, the patients were divided into a learning group and a mastery group. The general data and perioperative conditions of the two groups were compared. Independent sample t-tests, Mann-Whitney U tests, and χ2 tests were used for comparisons. Results: All 69 patients successfully completed the surgery without intraoperative complications. The diameter of tumors was (49.7±18.6) mm (range: 16 to 131 mm). The setup time for the robotic surgical system was (35.3±9.8) minutes (range: 20 to 61 minutes); the surgical time was (169.2±36.5) minutes (range: 70 to 305 minutes); intraoperative blood loss (M(IQR)) was 10.0 (15.0) ml (range: 2.0 to 200.0 ml). The tumors in 32 patients (46.4%) were adherent to major blood vessels. All patients were discharged without complications. The follow-up period lasted until February 2024, and no patients required reoperation, readmission, or died due to retroperitoneal benign tumors. There were no severe long-term complications, and no radiological evidence of tumor recurrence was found. The best-fit equation for the learning curve based on surgical time was CUSUM=0.010X³-1.648X²-68.573X-61.091, and the best-fit equation for the learning curve based on robotic system setup time was CUSUM=0.0018X³-0.285X²+10.460X+57.541 (where X represents the number of surgeries). The R² values of 2 learning curve models were 0.953 and 0.957, respectively, and the fit model tests had P<0.05. The inflection point of the learning curve based on surgical time was the 28th case, which is considered the minimum number of surgeries required to achieve proficiency in robotic-assisted retroperitoneal benign tumor resection. Based on this, the patients were divided into a learning group (cases 1 to 28) and a mastery group (cases 29 to 69). The surgical time for the learning group was significantly longer than that of the mastery group ((194.7±30.0) minutes vs. (151.9±31.4) minutes, t=4.126,P<0.01). No statistically significant differences were found for other parameters (all P>0.05). Conclusions: Robotic-assisted retroperitoneal benign tumor resection is feasible. The minimum number of surgeries required to achieve proficiency in overcoming the learning curve is about 28 cases.

Evaluation of the short-term efficacy of fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins in sublobar resection for early-stage non-small cell lung cancer

Objective: To investigate the effectiveness and safety of fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins during sublobar resection for the treatment of early-stage non-small cell lung cancer (NSCLC). Methods: This is a prospective cohort study. Patients with early-stage NSCLC who underwent fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins for sublobar resection in the Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, from January to April 2024 were included. Based on whether the artery or vein was blocked during surgery, the patients were divided into the arterial group and the venous group. The surgical time, intraoperative blood loss, distance from the lesion to the resection margin, and boundary duration were collected and compared between the two groups. Independent sample t test, Mann-Whitney U test, or χ2 test was used to compare the data between the two groups. Results: A total of 64 patients were enrolled. There were 25 males and 39 females, aged (57.3±12.1) years (range: 34 to 80 years). The tumor diameter was (9.8±2.9) mm (range: 5 to 16 mm), The distance between the surgical margin and the lesion was (16.5±3.9) mm (range: 10 to 30 mm) and the surgical time was (61.5±13.9) minutes (range: 30 to 120 minutes). Pathological examination of the surgical specimens showed that all margins met pathological requirements. The chest drainage tube retention time (M(IQR)) was 2 (1) days (range: 1 to 7 days), and no serious postoperative complications occurred. The boundary duration for the arterial group (n=23) and venous group (n=41) was (147.9±22.2) seconds (range: 119 to 188 seconds) and (40.9±8.0) seconds (range: 20 to 60 seconds), respectively (t=27.935, P<0.01). Conclusion: Fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins can effectively and accurately delineate surgical resection boundaries, ensuring sufficient margin width to meet oncological requirements.

Safety and efficacy of endoscopic resection for gastric gastrointestinal stromal tumors: a retrospective cohort study

Background The aim of this study was to verify the safety and efficacy of endoscopic resection (ER) for gastric gastrointestinal stromal tumors (GISTs). Methods Among a consecutive series of resections for gastric GISTs performed in a single center, the outcomes of patients who had ER were compared to standard surgical resection (SR). Results In the cohort, 329 consecutive primary localized gastric GISTs patients (n, ER/SR = 251/78) were enrolled. Patients receiving ER were revealed to have preferable post-treatment outcomes, prolonged overall survival (OS) and disease-free survival (DFS). Tumor diameter, the only independent risk factor for a complicated post-operative course, was utilized for propensity score matching (PSM). In the PSM cohort, patients receiving ER and SR with similar tumor size (4.0 [2.7–4.5] cm) shared similar aggressiveness in terms of stomach layers of tumor origination and invasion, and modified National Institutes of Health (mNIH) risk criteria. Shorter operative time, fewer economic costs, and shorter post-operative stay were still observed in the ER group (ER vs. SR: 80 [49–120] vs. 120 [98–160] minutes, p < 0.001; 44 [38–51] vs. 60 [49–84] thousand Renminbi [kRMB], p < 0.001; 7.0 [6.0–8.0] vs. 8.5 [6.0–12] days, p = 0.018, respectively). No significant difference in OS and DFS was demonstrated in the PSM cohort. Conclusions ER is safe and effective, thus a feasible treatment option for indicated gastric GISTs patients with the advantage of faster recovery and lower economic costs.

Predictive Modeling of Non-functioning Giant Pituitary Neuroendocrine Tumor Resection: A Multi-Planar Perspective.

Giant pituitary neuroendocrine tumor (GPitNET) are challenging tumors with low rates of gross total resection (GTR) and high morbidity. Previously reported machine-learning (ML) models for prediction of pituitary neuroendocrine tumor extent of resection (EOR) using preoperative imaging included a heterogenous dataset of functional and non-functional pituitary neuroendocrine tumors of various sizes leading to variability in results. The aim of this pilot study is to construct a ML model based on the multi-dimensional geometry of tumor to accurately predict the EOR of non-functioning GPitNET. A retrospective study of 100 large non-functioning GPitNETs (≥3 cm diameter, >10 cm³ volume) was conducted to develop predictive models for GTR or EOR based on 5 variables: tumor diameter, shape, revised Knosp grade, and modified Hardy classifications for sellar and extrasellar invasion. Model performance was assessed using ROC-AUC and confusion matrix metrics. The median pre-operative tumor volume was 17.35 cm3(IQR: 12.4-27.0).The median EOR was 97.6% (IQR: 84.9-100), and GTR was achieved in 49% of patients. The most predictive variables were the modified Hardy classification for extrasellar extension and Knosp Grade (AUC of 0.771 and 0.713,respectively). Among the constructed ML models, the XGBoost algorithm had the highest predictive capability, with an internal validation AUC of 0.86,while the external validation sensitivity, specificity, positive, and negative predictive values were 84%, 77%, 78% and 82%, respectively. Utilizing preoperative imaging parameters in a 3-dimensional manner proves highly valuable in predicting the EOR for non-functioning GPitNETs.These predictions can be easily calculated using an online open-access application: https://anonymousforreview.shinyapps.io/predicted_giant_pituitary_adenoma_resection/.

PTPN2 Expression in Hypopharyngeal Squamous Cell Carcinoma and Its Clinical Significance.

This study aimed to explore PTPN2 expression levels in Hypopharyngeal Squamous Cell Carcinoma (HPSCC) tissues and their relationship with the clinical characteristics and prognosis of HPSCC patients. PTPN2, a protein tyrosine phosphatase, has recently emerged as a promising target for cancer immunotherapy, and in many previous studies, PTPN2 may have a significant role in the growth, differentiation, metabolism and immune response of head and neck malignant tumors. In this study, PTPN2 expression in Head and Neck Squamous Cell Carcinoma (HNSCC) and other cancer tissues was analyzed using datasets derived from the Sangerbox database. Furthermore, we analyzed data on PTPN2 mRNA levels across various clinical stages of HNSCC (I, II, III, and IV), which was extracted from the Gene Expression Profiling Interactive Analysis (GEPIA) database. Clinical data from patients who underwent surgical resection for hypopharyngeal malignancies at the Third Affiliated Hospital of Zunyi Medical University between January 2013 and January 2024 were also obtained and analyzed. The patient specimens were categorized into two groups (the HPSCC tumor and paracarcinoma tissue groups) and compared for PTPN2 expression using Immunohistochemistry (IHC), Immunofluorescence (IF), and Western Blot (WB) analyses. According to the results, HPSCC patients were mostly elderly males with a history of tobacco and alcohol abuse. Furthermore, the most common site of HPSCC onset was piriform sinuses, and the disease was often diagnosed in the middle or advanced stages. Additionally, HPSCC tissues exhibited PTPN2 upregulation. Moreover, PTPN2 expression did not correlate significantly with patients' gender, Smoking Index (SI), alcohol abuse, tumor diameter, Hypertension (HTN), diabetes, and M stage. On the other hand, it correlated with HPSCC patients' T-stage, N-stage, Overall Survival (OS), and clinical stage. Based on these findings, we deduced that high PTPN2 expression could be involved in HPSCC patients' poor prognosis.

Questionnaire on the surgical indications for intrahepatic cholangiocarcinoma administered to Japanese board-certified expert hepatobiliary and pancreatic surgeons and instructors.

Treatment of intrahepatic cholangiocarcinoma (ICC) remains challenging owing to the lack of clear guidelines on surgical resection. The 2021 ICC guidelines have not fully resolved the ongoing debate between surgical and nonsurgical treatment options. This study aimed to identify trends and issues in ICC treatment strategies in the clinical field by surveying the attitudes of hepatobiliary and pancreatic (HBP) surgeons. A survey was conducted among 235 board-certified HBP surgeons affiliated with the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This survey explored the perspectives on tumor conditions that define resectable, borderline resectable, and unresectable diseases, focusing on tumor size, number, and vascular invasion. Notable variability was observed in the criteria for oncological resectability. While 42.1% of the respondents considered a maximum tumor diameter of 5 cm as resectable, 37.5% indicated no size limit for resectability. Opinions regarding the resectability of tumors with lymph node involvement and vascular invasion vary widely, highlighting the need for standardized criteria. This survey revealed diverse approaches for defining resectability in ICC, emphasizing the necessity for more precise guidelines. Further research and expert consensus are required to establish standardized criteria that can guide clinical decision-making and improve patient outcomes.

Multiomic quantification of the KRAS mutation dosage improves the preoperative prediction of survival and recurrence in patients with pancreatic ductal adenocarcinoma.

Most cancer mutation profiling studies are laboratory-based and lack direct clinical application. For clinical use, it is necessary to focus on key genes and integrate them with relevant clinical variables. We aimed to evaluate the prognostic value of the dosage of the KRAS G12 mutation, a key pancreatic ductal adenocarcinoma (PDAC) variant and to investigate the biological mechanism of the prognosis associated with the dosage of the KRAS G12 mutation. In this retrospective cohort study, we analyzed 193 surgically treated patients with PDAC between 2009 and 2016. RNA, whole-exome, and KRAS-targeted sequencing data were used to estimate the dosage of the KRAS G12 mutant. Our prognostic scoring system included the mutation dosage from targeted sequencing ( > 0.195, 1 point), maximal tumor diameter at preoperative imaging ( > 20 mm, 1 point), and carbohydrate antigen 19-9 levels ( > 150 U/mL, 1 point). The KRAS mutation dosage exhibited comparable performance with clinical variables for survival prediction. High KRAS mutation dosages activated the cell cycle, leading to high mutation rates and poor prognosis. According to prognostic scoring systems that integrate mutation dosage with clinical factors, patients with 0 points had superior median overall survival of 97.0 months and 1-year, 3-year, and 5-year overall survival rates of 95.8%, 70.8%, and 66.4%, respectively. In contrast, patients with 3 points had worse median overall survival of only 16.0 months and 1-year, 3-year, and 5-year overall survival rates of 65.2%, 8.7%, and 8.7%, respectively. The incorporation of the KRAS G12 mutation dosage variable into prognostic scoring systems can improve clinical variable-based survival prediction, highlighting the feasibility of an integrated scoring system with clinical significance.

Maximum Tumor Diameter is Associated with Relapse Risk in Limited-Stage Hodgkin Lymphoma: An International Study.

Tumour bulk is an established prognostic factor in Hodgkin lymphoma (HL) but most patients with limited-stage (LS) HL do not have 'bulk' by standard binary definitions. In the RAPID trial, maximum tumor diameter (MTD) was associated with risk of relapse for LS-HL patients achieving PET-negativity after ABVD chemotherapy. We aimed to externally validate these findings in the H10 trial. Patients with stage I/IIA HL, without mediastinal bulk, who achieved PET-negativity with ABVD were included. 'PET-negative' patients received 3x ABVD plus radiotherapy (n=208) or 3x ABVD alone (n=211) in RAPID, and 3-4x ABVD plus radiotherapy (n=556) or 4-6x ABVD alone (n=303) in H10. Baseline MTD was measured by CT. MTD was strongly associated with event-free survival (relapse or HL-related death) in H10 (HR=1.22, 95%CI:1.07-1.38, p=0.003), a similar effect to the RAPID trial (HR=1.19, 95%CI:1.02-1.39, p=0.02), giving an estimated 21% increase in HL-risk per centimetre MTD (HRpooled=1.21, 95%CI:1.09-1.33, p<0.001). Findings were consistent when adjusting for baseline risk stratification and chemotherapy cycles. The effect sizes were similar for patients treated with chemotherapy alone (HRpooled=1.19, 95%CI:1.01-1.35, p=0.005) and combined modality treatment (ABVD plus radiotherapy; HRpooled=1.24, 95%CI:1.05-1.46, p=0.009) with no evidence of a differential effect (pinteraction=0.97). Treatment modality and MTD were independent risk factors; patients with higher MTD receiving chemotherapy alone had the greatest risk of relapse. This international validation study confirms that MTD is strongly associated with the risk of relapse for LS-HL patients achieving PET-negativity. These findings refine assessment of risk in LS-HL and can inform clinical discussions for risk-adapted application of radiotherapy. NCT00943423 and NCT00433433.

Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases.

The recommended treatment for cutaneous squamous cell carcinoma is surgical excision. An initial punch biopsy is often performed as an aid to diagnosis. A retrospective registry-based study was performed to assess histopathological concordance of punch biopsy of cutaneous squamous cell carcinoma and subsequent excision. Analysis of 737 punch biopsies and subsequent matched excisions was performed. In total, 493 (67%) lesions were confirmed as invasive cutaneous squamous cell carcinoma on excision, 76% when excluding "scar" as a final diagnosis. Tumour diameter > 20mm was highly predictive of cutaneous squamous cell carcinoma (positive predictive value 91.1%). Tumours on the scalp were significantly more likely to demonstrate a final diagnosis of cutaneous squamous cell carcinoma than those on the arm (odds ratio 6.11, 95% confidence interval 3.1,12.0). There was moderate concordance between biopsy and excision in grade of histopathological differentiation. This study demonstrates that clinical high-risk features may be of more value in predicting a diagnosis of cutaneous squamous cell carcinoma than partial punch biopsy. Use of clinical and dermoscopic competencies in assessment of cutaneous tumours rather than reliance on biopsies both avoids delay in patient management in the case of high-risk cutaneous squamous cell carcinoma and may also minimize unnecessary surgical excisions if there is a low clinical index of suspicion of cutaneous squamous cell carcinoma.

Efficacy and safety of 3-dimensional printing noncoplanar template (3D-PNCT)-assisted high-dose-rate interstitial brachytherapy (HDR-ISBT) for reirradiation of recurrent cervical cancer: a prospective cohort.

This study aimed to investigate the efficacy and safety of 3-dimensional printing noncoplanar template (3D-PNCT)-assisted computed tomography (CT)-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for reirradiation of pelvic recurrent cervical carcinoma after external beam radiotherapy. From January 2019 to August 2023, 45 eligible patients were enrolled in this prospective cohort. All patients underwent 3D-PNCT-assisted CT-guided HDR-ISBT with a prescribed dose of 4-7 Gy/fraction to the high-risk clinical target volume (HR-CTV) over 3-8 fractions, either for curative or palliative purposes. The primary endpoints were local progression-free survival (LPFS) and tumor response rate (TRR). The secondary outcome measures included overall survival (OS), toxicities, and symptom resolution. Forty-five patients received 261 fractions of 3D-PNCT-assisted HDR-ISBT. Twenty-nine patients had isolated pelvic recurrence, and 16 patients had simultaneous extra-pelvic or distant recurrences. The TRR was 66.7%. The 2- and 5-year LPFS rates were 30.0% and 25.7%, respectively. The median OS was 23.2 months, and 2- and 5-year OS rates were 49.5% and 34.0%, respectively. The multivariate analysis indicated that squamous cell carcinoma, radical surgery, recurrence-free interval≥12 months, tumor diameter, pelvic recurrence type, and HR-CTV D90≥45 Gy were independent factors influencing LPFS (all p<0.05). D100≥21 Gy, V100≥83%, and V150≥45% were associated with better LPFS (all p<0.05). Tumor diameter and metastasis were independent predictive factors for OS (all p<0.05). The pain relief rate was 66.7% (10/15). Grade 3-4 toxicities occurred in 20.0% of patients. 3D-PNCT-assisted HDR-ISBT for reirradiation of recurrent cervical cancer proved to be an effective and safe alternative to radical surgery.

Survival benefit associated with liver transplantation for hepatocellular carcinoma based on tumor burden scores at listing.

Liver transplantation (LT) provides significant survival benefits to patients with unresectable HCC. In the United States, organ allocation policies for HCCs within the United Network for Organ Sharing criteria do not prioritize patients based on their differences in oncological characteristics. This study assessed whether transplant-associated survival benefits (TASBs) vary among patients with different tumor burden scores (TBS) measured at the time of listing. We analyzed data from adults applying for HCC MELD exception points between 2002 and 2019, with follow-up until December 2023, using the Scientific Registry of Transplant Recipients. TBS was determined based on the largest tumor diameter and number of HCCs. Patients were categorized into low (≤3), intermediate (3.1-5), and high (>5) TBS groups. TASB was measured as the difference in 5-year survival with and without LT. This study included 36,634 LT candidates. High-TBS patients had higher waitlist dropout rates and marginally lower post-transplant survival, resulting in a significantly greater TASB. The 5-year TASB for the low, intermediate, and high TBS groups were 15.7, 22.1, and 25.0 months, respectively. The adjusted survival benefit expressed in 5-year survival differences was 21.9%, 34.5%, and 39.4% in the low, intermediate, and high TBS groups, respectively (p<0.001). Higher TBS during listing correlates with greater LT benefits for patients with unresectable HCC within UNOS criteria. We conclude that organ allocation policies in the United States should prioritize patients with high TBS due to their increased risk of dropout and comparable post-transplant survival when compared to patients with less advanced tumors.

Comparison of postoperative adjuvant platinum-based chemotherapy and no further therapy after radical surgery in intermediate-risk early-stage cervical cancer.

To identify a relatively high-risk population in postoperative intermediate-risk cervical cancer and evaluate the effect of platinum-based adjuvant chemotherapy (CT). We retrospectively reviewed the medical records of patients with stage IA2-IIA cervical cancer who had been treated with radical hysterectomy and pelvic lymphadenectomy and classified as the intermediate-risk group for recurrence by postoperative pathological examination from January 2007 to December 2018 at 3 medical centers in Japan. First, patients with intermediate-risk were stratified by histological type and the number of intermediate-risk factors (IRF; large tumor diameter, lymph vascular space invasion, and deep cervical stromal invasion) and then divided into 2 groups: high and low-risk population (estimated 5-year recurrence-free survival [RFS] rate with no further therapy [NFT] <90% and ≥90%, respectively). Second, the efficacy of CT for the high-risk population was evaluated by comparing RFS and overall survival (OS) between the patients receiving CT and those with NFT. In total, 133 patients were included in the analysis. Among patients with squamous cell carcinoma (SCC) with all IRF or those with non-SCC with 2 to 3 IRF, the 5-year estimated RFS was <90% when treated with NFT. In this population, adjuvant CT was significantly superior to NFT regarding RFS (log-rank, p=0.014), although there was no statistical difference in OS. Patients with SCC with all 3 IRFs and those with non-SCC with 2 to 3 IRFs were at high risk for recurrence. Adjuvant CT is a valid treatment option for these populations.

Clinicopathological Correlation of Invasive Histological Features in Incidentally Detected Appendiceal Neuroendocrine Tumors (aNETs)

Aim: Appendiceal Neuroendocrine Tumors (aNETs) are rare and mostly detected incidentally patients operated on acute appendicitis. These are indolent tumors and mostly benign, however they carry risk of metastasis. This study aims to identify invasive histological features of aNET cases, that are correlated with aggressive behavior other than stage and grading parameters. Material and Methods: This retrospective study includes patient demographics, surgical margin status and pathological features of tumors. ANETs showing adenocarcinoma features, goblet cell features, and mixed features were not included in our study. Results: The mean age of cases with tumors is 41years (11-61 years). The mean tumor diameter was found to be 6.8 mm. Most of tumors were located in the distal appendix (55.5%). All of the tumors show invasive features. Four cases showed invasion to submucosa (pT₁), four cases to muscularis propria (pT₁), eight cases to subserosa (pT₃), and four cases to mesoappendix (pT₃). Follow-up information was available for only one case with Grade-2 features and MAI, no additional surgical treatment was required, and he has survived at 3-year follow-up with no metastasis. Conclusion: Even if it is grade 1stage 1 tumors, may exhibit invasive features with a risk of metastasis. Although LVI and PNI are not included in ANET staging, they are important factors affecting the course of the disease. The literature lacks consensus on the advisability of performing completion right hemicolectomy in patients exhibiting invasive histological features. We believe it prudent to maintain regular follow-up intervals for these individuals

Are Ki-67 and Procalcitonin Expression Levels Useful in Predicting the Biological Behavior of Hepatocellular Carcinoma After Liver Transplantation?

Background: Examinations of procalcitonin (PCT) and Ki-67 expression levels in hepatocellular carcinoma (HCC) patients who have undergone liver transplantation (LT) through immunohistochemical analyses of tumor tissue may reveal the biological characteristics of the tumor, thus informing the selection of HCC patients for LT. Methods: Hepatectomy specimens from 86 HCC patients who underwent LT were obtained and analyzed immunohistochemically for the expression of PCT and Ki-67. The percentage and intensity of PCT staining, as well as the percentage of Ki-67 expression, were assessed for each patient. The impacts of PCT and Ki-67 expression on disease-free survival, overall survival, and the recurrence rate were studied, as well as their correlations with other clinicopathological features. Results: The recurrent HCC group showed a higher Ki-67 level (p < 0.001), larger maximum dominant tumor diameter (p < 0.001), and higher rate of vascular invasion (p = 0.001). The pre-transplant AFP (p = 0.001), maximum dominant tumor diameter (p < 0.001), number of tumor nodules (p < 0.001), rate of vascular invasion (p = 0.001), and Ki-67 level (p = 0.044) were higher in patients beyond the Milan criteria. Similarly, the pre-transplant AFP (p < 0.001); maximum dominant tumor diameter (p < 0.001); number of tumor nodules (p < 0.001); rates of portal vein tumor thrombus (p = 0.002), poor differentiation (p = 0.021), and vascular invasion (p < 0.001); and Ki-67 level (p = 0.010) were higher in patients beyond the expanded Malatya criteria. The maximum dominant tumor diameter (p = 0.006); Ki-67 level (p = 0.003); rates of vascular invasion (p < 0.001), cases beyond the Milan criteria (p = 0.042) and the expanded Malatya criteria (p = 0.027), and portal vein tumor thrombus (p = 0.020); and presence of recurrence (p < 0.001) were higher in HCC patients with mortality. The Kaplan-Meier estimates indicated that Ki-67 levels exceeding 5% significantly affected DFS and OS. Although the Kaplan-Meier estimates indicated that a PCT staining percentage of ≥25% did not have a statistically significant effect on DFS or OS, the outcomes may be considered clinically significant. Conclusions: This study demonstrated that the Ki-67 proliferation index can be used as a predictive biomarker of the biological behavior of HCC. Furthermore, we claim that PCT expression over a particular threshold might impact recurrence and survival, and we believe that further multicenter prospective studies focused on standardized PCT antibody staining are crucial in order to determine its potential as a biomarker for HCC.