Primary Surgical Resection Research Articles

Ileocecal Intussusception of the Adult Induced by the Gastrointestinal Stromal Tumor of the Ileocecal Valve - A Case Report

Abstract Adult intussusception is a rare entity which is distinct frompaediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of allintestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusceptionin adults is a unique variant in which nearly 100% of cases havea malignant lead point. In our report, we described a case of apatient with ileocecal intussusception caused by a rare type of the gastro intestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in thestool. The result of CT scan of the abdomen and pelvis showed atumor mass and intussusception at the ileocecal junction, whichwas confirmed peroperatively. Open right hemicolectomy wasperformed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of theileocecal valvе. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with thepalpable abdominal mass, digestive tract obstruction, gastroin-testinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy,primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception inadults.

Abstract 17356: Recurrent Hemorrhagic Pericardial Effusion Requiring a Multimodality Imaging Approach: A Case Report

Background: A 24-year-old female with no medical history presented to the ED with chest pain and dyspnea. Vitals were notable for tachycardia to 120s. Physical examination was unremarkable. Clinical Course: Initial evaluation was notable for thrombocytopenia, NT-proBNP of 151 and high sensitivity troponin T of 18. Transthoracic echocardiogram (TTE) revealed a small pericardial effusion with tamponade physiology prompting urgent pericardiocentesis. Bloody pericardial fluid was drained and fluid studies were consistent with hemorrhagic effusion with no evidence of infection or malignancy on cytology. Surveillance TTEs showed rapid reaccumulation of pericardial fluid within 72 hours of the initial intervention. Urgent pericardial window with drain placement was performed and intraoperative transesophageal echocardiogram (TEE) revealed a right atrial (RA) mass not detected on prior TTE. Cardiac MRI confirmed the presence of a large (50 mm x 31 mm) immobile and heterogeneous mass in the superior aspect of the RA suggestive of a malignant etiology with invasion to the adjacent pericardium. Positron Emission Tomography (PET) scan demonstrated hypermetabolic activity concerning for malignancy with no evidence of mediastinal, hilar adenopathy, or distant disease. She underwent mini-sternotomy and biopsy with pathology suggestive of primary cardiac angiosarcoma. Due to the high-risk nature and location of the tumor, she was unable to undergo primary surgical resection. Neoadjuvant chemotherapy was initiated with plan for subsequent surgical reassessment. Conclusion: Workup of recurrent hemorrhagic pericardial effusions require a multimodal imaging approach.

Elective management of the N0 neck in maxillary sinus squamous cell carcinoma.

To demonstrate adequacy of radiation therapy alone to the neck in patients with maxillary sinus squamous cell carcinoma (MS-SCC) without clinical evidence of regional metastasis. Retrospective review between 2000 and 2018 from a single high-volume tertiary academic head and neck cancer center of all patients with MS-SCC. A total of 55 patients were treated for MS-SCC at our center. A clinically uninvolved neck on presentation was found in 46 patients (83.6%) in the initial dataset. Of the 39 patients with radiologic N0 disease who were treated with primary surgical resection, 15.4% (6 patients) did not undergo any treatment of the neck, 2.6% (1 patient) underwent a neck dissection only, 69.2% (27 patients) received RT only, and 12.8% (5 patients) were treated with both a neck dissection followed by RT. Median follow-up was 26 months (mean 48 months, interquartile range 9-76 months). Five-year overall survival of all patients with N0 necks treated with upfront surgical resection was 46.5% (95% CI, 32.3%-66.9%). No patients with N0 necks had isolated regional recurrence regardless of neck management. Regional recurrence is rare for patients with radiologic N0 MS-SCC. Single-modality elective neck radiation provides excellent regional disease control in these patients.

RUNX1 predicts poor prognosis and correlates with tumor progression in clear cell renal carcinoma

BackgroundRunt-related transcription factor 1 (RUNX1), also called acute myeloid leukaemia 1, is a member of RUNX family of transcription factors. This family is composed of evolutionarily conserved transcription factors that function as critical lineage determinants in various tissues, however its function in cancer development and clinical significance in RCC are still unknown. MethodsWe used paraffin-embedded tumor tissues from 100 patients and fresh-harvested and paired adjacent normal renal tissues from 15 RCC patients who underwent primary surgical resection in Xijing Hospital between 2018 and 2022. The expression level of RUNX1 was evaluated by immunohistochemistry and Western Blot. RUNX1 promoted tumor cells proliferation, migration and invasion were verified by CCK-8, wound-healing and transwell assays. Finally, we constructed a xenografts model of the 786-O cell lines to observe the effect of RUNX1 on tumorigenesis in vivo. ResultsTCGA database showed higher RUNX1 expression levels in KIRC (kidney renal clear cell carcinoma). In overall survival analysis, RCC patients with higher RUNX1 expression level would have a shorter survival period than those with lower expression. Similarly, immunohistochemical results of our cohort also showed that RUNX1 was over-expression in cancer tissues than in corresponding non-cancer tissues. We also proved this result at protein level by western-blot. Meanwhile, prognostic and OS analyses of our cohort showed that the RUNX1 expression level was an individual prognostic factor in RCC patients. CCK-8, wound-healing and transwell assays proved that the overexpression of RUNX1 in Caki-1 cells promoted the proliferation, migration and invasion of the cells. Knocking down RUNX1 in 786-O cells inhibited the proliferation, migration and invasion of cells. The experimental results of xenografts model in nude mice showed that the knockdown of RUNX1 in 786-O cells slowed down the growth of tumor. ConclusionRUNX1 is a poor prognostic factor of clear cell renal carcinoma, which may provide a novel therapeutic target for ccRCC.

Clinical application of transarterial chemoembolization combined with terminal branches portal vein embolization in planned hepatectomy

This study aimed to investigate the clinical efficacy of transarterial chemoembolization (TACE) in conjunction with terminal branches portal vein embolization (TBPVE) in the context of planned hepatectomy. A cohort of five patients afflicted by primary hepatocellular carcinoma who were deemed unsuitable candidates for primary surgical resection was gathered from August 2019 to December 2021. Following the application of TACE in combination with TBPVE as a therapeutic intervention, we observed postoperative general reactions, alterations in tumor biomarkers, hyperplasia of future liver remnant (FLR), and subsequent surgical resection. All patients successfully underwent the combined TACE and TBPVE procedure, achieving a technical success rate of 100%. One week after TACE, alpha-fetoprotein (AFP) levels decreased from 38.52±49.21 to 25.27±37.94 μg/L, and Protein Induced by Vitamin K Absence or Antagonist (PIVKA) levels decreased from 1689.30±1663.83 to 219.03±228.10 μg/L. Two weeks post-TBPVE, FLR exhibited an increment from 350.80±41.17 to 476.00±57.91 mL. The ratio of FLR to standard liver volume (SLV) increased from 30.94%±3.63% to 42.03%±5.62%. The combined application of TACE and TBPVE not only effectively manages tumor progression but also augments the FLR, thereby affording patients with a limited future liver remnant an opportunity for surgical resection of hepatocellular carcinoma.

Clinical application of transarterial chemoembolization combined with terminal branches portal vein embolization in planned hepatectomy

This study aimed to investigate the clinical efficacy of transarterial chemoembolization (TACE) in conjunction with terminal branches portal vein embolization (TBPVE) in the context of planned hepatectomy. A cohort of five patients afflicted by primary hepatocellular carcinoma who were deemed unsuitable candidates for primary surgical resection was gathered from August 2019 to December 2021. Following the application of TACE in combination with TBPVE as a therapeutic intervention, we observed postoperative general reactions, alterations in tumor biomarkers, hyperplasia of future liver remnant (FLR), and subsequent surgical resection. All patients successfully underwent the combined TACE and TBPVE procedure, achieving a technical success rate of 100%. One week after TACE, alpha-fetoprotein (AFP) levels decreased from 38.52±49.21 to 25.27±37.94 μg/L, and Protein Induced by Vitamin K Absence or Antagonist (PIVKA) levels decreased from 1689.30±1663.83 to 219.03±228.10 μg/L. Two weeks post-TBPVE, FLR exhibited an increment from 350.80±41.17 to 476.00±57.91 mL. The ratio of FLR to standard liver volume (SLV) increased from 30.94%±3.63% to 42.03%±5.62%. The combined application of TACE and TBPVE not only effectively manages tumor progression but also augments the FLR, thereby affording patients with a limited future liver remnant an opportunity for surgical resection of hepatocellular carcinoma.

Single Institution Experience of the Effect of Adjuvant Radiation on Outcomes for Patients with Uterine Carcinosarcoma

Uterine carcinosarcoma (UCS) is a rare but aggressive malignancy with poor outcomes. Due to its low incidence, there is no well-established optimal treatment. Standard treatment involves surgery and chemotherapy (CT) +/- adjuvant radiation therapy (RT). Our primary aim was to determine if patients who underwent adjuvant RT had improved distant metastasis free survival (DMFS) and locoregional recurrence free survival (LRRFS). Our secondary aim was to determine the effect of adjuvant RT on overall survival (OS). We performed a single institutional retrospective review of all patients with UCS who underwent primary surgical resection +/- CT and +/- RT between 2007 to 2021. Patients without at least 3 months of documented follow-up were excluded. We assessed DMFS, LRRFS, and OS between patients who did and did not receive adjuvant RT, consisting of vaginal brachytherapy (VBT), external beam radiation therapy (EBRT), or EBRT + VBT. Statistical analysis was performed with spreadsheet and statistical software. Sixty-four patients underwent primary surgical resection for FIGO stage I-IV UCS. Sixty six percent (n = 42) had early stage, FIGO I-II disease and 34% (n = 22) had late stage, FIGO III-IV disease. Eleven percent (n = 7) underwent surgery alone, 28% (n = 18) underwent surgery + CT, 6% (n = 4) underwent surgery + adjuvant RT, and 55% (n = 35) underwent surgery + CT + RT. Most patients who underwent surgery + CT + EBRT + VBT (n = 9) had worse clinicopathologic features including late stage (56%), lymphovascular invasion positive (78%) disease with 50% or greater myometrial invasion (56%). EBRT doses ranged from 45-50.4 Gray (Gy) in 1.8 Gy per fraction. VBT doses ranged from 21-25 Gy in 3-5 fractions when delivered alone and 10-15 Gy in 2-3 fractions when delivered as a boost. Median DMFS was 20.3 months, median LRRFS was 22.6 months, median DFS was 19.4 months, and median OS was 24.7 months. Rate of distant metastasis appeared to drive rate of disease-free survival (Table 1). Patients who underwent adjuvant RT had improved median DMFS (71.5 vs. 11.3 months, p = .002), median LRRFS (71.5 vs 22.5 months, p = .002), and median OS (60.7 vs. 22.5 months, p = .002) compared to those who did not receive RT. Prognosis of patients with UCS remains poor; however, adjuvant RT delivered after CT may offer potential benefit in survival outcomes despite worse clinicopathologic features in these patients.

Differential Response to Radiation Fractionation in Head and Neck Cancer Patient-Derived Xenografts

Despite optimal management with conventionally fractionated radiotherapy, head and neck cancer (HNC) mortality is driven by locoregional failure. With the increasing development of hypofractionated regimens in other malignancies, we sought to investigate the sensitivity of patient HNC to radiation fractionation using murine patient-derived xenografts (PDXs). We developed PDXs from three HNC patients who underwent primary surgical resection and enrolled on our IRB-approved (PRO00040992) prospective HNC tumor bank by implanting freshly resected tumors subcutaneously in the flank of NSG-SGM3 mice. PDXs from each patient were randomized to receive no radiation, 2 Gy x 5 fractions delivered daily (conventional arm) or 10 Gy in a single fraction (hypofractionation arm). Tumor volume was measured until 15 days post-RT, when mice were sacrificed. Bulk RNA sequencing analysis was performed on PDX tumors after intervention. Three PDX tumors from three unique patients (P006, P010 and P016) were successfully developed and irradiated per protocol. Unique responses to radiation were seen with each tumor: P010 showed equal sensitivity to both the conventional and hypofractionated regimens; P006 showed intermediate sensitivity to the conventional regimen with high sensitivity to hypofractionation, and P016 was resistant to conventional fractionation but showed sensitivity to hypofractionation. Concurrent with the patient-specific PDX response to fractionation, principal component analysis demonstrated that each patient PDX had a unique signature of differentially expressed genes in response to the conventional and hypofractionated regimens. HNC PDXs show differential tumor and genomic response to radiation fractionation regimens. A precision approach to radiation fractionation for HNC may improve tumor control outcomes in HNCs.

Subcategorization of Perineural Invasion Stratifies Oral Cavity Squamous Cell Carcinoma Prognosis.

To evaluate whether subcategorization of perineural invasion (PNI) improves the prognostic resolution of the American Joint Committee on Cancer, Eighth Edition (AJCC8) staging system in oral cavity squamous cell carcinoma (OCSCC). OCSCC tumor specimens from patients seen at a tertiary care institution who underwent primary surgical resection between January 2019 and June 2021 were sorted into four PNI categories: negative, intratumoral, peripheral, and extratumoral. The prognostic effect of these PNI categories were assessed through Kaplan-Meier, Cox regression, and log-rank testing using recurrence-free survival (RFS) and overall survival (OS) as primary and secondary outcomes respectively. A total of 158 patients were examined. The median follow-up time was 21 months. PNI subcategorization further stratified RFS (p = 0.007) and OS (p = 0.002). Extratumoral PNI was associated with a 4.5-fold increase in recurrence risk (adjusted hazards ratio [aHR]: 4.53; 95% confidence interval [CI]: 1.1-18.66) and worse OS when compared with PNI negative disease (aHR: 5.71; 95% CI: 1.0-32.67). Peripheral PNI was associated with worse OS (aHR: 5.7; 95% CI: 1.35-24.08) but not worse RFS (p = 0.18) when compared with PNI negative disease. Interestingly, intratumoral PNI was not associated with significant differences in RFS (p = 0.087) or OS (p = 0.22) when compared with PNI negative disease. Subcategorization of OCSCC tumors into extratumoral, peripheral, and intratumoral PNI stratifies RFS and OS when compared with patients with PNI negative disease in an incremental fashion. This pilot study suggests that there may be added benefit in subcategorization of PNI in the prognostic evaluation of OCSCC. 4 Laryngoscope, 134:1656-1662, 2024.

Prevalence of Recurrence in Early Tongue Cancer T1 or T2 with or Without Neck Dissection

Background: Patients with T1 T2 N0 mouth or tongue cancer that has been confirmed by a doctor may choose to have a neck dissection. Some say that nodal return of a T1 original tumor is well controlled, while others say that salvage is more often the exception than the rule. Objective: To determine the likelihood of recurrence in T1 or T2 early tongue carcinoma with or without neck dissection. Methods: The prospective cross-sectional clinical study was conducted from March 2021 to March 2023 at the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka. All 100 patients who presented with clinically determined T1 and T2 disease, as defined by the American Joint Committee on Cancer (AJCC), were treated at the Department of Otolaryngology of the Combined Military Hospital in Dhaka and underwent primary surgical resection of the tumor with or without neck dissection. The study eliminated cases of cancer involving the base of the tongue or recurring oral tongue cancer. Results: In the neck dissection group, 3(6%) experienced local recurrence, 2(4%) experienced regional recurrence, and 1 (2%) experienced both (local and regional recurrence). There will be no dissection. 10(20%) Local recurrence, 3 (6%), Regional recurrence, and 1 (2% combined local and regional recurrence). Recurrence was 4(8%) in the neck dissection group and 14(28%) in the no dissection group. Conclusion: In this study, the overall recurrence rate was 8% in neck dissection and 28% in no neck dissection. The overall recurrence rate in the no neck dissection group was significantly greater than in the neck dissection group. Bangladesh J Otorhinolaryngol 2023; 29(1): 5-10

Colonic Resection, Stoma, or Self-expanding Metal Stents for Obstructive Left Colon Cancer: the CROSCO-1 study protocol.

Colorectal cancer (CRC) is one of the most common cancers worldwide. There are several causes of a mechanical left bowel obstructive but CRC accounts for approximately 50% of cases and in 10-30% of whom it is the presenting syndrome. In most cases, the left colon is involved. At present, the range of therapeutic alternatives in the management of obstructive left CRC in emergency conditions (primary resection vs. staged resection with applied self-expanding metallic stents) is broad, whereas internationally validated clinical recommendations in each condition are still lacking. This enormous variability affects the scientific evidence on both the immediate and long-term surgical and oncological outcomes. CROSCO-1 (Colonic Resection, Stoma or Self-expanding Metal Stents for Obstructive Left Colon Cancer) study is a national, multi-center, prospective observational study intending to compare the clinical results of all these therapeutic regimens in a cohort of patients treated for obstructive left-sided CRC. The primary aim of the CROSCO-1 study is the 1-year stoma rate of patients undergoing primary emergency surgical resection (Hartmann procedure or primary resection and anastomosis) compared with patients undergoing staged resection. Secondary outcomes are 30-day and 90-day major morbidity and mortality, 1-year quality of life and the timing of chemotherapy initiation in the two groups. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies. The results of a large prospective cohort study which will analyze what really happens in the common clinical practice of managing patients with obstructive left CRC will have the aim of understanding which is the best strategy in terms of surgical and oncological outcomes. Indeed, the CROSCO-1 study will analyze the early surgical outcomes for patients with obstructed left CRC. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies.

Ethical Considerations of Biopsies in Early-Stage Pancreatic Cancer.

The standard of care in resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC) has evolved to include neoadjuvant treatment before surgical resection. Current guidelines call for obtaining histologic tissue diagnosis via endoscopic ultrasound fine-needle aspiration before administration of neoadjuvant therapy, which differ from guidelines discouraging delay in surgical resection for a biopsy. Whether to proceed with treatment before a biopsy confirms that malignancy is a nuanced decision and includes considerations of physical and psychological risks entailed in both pursuing and forgoing a biopsy. Accuracy of imaging and biopsy results, the presence of contributing clinical signs/symptoms, and the existing precedents of considering biopsies as waivable such as in scenarios with high clinical suspicion and primary surgical resection. When considering the aspects of ethical medical practice including beneficence (doing good), nonmaleficence (avoiding harm), autonomy (allowing patients to make decisions about their care), and utilitarianism (doing the most good for the most people), analysis of whether guidelines guiding biopsies should continue to differ between resection and neoadjuvant treatments in PDAC is prudent.

Predictors of postoperative complications and functional outcomes in pediatric patients with surgically treated fourth ventricle tumors.

Tumors of the fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with an analysis of our institutional cohort. A retrospective single-center study of patients aged ≤ 19years who underwent primary surgical resection of a fourth ventricular tumor over a 15-year period (2006-2021). Predictors analyzed included age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate. One hundred six patients were included (64 males, mean age 7.3years). The rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm3 (p = 0.020) were significant predictors. The presence of a deficit was the only significant predictor of reduced (less than 90) Lansky score (p = 0.005). CM occurred in 20.8% of patients and was influenced by medulloblastoma histology (p = 0.011), lateral tumor extension (p = 0.017), and male gender (p = 0.021). No significant difference between the transvermian and telovelar approach in the development of CM was detected (p = 0.478). No significant predictor was found for the EOR. EOR was not found to be a significant predictor of overall survival for both low-grade and high-grade tumors; however, gross total resection (GTR) was protective against tumor recurrence compared to near-total or subtotal resection (p < 0.001). In addition, survival was found to be better in older patients (≥ 7.0years, p = 0.019). The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (> 7years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor; however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.

Multimodal Therapy for T4 N2 Non–Small Cell Lung Cancer With Additional Ipsilateral Pulmonary Nodules

BackgroundThe optimal treatment strategy for T4 non–small cell lung cancer (NSCLC) with additional intrapulmonary nodules in a different ipsilateral lobe (T4-Add) is not well characterized across clinical N stages. This study evaluated long-term survival of patients with T4-Add N2 NSCLC who received multimodal therapy including surgical resection and chemotherapy vs concurrent chemoradiation. MethodsPatients with T4-Add N2 M0 NSCLC in the National Cancer Database from 2010 to 2015 were included. Long-term survival was evaluated and compared between patients who underwent primary site surgical resection with chemotherapy and those who received concurrent chemoradiation by Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching on 9 common prognostic variables including comorbidities. ResultsOf the 499 patients diagnosed with T4-Add N2 M0 NSCLC who satisfied study eligibility criteria, 220 (44.1%) received primary site surgical resection with chemotherapy and 279 (55.9%) received chemoradiation. After multivariable adjusted Cox proportional hazards modeling, surgical resection with chemotherapy was associated with better long-term survival than chemoradiation. In a propensity score–matched analysis of 100 patients who received surgical resection with chemotherapy and 100 patients who received chemoradiation, patients who received surgical resection with chemotherapy had better 5-year overall survival. ConclusionsThe results of this national analysis of patients with T4 N2 NSCLC with additional nodules in a different ipsilateral lobe suggest that multimodal therapy including surgery may confer a survival benefit compared with chemoradiation alone. These findings support further evaluation of surgical resection as part of multimodal therapy for carefully selected patients with T4-Add N2 disease.

Association of Core Biopsy With Extranodal Extension in Surgically Treated Human Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma

Extranodal extension (ENE) is an adverse feature in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and is an indication for adjuvant treatment escalation. Preoperative core needle biopsy (CNB) may cause lymph node capsule disruption related to ENE development; however, evidence regarding this association in OPSCC is lacking. To assess whether preoperative nodal CNB is associated with presence of ENE in final pathology findings among patients with HPV-associated OPSCC targeted for primary surgical resection. This retrospective cohort study was conducted at a single academic tertiary care center from 2012 to 2022. All patients with OPSCC treated with transoral robotic surgery were assessed for eligibility, and primary surgical patients with HPV-associated OPSCC and node-positive disease confirmed on neck dissection were included in analyses. Data were analyzed from November 28, 2022, to May 21, 2023. Preoperative nodal CNB. The primary outcome was presence of ENE in final pathology findings. Secondary outcomes included adjuvant chemotherapy and recurrence rates. Outcomes of interest were investigated against patient demographic, clinical, and pathologic features. Of 106 patients (mean [SD] age, 60.2 [10.9] years; 99 [93.4%] men) included in analyses, 23 patients (21.7%) underwent CNB. Mean (range) preoperative node size was 3.0 (0.9-6.0) cm. Pathologic node class was pN1 in 97 patients (91.5%) and pN2 in 9 patients (8.5%). A total of 49 patients (46.2%) had ENE identified in final pathology analysis. Of 94 patients who received adjuvant therapy, 58 (61.7%) underwent radiation therapy and 36 (38.3%) underwent chemoradiation therapy. There were 9 recurrences (8.5%). In univariate analysis, CNB was associated with ENE (odds ratio [OR], 2.70; 95% CI, 1.03-7.08), but there was no association in a multivariable model including pN class and preoperative node size (OR, 2.56; 95% CI, 0.97-7.27). Compared with pN1 class, pN2 class was associated with ENE (OR, 10.93; 95% CI, 1.32-90.80). There were no associations of ENE with preoperative node size, presence of cystic or necrotic nodes, fine needle aspiration, tobacco or alcohol exposure, pathologic T class, prior radiation, or age. Furthermore, use of CNB was not associated with macroscopic ENE, adjuvant chemotherapy, or recurrence. This cohort study of patients with HPV-associated OPSCC found that preoperative nodal CNB was strongly associated with ENE in final pathology, supporting the possibility of an artifactual ENE component in this population.

Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years’ clinical experience from a tertiary care center in Pakistan

BackgroundUterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes.MethodsA single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan–Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis.ResultsOf the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40–55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival.ConclusionUterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.

An analysis of National Cancer Data Base: Male breast cancer and overall survival.

e12513 Background: Male breast cancer unlike female breast cancer is rare, representing approximately 1% of cancers that occur in men and approximately 1% of all BCs worldwide. It is managed by extrapolating from breast cancer in women due to it is rarity. We aimed to perform a large retrospective study with a focus on disease characteristics and overall survival. Methods: We performed a retrospective analysis of male breast cancer patients from the National Cancer Database (2004–2020). We obtained demographic, tumor, clinical and therapy data. Kaplan-Meier survival curves were created to estimate overall survival. Cox regression analysis was used to compare the groups within each variable. Results: We identified 31348 patients with primary diagnosis of male breast cancer (median age 66 years). Patients were predominantly white (82.1%) then black (13.4%). Most of patients are located in urban or metropolitan areas (95.9%) within a median of only 8.4 miles from the hospital where they received care. Almost equal patients treated at community hospitals (48.2%) and academic hospitals (50%). Patients were mainly covered by Medicare (49.0%) then Private insurance (40.8%). Most men who diagnosed with MBC had invasive cancer (88.3%). Only 1433 (4.6%) patients presented with metastases at diagnosis. The median tumor size was 3 cm. Most of tumors were moderately differentiated (36.1%) then (24.0%) poorly differentiated. In most patients, the tumor is present in the central portion of the breast. Several treatment modalities were used, of which primary surgical resection was the most common [90.7%). Among systemic therapies, hormonal therapy was the most common (57.1%%) then chemotherapy (34.3%) then radiation therapy (30.6%) and immunotherapy (4.8%). In terms of duration, time from diagnosis to surgery was 26 days (shortest), diagnosis to immunotherapy was 57 days, diagnosis to chemotherapy was 59 days, and time from diagnosis to radiation was 145 days (longest). The overall 30-day mortality was 0.3% (75/26333), the 90-day mortality was 0.9% (224/26333). Median overall survival is 67.1% (95% CI 143.371-150.349). Using cox proportional hazards model; factors influencing survival rate including Age, race, CDS P &lt; 0.001, tumor size, year of diagnosis P &lt; 0.000. All treatment modalities including surgery, chemotherapy and hormonal therapy was associated with increase overall survival with P &lt; 0.001 (95% CI 1.245-1.370). Conclusions: This is the largest study to date on epidemiology and prognostic factors for MBC using NCDB. Old age, white race, greater comorbidity index, and larger tumor size are associated with decreased survival. Surgery and adjuvant therapy are associated with increased overall survival. Further studies warranted to elucidate the causes of improved survival associated with some of these factors will help improve quality of care for patients with MBC.

Surgical treatment outcomes of solitary fibrous tumors in the head and neck: A retrospective study

The aim of this study was to better characterize head and neck solitary fibrous tumors (SFTs) and to evaluate surgical treatment.This retrospective study included patients who presented with head and neck SFTs. Clinical, radiological, and histological information and data regarding the treatments performed were collected. The risk of locoregional and distant metastases was calculated, and for orbital SFTs a specific classification was used.Overall, 34 patients were included. The majority of the SFTs were found in the oral cavity (n = 10), followed by the neck region (n = 8). The mean time to recurrence was 67.4 months. All patients underwent primary surgical resection. Recurrence was observed in five patients with a low risk of locoregional recurrence and distant metastasis.The treatment of choice is complete resection. Recurrence seems to be highly correlated with positive surgical margins. The safety margin should be increased when removing the lesion, and long-term follow-up should be performed.

Pathobionts in the tumour microbiota predict survival following resection for colorectal cancer

Background and aimsThe gut microbiota is implicated in the pathogenesis of colorectal cancer (CRC). We aimed to map the CRC mucosal microbiota and metabolome and define the influence of the tumoral microbiota on oncological outcomes.MethodsA multicentre, prospective observational study was conducted of CRC patients undergoing primary surgical resection in the UK (n = 74) and Czech Republic (n = 61). Analysis was performed using metataxonomics, ultra-performance liquid chromatography-mass spectrometry (UPLC-MS), targeted bacterial qPCR and tumour exome sequencing. Hierarchical clustering accounting for clinical and oncological covariates was performed to identify clusters of bacteria and metabolites linked to CRC. Cox proportional hazards regression was used to ascertain clusters associated with disease-free survival over median follow-up of 50 months.ResultsThirteen mucosal microbiota clusters were identified, of which five were significantly different between tumour and paired normal mucosa. Cluster 7, containing the pathobionts Fusobacterium nucleatum and Granulicatella adiacens, was strongly associated with CRC (PFDR = 0.0002). Additionally, tumoral dominance of cluster 7 independently predicted favourable disease-free survival (adjusted p = 0.031). Cluster 1, containing Faecalibacterium prausnitzii and Ruminococcus gnavus, was negatively associated with cancer (PFDR = 0.0009), and abundance was independently predictive of worse disease-free survival (adjusted p = 0.0009). UPLC-MS analysis revealed two major metabolic (Met) clusters. Met 1, composed of medium chain (MCFA), long-chain (LCFA) and very long-chain (VLCFA) fatty acid species, ceramides and lysophospholipids, was negatively associated with CRC (PFDR = 2.61 × 10−11); Met 2, composed of phosphatidylcholine species, nucleosides and amino acids, was strongly associated with CRC (PFDR = 1.30 × 10−12), but metabolite clusters were not associated with disease-free survival (p = 0.358). An association was identified between Met 1 and DNA mismatch-repair deficiency (p = 0.005). FBXW7 mutations were only found in cancers predominant in microbiota cluster 7.ConclusionsNetworks of pathobionts in the tumour mucosal niche are associated with tumour mutation and metabolic subtypes and predict favourable outcome following CRC resection.E9vQ1bxk-JdT4E6GMYGhRXVideo

Abstract 4369: The effects of primary hepatocellular carcinoma surgical resection on five year survival rates among different races

Abstract Background: Hepatic surgical resection is the treatment of choice for noncirrhotic HCC patients. Previous studies indicate that Asian patients were proportionally more likely to be treated surgically. However, studies on the outcome of this preference are very limited. Methods:We examined data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database to identify patients diagnosed with HCC between 2004 and 2017.The disease specific and relative five year survival rates as well as 95% Cl were calculated. Results:Among the total of 6,716 Asian or Pacific Islander (A/P) patients diagnosed with localized HCC, 45.9% of them received surgical resection. The localized HCC surgical resection rates for White (27,360 total cases) and Black (4,546 total cases) were 35.6% and 33.1% respectively. This pattern remained the same for patients with regional and distant site involved HCC: Highest percentage of A/P patients received surgical resections. For patients with localized HCC, five year cause specific survival rate was statistically higher for A/P patients than White and Black (P&amp;lt;0.05) 24 months after the surgery. These trends continued until the end of the study. For patients with regional HCC, surgical resection played no significant role for the five year cause specific survival rate among the different races. However, for patients with distant involved HCC, five year cause specific survival gap between White and A/P gradually increased after surgery and reached a statistically significant level on month 48 (23.9% with 95% CI 18.6% to 29.6% for White and 9.7% with 95% CI 4.4% to 17.5% for A/P). The pattern remained the same between Black and A/P patients without statistical significance, most likely due to the limited sample size for both.. Our research also indicated that surgical resection may play a similar role for the five year relative survival rate. After localized HCC surgical resection, A/P patients had the highest five year relative survival rate compared to White and Black patients (P&amp;lt;0.05). For the patients with regional HCC, surgical resection played no significant role on five year relative survival rate among different races. However, for the patients diagnosed with distant involved HCC, five year relative survival gap between White and A/P gradually increased after surgery and reached a statistically significant level on month 48 (23.7% with 95% CI 18.3% to 29.4% for White and 10.5% with 95% CI 5.2% to 18.0% for A/P). The pattern remained the same between Black and A/P patients without statistical significance due to the limited sample size in both categories. Conclusion: A/P primary HCC patients were more likely to be treated surgically. However, the benefits of surgical resection for A/P patients can only be appreciated for those with localized HCC. For A/P patients diagnosed with distant site node involved HCC, surgical resection may cause more harm than good. Citation Format: Jingwei Song, Eric Song, Daniel Gharavi. The effects of primary hepatocellular carcinoma surgical resection on five year survival rates among different races. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4369.