Residual Tumor Rate Research Articles

Local recurrence and residual tumor rates following cryoablation for small early-stage breast cancers: systemic review and meta-analysis.

Cryoablation is currently being investigated as a minimally invasive alternative to breast-conserving surgery. This meta-analysis investigates the local recurrence and residual tumor rates after cryoablation for small early-stage breast cancers. A systematic search was conducted on Embase, PubMed, Google Scholar, and the International Clinical Trials Registry Platform from inception to 16 June 2024. Studies of patients with breast cancers ≤ 20mm treated with cryoablation only or cryoablation followed by surgery were included. Pooled local recurrence rates (cryoablation only) and pooled residual tumors rates (cryoablation followed by surgery) were estimated with mixed-effects models. Between-study heterogeneity was assessed using I2 statistics. Where I2 exceeded 50%, outlier and influence analysis, followed by sensitivity analysis excluding outliers, were conducted. Twelve studies met inclusion criteria, of which 7 studies (530 female patients, 531 breast tumors) reported on patients treated with cryoablation only and 5 studies (220 female patients, 222 breast tumors) reported on patients treated with cryoablation followed by surgery. For studies on cryoablation only, pooled local recurrence rate was 1.1% (95% CI 0.42-3.03%) with low between-study heterogeneity (I2 value = 0%; 95% CI 0.0-70.8%; p = 0.95). For studies on cryoablation followed by surgery, pooled residual tumor rate was 12.0% (95% CI 3.85-31.64%); however, substantial between-study heterogeneity (I2 value = 76.1%; 95% CI 41.7-90.2%; p < 0.01) was present. Influence analysis revealed 1 outlier study. When this study was excluded, pooled residual tumor rate was 8.2% (95% CI 3.84-16.68%) with improvement in heterogeneity (I2 value = 0%; 95% CI 0.0-84.7%; p = 0.64). Pooled local recurrence and residual tumor rates after cryoablation are comparable to local recurrence rates after breast-conserving therapy and re-excision rates following breast-conserving surgery, respectively. These results are encouraging but should be interpreted with caution due to lack of comparative studies.

Social determinants of health and outcome disparities in spine tumor surgery. Part 2: Neighborhood disadvantage and long-term outcomes.

Neighborhood-level resource disadvantage has been previously shown to predict extent of resection, oncological follow-up, adjuvant treatment, and clinical trial participation for malignancies, including glioblastoma. The authors aimed to characterize the association between neighborhood disadvantage and long-term outcomes after spine tumor surgery. The authors analyzed all patients who underwent surgery for primary or secondary (all metastatic pathologies) spine tumors at a single spinal oncology specialty center in the United States from 2015 to 2022. The Area Deprivation Index (ADI), a validated metric compositing 17 social determinants of health variables that ranges continuously from 0% (higher advantage) to 100% (higher disadvantage), was used to quantify neighborhood disadvantage. Patient addresses were matched to ADI on the basis of the census block of residence. Subsequently, the study population was dichotomized into advantaged (ADI 0%-33%) and disadvantaged (ADI 34%-100%) cohorts. The primary endpoint was functional status, as defined by Eastern Cooperative Oncology Group (ECOG) Performance Status Scale grade, with secondary endpoints including inpatient outcomes, mortality, readmissions, reoperations, and clinical research participation. Multivariable logistic, gamma log-link, and Cox regression adjusted for 14 confounders, including patient and oncological characteristics, general and tumor-related presenting severity, and treatment. In total, 237 patients underwent spine tumor surgery from 2015 to 2022, with an average age of 53.9 years, and 57.0% had primary tumors whereas 43.0% had secondary tumors; 55.3% (n = 131) were classified by ADI into the disadvantaged cohort. This cohort had higher rates of ambulation deficits on presentation (39.1% vs 23.5%, p = 0.015) and nonelective surgery (35.1% vs 23.6%, p = 0.030). Postoperatively, disadvantaged patients exhibited higher odds of residual tumor (OR 2.55, p = 0.026), especially for secondary tumors (OR 4.92, p = 0.045). Patients from disadvantaged neighborhoods additionally exhibited significantly higher odds of poor functional status at follow-up (OR 3.94, p = 0.002). Postoperative survival was 74.7% (mean follow-up 17.6 months), with the disadvantaged cohort experiencing significantly shorter survival (HR 1.92, p = 0.049). Moreover, this population had higher odds of readmission (OR 1.92, p = 0.046) and, for primary tumors, reoperation (OR 9.26, p = 0.005). Elective participation in prospective clinical research was lower among the disadvantaged cohort (OR 0.45, p = 0.016). Neighborhood disadvantage predicts higher rates of residual tumor, readmission, and reoperation, as well as poorer functional status, shorter postoperative survival, and decreased elective research participation. The ADI may be used to risk stratify spine oncology patients and guide targeted interventions to ameliorate neurosurgical disparities and to reduce barriers to research participation.

Clinical impact and potential utility of non-enhanced computed tomography performed immediately after transarterial chemoembolization for hepatocellular carcinoma.

Intratumoral lipiodol deposition following transarterial chemoembolization (TACE) is associated with the prognosis of hepatocellular carcinoma (HCC) patients. However, there is insufficient evidence regarding the actual clinical significance of the imaging tests conducted to evaluate the lipiodol uptake after TACE. This study evaluates the clinical impact and potential utility of performing immediate post-TACE non-enhanced computed tomography (NECT) on the treatment of HCC. This retrospective study at a tertiary referral center included patients undergoing their first session of conventional TACE for initial treatment of HCC from November 2021 to December 2022 with available immediate post-TACE NECT. Patients were categorized based on lipiodol uptake into Cohorts A (incomplete uptake with additional treatment before the first follow-up 1 month after TACE), B incomplete uptake without additional treatment before first follow-up), and C (complete uptake). Survival curves for the time to progression (TTP) were estimated using the Kaplan-Meier method and were compared by using the log-rank test. Out of 189 patients, 58 (29.6%) showed incomplete lipiodol uptake; 2 in Cohort A and 56 in Cohort B. Cohort C included 131 patients (69.3%). Cohort B had the highest rate of residual viable tumor (48.2%) 1 month after TACE, compared to the other cohorts (0% in Cohort A and 32.1% in Cohort C). The median TTP of Cohort B was 7.9 months [95% confidence interval (CI): 4.6-15.7 months], significantly shorter than the 15.4 months (95% CI: 10.9-20.9 months) for Cohort C (P=0.03). During follow-up, no progression occurred in Cohort A. Assessment of lipiodol uptake by performing immediate post-TACE NECT can stratify HCC patients and facilitate early prediction of therapeutic response. Identifying suboptimal lipiodol uptake immediately after TACE can aid future treatment adjustments and potentially improving oncologic outcomes.

Revisiting the Imaging Characteristics of Chondroblastoma with Special Emphasis on Prognosis and Radiological Predictors of Local Tumor Recurrence

Background Chondroblastoma is an uncommon benign cartilaginous tumor of young adults and adolescents, accounting for 1% of all bone tumors. We aim to analyze the imaging characteristics of pathologically proven chondroblastoma, measure the incidence rate of local recurrence of this tumor, and identify factors that may influence its local recurrence. Materials and methods The details of a total of 44 patients with pathologically proven chondroblastoma who underwent surgery and followed up by cross-sectional imaging between January 2006 and March 2021 at the KFSHRC in Riyadh were retrieved from our archive. All available modalities, including plain radiography, CT, and magnetic resonance imaging (MRI), performed at baseline and on follow-up were reviewed and correlated with the histopathological diagnosis. Recurrence was calculated from the date of surgery to the date of recurrence or the date of being lost to follow-up depending on the date of recurrence. The statistical software STATA was used to analyze the data. Results The tumor recurrence rate was 4.55% (n = 2). Similarly, the residual tumor rate was 4.55% (n = 2). No metastases were documented. The recurrence-free survival was 93.8% at the 722-day follow-up. More than 95% of lesions demonstrated typical imaging features including: a well-defined lobulated margin, intermediate-to-low signal on T2-weighted images, and perilesional edema. Conclusions This study emphasizes the imaging findings of chondroblastoma, which classically affects skeletally immature patients. Although imaging findings cannot be used to predict recurrence or survival, we obtained excellent prognosis following surgical treatment at our institution.

Neoadjuvant immune checkpoint inhibitors for patients with resectable stage III/IV melanoma: A nationwide real-life study in France (NEOMEL).

9578 Background: Several studies have shown the efficacy of neoadjuvant treatment (NT) with immune checkpoint inhibitors (ICI) for resectable stage III/IV melanoma. However, real-life data are lacking. Methods: NEOMEL is a national multicenter retrospective study assessing the efficacy and tolerability of NT with ICI (NT-ICI) for resectable metastatic melanoma in a real-life setting. Data were obtained in patients (pts) with resectable stage III/IV melanoma who initiated NT-ICI (at least one infusion). Primary endpoint was pathologic complete response (pCR) (i.e no residual tumor) rate. Secondary endpoints were pathologic response (pR) according to INMC, radiologic response (RECIST), safety profile (CTCAE) and survival outcomes. Results: A total of 166 pts with resectable stage III/IV melanoma were included. Median age was 67 years (range, 24-96). Most pts had primary cutaneous melanoma (n=157, 89%), stage IIIB-D disease (n=156, 94%); a BRAF V600-mutant melanoma was observed in 47% (n=78); 8% (n=14) pts had received a previous systemic treatment. The median number of infusions of NT-ICI was 3 (range, 1-5). ICI regimens were anti-PD-1 monotherapy (n=122, 73%) or nivolumab + ipilimumab (NIVO + IPI) (n=44, 27%). Median follow-up was 6.5 months (range, 1-85). Overall, 143 pts (86%) underwent surgery. A pCR was observed in 44% of pts (n=63/143), including 52% (n=51/99) treated with anti-PD-1 monotherapy, and 27% (n=12/44) treated with NIVO + IPI. Of note, 78 pts (54%) were treated with 3 infusions of pembrolizumab (PBZ) (according to SWOG 1801 protocol) and had a pCR in 45% (n=35). A pR was assessed according to INMC criteria in 58% of pts (n=83/143): 51% of pCR (n=42), 8% of near-pCR (n=7) corresponding to a major pR of 59% (n=49/83), 16% of pathologic partial response (n=13) and 25% of pathologic non-response (n=21). Twenty-three pts (14%) did not undergo surgery because of progressive disease (n=10), clinical and radiologic responses (8 complete responses, 1 partial response, 1 stable disease), toxicity (n=2) or patient’s choice (n=1). Radiologic overall response rate according to RECIST (data available after NT in 49% of pts) was 54% (n = 44/82). All grade immune-related adverse events (irAEs) of NT-ICI occurred in 31% (n=51) of pts, including grade 3-4 irAEs in 10% (n=17) and one grade 5 irAE (pneumonitis with PBZ). Severe irAEs (grade 3 or more) were observed in 4% (n=4/99) of pts treated with anti-PD1 monotherapy and 32% (n=14/44) of pts treated with NIVO + IPI. Adjuvant treatment was started for 120 pts (84%). At last follow-up, 26 pts (18%) have had recurrence after surgery, including 3 pts with a pCR and 23 pts with a non-pCR to NT-ICI. Survival data are not yet available. Conclusions: NT-ICI for advanced melanoma demonstrated its efficacy with high rates of pCR in a real-life setting and an acceptable safety profile, particularly NT anti-PD1 monotherapy.

Imaging in Interventional Radiology: Applications of Contrast-Enhanced Ultrasound.

This review explores the applications of contrast-enhanced ultrasound (CEUS) in interventional radiology, focusing on its role in endoleak detection after endovascular abdominal aortic aneurysm repair (EVAR), periprocedural thermal ablation guidance, and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). CEUS offers a dynamic assessment for the detection of endoleak following EVAR, facilitating accurate diagnosis and classification. In periprocedural thermal ablation, CEUS enhances target lesion delineation with the visualization of real-time perfusion changes, optimizing treatment strategies and reducing residual tumor rates. Finally, CEUS has demonstrated efficacy in intraprocedural evaluation and postprocedural follow-up in TACE for HCC, offering early detection of residual tumor enhancement and providing an alternative for patients with contraindications to contrast-enhanced computed tomography or magnetic resonance imaging. Overall, CEUS is a versatile and valuable tool with many applications to offer interventional radiologists enhanced diagnostic capabilities and improved patient management.

Differences in oncological benefits from second transurethral resection between white-light initial surgery and photodynamic diagnosis-guided initial surgery for primary high-risk non-muscle invasive bladder cancer.

The aim of this study was to compare clinical outcomes between patients receiving second TUR after initial white-light transurethral resection of bladder tumor (WL-TURBT) and initial photodynamic diagnosis (PDD)-assisted TURBT. A total of 1007 patients were divided into four groups based on the treatment pattern: WL-TURBT with second TUR (161 patients, WL-second group) or without second TUR (540 patients, WL-alone group) and PDD-TURBT with second TUR (112 patients, PDD-second group) or without second TUR (194 patients, PDD-alone group). Oncologic outcomes (bladder cancer recurrence, progression, urothelial cancer-specific mortality) and rates of residual tumor and risk stratification of non-muscle-invasive bladder cancer (NMIBC) after second TUR were evaluated. After propensity score-matching 121 patients were included each in the WL-alone and WL-second groups, and 63 patients each in the PDD-alone and PDD-second groups. In the WL group, the second TUR was significantly associated with improved progression-free (p = 0.012) and urothelial cancer-specific free survival (p = 0.011), but not with recurrence-free survival (p = 0.93). Patients initially treated with PDD-TURBT, and with a tumor diameter <30 mm and multifocality had a relatively high benefit from second TUR. The rates of residual tumor and risk stratification of NMIBC did not significantly differ between WL-TURBT and PDD-TURBT groups. Our findings suggested that a second TUR could be omitted after an initial PDD-TURBT in selected patients with high-risk NMIBC.

Rate of residual tumor after repeat surgery for positive margins in ductal carcinoma in Situ, and predictive factors

AimsTo evaluate the rate of residual tumor in re-excision specimen of patients with positive margins in ductal carcinoma in situ (DCIS) following breast-conservative surgery, and to identify predictive factors of residual tumor. Material and methodsWe conducted a monocentric, retrospective study, from January 2010 to December 2020. All 103 patients who underwent re-excision for positive margins in DCIS following breast-conservative surgery for in situ or invasive breast carcinoma were included. Positive margins were defined as inferior to 2 mm from the DCIS component. Two groups were defined, depending on the presence of residual tumor or not, and were compared on their clinical and histopathological characteristics to identify predictive factors of residual tumor. ResultsResidual tumor was found in re-excision specimen of 46 patients (44.7 %). The risk of residual tumor was increased in patients with more than 2 tumor foci (aOR: 12.4; 95 % CI: 1.2 -124.1; p = 0.032) and in those with extensive margin involvement (aOR: 3.2; 95 % CI: 1.3–8.2; p = 0.013). Finally, surgery performed after 2013 was associated with a lower risk of residual tumor (aOR: 0.23; 95 % CI: 0.09–0.058; p = 0.002). ConclusionThe rate of residual tumor in re-excision specimen of patients with positive margins in DCIS is high. Both the number of tumor foci and the extension of positive margins were identified as risk factors. Finally, the surgical learning curve for this procedure seems to be significantly correlated with the risk of residual tumor and needs to be considered.

Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance.

to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance. this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed. 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD. The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed.

Crooke Cell Adenoma Confers Poorer Endocrinological Outcomes Compared with Corticotroph Adenoma: Results of a Multicenter, International Analysis

Crooke cell adenomas (CCAs) are a rare, aggressive subset of secretory pituitary corticotroph adenomas (sCTAs) found in 5%-10% of patients with Cushing disease. Multiple studies support worse outcomes in CCAs but are limited by small sample size and single-institution databases. We compared outcomes in CCA and sCTA using a multicenter, international retrospective database of high-volume skull base centers. Patients surgically treated for pituitary adenoma from January 2017 through December 2020 were included. Among 2826 patients from 12 international centers, 20 patients with CCA and 480 patients with sCTA were identified. No difference in baseline demographics, tumor characteristics, or postoperative complications was seen. Microsurgical approaches (60% CCA vs. 62.3% sCTA) were most common. Gross total resection was higher in CCA patients (100% vs. 83%, P= 0.05). Among patients with gross total resection according to intraoperative findings, fewer CCA patients had postoperative hormone normalization of pituitary function (50% vs. 77.8%, P < 0.01) and remission of hypersecretion by 3-6 months (75% vs. 84.3%, P < 0.01). This was the case despite CCA having better local control rates (100% vs. 96%, P < 0.01) and fewer patients with remnant on magnetic resonance imaging (0% vs. 7.2%, P < 0.01). A systematic literature review of 35 studies reporting on various treatment strategies reiterated the high rate of residual tumor, persistent hypercortisolism, and tumor-related mortality in CCA patients. This modern, multicenter series of patients with CCA reflects their poor prognosis and reduced postsurgical hormonal normalization. Further work is necessary to better understand the pathophysiology of CCA to devise more targeted treatment approaches.

Investigation of vertical margin involvement in endoscopic resection for T1 colorectal cancer.

The resection of vertical margin-negative submucosally invasive colorectal cancer (CRC) relies on the pathological risk assessment of lymph node metastasis. However, no large-scale study has clarified the endoscopic resection (ER) outcome for submucosally invasive CRC, focusing on the vertical margin status. This retrospective study aimed to examine vertical margin involvement in ER for submucosally invasive CRC and explore the treatment consequences associated with vertical margin status. We analyzed 395 submucosally invasive CRC cases in 389 patients who underwent ER at our hospital between 2008 and 2020. The presence of residual tumors and simultaneous lymph node metastasis in patients who underwent additional surgery was assessed and compared between the vertical incomplete ER and the vertical margin-negative groups. Among the patients, 270 were men, with a median age of 69 years. The vertical incomplete ER rate was 21.5%, with positive vertical margins and unclear vertical margins identified in 12.2% and 9.3% of the cases, respectively. Among 154 patients who underwent additional surgery after ER, the vertical incomplete ER group had a significantly higher residual tumor rate than the vertical margin-negative group (P = 0.001). The vertical incomplete ER group had a significantly higher lymph node metastasis rate than the vertical margin-negative group (P = 0.029). This study clarified the substantial risk of vertical incomplete ER in submucosally invasive CRC and revealed the high risk of residual tumor and lymph node metastasis in vertical incomplete ER for submucosal CRC.

A Retrospective Study of Re-excised Skin Cancers in a Pathology Center.

Surgical re-excision is the recommended treatment for the complete removal of incompletely excised skin cancers (SCs), but it may not always lead to this goal. In the present study, the re-excision rate and the presence of residual tumors in re-excised SCs were evaluated. In this retrospective descriptive study, the pathological archives of a hospital center were examined for incompletely excised tumors. Out of the 96 incompletely excised tumors, 19 cases (19.8%) underwent re-excision, of which residual tumors were observed again in 7 cases (36.8%). The highest rate of residual tumor was found in the cheek (66.66%), and the involvement with tumor remnants of both margins combined was greater than the involvement of each of the lateral and deep margins alone. Collecting and reporting of surgical results of re-excised tumors may assist clinicians in determining the patient's condition and making appropriate decisions to increase the success rate of reoperations.

Surgical Management of Endolymphatic Sac Tumor: A Systematic Review and Meta-Analysis.

The aim of our study was to report rates of facial nerve palsy and residual tumor following surgical intervention and subsequent tumor recurrence in patients with endolymphatic sac tumors. A systematic literature review of preoperative assessment and surgical management is also included. Studies including patient/s affected by sporadic or von Hippel-Lindau disease related endolymphatic sac tumors, reporting levels of facial nerve function, residual and recurrence pathology following a surgical procedure, were considered. Data were combined for proportional meta-analysis, and the selected studies' methodological quality was also evaluated. Overall 34 papers, including 202 subjects (209 cases of endolymphatic sac tumors) were analyzed. Pooled proportion rate (95% CI) of overall facial nerve palsy was 39.7% (28.2-51.9) and residual tumor was 16.5% (10.3-23.7) after surgical procedure. Pooled proportion rate (95% CI) of tumor recurrence was 14.0% (9.7-19.3) during a mean follow-up period of 49.7 months (8-136). Our results showed that preoperative facial nerve function is impaired in almost 30% of patients with endolymphatic sac tumors. Surgical management of endolymphatic sac tumor may cause a worsening of facial nerve function in a low percentage of treated subjects. Residual and/or recurrence of endolymphatic sac tumors are not rare events, and follow-up strategies should be designed accordingly.

A phase II/III study of camrelizumab plus apatinib as perioperative treatment of resectable hepatocellular carcinoma at intermediate-high risk of recurrence: Primary results of major pathologic response from phase II stage.

4126 Background: Surgical resection remains an important treatment strategy for patients (pts) with liver cancer. However, the 5-year recurrence rate is still 50-70% in surgically resectable pts. Intermediate-high risk factors of recurrence in HCC include single tumor size &gt; 5 cm, multiple tumors, and microvascular invasion. The standardized perioperative regimen for resectable HCC has not been established. This study aimed to assess the efficacy and safety of camrelizumab plus apatinib (C+A) as a perioperative regimen in resectable HCC at intermediate-high risk of recurrence (Clinical trial: NCT04521153). Methods: In this multicentre, randomised, phase II/III study, eligible HCC pts (CNLC Ib-IIIa) were randomly assigned in a 1:1 ratio to treatment group and control group. Pts in treatment group received 2 cycles of C (200mg Q2W) plus A (250mg QD) followed by surgery and a post-surgical TACE. At least 6 cycles of sequential treatment of C (200mg Q3W) plus A (250mg QD) were performed after TACE. Pts in control group received surgical resection and a post-surgical TACE. Primary endpoint of phase III stage was 3-year EFS, of phase II stage was MPR (defined as less than 50% residual tumor) rate. In the phase II stage, futility analysis on a phase II outcome was performed after pts in treatment group completed surgical resection and pathological evaluation. If &lt; 15% of pts achieved an MPR, or &gt; 20% of pts had progression that precluded surgery, the study would not proceed to phase III stage. Results: In phase II stage, 60 pts were randomly assigned to treatment group, and 59 to control group. As of Nov 4, 2022, the last randomised pt underwent curatively surgical resection and pathological evaluation. The median age was 58 years (range, 21-75). 101(84.9%) were male, and 96 (80.7%) had HBV infection. In treatment group, 58 pts received neoadjuvant therapy, 52 completed 2 cycles of preoperative therapy and proceeded with planned resection. Surgery was aborted for 6 pts: 3 refused surgery, 2 deaths (1 for tumor rupture of HCC, 1 for immune related hepatitis), and 1 had protocol deviation. The MPR rates in the ITT population were 40% (24/60). Among them, 10% pts (6/60) had ≤ 5% surviving tumor cells in tumor bed. The MPR rate in pts who had surgical resection were 46.2% (24/52). 19.3% pts experienced ≥ 3 grade TRAEs, the most common of which were AST increased (5.3%), hypertension (5.3%), and ALT increased (3.5%). Conclusions: The phase II stage of the study did not meet the stopping criteria. Neoadjuvant camrelizumab plus apatinib therapy exhibits promising pathological response in HCC pts at intermediate-high risk of recurrence, with a tolerable safety profile. The phase III stage of the study is currently ongoing. Clinical trial information: NCT04521153 .

Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis.

Current treatment for non-muscle invasive bladder cancer (NMIBC) is the conventional transurethral resection of bladder tumor (CTURBT), but the en bloc transurethral resection of bladder tumor (ERBT) has been gaining more attraction in recent years considering better specimen integrity. Thus, we conducted this meta-analysis to compare the safety and efficacy of ERBT versus CTURBT. Trials were collected from an online database. The primary outcomes included identification of detrusor muscle in specimen, residual tumor, 3, 12, and 24-month recurrence rates and same-site recurrence rate. A total of 31 trials were included. The ERBT group had a higher rate of identification of detrusor muscle in specimens (p = 0.003) and lower residual tumor (p < 0.001). Other than that, lower rates of 3-month (p = 0.005) and 24-month recurrence rate (p < 0.001), same-site recurrence rate (p < 0.001) and complications were also observed. For perioperative outcomes, shorter hospitalization time (HT) (p < 0.001), and catheterization time (CT) (p < 0.001) were also revealed in the ERBT group. No significant difference was found in operative time (OT) (p = 0.93). The use of ERBT showed better pathological outcomes and fewer complications, so it could be considered a more effective treatment option for NMIBC.

Does Apoptotic Index Predict the Response to Neoadjuvant Chemotherapy in Patients with Breast Carcinoma?

Neoadjuvant chemotherapy (NACT) plays a major role in the treatment of patients with locally advanced breast carcinoma. Although most patients have benefited from NACT, the rate of residual tumors is still high after treatment (AT). An increase in apoptosis is expected in tru-cut biopsy (TCB) during treatment or AT as the mechanism of NACT is inducing apoptosis. This study aimed to investigate whether evaluating the apoptotic index (AI) from TCB can predict the response before treatment (TC-BT) and whether there is a correlation between AI and clinicopathologic parameters. Seventy cases of breast carcinomas were included. The AI was evaluated BT and AT by quantifying the apoptosis. The receiver operating characteristic analysis was performed with overall survival (OS) data, and low and high AI cut-offs were obtained. The relationship between AI and response and clinicopathological parameters was evaluated. A significant relationship was found between low AI in TC-BT and at least partial response (p=0.025), longer OS (p=0.01) and disease-free survival (p=0.01), and progesterone receptor-positive tumors (p=0.03). Her2-negative tumors were more prone to low AI. A significant decline in AI (p=0.001) and Ki67 proliferation index (p<0.001) was observed in resections AT. These data suggested that the AI is a simple and cost-effective tool that may play an important role in determining response, and a low AI in TC-BT may have some value as a predictive marker in breast carcinomas.

Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials.

We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes. Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review. Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P<0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P<0.05, RR=0.63, 95% CI 0.43-0.94. P<0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P=0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P=0.27). Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.

Importance of radiographic tumor regression during radiotherapy in squamous cell versus adenocarcinoma of the uterine cervix as assessed by MRI and cone beam CT

The purpose of this study was to evaluate the kinetics of tumor regression in cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) using computed tomography (CT) and magnetic resonance imaging (MRI), and to correlate rate of regression and residual tumor with progression and survival. Thirty-two patients with stage IB2-IVA cervical cancer were randomly selected from an institutional database with a 2:1 ratio of SCC to AC. All available on-treatment weekly cone beam CT (CBCT) and pre- and post-external beam MRIs were utilized to generate largest two-dimensional area of tumor and tumor gross tumor volumes (GTV), respectively. Tumor volume regression velocity and percent residual tumor were correlated to 5-year progression-free survival (PFS) and disease-specific survival (DSS) using threshold regression modeling. Kaplan-Meier and Fine-Grey estimators were used for survival and cumulative incidence analysis, respectively. With a median follow-up of 2.9 years, 32 patients were included, 22 (69%) with SCC and 10 (31%) with AC. All received concurrent chemoradiation followed by brachytherapy. The 2-year cumulative incidence (CI) of local progression for both SCC and AC was 10%, and 2-year CI of distant progression was 9% vs. 57% (p = 0.02). Deaths occurred in 3/22 (14%) with SCC and 7/10 (70%) with AC, with a 2-year DSS of 90% versus 60%, respectively. Extent and rate of regression on CBCTs were not correlated with progression or survival; however, consistent rates of tumor regression for both SCC and AC. Thresholds of ≥20% residual disease on post-external beam pre-brachytherapy MRI and regression velocity ≤1.8%/day were associated with worse PFS and DSS. This study showed cervical AC is associated with higher rates of distant progression and worse overall survival than SCC. Cervical AC tends to have a higher initial and residual tumor burden. Our identified thresholds of ≥20% residual tumor and tumor regression of ≤1.8%/day may help identify cases warranting dose escalation.

The Significance of Radiotherapy in Ovarian Clear Cell Carcinoma: A Systematic Review and Meta-Analysis.

To assess the response rate and survival effect of adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) during ovarian clear cell carcinoma (OCCC). We searched Web of Science, PubMed,Cochrane library electronic databases, Clinical Trials, WanFang Data and Chinese National Knowledge Infrastructure (CNKI)up to October2022. We also searched registers of clinical trials, abstracts of scientific meetings and reference listsof included studies. We identifieda total of4259patients from 14studies metthe inclusion criteria. The pooled response rate of residual tumors for RT/CRT was 80.0%, the pooled 5-year progression-free survival (PFS) ratio during RT/CRT group was 61.0%, and the pooled 5-year overall survival (OS) ratio during RT/CRT group was 68.0%; heterogeneity tests demonstrated significant difference between studies (I2 >50%). Cumulative results suggested adjuvant RT/CRT improved 5-year PFS ratio of OCCC patients (OR: 0.51 (95% CI: 0.42-.88), I2 = 22%, P = .009), had no impact on 5-year OS ratio (OR: 0.52 (95% CI: 0.19-1.44), I2 = 87%, P = .21); meta-regression of studies before and after 2000 found consistent results. Sub-analysis observed that adjuvant RT/CRT had no impact on 5-year OS ratio of early-stage (stage I + II) OCCC patients (OR: 0.67 (95% CI: 0.25-1.83), I2 = 85%, P = .44), but might improve 5-year OS ratio of advanced and recurrent OCCC patients (OR: 0.13(95% CI: 0.04-.44), P = .001). This analysis suggested that adjuvant RT/CRT might improve oncologic outcomes of OCCC, especially for advanced and recurrent cases. Due to the inherent selective biases of retrospective studies enrolled in the meta-analysis, more convincing evidences based on prospective randomized controlled trials (RCTs) are urgently needed.

Could we safely omit a Repeat Transurethral Resection of the Bladder (re-TURB) after Hexaminolevulinate Photodynamic Diagnostics (PDD)-TURB?

Bladder cancer (BC) is considered one of the malignancies with moderate-high incidence, high rate of recurrence and costly management. Diagnosis and staging are thus important for therapeutic purposes. Considering the risk of residual tumour and understaging, in specific cases, international guidelines recommend performing a second transurethral resection of the bladder (reTURB). Our study aimed to evaluate the impact of hexaminolevulinate Photodynamic Diagnostics (PDD) at first TURB on the rate of residual tumour. We retrospectively analysed patients undergoing TURB in our centre between 2012 and 2020. Eightytwo patients had a re-TURB after a first complete TURB with a delay < 3 months. Patients who had an incomplete first resection were excluded. We compared patients who underwent standard white light cystoscopy/TURB and then hexaminolevulinate PDDguided reTURB (group A, n = 49) and patients with PDD-cystoscopy/ TURB at the first procedure then white light cystoscopy/reTURB (group B, n = 33). The residual tumour rate at reTURB as well as median recurrence-free survival (RFS) were compared between the two groups. Residual tumour at reTURB was detected in 48.8% of cases in our cohort, with a significant difference between the two groups (71.4% in group A versus 12.5% in group B, p < 0.001). After a median follow-up of 22 months, the median RFS was 15 months in Group A and 32 months in Group B, but this difference was not significant (p = 0.7). Using PDD at the time of the initial TURB had a statistically significant impact on the rate of residual tumour at the reTURB. Nevertheless, the percentage of residual tumour even with the use of PDD does not allow for safely omitting second resection. Performing a reTURB with PDD for patients who did not have it initially, provides the same benefit in terms of recurrence-free survival.