Survival Benefit Of Surgery Research Articles

Long-term Outcomes of Surgical Treatment for Pancreatic Neuroendocrine Neoplasm with Synchronous Hepatic Metastasis: A Multicenter Retrospective Cohort Study

Abstract Objectives: To evaluate surgical impact on the overall survival (OS) of pancreatic neuroendocrine neoplasm (pNEN) with synchronous hepatic metastases (sHM). Methods: A total of 163 pNEN-sHM patients were recruited from 3 institutions in China, who were categorized into 3 groups: no resection (NR), resection of the primary lesion (PR) and resection of both primary and hepatic lesions (PHR). Cox regression was employed to evaluate surgical impact on the OS. Results: In the overall cohort analysis, PHR demonstrated a significant protective effect on OS (HR 0.302, 95% CI: 0.127–0.721, p = 0.007). Nevertheless, subgroup analysis revealed PHR conferred a survival advantage in patients with pancreatic neuroendocrine tumor (pNET) located on the pancreatic body/tail (bt-pNET-sHM) (HR 0.287, 95% CI: 0.087–0.946, p = 0.040), whereas surgical treatment did not significantly impact survival in the subgroups of pancreatic neuroendocrine carcinoma (pNEC)-sHM or pancreatic head/neck pNET-sHM (hn-pNET-sHM). Conclusions: In this study, the survival benefit of surgery was only observed in the bt-pNET-sHM subgroup. Considering the multifactorial nature of decision-making, surgical intervention for pNEN-sHM management should be approached with a careful and comprehensive assessment, to prevent excessive surgery strategies.

Surgery or radiotherapy improves survival in elderly patients with early non-small cell lung cancer: A population-based analysis.

There is a lack of evidence to support a consensus on whether surgery or radiotherapy is optimal for elderly or very elderly patients with early-stage non-small cell lung cancer (NSCLC). We aimed to assess the impact of surgery or radiotherapy on survival in elderly (≥70 years) and very elderly (≥80 years) patients with early-stage NSCLC. Patients aged ≥70 years diagnosed with early-stage NSCLC between January 1, 1975, and December 31, 2018, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were assessed based on surgery, radiotherapy, and no-treatment groups. Data for 15,224 NSCLC patients aged ≥70 years were collected, which consisted of 6949 (45.6%) patients who underwent surgery alone, 5014 (32.9%) who underwent radiotherapy alone, and 3261 (21.5%) who received no treatment. Surgery significantly improved patient survival compared with no treatment (MST: 74 months vs. 7 months, HR: 0.201, 95% CI: 0.186-0.217, P < 0.001), as did radiotherapy (MST: 28 months vs. 7 months, HR: 0.440; 95% CI: 0.413-0.469, P < 0.001). Surgery also resulted in improved survival compared with radiotherapy (74 months vs. 28 months, HR: 0.455; 95% CI: 0.430-0.482, P < 0.001). A similar conclusion was made from the analysis of CSS. A subgroup analysis further confirmed the survival benefits. The results of this large-scale retrospective study indicate that both surgery and radiotherapy significantly enhance survival outcomes in patients aged ≥70 or ≥80 years with early-stage NSCLC. The survival benefits of surgery were particularly notable.

Efficacy and surgical safety of sequential surgical resection after neoadjuvant chemoimmunotherapy for unresectable stage III NSCLC.

8073 Background: Neoadjuvant chemoimmunotherapy has been successfully used in resectable non-small cell lung cancer (NSCLC) patients. However, its application in advanced stage unresectable NSCLC remains a topic of debate. This retrospective study was designed to evaluate the efficacy and safety of neoadjuvant chemoimmunotherapy followed by surgical resection in patients with initial unresectable stage III NSCLC, focusing on the surgical resection rate and the survival benefits of surgery. Methods: Patients unresectable stage III NSCLC who received 2-4 cycles of neoadjuvant chemoimmunotherapy between January 2021 and December 2022 were retrospectively identified. Data on characteristics, radiological and pathological responses, and survival outcomes were collected. Results: In total, 148 patients with unresectable stage III NSCLC were recruited. After the last cycle of neoadjuvant therapy, 105 (70.9%) patients were evaluated to be eligible for surgery, and 102 patients ultimately underwent surgery. The rate of complete (R0) resection was 100%, with a major pathological response (MPR) observed in 63.7% and a pathologic complete response (pCR) in 41.2%. Postoperative complications were observed in 9 patients (8.8%), and there was no surgical-related mortality within 30 days. With a median follow-up of 21.9 months, the median progression-free survival (PFS) was 19.6 months in the non-surgery group and not reached in the surgery group. The median overall survival (OS) was not reached in either group. Conclusions: The use of neoadjuvant chemoimmunotherapy is effective in converting unresectable stage III NSCLC into resectable NSCLC. Subsequent radical surgery is safe with low complications and surgical-related mortality.

Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation.

Colorectal adenosquamous carcinoma (ASC) is a rare subtype of colorectal carcinoma. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of colorectal ASC. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with colorectal ASC diagnosed between 2000 and 2020 and assess factors associated with overall survival (OS) and cause-specific survival (CSS). Among 284 identified cases, the median age of diagnosis was 64 years. The majority of patients were White (69.0%), with income ≤ $70,000 ( 62.3%), and lived in metropolitan areas (85.6%). Regarding tumor characteristics, the majority of tumors were poorly differentiated (49.6%), regional stage (39.8%), size of > 4.0 cm ( 41.5%), and had a negative lymph node status (47.2%). Primary sites were the rectum (35.2%) and colon ( 64.8%). In patients with primary site to the rectum, the majority of treatment modality was multimodal therapy (40.0%). The main treatment modality for the primary site to the colon was surgery only (46.2%), followed by surgery + chemotherapy (34.2%). The overall 5-year survival was 31.3 (95% C.I. 28.4-34.2) and the 5-year cause-specific survival (CSS) was 40.1% (95% C.I. 36.9-43.3). Multivariate analysis showed age ≥ 60 years, regional stage, and distant stage were negative prognostic factors. An income of > $70,000, multimodal therapy, and surgery with chemotherapy were positive prognostic factors. Colorectal adenosquamous carcinomas are more common in the non-Hispanic White populations and appear more frequently later in life (based on the median age of diagnosis at 64). Factors that contributed to a worse prognosis were an age of diagnosis ≥ 60 years, regional stage, and distant stage.

Survival benefit of surgery in elderly patients with locally advanced rectal cancer.

Neoadjuvant therapy followed by radical surgery is standard for locally advanced rectal cancer (LARC). However, compared to younger patients, elderly patients often had multiple commodities and may refuse surgery due to being medically unfit or the high risk of operative mortality. This study aims to explore the effects of surgery on short- and long-term mortality in elderly LARC patients using a nationwide cancer registry. The cohort included 6211 patients aged over 65, with 2556 matched through propensity scoring for comparison between surgery (N = 1704) and non-surgery (N = 852) groups. The Cox proportional hazard model compared mortality between these groups. Our results showed that the elderly LARC patients who underwent surgery were more likely to be younger (65-75 years), have clinically-positive lymph nodes, and no comorbidities. Surgery was associated with significantly lower 3-month, 6-month, and 5-year mortality rates, with a greater absolute survival benefit (adjusted hazard ratio [aHR], 4.78; 95% CI, 2.71-8.43; aHR, 4.50; 95% CI, 3.07-6.58 and aHR, 3.81; 95% CI, 3.21-4.51). In stratified analysis, surgery remains provide significantly survival benefit according different age, gender and clinical classification. Furthermore, among non-surgical patients, those receiving chemoradiation had better survival outcomes compared to those receiving radiation, chemotherapy, or no treatment (all P < 0.001). This study highlights the survival advantage of surgery in elderly LARC patients and offers valuable guidance for clinical decision-making.

A 15-Gene-Based Risk Signature for Predicting Overall Survival in SCLC Patients Who Have Undergone Surgical Resection.

Small cell lung cancer (SCLC) is a malignancy with a poor prognosis whose treatment has not progressed for decades. The survival benefit of surgery and the selection of surgical candidates are still controversial in SCLC. This study is the first report to identify transcriptomic alterations associated with prognosis and propose a gene expression-based risk signature that can be used to predict overall survival (OS) in SCLC patients who have undergone potentially curative surgery. An integrative transcriptome analysis of three gene expression datasets (GSE30219, GSE43346, and GSE149507) revealed 1734 up-regulated and 2907 down-regulated genes. Cox-Mantel test, Cox regression, and Lasso regression analyses were used to identify genes to be included in the risk signature. EGAD00001001244 and GSE60052-cohorts were used for internal and external validation, respectively. Overall survival was significantly poorer in patients with high-risk scores compared to the low-risk group. The discriminatory performance of the risk signature was superior to other parameters. Multivariate analysis showed that the risk signature has the potential to be an independent predictor of prognosis. The prognostic genes were enriched in pathways including regulation of transcription, cell cycle, cell metabolism, and angiogenesis. Determining the roles of the identified prognostic genes in the pathogenesis of SCLC may contribute to the development of new treatment strategies. The risk signature needs to be validated in a larger cohort of patients to test its usefulness in clinical decision-making.

Survival benefit of surgery with postoperative radiotherapy in locally advanced cervical adenocarcinoma: a population-based analysis

BackgroundThe incidence of cervical adenocarcinoma (AC) has experienced a considerable increase in recent decades. Despite this, our understanding of the optimal management of locally advanced cervical AC remains limited. The present study sought to compare the clinical outcomes of radical hysterectomy with postoperative radiotherapy (PORT) and primary radiotherapy (RT) in patients with locally advanced cervical AC using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThe data were extracted from the SEER database utilizing the SEER ∗ STAT software (version 8.4.0.1). The study included patients diagnosed with locally advanced cervical AC between 2004 and 2017 with adequate information available for analysis. Patients were assigned to either the Surgery + PORT or Primary RT group based on treatment modality, and their clinical characteristics were compared. Propensity score matching (PSM) was utilized to adjust for differences in baseline characteristics between groups. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS).ResultsOf the 1363 patients who met the inclusion criteria, 302 (22.16%) underwent Surgery + PORT, while 1061 patients received Primary RT. The two groups differed significantly in terms of age, year of diagnosis, tumor size, grade, stage, T/N stage, and chemotherapy. PSM was performed to balance the baseline characteristics between the two groups, resulting in 594 patients being analyzed. After PSM, the Surgery + PORT group exhibited significantly improved survival rates. The 5-year OS rates were 69.7% (95% CI: 63.3%-76.9%) for the Surgery + PORT group and 60.9% (95% CI: 56.0%-66.3%) for the group receiving Primary RT (p = 0.002). The 5-year CSS rates for the two groups were 70.7% (95% CI: 64.3%-77.8%) and 66.2% (95% CI: 61.3%-71.5%), respectively (p = 0.049). Multivariate analysis revealed that Surgery + PORT was an independent favorable prognostic factor for OS (HR = 0.60, p = 0.001) and CSS (HR = 0.69, p = 0.022). Although the combined approach of surgery and PORT resulted in a favorable impact on OS in patients aged 65 years or older (HR = 0.57, p = 0.048), it did not result in a statistically significant improvement in CSS in the same age group (HR = 0.56, p = 0.087). Similarly, the combined treatment did not yield a statistically significant increase in either OS (HR = 0.78, p = 0.344) or CSS (HR = 0.89, p = 0.668) in patients with tumors larger than 60 mm.ConclusionThe present study demonstrated that Surgery + PORT was associated with improved OS and CSS in patients with locally advanced cervical AC when compared to Primary RT. As such, Surgery + PORT may be a preferable therapeutic option for carefully selected patients with cervical AC. These findings offer valuable insight into the management of locally advanced cervical AC and may assist in personalized treatment decisions.

Assessing major influences on decision-making and outcome for dogs presenting emergently with nontraumatic hemoabdomen.

To evaluate factors contributing to owner decision-making, satisfaction, and perception of quality of life (QOL) with treatment of dogs with nontraumatic hemoabdomen (NTH). 132 client-owned dogs. An electronic survey was administered to owners of 436 dogs that presented emergently with NTH to a single institution between January 2015 and May 2022. Following survey response, retrospective data collection was performed. Owners reported QOL as the most important factor influencing their decision-making (92%), followed by risk of cancer (57%) or time remaining with their pet (56%). QOL scores were significantly higher with surgery versus those with palliative care (P = .007). Median survival time (MST) was 213 days with surgery and 39 days with palliative care (P = .049). Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST, 81 days; P = .305). Owners were more likely to be satisfied when they chose surgery over either euthanasia or palliative care (P = .039). Thirty-four owners (26%) second-guessed or were unsure of their decision. Surgery resulted in the longest MST with greater perceived QOL and owner satisfaction compared with both palliative care and euthanasia and should therefore be considered highly. The importance of malignancy and survival time on owners' decisions, along with the negative impact of metastasis on survival, underscores the importance of timely preoperative staging. The rate of second-guessing highlights the need for standardization of NTH discussions including treatment options and potential outcomes in order to effectively and efficiently guide treatment of patients with this common presentation.

Primary cardiac sarcoma: demographics, genomic study correlation, and survival benefits of surgery with adjuvant therapy in U.S. population.

Cardiac sarcomas are rare and aggressive tumors with little known about the demographics, genetics, or treatment outcomes. The objectives of this study were to characterize the demographics, treatment modality, and survival associated with cardiac sarcomas and evaluate the potential for mutation-directed therapies. All cases from 2000 to 2018 of cardiac sarcoma were extracted from the SEER database. Genomic comparison utilized The Cancer Genome Atlas (TCGA) database, as well as reviews and re-analysis of past applicable genomic studies. Cardiac sarcomas occurred most often in White patients, compared with national census data cardiac sarcomas occurred at a significantly higher rate in Asians. The majority of cases were undifferentiated (61.7%) and without distant metastases (71%). Surgery was the most common primary treatment modality and offered survival benefit (HR 0.391 (p = 0.001) that was most pronounced and sustained as compared to patients who received chemotherapy (HR 0.423 (p = 0.001) or radiation (HR 0.826 (p = 0.241) monotherapy. There was no difference in survival when stratified by race or sex; however, younger patients (< 50) had better survival. Genomics data on histologically undifferentiated cardiac sarcomas revealed a significant number were likely poorly differentiated pulmonary intimal sarcomas and angiosarcomas. Cardiac sarcoma is a rare disease with surgery continuing to be a cornerstone of therapy followed by traditional chemotherapy. Case studies have indicated the potential for therapies directed to specific genetic aberrations to improve survival for these patients and utilization of next-generation sequencing (NGS) will help improve both classification and these therapies for cardiac sarcoma patients.

Survival Benefit of Surgery in Patients with Clinical T4 Esophageal Cancer Responded to Neoadjuvant Chemoradiotherapy/Radiotherapy

<h3>Purpose/Objective(s)</h3> This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT+S) is superior to definitive chemoradiotherapy/radiotherapy (dCRT/RT) in terms of survival in cT4 EC downstaged after nCRT/RT. <h3>Materials/Methods</h3> From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week radiotherapy (median dose, 40.71 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT+S group), 234 patients received definitive radiotherapy (dCRT/RT group). <h3>Results</h3> Median follow-up was for 58.25 months. The 3-year OS and corresponding PFS for cT4 ESCC were 33.3% and 35.6%. Moreover, the 3-year OS and PFS were 54.8% and 48.5% in the nCRT/RT+S group vs. 30.0% and 22.1% in the dCRT/RT group (both p < 0.0001). For the patients who achieved cCR/PR, IPTW was used to adjust the confounding variables and reduce bias in two groups. The adjusted 3-year OS rates was 50.4% in the nCRT/RT+S group vs. 50.8% in the dCRT/RT group (p = 0.15); however, the adjusted 3-year PFS rates was significantly different between the two groups (49.0% vs. 38.3%, p = 0.0036). Postoperative complications occurred in 18 (24.3%) patients, and 2 (2.9%) patients died within 30 days of surgery. In dCRT/RT group, no patient had grade 5 radiation-related toxicity. <h3>Conclusion</h3> The OS of cT4 ESCC has been significantly improved after the use of 3D-RT/CRT. In cT4 EC downstaged after nCRT/RT, surgery improves PFS.

Locoregional Therapy in De novo Metastatic Breast Cancer: A Retrospective Cohort Study.

Objective: Whether locoregional therapy (LRT) should be performed in patients with de novo metastatic breast cancer (dnMBC) has been debated. Here we report the survival outcomes of LRT in patients with dnMBC, focusing on the association of surgical timings and surgical margins with survival in this patient population. Methods: The retrospective study included patients with dnMBC in our hospital, between March 1, 2007 and December 31, 2017. Overall survival (OS) was evaluated by means of a stratified log-rank test and summarized with the use of Kaplan–Meier methods. Results: A total of 153 patients were included, of whom 87 underwent LRT and 66 systemic therapy alone (STA). LRT showed a significant OS benefit over STA (HR, 0.62; 95% CI, 0.39 to 0.99; P = .043). The OS of LRT group and STA group were 39 months (95% CI, 33.6 to 44.4 months) and 24.6 months (95% CI, 20.6 to 28.6 months), respectively. The benefit was consistent across most subgroups. The OS of patients undergoing surgery was better than that of patients without surgery (HR, 0.58; 95% CI, 0.35 to 0.94; P = .0001), and there was difference in survival improvement at different surgical timings (surgery before chemotherapy, during chemotherapy, and after chemotherapy) (P = .0001). The survival benefit of surgery after chemotherapy was significantly greater than that of the other 2 options (HR, 0.77; 95% CI, 0.63 to 0.94). Moreover, compared with patients with positive margins, the OS of patients with negative margins was significantly improved (HR, 0.22; 95% CI, 0.13 to 0.37; P < .001). Conclusions: Our results suggest that LRT is associated with improved OS in women with dnMBC, and patients who had surgery after systemic chemotherapy with negative surgical margins, are expected to benefit more.

Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy

Objective:This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT.Summary background data:Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not clear whether the latter provides survival benefit in patients downstaged after nCRT/RT.Methods:From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week RT (median dose, 40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT.Results:Median follow-up was 58 months. The 3-year overall survival (OS) and progression-free survival (PFS) rates for all patients were 33.3% and 35.6%, respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT group (both p < 0.0001). After adjusting the confounding variables with inverse probability of treatment weighting, the adjusted 3-year OS rates were 50.4% in the nCRT/RT + S group versus 50.8% in the dCRT/RT group (p = 0.15). However, the adjusted 3-year PFS rates were significantly different between the two groups (49.0% and versus 38.3%, p = 0.004). Postoperative complications occurred in 18 (24.3%) patients.Conclusion:The long-term survival of cT4 ESCC was improved after the use of three-dimensional CRT. In cT4, EC responded to nCRT/RT, surgery improves PFS but not OS.

Radical Minimally Invasive Surgery After Immuno-chemotherapy in Initially-unresectable Stage IIIB Non-small cell Lung Cancer.

Use of neoadjuvant immunotherapy agent in advanced stage NSCLC is controversial. Herein, we aim to report on a case series of successful conversion from initial unresectable stage cIIIB NSCLC to radical minimally invasive surgery through immunochemotherapy; with particular attention given to surgical outcomes and survival benefit of surgery. Fifty-one patients with initial stage cIIIB NSCLC who received PD-1 agents plus platinum-based chemotherapy between May, 2018 to August, 2020 were retrospectively identified. Surgical and oncological outcomes of enrolled patients were collected. Of 31 patients who underwent subsequent resection, 23 (74.2%) patients underwent lobectomy, 1 (3.2%) underwent pneumonectomy, 5 (16.1%) underwent sleeve lobectomy, and 2 (6.5%) with bilobectomy. The median surgical time was 205 minutes (range, 100-520). The average blood loss was 185 (range: 10-1100) ml. Dense adhesions or fibrosis was noted in 15 cases. The median postoperative hospital stay was 6 (range: 3-13) days. No surgical-related mortality was recorded, only 5 patients (16.1%) experienced any postoperative morbidity (no grade 3 complications). Ten patients (32.3%) had major pathological response, with mediastinal down-staging been observed in 22/31 (71.0%) patients. With a median after up of 15.4 months, thirty-one patients that had surgery had relatively longer median DFS/PFS compared to that of either non-responders or responders that without surgery (27.5 vs. 4.7 vs. 16.7 months, respectively). Radical surgery after chemoimmunotherapy in initial unresectable stage IIIB NSCLC seems to be safe with low surgical-related mortality and morbidity, and was favorably associated with longer DFS/PFS compared to those without surgery.

The Role of Surgery in IDH-Wild-Type Lower-Grade Gliomas: Threshold at a High Extent of Resection Should be Pursued.

While maximizing extent of resection (EOR) is associated with longer survival in lower-grade glioma (LGG) patients, the number of cases remains insufficient in determining a EOR threshold to elucidate the clinical benefits, especially in IDH-wild-type LGG patients. To identify the effects of EOR on the survival outcomes of IDH-wild-type LGG patients. IDH-wild-type LGG patients were retrospectively reviewed. The effect of EOR and other predictor variables on overall survival (OS) and progression-free survival (PFS) was analyzed using Cox regression models and the Kaplan-Meier method. A total of 94 patients (median OS: 48.9 mo; median follow-up: 30.6 mo) were included in this study. In the multivariable Cox regression analysis, postoperative residual volume was associated with prolonged OS (HR=2.238; 95% confidence interval [CI], 1.130-4.435; P=.021) and PFS (HR=2.075; 95% CI, 1.113-3.869; P=.022). Thresholds at a minimum EOR of 97.0% or a maximum residue of 3.0 cm3 were necessary to impact OS positively. For the telomerase reverse transcriptase (TERT)p-wild-type group, such an association was absent. Significant differences in survival existed between the TERTp-wild-type and mutant patients who underwent relatively incomplete resections (residual ≥2.0 cm3+TERTp wild type: median OS of 62.6 mo [95% CI: 39.7-85.5 mo]; residual ≥2.0 cm3+TERTp mutant: median OS of 20.0 mo [95% CI:14.6-25.4 mo]). Our results support the core role of maximal safe resection in the treatment of IDH-wild-type LGGs, especially for IDH-wild-type+TERTp-mutant LGGs. Importantly, the survival benefits of surgery could only be elucidated at a high EOR cut-off point.

Minimally invasive or open oesophagectomy for localized oesophageal cancer: Results of the ROMIO phase 3 randomized controlled trial.

e16057 Background: Patients with localised oesophageal adenocarcinoma or squamous cell cancer are frequently offered surgery, usually with neoadjuvant treatment. Whether minimally invasive surgical approaches are superior to standard open procedures in terms of patient recovery and survival benefit is unclear. Well-designed and well-conducted pragmatic trials are limited. The ROMIO study compared laparoscopic abdominal surgery and thoracotomy (LAO) with open oesophagectomy (OO), to test the hypothesis that LAO allows faster recovery than OO whilst maintaining the survival benefit of surgery. Methods: A pragmatic multi-centre randomised controlled trial (1:1 LAO vs. OO) was conducted in 9 major cancer centres in the UK. Included were patients with localised adenocarcinoma or squamous cell cancer selected by a multi-disciplinary team for oesophagectomy with or without neoadjuvant treatment. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons and intra-operative photographs of key agreed surgical components. The primary outcome was the physical function scale of the EORTC QLQ-C30 assessed during the first 3 months. Results: At enrolment to ROMIO 447 (85%) of 526 participants were male, mean age was 67 years (SD 9), 469 (89%) had an adenocarcinoma, 368 (70%) had a clinically staged T3 or T4a tumour, 295 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. 263 were randomly allocated to each of the two procedures, with 241 (92%) undergoing their allocated open surgery and 237 (91%) undergoing their allocated LAO (hybrid) surgery. Analyses are underway and this presentation will include the primary outcome measure and other short-term clinical outcomes including key complications and survival during the first 90 days (clinical data &gt;95% complete). Conclusions: ROMIO is the largest multi-centre randomised controlled surgical trial of minimal access versus open surgical approaches for oesophageal cancer. The provision of a surgical quality assessment tool will supplement trial data to provide for the first-time evidence of surgical standards of both approaches. Clinical trial information: ISRCTN10386621.

Survival benefit of surgery for very elderly patients with pancreatic cancer: what extent of pancreatectomy is acceptable?

ABSTRACTThe purpose of this study is to clarify the survival benefit and acceptable extent of surgery for very elderly patients with pancreatic cancer. Patients (n=55) ≥80 years with resectable pancreatic cancer were studied. 29 underwent pancreatectomy, 16 underwent chemotherapy, and 10 received best supportive care. Uni and multivariate analysis were performed to explore predictive factors for overall survival (OS) with surgery and chemotherapy (n=45). Postoperative survival of PD (pancreatoduodenectomy) and DP (distal pancreatectomy) and of PD-PVR (PD with portal vein resection) and PD were compared. OS was equivalent with surgery and chemotherapy (median survival time [MST]; 685 vs. 626 days, respectively; p=0.057); 6 patients surivived ≥3 years after surgery. Pancreatectomy was not a prognostic factor. Survival was significantly worse with PD-PVR than with PD, but equivalent with PD and DP. Within 2 years after PD-PVR, 8 patients have died. Surgery was not a positive prognostic factor for very elderly patients with pancreatic cancer, but was the sole chance for survival ≥3 years. Indication for PD-PVR for very elderly patients should be determined more cautiously compared with that for non-elderly patients.

A Pre-Operative Prognostic Score for Patients With Advanced Hepatocellular Carcinoma Who Underwent Resection.

BackgroundPrevious studies demonstrated a promising prognosis in advanced hepatocellular carcinoma (HCC) patients who underwent surgery, yet a consensus of which population would benefit most from surgery is still unreached.MethodA total of 496 advanced HCC patients who initially underwent liver resection were consecutively collected. Least absolute shrinkage and selection operator (LASSO) regression was performed to select significant pre-operative factors for recurrence-free survival (RFS). A prognostic score constructed from these factors was used to divide patients into different risk groups. Survivals were compared between groups with log-rank test. The area under curves (AUC) of the time-dependent receiver operating characteristics was used to evaluate the predictive accuracy of prognostic score.ResultFor the entire cohort, the median overall survival (OS) was 23.0 months and the median RFS was 12.1 months. Patients were divided into two risk groups according to the prognostic score constructed with ALBI score, tumor size, tumor-invaded liver segments, gamma-glutamyl transpeptidase, alpha fetoprotein, and portal vein tumor thrombus stage. The median RFS of the low-risk group was significantly longer than that of the high-risk group in both the training (10.1 vs 2.9 months, P<0.001) and the validation groups (13.7 vs 4.6 months, P=0.002). The AUCs of the prognostic score in predicting survival were 0.70 to 0.71 in the training group and 0.71 to 0.72 in the validation group.ConclusionSurgery could provide promising survival for HCC patients at an advanced stage. Our developed pre-operative prognostic score is effective in identifying advanced-stage HCC patients with better survival benefit for surgery.

Abstract PS1-35: Combined primary site resection and metastasectomy in patients with metastatic breast cancer

Abstract Background: We previously reported a significant survival benefit of surgery in patients with de novo stage IV breast cancer. However, prospective trials, focusing predominantly on the impact of lumpectomy or mastectomy in metastatic breast cancer (mBC) (versus metastatic resection, i.e. ‘metastasectomy’), have yielded inconclusive results. We sought to assess whether a combination of surgical approaches may be associated with optimal survival. Methods: This is a retrospective analysis of patients diagnosed with mBC between 2004 and 2016 using the National Cancer Database. We identified a cohort of patients undergoing both primary site resection and metastasectomy, describing them using frequency and distribution statistics. Subsequently, we conducted a multivariate Cox regression survival model to understand whether this surgical approach was associated with better overall survival (OS) compared to patients undergoing lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. This model controlled for relevant sociodemographic and clinicopathologic factors. Finally, we used the Kaplan-Meier method to demonstrate the utility of surgery in: 1) patients with mBC involving only 1 site, stratifying by tissue type as bone, brain liver, or lung and 2) patients with mBC involving &amp;gt;1 site. Results: A total of n=55,125 patients with mBC were included in this analysis. N=13,478 patients underwent lumpectomy/mastectomy alone, n=2116 underwent metastasectomy alone, n=912 underwent combined lumpectomy/mastectomy + metastasectomy, and n=38,619 did not undergo surgery. Of those that underwent combined resection, n=713 (78.2%) were White; n=132 (14.5%) were Black, and n=47 (5.2%) were Asian. Multivariate Cox regression survival modeling showed mBC patients undergoing combined resection exhibited the best OS (median OS: 50 months, HR 0.882, p=0.012) compared to patients undergoing lumpectomy/mastectomy alone (median OS: 43 months – reference category); while patients undergoing metastasectomy alone had worse OS (median OS: 30 months, HR 1.327, p&amp;lt;0.0001), and those who did not undergo surgery had the worst OS (median OS: 21 months, HR 1.824, p&amp;lt;0.0001). Kaplan-Meier modeling corroborated this survival benefit when mBC involved 1 site and when it involved multiple sites (log-rank p&amp;lt;0.001). In further subgroup univariate analysis of patients with metastasis to 1 site, patients undergoing combined lumpectomy/mastectomy + metastasectomy exhibited superior survival compared to lumpectomy/mastectomy alone, when metastatic disease involved the liver or lung (log-rank p&amp;lt;0.001), but not when it involved bone or the brain. Additionally, in patients with mBC involving only the lung, metastasectomy alone was also associated with a superior survival benefit to lumpectomy/mastectomy alone (log-rank p&amp;lt;0.001), highlighting the potential impact of pulmonary metastasectomy. Conclusions: Patients with newly-diagnosed mBC undergoing primary site resection in combination with metastasectomy exhibited longer survival compared to those undergoing only lumpectomy/mastectomy and those not undergoing surgery, particularly when metastasis involved only the liver or lung. Table 1: Multivariate Cox regression model for overall survival in de novo stage IV patientsDe Novo Stage IV Patients (n=55,125)aVariableNo. (%)Median OS (95% CI)#HR (95%CI)p-valueSurgical approach&amp;lt;0.0001Lumpectomy/mastectomy alone (ref)13,478 (24.4%)43 (42-44)1Metastasectomy alone2116 (3.8%)30 (28-32)1.327 (1.249-1.410)&amp;lt;0.0001Lumpectomy/mastectomy + metastasectomy912 (1.7%)50 (45-54)0.882 (0.799-0.973)0.012No surgery38,619 (70.1%)21 (21-22)1.824 (1.774-1.875)&amp;lt;0.0001Age&amp;lt;0.0001&amp;lt;50 (ref)10,057 (18.2%)39 (38-41)150-7029,437 (53.4%)29 (28-29)1.203 (1.166-1.242)&amp;lt;0.0001&amp;gt;7015,631 (28.4%)16 (15-17)1.623 (1.566-1.681)&amp;lt;0.0001Race&amp;lt;0.0001White (ref)40,128 (72.8%)27 (27-28)1Black9476 (17.2%)21 (21-22)1.097 (1.067-1.128)&amp;lt;0.0001Hispanic3038 (5.5%)38 (36-40)0.733 (0.696-0.772)&amp;lt;0.0001Asian1492 (2.7%)35 (33-38)0.812 (0.755-0.874)&amp;lt;0.0001Other991 (1.8%)32 (28-36)0.805 (0.738-0.878)&amp;lt;0.0001Charlson/Deyo comorbidity index&amp;lt;0.00010 (ref)44,069 (79.9%)29 (29-30)117982 (14.5%)19 (18-20)1.274 (1.238-1.312)&amp;lt;0.00012+661 (1.2%)11 (10-12)1.644 (1.576-1.715)&amp;lt;0.0001Molecular subtype&amp;lt;0.0001TNBC (ref)6721 (12.2%)12 (12-12)1HR+, HER2-27,905 (50.6%)32 (31-32)0.610 (0.588-0.632)&amp;lt;0.0001HR-. HER2+4171 (7.6%)30 (28-31)0.556 (0.529-0.585)&amp;lt;0.0001HR+, HER2+7394 (13.4%)40 (38-41)0.592 (0.566-0.619)&amp;lt;0.0001Radiation therapy&amp;lt;0.0001No (ref)36,848 (66.8%)24 (24-25)1Yes17,715 (32.1%)31 (31-32)1.036 (1.012-1.060)0.004Hormonal therapy&amp;lt;0.0001No (ref)24,662 (44.7%)14 (14-15)1Yes28,635 (51.9%)37 (36-37)0.449 (0.438-0.462)&amp;lt;0.0001Chemotherapy&amp;lt;0.0001No (ref)25,360 (46.0%)21 (20-21)1Yes28,342 (51.4%)32 (31-32)0.632 (0.616-0.649)&amp;lt;0.0001Immunotherapy&amp;lt;0.0001No (ref)48,276 (87.6%)25 (25-25)1Yes6616 (12.0%)41 (40-43)0.668 (0.639-0.698)&amp;lt;0.0001aNumber of cases with documented surgical status and survival data included in this model. #Median OS in months. Citation Format: Nadeem Bilani, Leah Elson, Hong Liang, Elizabeth Elimimian, Zeina Nahleh. Combined primary site resection and metastasectomy in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-35.

Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

Background: The role of surgery for small cell lung cancer (SCLC) is not clear. We aimed to evaluate this issue using a population-based database. Methods: Patients diagnosed between 2004 and 2014 with SCLC staged T1–4 N0–2 M0 disease were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to reduce bias between the surgical and nonsurgical patient groups. The Kaplan-Meier method and Cox regression analysis were used to compare overall survival (OS) for the matched patients. Results: A total of 8,811 patients were retrieved, including 863 patients who underwent surgical resection. After 1:1 PSM, a matched cohort with 1,562 patients was generated. In the matched cohort, surgery was associated with 5-year OS improvement (from 16.8 to 36.7%, p < 0.001) and lung cancer-specific survival improvement (from 21.6 to 43.2%, p < 0.001). Survival benefits of surgery were significant in all subgroups, including N1–2 disease, except for patients with a tumor size >5.0 cm or T3 disease. Conclusions: Patients with SCLC of limited stage can benefit from surgery, including N1–2 disease. However, patients with a tumor size >5.0 cm or advanced T stage may be unable to benefit from surgery.

Real-World Impact of Surgical Excision on Overall Survival in Primary Central Nervous System Lymphoma.

Substantial controversy still exists regarding the use of surgical excision in the treatment of primary central nervous system lymphoma (PCNSL). This study was aimed to evaluate the survival benefit of surgical excision in PCNSL patients based on a US population. Using the Surveillance, Epidemiology, and End Results (SEER) Program database, a total of 3,543 PCNSL patients were identified from 2000 to 2014 for analysis. Surgical excision was accessed via Kaplan–Meier and multivariate Cox regression survival analyses. Coarsened exact matching (CEM) analysis was additionally employed to intensify our findings. Finally, we found that surgical excision was significantly associated with increased survival over no surgery/biopsy (P < 0.001), and its survival benefit was also independent of baseline prognostic factors. The survival benefit of surgery was also validated in clinically important subsets. CEM analysis further validated the survival advantage of surgery (P < 0.001). Moreover, a novel prediction model with excellent performance was established to estimate the potential benefit from surgical excision of the lesion with respect to the end point of overall survival. The current study supports the favorable impact of surgical excision on clinical outcome in patients with PCNSL. Although further randomized controlled trials are warranted, currently available evidence should be considered in the clinical management of this disease.