FIGO changed the endometrialcancer staging system from a clinically to surgically based sys- tem in 1988, and revised in 2009, debate con- tinues regarding the roles, candidates for, and extent of surgical staging procedures especially in regards to lymphadenectomy. In the early- stages of endometrialcancer, whether SL or USL is more appropriate for patients is contro- versial for years. Although Pelvic lymph node metastases in endometrialcancer at pre-surgi- cal early stages are expected in 4.6% of cases , several studies suggest that lymph node resection is more reliable than surgery alone to determine whether endometrialcancer has metastasized and to reduce the risk of metas- tasis. And lymphadenectomy remains the most direct way to assess and reduce risk of metas- tasis [18-20]. Previous studies reported that high-risk patients who undergo para-aortic lymphadenectomy as part of their surgical stag- ing procedure exhibit higher survival rates than those who undergo simple surgical staging , two randomized controlled trials (RCTs) have shown that SL does not improve overall survival (OS) [6, 7]. Furthermore, SL may be associated with higher rates of lymph cysts and lymphedema .
Several previous studies have demonstrated that most “ young ” patients (premenopausal or aged 45 years or younger), who commonly have low-grade, minimally invasive tumors, have excellent clinical outcomes. 7,8 In addi- tion, the risk of myometrial invasion or lymph node metastasis in young patients is quite low. 9,10 Thus, the cure rate among this patient group is very high. Fertility-sparing treatment to improve patients ’ quality of life is an important consideration. The feasibility and safety of fertility-sparing treatment, mainly hormone therapy, in selected patients with early-stage EC or CAH have been demonstrated in multiple studies. 11–13 However, most studies were limited by a small sample size and/or a single-center design, and de ﬁ nitive conclusions could not be drawn. In contrast, several other researchers have demonstrated that fertility preservation may have a nonnegli- gible negative impact on patients ’ survival or risk of relapse.-
Abstract: Background: The value of systematiclymphadenectomy (SL) in the treatment of earlyendometrialcancer (ECC) is still being debated. The purpose of the present study was to assess the benefit of SL for ECC by performing a systematic review of the published literatures. Methods: Systematic research was performed on Pubmed Database, Embase, Medline, Web of Science and CENTRAL for studies from 2003 January to 2015 January. Firstly, the search was limited to clinical trials concerning the surgical treatments of endometrialcancerpatients which were written in English. Then, we included articles according the following criteria: 1) content of included study: comparison between SL group and no SL group; 2) ECC: stage I or II endometrialcancer according the International Federation of Gynecology and Obstetrics (FIGO) staging system in 1998 or 2009; 3) definition of SL versus no SL: removal of ≥10 lymph nodes or pelvic lymphadenectomy versus removal of versus <10 lymph nodes or pelvic and para-aortic lymphadenectomy. Methodological quality was assessed with the Jadad scale. Result: Eight studies were eligible for our analysis (including three randomized controlled trials and five observational studies), which included 13892 clinically ECC patients. On one hand, the results indicated that there was obvious difference between SL and no SL group in 5 year survival rate for ECC patients with high risk of lymph node metastasis (LNM) (OR 0.42, 95% CI, 0.26 to 0.68; P =0.0004). However, there was no statistical difference between SL and no SL group in 5 year survival rate for all ECC patients (OR 0.85, 95% CI, 0.60 to 1.21; P =0.37) and ECC patients with low risk of LNM (OR 0.73, 95% CI, 0.38 to 1.73; P =0.32). On the other hand, SL group has a higher incidence of long-term complications than no SL group (P<0.05). Conclusion: The present systematic review indicates that SL may improve 5 year survival rate for ECC patients with high risk of LNM, while risking then of long term complications.
Abstract: Background: In several studies, cytoreductive prostatectomy has been performed for the survival benefits in metastatic prostate cancer (mPCa). However, these researches revealed conflicting effects. The present study was designed to determine the relationship between cytoreductive prostatectomy and mPCa. Methods: Original articles concerning cytoreductive prostatectomy published until November 1st, 2018 were searched in PubMed database. The main clinical outcomes included overall mortality (OM), cancer-specific mortality (CSM) and progres- sion-free survival (PFS). Afterwards, meta-analysis was performed. Results: A total of 14 studies were included. Compared with no local therapy (NLT), radical prostatectomy (RP) of mPCa was associated with decreased OM (HR=0.47, 95% CI=0.44 to 0.51, I 2 =90.6%) and CSM (HR=0.36, 95% CI=0.31 to 0.43, I 2 =28.6%). Subsequent
 Fedirko V, Riboli E, Tjønneland A, Ferrari P, Olsen A, Bueno-de-Mesquita HB, van Duijnhoven FJ, Norat T, Jansen EH, Dahm CC, Overvad K, Boutron-Ruault MC, Clavel- Chapelon F, Racine A, Lukanova A, Teucher B, Boeing H, Aleksandrova K, Trichopoulou A, Benetou V, Trichopoulos D, Grioni S, Vineis P, Panico S, Palli D, Tumino R, Siersema PD, Peeters PH, Skeie G, Brustad M, Chirlaque MD, Barricarte A, Ramón Quirós J, Sánchez MJ, Dorronsoro M, Bonet C, Palmqvist R, Hallmans G, Key TJ, Crowe F, Khaw KT, Wareham N, Romieu I, McKay J, Wark PA, Romaguera D, Jenab M. Prediagnostic 25-hydroxyvitamin D, VDR and CASR polymorphisms, and survival in patients with colorectal cancer in western European ppulations. Cancer Epidemiol Biomarkers Prev 2012; 21: 582-93.
Our focus was on studies that evaluated the results of treatment in women with early BC. Our interested interven- tion was trastuzumab as adjuvant therapy in comparison with basic treatment without trastuzumab. Overall survival (OS) and disease- free survival (DFS) were considered as desired outcomes. Randomized controlled trials (RCTs) were the preferred study design. Studies that reported the results of monotherapy of the trastuzumab in BC were ex- cluded. Observational, experimental, and animal studies were also excluded.
The inclusion criteria were listed as follows: (1) studies dealing with CRC patients including the colon and rectum cancerpatients; (2) articles concerning about the association of LGR5 expression with either prognosis or clinicopath- ological features; (3) the expression of LGR5 was detected on cancer tissue, rather than in serum or any other kinds of specimens; (4) the detection method could be variable, including immunohistochemistry (IHC), tissue microarray and real-time PCR; (5) articles providing suffi- cient data to allow the estimation of an odds ratio (OR) of OS, PFS and clinicopathological features; (6) reviews, duplicated studies, com- ments, animal or cell experiments, and irrele- vant articles were excluded (Figure 1).
Based on results, this study was split into four parts: (1) Determination of whether IPF increased the risk of lung cancer through inci- dence of lung cancer in IPF patients; (2) Preoperative characteristics of patients with lung cancer and IPF (IPF-LC) and lung cancer only (LC-only) included age, sex (male), smoking status, primary site (left, low), operation per- formed (pneumonectomy, bilobectomy, lobec- tomy, limited resection), pathological stage (I, II, III, IV), histological diagnosis (adenocarcinoma, squamous carcinoma, large cell carcinoma, small cell carcinoma), pulmonary function test [percent forced vital capacity (%FVC), percent forced expiratory volume in 1 second (FEV1%), percent diffusing capacity of lung for carbon monoxide (%DLCO)], arterial blood gas analy- ses [arterial partial pressure of oxygen (PaO 2 ) (mmHg), and arterial partial pressure of carbon dioxide (PaCO 2 ) (mmHg)]; (3) Postoperative out- come measurements in IPF-LC and LC-only included postoperative pulmonary complica- tions, recurrence, AE, 30-day mortality, overall survival (OS), and disease free survival (DFS); (4) Preoperative characteristics of IPF-LC patients with or without AE included age, sex (male), surgery time, blood examination (white blood cell count (WBC, 10/UL), lactate dehydro- genase (LDH, IU/L), C reactive protein (CRP, mg/dl) and Krebs yon den lungen-6 (KL-6, U/ mL), pulmonary function test (%FVC, FEV1%, %DLCO), and arterial blood gas analyses [PaO 2 (mmHg), and PaCO 2 (mmHg)].
To further demonstrate the predictive value of pre-operative BMI and OS of EC patients, sub- group analyses for covariates adjusting were performed as a supplement. The analysis results of North America, sample size < 500, and prospective study groups showed signifi- cant association between higher pre-operation BMI group and OS of EC patients, comparing with lowest BMI group. Combined analysis of studies from other regions and sample size ≥ 500 revealed contrary results, pooled HR of was 0.92 (95% CI = 0.76-1.09) and 0.90 (95% CI = 0.67-1.12), respectively. When we analyzed the studies unadjusted for covariates, the asso- ciation between highest versus lowest pre- operation BMI category and OS of EC survivals was statistically significant (HR = 0.79, 95% CI = 0.64-0.95). However, we did not obtain mean- ingful result (HR = 0.93, 95% CI = 0.59-1.27) from studies adjusted for covariates. Only four studies included in this meta-analysis were adjusted for effect of tumor grade in EC cases. Survival of EC patients was strongly dictated by tumor stage after neoadjuvant chemotherapy . Both univariate (P = 0.007) and multivari- ate (P = 0.011) analysis revealed that better tumor grade was associated with longer sur- vival in esophageal cancer cases . Loss of weight, especially loss of skeletal muscle, may indicate the bad outcome of several cancers . Additionally, pancreatic cancerpatients who suffer from higher weight loss at diagnosis or during first-line chemotherapy had short- ened survival .
This study also showed that lymphadenectomy was the independent protective factor for postoperative relapse for Stage I OEC ( p = 0.0041), but the number of dissected lymph nodes was not. Theoretically, surgical resection of lymph nodes is conducive to preventing tumor microme- tastasis in patients with early-stage cancers. It has been re- ported in the literature that lymph node dissection reduces the probability of recurrence in patients with stage Ic or G2/G3 ovarian cancer, but had no effect on patients with stage IA/IB G1 ovarian cancer [15 – 17]. However, in Maggioni et al. ’ s study, 268 patients with early-stage ovarian cancer were randomly assigned to undergo lymphadenectomy and lymph node sampling and the results showed no significant difference in postopera- tive survival between the patients with or without being underwent lymphadenectomy . And Zhou et al. have conducted a meta-analysis and showed that systematiclymphadenectomy improved the OS for early-stage ovar- ian cancerpatients, but not DFS . The results of the latest larger-scale clinical study have verified lymphade- nectomy associated with a survival advantage for those with endometrioid carcinoma .
Study selection was conducted in two steps, (i) title and abstract and (ii) full text, in dupli- cate by two authors (LLPL and PHRFA). Conflicts over the inclusion of potential studies in the review were resolved by consensus between the two authors (LLPL and PHRFA). Rayyan application was used for title and abstract screening (https://rayyan.qcri.org) . Observa- tional studies evaluating women living in LAC countries with confirmed diagnosis of invasive breast cancer were considered eligible. For survival probability, clinical trials were also consid- ered eligible. We excluded studies evaluating: LAC women living in other regions (sometimes referred to latinas); patients diagnosed with Paget’s disease or Phyllodes tumor or which gave results including such patients; lactating and pregnant women; and exclusively men. Consider- ing that the incidence of male breast cancer is very low, studies that involve both sexes were not excluded even if results were not presented separately. Studies with a smaller population from the same location/registry of an included study were excluded because of the potential to include repeated patients. Multi-country studies not reporting results by country were excluded. We also excluded studies reporting only survival probability of early stages that included in situ cases and studies that reported stage at diagnosis only as aggregate categories including in situ stage (e.g.; earlystage: 0-IIa). For the survival probability outcome we excluded studies reporting only hazard ratios, and for stage at diagnosis we excluded studies evaluating specific disease stages.
The results of the present study are consistent with those of the meta-analysis conducted by Valachis et al. . However, there are additional considerations re- garding this comparison. First, the ZO-FAST study in- cluded in the current meta-analysis included data from a 60-month follow-up period, while the Valachis study an- alyzed data from a 54-month follow-up period. Secondly, the ABCSG-12 trial included 62- and 84-month follow-up data, while 62-month follow-up data were used in the present study. As a result, a more reliable evaluation of 5- year OS outcome was achieved. Third, while Valachis et al. analysed the OS for only five studies, and these did not include the Z-FAST and E-ZO-FAST trials which had negative results, the present meta-analysis did include all of these studies. Correspondingly, the present study in- cluded a robust sensitivity analysis. However, our review had several limitations to consider as well. First, our ana- lysis was based on published or presented data, and did not include individual patient data. Therefore, certain de- tails and prespecified subgroup data could not be ac- quired. For example, the AZURE trial  did not provide distant metastases data, thereby resulting in an incomplete analysis of DMFS (p-value = 0.05) for 3,995 patients. Secondly, subgroup analysis was not performed according to menopausal status since the definition of postmeno- pausal status was found to vary in the articles exam- ined. Furthermore, the majority of the subgroup analyses performed were unplanned, making comparisons unreli- able. Thirdly, some of the trials considered [16,17,22,23] included a control group that received a delayed adminis- tration of zoledronic acid. Moreover, if this treatment was
Abstract: Previous studies suggest an association between neuraxial anesthesia and cancer recurrence and survival for patients with prostate cancer. However, conclusions from these studies were controversial. Thus, we examine the association of neuraxial anesthesia (combined with or without general anesthesia (GA)) with prostate cancer recur- rence and survival after cancer surgery. Based on the inclusion and exclusion criteria, the association of neuraxial anesthesia with prostate cancer recurrence and survival were searched from various databases including PubMed, Embase, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI) up to July 10th, 2016 and the meta-analysis was performed with STATA and Review Manager statistical software. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the strength of the correlations. Additionally, different subgroup-analyses and a publication bias test were performed. Through a systematic literature search, 7 previous studies were identified and involved in this meta-analysis. Consequently, our evidence indicates no association be- tween neuraxial anesthesia and overall survival (OS) (HR=1.19, 95% CI=0.73-1.94, P=0.474) and recurrence-free survival (RFS) (HR=0.95, 95% CI=0.84-1.08, P=0.426) existed compared to GA. Similarly, no association was de- tected in different subgroups of RFS. In conclusion, this meta-analysis indicated there was no association between neuraxial anesthesia and prognosis of prostate cancer patient after surgery.
symptoms and the frequency of experiencing an inconvenient symptom (urinary-related qual- ity of life); score 0 being no symptoms and score 48 being severe overall filling/voiding/ incontinence symptoms. The degree of incon- venience of each symptom is measured on a Likert scale of 0 (least inconvenient) to 10 (extremely inconvenient). According to the degree of stress urinary incontinence (SUI) in the ICIQ-FLUTS questionnaire score standard, symptoms occurring less than 10 days in a peri- od of 4 weeks score as mild SUI (1 point), occur- ring 10-20 days score as moderate SUI (2 points), occurring more than 20 days score as severe SUI (3 points), occurring every day score as serious SUI . This questionnaire has been translated in Chinese dialects [12, 13]. Sexual functions of the study participants were assessed with the Female Sexual Function Index (FSFI); assessments were made twice: baseline and 12 months after surgery. This questionnaire was also translated in Chinese dialects [14, 15]. The survey is a brief, anony- mous multi-dimensional, questionnaire that is used to assess sexual function by asking 19 questions . The questions are grouped and scored for the domains of sexual desire (two questions), arousal (four questions), lubrication (four questions), orgasm (three questions), sat- isfaction (three questions), and pain during sexual intercourse (three questions). Domain factors are 0.6 for desire, 0.3 for arousal and lubrication, and 0.4 for orgasm, satisfaction, and pain. The total score was obtained by add- ing for each of the domains the sum of the scores and multiplying these sums by the domain factor. Therefore, the total FSFI score ranges from 2-36. A total score of 26.55 or less suggests female sexual dysfunction (FSD) . Patient follow-up was conducted through let- ters, telephone interviews and e-mail. If letters or e-mails were not answered after four attempts or phones were shut down, contact was made to either the patient’s unit or the police station. In cases where no information was returned, the patient was reported as “lost Table 3. Surgical outcomes in the two groups of patients
The summary result of this study found that pretreat- ment thrombocytosis was associated with a poor OS. Most of the included studies reported similar or non-significant trends for OS and several included studies reported incon- sistent results. Wang et al. did not observe a significant association between thrombocytosis before neoadjuvant chemotherapy and OS in patients with early-stage cervical cancer . Li et al. found that thrombocytosis before treat- ment was associated with an increased risk of mortality, although this association was not statistically significant in Cox regression analysis . Nakamura et al. reported pretreatment thrombocytosis to be associated with im- proved OS, which was not consistent with the results of previous studies . The potential explanations for this include differences in patient characteristics, treatment strategies, and platelet count cutoff values . Moreover, tumors may induce platelet activation and aggregation in the vasculature, which could cause the expression of angio- genesis regulatory factors .
Pancreatic ductal adenocarcinoma (PDAC) portends an overall poor prognosis and is expected to become the second lethal malignancy in the USA by 2030 [1, 2]. Al- though surgery remains the only curative-intent treat- ment for PDAC, the management based on surgery first (SF) has not substantially improved the survival of patients with potentially resectable disease over the past two decades, even after the effort of adjuvant therapy (AT) [2–4]. The main reason is the early recurrence caused by micrometastases that were not undetected be- fore surgery [3, 5, 6]. Based on these clinical evidence to- gether with other preclinical evidence, PDAC even in earlystage, analogous to breast cancer, should be recog- nized as a systemic disease [2, 7, 8]. Recently, neoadju- vant chemo(radio)therapy [NAC(R)T] is proposed as a new therapeutic strategy for early systemic treatment to increase completeness of resection (R0 rate) and control systemic micrometastases [3, 9]. The newest National Comprehensive Cancer Network (NCCN) guidelines, version 2.2018, recommended NACRT for the manage- ment of borderline resectable pancreatic cancer (BRPC). Also, NACRT is considered to be used in high-risk resectable pancreatic cancer (PRC). However, the recom- mendation of NCCN guidelines lacks high quality evi- dence [10, 11]. It is controversial for the application of NAC(R)T to RPC or BRPC in the real world, particularly in RPC, which is still intensely discussed at the European Society for Medical Oncology (EMSO) World Congress on Gastrointestinal Cancer 2019. Although there are several randomized controlled trials (RCTs) indicating NACRT increases survival in resectable or borderline re- sectable PDAC, the trials are limited by small sample sizes [9, 12]. It is still necessary to pool the existing stud- ies to perform a meta-analysis. Indeed, some scholars have done relevant meta-analyses, but most of them are single-arm meta-analyses, such as a recent meta-analysis by Versteijne et al. that lack direct comparison and ignore interstudy heterogeneity [11, 13, 14]. Other pub- lished meta-analyses did not focus on survival benefits . Additionally, it is a fact that the definition of RPC and BRPC has undergone several changes over time, which leads to the existence of mixture of RPC and BRPC in the population of included studies according to current standard of resectability status. From this point of view, interstudy heterogeneity exists in all previous meta-analyses.
Abstract: Background: The median age of patients with pancreatic ductal adenocarcinoma (PDAC) is approximately 70 years, and it rarely affects individuals younger than 45 years, when it is defined as early-onset pancreatic cancer (EOPC). Little is known about risk factors and outcomes for EOPC patients. Aim: To evaluate the clinico-pathological features, risk factors, and outcomes of EOPC. Methods: A retrospective analysis of pancreatic cancerpatients diag- nosed between January 1999 and December 2014 was performed. Information about environmental risk factors, clinical characteristics, treatment, and survival was collected. The risk factors of EOPC patients were compared to normal-onset pancreatic cancer (NOPC) patients. Results: Of 1789 patients with pathologically proven PDAC, 156 (8.7%) had EOPC. There was no difference regarding alcohol use, BMI, weight loss, and tumor location between EOPC and older subjects. EOPC patients were more likely to be male (75 vs. 63.9%) and to have a history of tobacco use (34.6% vs. 25.9%), compared NOPC patients. Among the 156 EOPC patients, there were 117 (75%) males, and 39 (25%) females, from 17 to 45 years old. Fifty-four (34.6%) had a smoking history, 55 had used alcohol, and 27 (17.3%) had a family history of cancer. For treatment, 32 underwent surgery to attempt curative resection of localized disease and 74 had palliative surgery. The median overall survival for the 156 EOPC patients was 8±0.5 months, with 1.2 years survival rates of 25.4 and 8%, respectively. For EOPC patients, the median overall survival of the patients treated with radical resection, palliative surgery, and medical treatment was 19±2.5, 8±0.6 and 6±0.3 months, respectively. The 1-year survival rates were 77.5, 17.6 and 4%, respectively. Survivalanalysis showed that the tumor size, tumor location, differentiation, treatment procedure, TNM stage, and first symptoms were associated with the overall survival (P < 0.05). Cox regression revealed that the TNM stage (RR=3.427; 95% CI: 1.802-6.519) and tumor size (RR=1.911; 95% CI: 1.054-3.463) are independent prognostic factors for EOPC patients. Conclusion: EOPC was associated with male gender and smoking history. Although EOPC patients display aggressive disease and have a worse outcome, radical resection is the best treatment. The TNM stage and tumor size are independent prognostic factors.
Abstract: The Japanese Gastric Cancer Treatment Guidelines (third edition) have assigned No. 7 station left gastric artery lymph nodes (LNs) to the D1 range of lymphatic dissection. We investigated the clinicopathological charac- teristics, survival impact, and appropriateness of ascribing No. 7 station LNs to D1 lymphadenectomy in gastric cancer. Patients (n=608) undergoing radical resection with No. 7 station LN dissection were recruited between January 1997 and June 2008. They were subdivided into four groups: N0, no LN metastasis; D1, LN without No. 7 station LN metastasis in the D1 lymphadenectomy region; No. 7, No. 7 station LN without LN metastasis in the D2 lymphadenectomy region; and D2, LN without No. 7 station LN metastasis in the D2 lymphadenectomy region. Of these, 17.2% (n=105) were positive for No. 7 LN metastasis, an important, independent prognostic factor associ- ated with poor clinicopathological parameters, advanced tumor stage, and reduced survival. Tumor behavior in the No. 7 group was similar to that in the D2 group, but poorer than in the D1 group in terms of advanced tumor stage, with 5-year survival rates of 34.3%, 25.9% and 54.6%, respectively. Five-year survival rates in the No. 7 group were comparable to those in the D2 group (P>0.05), but significantly lower than in the D1 group (P<0.05). Logistic mul- tivariate regression analysis established No. 3 and 9 station LN metastasis, node classification, and tumor-node- metastasis stage as independent risk factors for No. 7 station LN metastasis. Thus, No. 7 station LNs should be ascribed to D2 lymphadenectomy in gastric cancer.
Colorectal cancer is the 4th most common cancer and the second leading cause of can- cer-related death worldwide, creating a serious threat to public health. Approximately 20% of patients are diagnosed with metastatic colore- ctal cancer (mCRC, or stage IV CRC), and more than 1/3 of those initially diagnosed with local- ized disease will develop mCRC [1, 2]. Over the past several years, the distinction between right-sided and left-sided colorectal cancer has been emphasized for the following reasons: right-sided colorectal cancers (RCC) and left- sided colorectal cancers (LCC) are of different embryological origins, and thus various differ- ences exist between them. Recent studies have revealed an increased frequency of right- sided colorectal cancer over the last decade [3, 4], which has prompted the investigation of potential variations within different anatomic sites. Data regarding the prognosis of patients
as well as pelvic and para-aortic lymphadenectomy (PLND-PALND). In the case of histological subtype criterion endometrioid adenocarcinoma, FIGO grade 1 and 2, myometrial involvement less than 50%, and tumor size smaller than 2 cm, endometrialcancer would be considered a low risk (1). In these patients, the disease may be treated by the total hysterectomy and bilateral salpingo- oophorectomy since metastasis to lymph nodes is less than 4%. This therapeutic approach has no significant effect on the prognosis and therefore, lymphadenectomy can be ignored to prevent further morbidity and the related costs (2). Only a small proportion of patients with low-risk endometrialcancer may benefit from routine and comprehensive surgery like the lymphadenectomy. However, those with high–risk factors are treated with comprehensive staging surgery including PLND-PALND, Abstract