Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
Background:Information on long-term outcomes of colorectal endoscopic submucosal dissection (ESD) in real-world clinical practice remains limited. This study aimed to evaluate long-term local recurrence and its predictors after colorectal ESD. Methods:This prospective, multicenter study was conducted at 11 institutions in Hiroshima, Japan, and included all consecutive colorectal ESD cases (1838 lesions from 1732 patients) between 2014 and 2018. The primary outcome was the cumulative local recurrence rate. The secondary outcomes included factors associated with local recurrence, overall survival, and cancer-specific survival. Factors associated with local recurrence were evaluated using cause-specific Cox proportional hazards models using Firth's penalized partial likelihood. Results:The cumulative local recurrence rates at 1, 3, and 5 years were 0.06%, 0.64%, and 0.75%, respectively. The longest interval to recurrence was 52 months. No local recurrence was observed in patients who achieved curative resection. Rectal lesions (hazard ratio [HR] 3.93; P = 0.04), high-risk pathologic features (HR 14.3; P < 0.001), R1 resection (HR 7.59; P = 0.003), and delayed bleeding (HR 7.72; P = 0.009) were associated with local recurrence. The 5-year overall survival and cancer-specific survival rates were 95.3% and 100%, respectively; however, 1/10 patients with local recurrence developed liver and lung metastases and subsequently died 64 months after ESD. Conclusions:Colorectal ESD had a very low long-term local recurrence rate in real-world clinical settings. No recurrence was observed in patients who underwent curative resection. Long-term surveillance is warranted after noncurative resection.
Background: With the growing older adult population in developed countries, the number of older adults with cancer is also rising. Selecting appropriate treatments for these patients is challenging, owing to difficulties in assessing their tolerance to invasive surgery. This study aimed to identify the prognostic factors in octogenarians undergoing first-time hepatectomy for hepatocellular carcinoma (HCC). Methods: We enrolled 229 consecutive patients with resected HCC between 2008 and 2018, excluding three who died within 90 days post-surgery. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS) and recurrence-free survival (RFS). Results: Participants were aged 80–93 years and included 163 males and 63 females, with the majority having hepatitis C virus. Liver function was well-preserved (Child–Pugh grade A: 215; grade B: 12). Laparoscopic hepatectomy was performed in 34 patients. The following factors showed significant association with OS in the univariate analysis: age-adjusted Charlson comorbidity index (ACCI) ≥ 10, neutrophil-to-lymphocyte ratio ≥ 3, alpha-fetoprotein (AFP) > 100 ng/mL, tumor size > 50 mm, and multiple tumors. Multivariate analysis confirmed ACCI ≥ 10, AFP > 100 ng/mL, tumor size > 50 mm, and multiple tumors as independent risk factors for OS. Regarding RFS, the significant factors identified in the univariate analysis included sex, indocyanine green retention rate at 15 min > 10%, des-gamma-carboxy prothrombin > 500 mAU/mL, intraoperative bleeding, tumor size, multiple tumors, and vascular invasion. Multivariate analysis identified sex, multiple tumors, and vascular invasion as independent risk factors for RFS. Conclusions: Elevated tumor markers, multiple tumors, and ACCI ≥ 10 are risk factors for poor OS in older adults with primary HCC. Both tumor-related factors and ACCI score should be considered when selecting treatment for octogenarian patients with HCC.
Background: There is no clear information on structural changes of rotator cuff tears during nonsurgical management. In particular, the risk factors for the progression of tear size and fatty infiltration still remain poorly understood. Identifying such factors is essential for optimizing treatment strategies and follow-up planning. Methods: We retrospectively examined 80 shoulders (43 men, 37 women; mean age, 68.4 years) with partial- and full-thickness rotator cuff tears treated nonsurgically. All patients underwent initial and follow-up magnetic resonance imaging examinations at ≥12 months, with a mean follow-up of 22.2 ± 12.6 months. Progression of supraspinatus (SSP) tear size was defined as a mediolateral increase of ≥10 mm or ≥5 mm/yr, and progression of SSP fatty infiltration was defined as an increase in the modified Goutallier classification. Univariate analyses were conducted to determine potential risk factors, including age, sex, initial tear size, subscapularis (SSC) tear, infraspinatus (ISP) tear, initial fatty infiltration of SSC, SSP, and ISP, critical shoulder angle (CSA), and the presence of persistent pain at follow-up. Factors with significant associations were entered into multivariate logistic regression for determining independent predictors. Results: On follow-up magnetic resonance imaging, both SSP tear size and fatty infiltration demonstrated significant progression. Univariate analyses revealed a significant association between tear size progression and initial tear size (P < .001), SSC fatty infiltration (P = .004), and larger CSA (P = .013). SSP fatty infiltration progression was significantly associated with older age (P = .04), initial tear size (P = .01), SSC tear (P = .03), SSC fatty infiltration (P < .001), and larger CSA (P = .04). Multivariate logistic regression identified medium-sized tears (odds ratio [OR], 17.1; 95% confidence interval [CI], 4.3-68.3; P < .001) and SSC fatty infiltration grade ≥ 2 (OR, 8.1; 95% CI, 1.7-38.5; P = .009) as independent risk factors for SSP tear size progression, whereas CSA was not significant (OR, 1.1; P = .2). For fatty infiltration progression, SSC fatty infiltration grade ≥ 2 was an independent risk factor (OR, 10.4; 95% CI, 1.7-64.1; P = .01), whereas age (OR, 1.2; P = .05), medium-sized tears (OR, 3.3; P = .13), SSC complete tear (OR, 1.9; P = .5), and CSA (OR, 1.1; P = .41) were not significant. Conclusion: Progression of SSP tear size and fatty infiltration during nonsurgical treatment is closely associated with SSC fatty infiltration. Monitoring of SSC involvement may help identify patients at higher risk for progression of SSP tear size and fatty infiltration and support decisions.
The prognosis for patients diagnosed with oral mucosal melanoma is poor, and the etiology of this disease remains to be elucidated. The underlying reason for this is that no malignant melanoma (MM) cell line derived from oral mucosal tissue has been successfully established to date. The establishment of a human MM cell line designated OS-MM from a tissue sample of a patient diagnosed with palatal mucosal melanoma was undertaken. For a period exceeding three decades, tumor cells have undergone uninterrupted proliferation, exhibiting a spindle-like morphology. Chromosomes exhibit a low-triploid pattern with an observed mode of 47. Heterotransplantation of the cells into SCID mice has resulted in the formation of tumor masses. The cells expressed vascular endothelial growth factor (VEGF) and its receptors. The addition of exogenous recombinant VEGF165 did not alter proliferation but enhanced motility. A genetic analysis of OS-MM cells revealed the absence of BRAF and NRAS mutations; however, a GNAS mutation was identified. The OS-MM cell line should contribute to advances in personalized therapy for malignant oral mucosal melanoma.
