With recent advances in chemotherapy for unresectable pancreatic ductal adenocarcinoma (PDAC) with liver metastasis (LM), attempts have been made to resect the primary tumor in patients showing favorable responses to anti-cancer treatment (so-called “conversion surgery”; CS). This study aimed to clarify the outcomes of CS for PDAC with LM in a nationwide multicenter study. This retrospective, multicenter study was conducted as a project study of the Japan Pancreas Society and included patients with PDAC with LM at initial diagnosis, diagnosed radiologically or intraoperatively (occult LM), who underwent CS after at least 4 months of chemotherapy between 2010 and 2022. Survival outcomes and prognostic factors were analyzed. 90 patients were enrolled from 31 Japanese institutions. Median duration of preoperative chemotherapy was 10.4 (range, 4.2–58.5) months, and gemcitabine plus nab-paclitaxel was the most common first-line regimen, followed by folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin. Liver metastasectomy was performed in 27 patients (30
Abstract We analyzed the impact of the diagnosis-to-treatment interval (DTI) on survival in patients with CD5-positive diffuse large B-cell lymphoma (CD5 + DLBCL), using a data set of newly diagnosed patients. Among the 336 eligible patients, 247 (74%) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), and 89 (26%) were treated with dose-adjusted (DA)-EPOCH-R (etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, and rituximab). The median DTI was 18 days (range 0–118). The short DTI (≤ 14 days) group included 135 patients (40%), and the long DTI (> 14 days) group included 201 patients (60%). Compared with the long DTI group, the short DTI group had more aggressive disease characteristics. Both the progression-free survival (PFS) (P = 0.01) and the overall survival (OS) (P < 0.01) were significantly inferior in the short DTI group compared with those in the long DTI group. Among 89 patients who received DA-EPOCH-R, no significant differences in PFS (P = 0.92) or OS (P = 0.86) were observed between the two groups. Multivariate analysis revealed that no DA-EPOCH-R was a risk factor for PFS in the short DTI group (P = 0.06). A short DTI was a negative prognostic factor in our CD5 + DLBCL cohort. DA-EPOCH-R could be considered a potential treatment option for patients with a short DTI.
BACKGROUND:To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. METHODS:A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. RESULTS:Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. CONCLUSIONS:This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.
Radiotherapy (RT) is preferred over stent placement for dysphagia in unresectable esophageal squamous cell carcinoma (ESCC); however, low-radial-force self-expandable metallic stents (SEMS) may offer safer and more effective palliation. We aimed to compare the outcomes of RT and low-radial-force SEMS in ESCC patients. This retrospective study included patients with unresectable ESCC and dysphagia who underwent palliative RT or low-radial-force SEMS placement between 2013 and 2023. Adverse events were compared, and treatment efficacy was assessed based on changes in Dysphagia Score (DS) and the duration of maintaining DS ≤ 1 among those who achieved it. The stent and RT groups comprised 34 and 45 patients, respectively. Treatment-related adverse events of Grade ≥ 2 and ≥ 3 occurred in 29.4
BACKGROUND: Japan Clinical Oncology Group (JCOG) defined gastric cancer (GC) with bulky lymph node (Bulky N) and/or para-aortic lymph node (PAN) as extensive lymph node metastasis (ELM), and has developed neoadjuvant chemotherapy followed by D2 gastrectomy with PAN dissection (PAND) through three phase II trials using different regimens (JCOG0001: irinotecan/cisplatin, JCOG0405: cisplatin/S-1, JCOG1002: docetaxel/cisplatin/S-1). However, whether PAND provides survival benefit remains uncertain. METHODS: The therapeutic value index was investigated using integrated data from JCOG0001, JCOG0405, and JCOG1002. Patients were classified into Bulky N group (only bulky N without PAN) and PAN group (PAN regardless of bulky N) based on the clinical diagnosis. The index was calculated by multiplication of incidence of metastasis and percentage 5-year relapse-free survival (5yRFS) of patients with metastasis for each lymph node area. RESULTS: A total of 122 patients were analyzed (Bulky N group: 68, PAN group: 54). In Bulky N group, the proportion of metastasis/5yRFS/index in the PAN area was 15.2%/30.0%/4.5 (JCOG0001: 27.8%/20.0%/5.6, JCOG0405: 13.6%/33.3%/4.5, JCOG1002: 7.7%/50.0%/3.8). The proportion of metastasis decreased across trials. In PAN group, the proportion of metastasis/5yRFS/index in the PAN area was 44.4%/4.2%/1.9 (JCOG0001: 81.3%/7.7%/6.3, JCOG0405: 30.0%/0.0%/0.0, JCOG1002: 27.8%/0.0%/0.0). Notably, the indices of the recent two trials were zero. CONCLUSIONS: PAND may retain a potential role in the Bulky N group, whereas its benefit appears limited in the PAN group. Decreasing trends in PAN metastasis and therapeutic value were observed in both groups. Given the distinct characteristics of these subgroups, the omission of PAND should be determined through separate future validation.
