Prognostic Analysis of Different Metastatic Patterns in Invasive Intraductal Papillary Mucinous Neoplasm: A Surveillance, Epidemiology, and End Results Database Analysis

Objective. To evaluate the impacts of different metastatic patterns on the prognosis of patients with invasive intraductal papillary mucinous neoplasm (IPMN). Materials and Methods. All patients who were diagnosed with invasive IPMN in the Surveillance, Epidemiology, and End Results SEER database (2010–2015) were included in this study. They were grouped according to different metastatic patterns. Kaplan–Meier analysis and log-rank test were used for the comparison of their survival rates. The hazard ratio (HR) with 95% confidence interval (CI) was analyzed using the Cox proportional-hazards model. Results. A total of 2264 cases were included in this study. The most common metastatic site was the liver. The patients with the nonorgan metastasis demonstrated the best survival outcomes, while those with multiple metastases showed the worst survival outcomes. As compared to the patients with isolated liver metastasis, those with isolated lung and other organ metastases showed better overall survival rates and tumor-specific survival rates. The patients with liver, lung, multiple, and other organ metastases or of age >60 years were the independent predictors of poor prognosis. Conclusions. The patients with isolated lung and other organ metastases demonstrated better survival outcomes as compared to those with isolated liver metastasis. The patients with nonorgan metastasis demonstrated the best survival outcomes, while those with multiple metastases showed the worst survival outcomes. Further studies are needed to determine a highly selected subset of patients, who might benefit from surgery or chemotherapy.

Prognostic Value of Tumor Deposits in Colorectal Cancer: A Population-based Retrospective Cohort Study

BackgroundThe role of tumor deposits (TDs) in TNM staging of colorectal cancer is controversial, especially the relationship with distant metastasis.PurposeThe aim of this study was to determine the effect of TDs on the survival of colorectal cancer and the occurrence of distant metastasis, and to determine whether TDs (+) patients behaved similarly to stage IV patients.MethodsRetrospective analysis of CRC patients from two large independent cohorts from the Surveillance Epidemiology and End Results (SEER) database (n=58775) and the First Affiliated Hospital of Dalian Medical University (n=742).ResultsUnivariate logistic analyses revealed that TDs as an independent predictor of liver metastasis [p<0.001; odds ratio (OR): 5.738; 95% confidence interval (CI): 3.560-9.248] in the The First Affiliated Hospital of Dalian Medical University’s patients. Meanwhile, TDs was also an independent predictor of isolated organ metastasis [p<0.001; odds ratio (OR): 3.028; 95% confidence interval (CI): 2.414 - 3.79; multiple organ metastases [p<0.001; odds ratio (OR): 4.778; 95% confidence interval (CI): 4.109 - 5.556]; isolated liver metastasis [p<0.001; odds ratio (OR): 4.395; 95% confidence interval (CI): 4.099 - 4.713] and isolated lung metastasis [p<0.001; odds ratio (OR): 5.738; 95% confidence interval (CI): 3.560-9.248] in the SEER database. Multivariate analyses suggested TDs were an independent poor prognostic factor for distant metastasis (p<0.001).ConclusionsOur results have shown that compared with patients with negative TDs, CRC patients with positive TDs are more likely to develop distant metastasis. Patients who categorized T4aN2bM0 TDs (+) and T4bN2M0 TDs (+) have similar prognosis as those with stage IV, and these patients should be classified as stage IV.

A Comparative Study of Intralobar Sequestration and Extralobar Pulmonary Sequestration

Objective: This study aims to identify the difference between patients who have been diagnosed with either intralobar sequestration (ILS) or extralobar sequestration (ELS).Methods: In this clinical study, 29 children with pulmonary sequestration (PS), diagnosed via physical examination and imaging at our hospital between January 2019 and January 2020, were enrolled. We compared whether statistical differences existed in the blood loss, operative time, and post-operative hospital stay between the two groups (ILS and ELS) after thoracoscopic pulmonary wedge resection.Results: There were no significant differences in gender, operative age, preoperative weight, and isolated lung position between the ILS and ELS groups (p > 0.05). There was significantly more intra-operative bleeding in children with ILS than those with ELS (p < 0.05), and the operation time and postoperative hospitalization times were significantly longer for those with ILS(p < 0.05). Upon microscopic evaluation after surgery, we found the appearance of ILS and ELS to be similar.Conclusion: Different types of congenital PS have different influences onnewborns during and after operation. For children with ILS, surgery is more difficult and the postoperative recovery is slower than for children with ELS. For this reason, we suggest that more attention should be paid to the clinical treatment of children with ILS. Although ILS and ELS present with different manifestations, we found no evidence of a significant difference in the postoperative microscopy of the two conditions.

Complete lung agenesis caused by complex genomic rearrangements with neo-TAD formation at the SHH locus

During human organogenesis, lung development is a timely and tightly regulated developmental process under the control of a large number of signaling molecules. Understanding how genetic variants can disturb normal lung development causing different lung malformations is a major goal for dissecting molecular mechanisms during embryogenesis. Here, through exome sequencing (ES), array CGH, genome sequencing (GS) and Hi-C, we aimed at elucidating the molecular basis of bilateral isolated lung agenesis in three fetuses born to a non-consanguineous family. We detected a complex genomic rearrangement containing duplicated, triplicated and deleted fragments involving the SHH locus in fetuses presenting complete agenesis of both lungs and near-complete agenesis of the trachea, diagnosed by ultrasound screening and confirmed at autopsy following termination. The rearrangement did not include SHH itself, but several regulatory elements for lung development, such as MACS1, a major SHH lung enhancer, and the neighboring genes MNX1 and NOM1. The rearrangement incorporated parts of two topologically associating domains (TADs) including their boundaries. Hi-C of cells from one of the affected fetuses showed the formation of two novel TADs each containing SHH enhancers and the MNX1 and NOM1 genes. Hi-C together with GS indicate that the new 3D conformation is likely causative for this condition by an inappropriate activation of MNX1 included in the neo-TADs by MACS1 enhancer, further highlighting the importance of the 3D chromatin conformation in human disease.

Novel agents in a young patient with osteosarcoma: A short review

SummaryOsteosarcomas are rare malignant bone tumors, most frequently occurring in children as well as adolescents and young adults. Therapy of initially localized disease consists of neoadjuvant chemotherapy followed by surgical resection and adjuvant chemotherapy. Osteosarcomas often present relapses, most commonly lung metastases. Treatment of isolated lung metastasis most commonly includes surgical resection. The correct adjuvant treatment option is still under investigation. In this manuscript we describe the clinical course of an osteosarcoma patient and give a review of the literature regarding current standard treatment for localized as well as pulmonary metastatic disease.

Sites of Distant Metastases and Cancer-Specific Survival in Intraductal Papillary Mucinous Neoplasm With Associated Invasive Carcinoma: A Study of 1,178 Patients

BackgroundTo explore the impact of distant metastases on cancer-specific survival in patients with intraductal papillary mucinous neoplasm (IPMN) with associated invasive carcinoma and identify the risk factor of distant metastases in IPMN with associated invasive carcinoma.MethodsPatients with IPMN with associated invasive carcinoma between 2010 and 2015 were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database. The survival analyses were assessed by Kaplan-Meier analyses and log-rank test. The impact of distant metastases was evaluated by Cox regression model and the risk factors of distant metastases were identified by logistic regression analyses, respectively.ResultsThe median cancer-specific survival time of patients with no metastases, isolated liver, isolated lung, and multiple site metastases were 19 months, 4 months, 7 months, and 3 months, respectively. In patients with isolated liver metastases, multivariate analysis after adjustment indicated that chemotherapy (Hazard Ratio [HR]=0.351, 95% confidence interval [CI]=0.256-0.481, P&lt;0.001) was a protective prognostic factor for cancer-specific survival (CSS) in patients with isolated liver metastases. In isolated lung metastases subgroup, old age (HR=1.715, 95% CI=1.037-2.838, P=0.036) and chemotherapy (HR=0.242, 95% CI=0.134-0.435, P&lt;0.001) were related to CSS in multivariable Cox regression analysis(P&lt;0.05). Tumor located in the pancreatic body/tail (HR=2.239, 95% CI=1.140-4.400, P=0.019) and chemotherapy (HR=0.191, 95% CI=0.108-0.340, P&lt;0.001) were independent prognostic factors for CSS in patients with multiple metastases. Finally, a nomogram was constructed for cancer-specific survival and the predicted C-index was 0.780 (95% CI=0.762-0.798).ConclusionThe liver is the most common site of distant metastases in IPMN with associated invasive carcinoma. Tumor located in the pancreatic body/tail and chemotherapy are independent prognostic factors for CSS in patients with multiple metastases. Further, tumor located in body/tail is identified as a risk factor of distant metastases.

German Heart Surgery Report 2020: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2020 are analyzed. Under the more than extraordinary conditions of the ongoing worldwide coronavirus disease 2019 pandemic, a total of 161,817 procedures were submitted to the registry. A total of 92,809 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 29,444 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.6:1) was 97.2%. For the 35,469 isolated heart valve procedures, (17,471 transcatheter interventions included), the survival rate was 96.7%. Concerning short- and long-term circulatory support, a total of 2,852 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively, 843 assist device implantations (left/right/biventricular assist device, total artificial device), were registered. In 2020, the number of isolated heart transplantations increased to 340, a rise of 2.1% compared with the previous year. The isolated lung transplantations amounted to 291, a decrease of 6.4%.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.