Case Report: Pulmonary Metastases From Epithelioid Sarcoma in Extremity Favourably Responding to Immunotherapy With Camrelizumab

Epithelioid sarcoma (ES) is a rare soft tissue sarcoma (STS), with limited therapies available for metastatic disease. Here, we describe a case of a 30-year-old male with ES of the left knee and underwent surgery and radiation therapy for the primary disease. After 2 years, he had local recurrence and underwent extensive resection surgery; however, adjuvant chemotherapies were delayed due to recurrent wound infection. Nine months after the second surgery, progressive disease was confirmed after detection of metastases to the lungs and inguinal lymph nodes. Amputation was performed for the local recurrence, followed by inguinal lymph nodes dissection. Pazopanib was transiently administered but discontinued as a result of wound dehiscence. The tumour specimens were detected with unexpected high level of PD-L1 expression and tumoural infiltrating lymphocytes. Subsequently, he received camrelizumab 2.0 mg/kg every 21 days for 18 cycles with rapid remission of the pulmonary metastases. This promising response to camrelizumab indicates that immunotherapies may be an alternative choice for patients with metastatic ES in lung based on analysing the tumour immune microenvironment.

Lymph Nodes Dissection Guided by Nano-carbon in Laparoscopic Rectal Cancer Surgery

BackgroundTo evaluate the role of nano-carbon as a tool for achieving adequate lymph nodes (LNs) dissection and to compare the number of LNs retrieved with and without the use of nano-carbon in laparoscopic rectal cancer surgery.MethodsProspective data collected from September 2018 to August 2019 was retrospectively analyzed. 35 rectal cancer patients received nano-carbon guided laparoscopic rectal cancer surgery were compared with 35 patients without nano-carbon guidance in the evaluation of number of LNs harvest, as well as whether adequate number of LNs retrieved (defined as ≥12).ResultsThe average number of LNs harvest was significantly higher in the nano-carbon group than that in the control group (16.4 vs. 12.1, P=0.008). In patients received neoaduvant therapy, the average number of LNs harvest was also significantly higher in the nano-carbon group than that in the control group (13.8 vs. 7.4, P=0.011). The percentage of adequate LNs retrieval was higher in the nano-carbon group than that in the control group (82.9% vs. 62.9%, P=0.038). In patients received neoaduvant therapy, the percentage of adequate LNs retrieval was much higher in the nano-carbon group than that in the control group (75.0% vs. 28.6%, P=0.021).ConclusionThe use of nano-carbon increases the number of LNs harvested compared with the conventional procedure in laparoscopic rectal cancer surgery.

Lymphadenectomy after neoadjuvant chemoradiation for esophageal adenocarcinoma: what is the optimal lymph nodes dissection?

Background The optimal lymph nodes dissection (LND) for esophageal adenocarcinoma (EAC) patients who underwent neoadjuvant chemoradiotherapy (NCRT) is controversial. Methods Patients were selected from Surveillance Epidemiology and End Results database. Multivariable Cox analysis was used to identify predictors of overall survival (OS). Restricted Cubic Splines (RCS) was used to examine the relationship between the number of LND and OS. Result 2,019 patients with non-metastatic EAC underwent NCRT were stratified into three groups according to LND using X-tile software: group 1: 1–8, group 2: 9–14, group 3: ≥15. In Multivariable Cox Regression analysis, the death risk was reduced by 22% (P = 0.001), 43% (P < 0.001) respectively, for patients in groups 2, 3 compared with those in group 1. The results were similar for patients with pathological lymph node-negative (ypN0) EAC patients. But for pathological lymph node-positive (ypN+) patients, a significantly reduced hazard was present only in group 3 (P < 0.001). RCS exhibited a nonlinear relationship between the number of lymph nodes removed and OS for ypN0 EAC (P = 0.002). The risk of death sharply dropped until around 24 nodes removed and then started to steadily increase afterward. However, for ypN + EAC, it showed a linear relationship between LND and OS (P = 0.205), with a better OS when an increase in the number of lymph nodes removed. Conclusions For ypN0 patients, the optimal LND was approximately 24 lymph nodes, with the number of lymph nodes removed beyond 24 nodes did not provide additional benefit. However, for ypN + patients, a more extensive lymphadenectomy could favor survival.

The concept of broad exposure facilitates uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection

Background Systematic lymph node dissection is an important part of radical resection for lung cancer. Insufficient incision of the mediastinal pleura results in a tapered or tunnel-like operation surface, which increases the difficulty of uniportal video-assisted thoracoscopic mediastinal lymph node dissection. The objective of this study was to report our concept of broad exposure and investigate the efficacy and safety of this concept in uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection. Methods We retrospectively analyzed the clinical data of the 204 non-small cell lung cancer patients who underwent uniportal video-assisted thoracoscopic surgery for anatomical lobectomy and systematic lymph node dissection following the concept of broad exposure. SPSS 23.0 software was used for statistical analysis. Results All operations were completed under uniportal video-assisted thoracoscopic surgery following the concept of broad exposure. The median surgery time was 102 (range, 76–285) minutes and the median blood loss was 50 (range, 20–900) milliliters. The median chest tube duration time was 2 (range, 1–6) days, the median postoperative hospital duration time was 5 (range, 4–10) days. The median number of dissected lymph node stations and dissected lymph nodes were 8 (range,6–9) and 15(range,12–19), respectively. The median number of dissected mediastinal lymph nodes stations and dissected mediastinal lymph nodes were 5(range,3–6) and 11(range,10–15), respectively. The up-staging rate of N staging was 6.86%. The postoperative complication rate was 10.29% and there was no perioperative death. Conclusions According to our results, it’s effective and safe to perform uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection following the concept of broad exposure. This new concept not only emphasizes sufficient exposure, but also focuses on protection of important tissues.

Metastasectomy in colorectal carcinoma (CRC) patients (pts) with mBRAF: Prospective database analysis.

e15549 Background: Role of metastasectomy in pts with mBRAF metastatic CRC is still controversial. We performed analysis of prospective multicentric database of pts with mBRAF mCRC to evaluate the efficacy of metastasectomy in such group of pts in the real clinical practice. Methods: We analyzed a database of pts with mCRC in 7 cancer clinics in Russia and chose pts with metastasectomy with different mutational status. The primary endpoints were disease free survival (DFS) and overall survival (OS), which were calculated from the time of metastasectomy. Analysis was performed with the SPSS v.20 software package. Results: The study included 126 pts: 26 pts with mBRAF, 57 pts with mRAS and 43 pts with wtRAS/BRAF. Pts with mBRAF more often had synchronous metastases (50%/19,3/11,6%, p<0,01), N2 status (38,5%/11%/19,6%, p=0,04). In mBRAF cohort all but 1 pt had V600 mutations; peritonectomy performed in 19,2%, liver resection – in 34,6%, lung resection, ovariectomy, metastasectomy in brain and retroperitoneal lymph nodes dissection with removal of the local relapse – over 11,5%; R0 resection was achieved in 88,5%. Median DFS was 7 months in mBRAF pts, 14 months in mRAS and not achieved in wtRAS/BRAF group treated (HR 2,1, 95%CI 1,5-3.1, p<0.01). Median OS was 26 months in mBRAF, 38 months in mRAS and not achieved in wtRAS/BRAF group (HR 1,5, 95%CI 1,0-2,4, p=0.06). Perioperative chemotherapy didn’t improve DFS in pts with mBRAF (HR 1,9, 95%CI 0,67-5,7, p=0,2). The best median DFS were in pts after ovariectomy – 10 months, the worst - after retroperitoneal lymph nodes dissection with removal of the local relapse – 2 months. Conclusions: Prognosis of pts with mBRAF after metastasectomy is worse than with other mutational phenotypes. However in selected cases metastasectomy might be considered in such aggressive mCRC.

Survival After Lobectomy Versus Sublobar Resection for Stage IA Large-Cell Neuroendocrine Carcinoma of the Lung: A Population-Based Study

Background: Due to the low incidence of pulmonary large cell neuroendocrine carcinoma (LCNEC), the survival analysis for comparing lobectomy and sublobar resection (SLR) for stage IA LCNEC remains scarce. Methods: Patients diagnosed with pathological stage IA LCNEC between 1998 and 2016 were extracted from the Survenillance, Epidemiology, and End Results (SEER) database. The oncological outcomes were cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier analysis and Cox multivariate analysis were used to identify the independent prognostic factors for OS and CSS. Furthermore, propensity score matching (PSM) was performed between SLR and lobectomy to adjust the confounding factors. Results: A total of 308 patients with stage IA LCNEC met the inclusion criteria: 229 patients (74.4%) received lobectomy and 79 patients (25.6%) received SLR. Patients who underwent SLR were older (P<0.001), had smaller tumor size (P=0.010) and fewer lymph nodes dissection (P<0.001). The 5-year CSS and OS rates were 56.5% and 42.9% for SLR, and 67.8% and 55.7% for lobectomy, respectively (P=0.037 and 0.019, respectively). However, multivariate analysis did not identify any differences between SLR group and lobectomy group in CSS (P=0.135) and OS (P=0.285); and the PSM also supported these results. In addition, age at diagnosis and laterality of tumor were identified as significant predictors for CSS and OS, whereas the number of lymph nodes dissection was a significant predictor for CSS. Conclusions: Although SLR is not inferior to lobectomy in terms of oncological outcomes for patients with stage IA LCNEC, more lymph nodes can be dissected or sampled during lobectomy. Lobectomy should be considered as a standard procedure for patients with early-stage LCNEC who are able to withstand lobectomy.