bims-netuvo 2024-10-27 papers

Issue of 2024‒10‒27
six papers selected by
Maksym V. Kopanitsa, Charles River Laboratories

Medicine (Baltimore). 2024 Oct 18. 103(42): e40087

The relationship between the Prognostic Nutritional Index and lymphovascular and perineural invasion of the tumor in patients diagnosed with gastric cancer, and its effect on overall survival.

Pırıltı Özcan, Mehmet Sinan Çarkman.

A low Prognostic Nutritional Index (PNI) value, lymphovascular invasion (LVI), and perineural invasion (PeNI) have been identified as indicators of poor prognosis for many malignancies. We aimed to evaluate the relationship between PNI and LVI/PeNI, their prognostic significance, and their effect on overall survival in gastric cancer patients who underwent curative gastrectomy. A cutoff value of 39.8 was taken for the PNI, and PNI < 39.8 was defined as moderate to severe malnutrition. Patients were grouped as PNI-low (PNI < 39.8) and PNI-high (PNI ≥ 39.8). Paraffin-embedded tissue sections of surgical specimens were used to evaluate PeNI as defined by previously reported criteria. The study included 270 patients with ages ranging from 23 to 90 years. The mean PNI was calculated as 39.8 ± 6.35. PeNI was detected in 232 patients (85.93%), and LVI was identified in 248 patients (91.85%). It was observed that the PNI value of patients with an expired status in the PNI < 39.8 group was lower compared to those who survived, and in patients with PNI > 39.8, those without PeNI had better survival. The presence of PeNI in patients with PNI > 39.8 increased the mortality risk by 2.088 units, while in patients with PNI > 39.8, it was found that those without LVI had better survival, and the presence of LVI increased the mortality risk by 3.171 units. Mortality developed in 166 patients (61.48%) during the five-year follow-up period. The five-year overall survival was found to be 31.02 ± 21.73 months. In patients with gastric cancer, the PNI, LVI, and PeNI are independent prognostic factors for overall survival in postoperative patients. A low PNI score is an inherently poor prognostic factor. In patients with a high PNI score, the presence of positive LVI and PeNI negatively impacts survival. We found that in patients with a low PNI, the rates of PeNI and LVI are higher compared to those with a high PNI, and this significantly affects mortality.

DOI: https://doi.org/10.1097/MD.0000000000040087

World J Surg Oncol. 2024 Oct 22. 22(1): 277

Comprehensive neurosurgical and visceral surgical therapy of retroperitoneal nerve tumors: a descriptive and retrospective analysis.

Martin Petkov, Marko Kornmann, Ute Marlies Bäzner, Lena Minzenmay, Andrej Pala, Maria Teresa Pedro, Christian Rainer Wirtz, Gregor Antoniadis.

Nerve tumors in the retroperitoneal space are a rarity. Radical surgery according to soft tissue tumors can lead to persistent pain and neurological deficits. This study aims to evaluate clinical outcomes of patients treated by a visceral- / neurosurgical approach. 33 patients with a retroperitoneal nerve tumor underwent surgery between 01/2002 and 12/2022 at our department. A visceral surgeon provided access to the retroperitoneal space, followed by micro-neurosurgical tumor preparation under neuromonitoring. Clinical examination and MRI were performed 12 weeks after surgery and further 3 months (WHO grade > 1) or 12 months (WHO grade 1). Further examinations were based on MRI findings and residual symptoms with median follow-up time of 24 months. One patient was treated for two distinct masses resulting in a total of 34 histological findings. Schwannomas (n = 15; 44.1%) and neurofibromas (n = 10; 29.4%) were the most common tumors. Long-term improvements were noted in radicular pain (15/18 patients; 83.3%), motor deficits (7/16 patients; 43.8%), abdominal discomfort and pain (5/7 patients; 71.4%). Recurrences were observed in 3/33 (9,1%) patients. This study represents the largest series of retroperitoneal BPNSTs treated with microsurgical techniques. Prospective multicenter studies are warranted to establish standardized treatment guidelines.

Keywords: BPNST; MPNST; Nerve; Peripheral; Retroperitoneum; Surgery; Tumor; Visceral

DOI: https://doi.org/10.1186/s12957-024-03557-5

Neurooncol Adv. 2024 Oct;6(Suppl 3): iii83-iii93

Current state of spinal nerve sheath tumor management and future advances.

Chloe Gui, Luxshikka Canthiya, Gelareh Zadeh, Suganth Suppiah.

Nerve sheath tumors are the most common tumors of the spine after meningiomas. They include schwannomas, neurofibroma, and malignant peripheral nerve sheath tumors. These can arise sporadically or in association with tumor predisposition syndromes, including neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis. Though surgery is the traditional mainstay of treatment for these tumors, the discovery of the genetic and molecular basis of these diseases in recent decades has prompted investigation into targeted therapies. Here, we give a clinical overview of spinal nerve sheath tumors, their imaging features, current management practices, and explore ongoing advances in systemic therapies.

Keywords: malignant peripheral nerve sheath tumor; neurofibroma; neurofibromatosis; schwannoma; spinal nerve sheath tumor

DOI: https://doi.org/10.1093/noajnl/vdae067

Adv Radiat Oncol. 2024 Nov;9(11): 101619

Clinical Outcomes of Carbon Ion Radiation Therapy for Malignant Peripheral Nerve Sheath Tumors.

Maria Rosaria Fiore, Agnieszka Chalaszczyk, Amelia Barcellini, Viviana Vitolo, Giulia Fontana, Stefania Russo, Marco Rotondi, Silvia Molinelli, Alfredo Mirandola, Alessia Bazani, Ester Orlandi.

Purpose: To investigate the outcome and toxicity of patients affected by malignant peripheral nerve sheath tumors (MPNSTs) treated with high-dose carbon ion radiation therapy (CIRT).Methods and Materials: We retrospectively analyzed the outcome of 23 patients with MPNSTs treated between July 2013 and December 2020. Out of these, 13 patients (56.5%) had incompletely resected tumors, 8 patients (34.7%) experienced recurrence after surgery, and 2 patients (8.7%) had unresectable tumors. Before CIRT treatment, 4 patients underwent a second surgery after the first local recurrence (LR), and 1 patient underwent a third surgery for the second local relapse of the disease. Six (26%) patients received neoadjuvant chemotherapy. The most frequent tumor site was the brachial plexus (n = 9; 39.1%). In 5 patients (21.7%), neurofibromatosis type 1 disorder was found, while 4 patients (17, 4%) had radiation-induced MPNSTs. The median CIRT prescribed total dose was 69.8 Gy (relative biological effectiveness; range, 54-76.8) delivered in a median of 16 fractions (range, 15-22). Eleven patients (47.82%) were treated according to a sequential boost protocol with a median prescribed dose to clinical target volume LR of 45 Gy (relative biological effectiveness; range, 41.4-54).
Results: After a median follow-up time of 23 months (range, 3-100 months), the overall survival rates at 1 and 2 years were 82.38% and 61.51%, respectively. The 1-year and 2-year local relapse-free survival rates were 65.07% and 48.80%, respectively, and the 1-year and 2-year progression-free survival rates were 56.37% and 40.99%, respectively. No patients showed acute or late grade 4 toxicity or any treatment-related deaths. Ten patients (43.48%) reported acute toxicities of grade ≥ 2, which included dermatitis in 6 patients, mucositis in 2 patients, and peripheral neuropathy in 4 patients. Eight patients (34.78%) reported late toxicities of grade ≥ 2, mainly due to loco-regional neuropathy.
Conclusions: High-dose CIRT shows favorable local effects with acceptable toxicities in patients with gross residual and LR after surgery or unresectable malignant peripheral nerve sheath tumors. Advanced treatment modalities such as particle therapy should be considered for MPNSTs.

DOI: https://doi.org/10.1016/j.adro.2024.101619

Plast Surg (Oakv). 2024 Nov;32(4): 705-710

Solitary Extremity Schwannoma: A 20-Year Review of Outcomes.

Rachel V Currie, Kevin M McGarry, Serena V Martin, Andrew J Robinson, Harry Lewis.

Background: Reports on benign peripheral nerve sheath tumour extirpation over the last number of decades describe varying patient outcomes. We present our outcomes following excision of solitary extremity schwannoma over a 20-year period. Methods: A regional histopathology review was conducted for, "benign nerve sheath tumour" and schwannoma between 2000 and 2020. This search provided 131 histologically confirmed schwannomas that were excised from the extremities of 123 patients. Individual charts were reviewed retrospectively to establish presenting features and post-operative outcomes. Results: One hundred and twenty three patients underwent schwannoma excision, including 8 patients with synchronous tumours. The mean age at presentation was 49 years (range 11-92 years). The most common presenting symptoms were the following: palpable mass (88%), pain (70%), paraesthesia (21%), numbness (13%), and motor deficit (4%). Post-operative follow-up ranged from 1 to 168 months (mean 12.3 months) (N = 99). Fifty-eight cases reported complete resolution of symptoms by end of outpatient follow-up (59%). The remaining reported either residual or new numbness (21%), paraesthesia (11%), pain (10%), weakness (4%), hypertrophic or keloid scar (3%), or a combination. Thirty patients (30%) developed new symptoms post-operatively including numbness (13%), paraesthesia (10%), pain (2%), and weakness (2%). There was a trend towards higher risk of post-operative pain, numbness or paraesthesia in patients undergoing excision of schwannomas on larger mixed nerves than in patients undergoing excision on smaller sensory nerves (P = .0531). Conclusion: Surgical excision of benign schwannomas is a successful procedure, especially for pain management, however, complete symptom resolution cannot be guaranteed, and the risk of new or persisting numbness, paraesthesia, pain, and weakness should be highlighted to patients during the consent process.

Keywords: nerve surgery; peripheral nerve sheath tumour; schwannoma

DOI: https://doi.org/10.1177/22925503231169779

Quant Imaging Med Surg. 2024 Oct 01. 14(10): 7524-7539

Combination of single-source dual-energy computed tomography (CT) parameters and extracellular volume fraction for predicting lymphovascular and perineural invasion in colorectal cancer.

Yuting Zhang, Yurong Wen, Shenglin Li, Liangna Deng, Tao Han, Mengyuan Jing, Jianhong Zhao, Junlin Zhou.

Background: Lymphovascular invasion (LVI) and perineural invasion (PNI) are important histopathological variables that are directly related to the survival and recurrence of patients with colorectal cancer (CRC). Preoperative prediction of LVI and PNI status in CRC is helpful in selecting patients requiring appropriate adjuvant therapy and evaluating prognosis. This study aimed to investigate the value of combining single-source dual-energy computed tomography (ssDECT)-derived parameters with extracellular volume (ECV) fraction for preoperative evaluation of LVI and PNI in CRC.Methods: This retrospective study included patients with CRC who underwent contrast-enhanced ssDECT. All diagnoses were confirmed through histopathology, and the patients were classified into positive and negative groups based on the presence of LVI/PNI. Clinical data were collected. In the arterial (AP), venous (VP) and delayed phases (DP), the ssDECT-derived parameters were measured by two radiologists. The measurement consistency was evaluated using intraclass correlation coefficients. Differences between the two groups were analyzed using the t-test, Mann-Whitney U test, or Chi-square test. Binary logistic regression was employed to construct models incorporating multiple parameters. The diagnostic performance of various parameters or models was assessed by analyzing receiver operating characteristic curves.
Results: In total, 118 patients with CRC were included in the study. Serum carcinoembryonic antigen levels, T and N stages, and histological grades differed between the two groups (all P<0.05). The ssDECT-derived parameters in the VP and DP of LVI/PNI-positive group were higher than those of -negative group (all P<0.05). The ECV fraction in the DP of LVI/PNI-positive group was higher than that of -negative group (P=0.001). Discriminating capability analysis demonstrated that the diagnostic efficacies of the DP parameters were superior to those of the VP parameters, and the normalized iodine concentration in the DP exhibited the best performance [area under the curve (AUC): 0.750; 95% confidence interval (CI): 0.648-0.852]. The combination of ECV DP with clinical and ssDECT-derived parameters demonstrated the highest discriminative capability (AUC: 0.857; 95% CI: 0.786-0.928).
Conclusions: ssDECT-derived parameters and ECV fraction may serve as non-invasive tools for predicting the LVI/PNI status in CRC.

Keywords: Single-source dual-energy computed tomography (ssDECT); colorectal cancer (CRC); extracellular volume fraction (ECV fraction); lymphovascular invasion (LVI); perineural invasion (PNI)

DOI: https://doi.org/10.21037/qims-24-76