Distant nodal metastasis: is it always an unresectable disease?

Textbook outcome as indicator of surgical quality in a single Western center: results from 300 consecutive gastrectomies

Textbook outcome (TO) has been proposed as a tool to evaluate surgical quality. Textbook oncological outcome (TOO) adds chemotherapeutic compliance to TO. This study was conducted to analyze the TO and TOO of patients with gastric adenocarcinoma who underwent surgery at our center. Data from a prospective database of patients operated on for gastric adenocarcinoma between September 2018 and September 2022 were analyzed. Postoperative management followed Enhanced Recovery After Surgery guidelines. The Dutch Upper Gastrointestinal Cancer Audit group defined TO as a multidimensional measure (10 items). TOO also considers guideline-accordant chemotherapeutic compliance. Three hundred patients underwent surgery during the study period (167 men, 133 women). One hundred seventy-six (58.7%) reached TO. Achieving TO was influenced by patients' comorbidities, calculated via the Charlson Comorbidity Score (3 vs. 4; p = 0.002) and surgery type (subtotal gastrectomy; p < 0.001), but not by the American Society of Anesthesiologists (ASA) score (p = 0.057) or surgical approach (laparoscopic vs. open; p = 0.208). The analysis of TOO included 213 patients. Of these, 71 (33%) underwent complete adequate systemic treatment. Compared with the non-TOO group, patients who achieved TOO had a lower median age (64 vs. 73 years; p < 0.001) and lower ASA score (p < 0.001) and more frequently underwent preoperative chemotherapy (p < 0.001). Our results represent the experience of a single team at a high-volume Western institute. Patients' comorbidities and surgery type influenced whether TO was achieved. Conversely, younger age, lower ASA score and preoperative chemotherapy were associated with TOO.

Increased HSP27 correlates with malignant biological behavior of non-small cell lung cancer and predicts patient's survival

Heat shock protein 27 (HSP27) has been found to be related to tumorigenesis. The aim of this study was to investigate the expression pattern and clinical significance of HSP27 in non-small-cell lung cancer (NSCLC). The expression of HSP27 in tissues was examined by immunohistochemistry and serum level of HSP27 mRNA was detected by real-time PCR. The survival analysis was performed by a Kaplan Meier method and the estimation of risk factors was determined by the multiple regression analysis. The expression of HSP27 was increased in lung cancer tissues (p < 0.001) and serum (p < 0.001) of NSCLC patients and higher HSP27 in lung cancer tissues and serum of NSCLC patients was associated with poorly differentiated cancer (p < 0.001; p = 0.035), lymphatic metastasis (p < 0.001; p < 0.001), advanced TNM stage (p < 0.001; p < 0.001). And the levels of HSP27 in tissues and serum of lung cancer patients had a certain positive correlation (p = 0.046). Moreover, increased HSP27 expression correlated with shorter survival of NSCLC patients (p < 0.001). The results suggest that HSP27 may serve as a potential biomarker for diagnosis and prognosis of NSCLC.