OBJECTIVE: This meta-analysis aimed to evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with gastric cancer. METHODS: We systematically searched PubMed, Web of Science, Embas...OBJECTIVE: This meta-analysis aimed to evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with gastric cancer. METHODS: We systematically searched PubMed, Web of Science, Embase, Scopus, and Cochrane CENTRAL databases from inception to May 2025 to evaluate observational studies evaluating the relationship between preoperative NLR and overall survival (OS) in patients with gastric cancer. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled using a random-effects model (REML, Hartung-Knapp correction). Subgroup analysis, meta-regression sensitivity analysis, and publication bias assessment were performed. Study quality was assessed using the Newcastle-Ottawa scale (NOS), and the quality of evidence was assessed by the GRADE framework. RESULTS: Twenty observational studies involving a total of 3407 patients were included in this study. Elevated preoperative NLR was significantly associated with worse OS (pooled HR = 1.61; 95% CI: 1.51-1.72; p < 0.001), indicating a 61% increased risk of death. Subgroup analysis showed that the results were consistent across different geographic regions, clinical stages, treatment modalities, NLR cutoff thresholds, and sample sizes, with negligible heterogeneity (I = 0%). Meta-regression analysis showed that there was no significant linear correlation between HR values and the specific NLR threshold used (p = 0.47). The results of sensitivity analysis were robust, and no significant publication bias was detected (Egger test p = 0.28). Overall, the quality of evidence was rated as moderate. CONCLUSION: Elevated preoperative NLR robustly and consistently predicts worse overall survival in patients with gastric cancer, regardless of clinical stage, treatment strategy, or NLR threshold used. NLR is a convenient, reliable and clinically valuable biomarker that helps, among other aspects, to determine the prognosis and make individualized treatment decisions for patients with gastric cancer.
BACKGROUND: Early-stage supraglottic squamous cell carcinoma carries a substantial risk of occult lymph node metastasis, yet the benefit and extent of elective neck dissection (END) in clinically node-negative (cN0) pati...BACKGROUND: Early-stage supraglottic squamous cell carcinoma carries a substantial risk of occult lymph node metastasis, yet the benefit and extent of elective neck dissection (END) in clinically node-negative (cN0) patients remain debated. METHODS: This systematic review analyzed studies published between 2000 and 2025 evaluating END versus observation in adults with early-stage (cT1-T2N0) supraglottic tumors, following predefined criteria and PRISMA methodology. RESULTS: Sixteen studies met inclusion criteria. Occult nodal metastasis was identified in 13-37.5% of patients, with level II-especially sublevel IIA-representing the predominant site of disease (75-85%). In contrast, involvement of levels I, sublevel IIB, IV, and V was rare (<5%). Super-selective dissection limited to levels II-III (or sublevel IIA- level III) improved regional control compared with observation, although overall survival benefits were inconsistent across studies and often diminished after multivariable adjustment. Population-based analyses suggested a potential survival advantage with END, while institutional series reported variable outcomes. Factors associated with higher risk of occult metastasis included T2 classification, poor differentiation, and involvement of epilaryngeal structures such as the suprahyoid epiglottis, aryepiglottic folds, and arytenoids. CONCLUSIONS: END detects clinically occult disease in up to one-third of patients and enhances regional control. Level-II-III dissection appears adequate for lateralized tumors, permitting omission of level IV and sublevel IIB, while midline lesions may require bilateral neck management. Given the uncertain survival advantage, a risk-adapted approach is recommended, reserving END for patients with high-risk features and considering close surveillance for carefully selected low-risk individuals.
Liver retraction is critical for safe and efficient robotic liver transection. Conventional methods often require additional instruments, tacking sutures or continuous bedside assistance. This "How I Do It" article prese...Liver retraction is critical for safe and efficient robotic liver transection. Conventional methods often require additional instruments, tacking sutures or continuous bedside assistance. This "How I Do It" article presents our double rubber band technique, which enables stable, hands-free retraction during robotic liver transection. We provide a video demonstration of our standard retraction technique for hemihepatectomy and describe adaptations for complex resections.
BACKGROUND: Wire-guided localisation (WGL) has been historically widely used as the standard method of pre-operative localisation of non-palpable breast lesions. Magnetic seeds (Magseed) were developed to overcome the lo...BACKGROUND: Wire-guided localisation (WGL) has been historically widely used as the standard method of pre-operative localisation of non-palpable breast lesions. Magnetic seeds (Magseed) were developed to overcome the logistical and technical limitations associated with wires. The aim of this systematic review was to compare the clinical outcomes associated with Magseed and WGL techniques. METHODS: A systematic literature search of relevant databases was performed. A meta-analysis using the Mantel-Haenszel method was performed to calculate odds ratios (OR) for dichotomous outcomes and standardised mean differences (SMD) or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). RESULTS: 16 studies involving 8794 (Magseed, n = 3995; WGL, n = 4799) patients were included. The rate of positive or close margins trended towards a lower rate for those who had Magseed localisation (OR 0.86, 95% CI 0.66-1.11; p = 0.23). Magseed localisation was associated with significantly lower re-excision rates (OR 0.77 95% CI 0.60-0.98; p = 0.03) compared to WGL. No significant differences were seen in terms of conversion to mastectomy, perioperative complications, localisation failures or operative time. Smaller resection size was observed with Magseed localisation (SMD -0.53 95% CI -0.98-0.08; p = 0.02). CONCLUSION: Magseed localisation is a safe and effective alternative to WGL and is associated with reduced re-excision rates for positive margins. These findings support its use in breast conserving surgery, while awaiting further prospective data.
BACKGROUND AND METHODS: Cancer interventions are traditionally described as either "curative" or "palliative," but evolving cancer biology and new treatments have transformed some cancers into chronic diseases where surg...BACKGROUND AND METHODS: Cancer interventions are traditionally described as either "curative" or "palliative," but evolving cancer biology and new treatments have transformed some cancers into chronic diseases where surgery plays a non-curative, disease-targeted role. We conducted semi-structured interviews with cancer surgeons via purposive snowball sampling, exploring two hypothetical scenarios and discussing "disease-control" surgery as a category of neither palliative nor curative surgical intent. Interviews were thematically analyzed. RESULTS: Eighteen surgeons from 16 US institutions described how evolving cancer treatment paradigms challenge existing language for surgical intent. "Disease-control" surgery captured new adjuvant surgical roles including debulking to improve systemic therapy efficacy, resection of treatment-resistant disease, and "resetting the clock" for indolent tumors. Surgical goals are increasingly defined by individual patients' broader multidisciplinary treatment trajectory. CONCLUSIONS: Traditional "curative" versus "palliative" categories inadequately describe contemporary cancer surgery. New frameworks aligned with current understandings of cancer biology and new treatment modalities may facilitate clearer communication about surgical goals and enable developing appropriate research outcome measures. DISCUSSION: These findings highlight a need for standardized surgical intent terminology. Broader validation through multidisciplinary stakeholder engagement is needed to refine and implement this proposed framework.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We conducted a systematic review and meta-analysis of studies that developed, validated, or updated clinical p...Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We conducted a systematic review and meta-analysis of studies that developed, validated, or updated clinical prognostic tools to predict survival in adults with primary GIST, identifying 47 eligible studies (38 development and 9 validation studies). Meta-analyses were performed to assess performance in external validation cohorts. The MSKCC nomogram was most frequently validated, with a pooled C-statistic of 0.78 for recurrence-free survival.
BACKGROUND AND OBJECTIVES: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The a...BACKGROUND AND OBJECTIVES: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The aim of this study was to describe patient and tumor characteristics associated with disease-specific survival in young patients (< 45 years) versus older patients (≥ 45 years) with isolated CRLM. METHODS: The SEER database was queried for patients with CRLM who underwent colon and liver resection from 2010 to 2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. Cox regression was used to analyze demographic factors, tumor characteristics, and treatment order. RESULTS: The study group consisted of 2222 patients, with 299 patients less than 45 years old, and 1923 patients at least 45 years old. Higher nodal burden was associated with worse survival in both groups. Elevated CEA was associated with worse survival only in older patients. Younger patients experienced initial longer disease-specific survival. CONCLUSIONS: Typical prognostic factors for older patients do not have the same impact on disease-specific survival for younger patients. Further study may help describe patient and tumor selection for surgical resection of colorectal liver metastases in young patients.
BACKGROUND AND OBJECTIVES: Multimodal prehabilitation aims to improve surgical outcomes and preoperative fitness in patients undergoing surgery for colorectal cancer (CRC). This study evaluated implementation of a standa...BACKGROUND AND OBJECTIVES: Multimodal prehabilitation aims to improve surgical outcomes and preoperative fitness in patients undergoing surgery for colorectal cancer (CRC). This study evaluated implementation of a standardised prehabilitation programme for elective CRC surgery, assess its impact, and identify pitfalls and challenges during implementation. METHODS: Retrospective single-centre study, all CRC patients scheduled for resection between January 2022 and April 2024 were included. Since May 2023, standardised multimodal prehabilitation was introduced. Before, patients received physiotherapy and a dietician if indicated, although this was not routinely offered. Patients were divided into a prehabilitation and non-prehabilitation group. Clinical data, prehabilitation details, and physiotherapy results were collected from patient charts. RESULTS: Among 401 patients, 198 (49%) underwent prehabilitation. Participation increased after standardisation (40% vs. 59%, p < 0.001). Strength and physical fitness improved significantly (leg press 100 vs. 135 kg; steep ramp 160 vs. 213 W; p < 0.001). Patients in the non-standardised programme experienced a significantly longer postoperative hospital stay than those in standardised programme (4 vs. 3 days, p = 0.010). Despite more comorbidities in prehabilitated patients, complication rates were similar between patients without and with prehabilitation (28% vs. 24%, p = 0.45). CONCLUSION: Standardised prehabilitation appears beneficial and safe, improving participation, referral justification and outcomes, particularly in high-risk colorectal cancer patients.
OBJECTIVE: To characterize epidemiology, treatment efficacy, and prognosis in cervical cancer patients aged <25 years using SEER data and institutional validation, and propose personalized strategies. METHODS: We analyze...OBJECTIVE: To characterize epidemiology, treatment efficacy, and prognosis in cervical cancer patients aged <25 years using SEER data and institutional validation, and propose personalized strategies. METHODS: We analyzed 73,869 SEER database patients (2000-2021), including 544 aged <25 years. Epidemiological trends, histology, and staging were assessed. Survival models compared 3-/5-year survival rates: surgical (n = 25) vs. non-surgical (n = 9) treatment for stage IB3; surgical (n = 18) vs. non-surgical (n = 4) for stage IIA2; and adjuvant chemotherapy (n = 51) vs. non-chemotherapy (n = 6) for stages IIIA-IIIB. Findings were validated against institutional data (n = 12; 2009-present). RESULTS: Among SEER Database, the proportion of young patients significantly declined from 1.36% (2004) to 0.39% (2021), with poorly differentiated carcinoma predominating (51.65%). Squamous cell carcinoma accounted for the majority (59.56%), rare histological subtypes accounted for (12.68%) including small cell neuroendocrine carcinoma and clear cell carcinoma, with notable prognostic implications. Most young patients presented with early-stage disease (77.94%, n = 298/424). For stage IB3, surgery yielded higher 3-year (84% vs 55.56%) and 5-year survival (80% vs 44.44%) than non-surgical management. Stage IIA2 comparisons showed conflicting trends (potentially due to small samples). In stages IIIA-IIIB, adjuvant chemotherapy was associated with trends toward improved survival, and cumulative risk analysis suggested a potential reduction in long-term mortality risk in the chemotherapy group versus non-chemotherapy. Institutional data mirrored SEER treatment patterns. Histologic subtype emerged as a critical prognostic determinant; Both institutional deaths occurred in patients with rare histologies (stage IVB small cell neuroendocrine carcinoma; stage IIB clear cell carcinoma), suggesting histology may represent an important prognostic factor, potentially interacting with stage. CONCLUSION: Most young cervical cancer patients present with early-stage, poorly differentiated disease. Surgery may be beneficial for early-stage (≤IIB) disease in selected patients localized disease, while concurrent chemoradiotherapy (CCRT) plus brachytherapy remains the standard for advanced stages (IIIA-IIIB); the role of Adjuvant chemotherapy did not demonstrate a significant survival benefit and should be interpreted with caution. Tumor histology may outweigh stage as a prognostic determinant in this population. These findings are exploratory and require validation in prospective studies.
BACKGROUND: Safety-net hospitals (SNHs) provide a substantial segment of the U.S. population with complex health needs, yet the breadth of oncologic services available at SNHs remains unclear. METHODS: A survey on cancer...BACKGROUND: Safety-net hospitals (SNHs) provide a substantial segment of the U.S. population with complex health needs, yet the breadth of oncologic services available at SNHs remains unclear. METHODS: A survey on cancer-care delivery was distributed to oncology providers at stand-alone California SNHs. The survey queried feasibility, access, and wait times for screening exams, diagnostic tests, procedures, and specialist services for comprehensive cancer care. RESULTS: Of 15 SNHs queried, nine (60%) responded. Access to full-time surgical specialists varied considerably: 33% lacked breast surgeons and urologists, 44% lacked surgical oncologists/hepatobiliary and colorectal surgeons, 56% lacked thoracic surgeons, 67% lacked endocrine surgeons, and 89% lacked orthopedic oncologists. Most hospitals (78%) employ general surgeons to perform cancer operations. Specific procedures are performed with the following frequency: right hemicolectomy/LAR/APR 89%, gastrectomy 78%, pulmonary lobectomy 78%, pancreaticoduodenectomy 67%, melanoma surgery 67%, major hepatectomy 56%. Robotic surgery is available at two-thirds of SNHs. One hospital offered CRS/HIPEC, and no respondent site provided regional intraoperative chemotherapy techniques. CONCLUSIONS: Like the United States as a whole, much cancer surgery in respondent California SNHs is performed by general surgeons. Significant gaps in subspecialty and advanced therapies persist, potentially requiring patients to travel long distances to tertiary centers and limiting access to comprehensive cancer care.
Liver transplantation has emerged as a therapeutic option for highly selected patients with unresectable colorectal liver metastases (CRLM). This review evaluated oncologic and perioperative outcomes in 92 patients who u...Liver transplantation has emerged as a therapeutic option for highly selected patients with unresectable colorectal liver metastases (CRLM). This review evaluated oncologic and perioperative outcomes in 92 patients who underwent transplantation. One- and 3-year overall survival (OS) were 96.32% and 73.07%, respectively. Disease-free survival (DFS) was lower, with high rates of recurrence. Major complications occurred in 39.36%, and 90-day mortality was 1.03%. Further randomized studies are needed to better define the role of liver transplantation and optimize patient selection criteria.
PURPOSE: The 2025 American Thyroid Association guideline supports consideration of lobectomy (LT) for low-risk 2-4 cm differentiated thyroid cancer (DTC), but evidence on cancer-specific death (CSD) in this "gray zone" i...PURPOSE: The 2025 American Thyroid Association guideline supports consideration of lobectomy (LT) for low-risk 2-4 cm differentiated thyroid cancer (DTC), but evidence on cancer-specific death (CSD) in this "gray zone" is limited. We used a population-based cohort to evaluate associations of LT versus total thyroidectomy (TT) with CSD and to develop an exploratory CSD-prediction tool. METHODS: Using SEER 2000-2022 data, we included intrathyroidal 2-4 cm N0M0 DTC treated with LT or TT without radiotherapy or chemotherapy. After 1:1 propensity-score matching, overall and cancer-specific survival were analyzed. CSD and other-cause death (OCD) were evaluated using Fine-Gray competing-risk models, and independent predictors were incorporated into a nomogram. RESULTS: We identified 4192 patients and matched 1620 (810 LT; 810 TT). LT was not associated with higher overall or cancer-specific mortality. In multivariable Fine-Gray models, TT showed higher subdistribution hazard of CSD, although this association may reflect residual confounding. Subgroup analyses suggested that lower-risk scenarios-tumors 21-30 mm, unifocal disease, and no lymph-node evaluation-were associated with lower CSD with LT, whereas differences were attenuated for 31-40 mm tumors or multifocal disease. The nomogram demonstrated acceptable discrimination and calibration for exploratory CSD risk stratification. CONCLUSION: In a strictly defined ATA-2025 low-risk 2-4 cm DTC cohort, LT was not associated with higher CSD compared with TT. The competing-risk nomogram may provide exploratory individualized risk stratification rather than direct guidance for surgical selection in this "gray-zone" population.
BACKGROUND: The prognostic significance of capsular invasion and its interaction with tumor size in differentiated thyroid carcinoma remains unclear. METHODS: We analyzed 86,902 surgically treated differentiated thyroid...BACKGROUND: The prognostic significance of capsular invasion and its interaction with tumor size in differentiated thyroid carcinoma remains unclear. METHODS: We analyzed 86,902 surgically treated differentiated thyroid carcinoma patients from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2015). Disease-specific survival was assessed using Kaplan-Meier analysis and multivariate Cox models. Restricted cubic spline analysis examined capsular invasion effects across the continuous tumor size spectrum. Interaction effects were evaluated on multiplicative and additive scales, with stratified analyses by age and tumor size. Sensitivity analyses employed Fine-Gray competing risk models. RESULTS: Capsular invasion occurred in 9.4% of patients and independently predicted inferior disease-specific survival (adjusted HR: 1.41, 95% CI: 1.14-1.75). The prognostic effect demonstrated significant nonlinear variation across tumor size, showing minimal impact below 10 mm, progressive increases beginning at 20 mm, and substantial amplification at 35-40 mm. Formal interaction testing revealed significant super-additive effects (relative excess risk due to interaction: 0.95, 95% CI: 0.08-1.83). Adverse prognostic impact concentrated in patients older than 55 years with tumors measuring 21-40 mm (adjusted HR: 1.66, 95% CI: 1.20-2.31), whereas capsular invasion showed negligible significance in smaller tumors regardless of age. CONCLUSIONS: Capsular invasion functions as a context-dependent prognostic factor modified by tumor size and patient age. These findings support refined risk stratification, enabling identification of patients requiring treatment intensification while avoiding overtreatment in favorable-prognosis groups.
BACKGROUND: Sentinel lymph node (SLN) biopsy is the standard procedure for staging patients with early-stage breast cancer. Indocyanine green (ICG), a near-infrared fluorescent dye, has emerged as an alternative to other...BACKGROUND: Sentinel lymph node (SLN) biopsy is the standard procedure for staging patients with early-stage breast cancer. Indocyanine green (ICG), a near-infrared fluorescent dye, has emerged as an alternative to other colorimetric and radioactive tracers for SLN mapping that has high sensitivity and is rarely allergenic. METHODS: The Observational Assess SLN Infracyanine® (ICG) Surgery (OASIS) study was a prospective, multicenter, observational, single-arm study that enrolled 101 female patients with breast cancer undergoing SLN biopsy in metropolitan centers in France. RESULTS: Mean (standard deviation) patient age was 62.5 (12.9) years and 75% were post-menopausal. Ninety-eight patients were evaluable. ICG was administered alone in 44 patients, in combination with Tc in 51 patients, and with methylene blue in 3 patients. Only one ICG injection was used for 57 patients, while 2-site and 4-site doses were required for 25 and 16 patients, respectively. All patients had ICG administered via the periareolar route. SLN mapping was performed using ICG in 96 patients (95%). At least 1 SLN was detected in 94 patients (95.9% [95% confidence interval: 90.0-98.4%]) and in 95/100 surgeries (95%). A median of 2 SLNs were detected per patient using ICG. The median (interquartile range) time from first injection to visualization of first SLN was 21 (15, 28) minutes. The detection rate appeared to be similar in obese/non-obese patients and across cancer stages. No adverse events or serious adverse events were reported. CONCLUSION: ICG demonstrated real-world effectiveness for identifying SLNs in French patients undergoing surgery for early-stage breast cancer.
BACKGROUND: This present systematic review and meta-analysis aims to compare overall survival (OS), disease-free survival (DFS), morbidity and mortality outcomes in patients undergoing colorectal first (CRf) versus liver...BACKGROUND: This present systematic review and meta-analysis aims to compare overall survival (OS), disease-free survival (DFS), morbidity and mortality outcomes in patients undergoing colorectal first (CRf) versus liver first (Lf) resections with synchronous colorectal liver metastases. METHODOLOGY: A literature search was performed in PubMed, Cochrane Central trials register, and Google Scholar databases. This was conducted in line with current PRISMA guidelines. 95% confidence intervals were calculated for the primary endpoints and odds ratios for secondary endpoints. The Cochrane Q test and the measurement of inconsistency test were used to assess the degree of heterogeneity among the included studies. RESULTS: Fifteen studies were included with a total of 8611 patients from 2010 to 2025. A statistically significant survival benefit was seen in the overall 1-year survival of the CRf group compared to the Lf group, with no significant difference in 3- and 5-year follow-up. In addition, a statistically significant benefit in 1-, 3-, and 5- year DFS rates was seen in the CRf group when compared to the Lf group. No significant difference was seen in major morbidity and 90-day mortality, and failure to proceed to the second resection stage. CONCLUSION: DFS was significantly increased in the CRf group compared to the Lf group, with no difference in secondary outcomes. One-year OS was also found to be higher in the CRf group; however, this finding likely reflects the heterogeneity of the included studies and perioperative course after hepatic resections. To our knowledge, this is the first meta-analysis to demonstrate such a significant difference of one strategy over the other. However, caution should be used in the interpretation of these results due to the lack of available randomized control trials.
BACKGROUND: Risk factors for dermal leiomyosarcoma (dLMS) metastasis remain poorly defined because methodological constraints, small sample sizes, and short follow-up have limited previous studies. OBJECTIVES: To investi...BACKGROUND: Risk factors for dermal leiomyosarcoma (dLMS) metastasis remain poorly defined because methodological constraints, small sample sizes, and short follow-up have limited previous studies. OBJECTIVES: To investigate risk factors for metastasis and local recurrence, and to propose a high- and low-risk classification for dLMS. METHODS: All patients diagnosed with dLMS in Denmark between 1980 and 2022 were included. Absolute 5‑year risks were estimated using the Aalen-Johansen method, treating all‑cause mortality as a competing risk. RESULTS: Among 381 patients (median age 66 years, 71% male), the 5-year risk of metastasis was 2.4% and 10% for local recurrence. The most important risk factors for metastasis were tumor necrosis, mitotic grade 3, and perineural/intravascular invasion, with 5-year absolute risks ranging between 9% and 25%. Positive surgical margins and perineural/intravascular invasion were associated with increased 5-year absolute risks of local recurrence, ranging between 26% and 50%. CONCLUSION: Although few distant metastases were observed, high-risk dLMS features may include tumor necrosis, mitotic grade 3, perineural/intravascular invasion, or positive surgical margins. Cases without these features may be classified as low-risk dLMS. We propose regular cross-sectional imaging in the follow-up of patients with high-risk dLMS, whereas follow-up for patients with low-risk dLMS could be limited to clinical examinations.
BACKGROUND: Despite an overall decrease in colorectal cancer (CRC) mortality in recent decades, incidence and mortality of CRC among individuals younger than 50 (early onset CRC; EOCRC) has increased. Individual and popu...BACKGROUND: Despite an overall decrease in colorectal cancer (CRC) mortality in recent decades, incidence and mortality of CRC among individuals younger than 50 (early onset CRC; EOCRC) has increased. Individual and population-level exposures contribute to EOCRC, but it is not clear how rurality and traveling for care impact survival. METHODS: Using the National Cancer Database (NCDB, 2010-2022), we (1) characterized and compared the EOCRC population to the average-onset (AOCRC) population, and (2) analyzed individual and population-level sociodemographic and clinical factors associated with 5-year survival. We used accelerated failure-time models; hazard ratios (HR) and 95% confidence intervals (CI) are reported. RESULTS: Among 404,440 individuals with CRC (15.7% EOCRC), more EOCRC patients were non-white (32.2% vs. 24.6%; p < 0.001), had rectal cancer (43% vs. 34%; p < 0.001), and presented at later stages compared to AOCRC patients. EOCRC patients traveled farther for care overall, and rural EOCRC patients with rectal cancer traveled farthest of any group (median 41.7 miles). In adjusted EOCRC survival models, compared to urban patients traveling for care, survival was worse for urban patients who did not travel (HR 1.09, 95% CI 1.05-1.12) and rural patients regardless of travel (rural, traveled: HR 1.12, 95% CI 1.07-1.18; rural, no travel: HR 1.16, 95% CI 1.09-1.22). CONCLUSIONS: EOCRC individuals living in urban areas experienced improved survival when traveling farther for care, though their rural counterparts did not necessarily gain the same survival benefit by traveling. Using exposures and health behaviors to guide screening beyond age-based guidelines could improve early detection and survival.
BACKGROUND: Predictions concerning the natural history of peritoneal surface malignancy may be available from the study of the sites of cancer progression on the peritoneal surface. As a first step to identify useful cli...BACKGROUND: Predictions concerning the natural history of peritoneal surface malignancy may be available from the study of the sites of cancer progression on the peritoneal surface. As a first step to identify useful clinical and histopathological correlations the multiple morphologic types of peritoneal metastases must be identified and a meaningful nomenclature associated with each type. METHODS: The morphological types were selected from their appearance on peritoneal surfaces. Both open and laparoscopic observations and photographs were utilized. The pathophysiology that was responsible for the lesion's appearance was an important consideration in separating the numerous shapes and sizes into specific morphologic types. RESULTS: As an initial step peritoneal lesions were separated into raised types and flat types. Line drawings of each of the 10 morphologic types were constructed and a single illustrative photograph associated with each morphologic type. A description of the pathophysiology of each type was contained within the text. CONCLUSIONS: Ten morphologic types of peritoneal surface malignancies were selected, illustrated and provided with a definitive nomenclature. The pathophysiology of each type was presented. These morphologic types are considered the starting place for further study of morphology in the prediction of outcome of peritoneal metastases treatments.