Management strategy and role of thermal ablation in ground-glass nodules / 中国胸心血管外科临床杂志

@#The majority of incidentally found and screen-detected lung cancer is manifested as ground-glass nodule (GGN), which is more likely to be detected in the young people, women and non-smokers. An appropriate management strategy for GGN can not only reduce the mortality of lung cancer but also minimize overtreatment. Although most of persistent GGNs are finally diagnosed as adenocarcinoma or precursor glandular lesions, the GGN-featured lung cancer is characterized as indolent growth or even non-growth. Therefore, scheduled follow-up might be safe for the special radiologic type under a certain condition. We should design the individualized diagnosis and treatment strategy for each patient. The treatment decision-making depends on various factors, including invasion, dynamic change, efficacy and safety of the treatment, as well as physical and psychic condition of the patients. Different from other types of lung cancer, the indolent feature of GGN-featured lung cancer allows a long time to intervene. Therefore, the determination of proper timing for intervention should be made cautiously. Surgical resection is still the principal treatment for GGN-featured lung cancer. However, there is still no consensus on the optimal surgical approach for GGN-featured lung adenocarcinoma. Currently, sublobar resection without lymphadenectomy has been recommended to the patients with precursor glandular lesions. In light of the GGN-featured lung cancer which generally represents a local lesion, local ablation therapies have been used in those patients, especially in the ones who are inoperable or refuse to undergo surgery. The percutaneous local ablation includes different techniques: radiofrequency ablation, microwave ablation and argon-helium cryoablation. The local ablation is safe, minimally invasive and repeatable. In addition, it offers the advantage to biopsy and treatment synchronously. Percutaneous ablation has the potential to be an alternative of surgery to cure GGN-featured lung cancer based on emerging evidences. The efficacy of transbronchial ablation guided by  ultrasound or electromagnetic navigational system in the treatment of GGN-featured lung cancer has been primarily validated. As a developing technology, it might be a promising approach but needs further exploration. With the advance in ablation technology, we do believe that the interventional therapy will play an equal role as surgery in curative treatment of GGN-featured lung cancer in the future. Personalized treatment considering the condition of patients and the features of the lesion will maximize the benefit of every patient. This article will explore the diagnosis and treatment strategies of GGN on the basis of further understanding of GGN, and introduce the application of ablation therapy in GGN from the perspective of respiratory intervention.

Assessment of the Surveillance Interval at 1 Year after Curative Treatment in Hepatocellular Carcinoma: Risk Stratification

BACKGROUND/AIMS: Guidelines recommend surveillance for hepatocellular carcinoma (HCC) recurrence at 3-month intervals during the first year after curative treatment and 6-month intervals thereafter in all patients. This strategy does not reflect individual risk of recurrence. We aimed to stratify risk of recurrence to optimize surveillance intervals 1 year after treatment. METHODS: We retrospectively analyzed 1,316 HCC patients treated with resection/radiofrequency ablation at Barcelona Clinic Liver Cancer stage 0/ A. In patients without 1-year recurrence under 3-monthly surveillance, a new model for recurrence was developed using backward elimination methods: training (n=582)/ validation cohorts (n=291). Overall survival (OS) according to risk stratified by the new model was compared according to surveillance intervals: 3-monthly versus 6-monthly (n=401) after lead time bias correction and propensity-score matching analyses. RESULTS: Among patients without 1-year recurrence, age and international normalized ratio values were significant factors for recurrence (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00 to 1.03; p=0.009 and HR, 5.63; 95% CI, 2.24 to 14.18; p < 0.001; respectively). High-risk patients stratified by the new model showed significantly higher recurrence rates than low-risk patients in the validation cohort (HR, 1.73; 95% CI, 1.18 to 2.53; p=0.005). After propensity-score matching between the 3-monthly and 6-monthly surveillance groups, OS in high-risk patients under 3-monthly surveillance was significantly higher than that under 6-monthly surveillance (p=0.04); however, OS in low-risk patients under 3-monthly surveillance was not significantly different from that under 6-monthly surveillance (p=0.17). CONCLUSIONS: In high-risk patients, 3-monthly surveillance can prolong survival compared to 6-monthly surveillance. However, in low-risk patients, 3-monthly surveillance might not be beneficial for survival compared to 6-monthly surveillance.

Primary carcinosarcoma of the gallbladder / 대한외과학회지

Carcinosarcoma of gallbladder (CSGB) is a rare malignancy characterized by malignant epithelial and mesenchymal components. Its pathogenesis is unknown and most CSGBs are associated with poor survival because the disease normally presents at an advanced stage, and as a result, curative resection is uncommon. This report describes a case that underwent curative resection. A 77-year-old woman presented with right upper quadrant pain. The preoperative diagnosis was gallbladder (GB) cancer, and thus, curative radical cholecystectomy was performed. However, pathologic examination of the surgical specimen revealed that the tumor was composed of two histologic components of squamous cell carcinoma and spindle cell sarcoma, which was consistent with a diagnosis of carcinosarcoma. The tumor was found to extend to the perimuscular connective tissue and to have metastasized to one lymph node (LN). The prognosis of CSGB remains poor despite curative resection, and thus, the authors recommend that effort be made to improve surgical outcomes.