Objective To compare outcomes for patients with hepatocellular carcinoma (HCC) treated with either liver resection or transplantation. Methods A retrospective, single institution analysis of 413 HCC patients from 1999–2009. Results 413 patients with HCC underwent surgical resection (n=106), transplantation (n=270), or were listed without receiving transplantation (n=37). Excluding transplanted patients with incidental tumors (n=50), 257 patients with suspected HCC were listed with the intent to transplant (ITT). The median diameter of the largest tumor by radiography was 6.0 cm in resected, 3.0 cm in transplanted, and 3.4 cm in the listed-but-not-transplanted patients. Median time to transplant was 48 days. Recurrence rates were 19.8% for resection and 12.1% for all ITT patients. Overall, patient survival for resection vs. ITT patients was similar (5-year survival of 53.0% vs. 52.0%, NS). However, for HCC patients with MELD scores <10 and who radiologically met Milan or UCSF criteria, 1-year and 5-year survival rates were significantly improved in resected patients. For patients with MELD <10 and who met Milan criteria, 1-year and 5-year survival were 92.0% and 63.0% for resection (n=26) vs. 83.0% and 41.0% for ITT (n=73, p=0.036). For those with MELD <10 and met UCSF criteria, 1-year and 5-year survival was 94.0% and 62.0% for resection (n=33) vs. 81.0% and 40.0% for ITT (n=78, p=0.027). Conclusions Among known HCC patients with preserved liver function, resection was associated with superior patient survival versus transplantation. These results suggest surgical resection should remain the first line therapy for patients with HCC and compensated liver function who are candidates for resection.

Objective: Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. Methods: In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0–III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM (“shave” group) or not (“no shave” group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. Results: Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the “shave” group and 200 to the “no shave” group. Median patient age was 65 years (range; 29–94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). Conclusion: Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.

IMPORTANCE Recent recognition of the overdiagnosis and overtreatment of ductal carcinoma in situ (DCIS) detected by mammography has led to the development of clinical trials randomizing women with non-high-grade DCIS to active surveillance, defined as imaging surveillance with or without endocrine therapy, vs standard surgical care.OBJECTIVE To determine the factors associated with underestimation of invasive cancer in patients with a clinical diagnosis of non-high-grade DCIS that would preclude active surveillance. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted using records from the National Cancer Database from January 1, 1998, to December 31, 2012, of female patients 40 to 99 years of age with a clinical diagnosis of non-high-grade DCIS who underwent definitive surgical treatment. Data analysis was conducted from November 1, 2015, to February 4, 2017.EXPOSURES Patients with an upgraded diagnosis of invasive carcinoma vs those with a diagnosis of DCIS based on final surgical pathologic findings. MAIN OUTCOMES AND MEASURESThe proportions of cases with an upgraded diagnosis of invasive carcinoma from final surgical pathologic findings were compared by tumor, host, and system characteristics. RESULTSOf 37 544 women (mean [SD] age, 59.3 [12.4] years) presenting with a clinical diagnosis of non-high-grade DCIS, 8320 (22.2%) had invasive carcinoma based on final pathologic findings. Invasive carcinomas were more likely to be smaller (>0.5 to Յ1.0 cm vs Յ0.

There is a cooperative survival benefit for neoadjuvant radiation and adequate lymphadenectomy in patients with node-positive EAC. Both are independent predictors of improved survival. Patients who have clinically node-positive disease should undergo both neoadjuvant radiation and adequate lymphadenectomy to ensure optimal outcome.

BackgroundGastric cancer (GC) peritoneal carcinomatosis (PC) is associated with a poor prognosis. Although grade, histology, and stage are associated with PC, the cumulative risk of PC when multiple risk factors are present is unknown. This study aimed to develop a cumulative GCPC risk score based on individual demographic/tumor characteristics.MethodsPatient-level data (2004–2014) from the California Cancer Registry were reviewed by creating a keyword search algorithm to identify patients with gastric PC. Multivariable logistic regression was used to assess demographic/tumor characteristics associated with PC in a randomly selected testing cohort. Scores were assigned to risk factors based on beta coefficients from the logistic regression result, and these scores were applied to the remainder of the subjects (validation cohort). The summed scores of each risk factor formed the total risk score. These were grouped, showing the percentages of patients with PC.ResultsThe study identified 4285 patients with gastric adenocarcinoma (2757 males, 64.3%). The median age of the patients was 67 years (interquartile range [IQR], 20 years). Most of the patients were non-Hispanic white (n = 1748, 40.8%), with proximal (n = 1675, 39.1%) and poorly differentiated (n = 2908, 67.9%) tumors. The characteristics most highly associated with PC were T4 (odds ratio [OR], 3.12; 95% confidence interval [CI], 2.19–4.44), overlapping location (OR 2.27; 95% CI 1.52–3.39), age of 20–40 years (OR 3.42; 95% CI 2.24–5.21), and Hispanic ethnicity (OR 1.86; 95% CI 1.36–2.54). The demographic/tumor characteristics used in the risk score included age, race/ethnicity, T stage, histology, tumor grade, and location. Increasing GCPC score was associated with increasing percentage of patients with PC.ConclusionBased on demographic/tumor characteristics in GC, it is possible to distinguish groups with varying odds for PC. Understanding the risk for PC based on the cumulative effect of high-risk features can help clinicians to customize surveillance strategies and can aid in early identification of PC.