Influence of Microscopically Positive Resection Margins on Long-Term (>5-Year) Survival after Resection of Pancreatic Ductal Adenocarcinoma

Context The impact of R1 resection on outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) is unclear, with most studies assessing survival for up to 5 years. Objective The aim of this study was to evaluate the prognostic influence of R1 and R0 resection on >5-year survival in patients with PDAC. Material and methods Of the 271 patients with PDAC who underwent pancreatic resection over a 26-year period, 33 had survived for ≥5 years. R1 status was defined as the presence of tumor tissue ≤1 mm from a circumferential margin surface. Patients were followed-up for 61 to 288 months. Results Of the 33 long-term survivors, 19 and 14 underwent R0 and R1 resection, respectively. The percentage of male patients was significantly higher in the R1 than in the R0 group. The R0 group tended to show a weaker relationship between R status and stage than the R1 group. Multivariate analysis showed that R status was an independent prognostic marker (P=0.0071), and Kaplan–Meier curves showed that >5-year survivors in the R1 group had significantly poorer prognoses (P=0.002). Conclusions Patients who have survived >5 years following R1 resection for PDAC can experience tumor recurrence in the resected area.Image: Kaplan–Meier survival curves of patients with PDAC

Identification of a Novel ACVRL1 Gene Mutation (c.100T>A, p.Cys34Ser) in a Japanese Patient with Possible Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)

Hereditary hemorrhagic telangiectasia (HHT; also known as Osler-Weber-Rendu disease) is an autosomal dominant genetic disorder that causes frequent epistaxis, mucocutaneous telangiectasia, and visceral arteriovenous malformations. Four genes (ENG, ACVRL1, SMAD4, and GDF2) have been identified as pathogenic in HHT. We describe the case of a 50-year-old Japanese man highly suspected of having HHT due to recurrent epistaxis, mucocutaneous telangiectasia, and a family history. Genomic analysis revealed a novel missense mutation of c.100T>A, p.Cys34Ser in the patient’s ACVRL1 gene. We used 6 freeware programs to perform an in silico analysis of this mutation. The results demonstrated the mutation’s high pathogenicity

Prediction of pathologic node-negative clinical stage IA lung adenocarcinoma for optimal candidates undergoing sublobar resection

ObjectivePatients with pathologic node-negative early lung cancer may be optimal candidates for sublobar resection. We aimed to identify predictors of pathologic lymph node involvement in clinical stage IA lung adenocarcinoma.MethodsThe data from a multicenter database of 502 patients with completely resected clinical stage IA lung adenocarcinoma were retrospectively analyzed to determine the relationship between the lymph node metastasis status and tumor size on high-resolution computed tomography (HRCT) or maximum standardized uptake value (SUVmax) on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). Revised SUVmax was used to correct interinstitutional discrepancies.ResultsIn multivariate analyses, either a solid tumor size on HRCT (P = .001) or an SUVmax on FDG-PET/CT (P = .049) was an independent predictor of lymph node metastasis. The predictive criteria of pathologic node-negative early lung cancer were a solid tumor size of less than 0.8 cm or an SUVmax of less than 1.5. Patients who met the predictive criteria of pathologic node-negative disease had less pathologic invasiveness, such as lymphatic, vascular, or pleural invasion (P < .001), and better disease-free survival (P < .0001) than those who did not, and 86 (40.4%) of the 213 patients with T1b (2-3 cm) tumors met the predictive criteria.ConclusionsEither a solid tumor size or an SUVmax was a significant independent predictor of nodal involvement in clinical stage IA lung adenocarcinoma. The pathologic node-negative status criteria of a solid tumor size of less than 0.8 cm on HRCT or an SUVmax of less than1.5 on FDG-PET/CT may be helpful for avoiding systematic lymphadenectomy for clinical stage IA lung adenocarcinoma, even in cases of T1b (2-3 cm) tumor

Hydrography, circulation, and response to atmospheric forcing in the vicinity of the central Getz Ice Shelf, Amundsen Sea, Antarctica

Ice shelves in the Amundsen Sea are thinning rapidly as ocean currents bring warm water into the cavities beneath the floating ice. Although the reported melt rates for the Getz Ice Shelf are comparatively low for the region, its size makes it one of the largest freshwater sources around Antarctica, with potential consequences for, bottom water formation downstream, for example. Here, we use a 2-year-long novel mooring record (2016–2018) and 16-year-long regional model simulations to describe, for the first time, the hydrography and circulation in the vicinity of the ice front between Siple and Carney Island. We find that, throughout the mooring record, temperatures in the trough remain below 0.15 ∘C, more than 1 ∘C lower than in the neighboring Siple and Dotson Trough, and we observe a mean current (0.03 m s−1) directed toward the ice shelf front. The variability in the heat transport toward the ice shelf appears to be governed by nonlocal ocean surface stress over the Amundsen Sea Polynya region, and northward to the continental shelf break, where strengthened westward ocean surface stress leads to increased southward flow at the mooring site. The model simulations suggest that the heat content in the trough during the observed period was lower than normal, possibly owing to anomalously low summertime sea ice concentration and weak winds.publishedVersio