Surgical Oncology

Conversion therapy before resection improves outcomes in intermediate-stage hepatocellular carcinoma

This multicentre study enrolled 248 patients with intermediate-stage hepatocellular carcinoma treated with conversion therapy plus resection, direct resection, or nonsurgical comprehensive therapy. Among conversion-resection patients, 23.2% achieved pathologic complete response and 51.8% major pathologic response. Conversion therapy was associated with markedly less microvascular invasion and better tumor differentiation than direct resection. Conversion-resection achieved superior recurrence-free survival and 3-year overall survival compared with direct resection and nonsurgical therapy. 1

Starting adjuvant chemotherapy up to 12 weeks after gastrectomy is noninferior for stage II–III gastric cancer

This target trial emulation included 1,637 patients with stage II–III gastric cancer undergoing D2 gastrectomy and platinum–fluoropyrimidine adjuvant chemotherapy. Adjuvant chemotherapy initiated at 7–12 weeks was noninferior to ≤6 weeks for 5-year all-cause mortality within a 10% absolute margin. The estimated 5-year mortality risk difference was -0.52%, with the upper confidence bound below the noninferiority threshold. Results were robust across sensitivity analyses and clinical subgroups, although residual confounding cannot be excluded. 2

Five-day preoperative radiotherapy maintains local control in high-risk soft tissue sarcoma

In this single-arm phase 2 trial, 110 patients with extremity or trunk soft tissue sarcoma received 30 Gy in 5 preoperative fractions followed by surgery. At two years, 18.9% of evaluable patients had grade 2 or higher radiation toxicity, with lower rates in the later expansion cohort. Major wound complications occurred in 30% of patients, comparable with historical 5-week preoperative radiotherapy series. Two-year local control was 92.4% after adjusting for competing mortality, with few fractures and amputations observed. 3

Risk score stratifies recurrence in lymph node–negative pancreatic neuroendocrine tumors

This multicenter study developed a 13-point recurrence risk score in 770 patients with lymph node–negative pancreatic neuroendocrine tumors and at least eight examined nodes. Independent recurrence predictors were male sex, tumor size 3 cm or larger, WHO grade 2 or higher, and lymphovascular invasion. The score showed strong discrimination, with area under the curve 0.83 internally and 0.95 in an external validation cohort. Low-, intermediate-, and high-risk groups had recurrence rates of 2.4%, 9.0%, and 27.7%, with 10-year DFS 96.1%, 83.6%, and 51.3%, respectively. 4