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16. Benchmarks and Geographic Differences in Gallbladder Cancer Surgery: An International Multicenter Study

Author

Vega, Eduardo A., Newhook, Timothy E., Mellado, Sebastian, Ruzzenente, Andrea, Okuno, Masayuki, De Bellis, Mario, Panettieri, Elena, Ahmad, M. Usman, Merlo, Ignacio, Rojas, Jesus, De Rose, Agostino M., Nishino, Hiroto, Sinnamon, Andrew J., Donadon, Matteo, Hauger, Marit S., Guevara, Oscar A., Munoz, Cesar, Denbo, Jason W., Chun, Yun Shin, Tran Cao, Hop S., Sanchez Claria, Rodrigo, Tzeng, Ching-Wei D., De Aretxabala, Xabier, Vivanco, Marcelo, Brudvik, Kristoffer W., Seo, Satoru, Pekolj, Juan, Poultsides, George A., Torzilli, Guido, Giuliante, Felice, Anaya, Daniel A., Guglielmi, Alfredo, Vinuela, Eduardo, and Vauthey, Jean-Nicolas

Published
2023
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32. Current Perspectives and Progress in Preoperative Portal Vein Embolization with Stem Cell Augmentation (PVESA).

Author

Barcena, Allan John R., Owens, Tyler C., Melancon, Sophie, Workeneh, Isias, Tran Cao, Hop S., Vauthey, Jean-Nicolas, and Huang, Steven Y.

Subjects
HEMATOPOIETIC stem cells, MESENCHYMAL stem cells, PORTAL vein, SOMATIC cells, STEM cells, LIVER regeneration
Abstract

Portal vein embolization with stem cell augmentation (PVESA) is an emerging approach for enhancing the growth of the liver segment that will remain after surgery (i.e., future liver remnant, FLR) in patients with liver cancer. Conventional portal vein embolization (PVE) aims to induce preoperative FLR growth, but it has a risk of failure in patients with underlying liver dysfunction and comorbid illnesses. PVESA combines PVE with stem cell therapy to potentially improve FLR size and function more effectively and efficiently. Various types of stem cells can help improve liver growth by secreting paracrine signals for hepatocyte growth or by transforming into hepatocytes. Mesenchymal stem cells (MSCs), unrestricted somatic stem cells, and small hepatocyte-like progenitor cells have been used to augment liver growth in preclinical animal models, while clinical studies have demonstrated the benefit of CD133 + bone marrow–derived MSCs and hematopoietic stem cells. These investigations have shown that PVESA is generally safe and enhances liver growth after PVE. However, optimizing the selection, collection, and application of stem cells remains crucial to maximize benefits and minimize risks. Additionally, advanced stem cell technologies, such as priming, genetic modification, and extracellular vesicle-based therapy, that could further enhance efficacy outcomes should be evaluated. Despite its potential, PVESA requires more investigations, particularly mechanistic studies that involve orthotopic animal models of liver cancer with concomitant liver injury as well as larger human trials. [ABSTRACT FROM AUTHOR]

Published
2024
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33. Escalated‐dose radiotherapy for unresected locally advanced pancreatic cancer: Patterns of care and survival in the United States.

Author

Shi, Christopher, De, Brian, Tran Cao, Hop S., Liu, Suyu, Florez, Marcus A., Kouzy, Ramez, Grippin, Adam J., Katz, Matthew H. G., Tzeng, Ching‐Wei D., Ikoma, Naruhiko, Kim, Michael P., Lee, Sunyoung, Willis, Jason, Noticewala, Sonal S., Minsky, Bruce D., Smith, Grace L., Holliday, Emma B., Taniguchi, Cullen M., Koong, Albert C., and Das, Prajnan

Subjects
CANCER treatment, PANCREATIC cancer, RADIOTHERAPY, ODDS ratio, LOGISTIC regression analysis, PLANNING techniques
Abstract

Introduction: With locally advanced pancreatic cancer (LAPC), uncontrolled local tumor growth frequently leads to mortality. Advancements in radiotherapy (RT) techniques have enabled conformal delivery of escalated‐dose RT (EDR), which may have potential local control and overall survival (OS) benefits based on retrospective and early prospective studies. With evidence for EDR emerging, we characterized the adoption of EDR across the United States and its associated outcomes. Methods: We searched the National Cancer Database for nonsurgically managed LAPC patients diagnosed between 2004 and 2019. Pancreas‐directed RT with biologically effective doses (BED10) ≥39 and ≤70 Gy was labeled conventional‐dose RT (CDR), and BED10 >70 and ≤132 Gy was labeled EDR. We identified associations of EDR and OS using logistic and Cox regressions, respectively. Results: Among the definitive therapy subset (n = 54,115) of the entire study cohort (n = 91,493), the most common treatments were chemotherapy alone (69%), chemotherapy and radiation (29%), and RT alone (2%). For the radiation therapy subset (n = 16,978), use of pancreas‐directed RT remained between 13% and 17% over the study period (ptrend > 0.999). Using multivariable logistic regression, treatment at an academic/research facility (adjusted odds ratio [aOR] 1.46, p < 0.001) and treatment between 2016 and 2019 (aOR 2.54, p < 0.001) were associated with greater receipt of EDR, whereas use of chemotherapy (aOR 0.60, p < 0.001) was associated with less receipt. Median OS estimates for EDR and CDR were 14.5 months and 13.0 months (p < 0.0001), respectively. For radiation therapy subset patients with available survival data (n = 13,579), multivariable Cox regression correlated EDR (adjusted hazard ratio 0.85, 95% confidence interval 0.80–0.91; p < 0.001) with longer OS versus CDR. Discussion and Conclusions: Utilization of EDR has increased since 2016, but overall utilization of RT for LAPC has remained at less than one in five patients for almost two decades. These real‐world results additionally provide an estimate of effect size of EDR for future prospective trials. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Laparoscopic transverse abdominis plane block: how I do it and a cost efficiency analysis.

Author

Hirata, Yuki, Gottumukkala, Vijaya, Ajith, Jeeva, Schmeisser, Jason A., Ninan, Elizabeth P., Maxwell, Jessica E., Snyder, Rebecca A., Kim, Michael P., Tran Cao, Hop S., Tzeng, Ching-Wei D., Badgwell, Brian D., Katz, Matthew H. G., and Ikoma, Naruhiko

Subjects
ANATOMICAL planes, COST analysis, PANCREATECTOMY, LAPAROSCOPIC surgery, MINIMALLY invasive procedures, GASTRECTOMY
Abstract

Purpose: To determine the efficacy and efficiency of laparoscopic transverse abdominis plane block (Lap-TAP) in patients undergoing pancreatoduodenectomy and gastrectomy compared to those of ultrasound-guided TAP (US-TAP). Methods: We retrospectively analyzed the records of patients who underwent open or minimally invasive (MIS) pancreatoduodenectomy and major gastrectomy with the use of Lap-TAP or US-TAP at our institution between November 1, 2018, and September 30, 2021. We compared the estimated time and cost associated with Lap-TAP and US-TAP. We also compared postoperative opioid use and pain scores between patients who underwent open laparotomy with these TAPs. Results: A total of 194 patients were included. Overall, 114 patients (59%) underwent pancreatectomy, and 80 patients (41%) underwent gastrectomy. Additionally, 138 patients (71%) underwent an open procedure, and 56 patients (29%) underwent MIS. A total of 102 patients (53%) underwent US-TAP, and 92 (47%) underwent Lap-TAP. The median time to skin incision was significantly shorter in the Lap-TAP group (US-TAP, 59 min vs. Lap-TAP, 45 min; P < 0.001), resulting in an estimated reduction in operation cost by $602. Pain scores and postoperative opioid use were similar between Lap-TAP and US-TAP among open surgery patients, indicating equivalent pain control between Lap-TAP and US-TAP. Conclusion: Lap-TAP was equally effective in pain control as US-TAP after pancreatectomy and gastrectomy, and Lap-TAP can reduce operation time and cost. Lap-TAP is considered the preferred approach for MIS pancreatectomy and gastrectomy, which occasionally needs conversion to laparotomy. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience

Author

Tzeng, Ching-Wei D., Teshome, Mediget, Katz, Matthew H. G., Weinberg, Jeffrey S., Lai, Stephen Y., Antonoff, Mara B., Bird, Justin E., Shafer, Aaron, Davis, John W., Adelman, David M., Moon, Bryan, Reece, Gregory, Prabhu, Sujit S., DeSnyder, Sarah M., Skibber, John M., Mehran, Reza, Schmeler, Kathleen, Roland, Christina L., Tran Cao, Hop S., Aloia, Thomas A., Caudle, Abigail S., Swisher, Stephen G., and Vauthey, Jean-Nicolas

Published
2020
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46. Endocrine incidentalomas

Author

Starker, Lee F., Prieto, Peter A., Liles, J. Spencer, Tran Cao, Hop S., Grubbs, Elizabeth G., Lee, Jeffrey E., Perrier, Nancy D., and Graham, Paul H.

Published
2016
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47. Clinical and Prognostic Biomarker Value of Blood-Circulating Inflammatory Cytokines in Hepatocellular Carcinoma.

Author

Chamseddine, Shadi, Mohamed, Yehia I., Lee, Sunyoung S., Yao, James C., Hu, Zishuo Ian, Tran Cao, Hop S., Xiao, Lianchun, Sun, Ryan, Morris, Jeffrey S., Hatia, Rikita I., Hassan, Manal, Duda, Dan G., Diab, Maria, Mohamed, Amr, Nassar, Ahmed, Datar, Saumil, Amin, Hesham M., and Kaseb, Ahmed Omar

Subjects
CYTOKINES, INTERLEUKINS, ACADEMIC medical centers, CONFIDENCE intervals, LOG-rank test, CARCINOGENESIS, HOSPITAL wards, DESCRIPTIVE statistics, TUMOR markers, HEPATOCELLULAR carcinoma, OVERALL survival, ONCOLOGY
Abstract

Introduction: Circulating inflammatory cytokines play critical roles in tumor-associated inflammation and immune responses. Recent data have suggested that several interleukins (ILs) mediate carcinogenesis in hepatocellular carcinoma (HCC). However, the predictive and prognostic value of circulating ILs is yet to be validated. Our study aimed to evaluate the association of the serum ILs with overall survival (OS) and clinicopathologic features in a large cohort of HCC patients. Methods: We prospectively collected data and serum samples from 767 HCC patients treated at the University of Texas MD Anderson Cancer Center between 2001 and 2014, with a median follow-up of 67.4 months (95% confidence interval [CI]: 52.5, 83.3). Biomarker association with OS was evaluated by the log-rank method. Results: The median OS in this cohort was 14.2 months (95% CI: 12, 16.1 months). Clinicopathologic features were more advanced, and OS was significantly inferior in patients with high circulating levels of IL1-R1, IL-6, IL-8, IL-10, IL-15, IL-16, and IL-18. Conclusion: Our study shows that several serum IL levels are valid prognostic biomarker candidates and potential targets for therapy in HCC. [ABSTRACT FROM AUTHOR]

Published
2023
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48. The Gut Microbiome as a Biomarker and Therapeutic Target in Hepatocellular Carcinoma.

Author

Gok Yavuz, Betul, Datar, Saumil, Chamseddine, Shadi, Mohamed, Yehia I., LaPelusa, Michael, Lee, Sunyoung S., Hu, Zishuo Ian, Koay, Eugene J., Tran Cao, Hop S., Jalal, Prasun Kumar, Daniel-MacDougall, Carrie, Hassan, Manal, Duda, Dan G., Amin, Hesham M., and Kaseb, Ahmed O.

Subjects
BIOMARKERS, PREBIOTICS, GUT microbiome, PROBIOTICS, RESEARCH funding, FECAL microbiota transplantation, HEPATOCELLULAR carcinoma, IMMUNOTHERAPY
Abstract

Simple Summary: Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for approximately 85–90% of all cases of liver cancer worldwide. The gut microbiome can serve as a potential non-invasive biomarker for early HCC detection and may also impact the effectiveness of immunotherapy in cancer treatment. This review examines the gut microbiome's role as a predictive and diagnostic marker for HCC and explores its potential as a novel therapeutic approach, particularly in the context of immunotherapy. The microbiome is pivotal in maintaining health and influencing disease by modulating essential inflammatory and immune responses. Hepatocellular carcinoma (HCC), ranking as the third most common cause of cancer-related fatalities globally, is influenced by the gut microbiome through bidirectional interactions between the gut and liver, as evidenced in both mouse models and human studies. Consequently, biomarkers based on gut microbiota represent promising non-invasive tools for the early detection of HCC. There is a growing body of evidence suggesting that the composition of the gut microbiota may play a role in the efficacy of immunotherapy in different types of cancer; thus, it could be used as a predictive biomarker. In this review, we will dissect the gut microbiome's role as a potential predictive and diagnostic marker in HCC and evaluate the latest progress in leveraging the gut microbiome as a novel therapeutic avenue for HCC patients, with a special emphasis on immunotherapy. [ABSTRACT FROM AUTHOR]

Published
2023
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