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doi: 10.1097/01.COT.0000553969.43758.dd
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Aspirin Intake and Hepatocellular Cancer Risk

The use of aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) reduces the risk of several malignancies; the evidence base is most robust for colorectal neoplasia. The possibility that regular long-term aspirin use might reduce the risk of hepatocellular carcinoma (HCC) was addressed in a combined cohort study of the Nurses' Health Study and the Health Professionals Follow-up Study. Among the 133,371 participants who were followed for over 26 years, there were 108 cases of HCC. Regular use of aspirin (but not other NSAIDs) was associated with a 50 percent reduced risk of HCC. The association was dose- and duration-dependent; a decreased risk was apparent with use of 1.5 or more standard-dose (325 mg) tablets per week for five or more years. Additional studies are needed to clarify the role of aspirin, if any, for primary prevention of HCC, particularly in high-risk individuals.

Short- and Long-Term Outcomes of Laparoscopic Versus Open Distal Pancreatectomy

Lesions of the body and tail of the pancreas can be resected by an open or laparoscopic procedure. In a multicenter, patient-blinded randomized trial, laparoscopic distal pancreatectomy reduced blood loss and the time to functional recovery compared with open surgery. Although two recent large propensity score-matched retrospective studies both demonstrated comparable survival at up to three years after open versus laparoscopic distal pancreatectomy for cancer, key details, such as positive margin rate and lymph node yield, were discordant in opposite directions. More randomized trials with longer follow-up are needed to confirm the oncologic safety of the laparoscopic approach.

Prostate-Directed Radiotherapy for Oligometastatic Prostate Cancer

For men with metastatic prostate cancer at diagnosis, the benefit of local prostate-directed therapy has been controversial. In the STAMPEDE trial, in which over 2000 men with newly diagnosed metastatic prostate cancer were randomly assigned to systemic therapy alone or with prostate radiotherapy (RT), the addition of RT improved failure-free but not overall survival. In a prespecified subgroup analysis, RT in men with a low metastatic disease burden improved survival. However, a survival impact with RT was not seen in those with a high metastatic burden (four or more bone metastases with at least one outside of the vertebral bodies or pelvis, or visceral metastases, or both). Prostate radiotherapy was well tolerated, with few grade 3 or 4 adverse effects occurring during (5 percent) and after (4 percent) treatment. For men with newly diagnosed metastatic prostate cancer, a low burden of bone metastases, and no visceral metastases, we suggest prostate RT in conjunction with systemic therapy, rather than systemic therapy alone.

FIGO Introduces Changes to the Cervical Cancer Staging System

The International Federation of Gynecology and Obstetrics (FIGO) has published an updated cervical cancer staging system. Among the changes, the list of tests and procedures that may be used to assign stage was expanded to include imaging and pathologic findings where available, tumor size criteria for some stages were revised, and lymph node metastases were included in staging. Since cervical cancer outcomes depend greatly on tumor size and lymph node involvement, these changes improve the ability of stage to predict prognosis and plan treatment.

Human Papillomavirus Testing in Oropharyngeal Squamous Cell Carcinoma

Human papillomavirus (HPV) infection is a causative agent for oropharyngeal squamous cell carcinoma (SCC), and HPV tumor status is incorporated into the staging system of these tumors. An approach to HPV evaluation has been proposed by the College of American Pathologists (CAP) and endorsed by the American Society of Clinical Oncology (ASCO). HPV tumor status should be determined for all cases of newly diagnosed oropharyngeal SCC. HPV tumor status is not appropriate for the routine evaluation of nonsquamous carcinoma of the oropharynx or nonoropharyngeal SCC of the head and neck. It may be useful in select cases of oropharyngeal cancer with uncertain histology.

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