Palliative Surgery

The tumor samples from metastatic lesions isolated during palliative surgery at MD Anderson Cancer Center were obtained using an Institutional Review Board (IRB) approved laboratory protocol (LAB06-0755). The tumor samples were cut into 3–5 mm² fragments and placed in TIL culture media (TIL-CM) and 6,000 IU/ml IL-2 (Proleukin™) in 24-well plates for a period of 4–5 weeks (1 fragment per well). The TIL-CM contained RPMI 1640 with Glutamax (Gibco/Invitrogen; Carlsbad, CA), 1 mM pyruvate (Gibco/Invitrogen; Carlsbad, CA), 20 µg/ml Gentamicin (Gibco/Invitrogen; Carlsbad, CA), 50 µM 2-mercaptoethanol (Gibco/Invitrogen; Carlsbad, CA), 10% human AB serum (Sigma-Aldrich, St. Louis, MO) and 1X Pen-Strep (Gibco/Invitrogen; Carlsbad, CA). The TIL-CM was used for the rest of our experiments. The TIL were split 1∶1 in new TIL-CM and IL-2 across the plate from well-to-well after reaching confluence. After 4–5 weeks, the cells were harvested and designated as “pre-rapid expansion protocol TIL” (pre-REP TIL). Pre-REP TIL that were not expanded immediately further expanded using the REP were cryopreserved in 10% DMSO, 90% human AB serum and stored in liquid nitrogen.

The StuDoQ|Colon carcinoma and StuDoQ|Rectal carcinoma registers are prospectively documented databases for surgical interventions in colorectal carcinomas, which were set up by the DGAV in January 2010 (www.dgav.de/studoq, www.en.studoq.de). They were developed to facilitate the assessment of the quality and risk factors of colorectal cancer surgery in Germany. The declaration of consent, ethic approvment and the data security procedures were approved by the Society for Technology, Methods and Infrastructure for Networked Medical Research (http://www.tmf-ev.de). Written consent was obtained from all participants. The publication guidelines were determined by the DGAV (http://www.dgav.de/studoq/datenschutzkonzept-und-publikations guidelines.html). The data from participating centers are entered prospectively in pseudonymized form using a browser-based tool and subjected to automatic plausibility checks. Validation by cross-checking with institutional medical control data is part of the annual certification process. For the present study, all cases that underwent curative resection due to colorectal cancer were identified in the StuDoQ|Colon cancer and StuDoQ|Rectal cancer registry, and relevant demographic data, comorbidities, as well as information on operations, histology and perioperative history for analysis extracted in anonymous form. Full wall excision, simple polypectomy, endoscopic mucosal resection, and other endoluminal procedures, as well as palliative interventions regardless of the size of the operation, were excluded. Basic registration structures are comparable to the StuDoQ|Pancreas registration [14 (link)].
Postoperative complications included anastomotic leakage (grade C) [15 (link), 16 (link)], infection of the surgical site [17 (link)], Clavien-Dindo classification (CDC) [18 (link)], burst abdomen, reoperation, and hospital mortality. They were defined as either present or not present. Additional postoperative parameters that were assessed were the need for unscheduled postoperative ventilation lasting more than 48 hours, pneumonia, length of stay (LOS), and readmission. Postoperative total morbidity was summarized as none (CDC 0), minor (CDC 1–2), severe (CDC 3a-4), and fatal (CDC 5) according to the CDC. Patients were counted as MTL30 positive if they had died within 30 days after index operation, the postoperative length of stay exceeded 30 days or if they had been transferred to another acute hospital or in hospital unit (e.g. transfer to a tertiary center due to surgical complications or to internal medicine due to postoperative pulmonary emboly). Transfer to a postoperative rehabilitation did not count as positive.
Statistical analysis was performed with a bilateral significance level of 0.05. Scale variables were expressed as median and range and categorical parameters as absolute frequency and percentage. Univariate analysis was performed using the chi-square test for categorical variables and the Mann-Whitney test for ratio variables.
All variables with a p-value <0.1 in the univariate analysis were included in the multivariate analysis. The multivariable analysis was carried out by logistic regression.

We searched all publications related to palliative care and breast cancer from 2012 to 2022 in the Web of Science core database, including Science Citation Index-EXPANDED, Social Sciences Citation Index, and Arts & Humanities Citation Index (all 2003 to present); Emerging Sources Citation Index (2017 to present); Current Chemical Reactions-EXPANDED (1985 to present); and Index Chemicus (1993 to present). The Medical Subject Headings and entry terms “palliative care” and “breast cancer” were used as search strategies. Retrieval queries included the following: #1, ALL=(“Palliative Care”) OR ALL=(“Palliative Treatment*”) OR ALL=(“Palliative Therapy”) OR ALL=(“Palliative Supportive Care”) OR ALL=(“Palliative Surgery”); #2, ALL=(“breast cancer”) OR ALL=(“Breast Neoplasm”) OR ALL=(“Breast Tumor*”) OR ALL=(“Mammary Cancer*”) OR ALL=(“Malignant Neoplasm of Breast”) OR ALL=(“Breast Malignant Neoplasm*”) OR ALL=(“Breast Malignant Tumor*”) OR ALL=(“Mammary Carcinoma, Human”) OR ALL=(“Mammary Neoplasms, Human”) OR ALL=(“Breast Carcinoma*”); “#3”, “#1”, and “#2”. Also, the timespan of these publications was then filtered from 2012 to 2022. The search was conducted on July 10, 2022 and yielded 1654 articles. We set the document type to article or review article, restricted the language to English, and excluded one retracted publication. This yielded 1529 publications including 1134 articles (74.17%) and 395 review articles (25.83%); meanwhile, 125 publications were excluded including 69 non-English documents, 38 early access articles, 16 proceedings papers, 1 book chapter, and 1 retracted publication.

The study was conducted in accordance with the Helsinki Declaration (as revised in 2013). This study was approved by the Ethics Committee of Weifang People's Hospital. All patients consented to data being used for research when receiving treatment. Inclusion criteria were as follows: Aged 18 to 80, gastroscopic biopsy-confirmed gastric cancer, pathological staging (pT1∼4_aN0∼3M0), obtain informed consent of patients. Exclusion criteria were as follows:received neoadjuvant radiotherapy and chemotherapy prior to surgery, Palliative surgery, history of other primary malignacies, incomplete information or loss to follow-up. A flowchart of the study is shown in Figure 1.
The study protocol was approved by the research ethics committee of Weifang People's Hospital. Written informed consent was obtained from all patients prior to surgery. Each patient signed an informed consent to allow their treatment-related information to be used in future studies.

The inclusion criteria for our meta-analysis included: 1, Patients with gastrointestinal cancer (CRC, GC, EC, liver cancer, cholangiocarcinoma, or pancreatic cancer) who received radical or palliative intent surgery; 2, Patients were divided into the high ALI group and the low ALI group; and 3, Prognosis including OS, DFS, or CSS was reported (both effect value and survival curves were allowed). The exclusion criteria included: 1, Studies’ types were reviews, case reports, letters, conferences, comments, or preprint articles; and 2, Data was repeated or overlapped. When two studies had overlapped data, the study with a larger sample size would be included. The PICO framework was more intuitive and was shown in a supplementary document.