BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surger...BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.展开更多
Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A sign...Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A significant barrier,though,is the high morbidity and drawn-out recovery after extensive surgical resection,which may postpone or prohibit the prompt administration of adjuvant therapy.Thereby,acknowledging the efficacy of neoadjuvant therapy in various digestive tract malignancies like rectal,gastric,and oesophagal cancers in en-hancing long-term survival and the likelihood of successful resection,researchers have turned their attention to exploring its potential benefits in the context of both resectable and borderline resectable pancreatic cancer(RPC).According to recent data,neoadjuvant chemoradiation has major advantages for both resectable and borderline RPC.These advantages include increased surgical resection rates,longer survival times,decreased recurrence rates,and better overall disease control with a manageable toxicity profile.Despite its benefits,research is still being done to determine the best way to sequence and combine chemotherapy and radiation.Furthermore,studies have demonstrated the potential for cus-tomized therapy regimens based on the patient’s general health status and the tumor’s biological behavior to maximize the neoadjuvant approach.As progress continues,neoadjuvant chemoradiation is set to become a key component of treatment for both resectable and borderline RPC,providing a more efficient way to manage this deadly condition.While further development is required to fully grasp its potential in enhancing long-term patient outcomes,evidence supports its increasing usage in clinical practice.展开更多
This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various ...This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.展开更多
Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFO...Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFOX-6)regimen on the post-transplant prognosis of HCC patients.Methods:HCC patients who underwent LT at our institution from June 2017 to December 2019 were enrolled.The cohort was divided into the ACT group(n=57)and the non-ACT group(n=93).The median post-transplant follow-up period was 54.0 months.The study endpoints were HCC recurrence and patient mortality following LT.The association between ACT and recurrence/mortality were evaluated through univariate and multivariate analyses utilizing a Cox proportional hazards model,propensity score adjustment,propensity score matching,and inverse probability of treatment weighting(IPTW)analyses.A stratification analysis was performed to determine the interaction effects.Results:The ACT group was younger and had worse tumor characteristics including tumor number,tu-mor size,portal vein tumor thrombosis,pathological differentiation and microvascular invasion(MVI).The ACT group also demonstrated a lower risk of mortality than the non-ACT group(hazard ratio=0.36,P=0.017).It was consistent across sensitivity analyses utilizing propensity score adjustment and match-ing.There was a significant stronger association between ACT and recurrence-free benefit in patients with grade M2 of MVI compared to patients with grade M0/1(P for interaction=0.002).Conclusions:ACT with mFOLFOX-6 regimen decreased the recurrence and mortality risks following LT for HCC patients.ACT may be considered in HCC patients with high risk of recurrence and mortality after LT.展开更多
BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients re...BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage Ⅱ/Ⅲ gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.展开更多
BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve p...BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve patient survival,adjuvant chemotherapy is commonly administered based on established postoperative guidelines.Despite advancements in chemotherapy delivery,the overall response rate remains below 50%,primarily due to the lack of targeted therapies tailored to specific patient populations.AIM To explore sensitive biomarkers to assess the efficacy of postoperative adjuvant chemotherapy in appropriate patient subgroups.METHODS This study retrospectively analyzed 1628 patients who underwent radical gastrectomy for GC at our hospital in 2017 and 2018,with a subsequent five-year follow-up.Patients were divided based on whether they received postoperative adjuvant chemotherapy.The study aimed to determine optimal cutoff values for various biomarkersneutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724,and CA242-using receiver operating characteristic(ROC)curves.Based on the optimal ROC cut-off,a novel combined metric,NLR-CEA,was developed to assess the efficacy of adjuvant chemotherapy following GC surgery.RESULTS Cox subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved overall survival in the NLR-CEA_Low group with a rate of 0.41(0.26-0.63).In the NLR-CEA_Middle group,the protective effect was observed at 0.69(0.54-0.87),while in the NLR-CEA_High group,it was 0.73(0.53-0.99).Notably,a 32%difference in the efficacy of chemotherapy was observed between the NLR-CEA_Low and NLR-CEA_High groups.CONCLUSION NLR-CEA is an effective biomarker for evaluating the efficacy of postoperative adjuvant chemotherapy in GC.Patients with NLR-CEA_Low exhibit significantly better responses to chemotherapy compared to those with NLRCEA_High.展开更多
The aluminum hydroxide adjuvant possesses a poorly crystalline boehmite (PCB) structure, the stability of which is significantly affected by storage conditions. In the present study, we conducted a comprehensive inves...The aluminum hydroxide adjuvant possesses a poorly crystalline boehmite (PCB) structure, the stability of which is significantly affected by storage conditions. In the present study, we conducted a comprehensive investigation into the structural and quality alterations of aluminum hydroxide adjuvants under varying temperature conditions over time. Three batches of the adjuvant were stored at 2–8℃, 18–25℃, and 37℃, respectively, for 6 months. Key parameters, including X-ray diffraction patterns, pH, isoelectric point (pI), adsorption capacity, and average particle size, were analyzed to assess the impact of storage temperatures. X-ray diffraction analysis confirmed the PCB structure of the aluminum hydroxide adjuvant. Notably, after 1 month of storage at 37℃, new diffraction peaks emerged at 18.2 °2θ, with their intensity increasing progressively over time. Concurrently, the largest decreases in pI and pH were observed, measuring 0.78 and 1.33, respectively. In contrast, adjuvants stored at 2–8℃ for 6 months exhibited only faint diffraction peaks at 18.2 °2θ, indicating minor structural changes. Under these conditions, the reductions in pI and pH were comparatively smaller, at 0.43 and 0.80, respectively. The average particle size of the adjuvants remained within 110–140 nm across all storage conditions. Additionally, the aluminum hydroxide adjuvant consistently demonstrated a high protein adsorption capacity, approximately 8 mg BSA/mg Al^(3+), with no statistically significant differences in adsorption rates observed among the different temperature conditions (P > 0.05). These findings highlighted the remarkable adsorption efficiency of nanoparticle aluminum hydroxide adjuvants throughout storage, reinforcing their potential as superior vaccine adsorbents. However, elevated storage temperatures were shown to accelerate structural aging, promoting the formation of highly crystalline phases such as gibbsite or bayerite, which could compromise the stability and quality of the adjuvant.展开更多
Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before a...Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before and after adjuvant chemotherapy.Methods A total of 222 breast cancer patients with consistent ER and PR expression scheduled to undergo adjuvant chemotherapy were classified according to TCM syndrome differentiation before and after chemotherapy.The data were analyzed using chi-square tests and binary logistic regression with SPSS 26.0 software,and compared with ER/PR expression results.Results(i)In the ER-positive/PR-positive group,compared with prechemotherapy,syndromes of spleen qi deficiency,spleen deficiency with dampness-phlegm,and spleen–kidney deficiency significantly increased during mid-chemotherapy and after chemotherapy.Compared with mid-chemotherapy,spleen yang deficiency syndrome significantly increased after chemotherapy,with statistical significance(p<0.05).(ii)In the ER-negative/PR-negative group,compared with prechemotherapy,syndromes of spleen qi deficiency and spleen deficiency with dampness-phlegm significantly increased during mid-chemotherapy,while spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased after chemotherapy.Compared with mid-chemotherapy,spleen–kidney deficiency and spleen yang deficiency syndromes significantly increased after chemotherapy,with statistical significance(p<0.05).(iii)The distribution of spleen qi deficiency syndrome during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group,with statistical significance(p<0.05).(iv)ER and PR were not independent influencing factors for the various syndrome types before and after adjuvant chemotherapy(p>0.05).Conclusion After chemotherapy initiation,syndromes of spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased in both ER-positive/PR-positive and ER-negative/PR-negative groups.The distribution of spleen qi deficiency during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group.ER and PR were not independent influencing factors for the syndrome types before and after adjuvant chemotherapy.展开更多
Aluminum hydroxide adjuvant exhibits a poorly crystalline boehmite(PCB)structure,which demonstrates instability during prolonged storage.In the present study,we systematically investigated the quality alterations of t...Aluminum hydroxide adjuvant exhibits a poorly crystalline boehmite(PCB)structure,which demonstrates instability during prolonged storage.In the present study,we systematically investigated the quality alterations of the adjuvant stored at roo m temperature by analyzing its crystal structure,particle size distribution,electron microscopic characteristics,pH,isoelectric point(pI),and adsorption capacity.These assessments aimed to ensure the effectiveness and safety of vaccine production.Three batches of adjuvants were stored at room temperature for 15 months,and their changes were monitored using X-ray diffraction patterns,transmission electron microscopy(TEM),pH measurements,pI determination,and adsorption capacity analysis.X-ray diffraction revealed that the crystalline phases of aluminum hydroxide initially exhibited a PCB structure,which became progressively more ordered during storage.Notably,after 12 months,a new diffraction peak emerged at 18.2°2θ,with its intensity increasing over time.This corresponded to the formation of highly crystalline gibbsite and bayerite,which compromised the stability of the adjuvant.Furthermore,the pH and pI values decreased during storage,reflecting a decline in the chemical stability of the adjuvant.Comprising nanoparticles with a mean diameter of 130 nm,the adjuvant maintained a high surface area and excellent adsorption capacity.The adsorption rate at 8 mg BSA/mg Al3+consistently exceeded 97%,with no statistically significant differences observed between the adsorption capacities at 1 and 15 months(P>0.05).This indicated that the nanoparticle aluminum hydroxide adjuvant sustained high adsorption efficiency throughout the storage period,underscoring its reliability as a vaccine adsorbent.However,in the later stages of storage,the emergence of highly crystalline gibbsite and bayerite,coupled with declines in pH and pI,negatively impacted the adjuvant’s stability.Based on these findings,we recommended that aluminum hydroxide adjuvants should not be stored at room temperature for longer than 12 months to preserve their quality and efficacy.展开更多
Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore w...Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.展开更多
This paper investigates the effects of graphene quantum dots and mesoporous silica as nanomaterial adjuvants on immune activity in mice both in vitro and in vivo.The two materials have distinct properties;graphene qua...This paper investigates the effects of graphene quantum dots and mesoporous silica as nanomaterial adjuvants on immune activity in mice both in vitro and in vivo.The two materials have distinct properties;graphene quantum dots possess unique optical and electrical characteristics,while mesoporous silica features a regular pore structure.In vitro experiments show differences in their effects on immune cell activation and cytokine secretion;in vivo experiments reveal varying performances in antibody production and immune cell function regulation.Their mechanisms of action and safety profiles also differ,offering distinct advantages in application prospects.These two nanomaterial adjuvants provide new directions for the development of immunology,warranting further exploration.展开更多
Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has ri...Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has risen,making it the country’s second-deadliest tumor.Hepatocellular carcinoma(HCC),the predo-minant histological subtype,remains a substantial therapeutic challenge.Hepa-tectomy is the treatment of choice for HCC;however,because of its insidious onset and aggressive progression,the global 5-year survival rate is only 14.1%,and up to 70%of patients experience recurrence within five years after surgery.Consequently,reducing postoperative recurrence and prolonging survival have become critical research priorities.Currently,no consensus or guidelines exist regarding the clinical efficacy or potential synergistic effects of diagnostic and therapeutic strategies to prevent postoperative recurrence.In recent years,interest has grown in systemic therapies and combined local modalities-particularly targeted agents and immune checkpoint inhibitors,as adjuvant treatments.This review synthesizes recent advances in targeted and immunotherapeutic adjuvant therapies for postoperative HCC to inform clinical practice and improve patient outcomes.展开更多
BACKGROUND Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer.Despite the increased risk of pulmonary complications,such as p...BACKGROUND Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer.Despite the increased risk of pulmonary complications,such as pleural effusion and pulmonary infection,postoperative recovery time and survival outcomes are similar to younger patients.AIM To investigate the safety and efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer by comparing treatment-related complications,surgical outcomes,and long-term survival between elderly patients(≥65 years)and younger patients(<65 years).METHODS The clinical data of 148 patients with advanced gastric cancer in elderly patients who received neoadjuvant chemotherapy in our hospital from January 2015 to October 2023 were retrospectively analyzed,and these patients were divided into young and middle-aged groups(111 patients)and elderly groups(37 patients),and their clinicopathology and prognosis were compared.RESULTS Neoadjuvant chemotherapy induced anemia(χ^(2)=0.235,P=0.628),leukopenia(χ^(2)=0.613,P=0.434),neutropenia(χ^(2)=0.011,P=0.918)and thrombocytopenia(χ^(2)=0.253,P=0.628)in both groups.Hematological complications,nausea(χ^(2)=0.092,P=0.762),vomiting(χ^(2)=0.166,P=0.683),diarrhea(χ^(2)=0.015,P=0.902)and mucositis(χ^(2)=0.199),and there was no significant difference in the incidence of nonhematological complications(P=0.766).Between the old group and the young and middle-aged groups,no significant differences were observed in operative time(t=0.270,P=0.604),intraoperative blood loss(t=1.140,P=0.250),or R0 removal rate(χ^(2)=0.105,P=0.750).Although the incidence of postoperative complications was higher in the old group(37.8%)compared to the young and middle-aged groups(25.2%),this difference did not reach statistical significance(χ^(2)=2.172,P=0.141).However,the elderly group demonstrated significantly higher incidences of pleural effusion(χ^(2)=7.007,P=0.008)and pulmonary infection(χ^(2)=10.204,P=0.001)than the young and middleaged groups.When examining survival outcomes,neither the 3-year progression-free survival(t=0.494,P=0.482)nor the 3-year overall survival(t=0.013,P=0.908)showed significant differences between the elderly group and the young and middle-aged groups.CONCLUSION Neoadjuvant chemotherapy combined with radical gastrectomy is safe and effective in elderly patients with advanced gastric cancer,but there are more pulmonary complications(specifically pleural effusion and pulmonary infection)during the perioperative period.展开更多
Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients b...Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients between May 2022 and December 2024,who were randomly allocated into two equal treatment groups(n=30 each).The control group received standard chemotherapy,whereas the observation group was treated with a combined adjuvant regimen of epirubicin and docetaxel.Therapeutic outcomes were systematically compared between the groups.Results:The comparative analysis of chemotherapy regimens revealed significant intergroup differences in multiple outcome measures.The observation group demonstrated superior clinical efficacy(96.67%vs 80.00%,P<0.05)alongside a more favorable safety profile(adverse reaction incidence:3.33%vs 20.00%,P<0.05).Metabolic assessments showed better glycemic control in the observation group,with both fasting and postprandial blood glucose levels being significantly lower than controls(P<0.05),while maintaining comparable values to pretreatment baselines(P>0.05).Furthermore,quality of life assessments indicated significantly better outcomes in the observation group compared to controls(P<0.05).Conclusion:The combination of epirubicin and docetaxel as adjuvant chemotherapy for patients after radical mastectomy for breast cancer has significant clinical effects,can improve patients’quality of life,and has high safety.It is worthy of adoption.展开更多
OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in ...OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in this study.All patients were categorized into the traditional herbal medicine(THM) group(n = 115) or the non-THM treatment(nTHM) group(n = 239),with the Jiedu formula administered twice a day to the patients in the THM group.The primary outcome was recurrence-free survival(RFS).Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors associated with RFS.Then,the high risk of recurrence among patients was identified,and propensity score matching(PSM) and RFS analysis were performed to analyze the prognostic factors for the outcomes of patients at a high risk of recurrence in different groups.RESULTS:The one,two,three,and five-year RFS rates of the THM and nTHM groups were 76.4% vs 66.1%,65.5% vs 48.8%,57.9% vs 39.9%,and 43.9% vs 29.2%,respectively.The results of the Multivariate Cox analysis showed that giant tumors [hazard ratio(HR),1.54,P = 0.04],poor degree of differentiation,microsatellite,or microvascular invasion(HR,1.29,P = 0.09) increased the risk of recurrence.In the population with a high risk of recurrence,after PSM,the one,two,three,and five-year survival rates were 70.6% vs 68.0%,63.0% vs 43.1%,59.6% vs 33.3%,and 41.9% vs 26.4%,respectively.CONCLUSION:In this study,THM was found to be an effective agent for adjuvant therapy for HCC to prevent early recurrence of HCC after hepatic resection.展开更多
Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization s...Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.展开更多
Allergen specific immunotherapy(AIT)has a history spanning over 110 years and represents the only diseasemodifying treatment for allergic diseases,with potential preventive effects.Nevertheless,the broader application...Allergen specific immunotherapy(AIT)has a history spanning over 110 years and represents the only diseasemodifying treatment for allergic diseases,with potential preventive effects.Nevertheless,the broader application of AIT is limited by the inherent drawbacks of natural allergen extracts,such as variability in composition,risk of side effects,and complex,lengthy treatment regimens.Advances in molecular allergology have enabled the development of novel vaccine strategies-including recombinant allergens,hypoallergenic derivatives,allergen-derived peptides,and nucleic acid-based vaccines-that aim to improve safety,efficacy,and precision.However,no molecule-based AIT product has yet achieved regulatory approval,largely due to technical and clinical trial challenges.In parallel,immunomodulatory adjuvants such as monophosphoryl lipid A,CpG oligodeoxynucleotides,flagellin and mannan have demonstrated promising properties.These innovations have the potential to enhance AIT outcomes by promoting immune tolerance,reducing IgE responses,and improving patient compliance.This review summarizes the current landscape of allergen vaccines and adjuvant technologies under investigation for AIT,highlighting key advances,clinical data,and future directions aimed at overcoming existing limitations and optimizing treatment strategies for allergic diseases.展开更多
BACKGROUND Esophageal cancer(EC),primarily esophageal squamous cell carcinoma in China,has a poor prognosis with a 5-year survival rate of approximately 25%after surgery alone.Neoadjuvant chemoradiotherapy combined wi...BACKGROUND Esophageal cancer(EC),primarily esophageal squamous cell carcinoma in China,has a poor prognosis with a 5-year survival rate of approximately 25%after surgery alone.Neoadjuvant chemoradiotherapy combined with surgery is the standard treatment for locally advanced EC,with a 47%5-year survival rate,although adverse events are common.Immunotherapy,particularly PD-1 inhibitors,has shown promise in treating advanced EC,and neoadjuvant chemotherapy with immunotherapy is effective.However,the efficacy of postoperative immunotherapy remains unclear,with studies like Checkmate577 showing promising results but limited applicability to surgery-only patients,highlighting the need for further research.AIM To evaluate the efficacy,prognostic factors,and safety of adjuvant immunotherapy with anti-PD-1 inhibitors following radical surgery for EC.METHODS A retrospective analysis was conducted on EC patients who received adjuvant immunotherapy after radical treatment at the 900th Hospital of the China Joint Logistics Force between January 2018 and October 2024.Demographic,treatment and laboratory data were collected.Progression-free survival(PFS)was assessed using the Kaplan-Meier method,and independent prognostic factors were identified using Cox regression.Optimal cutoff values for continuous variables,including body mass index(BMI)difference and neutrophil-to-lymphocyte ratio(NLR),were determined using the maxstat package in R.RESULTS A total of 44 patients were included,with a 2-year PFS rate of 68.6%[95%confidence interval(CI):53%-88.7%].Univariate analysis identified several factors significantly associated with prognosis,including the interval between surgery and immunotherapy,BMI difference between before surgery and first immunotherapy,presurgical lymphocyte count,and presurgical NLR.Multivariable Cox regression revealed that a BMI difference<3.86 was an independent protective factor for PFS(hazard ratio:0.42,95%CI:0.21-0.85,P<0.05).At the last followup,the median PFS for patients with BMI<3.86 had not been reached,compared to 8.83 months for those with BMI>3.86.The 1-year PFS for patients receiving postoperative chemotherapy combined with immunotherapy was 88.5%,suggesting superior efficacy over chemotherapy alone.CONCLUSION Adjuvant immunotherapy for EC shows good efficacy and safety.A BMI difference<3.86 is a protective factor for PFS,highlighting the importance of monitoring nutrition and inflammation for personalized treatment.展开更多
Chirality is pervasive and plays a crucial role in biological processes.Although amino acids possess inherent chirality,the stereochemical influence of this property on the regulation of immune cells remains insuffici...Chirality is pervasive and plays a crucial role in biological processes.Although amino acids possess inherent chirality,the stereochemical influence of this property on the regulation of immune cells remains insufficiently explored.To address this,the unimolecular chiral poly(amino acid)s were synthesized to evaluate their immunostimulatory effects and anti-cancer potential.Among the candidates,G0-P_(D)-Lys_(50)emerged as the most effective adjuvant through in vitro screening.When complexed with antigen ovalbumin(OVA)to form chiral nanovaccines,G0-P_(L)-Lys_(50)-OVA and G0-P_(D)-Lys_(50)-OVA exhibited similar morphology,particle size,and zeta potential.Despite these comparable physicochemical properties,G0-P_(D)Lys_(50)-OVA induced significantly stronger activation of dendritic cells(DCs).Specifically,it resulted in 1.38-and 1.34-fold increases in CD11c^(+)CD80^(+)DCs and CD11c^(+)SIINFEKL-H-2Kb^(+)DCs in lymph nodes,respectively.In the LLC-OVA cancer model,G0-P_(D)-Lys_(50)-OVA reduced tumor volume by 50%compared to its enantiomer.These results establish a unique approach to designing chiral nanovaccines and provide a foundational strategy for developing broadly applicable immunotherapies.展开更多
Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(198...Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(1988–2018)were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Multivariate Cox analysis was used to control confounders.Logistic regression was used to explore factors associated with adjuvant chemotherapy.Cox regression analysis and Kaplan-Meier curves were used to assess the survival benefits.Single-center clinical data and meta-analysis following PRISMA guidelines provided external validation.Result:Adjuvant chemotherapy correlated with improved survival(Hazard Ratio(HR):0.860,p=0.011),as did lymphadenectomy(HR:0.842,p<0.001).Higher age,pathological stage,and tumor grade negatively affected survival.Chemotherapy administration associated with higher pathological stage(IB:Odds Ratio(OR)1.565,p<0.001;IC:OR 4.091,p<0.001),higher grade(G2:OR 2.336,p<0.001;G3:OR 4.563,p<0.001),and lymphadenectomy(OR 1.148,p=0.040).Stratification analysis showed adjuvant chemotherapy failed to improve prognosis in stage IA/IB patients regardless of grade or lymphadenectomy.For stage IC patients,chemotherapy benefited grade 1-2 or grade 3 patients without lymphadenectomy,and grade 3 patients with lymphadenectomy.Meta-analysis revealed reduced recurrence in stage IC patients(OR=0.50,p=0.035).Conclusion:Adjuvant chemotherapy confers survival benefits for stage IC patients,particularly those without lymphadenectomy.展开更多
基金Supported by the Hunan Province Clinical Medical Technology Innovation Guidance Project,No.2020SK50912Annual Scientific Research Plan Project of Hunan Provincial Health Commission,No.C2019057Hunan Provincial Natural Science Foundation of China,No.2023JJ40381.
文摘BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.
文摘Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A significant barrier,though,is the high morbidity and drawn-out recovery after extensive surgical resection,which may postpone or prohibit the prompt administration of adjuvant therapy.Thereby,acknowledging the efficacy of neoadjuvant therapy in various digestive tract malignancies like rectal,gastric,and oesophagal cancers in en-hancing long-term survival and the likelihood of successful resection,researchers have turned their attention to exploring its potential benefits in the context of both resectable and borderline resectable pancreatic cancer(RPC).According to recent data,neoadjuvant chemoradiation has major advantages for both resectable and borderline RPC.These advantages include increased surgical resection rates,longer survival times,decreased recurrence rates,and better overall disease control with a manageable toxicity profile.Despite its benefits,research is still being done to determine the best way to sequence and combine chemotherapy and radiation.Furthermore,studies have demonstrated the potential for cus-tomized therapy regimens based on the patient’s general health status and the tumor’s biological behavior to maximize the neoadjuvant approach.As progress continues,neoadjuvant chemoradiation is set to become a key component of treatment for both resectable and borderline RPC,providing a more efficient way to manage this deadly condition.While further development is required to fully grasp its potential in enhancing long-term patient outcomes,evidence supports its increasing usage in clinical practice.
文摘This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.
基金supported by grants from Zhejiang Provincial Natural Science Foundation of China(LTGY24H030006)Re-search Project of Jinan Microecological Biomedicine Shandong Lab-oratory(JNL-2022015B).
文摘Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFOX-6)regimen on the post-transplant prognosis of HCC patients.Methods:HCC patients who underwent LT at our institution from June 2017 to December 2019 were enrolled.The cohort was divided into the ACT group(n=57)and the non-ACT group(n=93).The median post-transplant follow-up period was 54.0 months.The study endpoints were HCC recurrence and patient mortality following LT.The association between ACT and recurrence/mortality were evaluated through univariate and multivariate analyses utilizing a Cox proportional hazards model,propensity score adjustment,propensity score matching,and inverse probability of treatment weighting(IPTW)analyses.A stratification analysis was performed to determine the interaction effects.Results:The ACT group was younger and had worse tumor characteristics including tumor number,tu-mor size,portal vein tumor thrombosis,pathological differentiation and microvascular invasion(MVI).The ACT group also demonstrated a lower risk of mortality than the non-ACT group(hazard ratio=0.36,P=0.017).It was consistent across sensitivity analyses utilizing propensity score adjustment and match-ing.There was a significant stronger association between ACT and recurrence-free benefit in patients with grade M2 of MVI compared to patients with grade M0/1(P for interaction=0.002).Conclusions:ACT with mFOLFOX-6 regimen decreased the recurrence and mortality risks following LT for HCC patients.ACT may be considered in HCC patients with high risk of recurrence and mortality after LT.
基金Supported by Xiamen Natural Science Foundation of China,No.3502Z20227347.
文摘BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage Ⅱ/Ⅲ gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.
文摘BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve patient survival,adjuvant chemotherapy is commonly administered based on established postoperative guidelines.Despite advancements in chemotherapy delivery,the overall response rate remains below 50%,primarily due to the lack of targeted therapies tailored to specific patient populations.AIM To explore sensitive biomarkers to assess the efficacy of postoperative adjuvant chemotherapy in appropriate patient subgroups.METHODS This study retrospectively analyzed 1628 patients who underwent radical gastrectomy for GC at our hospital in 2017 and 2018,with a subsequent five-year follow-up.Patients were divided based on whether they received postoperative adjuvant chemotherapy.The study aimed to determine optimal cutoff values for various biomarkersneutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724,and CA242-using receiver operating characteristic(ROC)curves.Based on the optimal ROC cut-off,a novel combined metric,NLR-CEA,was developed to assess the efficacy of adjuvant chemotherapy following GC surgery.RESULTS Cox subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved overall survival in the NLR-CEA_Low group with a rate of 0.41(0.26-0.63).In the NLR-CEA_Middle group,the protective effect was observed at 0.69(0.54-0.87),while in the NLR-CEA_High group,it was 0.73(0.53-0.99).Notably,a 32%difference in the efficacy of chemotherapy was observed between the NLR-CEA_Low and NLR-CEA_High groups.CONCLUSION NLR-CEA is an effective biomarker for evaluating the efficacy of postoperative adjuvant chemotherapy in GC.Patients with NLR-CEA_Low exhibit significantly better responses to chemotherapy compared to those with NLRCEA_High.
文摘The aluminum hydroxide adjuvant possesses a poorly crystalline boehmite (PCB) structure, the stability of which is significantly affected by storage conditions. In the present study, we conducted a comprehensive investigation into the structural and quality alterations of aluminum hydroxide adjuvants under varying temperature conditions over time. Three batches of the adjuvant were stored at 2–8℃, 18–25℃, and 37℃, respectively, for 6 months. Key parameters, including X-ray diffraction patterns, pH, isoelectric point (pI), adsorption capacity, and average particle size, were analyzed to assess the impact of storage temperatures. X-ray diffraction analysis confirmed the PCB structure of the aluminum hydroxide adjuvant. Notably, after 1 month of storage at 37℃, new diffraction peaks emerged at 18.2 °2θ, with their intensity increasing progressively over time. Concurrently, the largest decreases in pI and pH were observed, measuring 0.78 and 1.33, respectively. In contrast, adjuvants stored at 2–8℃ for 6 months exhibited only faint diffraction peaks at 18.2 °2θ, indicating minor structural changes. Under these conditions, the reductions in pI and pH were comparatively smaller, at 0.43 and 0.80, respectively. The average particle size of the adjuvants remained within 110–140 nm across all storage conditions. Additionally, the aluminum hydroxide adjuvant consistently demonstrated a high protein adsorption capacity, approximately 8 mg BSA/mg Al^(3+), with no statistically significant differences in adsorption rates observed among the different temperature conditions (P > 0.05). These findings highlighted the remarkable adsorption efficiency of nanoparticle aluminum hydroxide adjuvants throughout storage, reinforcing their potential as superior vaccine adsorbents. However, elevated storage temperatures were shown to accelerate structural aging, promoting the formation of highly crystalline phases such as gibbsite or bayerite, which could compromise the stability and quality of the adjuvant.
基金supported by the 2022 Traditional Chinese Medicine Scientific Research Special Project of Henan Province,China(2022ZY1048)2023 Traditional Chinese Medicine Scientific Research Special Project of Henan Province,China(2023YZ2043)General Program of Natural Science Foundation of Henan Province,China(232300421183).
文摘Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before and after adjuvant chemotherapy.Methods A total of 222 breast cancer patients with consistent ER and PR expression scheduled to undergo adjuvant chemotherapy were classified according to TCM syndrome differentiation before and after chemotherapy.The data were analyzed using chi-square tests and binary logistic regression with SPSS 26.0 software,and compared with ER/PR expression results.Results(i)In the ER-positive/PR-positive group,compared with prechemotherapy,syndromes of spleen qi deficiency,spleen deficiency with dampness-phlegm,and spleen–kidney deficiency significantly increased during mid-chemotherapy and after chemotherapy.Compared with mid-chemotherapy,spleen yang deficiency syndrome significantly increased after chemotherapy,with statistical significance(p<0.05).(ii)In the ER-negative/PR-negative group,compared with prechemotherapy,syndromes of spleen qi deficiency and spleen deficiency with dampness-phlegm significantly increased during mid-chemotherapy,while spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased after chemotherapy.Compared with mid-chemotherapy,spleen–kidney deficiency and spleen yang deficiency syndromes significantly increased after chemotherapy,with statistical significance(p<0.05).(iii)The distribution of spleen qi deficiency syndrome during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group,with statistical significance(p<0.05).(iv)ER and PR were not independent influencing factors for the various syndrome types before and after adjuvant chemotherapy(p>0.05).Conclusion After chemotherapy initiation,syndromes of spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased in both ER-positive/PR-positive and ER-negative/PR-negative groups.The distribution of spleen qi deficiency during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group.ER and PR were not independent influencing factors for the syndrome types before and after adjuvant chemotherapy.
文摘Aluminum hydroxide adjuvant exhibits a poorly crystalline boehmite(PCB)structure,which demonstrates instability during prolonged storage.In the present study,we systematically investigated the quality alterations of the adjuvant stored at roo m temperature by analyzing its crystal structure,particle size distribution,electron microscopic characteristics,pH,isoelectric point(pI),and adsorption capacity.These assessments aimed to ensure the effectiveness and safety of vaccine production.Three batches of adjuvants were stored at room temperature for 15 months,and their changes were monitored using X-ray diffraction patterns,transmission electron microscopy(TEM),pH measurements,pI determination,and adsorption capacity analysis.X-ray diffraction revealed that the crystalline phases of aluminum hydroxide initially exhibited a PCB structure,which became progressively more ordered during storage.Notably,after 12 months,a new diffraction peak emerged at 18.2°2θ,with its intensity increasing over time.This corresponded to the formation of highly crystalline gibbsite and bayerite,which compromised the stability of the adjuvant.Furthermore,the pH and pI values decreased during storage,reflecting a decline in the chemical stability of the adjuvant.Comprising nanoparticles with a mean diameter of 130 nm,the adjuvant maintained a high surface area and excellent adsorption capacity.The adsorption rate at 8 mg BSA/mg Al3+consistently exceeded 97%,with no statistically significant differences observed between the adsorption capacities at 1 and 15 months(P>0.05).This indicated that the nanoparticle aluminum hydroxide adjuvant sustained high adsorption efficiency throughout the storage period,underscoring its reliability as a vaccine adsorbent.However,in the later stages of storage,the emergence of highly crystalline gibbsite and bayerite,coupled with declines in pH and pI,negatively impacted the adjuvant’s stability.Based on these findings,we recommended that aluminum hydroxide adjuvants should not be stored at room temperature for longer than 12 months to preserve their quality and efficacy.
文摘Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.
文摘This paper investigates the effects of graphene quantum dots and mesoporous silica as nanomaterial adjuvants on immune activity in mice both in vitro and in vivo.The two materials have distinct properties;graphene quantum dots possess unique optical and electrical characteristics,while mesoporous silica features a regular pore structure.In vitro experiments show differences in their effects on immune cell activation and cytokine secretion;in vivo experiments reveal varying performances in antibody production and immune cell function regulation.Their mechanisms of action and safety profiles also differ,offering distinct advantages in application prospects.These two nanomaterial adjuvants provide new directions for the development of immunology,warranting further exploration.
基金Supported by the Lianyungang Comprehensive Cancer Management and Technology Advancement Project,No.QN202302the First People’s Hospital of Lianyungang Young Talent Development Initiative,No.QN2212Jiangsu Society of Research Hospital Translational Medicine Research Grant,No.2024-GDZXKT-01-07.
文摘Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has risen,making it the country’s second-deadliest tumor.Hepatocellular carcinoma(HCC),the predo-minant histological subtype,remains a substantial therapeutic challenge.Hepa-tectomy is the treatment of choice for HCC;however,because of its insidious onset and aggressive progression,the global 5-year survival rate is only 14.1%,and up to 70%of patients experience recurrence within five years after surgery.Consequently,reducing postoperative recurrence and prolonging survival have become critical research priorities.Currently,no consensus or guidelines exist regarding the clinical efficacy or potential synergistic effects of diagnostic and therapeutic strategies to prevent postoperative recurrence.In recent years,interest has grown in systemic therapies and combined local modalities-particularly targeted agents and immune checkpoint inhibitors,as adjuvant treatments.This review synthesizes recent advances in targeted and immunotherapeutic adjuvant therapies for postoperative HCC to inform clinical practice and improve patient outcomes.
文摘BACKGROUND Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer.Despite the increased risk of pulmonary complications,such as pleural effusion and pulmonary infection,postoperative recovery time and survival outcomes are similar to younger patients.AIM To investigate the safety and efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer by comparing treatment-related complications,surgical outcomes,and long-term survival between elderly patients(≥65 years)and younger patients(<65 years).METHODS The clinical data of 148 patients with advanced gastric cancer in elderly patients who received neoadjuvant chemotherapy in our hospital from January 2015 to October 2023 were retrospectively analyzed,and these patients were divided into young and middle-aged groups(111 patients)and elderly groups(37 patients),and their clinicopathology and prognosis were compared.RESULTS Neoadjuvant chemotherapy induced anemia(χ^(2)=0.235,P=0.628),leukopenia(χ^(2)=0.613,P=0.434),neutropenia(χ^(2)=0.011,P=0.918)and thrombocytopenia(χ^(2)=0.253,P=0.628)in both groups.Hematological complications,nausea(χ^(2)=0.092,P=0.762),vomiting(χ^(2)=0.166,P=0.683),diarrhea(χ^(2)=0.015,P=0.902)and mucositis(χ^(2)=0.199),and there was no significant difference in the incidence of nonhematological complications(P=0.766).Between the old group and the young and middle-aged groups,no significant differences were observed in operative time(t=0.270,P=0.604),intraoperative blood loss(t=1.140,P=0.250),or R0 removal rate(χ^(2)=0.105,P=0.750).Although the incidence of postoperative complications was higher in the old group(37.8%)compared to the young and middle-aged groups(25.2%),this difference did not reach statistical significance(χ^(2)=2.172,P=0.141).However,the elderly group demonstrated significantly higher incidences of pleural effusion(χ^(2)=7.007,P=0.008)and pulmonary infection(χ^(2)=10.204,P=0.001)than the young and middleaged groups.When examining survival outcomes,neither the 3-year progression-free survival(t=0.494,P=0.482)nor the 3-year overall survival(t=0.013,P=0.908)showed significant differences between the elderly group and the young and middle-aged groups.CONCLUSION Neoadjuvant chemotherapy combined with radical gastrectomy is safe and effective in elderly patients with advanced gastric cancer,but there are more pulmonary complications(specifically pleural effusion and pulmonary infection)during the perioperative period.
基金Suzhou“Science and Education Promote Health”Youth Science and Technology Project,Study on the Effect and Mechanism of Metformin-loaded Red Blood Cell Membrane Nanodrug Delivery System on Inhibiting the Growth and Metastasis of HER2-Positive Breast Cancer(KJXW2022082)。
文摘Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients between May 2022 and December 2024,who were randomly allocated into two equal treatment groups(n=30 each).The control group received standard chemotherapy,whereas the observation group was treated with a combined adjuvant regimen of epirubicin and docetaxel.Therapeutic outcomes were systematically compared between the groups.Results:The comparative analysis of chemotherapy regimens revealed significant intergroup differences in multiple outcome measures.The observation group demonstrated superior clinical efficacy(96.67%vs 80.00%,P<0.05)alongside a more favorable safety profile(adverse reaction incidence:3.33%vs 20.00%,P<0.05).Metabolic assessments showed better glycemic control in the observation group,with both fasting and postprandial blood glucose levels being significantly lower than controls(P<0.05),while maintaining comparable values to pretreatment baselines(P>0.05).Furthermore,quality of life assessments indicated significantly better outcomes in the observation group compared to controls(P<0.05).Conclusion:The combination of epirubicin and docetaxel as adjuvant chemotherapy for patients after radical mastectomy for breast cancer has significant clinical effects,can improve patients’quality of life,and has high safety.It is worthy of adoption.
基金Natural Science Foundation-funded Project:Mechanism of Action of Detoxification Formula to Inhibit Hypoxia-Inducible Factor 1 Alpha-Exosomal MicroRNA-130b-3p-Sterile Alpha Motif Domain-Containing Protein 90-mediated Macrophage M2-type Polarisation to Improve the Immunosuppressive Microenvironment in Hepatocellular Carcinoma (No.82374540)Medical Innovation Research Project of Shanghai Science and Technology Commission:a Multicenter Prospective Randomized Controlled Study of “Arsenic Target” Combination Therapy for Unresectable Hepatocellular Carcinoma (No.22Y11921200)。
文摘OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in this study.All patients were categorized into the traditional herbal medicine(THM) group(n = 115) or the non-THM treatment(nTHM) group(n = 239),with the Jiedu formula administered twice a day to the patients in the THM group.The primary outcome was recurrence-free survival(RFS).Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors associated with RFS.Then,the high risk of recurrence among patients was identified,and propensity score matching(PSM) and RFS analysis were performed to analyze the prognostic factors for the outcomes of patients at a high risk of recurrence in different groups.RESULTS:The one,two,three,and five-year RFS rates of the THM and nTHM groups were 76.4% vs 66.1%,65.5% vs 48.8%,57.9% vs 39.9%,and 43.9% vs 29.2%,respectively.The results of the Multivariate Cox analysis showed that giant tumors [hazard ratio(HR),1.54,P = 0.04],poor degree of differentiation,microsatellite,or microvascular invasion(HR,1.29,P = 0.09) increased the risk of recurrence.In the population with a high risk of recurrence,after PSM,the one,two,three,and five-year survival rates were 70.6% vs 68.0%,63.0% vs 43.1%,59.6% vs 33.3%,and 41.9% vs 26.4%,respectively.CONCLUSION:In this study,THM was found to be an effective agent for adjuvant therapy for HCC to prevent early recurrence of HCC after hepatic resection.
基金supported by the National Natural Science Foundation of China(Grant No.82172567)the Key R&D Plan of Jiangxi Province(Grant No.2021BBG71006)the Key Project of Science and Technology Innovation of Health Commission of Jiangxi Province(Grant Nos.2023ZD005 and 2024ZD008).
文摘Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.
文摘Allergen specific immunotherapy(AIT)has a history spanning over 110 years and represents the only diseasemodifying treatment for allergic diseases,with potential preventive effects.Nevertheless,the broader application of AIT is limited by the inherent drawbacks of natural allergen extracts,such as variability in composition,risk of side effects,and complex,lengthy treatment regimens.Advances in molecular allergology have enabled the development of novel vaccine strategies-including recombinant allergens,hypoallergenic derivatives,allergen-derived peptides,and nucleic acid-based vaccines-that aim to improve safety,efficacy,and precision.However,no molecule-based AIT product has yet achieved regulatory approval,largely due to technical and clinical trial challenges.In parallel,immunomodulatory adjuvants such as monophosphoryl lipid A,CpG oligodeoxynucleotides,flagellin and mannan have demonstrated promising properties.These innovations have the potential to enhance AIT outcomes by promoting immune tolerance,reducing IgE responses,and improving patient compliance.This review summarizes the current landscape of allergen vaccines and adjuvant technologies under investigation for AIT,highlighting key advances,clinical data,and future directions aimed at overcoming existing limitations and optimizing treatment strategies for allergic diseases.
基金Supported by Wu Jieping Medical Foundation,No.320.6750.2024-16-28.
文摘BACKGROUND Esophageal cancer(EC),primarily esophageal squamous cell carcinoma in China,has a poor prognosis with a 5-year survival rate of approximately 25%after surgery alone.Neoadjuvant chemoradiotherapy combined with surgery is the standard treatment for locally advanced EC,with a 47%5-year survival rate,although adverse events are common.Immunotherapy,particularly PD-1 inhibitors,has shown promise in treating advanced EC,and neoadjuvant chemotherapy with immunotherapy is effective.However,the efficacy of postoperative immunotherapy remains unclear,with studies like Checkmate577 showing promising results but limited applicability to surgery-only patients,highlighting the need for further research.AIM To evaluate the efficacy,prognostic factors,and safety of adjuvant immunotherapy with anti-PD-1 inhibitors following radical surgery for EC.METHODS A retrospective analysis was conducted on EC patients who received adjuvant immunotherapy after radical treatment at the 900th Hospital of the China Joint Logistics Force between January 2018 and October 2024.Demographic,treatment and laboratory data were collected.Progression-free survival(PFS)was assessed using the Kaplan-Meier method,and independent prognostic factors were identified using Cox regression.Optimal cutoff values for continuous variables,including body mass index(BMI)difference and neutrophil-to-lymphocyte ratio(NLR),were determined using the maxstat package in R.RESULTS A total of 44 patients were included,with a 2-year PFS rate of 68.6%[95%confidence interval(CI):53%-88.7%].Univariate analysis identified several factors significantly associated with prognosis,including the interval between surgery and immunotherapy,BMI difference between before surgery and first immunotherapy,presurgical lymphocyte count,and presurgical NLR.Multivariable Cox regression revealed that a BMI difference<3.86 was an independent protective factor for PFS(hazard ratio:0.42,95%CI:0.21-0.85,P<0.05).At the last followup,the median PFS for patients with BMI<3.86 had not been reached,compared to 8.83 months for those with BMI>3.86.The 1-year PFS for patients receiving postoperative chemotherapy combined with immunotherapy was 88.5%,suggesting superior efficacy over chemotherapy alone.CONCLUSION Adjuvant immunotherapy for EC shows good efficacy and safety.A BMI difference<3.86 is a protective factor for PFS,highlighting the importance of monitoring nutrition and inflammation for personalized treatment.
基金financially supported by the National Natural Science Foundation of China(Nos.U23A20591,82472144,52273158,52273159,and W2421115)the Science and Technology Department Project of Jilin Province(No.20220204018YY)+3 种基金the Industrial Technology Research and Development Project of Jilin Province(No.2023C040-8)the Health Research Talent Special Project of Jilin Province(Nos.2023SCZ70 and 2024SCZ46)the Youth Innovation Promotion Association of Chinese Academy of Sciences(No.Y2023066)the Bethune Project of Jilin University(No.2023B01)。
文摘Chirality is pervasive and plays a crucial role in biological processes.Although amino acids possess inherent chirality,the stereochemical influence of this property on the regulation of immune cells remains insufficiently explored.To address this,the unimolecular chiral poly(amino acid)s were synthesized to evaluate their immunostimulatory effects and anti-cancer potential.Among the candidates,G0-P_(D)-Lys_(50)emerged as the most effective adjuvant through in vitro screening.When complexed with antigen ovalbumin(OVA)to form chiral nanovaccines,G0-P_(L)-Lys_(50)-OVA and G0-P_(D)-Lys_(50)-OVA exhibited similar morphology,particle size,and zeta potential.Despite these comparable physicochemical properties,G0-P_(D)Lys_(50)-OVA induced significantly stronger activation of dendritic cells(DCs).Specifically,it resulted in 1.38-and 1.34-fold increases in CD11c^(+)CD80^(+)DCs and CD11c^(+)SIINFEKL-H-2Kb^(+)DCs in lymph nodes,respectively.In the LLC-OVA cancer model,G0-P_(D)-Lys_(50)-OVA reduced tumor volume by 50%compared to its enantiomer.These results establish a unique approach to designing chiral nanovaccines and provide a foundational strategy for developing broadly applicable immunotherapies.
基金supported by the scientific research project of Jiangsu Province’s“333 Project”(BRA2019097)Jiangsu Provincial Key Medical Discipline of the 14th Five-Year Plan(ZDXK202210)Jiangsu Province Medicine Science and Technology Development Project(No.ZD202014).
文摘Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(1988–2018)were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Multivariate Cox analysis was used to control confounders.Logistic regression was used to explore factors associated with adjuvant chemotherapy.Cox regression analysis and Kaplan-Meier curves were used to assess the survival benefits.Single-center clinical data and meta-analysis following PRISMA guidelines provided external validation.Result:Adjuvant chemotherapy correlated with improved survival(Hazard Ratio(HR):0.860,p=0.011),as did lymphadenectomy(HR:0.842,p<0.001).Higher age,pathological stage,and tumor grade negatively affected survival.Chemotherapy administration associated with higher pathological stage(IB:Odds Ratio(OR)1.565,p<0.001;IC:OR 4.091,p<0.001),higher grade(G2:OR 2.336,p<0.001;G3:OR 4.563,p<0.001),and lymphadenectomy(OR 1.148,p=0.040).Stratification analysis showed adjuvant chemotherapy failed to improve prognosis in stage IA/IB patients regardless of grade or lymphadenectomy.For stage IC patients,chemotherapy benefited grade 1-2 or grade 3 patients without lymphadenectomy,and grade 3 patients with lymphadenectomy.Meta-analysis revealed reduced recurrence in stage IC patients(OR=0.50,p=0.035).Conclusion:Adjuvant chemotherapy confers survival benefits for stage IC patients,particularly those without lymphadenectomy.
