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
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
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 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: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 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
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
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
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
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
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
Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic ...Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic search was performed in PubMed,EMBASE,Cochrane Library,and Web of Science databases.Studies comparing overall survival(OS)and recurrence-free survival(RFS)of patients who underwent AT or not following AmC resection were included.Results:A total of 3971 patients in 21 studies were analyzed.Overall pooled data showed no significant difference in effect on the OS by AT[hazard ratio(HR)=0.998,95%confidence interval(CI):0.768–1.297].No significant difference in recurrence between the AT and non-AT(nAT)groups was noted(HR=1.158,95%CI:0.764–1.755).In subgroup analysis,patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC(HR=0.627,95%CI:0.451–0.870).Neither AT consisted of adjuvant chemotherapy with radiotherapy(HR=0.804,95%CI:0.563–1.149)nor AT with adjuvant chemotherapy(HR=0.883,95%CI:0.642–1.214)showed any significant effect on the OS.Conclusions:The effect of AT in AmC on survival and recurrence did not show a significant benefit.Furthermore,effectiveness according to AT strategies did not show enhancement in survival.AT had an advantage in survival compared with nAT strategy in nodal-positive AmC.In cases of AmC with positive lymph nodal involvement,AT may be warranted regardless of detailed strategies.展开更多
Approximately 50%-70%of patients with hepatocellular carcinoma experience recurrence within five years after curative hepatic resection or ablation.As a result,many patients receive adjuvant therapy after curative res...Approximately 50%-70%of patients with hepatocellular carcinoma experience recurrence within five years after curative hepatic resection or ablation.As a result,many patients receive adjuvant therapy after curative resection or ablation in order to prolong recurrence-free survival.The therapy recommended by national guidelines can differ,and guidelines do not specify when to initiate adjuvant therapy or how long to continue it.These and other unanswered questions around adjuvant therapies make it difficult to optimize them and determine which may be more appropriate for a given type of patient.These questions need to be addressed by clinicians and researchers.展开更多
BACKGROUND For resectable hepatocellular carcinoma(HCC),radical hepatectomy is commonly used as a curative treatment.However,postoperative recurrence significantly diminishes the overall survival(OS)of HCC patients,es...BACKGROUND For resectable hepatocellular carcinoma(HCC),radical hepatectomy is commonly used as a curative treatment.However,postoperative recurrence significantly diminishes the overall survival(OS)of HCC patients,especially with microva-scular invasion(MVI)as an independent high-risk factor for recurrence.While some studies suggest that postoperative adjuvant therapy may decrease the risk of recurrence following liver resection in HCC patients,the specific role of adju-vant therapies in those with MVI remains unclear.AIM To conduct a network meta-analysis(NMA)to evaluate the efficacy of various adjuvant therapies and determine the optimal adjuvant regimen.METHODS A systematic literature search was conducted on PubMed,EMBASE,and Web of Science until April 6,2023.Studies comparing different adjuvant therapies or comparing adjuvant therapy with hepatectomy alone were included.Hazard ratios(HRs)with 95%confidence intervals were used to combine data on recurrence free survival and OS in both pairwise meta-analyses and NMA.RESULTS Fourteen eligible trials(2268 patients)reporting five different therapies were included.In terms of reducing the risk of recurrence,radiotherapy(RT)[HR=0.34(0.23,0.5);surface under the cumulative ranking curve(SUCRA)=97.7%]was found to be the most effective adjuvant therapy,followed by hepatic artery infusion chemotherapy[HR=0.52(0.35,0.76);SUCRA=65.1%].Regarding OS improvement,RT[HR:0.35(0.2,0.61);SUCRA=93.1%]demonstrated the highest effectiveness,followed by sorafenib[HR=0.48(0.32,0.69);SUCRA=70.9%].INTRODUCTION Hepatocellular carcinoma(HCC)is the sixth most common malignant tumor in the world and ranks third in terms of worldwide malignant tumor mortality rates in 2020[1].Curative treatments for HCC include ablation,radical hepatectomy,and liver transplantation.However,ablation is suitable only for early-stage HCC patients,who represent a small percentage of the overall HCC population.Although liver transplantation serves as the optimal treatment for HCC patients,the scarcity of donor organs restricts the availability of this procedure.Therefore,hepatectomy is the most commonly employed curative treatment for resectable HCC.Unfortunately,the 5-year recurrence rate for patients who undergoing hepatectomy ranges from 50%to 70%[2,3].Recurrence of HCC is associated with several risk factors[4],including single nodule>5 cm,vascular invasion,and multiple nodules.Among these factors,microvascular invasion(MVI)is an independent risk factor for recurrence.MVI is defined as the presence of cancer cells in the lumen of endothelium-lined vessels,typically in the small branches of the portal and hepatic veins of the paracancerous liver tissue,visible only under the microscope[5].Previous studies have shown that among HCC patients who underwent hepatectomy,those with MVI had a higher risk of recurrence and shorter overall survival(OS)than those without MVI[6].Several studies have indicated that adjuvant therapy following curative hepatectomy can prevent recurrence and improve OS in HCC patients with MVI.These postoperative adjuvant therapies include transarterial chemoembolization(TACE)[7],sorafenib[8],hepatic artery infusion chemotherapy(HAIC)[9],and radiotherapy(RT)[10].However,the existing studies mostly compare individual adjuvant therapy with hepatectomy alone.Direct or indirect comparisons between the various adjuvant therapies are lacking.Therefore,we performed the network meta-analysis(NMA)to compare the relative efficacy of each adjuvant therapy to determine the optimal treatment.展开更多
Objective The present study aimed to evaluate the immunogenicity of BA.2 variant receptor binding domain(RBD)recombinant protein formulated with CpG 1826 plus alum dual adjuvant.Methods The BA.2 variant RBD(residues 3...Objective The present study aimed to evaluate the immunogenicity of BA.2 variant receptor binding domain(RBD)recombinant protein formulated with CpG 1826 plus alum dual adjuvant.Methods The BA.2 variant RBD(residues 308-548)fusing TT-P2 epitope was obtained from prokaryotic expression system,purification technology and dialysis renaturation,which was designated as Sot protein.The soluble Sot protein formulated with CpG 1826 plus alum dual adjuvant was designated as Sot/CA subunit vaccine and then the BALB/c mice were intramuscularly administrated with two doses of the Sot/CA subunit vaccine at 14-day interval(day 0 and 14).On day 28,the number of effector T lymphocytes secreting IFN-γand IL-4 in mice spleen were determined by enzyme-linked immunospot(ELISpot)assay.The serum IgG,IgG1 and IgG2a antibodies were examined by enzyme-linked immunosorbent assay(ELISA).In addition,the level of neutralizing antibodies(NAbs)induced by Sot/CA subunit vaccine was also evaluated by the microneutralization assay.Results The high-purity soluble Sot protein with antigenicity was successfully obtained by the prokaryotic expression,protein purification and dialysis renaturation.The Sot/CA subunit vaccine induced a high level of IgG antibodies and NAbs,which were of cross-neutralizing activity against SARS-CoV-2 BA.2 and XBB.1.5 variants.Meanwhile,Sot/CA subunit vaccine also induced a high level of effector T lymphocytes secreting IFN-γ(635.00±17.62)and IL-4(279.20±13.10),respectively.Combined with a decreased IgG1/IgG2a ratio in the serum,which indicating Sot/CA subunit vaccine induced a Th1-type predominant immune response.Conclusion The Sot protein formulated with CpG 1826 plus alum dual adjuvant showed that the excellent cellular and humoral immunogenicity,which provided a scientific basis for the development of BA.2 variant subunit vaccines and references for the adjuvant application of subunit vaccines.展开更多
Pesticide adjuvants,as crop protection products,have been widely used to reduce drift loss and improve utilization efficiency by regulating droplet spectrum.However,the coordinated regulation mechanisms of adjuvants a...Pesticide adjuvants,as crop protection products,have been widely used to reduce drift loss and improve utilization efficiency by regulating droplet spectrum.However,the coordinated regulation mechanisms of adjuvants and nozzles on droplet spectrum remain unclear.Here,we established the relationship between droplet spectrum evolution and liquid atomization by investigating the typical characteristics of droplet diameter distribution near the nozzle.Based on this,the regulation mechanisms of distinctive pesticide adjuvants on droplet spectrum were clarified,and the corresponding drift reduction performances were quantitively evaluated by wind tunnel experiments.It shows that the droplet diameter firstly shifts to the smaller due to the liquid sheet breakup and then prefers to increase caused by droplet interactions.Reducing the surface tension of sprayed liquid facilitates the uniform liquid breakup and increasing the viscosity inhibits the liquid deformation,which prolong the atomization process and effectively improve the droplet spectrum.As a result,the drift losses of flat-fan and hollow cone nozzles are reduced by about 50%after adding organosilicon and vegetable oil adjuvants.By contrast,the air induction nozzle shows a superior anti-drift ability,regardless of distinctive adjuvants.Our findings provide insights into rational adjuvant design and nozzle selection in the field application.展开更多
BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve...BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.展开更多
BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of...BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection difficult.An adjuvant method to remove or resolve the residual crystals during the operation is necessary.CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the adjuvant.After resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was observed.Considering the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot lesion.After resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s solution.CONCLUSION The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.展开更多
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.
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 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.
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.
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.
文摘Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic search was performed in PubMed,EMBASE,Cochrane Library,and Web of Science databases.Studies comparing overall survival(OS)and recurrence-free survival(RFS)of patients who underwent AT or not following AmC resection were included.Results:A total of 3971 patients in 21 studies were analyzed.Overall pooled data showed no significant difference in effect on the OS by AT[hazard ratio(HR)=0.998,95%confidence interval(CI):0.768–1.297].No significant difference in recurrence between the AT and non-AT(nAT)groups was noted(HR=1.158,95%CI:0.764–1.755).In subgroup analysis,patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC(HR=0.627,95%CI:0.451–0.870).Neither AT consisted of adjuvant chemotherapy with radiotherapy(HR=0.804,95%CI:0.563–1.149)nor AT with adjuvant chemotherapy(HR=0.883,95%CI:0.642–1.214)showed any significant effect on the OS.Conclusions:The effect of AT in AmC on survival and recurrence did not show a significant benefit.Furthermore,effectiveness according to AT strategies did not show enhancement in survival.AT had an advantage in survival compared with nAT strategy in nodal-positive AmC.In cases of AmC with positive lymph nodal involvement,AT may be warranted regardless of detailed strategies.
基金the Specific Research Project of Guangxi for Research Bases and Talents,No.GuiKe AD22035057the National Natural Science Foundation of China,No.82060510 and No.82260569.
文摘Approximately 50%-70%of patients with hepatocellular carcinoma experience recurrence within five years after curative hepatic resection or ablation.As a result,many patients receive adjuvant therapy after curative resection or ablation in order to prolong recurrence-free survival.The therapy recommended by national guidelines can differ,and guidelines do not specify when to initiate adjuvant therapy or how long to continue it.These and other unanswered questions around adjuvant therapies make it difficult to optimize them and determine which may be more appropriate for a given type of patient.These questions need to be addressed by clinicians and researchers.
文摘BACKGROUND For resectable hepatocellular carcinoma(HCC),radical hepatectomy is commonly used as a curative treatment.However,postoperative recurrence significantly diminishes the overall survival(OS)of HCC patients,especially with microva-scular invasion(MVI)as an independent high-risk factor for recurrence.While some studies suggest that postoperative adjuvant therapy may decrease the risk of recurrence following liver resection in HCC patients,the specific role of adju-vant therapies in those with MVI remains unclear.AIM To conduct a network meta-analysis(NMA)to evaluate the efficacy of various adjuvant therapies and determine the optimal adjuvant regimen.METHODS A systematic literature search was conducted on PubMed,EMBASE,and Web of Science until April 6,2023.Studies comparing different adjuvant therapies or comparing adjuvant therapy with hepatectomy alone were included.Hazard ratios(HRs)with 95%confidence intervals were used to combine data on recurrence free survival and OS in both pairwise meta-analyses and NMA.RESULTS Fourteen eligible trials(2268 patients)reporting five different therapies were included.In terms of reducing the risk of recurrence,radiotherapy(RT)[HR=0.34(0.23,0.5);surface under the cumulative ranking curve(SUCRA)=97.7%]was found to be the most effective adjuvant therapy,followed by hepatic artery infusion chemotherapy[HR=0.52(0.35,0.76);SUCRA=65.1%].Regarding OS improvement,RT[HR:0.35(0.2,0.61);SUCRA=93.1%]demonstrated the highest effectiveness,followed by sorafenib[HR=0.48(0.32,0.69);SUCRA=70.9%].INTRODUCTION Hepatocellular carcinoma(HCC)is the sixth most common malignant tumor in the world and ranks third in terms of worldwide malignant tumor mortality rates in 2020[1].Curative treatments for HCC include ablation,radical hepatectomy,and liver transplantation.However,ablation is suitable only for early-stage HCC patients,who represent a small percentage of the overall HCC population.Although liver transplantation serves as the optimal treatment for HCC patients,the scarcity of donor organs restricts the availability of this procedure.Therefore,hepatectomy is the most commonly employed curative treatment for resectable HCC.Unfortunately,the 5-year recurrence rate for patients who undergoing hepatectomy ranges from 50%to 70%[2,3].Recurrence of HCC is associated with several risk factors[4],including single nodule>5 cm,vascular invasion,and multiple nodules.Among these factors,microvascular invasion(MVI)is an independent risk factor for recurrence.MVI is defined as the presence of cancer cells in the lumen of endothelium-lined vessels,typically in the small branches of the portal and hepatic veins of the paracancerous liver tissue,visible only under the microscope[5].Previous studies have shown that among HCC patients who underwent hepatectomy,those with MVI had a higher risk of recurrence and shorter overall survival(OS)than those without MVI[6].Several studies have indicated that adjuvant therapy following curative hepatectomy can prevent recurrence and improve OS in HCC patients with MVI.These postoperative adjuvant therapies include transarterial chemoembolization(TACE)[7],sorafenib[8],hepatic artery infusion chemotherapy(HAIC)[9],and radiotherapy(RT)[10].However,the existing studies mostly compare individual adjuvant therapy with hepatectomy alone.Direct or indirect comparisons between the various adjuvant therapies are lacking.Therefore,we performed the network meta-analysis(NMA)to compare the relative efficacy of each adjuvant therapy to determine the optimal treatment.
基金funded by the National Key R&D Program of China(2023YFC2605302).
文摘Objective The present study aimed to evaluate the immunogenicity of BA.2 variant receptor binding domain(RBD)recombinant protein formulated with CpG 1826 plus alum dual adjuvant.Methods The BA.2 variant RBD(residues 308-548)fusing TT-P2 epitope was obtained from prokaryotic expression system,purification technology and dialysis renaturation,which was designated as Sot protein.The soluble Sot protein formulated with CpG 1826 plus alum dual adjuvant was designated as Sot/CA subunit vaccine and then the BALB/c mice were intramuscularly administrated with two doses of the Sot/CA subunit vaccine at 14-day interval(day 0 and 14).On day 28,the number of effector T lymphocytes secreting IFN-γand IL-4 in mice spleen were determined by enzyme-linked immunospot(ELISpot)assay.The serum IgG,IgG1 and IgG2a antibodies were examined by enzyme-linked immunosorbent assay(ELISA).In addition,the level of neutralizing antibodies(NAbs)induced by Sot/CA subunit vaccine was also evaluated by the microneutralization assay.Results The high-purity soluble Sot protein with antigenicity was successfully obtained by the prokaryotic expression,protein purification and dialysis renaturation.The Sot/CA subunit vaccine induced a high level of IgG antibodies and NAbs,which were of cross-neutralizing activity against SARS-CoV-2 BA.2 and XBB.1.5 variants.Meanwhile,Sot/CA subunit vaccine also induced a high level of effector T lymphocytes secreting IFN-γ(635.00±17.62)and IL-4(279.20±13.10),respectively.Combined with a decreased IgG1/IgG2a ratio in the serum,which indicating Sot/CA subunit vaccine induced a Th1-type predominant immune response.Conclusion The Sot protein formulated with CpG 1826 plus alum dual adjuvant showed that the excellent cellular and humoral immunogenicity,which provided a scientific basis for the development of BA.2 variant subunit vaccines and references for the adjuvant application of subunit vaccines.
基金financially supported by the National Key Research and Development Program of China(2017YFD0200304)。
文摘Pesticide adjuvants,as crop protection products,have been widely used to reduce drift loss and improve utilization efficiency by regulating droplet spectrum.However,the coordinated regulation mechanisms of adjuvants and nozzles on droplet spectrum remain unclear.Here,we established the relationship between droplet spectrum evolution and liquid atomization by investigating the typical characteristics of droplet diameter distribution near the nozzle.Based on this,the regulation mechanisms of distinctive pesticide adjuvants on droplet spectrum were clarified,and the corresponding drift reduction performances were quantitively evaluated by wind tunnel experiments.It shows that the droplet diameter firstly shifts to the smaller due to the liquid sheet breakup and then prefers to increase caused by droplet interactions.Reducing the surface tension of sprayed liquid facilitates the uniform liquid breakup and increasing the viscosity inhibits the liquid deformation,which prolong the atomization process and effectively improve the droplet spectrum.As a result,the drift losses of flat-fan and hollow cone nozzles are reduced by about 50%after adding organosilicon and vegetable oil adjuvants.By contrast,the air induction nozzle shows a superior anti-drift ability,regardless of distinctive adjuvants.Our findings provide insights into rational adjuvant design and nozzle selection in the field application.
基金Supported by Shanghai Science and Technology Commission of Shanghai Municipality,No.20Y11908600Shanghai Municipal Health Commission,No.20194Y0195Medical Engineering Jiont Fund of Fudan University,No.XM03231533.
文摘BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.
文摘BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection difficult.An adjuvant method to remove or resolve the residual crystals during the operation is necessary.CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the adjuvant.After resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was observed.Considering the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot lesion.After resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s solution.CONCLUSION The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.
