Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve bette...Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve better efficacy in LS-SCLC patients.Methods:We evaluated 122 LS-SCLC patients who received concurrent chemoradiotherapy(CCRT)or sequential chemoradiotherapy(SCRT)(Group A)and immunotherapy combined with CCRT/SCRT followed by immunotherapy(Group B),to assess the objective response rate(ORR),disease control rate(DCR),and progression-free survival(PFS).Factors affecting prognosis were also explored using Cox analysis.The prognosis of patients with type 2 diabetes and patients with different TNM stages was compared to guide the selection of clinical regimens.Results:The overall ORR was 55.93%.The overall DCR was 98.31%.The DCR was 100%in Group A and 96.61%in Group B.There was no statistical difference in ORR and DCR.The overall median PFS was 9.86 months(95%CI,8.62-11.10),and the difference in median PFS between the two groups was statistically significant(8.94 vs.11.89 months,p=0.03).The Cox regression analysis showed type 2 diabetes was associated with the survival prognosis.Patients with type 2 diabetes tended to choose immunotherapy combined with CCRT/SCRT.Patients in TNM stage IIIB had a significantly worse prognosis than those in stage I+II+IIIA.Conclusion:We suggest that LS-SCLC patients who receive immunotherapy combined with CCRT/SCRT can achieve longer PFS than those with CCRT/SCRT.Type 2 diabetes and TNM stage affect the survival prognosis.Patients with type 2 diabetes may benefit from immunotherapy combination treatments.展开更多
Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study a...Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.展开更多
As a rising immune checkpoint on tumor cells,CD24 is closely related to tumorigenesis and progression.CD24 can directly regulate the malignant behavior of tumor cells and indirectly inhibit the function of immune cell...As a rising immune checkpoint on tumor cells,CD24 is closely related to tumorigenesis and progression.CD24 can directly regulate the malignant behavior of tumor cells and indirectly inhibit the function of immune cells in the meantime,which promotes the immune escape of tumor cells,induces cancer invasion and causes poor prognosis.The basic principle of cancer treatment is to induce cell death and inhibit cell survival.Resistance to chemoradiotherapy is a critical challenge in oncology,which limits the effectiveness of anti-cancer treatments.Many studies have shown a strong association between CD24 and chemoradiotherapy resistance in tumor cells,but the specific mechanism remains unclear.Understanding the mechanisms that CD24 induces chemoradiotherapy resistance may allow us to develop new promising therapeutic strategies to enhance the efficacy of chemoradiotherapy and improve clinical outcomes in the treatment of cancer patients.In this review,we summarized the basic characteristics and functions of CD24,as well as its role in the development of cancer.We focused on the resistance to radiotherapy and chemotherapy mediated by CD24,deciphered fundamental mechanisms and introduced existing clinical studies,with an attempt to propose potential solutions for future explorations.展开更多
BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a ...BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.展开更多
Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including o...Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.展开更多
BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or fa...BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or family history of bleeding disorders.While AHA has been reported in association with various cancers,this case represents,to our knowledge,the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy.CASE SUMMARY We present the case of a 65-year-old male with a history of hypopharyngeal squa-mous cell carcinoma(T4bN2cM0,AJCC 8^(th) edition)who developed AHA after extensive surgical resection and chemoradiotherapy.He presented with recurrent hemoptysis and ecchymosis.Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies.FVIII activity was<1%,and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units.Hemostasis was initially achieved with tranexamic acid and batroxobin.Immunosuppression with prednisone and cyclophosphamide was started;due to gastrointestinal bleeding,rituximab was added.Treatment was later transitioned to azathioprine with prednisone,fol-lowed by tapering.FVIII activity recovered to 188.2%,and the patient remained in remission over six years without AHA or malignancy recurrence.CONCLUSION This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.展开更多
BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurre...BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.展开更多
BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual ...BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual treatment responses vary considerably,highlighting the need for robust predictive tools to guide clinical decision-making.AIM To develop a nomogram model integrating clinical characteristics and biomarkers to predict the likelihood of poor response to nCRT in LARC.METHODS A retrospective analysis was performed on 178 patients with stage II-III LARC treated from January 2021 to December 2023.All patients underwent standardized nCRT followed by total mesorectal excision.Clinical data,inflammatory markers[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factoralpha],and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9]were collected.Logistic regression was used to identify independent predictors of poor nCRT response.A nomogram was constructed using significant predictors and validated via concordance index(C-index),receiver operating characteristic curve,calibration plot,and decision curve analysis(DCA).RESULTS A total of 178 patients were enrolled,with 36(20.2%)achieving a good response and 142(79.8%)exhibiting a poor response to nCRT.Baseline factors,including age and comorbidities,showed no significant differences.However,poor responders more frequently had lymph node metastasis,advanced tumor node metastasis/T stage,larger tumor diameter,and elevated CRP,IL-6,and CEA levels.Logistic regression confirmed CRP,IL-6,and CEA as independent predictors of poor response.The nomogram demonstrated high accuracy(area under the curve=0.928),good calibration(Hosmer-Lemeshow P=0.928),and a sensitivity of 88.1%with 82.6%specificity.Internal validation via bootstrap resampling(n=1000)yielded an adjusted C-index of 0.716,and DCA confirmed substantial clinical utility.CONCLUSION A nomogram incorporating serum CRP,IL-6,and CEA accurately predicts poor nCRT response in patients with LARC.This model provides a valuable framework for individualized treatment planning,potentially improving clinical outcomes.展开更多
Objective:Identifying biomarkers that predict the efficacy and prognosis of chemoradiotherapy is important for individualized clinical treatment.We previously reported that high murine double minute 1(MDM1)expression ...Objective:Identifying biomarkers that predict the efficacy and prognosis of chemoradiotherapy is important for individualized clinical treatment.We previously reported that high murine double minute 1(MDM1)expression in patients with rectal cancer is linked to a favorable chemoradiation response.In this study the role of MDM1 in the chemoradiotherapy response in colorectal cancer(CRC)patients was evaluated.Methods:Colony formation and cell proliferation assays as well as xenograft models were used to determine if MDM1 expression affects the sensitivity of CRC cells to chemoradiation.RNA sequencing revealed that MDM1 regulates tumor protein 53(TP53)expression and apoptosis.A series of molecular biology experiments were performed to determine how MDM1 affects p53 expression.The effects of inhibitors targeting apoptosis on MDM1 knockout cells were evaluated.Results:Gene expression profiling revealed that MDM1 is a potential chemoradiotherapy sensitivity marker.The sensitivity of CRC cells to chemoradiation treatment decreased after MDM1 knockout and increased after MDM1 overexpression.MDM1 affected p53 expression,thereby regulating apoptosis.MDM1 overexpression limited YBX1 binding to TP53 promoter,regulated TP53 expression,and rendered CRC cells more sensitive to chemoradiation.In CRC cells with low MDM1 expression,a combination of apoptosis-inducing inhibitors and chemoradiation treatment restored sensitivity to cancer therapy.Conclusions:The current study showed that MDM1 expression influences the sensitivity of CRC cells to chemoradiation by influencing p53 and apoptosis pathways,which is the basis for the underlying molecular mechanism,and serves as a possible predictive marker for chemoradiotherapy prognosis.展开更多
BACKGROUND Pelvic squamous cell carcinoma of unknown primary(CUP)is extremely rare,accounting for less than one percent of all CUP cases,and its infrequency has lim-ited the development of standardized diagnostic and ...BACKGROUND Pelvic squamous cell carcinoma of unknown primary(CUP)is extremely rare,accounting for less than one percent of all CUP cases,and its infrequency has lim-ited the development of standardized diagnostic and treatment guidelines.CASE SUMMARY A 77-year-old female with a history of resected lung adenocarcinoma presented with worsening constipation.Imaging revealed a 2.5 cm mass adjacent to the right levator ani muscle.Biopsy confirmed poorly differentiated squamous cell carcinoma,positive for pancytokeratin and p40,and negative for p16,cytokeratin 7,cytokeratin 20,and neuroendocrine markers.No primary lesion was identified despite extensive evaluation.She underwent five cycles of 5-fluorouracil(1000 mg/m^(2) continuous infusion,days 1-4)and mitomycin-C(10 mg/m^(2) on day 1)with concurrent pelvic radiotherapy(50.4 Gy in 28 fractions).Follow-up imaging demonstrated complete remission sustained for 12 months.Electrocorticography performance status improved from 2 at diagnosis to 1 during follow-up.CONCLUSION This case highlights the potential role of chemoradiotherapy in managing pelvic squamous cell CUP,achieving durable remission in selected patients.展开更多
BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach durin...BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.展开更多
BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT e...BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.展开更多
Colorectal cancer is one of the most common malignant tumors, and the morbidity and mortality are increasing gradually over the last years in China. Neoadjuvant chemoradiotherapy(nCRT) is currently applied to the trea...Colorectal cancer is one of the most common malignant tumors, and the morbidity and mortality are increasing gradually over the last years in China. Neoadjuvant chemoradiotherapy(nCRT) is currently applied to the treatment of colorectal cancer patients, and it is helpful to improve the prognosis. The sensitivity of patients to nCRT is different due to individual differences. Predicting the therapeutic effect of nCRT is of great importance for the further treatment methods. Texture analysis, as an image post-processing technique, has been more and more utilized in the field of oncologic imaging. This article reviews the application and progress of texture analysis in the therapeutic effect prediction and prognosis of nCRT for colorectal cancer.展开更多
BACKGROUND Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.AIM To investigate the clinical outcomes of patients with locally advanc...BACKGROUND Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.AIM To investigate the clinical outcomes of patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy using tegafur/gimeracil/oteracil(S-1)plus irinotecan(CPT-11).METHODS This was a single-center retrospective study of 82 patients who underwent radical surgery for rectal cancer after chemoradiotherapy with S-1(80 mg/m2/d),CPT-11(60 mg/m2/d),and radiation(total 45 Gy)between 2009 and 2016.The median follow-up was 51 mo(range:17–116 mo).RESULTS Twenty-nine patients(35.4%)had T3 or T4 rectal cancer with mesorectal fascia invasion,36(43.9%)had extramural vascular invasion,24(29.8%)had N2 rectal cancer and eight(9.8%)had lateral lymph node swelling.The relative dose intensity was 90.1%for S-1 and 92.9%for CPT-11.Seventy-nine patients(96.3%)underwent R0 resection.With regard to pathological response,13 patients(15.9%)had a pathological complete response and 52(63.4%)a good response(tumor regression grade 2/3).The 5-year local recurrence-free survival,relapsefree survival and overall survival rates were 90.1%,72.5%and 91.3%,respectively.We analyzed the risk factors for local recurrence-free survival by Cox regression analysis and none were detected.Previously described risk factors such as T4 stage,mesorectal fascia invasion or lateral lymph node swelling were not detected as negative factors for local recurrence-free survival.CONCLUSION We demonstrated good compliance and favorable tumor regression in patients with locally advanced rectal cancer treated with preoperative S-1 and CPT-11.展开更多
To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patien...To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.展开更多
AIM:To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS:We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done ...AIM:To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS:We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed.Trial validity assessment was performed and a trial quality score was assigned. RESULTS:Eleven randomized controlled trials(RCTs) including 1308 patients were selected.Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone.Odds ratio(OR) [95%confidence interval(CI),P value],expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone,was 1.28(1.01-1.64,P=0.05)for 1-year survival,1.78(1.20-2.66,P=0.004)for 3-year survival,and 1.46(1.07-1.99,P=0.02)for 5-year survival.Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy(OR: 1.68,95%CI:1.03-2.73,P=0.04),but incidence of postoperative complications was similar in two groups (OR:1.14,95%CI:0.88-1.49,P=0.32).Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence(OR:0.64,95%CI:0.41-0.99,P=0.04), but incidence of distant cancer recurrence was similar (OR:0.94,95%CI:0.68-1.31,P=0.73).Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvantchemoradiotherapy,OR(95%CI,P value)was 1.16(0.85-1.57,P=0.34)for 1-year survival,1.34 (0.98-1.82,P=0.07)for 3-year survival and 1.41 (0.98-2.02,P=0.06)for 5-year survival. CONCLUSION:Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.展开更多
AIM： To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer.METHODS： Patients with T3-4 and N0-1 esophageal carcinoma from...AIM： To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer.METHODS： Patients with T3-4 and N0-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy （CCRT） with weekly cisplatin 30 mg/m^2 followed by systemic adjuvant chemotherapy （four monthly cycles of cisplatin 20 mg/m^2 and 5-fluorouracil 1 000 mg/m^2 for five consecutive days）, or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients＇ improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-totreat patients＇ outcome of survival. RESULTS： A total of 60 patients （n=30 per group） were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematological and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival （30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1） and 3-year survival （70.0% vs 33.7%; P=0.003）. Low histological grade of tumor （P〈0.001） was associated with favorable survival in these locally advanced patients. CONCLUSION： For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.展开更多
AIM： Esophageal squamous cell carcinoma is generally sensitive to chemoradiotherapy （CRT）, but some cases are not. Using a retrospective analysis, we aimed to identify the predictors of the response by esophageal s...AIM： Esophageal squamous cell carcinoma is generally sensitive to chemoradiotherapy （CRT）, but some cases are not. Using a retrospective analysis, we aimed to identify the predictors of the response by esophageal squamous cell carcinoma to definitive CRT. METHODS： The intensities of expression of p53, Ki67, Bci-2, Bax, olclin D1, VEGF, CDC25B, and metallothionein （MT） were evaluated immunohistochemically in the biopsy specimens obtained before CRT, and the intensities of their expression were tested for correlations with the clinical effects of CRT. RESULTS： The esophageal squamous cell carcinomas with negative p53, positive CDC25B, and negative MT expression were found to be significantly more sensitive to CRT. In addition, p53 positivity and CDC25B positivity respomd well to CRT. CONCLUSION： Esophageal squamous cell carcinomas with negative p53,positive CDC25B, and negative MT expressions respond well to CRT. Even with p53 positivity, if with CDC25B positivity, CRT can be expected. 2005 The WJG Press and Elsevier Inc. All rights reserved展开更多
Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete respo...Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.展开更多
AIM:To evaluate the predictive value of the lymph node(LN) ratio(LNR,number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative che...AIM:To evaluate the predictive value of the lymph node(LN) ratio(LNR,number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy(PCRT).METHODS:From 2000 to 2009,967 patients with metastatic LNs after curative resection for locally advanced rectal cancer were identified.Patients were categorized according to PCRT(PCRT vs No PCRT).The cut-off LNR was determined based on the p N1 vs p N2 when the recommended number of LNs was harvested.The 5-year recurrence-free survival(RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group.RESULTS:Among patients with the same p/yp N stage,the 5-year RFS rate differed according to the LNR.In addition,the 5-year RFS rate was significantly different between p N and LNR groups in patients with No PCRT.In PCRT group,however,only LNR was associated with prognosis.On multivariate analysis,both p N and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group.In the PCRT group,only LNR category was found to be associated with RFS(HR = 2.36,95%CI:1.31-3.84,and P = 0.001).CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT.Current p N categories could not discriminate between prognostic groups of RFS after PCRT.展开更多
基金funded by the National Natural Science Foundation of China(grant no.82273162)the National Natural Science Foundation of China(grant no.82203272)the Science and Technology Development Foundation of Nanjing Medical University(grant NMUB20240119)。
文摘Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve better efficacy in LS-SCLC patients.Methods:We evaluated 122 LS-SCLC patients who received concurrent chemoradiotherapy(CCRT)or sequential chemoradiotherapy(SCRT)(Group A)and immunotherapy combined with CCRT/SCRT followed by immunotherapy(Group B),to assess the objective response rate(ORR),disease control rate(DCR),and progression-free survival(PFS).Factors affecting prognosis were also explored using Cox analysis.The prognosis of patients with type 2 diabetes and patients with different TNM stages was compared to guide the selection of clinical regimens.Results:The overall ORR was 55.93%.The overall DCR was 98.31%.The DCR was 100%in Group A and 96.61%in Group B.There was no statistical difference in ORR and DCR.The overall median PFS was 9.86 months(95%CI,8.62-11.10),and the difference in median PFS between the two groups was statistically significant(8.94 vs.11.89 months,p=0.03).The Cox regression analysis showed type 2 diabetes was associated with the survival prognosis.Patients with type 2 diabetes tended to choose immunotherapy combined with CCRT/SCRT.Patients in TNM stage IIIB had a significantly worse prognosis than those in stage I+II+IIIA.Conclusion:We suggest that LS-SCLC patients who receive immunotherapy combined with CCRT/SCRT can achieve longer PFS than those with CCRT/SCRT.Type 2 diabetes and TNM stage affect the survival prognosis.Patients with type 2 diabetes may benefit from immunotherapy combination treatments.
基金supported by grants through funding from the National Science and Technology Council(NSTC112-2314-B-037-050-MY3,NSTC114-2314-B-037-103-MY3,NSTC114-2321-B-037-003)the Ministry of Health and Welfare(MOHW113-TDU-B-222-134014)+2 种基金funded by the health and welfare surcharge of on tobacco products,and the Kaohsiung Medical University Hospital(KMUH113-3R31,KMUH113-3R32,KMUH113-3R33,KMUH113-3M58,KMUH113-3M59,KMUH-S11412,KMUH-SH11403)Kaohsiung Medical University Research Center Grant(KMU-TC113A04)supported by the Grant of Taiwan Precision Medicine Initiative and Taiwan Biobank,Academia Sinica,Taiwan.
文摘Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.
基金supported by Health Commission of Hubei Province Scientific Research Project(No.WJ2023M068)Leading Discipline of Oncology Construction Project of Zhongnan Hospital of Wuhan University(No.XKJS202005)+8 种基金Youth Interdisciplinary Special Fund of Zhongnan Hospital of Wuhan University(No.ZNQNJC2022003)Knowledge Innovation Program of Wuhan-Shuguang Project(No.2023020201020510)Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University(ZNJC202322)Fundamental Research Funds for the Central Universities(Wuhan University,Clinical Medicine+X,2042024YXB017)Hubei Province Chinese Medicine Research Project(ZY2023Q015)Natural Science Foundation of Hubei Province(2023A FB665)Medical Young Talents Program of Hubei Province,Wuhan Young Medical Talents Training Project to L.-L.Bu,Youth Fund of the National Natural Science Foundation of China(82001644)Medical Young Talents Program of Hubei Province(7020206)“Dawn of Scientific and Technological Innovation”Program of Wuhan(703030804).
文摘As a rising immune checkpoint on tumor cells,CD24 is closely related to tumorigenesis and progression.CD24 can directly regulate the malignant behavior of tumor cells and indirectly inhibit the function of immune cells in the meantime,which promotes the immune escape of tumor cells,induces cancer invasion and causes poor prognosis.The basic principle of cancer treatment is to induce cell death and inhibit cell survival.Resistance to chemoradiotherapy is a critical challenge in oncology,which limits the effectiveness of anti-cancer treatments.Many studies have shown a strong association between CD24 and chemoradiotherapy resistance in tumor cells,but the specific mechanism remains unclear.Understanding the mechanisms that CD24 induces chemoradiotherapy resistance may allow us to develop new promising therapeutic strategies to enhance the efficacy of chemoradiotherapy and improve clinical outcomes in the treatment of cancer patients.In this review,we summarized the basic characteristics and functions of CD24,as well as its role in the development of cancer.We focused on the resistance to radiotherapy and chemotherapy mediated by CD24,deciphered fundamental mechanisms and introduced existing clinical studies,with an attempt to propose potential solutions for future explorations.
文摘BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.
文摘Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.
文摘BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or family history of bleeding disorders.While AHA has been reported in association with various cancers,this case represents,to our knowledge,the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy.CASE SUMMARY We present the case of a 65-year-old male with a history of hypopharyngeal squa-mous cell carcinoma(T4bN2cM0,AJCC 8^(th) edition)who developed AHA after extensive surgical resection and chemoradiotherapy.He presented with recurrent hemoptysis and ecchymosis.Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies.FVIII activity was<1%,and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units.Hemostasis was initially achieved with tranexamic acid and batroxobin.Immunosuppression with prednisone and cyclophosphamide was started;due to gastrointestinal bleeding,rituximab was added.Treatment was later transitioned to azathioprine with prednisone,fol-lowed by tapering.FVIII activity recovered to 188.2%,and the patient remained in remission over six years without AHA or malignancy recurrence.CONCLUSION This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.
文摘BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.
文摘BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual treatment responses vary considerably,highlighting the need for robust predictive tools to guide clinical decision-making.AIM To develop a nomogram model integrating clinical characteristics and biomarkers to predict the likelihood of poor response to nCRT in LARC.METHODS A retrospective analysis was performed on 178 patients with stage II-III LARC treated from January 2021 to December 2023.All patients underwent standardized nCRT followed by total mesorectal excision.Clinical data,inflammatory markers[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factoralpha],and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9]were collected.Logistic regression was used to identify independent predictors of poor nCRT response.A nomogram was constructed using significant predictors and validated via concordance index(C-index),receiver operating characteristic curve,calibration plot,and decision curve analysis(DCA).RESULTS A total of 178 patients were enrolled,with 36(20.2%)achieving a good response and 142(79.8%)exhibiting a poor response to nCRT.Baseline factors,including age and comorbidities,showed no significant differences.However,poor responders more frequently had lymph node metastasis,advanced tumor node metastasis/T stage,larger tumor diameter,and elevated CRP,IL-6,and CEA levels.Logistic regression confirmed CRP,IL-6,and CEA as independent predictors of poor response.The nomogram demonstrated high accuracy(area under the curve=0.928),good calibration(Hosmer-Lemeshow P=0.928),and a sensitivity of 88.1%with 82.6%specificity.Internal validation via bootstrap resampling(n=1000)yielded an adjusted C-index of 0.716,and DCA confirmed substantial clinical utility.CONCLUSION A nomogram incorporating serum CRP,IL-6,and CEA accurately predicts poor nCRT response in patients with LARC.This model provides a valuable framework for individualized treatment planning,potentially improving clinical outcomes.
基金supported by grants from the National Natural Science Foundation(Grant No.81972859 to W.T.)Beijing Municipal Science&Technology Commission Grant(Grant No.D0905001040531 to D.L.)State Key Laboratory of Molecular Oncology Grant(Grant No.SKLMO-KF2023-03 to D.L.).
文摘Objective:Identifying biomarkers that predict the efficacy and prognosis of chemoradiotherapy is important for individualized clinical treatment.We previously reported that high murine double minute 1(MDM1)expression in patients with rectal cancer is linked to a favorable chemoradiation response.In this study the role of MDM1 in the chemoradiotherapy response in colorectal cancer(CRC)patients was evaluated.Methods:Colony formation and cell proliferation assays as well as xenograft models were used to determine if MDM1 expression affects the sensitivity of CRC cells to chemoradiation.RNA sequencing revealed that MDM1 regulates tumor protein 53(TP53)expression and apoptosis.A series of molecular biology experiments were performed to determine how MDM1 affects p53 expression.The effects of inhibitors targeting apoptosis on MDM1 knockout cells were evaluated.Results:Gene expression profiling revealed that MDM1 is a potential chemoradiotherapy sensitivity marker.The sensitivity of CRC cells to chemoradiation treatment decreased after MDM1 knockout and increased after MDM1 overexpression.MDM1 affected p53 expression,thereby regulating apoptosis.MDM1 overexpression limited YBX1 binding to TP53 promoter,regulated TP53 expression,and rendered CRC cells more sensitive to chemoradiation.In CRC cells with low MDM1 expression,a combination of apoptosis-inducing inhibitors and chemoradiation treatment restored sensitivity to cancer therapy.Conclusions:The current study showed that MDM1 expression influences the sensitivity of CRC cells to chemoradiation by influencing p53 and apoptosis pathways,which is the basis for the underlying molecular mechanism,and serves as a possible predictive marker for chemoradiotherapy prognosis.
文摘BACKGROUND Pelvic squamous cell carcinoma of unknown primary(CUP)is extremely rare,accounting for less than one percent of all CUP cases,and its infrequency has lim-ited the development of standardized diagnostic and treatment guidelines.CASE SUMMARY A 77-year-old female with a history of resected lung adenocarcinoma presented with worsening constipation.Imaging revealed a 2.5 cm mass adjacent to the right levator ani muscle.Biopsy confirmed poorly differentiated squamous cell carcinoma,positive for pancytokeratin and p40,and negative for p16,cytokeratin 7,cytokeratin 20,and neuroendocrine markers.No primary lesion was identified despite extensive evaluation.She underwent five cycles of 5-fluorouracil(1000 mg/m^(2) continuous infusion,days 1-4)and mitomycin-C(10 mg/m^(2) on day 1)with concurrent pelvic radiotherapy(50.4 Gy in 28 fractions).Follow-up imaging demonstrated complete remission sustained for 12 months.Electrocorticography performance status improved from 2 at diagnosis to 1 during follow-up.CONCLUSION This case highlights the potential role of chemoradiotherapy in managing pelvic squamous cell CUP,achieving durable remission in selected patients.
文摘BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.
文摘BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.
基金Supported by the National Public Welfare Basic Scientific Research Program of Chinese Academy of Medical Sciences(2018PT32003 and 2017 PT32004)
文摘Colorectal cancer is one of the most common malignant tumors, and the morbidity and mortality are increasing gradually over the last years in China. Neoadjuvant chemoradiotherapy(nCRT) is currently applied to the treatment of colorectal cancer patients, and it is helpful to improve the prognosis. The sensitivity of patients to nCRT is different due to individual differences. Predicting the therapeutic effect of nCRT is of great importance for the further treatment methods. Texture analysis, as an image post-processing technique, has been more and more utilized in the field of oncologic imaging. This article reviews the application and progress of texture analysis in the therapeutic effect prediction and prognosis of nCRT for colorectal cancer.
文摘BACKGROUND Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.AIM To investigate the clinical outcomes of patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy using tegafur/gimeracil/oteracil(S-1)plus irinotecan(CPT-11).METHODS This was a single-center retrospective study of 82 patients who underwent radical surgery for rectal cancer after chemoradiotherapy with S-1(80 mg/m2/d),CPT-11(60 mg/m2/d),and radiation(total 45 Gy)between 2009 and 2016.The median follow-up was 51 mo(range:17–116 mo).RESULTS Twenty-nine patients(35.4%)had T3 or T4 rectal cancer with mesorectal fascia invasion,36(43.9%)had extramural vascular invasion,24(29.8%)had N2 rectal cancer and eight(9.8%)had lateral lymph node swelling.The relative dose intensity was 90.1%for S-1 and 92.9%for CPT-11.Seventy-nine patients(96.3%)underwent R0 resection.With regard to pathological response,13 patients(15.9%)had a pathological complete response and 52(63.4%)a good response(tumor regression grade 2/3).The 5-year local recurrence-free survival,relapsefree survival and overall survival rates were 90.1%,72.5%and 91.3%,respectively.We analyzed the risk factors for local recurrence-free survival by Cox regression analysis and none were detected.Previously described risk factors such as T4 stage,mesorectal fascia invasion or lateral lymph node swelling were not detected as negative factors for local recurrence-free survival.CONCLUSION We demonstrated good compliance and favorable tumor regression in patients with locally advanced rectal cancer treated with preoperative S-1 and CPT-11.
文摘To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.
文摘AIM:To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS:We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed.Trial validity assessment was performed and a trial quality score was assigned. RESULTS:Eleven randomized controlled trials(RCTs) including 1308 patients were selected.Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone.Odds ratio(OR) [95%confidence interval(CI),P value],expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone,was 1.28(1.01-1.64,P=0.05)for 1-year survival,1.78(1.20-2.66,P=0.004)for 3-year survival,and 1.46(1.07-1.99,P=0.02)for 5-year survival.Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy(OR: 1.68,95%CI:1.03-2.73,P=0.04),but incidence of postoperative complications was similar in two groups (OR:1.14,95%CI:0.88-1.49,P=0.32).Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence(OR:0.64,95%CI:0.41-0.99,P=0.04), but incidence of distant cancer recurrence was similar (OR:0.94,95%CI:0.68-1.31,P=0.73).Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvantchemoradiotherapy,OR(95%CI,P value)was 1.16(0.85-1.57,P=0.34)for 1-year survival,1.34 (0.98-1.82,P=0.07)for 3-year survival and 1.41 (0.98-2.02,P=0.06)for 5-year survival. CONCLUSION:Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.
文摘AIM： To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer.METHODS： Patients with T3-4 and N0-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy （CCRT） with weekly cisplatin 30 mg/m^2 followed by systemic adjuvant chemotherapy （four monthly cycles of cisplatin 20 mg/m^2 and 5-fluorouracil 1 000 mg/m^2 for five consecutive days）, or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients＇ improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-totreat patients＇ outcome of survival. RESULTS： A total of 60 patients （n=30 per group） were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematological and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival （30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1） and 3-year survival （70.0% vs 33.7%; P=0.003）. Low histological grade of tumor （P〈0.001） was associated with favorable survival in these locally advanced patients. CONCLUSION： For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.
文摘AIM： Esophageal squamous cell carcinoma is generally sensitive to chemoradiotherapy （CRT）, but some cases are not. Using a retrospective analysis, we aimed to identify the predictors of the response by esophageal squamous cell carcinoma to definitive CRT. METHODS： The intensities of expression of p53, Ki67, Bci-2, Bax, olclin D1, VEGF, CDC25B, and metallothionein （MT） were evaluated immunohistochemically in the biopsy specimens obtained before CRT, and the intensities of their expression were tested for correlations with the clinical effects of CRT. RESULTS： The esophageal squamous cell carcinomas with negative p53, positive CDC25B, and negative MT expression were found to be significantly more sensitive to CRT. In addition, p53 positivity and CDC25B positivity respomd well to CRT. CONCLUSION： Esophageal squamous cell carcinomas with negative p53,positive CDC25B, and negative MT expressions respond well to CRT. Even with p53 positivity, if with CDC25B positivity, CRT can be expected. 2005 The WJG Press and Elsevier Inc. All rights reserved
文摘Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.
文摘AIM:To evaluate the predictive value of the lymph node(LN) ratio(LNR,number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy(PCRT).METHODS:From 2000 to 2009,967 patients with metastatic LNs after curative resection for locally advanced rectal cancer were identified.Patients were categorized according to PCRT(PCRT vs No PCRT).The cut-off LNR was determined based on the p N1 vs p N2 when the recommended number of LNs was harvested.The 5-year recurrence-free survival(RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group.RESULTS:Among patients with the same p/yp N stage,the 5-year RFS rate differed according to the LNR.In addition,the 5-year RFS rate was significantly different between p N and LNR groups in patients with No PCRT.In PCRT group,however,only LNR was associated with prognosis.On multivariate analysis,both p N and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group.In the PCRT group,only LNR category was found to be associated with RFS(HR = 2.36,95%CI:1.31-3.84,and P = 0.001).CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT.Current p N categories could not discriminate between prognostic groups of RFS after PCRT.
