Small-molecule prodrug nanoassembly technology with a unique advantage in off-target toxicity reduction has been widely used for antitumor drug delivery.However,prodrug activation remains a rate-limiting step for exer...Small-molecule prodrug nanoassembly technology with a unique advantage in off-target toxicity reduction has been widely used for antitumor drug delivery.However,prodrug activation remains a rate-limiting step for exerting therapeutic actions,which requires to quickly reach the minimum valid concentrations of free drugs.Fortunately,we find that a natural compound(BL-193)selectively improves the chemotherapy sensitivity of breast cancer cells to podophyllotoxin(PPT)at ineffective dose concentrations.Based on this,we propose to combine prodrug nanoassembly with chemotherapy sensitization to fully unleash the chemotherapeutic potential of PPT.Specifically,a redox-sensitive prodrug(PSSF)of PPT is synthesized by coupling 9-fluorenyl-methanol(Fmoc-OH)with PPT linked via disulfide bond.Intriguingly,PSSF with aπ-conjugated structure readily co-assembles with BL-193 into stable nanoassembly.Significantly,BL-193 serves as an excellent chemosensitizer that creates an ultra-low-dose chemotherapeutic windowfor PPT.Moreover,prodrug design and precise hybrid nanoassembly well manage off-target toxicity.As expected,such a BL-193-empowered prodrug nanoassembly elicits potent antitumor responses.This study offers a novel paradigm to magnify chemotherapy efficacy-toxicity benefits.展开更多
For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cos...For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cost alternatives without sacrificing outcomes or quality of care. This paper describes the steps of development of a functioning pathways program beginning in an environment of full-risk capitation, including drugs. The next steps involved quantitating the potential impact of such a program and then collaborating with a payer to test the concept. When these studies showed promise, the practices adopting pathways used them as a backbone for drug management in the Oncology Care Model. These experiences very likely represent steps in a continuum towards placing more of the drug delivery costs at risk. The potential for again considering capitated payments is discussed.展开更多
The experiment will be aimed at lung cancer chemotherapy patients with the application of nurses and patients participation nursing, further adjust the patient's mentality, promote patients to face the disease and...The experiment will be aimed at lung cancer chemotherapy patients with the application of nurses and patients participation nursing, further adjust the patient's mentality, promote patients to face the disease and its treatment. Methods: The study selected lung cancer chemotherapy patients admitted from January 2020 to October 2020 as the research object, a total of 80 people met the inclusion criteria of the survey .Divided into 2 groups by random draw. The control group was treated with conventional nursing measures (30 patients), and the observation group was treated with nurses and patients participation nursing (31 patients), and the nursing outcomes were analyzed. Results: from the perspective of nursing quality, the observation group patients' bad mood was improved compared with before treatment, that is, through the joint efforts of nursing staff, patients' psychological problems were relieved, compared with the control group, the overall situation reached a relief effect, the difference between groups has statistical significance (P < 0.05). At the same time, the PSQI scale was applied in the assessment and analysis of sleep quality. After intervention, the PSQI scale score of the observation group was (4.21±2.54) points, while that of the control group was (7.13±2.28) points, with statistically significant difference (P < 0.05). Finally, in the survey of nursing satisfaction, the observation group was 95.0%, the control group was 87.5%, and the difference was statistically significant. Conclusion: the use of nurses and patients participation nursing mode can help improve the mood of patients with lung cancer chemotherapy, but also help patients to understand the condition, actively participate in the treatment, as far as possible to improve the quality of life, has clinical promotion value.展开更多
This is a summary,with extensive references,of several areas of chemistry in which the Breslow lab has been involved,leading to work still underway in several of them.The principal conclusions are described,but it wil...This is a summary,with extensive references,of several areas of chemistry in which the Breslow lab has been involved,leading to work still underway in several of them.The principal conclusions are described,but it will be necessary to consult the references for details of the work involved.展开更多
Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonge...Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival(OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.展开更多
In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative mana...In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative management is highly needed.One key question is to what extent promising results produced by randomized controlled trials(RCTs)correspond to clinically meaningful outcomes in patients treated outside the strict frames of a clinical trial.To answer such questions,real-world evidence is necessary.The present paper reviews and discusses the current literature on first-and second-line palliative chemotherapy in PDAC.Notably,a growing number of studies report that the outcomes of the two predominant first-line multidrug regimens,i.e.gemcitabine plus nabpaclitaxel(GnP)and folfirinox(FFX),is similar in RCTs and real-life populations.Outcomes of second-line therapy following failure of first-line regimens are still dismal,and considerable uncertainty of the optimal management remains.Additional RCTs and real-world evidence studies focusing on the optimal treatment sequence,such as FFX followed by GnP or vice versa,are urgently needed.Finally,the review highlights the need for prognostic and predictive biomarkers to inform clinical decision making and enable personalized management in advanced PDAC.展开更多
Relapse and metastasis are frequent in colon cancer and may be linked to stem cell characteristics.This study isolated side population（SP） cells from a colon cancer cell line（Colo-320） and examined their self-rene...Relapse and metastasis are frequent in colon cancer and may be linked to stem cell characteristics.This study isolated side population（SP） cells from a colon cancer cell line（Colo-320） and examined their self-renewal and differentiation abilities.Compared to non-SP（NSP） cells,SP colon cancer cells were more tumorigenic in vivo and exhibited more invasive characteristics and a greater ability to form colonies.Additionally,more cells were in G0/G1 phase and more highly expressed the multidrug resistance protein BCRP/ABCG2.We achieved enhanced chemotherapy sensitivity by transfecting SP cells with a hairpin-like,small interfering RNA（si RNA） eukaryotic expression plasmid targeting BCRP/ABCG2.展开更多
BACKGROUND Gastric cancer is a malignant digestive tract tumor that originates from the epithelium of the gastric mucosa and occurs in the gastric antrum,particularly in the lower curvature of the stomach.AIM To evalu...BACKGROUND Gastric cancer is a malignant digestive tract tumor that originates from the epithelium of the gastric mucosa and occurs in the gastric antrum,particularly in the lower curvature of the stomach.AIM To evaluate the impact of a positive web-based psychological intervention on emotions,psychological capital,and quality of survival in gastric cancer patients on chemotherapy.METHODS From January 2020 to October 2023,121 cases of gastric cancer patients on chemotherapy admitted to our hospital were collected and divided into a control group(n=60)and an observation group(n=61)according to the admission order.They were given either conventional nursing care alone and conventional nursing care combined with web-based positive psychological interventions,respectively.The two groups were compared in terms of negative emotions,psychological capital,degree of cancer-caused fatigue,and quality of survival.RESULTS After intervention,the number of patients in the observation group who had negative feelings toward chemotherapy treatment was significantly lower than that of the control group(P<0.05);the Positive Psychological Capital Questionnaire score was considerably higher than that of the control group(P<0.05);the degree of cancer-caused fatigue was significantly lower than that of the control group(P<0.05);and the Quality of Life Scale for Cancer Patients(QLQ-30)score was significantly higher than that of the control group(P<0.05).CONCLUSION Implementing a web-based positive psychological intervention for gastric cancer chemotherapy patients can effectively improve negative emotions,enhance psychological capital,and improve the quality of survival.展开更多
Objective： To understand the changing trajectory of quality of life（QOL） during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affec...Objective： To understand the changing trajectory of quality of life（QOL） during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affect QOL.Methods： The M.D. Anderson Symptom Inventory Scale, the Hospital Anxiety and Depression Scale（HADS）, and the Functional Assessment of Cancer Therapy-Breast（FACT-B） scale were used to perform a survey on 174 breast cancer patients who received the TAC（docetaxel, Adriamycin, and cyclophosphamide） chemotherapy regimen before postoperative chemotherapy and 5-7 days after each chemotherapy course.Results： The QOL scores of the breast cancer patients were the lowest before the postoperative chemotherapy（81.2 ± 19.6） and the highest after the second chemotherapy course（94.5 ± 14.4）. After the fourth and fifth chemotherapy courses, the scores were much lower again, with values of 82.7 ± 13.9and 82.6 ± 13.1, respectively. The scores improved again after the sixth chemotherapy course（93.9 ± 18.7）. Furthermore, each treatment course had different related symptoms that affected the QOL of the patients.Conclusions： More attention should be paid to the changing trajectory of QOL of patients in all treatment courses and to the influence of treatment-related symptoms on the QOL of patients; moreover, interventions should be adopted by medical care personnel to increase QOL in cancer patients.展开更多
Objective:To evaluate the intervention effect of nutritional intervention combined with predictive nursing on patients undergoing chemotherapy for lung cancer.Methods:A total of 88 lung cancer chemotherapy patients ad...Objective:To evaluate the intervention effect of nutritional intervention combined with predictive nursing on patients undergoing chemotherapy for lung cancer.Methods:A total of 88 lung cancer chemotherapy patients admitted between January 2023 and June 2024 were selected and randomly divided into groups using a random number table.The experimental group(44 cases)received nutritional intervention combined with predictive nursing,while the control group(44 cases)received predictive nursing alone.Nutritional status scores,nutritional indicators,quality of life scores,and adverse reaction rates were compared between the two groups.Results:After the intervention,the nutritional status scores of the experimental group were lower than those of the control group,while the levels of nutritional indicators in the experimental group were better than those in the control group.The quality of life scores in the experimental group were lower than in the control group,and the adverse reaction rates were also lower in the experimental group(P<0.05).Conclusion:Nutritional intervention combined with predictive nursing can improve the nutritional status of lung cancer chemotherapy patients,regulate multiple nutritional indicators,enhance quality of life,and reduce chemotherapy-related adverse reactions.展开更多
The effective intracellular accumulation of doxorubicin(DOX)is crucial for improving antitumor efficacy,which is severely impeded by limited drug penetration,uncontrollable drug release,and drug resistance.In this stu...The effective intracellular accumulation of doxorubicin(DOX)is crucial for improving antitumor efficacy,which is severely impeded by limited drug penetration,uncontrollable drug release,and drug resistance.In this study,a thermal-deformative polymer embedding ultrasmall ceria(CeO_(2))was rationally designed for deep tumor drug shuttling and hypoxia reversal to improve chemotherapy.Structurally,the CeO_(2)nanozyme was covalently grafted with a polymer of p(NIPAM-co-AM)that could sharply shrink for DOX loading,which was consolidated with polydopamine(PDA)film encapsulation.Thereafter,a tumor penetration guide of apolipoprotein A-I(apoA-I)conjugated iRGD peptide(apoA-I-iRGD)was further decorated onto the PDA shell via Michael addition for preparing CeO_(2)P/DOX@iAPDA.With the aid of apoA-I-iRGD,CeO_(2)P/DOX@iAPDA penetrated both the tumor spheroids(∼78μm)and the tumors of the mouse model deeply.After internalization by tumor cells and triggering by low pH in lysosomes,rapid DOX release was achieved by peeling off the PDA shell and thermosensitive deformation of p(NIPAM-co-AM).CeO_(2)P/DOX@iAPDA provided 66.4%tumor suppression in 4T1-derived tumor spheroids and 63.2%in 4T1-tumorbearing mice,respectively.Preliminary mechanistic research involving western blotting and immunohistochemistry revealed that CeO_(2)P/DOX@iAPDA reversed resistance through the through HIF-1α-P-gp/lipid axis.Collectively,this study intelligently integrated CeO_(2)nanozymes,temperature-sensitive polymers,and imitated biochemical modifications to improve chemotherapy for breast cancer.展开更多
AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all publ...AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials(RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio(OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gas-troesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group(NAC plus surgery) vs control group(surgery alone) and was presented as a point estimate with 95% confidence intervals(CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group(n = 620) and control group(n = 629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7(5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate(OR 1.40,95%CI 1.11-1.76;P = 0.005),which was statistically significant.The 3-year progression-free survival rate was significantly higher in treatment group than in control group(37.7% vs 27.3%)(OR 1.62,95%CI 1.21-2.15;P = 0.001).The tumor down-stage rate was higher in treatment group than in control group(55.76% vs 41.38%)(OR 1.77,95%CI 1.27-2.49;P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group(75.11% vs 68.56%)(OR 1.38,95%CI 1.03-1.85;P = 0.03),with significant differences.No obvious safety concerns about mortality and complications were raised in these trials.There were no statistically significant differences in perioperative mortality(5.08% vs 4.86%)(OR 1.05,95%CI 0.57-1.94;P = 0.87 fixed-effect model) and in the complication rate between the two groups(13.25% vs 9.66%)(OR 1.40,95%CI 0.91-2.14;P = 0.12 fixed-effect model).Trials showed that patients from Western countries favored NAC compared with those from Asian countries(OR 1.40,95%CI 1.07-1.83).Monotherapy was inferior tomultiple chemotherapy(OR 1.40,95%CI 1.07-1.83).Intravenous administration of NAC was more advantageous than oral route(OR 1.41,95%CI 1.09-1.81).CONCLUSION:Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer.Additionally,NAC can down the tumor stage and improve R0 resection.展开更多
This study was designed to investigate the effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese female breast cancer patients. The expression of estrogen receptor（ER）, proges...This study was designed to investigate the effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese female breast cancer patients. The expression of estrogen receptor（ER）, progesterone receptor（PR） and Ki67 among 525 neoadjuvant chemotherapy cases was studied by immunohistochemistry.Differences between specimens made through preoperative core needle biopsy and excised tissue biopsy were observed. The positive rates of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy were 65.3% and 63.2%, 51.0% and 42.6%, 65.6% and 43.4%, respectively. The expression of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy had no statistically significant difference. However, after neoadjuvant chemotherapy, the discordance rates of ER, PR and Ki67 were 15.2%（79/521）, 26.9%（140/520） and 44.8%（225/502）, respectively. The ER, PR and Ki67 status changed from positive to negative in 7.5%（39/521）, 13.3%（69/520） and 21.1%（106/502） of the patients, whereas ER, PR and Ki67 status changed from negative to positive in 7.7%（40/521）, 13.6%（71/520）and 23.7%（119/502） of the patients, respectively. These results showed that the status of some biomarkers changes after neoadjuvant chemotherapy and biomarker status needs to be reexamined to optimize adjuvant systemic therapy and better prognosis assessment.展开更多
Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk...Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk factors influencing its prognosis and decide the indication for adjuvant chemotherapy.Methods: In this retrospective study, 108 patients with MIBC were recruited according to seventh edition of the staging manual of the American Joint Committee on Cancer(AJCC). The subjects were divided into chemotherapy and non-chemotherapy groups.We compared the 5-year disease-free survival(DFS) and overall survival(OS) rates between groups. Furthermore, we analyzed the factors related to prognosis for patients with MIBC using univariate and multivariate analyses. We also evaluated the impact of adjuvant chemotherapy on the prognostic factors by subgroup analysis after median follow-up time of 33 months(13-104months).Results: The 5-year DFS and OS rates for the chemotherapy group were 93.7% and 97.5%, whereas those for the nonchemotherapy group were 89.7% and 100%. Results indicate that 5-year DFS was superior, but OS was inferior, in the former group compared with the latter group. However, no statistical significance was observed in the 5-year DFS(P=0.223) or OS(P=0.530) rate of the two groups. Most relevant poor-prognostic factors were Ki-67 overexpression and negative hormonal receptors. Cumulative survival was 98.2% vs. 86.5% between low Ki-67(≤20%) and high Ki-67(>20%). The hazard ratio of patients with high Ki-67 was 16.585 [95% confidence interval(CI), 1.969-139.724; P=0.010]. Meanwhile, ER(-)/PR(-) patients with MIBC had cumulative survival of 79.3% compared with 97.5% for ER(+) or PR(+) patients with MIBC. The hazard ratio for ER(-)/PR(-) patients with MIBC was 19.149(95% CI, 3.702-99.057; P<0.001). Subgroup analysis showed that chemotherapy could improve the outcomes of ER(-)/PR(-) patients(P=0.014), but not those who overexpress Ki-67(P=0.105).Conclusions: Patients with MIBC who overexpress Ki-67 and with negative hormonal receptors have relatively substantial risk of relapse within the first five years after surgery. However, adjuvant chemotherapy can only improve the outcomes of ER(-)/PR(-)patients, but not those who overexpress Ki-67. Further studies with prolonged follow-up of large cohorts are recommended to assess the prognostic significance and treatment of this lesion.展开更多
Objective：To evaluate the ef icacy of autologous cytokine-induced kil er （CIK） cells transfusion combined with chemotherapy in patients suf ered from advanced colorectal cancer. Methods： Sixty untreated patients w...Objective：To evaluate the ef icacy of autologous cytokine-induced kil er （CIK） cells transfusion combined with chemotherapy in patients suf ered from advanced colorectal cancer. Methods： Sixty untreated patients with advanced colorectal cancer were randomly divided into two groups. The 30 patients in the control group received chemotherapy with the regimen of xeloda plus oxiplatin （XELOX）. The 30 patients in the trial group were treated with chemotherapy （XELOX） in combination with autologous CIK celltransfusion. T-lymphocyte subgroups were separated and measured by flow cytometry quality of life （QOL） was determined by EORTC QLQ-C30. The short-term curative ef ect was evaluated via imaging examina-tions. The patients’ median progression free survival time was estimated by Kaplan-Meier. Results：The T-lymphocyte im-mune activity was improved in patients received autologous CIK celltransfusion than those treated with chemotherapy alone. The subgroup of CD3＋CD56＋T lymphocyte was significantly increased （4.28 ± 0.45 vs 10.14 ± 1.02, P=0.01）. Short-term ef icacy evaluation revealed that there was no significant dif erence in terms of objective response rate （ORR） between the two groups, but the disease control rate （DCR） was markedly increased （86.7%vs 56.7%, P=0.020） in the group treated by chemotherapy plus CIK cells compared to the group treated with chemotherapy alone. The progression free survival time was 8.64 months （ 95%CI 6.25-9.75 months） in control group and 10.15 months （ 95%CI 7.48-12.52 months） in trial group. Compared to patients in control group, the patients in trial group had significantly longer progression-free survival （P=0.046）. The QOL assessment suggested the QOL in trial group was obviously improved than that in the control group. Compared with the control group, patients treated with autologous CIK celltransfusion scored more in the area of physical function and general health status, while the symptomatic scores in terms of pain, fatigue, nausea and vomiting and diarrhea were significantly reduced. Conclusion：Autologous CIK celltransfusion combined with chemotherapy can ef ectively enhance the immune activity of T-lymphocytes, prevent disease progression and improve the progression-free survival and QOL in patients with advanced colorectal cancer.展开更多
BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatme...BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.展开更多
Despite the advances in surgical techniques, adjuvant chemotherapy and targeted therapy, approximately 40%-70% of patients with progressive colorectal cancer will develop liver metastases, of whom one-third are found ...Despite the advances in surgical techniques, adjuvant chemotherapy and targeted therapy, approximately 40%-70% of patients with progressive colorectal cancer will develop liver metastases, of whom one-third are found at the time of diagnosis.[1] Surgical resection is now the standard treatment and also the only potentially curative treatment for resectable lesions.展开更多
The systematic treatment based on gemcitabine plus cisplatin is recommended as the current standard chemotherapy for unresectable or metastatic biliary tract cancers.However,the exact benefits from the recognized regi...The systematic treatment based on gemcitabine plus cisplatin is recommended as the current standard chemotherapy for unresectable or metastatic biliary tract cancers.However,the exact benefits from the recognized regime are still dismal.We thus elicit this study in an attempt to analyze whether targeted therapy coupled with various chemotherapy could produce improvement of survival benefits.The clinical trials were searched electronically from databases till July 2016 published in English and Chinese.Nine hundred and sixty-four patients from 7 trials were identified in our analysis.The overall analysis achieved a significantly higher overall response rate（ORR） among the patients treated with targeted drugs plus chemotherapy than chemotherapy alone（OR=1.87;95% CI：1.37–2.57;P=0.000）,but failed in the overall progression-free survival（PFS） [mean difference（MD）=0.63;95% CI：–0.45–1.72;P=0.26] and overall survival（OS）（MD=–0.67;95% CI：–2.54–1.20;P=0.49）.In the sub analysis,better ORR was obtained with the addition of EGFR（OR=1.75;95% CI：1.20–2.56;P=0.004） and VEGFR（OR=2.5;95% CI：1.28–4.87;P=0.007） targeted therapy.Furthermore,the sub analysis of EGFR target showed an significant improvement on PFS（MD=1.36;95% CI：0.29–2.43;P=0.01）.No significant differences were observed in the incidences of neutropenia（OR=1.37;95% CI：0.89–2.12）,thrombocytopenia（OR=1.40;95% CI：0.83–2.39）,anemia（OR=1.21;95% CI：0.62–2.38）,peripheral neuropathy（OR=1.52;95% CI：0.81–2.88）,increased AST/ALT（OR=1.40;95% CI：0.82–2.39） as well as fatigue（OR=1.65;95% CI：0.96–2.84） in either of the treatment groups.In conclusion,better ORR associated with chemotherapy combined with targeted therapy（both targeting EGFR and VEGF） is found in the present meta-analysis without the cost of increased unacceptable toxicities,but regretfully not for the OS.The sub-analysis of targeting EGFR instead of VEGF obtains a superior PFS.Otherwise,there is no statistically significant difference in the overall PFS between the combination regime and chemotherapy alone.Given the paucity of favorable data,we need further studies to characterize optimal targeted agents to confirm the potential value to biliary tract cancer.展开更多
Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advan...Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients.Moreover,surgery is still associated with high post-operative morbidity,while other therapies still offer very disappointing results.This article reviews every aspect of pancreatic cancer,focusing on the elements that can improve prognosis.It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.展开更多
Sialic acids (neuraminic acids) are a special series of 9 carbon ring negatively charged carbohydrates, which has been found to be selectively changed in malignant cells from structures (both synthesis and structure ...Sialic acids (neuraminic acids) are a special series of 9 carbon ring negatively charged carbohydrates, which has been found to be selectively changed in malignant cells from structures (both synthesis and structure modifications) to functions (up and down regulation in cells). Sialic acids, in single forms or conjugates, have been systematically studied both in lab and in clinics by GC, GC MS, NMR, HPTLC, HPLC and other modern analytical means. Sialic acids and related conjugates are predicted to be used in cancer diagnosis, cancer prognostic forecasting, designing of cancer chemotherapy regimens, uncovering carcinogenetic processes and neoplasm metastasis. Tumor cell regulative systems and pathways are correlated with sialic acids, which can be applied to prognostic evaluation of cancer patients, and antimetastatic chemotherapy by sialic acid derivatives and analogues. Searching for new biological characteristics of sialic acids in cells have also been extensively studied these days. In this paper, main stream discoveries and advancements are provided , also discussions of possible mechanisms and hypotheses are invoked.展开更多
基金supported by the Basic Research Projects of Liaoning Provincial Department of Education(LJKZZ20220109)the Shenyang Youth Science and Technology Innovation Talents Program(No.RC210452)+1 种基金the National Natural Science Foundation of China(No.82204317)the Natural Science Foundation of Liaoning Province(No.2022-BS-162).
文摘Small-molecule prodrug nanoassembly technology with a unique advantage in off-target toxicity reduction has been widely used for antitumor drug delivery.However,prodrug activation remains a rate-limiting step for exerting therapeutic actions,which requires to quickly reach the minimum valid concentrations of free drugs.Fortunately,we find that a natural compound(BL-193)selectively improves the chemotherapy sensitivity of breast cancer cells to podophyllotoxin(PPT)at ineffective dose concentrations.Based on this,we propose to combine prodrug nanoassembly with chemotherapy sensitization to fully unleash the chemotherapeutic potential of PPT.Specifically,a redox-sensitive prodrug(PSSF)of PPT is synthesized by coupling 9-fluorenyl-methanol(Fmoc-OH)with PPT linked via disulfide bond.Intriguingly,PSSF with aπ-conjugated structure readily co-assembles with BL-193 into stable nanoassembly.Significantly,BL-193 serves as an excellent chemosensitizer that creates an ultra-low-dose chemotherapeutic windowfor PPT.Moreover,prodrug design and precise hybrid nanoassembly well manage off-target toxicity.As expected,such a BL-193-empowered prodrug nanoassembly elicits potent antitumor responses.This study offers a novel paradigm to magnify chemotherapy efficacy-toxicity benefits.
文摘For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cost alternatives without sacrificing outcomes or quality of care. This paper describes the steps of development of a functioning pathways program beginning in an environment of full-risk capitation, including drugs. The next steps involved quantitating the potential impact of such a program and then collaborating with a payer to test the concept. When these studies showed promise, the practices adopting pathways used them as a backbone for drug management in the Oncology Care Model. These experiences very likely represent steps in a continuum towards placing more of the drug delivery costs at risk. The potential for again considering capitated payments is discussed.
文摘The experiment will be aimed at lung cancer chemotherapy patients with the application of nurses and patients participation nursing, further adjust the patient's mentality, promote patients to face the disease and its treatment. Methods: The study selected lung cancer chemotherapy patients admitted from January 2020 to October 2020 as the research object, a total of 80 people met the inclusion criteria of the survey .Divided into 2 groups by random draw. The control group was treated with conventional nursing measures (30 patients), and the observation group was treated with nurses and patients participation nursing (31 patients), and the nursing outcomes were analyzed. Results: from the perspective of nursing quality, the observation group patients' bad mood was improved compared with before treatment, that is, through the joint efforts of nursing staff, patients' psychological problems were relieved, compared with the control group, the overall situation reached a relief effect, the difference between groups has statistical significance (P < 0.05). At the same time, the PSQI scale was applied in the assessment and analysis of sleep quality. After intervention, the PSQI scale score of the observation group was (4.21±2.54) points, while that of the control group was (7.13±2.28) points, with statistically significant difference (P < 0.05). Finally, in the survey of nursing satisfaction, the observation group was 95.0%, the control group was 87.5%, and the difference was statistically significant. Conclusion: the use of nurses and patients participation nursing mode can help improve the mood of patients with lung cancer chemotherapy, but also help patients to understand the condition, actively participate in the treatment, as far as possible to improve the quality of life, has clinical promotion value.
基金supported by grants from the U. S. National Institutes of Healththe U. S. National Science Foundation
文摘This is a summary,with extensive references,of several areas of chemistry in which the Breslow lab has been involved,leading to work still underway in several of them.The principal conclusions are described,but it will be necessary to consult the references for details of the work involved.
文摘Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival(OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.
文摘In spite of recent diagnostic and therapeutic advances,the prognosis of pancreatic ductal adenocarcinoma(PDAC)remains very poor.As most patients are not amenable to curative intent treatments,optimized palliative management is highly needed.One key question is to what extent promising results produced by randomized controlled trials(RCTs)correspond to clinically meaningful outcomes in patients treated outside the strict frames of a clinical trial.To answer such questions,real-world evidence is necessary.The present paper reviews and discusses the current literature on first-and second-line palliative chemotherapy in PDAC.Notably,a growing number of studies report that the outcomes of the two predominant first-line multidrug regimens,i.e.gemcitabine plus nabpaclitaxel(GnP)and folfirinox(FFX),is similar in RCTs and real-life populations.Outcomes of second-line therapy following failure of first-line regimens are still dismal,and considerable uncertainty of the optimal management remains.Additional RCTs and real-world evidence studies focusing on the optimal treatment sequence,such as FFX followed by GnP or vice versa,are urgently needed.Finally,the review highlights the need for prognostic and predictive biomarkers to inform clinical decision making and enable personalized management in advanced PDAC.
基金supported by grants from the National Nature Science Foundation of China(No.81101870)the National Key Clinical Specialist Construction Programs of China(No.2013-544)the Key Programs of National Health and Family Planning Commission of Tianjin(No.16KG127)
文摘Relapse and metastasis are frequent in colon cancer and may be linked to stem cell characteristics.This study isolated side population（SP） cells from a colon cancer cell line（Colo-320） and examined their self-renewal and differentiation abilities.Compared to non-SP（NSP） cells,SP colon cancer cells were more tumorigenic in vivo and exhibited more invasive characteristics and a greater ability to form colonies.Additionally,more cells were in G0/G1 phase and more highly expressed the multidrug resistance protein BCRP/ABCG2.We achieved enhanced chemotherapy sensitivity by transfecting SP cells with a hairpin-like,small interfering RNA（si RNA） eukaryotic expression plasmid targeting BCRP/ABCG2.
文摘BACKGROUND Gastric cancer is a malignant digestive tract tumor that originates from the epithelium of the gastric mucosa and occurs in the gastric antrum,particularly in the lower curvature of the stomach.AIM To evaluate the impact of a positive web-based psychological intervention on emotions,psychological capital,and quality of survival in gastric cancer patients on chemotherapy.METHODS From January 2020 to October 2023,121 cases of gastric cancer patients on chemotherapy admitted to our hospital were collected and divided into a control group(n=60)and an observation group(n=61)according to the admission order.They were given either conventional nursing care alone and conventional nursing care combined with web-based positive psychological interventions,respectively.The two groups were compared in terms of negative emotions,psychological capital,degree of cancer-caused fatigue,and quality of survival.RESULTS After intervention,the number of patients in the observation group who had negative feelings toward chemotherapy treatment was significantly lower than that of the control group(P<0.05);the Positive Psychological Capital Questionnaire score was considerably higher than that of the control group(P<0.05);the degree of cancer-caused fatigue was significantly lower than that of the control group(P<0.05);and the Quality of Life Scale for Cancer Patients(QLQ-30)score was significantly higher than that of the control group(P<0.05).CONCLUSION Implementing a web-based positive psychological intervention for gastric cancer chemotherapy patients can effectively improve negative emotions,enhance psychological capital,and improve the quality of survival.
基金supported by a project of scientific research of the Affiliated Hospital of Luzhou Medical College(No.14039)
文摘Objective： To understand the changing trajectory of quality of life（QOL） during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affect QOL.Methods： The M.D. Anderson Symptom Inventory Scale, the Hospital Anxiety and Depression Scale（HADS）, and the Functional Assessment of Cancer Therapy-Breast（FACT-B） scale were used to perform a survey on 174 breast cancer patients who received the TAC（docetaxel, Adriamycin, and cyclophosphamide） chemotherapy regimen before postoperative chemotherapy and 5-7 days after each chemotherapy course.Results： The QOL scores of the breast cancer patients were the lowest before the postoperative chemotherapy（81.2 ± 19.6） and the highest after the second chemotherapy course（94.5 ± 14.4）. After the fourth and fifth chemotherapy courses, the scores were much lower again, with values of 82.7 ± 13.9and 82.6 ± 13.1, respectively. The scores improved again after the sixth chemotherapy course（93.9 ± 18.7）. Furthermore, each treatment course had different related symptoms that affected the QOL of the patients.Conclusions： More attention should be paid to the changing trajectory of QOL of patients in all treatment courses and to the influence of treatment-related symptoms on the QOL of patients; moreover, interventions should be adopted by medical care personnel to increase QOL in cancer patients.
文摘Objective:To evaluate the intervention effect of nutritional intervention combined with predictive nursing on patients undergoing chemotherapy for lung cancer.Methods:A total of 88 lung cancer chemotherapy patients admitted between January 2023 and June 2024 were selected and randomly divided into groups using a random number table.The experimental group(44 cases)received nutritional intervention combined with predictive nursing,while the control group(44 cases)received predictive nursing alone.Nutritional status scores,nutritional indicators,quality of life scores,and adverse reaction rates were compared between the two groups.Results:After the intervention,the nutritional status scores of the experimental group were lower than those of the control group,while the levels of nutritional indicators in the experimental group were better than those in the control group.The quality of life scores in the experimental group were lower than in the control group,and the adverse reaction rates were also lower in the experimental group(P<0.05).Conclusion:Nutritional intervention combined with predictive nursing can improve the nutritional status of lung cancer chemotherapy patients,regulate multiple nutritional indicators,enhance quality of life,and reduce chemotherapy-related adverse reactions.
基金supported by National Natural Science Foundation of China(Nos.82473949 and 82273955)Scientific research project of Jiangsu Provincial Health Commission(No.M2022080)+1 种基金Jiangsu Province Capability Improvement Project through Science,Technology and Education(ZDXK202234)Jiangsu Provincial Research Hospital(YJXYY202204),China.
文摘The effective intracellular accumulation of doxorubicin(DOX)is crucial for improving antitumor efficacy,which is severely impeded by limited drug penetration,uncontrollable drug release,and drug resistance.In this study,a thermal-deformative polymer embedding ultrasmall ceria(CeO_(2))was rationally designed for deep tumor drug shuttling and hypoxia reversal to improve chemotherapy.Structurally,the CeO_(2)nanozyme was covalently grafted with a polymer of p(NIPAM-co-AM)that could sharply shrink for DOX loading,which was consolidated with polydopamine(PDA)film encapsulation.Thereafter,a tumor penetration guide of apolipoprotein A-I(apoA-I)conjugated iRGD peptide(apoA-I-iRGD)was further decorated onto the PDA shell via Michael addition for preparing CeO_(2)P/DOX@iAPDA.With the aid of apoA-I-iRGD,CeO_(2)P/DOX@iAPDA penetrated both the tumor spheroids(∼78μm)and the tumors of the mouse model deeply.After internalization by tumor cells and triggering by low pH in lysosomes,rapid DOX release was achieved by peeling off the PDA shell and thermosensitive deformation of p(NIPAM-co-AM).CeO_(2)P/DOX@iAPDA provided 66.4%tumor suppression in 4T1-derived tumor spheroids and 63.2%in 4T1-tumorbearing mice,respectively.Preliminary mechanistic research involving western blotting and immunohistochemistry revealed that CeO_(2)P/DOX@iAPDA reversed resistance through the through HIF-1α-P-gp/lipid axis.Collectively,this study intelligently integrated CeO_(2)nanozymes,temperature-sensitive polymers,and imitated biochemical modifications to improve chemotherapy for breast cancer.
文摘AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials(RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio(OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gas-troesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group(NAC plus surgery) vs control group(surgery alone) and was presented as a point estimate with 95% confidence intervals(CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group(n = 620) and control group(n = 629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7(5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate(OR 1.40,95%CI 1.11-1.76;P = 0.005),which was statistically significant.The 3-year progression-free survival rate was significantly higher in treatment group than in control group(37.7% vs 27.3%)(OR 1.62,95%CI 1.21-2.15;P = 0.001).The tumor down-stage rate was higher in treatment group than in control group(55.76% vs 41.38%)(OR 1.77,95%CI 1.27-2.49;P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group(75.11% vs 68.56%)(OR 1.38,95%CI 1.03-1.85;P = 0.03),with significant differences.No obvious safety concerns about mortality and complications were raised in these trials.There were no statistically significant differences in perioperative mortality(5.08% vs 4.86%)(OR 1.05,95%CI 0.57-1.94;P = 0.87 fixed-effect model) and in the complication rate between the two groups(13.25% vs 9.66%)(OR 1.40,95%CI 0.91-2.14;P = 0.12 fixed-effect model).Trials showed that patients from Western countries favored NAC compared with those from Asian countries(OR 1.40,95%CI 1.07-1.83).Monotherapy was inferior tomultiple chemotherapy(OR 1.40,95%CI 1.07-1.83).Intravenous administration of NAC was more advantageous than oral route(OR 1.41,95%CI 1.09-1.81).CONCLUSION:Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer.Additionally,NAC can down the tumor stage and improve R0 resection.
基金supported by National Natural Science Foundation of China (NSFC) (81372851)
文摘This study was designed to investigate the effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese female breast cancer patients. The expression of estrogen receptor（ER）, progesterone receptor（PR） and Ki67 among 525 neoadjuvant chemotherapy cases was studied by immunohistochemistry.Differences between specimens made through preoperative core needle biopsy and excised tissue biopsy were observed. The positive rates of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy were 65.3% and 63.2%, 51.0% and 42.6%, 65.6% and 43.4%, respectively. The expression of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy had no statistically significant difference. However, after neoadjuvant chemotherapy, the discordance rates of ER, PR and Ki67 were 15.2%（79/521）, 26.9%（140/520） and 44.8%（225/502）, respectively. The ER, PR and Ki67 status changed from positive to negative in 7.5%（39/521）, 13.3%（69/520） and 21.1%（106/502） of the patients, whereas ER, PR and Ki67 status changed from negative to positive in 7.7%（40/521）, 13.6%（71/520）and 23.7%（119/502） of the patients, respectively. These results showed that the status of some biomarkers changes after neoadjuvant chemotherapy and biomarker status needs to be reexamined to optimize adjuvant systemic therapy and better prognosis assessment.
文摘Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk factors influencing its prognosis and decide the indication for adjuvant chemotherapy.Methods: In this retrospective study, 108 patients with MIBC were recruited according to seventh edition of the staging manual of the American Joint Committee on Cancer(AJCC). The subjects were divided into chemotherapy and non-chemotherapy groups.We compared the 5-year disease-free survival(DFS) and overall survival(OS) rates between groups. Furthermore, we analyzed the factors related to prognosis for patients with MIBC using univariate and multivariate analyses. We also evaluated the impact of adjuvant chemotherapy on the prognostic factors by subgroup analysis after median follow-up time of 33 months(13-104months).Results: The 5-year DFS and OS rates for the chemotherapy group were 93.7% and 97.5%, whereas those for the nonchemotherapy group were 89.7% and 100%. Results indicate that 5-year DFS was superior, but OS was inferior, in the former group compared with the latter group. However, no statistical significance was observed in the 5-year DFS(P=0.223) or OS(P=0.530) rate of the two groups. Most relevant poor-prognostic factors were Ki-67 overexpression and negative hormonal receptors. Cumulative survival was 98.2% vs. 86.5% between low Ki-67(≤20%) and high Ki-67(>20%). The hazard ratio of patients with high Ki-67 was 16.585 [95% confidence interval(CI), 1.969-139.724; P=0.010]. Meanwhile, ER(-)/PR(-) patients with MIBC had cumulative survival of 79.3% compared with 97.5% for ER(+) or PR(+) patients with MIBC. The hazard ratio for ER(-)/PR(-) patients with MIBC was 19.149(95% CI, 3.702-99.057; P<0.001). Subgroup analysis showed that chemotherapy could improve the outcomes of ER(-)/PR(-) patients(P=0.014), but not those who overexpress Ki-67(P=0.105).Conclusions: Patients with MIBC who overexpress Ki-67 and with negative hormonal receptors have relatively substantial risk of relapse within the first five years after surgery. However, adjuvant chemotherapy can only improve the outcomes of ER(-)/PR(-)patients, but not those who overexpress Ki-67. Further studies with prolonged follow-up of large cohorts are recommended to assess the prognostic significance and treatment of this lesion.
基金Supported by a grant from the Key Project of National 12th Five-year Research Program of China(No.2012ZX0903016-002)
文摘Objective：To evaluate the ef icacy of autologous cytokine-induced kil er （CIK） cells transfusion combined with chemotherapy in patients suf ered from advanced colorectal cancer. Methods： Sixty untreated patients with advanced colorectal cancer were randomly divided into two groups. The 30 patients in the control group received chemotherapy with the regimen of xeloda plus oxiplatin （XELOX）. The 30 patients in the trial group were treated with chemotherapy （XELOX） in combination with autologous CIK celltransfusion. T-lymphocyte subgroups were separated and measured by flow cytometry quality of life （QOL） was determined by EORTC QLQ-C30. The short-term curative ef ect was evaluated via imaging examina-tions. The patients’ median progression free survival time was estimated by Kaplan-Meier. Results：The T-lymphocyte im-mune activity was improved in patients received autologous CIK celltransfusion than those treated with chemotherapy alone. The subgroup of CD3＋CD56＋T lymphocyte was significantly increased （4.28 ± 0.45 vs 10.14 ± 1.02, P=0.01）. Short-term ef icacy evaluation revealed that there was no significant dif erence in terms of objective response rate （ORR） between the two groups, but the disease control rate （DCR） was markedly increased （86.7%vs 56.7%, P=0.020） in the group treated by chemotherapy plus CIK cells compared to the group treated with chemotherapy alone. The progression free survival time was 8.64 months （ 95%CI 6.25-9.75 months） in control group and 10.15 months （ 95%CI 7.48-12.52 months） in trial group. Compared to patients in control group, the patients in trial group had significantly longer progression-free survival （P=0.046）. The QOL assessment suggested the QOL in trial group was obviously improved than that in the control group. Compared with the control group, patients treated with autologous CIK celltransfusion scored more in the area of physical function and general health status, while the symptomatic scores in terms of pain, fatigue, nausea and vomiting and diarrhea were significantly reduced. Conclusion：Autologous CIK celltransfusion combined with chemotherapy can ef ectively enhance the immune activity of T-lymphocytes, prevent disease progression and improve the progression-free survival and QOL in patients with advanced colorectal cancer.
基金Shanghai Pudong New Area Health Commission’s Excellent Young Medical Talent Training Plan,No.PWRq2020-68Shanghai Pudong New Area Health Commission Discipline Leader Training Project,No.PWRd2020-16Shanghai Pudong New Area Science and Technology Development Fund,No.PKJ2020-Y36.
文摘BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.
文摘Despite the advances in surgical techniques, adjuvant chemotherapy and targeted therapy, approximately 40%-70% of patients with progressive colorectal cancer will develop liver metastases, of whom one-third are found at the time of diagnosis.[1] Surgical resection is now the standard treatment and also the only potentially curative treatment for resectable lesions.
基金supported by funds from Science and Technology Research Project of Hunan Province(No.2015SK2044)Health Department of Scientific Research of Hunan Province,China(No.B2014-090)
文摘The systematic treatment based on gemcitabine plus cisplatin is recommended as the current standard chemotherapy for unresectable or metastatic biliary tract cancers.However,the exact benefits from the recognized regime are still dismal.We thus elicit this study in an attempt to analyze whether targeted therapy coupled with various chemotherapy could produce improvement of survival benefits.The clinical trials were searched electronically from databases till July 2016 published in English and Chinese.Nine hundred and sixty-four patients from 7 trials were identified in our analysis.The overall analysis achieved a significantly higher overall response rate（ORR） among the patients treated with targeted drugs plus chemotherapy than chemotherapy alone（OR=1.87;95% CI：1.37–2.57;P=0.000）,but failed in the overall progression-free survival（PFS） [mean difference（MD）=0.63;95% CI：–0.45–1.72;P=0.26] and overall survival（OS）（MD=–0.67;95% CI：–2.54–1.20;P=0.49）.In the sub analysis,better ORR was obtained with the addition of EGFR（OR=1.75;95% CI：1.20–2.56;P=0.004） and VEGFR（OR=2.5;95% CI：1.28–4.87;P=0.007） targeted therapy.Furthermore,the sub analysis of EGFR target showed an significant improvement on PFS（MD=1.36;95% CI：0.29–2.43;P=0.01）.No significant differences were observed in the incidences of neutropenia（OR=1.37;95% CI：0.89–2.12）,thrombocytopenia（OR=1.40;95% CI：0.83–2.39）,anemia（OR=1.21;95% CI：0.62–2.38）,peripheral neuropathy（OR=1.52;95% CI：0.81–2.88）,increased AST/ALT（OR=1.40;95% CI：0.82–2.39） as well as fatigue（OR=1.65;95% CI：0.96–2.84） in either of the treatment groups.In conclusion,better ORR associated with chemotherapy combined with targeted therapy（both targeting EGFR and VEGF） is found in the present meta-analysis without the cost of increased unacceptable toxicities,but regretfully not for the OS.The sub-analysis of targeting EGFR instead of VEGF obtains a superior PFS.Otherwise,there is no statistically significant difference in the overall PFS between the combination regime and chemotherapy alone.Given the paucity of favorable data,we need further studies to characterize optimal targeted agents to confirm the potential value to biliary tract cancer.
文摘Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients.Moreover,surgery is still associated with high post-operative morbidity,while other therapies still offer very disappointing results.This article reviews every aspect of pancreatic cancer,focusing on the elements that can improve prognosis.It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.
文摘Sialic acids (neuraminic acids) are a special series of 9 carbon ring negatively charged carbohydrates, which has been found to be selectively changed in malignant cells from structures (both synthesis and structure modifications) to functions (up and down regulation in cells). Sialic acids, in single forms or conjugates, have been systematically studied both in lab and in clinics by GC, GC MS, NMR, HPTLC, HPLC and other modern analytical means. Sialic acids and related conjugates are predicted to be used in cancer diagnosis, cancer prognostic forecasting, designing of cancer chemotherapy regimens, uncovering carcinogenetic processes and neoplasm metastasis. Tumor cell regulative systems and pathways are correlated with sialic acids, which can be applied to prognostic evaluation of cancer patients, and antimetastatic chemotherapy by sialic acid derivatives and analogues. Searching for new biological characteristics of sialic acids in cells have also been extensively studied these days. In this paper, main stream discoveries and advancements are provided , also discussions of possible mechanisms and hypotheses are invoked.
