BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a f...BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a frequent complication in these patients.AIM To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer.METHODS The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College,Pidu District People’s Hospital,Chengdu,China,between January 2016 and January 2021,were retrospectively analyzed.All patients underwent a tegafur+oxaliplatin+apatinib chemotherapy regimen.According to the efficacy of chemotherapy,they were divided into an effective group(complete or partial response,n=121)and an ineffective group(stable disease or disease progression,n=64).The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses.The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared.RESULTS Univariate analysis showed that the proportion of patients with a tumor diameter>5 cm,non-tubular adenocarcinoma,lymph node metastasis,hematocrit<33%,low mean red blood cell(RBC)protein content,low RBC distribution width,hemoglobin<107 g/L,and platelets>266×109/L in the ineffective group were significantly higher than those in the effective group(P<0.05).Logistic multivariate analysis showed that a tumor diameter>5 cm,lymph node metastasis,≤3 chemotherapy cycles,hematocrit<33%,and hemoglobin<107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer(P<0.05).The 1-year,2-year,and 3-year survival rates in the effective group were 93.39%,83.47%,and 60.33%,respectively.These rates were significantly higher than those in the ineffective group(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hematocrit<33%were 74.67%,49.33%,and 29.33%,respectively,which were significantly lower than those of patients with hematocrit≥33%(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hemoglobin<107 g/L were 80.39%,58.82%,and 39.22%,respectively,which were significantly lower than those of patients with hemoglobin≥107 g/L(P<0.05).CONCLUSION Hematocrit<33%and hemoglobin<107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer.They are associated with poorer prognosis and reduced 3-year survival rates.展开更多
BACKGROUND Neutrophil extracellular traps(NETs)are associated with an immunosuppressive tumor microenvironment and may influence the efficacy of immune-based therapies.However,their role in neoadjuvant chemotherapy co...BACKGROUND Neutrophil extracellular traps(NETs)are associated with an immunosuppressive tumor microenvironment and may influence the efficacy of immune-based therapies.However,their role in neoadjuvant chemotherapy combined with immunotherapy(NACI)for locally advanced gastric cancer(LAGC)remains unclear.AIM To investigate the prognostic and predictive value of NET density in LAGC patients undergoing NACI.METHODS We enrolled 31 LAGC patients treated with NACI.NET density was assessed through dual immunofluorescence staining of citrullinated histone H3 and myeloperoxidase in pretreatment biopsy and post-treatment surgical specimens.Patients were stratified into high and low pre-NACI NET groups based on median NET density.Pathological complete response(pCR)and overall response rates were evaluated in relation to NET density.Logistic regression analyses were performed to identify independent predictors of treatment outcomes.Dynamic changes in NET density during NACI were also analyzed.RESULTS Patients with low pre-NACI NET density demonstrated significantly higher rates of pCR(40%vs 6%,P=0.037)and overall response(53%vs 12%,P=0.023)compared to those with high NET density.Low pre-NACI NET density and higher programmed death protein ligand 1 expression were identified as independent protective factors for achieving pCR and better response rates.NACI increased NET density;however,this increase was primarily observed in non-pCR and nonresponder groups.Patients in the pCR and responder groups showed stable NET density before and after treatment.Higher post-NACI NET density was associated with poorer respond to NACI.High post-NACI NET density was associated with increased infiltration of immunosuppressive FOXP3+T regulatory cells(P=0.025)and CD68+macrophages(P=0.038).CONCLUSION Pre-NACI NET density serves as a prognostic and predictive biomarker for NACI efficacy in LAGC patients.Low pretreatment NET density is associated with favorable outcomes,while increased post-treatment NET density correlates with poorer response.Targeting NET formation may represent a novel therapeutic strategy to enhance NACI efficacy in LAGC.展开更多
Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFO...Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFOX-6)regimen on the post-transplant prognosis of HCC patients.Methods:HCC patients who underwent LT at our institution from June 2017 to December 2019 were enrolled.The cohort was divided into the ACT group(n=57)and the non-ACT group(n=93).The median post-transplant follow-up period was 54.0 months.The study endpoints were HCC recurrence and patient mortality following LT.The association between ACT and recurrence/mortality were evaluated through univariate and multivariate analyses utilizing a Cox proportional hazards model,propensity score adjustment,propensity score matching,and inverse probability of treatment weighting(IPTW)analyses.A stratification analysis was performed to determine the interaction effects.Results:The ACT group was younger and had worse tumor characteristics including tumor number,tu-mor size,portal vein tumor thrombosis,pathological differentiation and microvascular invasion(MVI).The ACT group also demonstrated a lower risk of mortality than the non-ACT group(hazard ratio=0.36,P=0.017).It was consistent across sensitivity analyses utilizing propensity score adjustment and match-ing.There was a significant stronger association between ACT and recurrence-free benefit in patients with grade M2 of MVI compared to patients with grade M0/1(P for interaction=0.002).Conclusions:ACT with mFOLFOX-6 regimen decreased the recurrence and mortality risks following LT for HCC patients.ACT may be considered in HCC patients with high risk of recurrence and mortality after LT.展开更多
BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve p...BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve patient survival,adjuvant chemotherapy is commonly administered based on established postoperative guidelines.Despite advancements in chemotherapy delivery,the overall response rate remains below 50%,primarily due to the lack of targeted therapies tailored to specific patient populations.AIM To explore sensitive biomarkers to assess the efficacy of postoperative adjuvant chemotherapy in appropriate patient subgroups.METHODS This study retrospectively analyzed 1628 patients who underwent radical gastrectomy for GC at our hospital in 2017 and 2018,with a subsequent five-year follow-up.Patients were divided based on whether they received postoperative adjuvant chemotherapy.The study aimed to determine optimal cutoff values for various biomarkersneutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724,and CA242-using receiver operating characteristic(ROC)curves.Based on the optimal ROC cut-off,a novel combined metric,NLR-CEA,was developed to assess the efficacy of adjuvant chemotherapy following GC surgery.RESULTS Cox subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved overall survival in the NLR-CEA_Low group with a rate of 0.41(0.26-0.63).In the NLR-CEA_Middle group,the protective effect was observed at 0.69(0.54-0.87),while in the NLR-CEA_High group,it was 0.73(0.53-0.99).Notably,a 32%difference in the efficacy of chemotherapy was observed between the NLR-CEA_Low and NLR-CEA_High groups.CONCLUSION NLR-CEA is an effective biomarker for evaluating the efficacy of postoperative adjuvant chemotherapy in GC.Patients with NLR-CEA_Low exhibit significantly better responses to chemotherapy compared to those with NLRCEA_High.展开更多
Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before a...Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before and after adjuvant chemotherapy.Methods A total of 222 breast cancer patients with consistent ER and PR expression scheduled to undergo adjuvant chemotherapy were classified according to TCM syndrome differentiation before and after chemotherapy.The data were analyzed using chi-square tests and binary logistic regression with SPSS 26.0 software,and compared with ER/PR expression results.Results(i)In the ER-positive/PR-positive group,compared with prechemotherapy,syndromes of spleen qi deficiency,spleen deficiency with dampness-phlegm,and spleen–kidney deficiency significantly increased during mid-chemotherapy and after chemotherapy.Compared with mid-chemotherapy,spleen yang deficiency syndrome significantly increased after chemotherapy,with statistical significance(p<0.05).(ii)In the ER-negative/PR-negative group,compared with prechemotherapy,syndromes of spleen qi deficiency and spleen deficiency with dampness-phlegm significantly increased during mid-chemotherapy,while spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased after chemotherapy.Compared with mid-chemotherapy,spleen–kidney deficiency and spleen yang deficiency syndromes significantly increased after chemotherapy,with statistical significance(p<0.05).(iii)The distribution of spleen qi deficiency syndrome during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group,with statistical significance(p<0.05).(iv)ER and PR were not independent influencing factors for the various syndrome types before and after adjuvant chemotherapy(p>0.05).Conclusion After chemotherapy initiation,syndromes of spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased in both ER-positive/PR-positive and ER-negative/PR-negative groups.The distribution of spleen qi deficiency during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group.ER and PR were not independent influencing factors for the syndrome types before and after adjuvant chemotherapy.展开更多
BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients re...BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage Ⅱ/Ⅲ gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.展开更多
Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore w...Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.展开更多
Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients b...Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients between May 2022 and December 2024,who were randomly allocated into two equal treatment groups(n=30 each).The control group received standard chemotherapy,whereas the observation group was treated with a combined adjuvant regimen of epirubicin and docetaxel.Therapeutic outcomes were systematically compared between the groups.Results:The comparative analysis of chemotherapy regimens revealed significant intergroup differences in multiple outcome measures.The observation group demonstrated superior clinical efficacy(96.67%vs 80.00%,P<0.05)alongside a more favorable safety profile(adverse reaction incidence:3.33%vs 20.00%,P<0.05).Metabolic assessments showed better glycemic control in the observation group,with both fasting and postprandial blood glucose levels being significantly lower than controls(P<0.05),while maintaining comparable values to pretreatment baselines(P>0.05).Furthermore,quality of life assessments indicated significantly better outcomes in the observation group compared to controls(P<0.05).Conclusion:The combination of epirubicin and docetaxel as adjuvant chemotherapy for patients after radical mastectomy for breast cancer has significant clinical effects,can improve patients’quality of life,and has high safety.It is worthy of adoption.展开更多
Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(198...Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(1988–2018)were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Multivariate Cox analysis was used to control confounders.Logistic regression was used to explore factors associated with adjuvant chemotherapy.Cox regression analysis and Kaplan-Meier curves were used to assess the survival benefits.Single-center clinical data and meta-analysis following PRISMA guidelines provided external validation.Result:Adjuvant chemotherapy correlated with improved survival(Hazard Ratio(HR):0.860,p=0.011),as did lymphadenectomy(HR:0.842,p<0.001).Higher age,pathological stage,and tumor grade negatively affected survival.Chemotherapy administration associated with higher pathological stage(IB:Odds Ratio(OR)1.565,p<0.001;IC:OR 4.091,p<0.001),higher grade(G2:OR 2.336,p<0.001;G3:OR 4.563,p<0.001),and lymphadenectomy(OR 1.148,p=0.040).Stratification analysis showed adjuvant chemotherapy failed to improve prognosis in stage IA/IB patients regardless of grade or lymphadenectomy.For stage IC patients,chemotherapy benefited grade 1-2 or grade 3 patients without lymphadenectomy,and grade 3 patients with lymphadenectomy.Meta-analysis revealed reduced recurrence in stage IC patients(OR=0.50,p=0.035).Conclusion:Adjuvant chemotherapy confers survival benefits for stage IC patients,particularly those without lymphadenectomy.展开更多
BACKGROUND Neoadjuvant chemotherapy improves the resection rate and reduces postoperative recurrence in gastric cancer(GC)but is often associated with significant toxicity.Traditional Chinese medicine has unique advan...BACKGROUND Neoadjuvant chemotherapy improves the resection rate and reduces postoperative recurrence in gastric cancer(GC)but is often associated with significant toxicity.Traditional Chinese medicine has unique advantages in the treatment of cancer,and Baohe Pingwei powder can help alleviate the side effects of chemotherapy and enhance the therapeutic effect.However,there is no clinical evidence supporting its use in patients who underwent surgery for GC treatment.AIM To evaluate the safety and efficacy of Baohe Pingwei powder combined with neoadjuvant chemotherapy in postoperative patients with GC and to provide evidence-based medical evidence for the treatment of postoperative patients with GC with integrated traditional Chinese and Western medicine.METHODS A retrospective analysis was conducted on 80 postoperative patients with GC admitted to the Department of Gastroenterology of our hospital and treated between May 2024 and November 2024.According to different treatment methods,they were divided into a control group(54 patients received S-1+oxaliplatin chemotherapy 4 weeks after surgery)and a study group(26 cases were combined with Baohe Pingwei powder combined with S-1+oxaliplatin).Clinical data were collected to compare the differences in objective response rate(ORR),disease control rate(DCR),progression-free survival,overall survival,and adverse reactions of patients with GC after surgery under different treatment methods.Further based on the control of GC,patients were divided into an effective group(62 cases)and an ineffective group(18 cases).The relationship between Baohe Pingwei powder and clinical efficacy was analyzed through univariate and multivariate logistic regression analysis as well as a multivariate Cox risk model.RESULTS The baseline characteristics including age,gender,and other demographic factors showed no significant differences between the control and observation groups(P>0.05).In the observation group,there were 24 cases of effective treatment and 2 cases of ineffective treatment,with an ORR of 84.62%and a DCR of 92.31%.In the control group,there were 38 cases of effective treatment and 16 cases of ineffective treatment,with an ORR of 46.30%and a DCR of 70.37%.The treatment effect of the observation group was significantly higher than that of the control group(P<0.05).The Kaplan Meier curve showed that the risk of tumor recurrence and death in the observation group was significantly reduced compared to the control group(log rank P=0.030 and P=0.035,respectively).Subsequent stratification based on treatment response identified 62 patients in the effective group and 18 in the ineffective group.Intergroup comparison showed that the effective group had a higher proportion of Baohe Pingwei powder(P=0.000),and there were statistically significant differences in tumor size,differentiation degree,and post-treatment levels of CD3+,CD4+,CA19-9,CA242,IL-6,IL-10,and TNF-αbetween the groups(P<0.05).Further univariate and multivariate logistic analysis revealed that CD3+and CD4+T cell levels were significantly associated with treatment efficacy.The use of Baohe Pingwei powder was a protective factor for effective treatment,while CA19-9 and IL-6 levels were independent risk factors for ineffective treatment(P<0.05).Multivariate Cox proportional hazards model analysis found that without adjusting the model,the risk of ineffective treatment in patients significantly decreased with the increase of CD3+and CD4+and the decrease of CA19-9 and IL-6(group 1 as a reference;group 2 hazard ratio:0.624,95%confidence interval:0.437-0.986,P=0.019).After adjusting for confounding factors such as Baohe Pingwei powder in Model 3,Cox regression results showed an increased risk of treatment failure.With the decrease of CD3+and CD4+and the increase of CA19-9 and IL-6,the risk of treatment failure in patients significantly increased(Group 1 as a reference;Group 2 hazard ratio:1.439,95%confidence interval:1.208-1.614,P=0.006).CONCLUSION The combination therapy of Baohe Pingwei powder with neoadjuvant chemotherapy demonstrated significant clinical benefits in postoperative patients with GC,including improved the ORR,DCR,extended progression-free survival,and overall survival as well as a reduced incidence of treatment-related adverse events.Furthermore,our finding indicated that decreased CD3+and CD4+levels along with evaluated CA199 and IL-6 levels served as important biomarkers predicting increased risk of treatment failure in this patient population.展开更多
Background:This study assessed the frequency of changes in some key receptor status of tumors after neoadjuvant chemotherapy(NAC)in patients with invasive breast cancer and the prognostic impact of these changes.Metho...Background:This study assessed the frequency of changes in some key receptor status of tumors after neoadjuvant chemotherapy(NAC)in patients with invasive breast cancer and the prognostic impact of these changes.Methods:This study included 300 patients diagnosed with invasive breast cancer who were treated with both NAC and surgery between 2012 and 2021.The hormone receptor(HR)and human epidermal growth factor receptor 2(HER2)levels were measured before and after NAC.The prognostic impact of receptor conversion was also evaluated in patients receiving NAC,by using the Kaplan-Meier method and Cox proportional hazards models as statistical methods.Results:The conversion rate of estrogen receptor–positive(ER^(+))to ER-negative(ER^(-))was similar to that of ER^(-)to ER^(+)(9.2%and10.9%,respectively).The proportion of HR^(-)to HR^(+)was remarkably higher than that of HR^(+)to HR^(-)(14.8%vs 9.2%,respectively).The change from HER2^(+)to HER2^(-)was significantly more frequently than that from HER2^(-)to HER2^(+)(20.3%vs 6%,respectively).Patients with ER and HR status changes from(-)to(+)after NAC had significantly worse recurrence-free survival(RFS)and overall survival(OS)than those in the other 3 groups(ER^(-)to ER^(+):RFS:p=0.002,OS:p<0.001;HR^(-)to HR^(+):RFS:p=0.003,OS:p<0.001).The 4 HER2 conversion subgroups were not significantly associated with RFS or OS.Conclusions:This study demonstrated a discordance in HR status after NAC and identified predictors of conversion.Patients whose HR status switched to positive after NAC had the worst 3-year RFS and OS rates.展开更多
BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumo...BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.展开更多
BACKGROUND Gastric cancer(GC)remains a significant global health challenge,with high incidence and mortality rates.Neoadjuvant chemotherapy is increasingly used to improve surgical outcomes and long-term survival in a...BACKGROUND Gastric cancer(GC)remains a significant global health challenge,with high incidence and mortality rates.Neoadjuvant chemotherapy is increasingly used to improve surgical outcomes and long-term survival in advanced cases.However,individual responses to treatment vary widely,and current imaging methods often fall short in accurately predicting efficacy.Advanced imaging techniques,such as computed tomography(CT)3D reconstruction and texture analysis,offer potential for more precise assessment of therapeutic response.AIM To explore the application value of CT 3D reconstruction volume change rate,texture feature analysis,and visual features in assessing the efficacy of neoadjuvant chemotherapy for advanced GC.METHODS A retrospective analysis was conducted on the clinical and imaging data of 97 patients with advanced GC who received S-1 plus Oxaliplatin combined chemotherapy regimen neoadjuvant chemotherapy from January 2022 to March 2024.CT texture feature analysis was performed using MaZda software,and ITK-snap software was used to measure the tumor volume change rate before and after chemotherapy.CT visual features were also evaluated.Using postoperative pathological tumor regression grade(TRG)as the gold standard,the correlation between various indicators and chemotherapy efficacy was analyzed,and a predictive model was constructed and internally validated.RESULTS The minimum misclassification rate of texture features in venous phase CT images(7.85%)was lower than in the arterial phase(13.92%).The volume change rate in the effective chemotherapy group(75.20%)was significantly higher than in the ineffective group(41.75%).There was a strong correlation between volume change rate and TRG grade(r=-0.886,P<0.001).Multivariate analysis showed that gastric wall peristalsis(OR=0.286)and thickness change rate≥40%(OR=0.265)were independent predictive factors.Receiver operating characteristic curve analysis indicated that the volume change rate[area under the curve(AUC)=0.885]was superior to the CT visual feature model(AUC=0.795).When the cutoff value was 82.56%,the sensitivity and specificity were 85.62%and 96.45%,respectively.CONCLUSION The CT 3D reconstruction volume change rate can serve as a preferred quantitative indicator for evaluating the efficacy of neoadjuvant chemotherapy in GC.Combining it with a CT visual feature predictive model can further improve the accuracy of efficacy evaluation.展开更多
Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are...Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.展开更多
Objective： To compare the effect of neoadjuvant chemotherapy （NACT） with adjuvant chemotherapy （ACT） using oxaliplatin plus S-1 （sex） or capecitabine （CapeOX） on gastric cancer patients with D2 lymphadenectom...Objective： To compare the effect of neoadjuvant chemotherapy （NACT） with adjuvant chemotherapy （ACT） using oxaliplatin plus S-1 （sex） or capecitabine （CapeOX） on gastric cancer patients with D2 lymphadenectomy. Methods： This was a two-by-two factorial randomized phase Ⅱ-Ⅲ trial, and registered on ISRCTN registry （No. ISRCTN12206108）. Locally advanced gastric cancer patients were randomized to neoadjuvant sex, neoadjuvant CapeOX, adjuvant sex, or adjuvant CapeOX arms. Primary analysis was performed on an intention- to-treat （ITT） basis using overall survival （OS） as primary endpoint. Results： This trial started in September 2011 and closed in December 2012 with 100 patients enrolled. Treatment completion rate was 56%, 52%, 38% and 30% in the four arms, respectively. NACT group had fewer dropouts due to unacceptable toxicity （P=0.042）. Surgical complication rate did not differ by the four groups （P=0.986）. No survival signifcant difference was found comparing NACT with ACT （P=0.664; 5-year-OS： 70% vs. 74% respectively）, nor between the sex and CapeOX groups （P=0.252; 5-year-OS： 78% vs. 66% respectively）. Subgroup analysis showed sex significantly improved survival in patents with diffuse type （P=0.048）. Conclusions： No significant survival difference was found between NACT and ACT. sex and CapeOX had good safety and efficacy as neoadjuvant regimens. Diffuse type patients may survive longer due to sex.展开更多
BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gas...BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.展开更多
Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus...Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.展开更多
Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time ...Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.展开更多
Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric canc...Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric cancer requires neoadjuvant therapy to shrink the tumour, suppress potential metastases, achieve down-staging, and provide patients with the opportunity for radical surgery to prolong their survival. This article reviews the current status and progress of neoadjuvant chemotherapy for locally advanced gastric cancer.展开更多
Breast cancer continues to be one of the leading causes of cancer mortality in the world. The treatment generally involves multiple modalities including surgery, radiation and/or chemotherapy. Anthracyclines, one of t...Breast cancer continues to be one of the leading causes of cancer mortality in the world. The treatment generally involves multiple modalities including surgery, radiation and/or chemotherapy. Anthracyclines, one of the first chemotherapeutic agents introduced in the 1960 s, has been the backbone for the last 30 years and has been used extensively so far. However, the cardiac toxicity and the concern for secondary hematological malignancy has always been a challenge. A better understanding of the tumor biology, role of Her2 expression and the discovery of trastuzumab and other anti-Her 2 agents along with other effective novel therapeutic options, have revolutionized the treatment for breast cancer. The role of anthracyclines has come under close scrutiny, especially in the adjuvant setting for patients with early stage breast cancer and those with low or intermediate risk of disease recurrence. Recent studies have highlighted such a shift in the use of anthracyclines in both the academic and community clinical practice. However, in patients with a high risk of relapse, anthracyclines still hold promise. Ongoing clinical trials are underway to further define the role of anthracyclines in such a patient population. This review highlights the development, clinical utility, limitations and potential future use of anthracyclinesin the adjuvant setting for patients with breast cancer. We consulted Pub Med, Scopus, MEDLINE, ASCO annual symposium abstracts, and http://clinicaltrials.gov/ for the purpose of this review.展开更多
文摘BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a frequent complication in these patients.AIM To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer.METHODS The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College,Pidu District People’s Hospital,Chengdu,China,between January 2016 and January 2021,were retrospectively analyzed.All patients underwent a tegafur+oxaliplatin+apatinib chemotherapy regimen.According to the efficacy of chemotherapy,they were divided into an effective group(complete or partial response,n=121)and an ineffective group(stable disease or disease progression,n=64).The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses.The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared.RESULTS Univariate analysis showed that the proportion of patients with a tumor diameter>5 cm,non-tubular adenocarcinoma,lymph node metastasis,hematocrit<33%,low mean red blood cell(RBC)protein content,low RBC distribution width,hemoglobin<107 g/L,and platelets>266×109/L in the ineffective group were significantly higher than those in the effective group(P<0.05).Logistic multivariate analysis showed that a tumor diameter>5 cm,lymph node metastasis,≤3 chemotherapy cycles,hematocrit<33%,and hemoglobin<107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer(P<0.05).The 1-year,2-year,and 3-year survival rates in the effective group were 93.39%,83.47%,and 60.33%,respectively.These rates were significantly higher than those in the ineffective group(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hematocrit<33%were 74.67%,49.33%,and 29.33%,respectively,which were significantly lower than those of patients with hematocrit≥33%(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hemoglobin<107 g/L were 80.39%,58.82%,and 39.22%,respectively,which were significantly lower than those of patients with hemoglobin≥107 g/L(P<0.05).CONCLUSION Hematocrit<33%and hemoglobin<107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer.They are associated with poorer prognosis and reduced 3-year survival rates.
文摘BACKGROUND Neutrophil extracellular traps(NETs)are associated with an immunosuppressive tumor microenvironment and may influence the efficacy of immune-based therapies.However,their role in neoadjuvant chemotherapy combined with immunotherapy(NACI)for locally advanced gastric cancer(LAGC)remains unclear.AIM To investigate the prognostic and predictive value of NET density in LAGC patients undergoing NACI.METHODS We enrolled 31 LAGC patients treated with NACI.NET density was assessed through dual immunofluorescence staining of citrullinated histone H3 and myeloperoxidase in pretreatment biopsy and post-treatment surgical specimens.Patients were stratified into high and low pre-NACI NET groups based on median NET density.Pathological complete response(pCR)and overall response rates were evaluated in relation to NET density.Logistic regression analyses were performed to identify independent predictors of treatment outcomes.Dynamic changes in NET density during NACI were also analyzed.RESULTS Patients with low pre-NACI NET density demonstrated significantly higher rates of pCR(40%vs 6%,P=0.037)and overall response(53%vs 12%,P=0.023)compared to those with high NET density.Low pre-NACI NET density and higher programmed death protein ligand 1 expression were identified as independent protective factors for achieving pCR and better response rates.NACI increased NET density;however,this increase was primarily observed in non-pCR and nonresponder groups.Patients in the pCR and responder groups showed stable NET density before and after treatment.Higher post-NACI NET density was associated with poorer respond to NACI.High post-NACI NET density was associated with increased infiltration of immunosuppressive FOXP3+T regulatory cells(P=0.025)and CD68+macrophages(P=0.038).CONCLUSION Pre-NACI NET density serves as a prognostic and predictive biomarker for NACI efficacy in LAGC patients.Low pretreatment NET density is associated with favorable outcomes,while increased post-treatment NET density correlates with poorer response.Targeting NET formation may represent a novel therapeutic strategy to enhance NACI efficacy in LAGC.
基金supported by grants from Zhejiang Provincial Natural Science Foundation of China(LTGY24H030006)Re-search Project of Jinan Microecological Biomedicine Shandong Lab-oratory(JNL-2022015B).
文摘Background:Hepatocellular carcinoma(HCC)recurrence following liver transplantation(LT)remains a major challenge.This study aimed to investigate the effect of adjuvant chemotherapy(ACT)with the modified FOLFOX-6(mFOLFOX-6)regimen on the post-transplant prognosis of HCC patients.Methods:HCC patients who underwent LT at our institution from June 2017 to December 2019 were enrolled.The cohort was divided into the ACT group(n=57)and the non-ACT group(n=93).The median post-transplant follow-up period was 54.0 months.The study endpoints were HCC recurrence and patient mortality following LT.The association between ACT and recurrence/mortality were evaluated through univariate and multivariate analyses utilizing a Cox proportional hazards model,propensity score adjustment,propensity score matching,and inverse probability of treatment weighting(IPTW)analyses.A stratification analysis was performed to determine the interaction effects.Results:The ACT group was younger and had worse tumor characteristics including tumor number,tu-mor size,portal vein tumor thrombosis,pathological differentiation and microvascular invasion(MVI).The ACT group also demonstrated a lower risk of mortality than the non-ACT group(hazard ratio=0.36,P=0.017).It was consistent across sensitivity analyses utilizing propensity score adjustment and match-ing.There was a significant stronger association between ACT and recurrence-free benefit in patients with grade M2 of MVI compared to patients with grade M0/1(P for interaction=0.002).Conclusions:ACT with mFOLFOX-6 regimen decreased the recurrence and mortality risks following LT for HCC patients.ACT may be considered in HCC patients with high risk of recurrence and mortality after LT.
文摘BACKGROUND Gastric cancer(GC)is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy.To enhance treatment efficacy,reduce recurrence,and improve patient survival,adjuvant chemotherapy is commonly administered based on established postoperative guidelines.Despite advancements in chemotherapy delivery,the overall response rate remains below 50%,primarily due to the lack of targeted therapies tailored to specific patient populations.AIM To explore sensitive biomarkers to assess the efficacy of postoperative adjuvant chemotherapy in appropriate patient subgroups.METHODS This study retrospectively analyzed 1628 patients who underwent radical gastrectomy for GC at our hospital in 2017 and 2018,with a subsequent five-year follow-up.Patients were divided based on whether they received postoperative adjuvant chemotherapy.The study aimed to determine optimal cutoff values for various biomarkersneutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724,and CA242-using receiver operating characteristic(ROC)curves.Based on the optimal ROC cut-off,a novel combined metric,NLR-CEA,was developed to assess the efficacy of adjuvant chemotherapy following GC surgery.RESULTS Cox subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved overall survival in the NLR-CEA_Low group with a rate of 0.41(0.26-0.63).In the NLR-CEA_Middle group,the protective effect was observed at 0.69(0.54-0.87),while in the NLR-CEA_High group,it was 0.73(0.53-0.99).Notably,a 32%difference in the efficacy of chemotherapy was observed between the NLR-CEA_Low and NLR-CEA_High groups.CONCLUSION NLR-CEA is an effective biomarker for evaluating the efficacy of postoperative adjuvant chemotherapy in GC.Patients with NLR-CEA_Low exhibit significantly better responses to chemotherapy compared to those with NLRCEA_High.
基金supported by the 2022 Traditional Chinese Medicine Scientific Research Special Project of Henan Province,China(2022ZY1048)2023 Traditional Chinese Medicine Scientific Research Special Project of Henan Province,China(2023YZ2043)General Program of Natural Science Foundation of Henan Province,China(232300421183).
文摘Objective This study aims to explore the correlation between traditional Chinese medicine(TCM)syndromes and the expression status of estrogen receptor(ER)and progesterone receptor(PR)in breast cancer patients before and after adjuvant chemotherapy.Methods A total of 222 breast cancer patients with consistent ER and PR expression scheduled to undergo adjuvant chemotherapy were classified according to TCM syndrome differentiation before and after chemotherapy.The data were analyzed using chi-square tests and binary logistic regression with SPSS 26.0 software,and compared with ER/PR expression results.Results(i)In the ER-positive/PR-positive group,compared with prechemotherapy,syndromes of spleen qi deficiency,spleen deficiency with dampness-phlegm,and spleen–kidney deficiency significantly increased during mid-chemotherapy and after chemotherapy.Compared with mid-chemotherapy,spleen yang deficiency syndrome significantly increased after chemotherapy,with statistical significance(p<0.05).(ii)In the ER-negative/PR-negative group,compared with prechemotherapy,syndromes of spleen qi deficiency and spleen deficiency with dampness-phlegm significantly increased during mid-chemotherapy,while spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased after chemotherapy.Compared with mid-chemotherapy,spleen–kidney deficiency and spleen yang deficiency syndromes significantly increased after chemotherapy,with statistical significance(p<0.05).(iii)The distribution of spleen qi deficiency syndrome during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group,with statistical significance(p<0.05).(iv)ER and PR were not independent influencing factors for the various syndrome types before and after adjuvant chemotherapy(p>0.05).Conclusion After chemotherapy initiation,syndromes of spleen qi deficiency,spleen yang deficiency,and spleen–kidney deficiency significantly increased in both ER-positive/PR-positive and ER-negative/PR-negative groups.The distribution of spleen qi deficiency during mid-chemotherapy and after chemotherapy was significantly higher in the ER-positive/PR-positive group than in the ER-negative/PR-negative group.ER and PR were not independent influencing factors for the syndrome types before and after adjuvant chemotherapy.
基金Supported by Xiamen Natural Science Foundation of China,No.3502Z20227347.
文摘BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage Ⅱ/Ⅲ gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.
文摘Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.
基金Suzhou“Science and Education Promote Health”Youth Science and Technology Project,Study on the Effect and Mechanism of Metformin-loaded Red Blood Cell Membrane Nanodrug Delivery System on Inhibiting the Growth and Metastasis of HER2-Positive Breast Cancer(KJXW2022082)。
文摘Objective:To explore and analyze the clinical effect of combination adjuvant chemotherapy with epirubicin and docetaxel for patients after radical mastectomy for breast cancer.Methods:This study enrolled 60 patients between May 2022 and December 2024,who were randomly allocated into two equal treatment groups(n=30 each).The control group received standard chemotherapy,whereas the observation group was treated with a combined adjuvant regimen of epirubicin and docetaxel.Therapeutic outcomes were systematically compared between the groups.Results:The comparative analysis of chemotherapy regimens revealed significant intergroup differences in multiple outcome measures.The observation group demonstrated superior clinical efficacy(96.67%vs 80.00%,P<0.05)alongside a more favorable safety profile(adverse reaction incidence:3.33%vs 20.00%,P<0.05).Metabolic assessments showed better glycemic control in the observation group,with both fasting and postprandial blood glucose levels being significantly lower than controls(P<0.05),while maintaining comparable values to pretreatment baselines(P>0.05).Furthermore,quality of life assessments indicated significantly better outcomes in the observation group compared to controls(P<0.05).Conclusion:The combination of epirubicin and docetaxel as adjuvant chemotherapy for patients after radical mastectomy for breast cancer has significant clinical effects,can improve patients’quality of life,and has high safety.It is worthy of adoption.
基金supported by the scientific research project of Jiangsu Province’s“333 Project”(BRA2019097)Jiangsu Provincial Key Medical Discipline of the 14th Five-Year Plan(ZDXK202210)Jiangsu Province Medicine Science and Technology Development Project(No.ZD202014).
文摘Background:The benefit of adjuvant chemotherapy for stage I ovarian endometrioid carcinoma(OEC)remains controversial.Hence,the study sought to explore its value in stage I OEC patients.Methods:Stage I OEC patients(1988–2018)were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Multivariate Cox analysis was used to control confounders.Logistic regression was used to explore factors associated with adjuvant chemotherapy.Cox regression analysis and Kaplan-Meier curves were used to assess the survival benefits.Single-center clinical data and meta-analysis following PRISMA guidelines provided external validation.Result:Adjuvant chemotherapy correlated with improved survival(Hazard Ratio(HR):0.860,p=0.011),as did lymphadenectomy(HR:0.842,p<0.001).Higher age,pathological stage,and tumor grade negatively affected survival.Chemotherapy administration associated with higher pathological stage(IB:Odds Ratio(OR)1.565,p<0.001;IC:OR 4.091,p<0.001),higher grade(G2:OR 2.336,p<0.001;G3:OR 4.563,p<0.001),and lymphadenectomy(OR 1.148,p=0.040).Stratification analysis showed adjuvant chemotherapy failed to improve prognosis in stage IA/IB patients regardless of grade or lymphadenectomy.For stage IC patients,chemotherapy benefited grade 1-2 or grade 3 patients without lymphadenectomy,and grade 3 patients with lymphadenectomy.Meta-analysis revealed reduced recurrence in stage IC patients(OR=0.50,p=0.035).Conclusion:Adjuvant chemotherapy confers survival benefits for stage IC patients,particularly those without lymphadenectomy.
基金Supported by Scientific Research Project of Hebei Administration of Traditional Chinese Medicine,No.2025271the Construction Project of National Clinical Research Base of Traditional Chinese Medicine,Science Letter[2018],No.131+4 种基金Natural Science Foundation of Hebei Province,No.H2023423001Key Research Project of the Ministry of Science and Technology,No.2018YFC1704100 and No.2018YFC1704102Provincial Science and Technology Program of Hebei Province,No.21377724D and No.21377740DScientific Research Project of Hebei Administration of Traditional Chinese Medicine,No.2021034,No.2022026,No.2022032,and No.2023022Medical Science Research Project of Hebei Province,No.20190756.
文摘BACKGROUND Neoadjuvant chemotherapy improves the resection rate and reduces postoperative recurrence in gastric cancer(GC)but is often associated with significant toxicity.Traditional Chinese medicine has unique advantages in the treatment of cancer,and Baohe Pingwei powder can help alleviate the side effects of chemotherapy and enhance the therapeutic effect.However,there is no clinical evidence supporting its use in patients who underwent surgery for GC treatment.AIM To evaluate the safety and efficacy of Baohe Pingwei powder combined with neoadjuvant chemotherapy in postoperative patients with GC and to provide evidence-based medical evidence for the treatment of postoperative patients with GC with integrated traditional Chinese and Western medicine.METHODS A retrospective analysis was conducted on 80 postoperative patients with GC admitted to the Department of Gastroenterology of our hospital and treated between May 2024 and November 2024.According to different treatment methods,they were divided into a control group(54 patients received S-1+oxaliplatin chemotherapy 4 weeks after surgery)and a study group(26 cases were combined with Baohe Pingwei powder combined with S-1+oxaliplatin).Clinical data were collected to compare the differences in objective response rate(ORR),disease control rate(DCR),progression-free survival,overall survival,and adverse reactions of patients with GC after surgery under different treatment methods.Further based on the control of GC,patients were divided into an effective group(62 cases)and an ineffective group(18 cases).The relationship between Baohe Pingwei powder and clinical efficacy was analyzed through univariate and multivariate logistic regression analysis as well as a multivariate Cox risk model.RESULTS The baseline characteristics including age,gender,and other demographic factors showed no significant differences between the control and observation groups(P>0.05).In the observation group,there were 24 cases of effective treatment and 2 cases of ineffective treatment,with an ORR of 84.62%and a DCR of 92.31%.In the control group,there were 38 cases of effective treatment and 16 cases of ineffective treatment,with an ORR of 46.30%and a DCR of 70.37%.The treatment effect of the observation group was significantly higher than that of the control group(P<0.05).The Kaplan Meier curve showed that the risk of tumor recurrence and death in the observation group was significantly reduced compared to the control group(log rank P=0.030 and P=0.035,respectively).Subsequent stratification based on treatment response identified 62 patients in the effective group and 18 in the ineffective group.Intergroup comparison showed that the effective group had a higher proportion of Baohe Pingwei powder(P=0.000),and there were statistically significant differences in tumor size,differentiation degree,and post-treatment levels of CD3+,CD4+,CA19-9,CA242,IL-6,IL-10,and TNF-αbetween the groups(P<0.05).Further univariate and multivariate logistic analysis revealed that CD3+and CD4+T cell levels were significantly associated with treatment efficacy.The use of Baohe Pingwei powder was a protective factor for effective treatment,while CA19-9 and IL-6 levels were independent risk factors for ineffective treatment(P<0.05).Multivariate Cox proportional hazards model analysis found that without adjusting the model,the risk of ineffective treatment in patients significantly decreased with the increase of CD3+and CD4+and the decrease of CA19-9 and IL-6(group 1 as a reference;group 2 hazard ratio:0.624,95%confidence interval:0.437-0.986,P=0.019).After adjusting for confounding factors such as Baohe Pingwei powder in Model 3,Cox regression results showed an increased risk of treatment failure.With the decrease of CD3+and CD4+and the increase of CA19-9 and IL-6,the risk of treatment failure in patients significantly increased(Group 1 as a reference;Group 2 hazard ratio:1.439,95%confidence interval:1.208-1.614,P=0.006).CONCLUSION The combination therapy of Baohe Pingwei powder with neoadjuvant chemotherapy demonstrated significant clinical benefits in postoperative patients with GC,including improved the ORR,DCR,extended progression-free survival,and overall survival as well as a reduced incidence of treatment-related adverse events.Furthermore,our finding indicated that decreased CD3+and CD4+levels along with evaluated CA199 and IL-6 levels served as important biomarkers predicting increased risk of treatment failure in this patient population.
基金supported by grants from the Basic Research Project of Shanxi Science and Technology Department(no.202303021221190)the Shanxi General Surgery“136”Healthcare Engineering Project(no.2024XYZ03)。
文摘Background:This study assessed the frequency of changes in some key receptor status of tumors after neoadjuvant chemotherapy(NAC)in patients with invasive breast cancer and the prognostic impact of these changes.Methods:This study included 300 patients diagnosed with invasive breast cancer who were treated with both NAC and surgery between 2012 and 2021.The hormone receptor(HR)and human epidermal growth factor receptor 2(HER2)levels were measured before and after NAC.The prognostic impact of receptor conversion was also evaluated in patients receiving NAC,by using the Kaplan-Meier method and Cox proportional hazards models as statistical methods.Results:The conversion rate of estrogen receptor–positive(ER^(+))to ER-negative(ER^(-))was similar to that of ER^(-)to ER^(+)(9.2%and10.9%,respectively).The proportion of HR^(-)to HR^(+)was remarkably higher than that of HR^(+)to HR^(-)(14.8%vs 9.2%,respectively).The change from HER2^(+)to HER2^(-)was significantly more frequently than that from HER2^(-)to HER2^(+)(20.3%vs 6%,respectively).Patients with ER and HR status changes from(-)to(+)after NAC had significantly worse recurrence-free survival(RFS)and overall survival(OS)than those in the other 3 groups(ER^(-)to ER^(+):RFS:p=0.002,OS:p<0.001;HR^(-)to HR^(+):RFS:p=0.003,OS:p<0.001).The 4 HER2 conversion subgroups were not significantly associated with RFS or OS.Conclusions:This study demonstrated a discordance in HR status after NAC and identified predictors of conversion.Patients whose HR status switched to positive after NAC had the worst 3-year RFS and OS rates.
文摘BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.
文摘BACKGROUND Gastric cancer(GC)remains a significant global health challenge,with high incidence and mortality rates.Neoadjuvant chemotherapy is increasingly used to improve surgical outcomes and long-term survival in advanced cases.However,individual responses to treatment vary widely,and current imaging methods often fall short in accurately predicting efficacy.Advanced imaging techniques,such as computed tomography(CT)3D reconstruction and texture analysis,offer potential for more precise assessment of therapeutic response.AIM To explore the application value of CT 3D reconstruction volume change rate,texture feature analysis,and visual features in assessing the efficacy of neoadjuvant chemotherapy for advanced GC.METHODS A retrospective analysis was conducted on the clinical and imaging data of 97 patients with advanced GC who received S-1 plus Oxaliplatin combined chemotherapy regimen neoadjuvant chemotherapy from January 2022 to March 2024.CT texture feature analysis was performed using MaZda software,and ITK-snap software was used to measure the tumor volume change rate before and after chemotherapy.CT visual features were also evaluated.Using postoperative pathological tumor regression grade(TRG)as the gold standard,the correlation between various indicators and chemotherapy efficacy was analyzed,and a predictive model was constructed and internally validated.RESULTS The minimum misclassification rate of texture features in venous phase CT images(7.85%)was lower than in the arterial phase(13.92%).The volume change rate in the effective chemotherapy group(75.20%)was significantly higher than in the ineffective group(41.75%).There was a strong correlation between volume change rate and TRG grade(r=-0.886,P<0.001).Multivariate analysis showed that gastric wall peristalsis(OR=0.286)and thickness change rate≥40%(OR=0.265)were independent predictive factors.Receiver operating characteristic curve analysis indicated that the volume change rate[area under the curve(AUC)=0.885]was superior to the CT visual feature model(AUC=0.795).When the cutoff value was 82.56%,the sensitivity and specificity were 85.62%and 96.45%,respectively.CONCLUSION The CT 3D reconstruction volume change rate can serve as a preferred quantitative indicator for evaluating the efficacy of neoadjuvant chemotherapy in GC.Combining it with a CT visual feature predictive model can further improve the accuracy of efficacy evaluation.
基金supported by an intramural proof of concept grant of the NCT Heidelberg.
文摘Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.
基金supported in part by the grants from Beijing Municipal Science&Technology Commission(No D171100006517002)
文摘Objective： To compare the effect of neoadjuvant chemotherapy （NACT） with adjuvant chemotherapy （ACT） using oxaliplatin plus S-1 （sex） or capecitabine （CapeOX） on gastric cancer patients with D2 lymphadenectomy. Methods： This was a two-by-two factorial randomized phase Ⅱ-Ⅲ trial, and registered on ISRCTN registry （No. ISRCTN12206108）. Locally advanced gastric cancer patients were randomized to neoadjuvant sex, neoadjuvant CapeOX, adjuvant sex, or adjuvant CapeOX arms. Primary analysis was performed on an intention- to-treat （ITT） basis using overall survival （OS） as primary endpoint. Results： This trial started in September 2011 and closed in December 2012 with 100 patients enrolled. Treatment completion rate was 56%, 52%, 38% and 30% in the four arms, respectively. NACT group had fewer dropouts due to unacceptable toxicity （P=0.042）. Surgical complication rate did not differ by the four groups （P=0.986）. No survival signifcant difference was found comparing NACT with ACT （P=0.664; 5-year-OS： 70% vs. 74% respectively）, nor between the sex and CapeOX groups （P=0.252; 5-year-OS： 78% vs. 66% respectively）. Subgroup analysis showed sex significantly improved survival in patents with diffuse type （P=0.048）. Conclusions： No significant survival difference was found between NACT and ACT. sex and CapeOX had good safety and efficacy as neoadjuvant regimens. Diffuse type patients may survive longer due to sex.
基金Supported by Special Fund for the Beijing Hope Marathon of the China Cancer Foundation,No.LC2019 L05and the Capital Health Development Research Special Fund Project,No.2024-2-4026.
文摘BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.
文摘Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.
文摘Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.
文摘Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric cancer requires neoadjuvant therapy to shrink the tumour, suppress potential metastases, achieve down-staging, and provide patients with the opportunity for radical surgery to prolong their survival. This article reviews the current status and progress of neoadjuvant chemotherapy for locally advanced gastric cancer.
文摘Breast cancer continues to be one of the leading causes of cancer mortality in the world. The treatment generally involves multiple modalities including surgery, radiation and/or chemotherapy. Anthracyclines, one of the first chemotherapeutic agents introduced in the 1960 s, has been the backbone for the last 30 years and has been used extensively so far. However, the cardiac toxicity and the concern for secondary hematological malignancy has always been a challenge. A better understanding of the tumor biology, role of Her2 expression and the discovery of trastuzumab and other anti-Her 2 agents along with other effective novel therapeutic options, have revolutionized the treatment for breast cancer. The role of anthracyclines has come under close scrutiny, especially in the adjuvant setting for patients with early stage breast cancer and those with low or intermediate risk of disease recurrence. Recent studies have highlighted such a shift in the use of anthracyclines in both the academic and community clinical practice. However, in patients with a high risk of relapse, anthracyclines still hold promise. Ongoing clinical trials are underway to further define the role of anthracyclines in such a patient population. This review highlights the development, clinical utility, limitations and potential future use of anthracyclinesin the adjuvant setting for patients with breast cancer. We consulted Pub Med, Scopus, MEDLINE, ASCO annual symposium abstracts, and http://clinicaltrials.gov/ for the purpose of this review.
