BACKGROUND Many biomarkers have predictive value for overall survival(OS)and disease-free survival(DFS)in tumor patients.However,the role of indirect bilirubin(IBIL)in local advanced rectal cancer(LARC)patients treate...BACKGROUND Many biomarkers have predictive value for overall survival(OS)and disease-free survival(DFS)in tumor patients.However,the role of indirect bilirubin(IBIL)in local advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT)has not been studied.AIM To explore the predictive value of IBIL before nCRT(pre-IBIL)for the OS and DFS of LARC patients treated with nCRT.METHODS A total of 324 LARC patients undergoing nCRT with total mesorectal excision(TME)were enrolled.Preoperative clinical features and postoperative pathological characteristics were collected.Cox regression analysis was performed,and a Cox-based nomogram was developed to predict OS and DFS.We also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic(ROC)curves.RESULTS Among 324 patients,the median pre-IBIL was 6.2μmol/L(interquartile range:4.6μmol/L-8.4μmol/L).In the Cox multivariate regression analysis,we found that pre-IBIL,smoking history,tumor regression grade(TRG),vascular invasion,and carbohydrate antigen 19-9 before nCRT(pre-CA19-9)were predictors of OS.Additionally,pre-IBIL,body mass index(BMI),nCRT with surgery interval,TRG,and vascular invasion were predictors of DFS.Predictive nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355,respectively.Good statistical performance on internal validation was shown by calibration plots and ROC curves.CONCLUSION This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by TME.Nomograms incorporating pre-IBIL,BMI,smoking history,nCRT with surgery interval,TRG,vascular invasion,and pre-CA19-9 could be helpful to predict OS and DFS.展开更多
Objective:To study the clinical efficacy and methods of permanent implantation of radioactive I-125 seed in surgery for local advanced non small lung cancer(LANSCLC).Methods:From Apr.2004 to Apr.2006,the I-125 seeds w...Objective:To study the clinical efficacy and methods of permanent implantation of radioactive I-125 seed in surgery for local advanced non small lung cancer(LANSCLC).Methods:From Apr.2004 to Apr.2006,the I-125 seeds were implanted into 30 patients with LANSCLC in surgery.The numbers of seeds were 10-40.The chemotherapy was performed in 10 to 14 days after operation.Results:There was no operative death,and the distribution of seeds and complications were reviewed by CT and X-ray after treatment.The distribution of seeds was satisfactory in all patients.The complete response rate(CR)was 56.6%and the part response(PR)was 26.6%.The overall response rate was 83.3%after 4-24 months of surgery.There was no one occurred radiation pneumonia.Prospective efficacy await further follow-up.Conclusion:Permanent implantation of 1-125 seed in surgery for LANSCLC,is a safe and effective method with mild complications.展开更多
Background:Locally advanced laryngeal squamous cell carcinoma(LA-LSCC)presents clinical challenges due to the lack of reliable non-invasive biomarkers.This study aimed to evaluate miR-449a as a diagnostic and prognost...Background:Locally advanced laryngeal squamous cell carcinoma(LA-LSCC)presents clinical challenges due to the lack of reliable non-invasive biomarkers.This study aimed to evaluate miR-449a as a diagnostic and prognostic biomarker in LA-LSCC.Methods:miR-449a expression was analyzed in tumor tissues,adjacent normal tissues,and serum from 81 LA-LSCC patients and 50 controls using quantitative real-time reverse transcription polymerase chain reaction(qRT-PCR).We assessed the diagnostic accuracy by Receiver Operating Characteristic curve(ROC curves),clinicopathological associations,survival outcomes(Kaplan-Meier),and treatment response dynamics.Results:miR-449a was significantly downregulated in LA-LSCC tissues(p<0.0001)and serum(p<0.0001),with a strong tissue-serum correlation(R^(2)=0.988).Tissue miR-449a demonstrated a diagnostic accuracy(Area Under the Curve,AUC=0.857),while serum showed moderate accuracy(AUC=0.734).High miR-449a expression correlated with favorable clinicopathological features and improved survival(median overall survival:67.82 vs.23.74 months;p=0.0012).Multivariate analysis confirmed miR-449a as an independent prognostic factor(p<0.001).miR-449a levels increased post-treatment,particularly in responders to chemotherapy/radiation(p<0.0001).Conclusion:miR-449a serves as a non-invasive biomarker for LA-LSCC diagnosis,prognosis,and treatment monitoring.Its dynamic expression highlights potential for risk stratification and therapy response prediction,warranting further validation in larger cohorts.展开更多
Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study a...Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.展开更多
BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual ...BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual treatment responses vary considerably,highlighting the need for robust predictive tools to guide clinical decision-making.AIM To develop a nomogram model integrating clinical characteristics and biomarkers to predict the likelihood of poor response to nCRT in LARC.METHODS A retrospective analysis was performed on 178 patients with stage II-III LARC treated from January 2021 to December 2023.All patients underwent standardized nCRT followed by total mesorectal excision.Clinical data,inflammatory markers[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factoralpha],and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9]were collected.Logistic regression was used to identify independent predictors of poor nCRT response.A nomogram was constructed using significant predictors and validated via concordance index(C-index),receiver operating characteristic curve,calibration plot,and decision curve analysis(DCA).RESULTS A total of 178 patients were enrolled,with 36(20.2%)achieving a good response and 142(79.8%)exhibiting a poor response to nCRT.Baseline factors,including age and comorbidities,showed no significant differences.However,poor responders more frequently had lymph node metastasis,advanced tumor node metastasis/T stage,larger tumor diameter,and elevated CRP,IL-6,and CEA levels.Logistic regression confirmed CRP,IL-6,and CEA as independent predictors of poor response.The nomogram demonstrated high accuracy(area under the curve=0.928),good calibration(Hosmer-Lemeshow P=0.928),and a sensitivity of 88.1%with 82.6%specificity.Internal validation via bootstrap resampling(n=1000)yielded an adjusted C-index of 0.716,and DCA confirmed substantial clinical utility.CONCLUSION A nomogram incorporating serum CRP,IL-6,and CEA accurately predicts poor nCRT response in patients with LARC.This model provides a valuable framework for individualized treatment planning,potentially improving clinical outcomes.展开更多
BACKGROUND Immunotherapy is an approved treatment for metastatic rectal cancer in patients with defective mismatch repair(MMR).AIM To examine the clinical efficacy of neoadjuvant immunotherapy combined with radiothera...BACKGROUND Immunotherapy is an approved treatment for metastatic rectal cancer in patients with defective mismatch repair(MMR).AIM To examine the clinical efficacy of neoadjuvant immunotherapy combined with radiotherapy and chemotherapy for the treatment of locally advanced rectal cancer(LARC),with a focus on patients with proficient MMR(pMMR)and mic-rosatellite stability.METHODS Two researchers searched multiple databases for publications up to September 2024.All included publications examined neoadjuvant immunotherapy for LARC,and reported major pathological response(MPR),pathological complete response(pCR),clinical complete response(CCR),and rates of R0 resection and anus-pre-serving surgery.Meta-analysis,subgroup analysis,sensitivity analysis,and ana-lysis of publication bias were performed.RESULTS We included 15 publications(796 patients).The MPR,pCR,and CCR were sig-nificantly better in the group that received immunotherapy(all P<0.05),espe-cially for patients with pMMR.In addition,the rate of R0 resection and anus-preserving surgery were also significantly greater in the group that received neoadjuvant immunotherapy(both P<0.05).Hematological toxicity and abnormal liver function were the most common clinical adverse events above grade 3.Most patients successfully completed the immunotherapy treatment.The incidence of immune-related adverse reactions was 0%-13.5%,and the severities of these events were generally considered acceptable.CONCLUSION The addition of neoadjuvant immunotherapy improved the clinical remission rate of patients who had LARC with pMMR,and the treatment-related adverse reactions were generally acceptable.Neoadjuvant immunotherapy combined with radiotherapy and chemotherapy should be considered for patients with LARC.展开更多
BACKGROUND Coagulation status is closely related to the progression of malignant tumors.In the era of neoadjuvant immunochemotherapy(NICT),the prognostic utility of coagulation indicators in patients with locally adva...BACKGROUND Coagulation status is closely related to the progression of malignant tumors.In the era of neoadjuvant immunochemotherapy(NICT),the prognostic utility of coagulation indicators in patients with locally advanced gastric cancer(LAGC)undergoing new treatments remains to be determined.AIM To determine whether hypercoagulation is an effective prognostic indicator in patients with LAGC who underwent radical resection after NICT.METHODS A retrospective analysis of clinical data from 104 patients with LAGC,who underwent radical resection after NICT between 2020 and 2023,was performed.Ddimer and fibrinogen concentrations were measured one week before NICT,and again one week before surgery,to analyze the association between these two indicators and their combined indices[non-hypercoagulation(D-dimer and fibrinogen concentrations within the upper limit of normal)vs hypercoagulation(D-dimer or fibrinogen concentrations above the upper limit of normal)]with prognosis.After radical resection,patients were followed-up periodically.The median follow-up duration was 21 months.RESULTS Data collected after NICT revealed that the three-year overall survival(OS)and disease-free survival(DFS)rates the non-hypercoagulation group were significantly better than those in the hypercoagulation group[94.4%vs 78.0%(P=0.019)and 87.0%vs 68.0%(P=0.027),respectively].Multivariate analysis indicated that hypercoagulation after NICT was an independent factor for poor postoperative OS[hazard ratio(HR)4.436,P=0.023]and DFS(HR 2.551,P=0.039).Pre-NICT data demonstrated no statistically significant difference in three-year OS between the non-hypercoagulation and hypercoagulation groups(88.3%vs 84.1%,respectively;P=0.443).CONCLUSION Hypercoagulation after NICT is an effective prognostic indicator in patients with LAGC undergoing radical gastrectomy.展开更多
BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresecta...BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.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
The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published s...The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.展开更多
The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This a...The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.展开更多
In this article,the department of the author Joo-Ho Lee“Department of Surgery,Ewha Womans University Mokdong Hospital,Seoul 07985,Republic of Korea”was incorrectly listed.It has been updated as follows:Joo-Ho Lee.De...In this article,the department of the author Joo-Ho Lee“Department of Surgery,Ewha Womans University Mokdong Hospital,Seoul 07985,Republic of Korea”was incorrectly listed.It has been updated as follows:Joo-Ho Lee.Department of Surgery,Nowon Eulji Medical Center,Eulji University,Seoul 01830,Republic of Korea.展开更多
Objective:To analyze the efficacy of whole-course local simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)on patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods:88 pat...Objective:To analyze the efficacy of whole-course local simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)on patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods:88 patients with ESCC admitted to the hospital between October 2022 and October 2024 were selected and randomly divided into two groups using a random number table.The experimental group received SIB-IMRT treatment,while the control group received conventional intensity-modulated radiotherapy(C-IMRT).The objective remission rate,immune function,tumor markers,and adverse reaction rate were compared between the two groups.Results:The objective remission rate in the experimental group was higher than that in the control group(P<0.05).Before treatment,there was no difference in immune function levels and tumor marker levels between the two groups(P>0.05).After treatment,the immune function levels in the experimental group were better than those in the control group,and the tumor marker levels were lower than those in the control group(P<0.05).The adverse reaction rate in the experimental group was lower than that in the control group(P<0.05).Conclusion:SIB-IMRT can improve the objective remission rate of patients with ESCC,protect their immune function,down-regulate tumor marker levels,and prevent side effects after treatment.展开更多
To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patien...To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.展开更多
Many patients with pancreas cancer present with locally advanced pancreatic cancer(LAPC).The principle tools used for diagnosis and staging of LAPC include endoscopic ultrasound,axial imaging with computed tomography ...Many patients with pancreas cancer present with locally advanced pancreatic cancer(LAPC).The principle tools used for diagnosis and staging of LAPC include endoscopic ultrasound,axial imaging with computed tomography and magnetic resonance imaging,and diagnostic laparoscopy.The definition of resectability has historically been vague,as there is considerable debate and controversy as to the definition of LAPC.For the patient with LAPC,there is some level of involvement of the surrounding vascular structures,which include the superior mesenteric artery,celiac axis,hepatic artery,superior mesenteric vein,or portal vein.When feasible,most surgeons would recommend possible surgical resection for patients with borderline LAPC,with the goal of an R0 resection.For initially unresectable LAPC,neoadjuvant should be strongly considered.Specifically,these patients should be offered neoadjuvant therapy,and the tumor should be assessed for possible response and eventual resection.The efficacy of neoadjuvant therapy with this approach as a bridge to potential curative resection is broad,ranging from 3%-79%.The different modalities of neoadjuvant therapy include sin-gle or multi-agent chemotherapy combined with radiation,chemotherapy alone,and chemotherapy followed by chemotherapy with radiation.This review focuses on patients with LAPC and addresses recent advances and controversies in the field.展开更多
The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controve...The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.展开更多
BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.A...BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and described.Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for LLND.Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients.The median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,respectively.The median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)cases.Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.展开更多
Aim： To investigate the outcomes for Asian populations with locally advanced/clinical stage Ⅲ prostate cancer （PCa） treated with currently prevailing modalities. Methods： We reviewed the record of 209 patients wi...Aim： To investigate the outcomes for Asian populations with locally advanced/clinical stage Ⅲ prostate cancer （PCa） treated with currently prevailing modalities. Methods： We reviewed the record of 209 patients with clinical stage Ⅲ PCa, who were treated at Niigata Cancer Center Hospital between 1992 and 2003. Treatment options included hormone therapy-combined radical prostatectomy （RP＋HT）, hormone therapy-combined external beam irradiation （EBRT＋HT） and primary hormone therapy （PHT）. Results： The 5- and 10-year overall survival rates were 80.3% and 46.1% in all cohorts, respectively. The survival rates were 87.3% and 66.5% in the RP＋HT group, 94.9% and 70.0% in the EBRT＋HT group and 66.1% and 17.2% in the PHT group, respectively. A significant survival advantage was found in the EBRT＋HT group compared with that in the PHT group （P 〈 0.0001）. Also, the RP＋HT group had better survival than the PHT group （P = 0.0107）. The 5- and 10-year disease-specific survival rates for all cases were 92.5% and 80.0%, respectively. They were 93.8% and 71.4% in the RP＋HT group, 96.6% and 93.6% in the EBRT＋HT group and 88.6% and 62.3% in the PHT group, respectively. A survival advantage was found in the EBRT＋HT group compared with the PHT group （P = 0.029）. No significant difference was found in disease-specific survival between the EBRT＋HT and RP＋HT groups or between the RP＋HT and PHT groups. Condusion： Although our findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa, we recommend therapies that take into account the patients＇ social and medical conditions for Asian men with clinical stage Ⅲ PCa.展开更多
BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To ...BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.展开更多
Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from 125 ^I seed implantation. This re...Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from 125 ^I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients（61.2%） in the implantation（IP） group and 87（38.9%） in the non-implantation（NIP） group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group（243±51 vs. 214±77 min）. The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively（P〈0.05）. The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from 125 I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.展开更多
文摘BACKGROUND Many biomarkers have predictive value for overall survival(OS)and disease-free survival(DFS)in tumor patients.However,the role of indirect bilirubin(IBIL)in local advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT)has not been studied.AIM To explore the predictive value of IBIL before nCRT(pre-IBIL)for the OS and DFS of LARC patients treated with nCRT.METHODS A total of 324 LARC patients undergoing nCRT with total mesorectal excision(TME)were enrolled.Preoperative clinical features and postoperative pathological characteristics were collected.Cox regression analysis was performed,and a Cox-based nomogram was developed to predict OS and DFS.We also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic(ROC)curves.RESULTS Among 324 patients,the median pre-IBIL was 6.2μmol/L(interquartile range:4.6μmol/L-8.4μmol/L).In the Cox multivariate regression analysis,we found that pre-IBIL,smoking history,tumor regression grade(TRG),vascular invasion,and carbohydrate antigen 19-9 before nCRT(pre-CA19-9)were predictors of OS.Additionally,pre-IBIL,body mass index(BMI),nCRT with surgery interval,TRG,and vascular invasion were predictors of DFS.Predictive nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355,respectively.Good statistical performance on internal validation was shown by calibration plots and ROC curves.CONCLUSION This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by TME.Nomograms incorporating pre-IBIL,BMI,smoking history,nCRT with surgery interval,TRG,vascular invasion,and pre-CA19-9 could be helpful to predict OS and DFS.
文摘Objective:To study the clinical efficacy and methods of permanent implantation of radioactive I-125 seed in surgery for local advanced non small lung cancer(LANSCLC).Methods:From Apr.2004 to Apr.2006,the I-125 seeds were implanted into 30 patients with LANSCLC in surgery.The numbers of seeds were 10-40.The chemotherapy was performed in 10 to 14 days after operation.Results:There was no operative death,and the distribution of seeds and complications were reviewed by CT and X-ray after treatment.The distribution of seeds was satisfactory in all patients.The complete response rate(CR)was 56.6%and the part response(PR)was 26.6%.The overall response rate was 83.3%after 4-24 months of surgery.There was no one occurred radiation pneumonia.Prospective efficacy await further follow-up.Conclusion:Permanent implantation of 1-125 seed in surgery for LANSCLC,is a safe and effective method with mild complications.
基金The authors extend their appreciation to Taif University,Saudi Arabia,for supporting this work through project No.(TU-DSPP-2024-54).
文摘Background:Locally advanced laryngeal squamous cell carcinoma(LA-LSCC)presents clinical challenges due to the lack of reliable non-invasive biomarkers.This study aimed to evaluate miR-449a as a diagnostic and prognostic biomarker in LA-LSCC.Methods:miR-449a expression was analyzed in tumor tissues,adjacent normal tissues,and serum from 81 LA-LSCC patients and 50 controls using quantitative real-time reverse transcription polymerase chain reaction(qRT-PCR).We assessed the diagnostic accuracy by Receiver Operating Characteristic curve(ROC curves),clinicopathological associations,survival outcomes(Kaplan-Meier),and treatment response dynamics.Results:miR-449a was significantly downregulated in LA-LSCC tissues(p<0.0001)and serum(p<0.0001),with a strong tissue-serum correlation(R^(2)=0.988).Tissue miR-449a demonstrated a diagnostic accuracy(Area Under the Curve,AUC=0.857),while serum showed moderate accuracy(AUC=0.734).High miR-449a expression correlated with favorable clinicopathological features and improved survival(median overall survival:67.82 vs.23.74 months;p=0.0012).Multivariate analysis confirmed miR-449a as an independent prognostic factor(p<0.001).miR-449a levels increased post-treatment,particularly in responders to chemotherapy/radiation(p<0.0001).Conclusion:miR-449a serves as a non-invasive biomarker for LA-LSCC diagnosis,prognosis,and treatment monitoring.Its dynamic expression highlights potential for risk stratification and therapy response prediction,warranting further validation in larger cohorts.
基金supported by grants through funding from the National Science and Technology Council(NSTC112-2314-B-037-050-MY3,NSTC114-2314-B-037-103-MY3,NSTC114-2321-B-037-003)the Ministry of Health and Welfare(MOHW113-TDU-B-222-134014)+3 种基金funded by the health and welfare surcharge of on tobacco products,and the Kaohsiung Medical University Hospital(KMUH113-3R31,KMUH113-3R32,KMUH113-3R33,KMUH113-3M58,KMUH113-3M59,KMUH-S11412,KMUH-SH11403)Kaohsiung Medical University Research Center Grant(KMU-TC113A04)National Tsing Hua University-Kaohsiung Medical University Joint Research Project(NTHU-KMU-KT114P008)supported by the Grant of Taiwan Precision Medicine Initiative and Taiwan Biobank,Academia Sinica,Taiwan.
文摘Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.
文摘BACKGROUND Locally advanced rectal cancer(LARC)carries a substantial risk of recurrence,prompting the use of neoadjuvant chemoradiotherapy(nCRT)to improve tumor resectability and long-term outcomes.However,individual treatment responses vary considerably,highlighting the need for robust predictive tools to guide clinical decision-making.AIM To develop a nomogram model integrating clinical characteristics and biomarkers to predict the likelihood of poor response to nCRT in LARC.METHODS A retrospective analysis was performed on 178 patients with stage II-III LARC treated from January 2021 to December 2023.All patients underwent standardized nCRT followed by total mesorectal excision.Clinical data,inflammatory markers[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factoralpha],and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9]were collected.Logistic regression was used to identify independent predictors of poor nCRT response.A nomogram was constructed using significant predictors and validated via concordance index(C-index),receiver operating characteristic curve,calibration plot,and decision curve analysis(DCA).RESULTS A total of 178 patients were enrolled,with 36(20.2%)achieving a good response and 142(79.8%)exhibiting a poor response to nCRT.Baseline factors,including age and comorbidities,showed no significant differences.However,poor responders more frequently had lymph node metastasis,advanced tumor node metastasis/T stage,larger tumor diameter,and elevated CRP,IL-6,and CEA levels.Logistic regression confirmed CRP,IL-6,and CEA as independent predictors of poor response.The nomogram demonstrated high accuracy(area under the curve=0.928),good calibration(Hosmer-Lemeshow P=0.928),and a sensitivity of 88.1%with 82.6%specificity.Internal validation via bootstrap resampling(n=1000)yielded an adjusted C-index of 0.716,and DCA confirmed substantial clinical utility.CONCLUSION A nomogram incorporating serum CRP,IL-6,and CEA accurately predicts poor nCRT response in patients with LARC.This model provides a valuable framework for individualized treatment planning,potentially improving clinical outcomes.
基金Supported by Start-up Fund for Doctor's Scientific Research in Shanxi Cancer Hospital,No.Dr202314and Natural Exploration Category of Shanxi Basic Research Plan,No.202203021221284.
文摘BACKGROUND Immunotherapy is an approved treatment for metastatic rectal cancer in patients with defective mismatch repair(MMR).AIM To examine the clinical efficacy of neoadjuvant immunotherapy combined with radiotherapy and chemotherapy for the treatment of locally advanced rectal cancer(LARC),with a focus on patients with proficient MMR(pMMR)and mic-rosatellite stability.METHODS Two researchers searched multiple databases for publications up to September 2024.All included publications examined neoadjuvant immunotherapy for LARC,and reported major pathological response(MPR),pathological complete response(pCR),clinical complete response(CCR),and rates of R0 resection and anus-pre-serving surgery.Meta-analysis,subgroup analysis,sensitivity analysis,and ana-lysis of publication bias were performed.RESULTS We included 15 publications(796 patients).The MPR,pCR,and CCR were sig-nificantly better in the group that received immunotherapy(all P<0.05),espe-cially for patients with pMMR.In addition,the rate of R0 resection and anus-preserving surgery were also significantly greater in the group that received neoadjuvant immunotherapy(both P<0.05).Hematological toxicity and abnormal liver function were the most common clinical adverse events above grade 3.Most patients successfully completed the immunotherapy treatment.The incidence of immune-related adverse reactions was 0%-13.5%,and the severities of these events were generally considered acceptable.CONCLUSION The addition of neoadjuvant immunotherapy improved the clinical remission rate of patients who had LARC with pMMR,and the treatment-related adverse reactions were generally acceptable.Neoadjuvant immunotherapy combined with radiotherapy and chemotherapy should be considered for patients with LARC.
基金Natural Science Foundation of Hubei Province of China,No.2024AFB655Key Research and Development Program of Hubei Province of China,No.2021BCA116National Natural Science Foundation of China,No.82072736,No.82003205,No.
文摘BACKGROUND Coagulation status is closely related to the progression of malignant tumors.In the era of neoadjuvant immunochemotherapy(NICT),the prognostic utility of coagulation indicators in patients with locally advanced gastric cancer(LAGC)undergoing new treatments remains to be determined.AIM To determine whether hypercoagulation is an effective prognostic indicator in patients with LAGC who underwent radical resection after NICT.METHODS A retrospective analysis of clinical data from 104 patients with LAGC,who underwent radical resection after NICT between 2020 and 2023,was performed.Ddimer and fibrinogen concentrations were measured one week before NICT,and again one week before surgery,to analyze the association between these two indicators and their combined indices[non-hypercoagulation(D-dimer and fibrinogen concentrations within the upper limit of normal)vs hypercoagulation(D-dimer or fibrinogen concentrations above the upper limit of normal)]with prognosis.After radical resection,patients were followed-up periodically.The median follow-up duration was 21 months.RESULTS Data collected after NICT revealed that the three-year overall survival(OS)and disease-free survival(DFS)rates the non-hypercoagulation group were significantly better than those in the hypercoagulation group[94.4%vs 78.0%(P=0.019)and 87.0%vs 68.0%(P=0.027),respectively].Multivariate analysis indicated that hypercoagulation after NICT was an independent factor for poor postoperative OS[hazard ratio(HR)4.436,P=0.023]and DFS(HR 2.551,P=0.039).Pre-NICT data demonstrated no statistically significant difference in three-year OS between the non-hypercoagulation and hypercoagulation groups(88.3%vs 84.1%,respectively;P=0.443).CONCLUSION Hypercoagulation after NICT is an effective prognostic indicator in patients with LAGC undergoing radical gastrectomy.
文摘BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.
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.
文摘The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.
文摘The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.
文摘In this article,the department of the author Joo-Ho Lee“Department of Surgery,Ewha Womans University Mokdong Hospital,Seoul 07985,Republic of Korea”was incorrectly listed.It has been updated as follows:Joo-Ho Lee.Department of Surgery,Nowon Eulji Medical Center,Eulji University,Seoul 01830,Republic of Korea.
文摘Objective:To analyze the efficacy of whole-course local simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)on patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods:88 patients with ESCC admitted to the hospital between October 2022 and October 2024 were selected and randomly divided into two groups using a random number table.The experimental group received SIB-IMRT treatment,while the control group received conventional intensity-modulated radiotherapy(C-IMRT).The objective remission rate,immune function,tumor markers,and adverse reaction rate were compared between the two groups.Results:The objective remission rate in the experimental group was higher than that in the control group(P<0.05).Before treatment,there was no difference in immune function levels and tumor marker levels between the two groups(P>0.05).After treatment,the immune function levels in the experimental group were better than those in the control group,and the tumor marker levels were lower than those in the control group(P<0.05).The adverse reaction rate in the experimental group was lower than that in the control group(P<0.05).Conclusion:SIB-IMRT can improve the objective remission rate of patients with ESCC,protect their immune function,down-regulate tumor marker levels,and prevent side effects after treatment.
文摘To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.
文摘Many patients with pancreas cancer present with locally advanced pancreatic cancer(LAPC).The principle tools used for diagnosis and staging of LAPC include endoscopic ultrasound,axial imaging with computed tomography and magnetic resonance imaging,and diagnostic laparoscopy.The definition of resectability has historically been vague,as there is considerable debate and controversy as to the definition of LAPC.For the patient with LAPC,there is some level of involvement of the surrounding vascular structures,which include the superior mesenteric artery,celiac axis,hepatic artery,superior mesenteric vein,or portal vein.When feasible,most surgeons would recommend possible surgical resection for patients with borderline LAPC,with the goal of an R0 resection.For initially unresectable LAPC,neoadjuvant should be strongly considered.Specifically,these patients should be offered neoadjuvant therapy,and the tumor should be assessed for possible response and eventual resection.The efficacy of neoadjuvant therapy with this approach as a bridge to potential curative resection is broad,ranging from 3%-79%.The different modalities of neoadjuvant therapy include sin-gle or multi-agent chemotherapy combined with radiation,chemotherapy alone,and chemotherapy followed by chemotherapy with radiation.This review focuses on patients with LAPC and addresses recent advances and controversies in the field.
文摘The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.
基金Supported by The National Natural Science Foundation of China,No.81874201.
文摘BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and described.Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for LLND.Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients.The median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,respectively.The median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)cases.Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.
文摘Aim： To investigate the outcomes for Asian populations with locally advanced/clinical stage Ⅲ prostate cancer （PCa） treated with currently prevailing modalities. Methods： We reviewed the record of 209 patients with clinical stage Ⅲ PCa, who were treated at Niigata Cancer Center Hospital between 1992 and 2003. Treatment options included hormone therapy-combined radical prostatectomy （RP＋HT）, hormone therapy-combined external beam irradiation （EBRT＋HT） and primary hormone therapy （PHT）. Results： The 5- and 10-year overall survival rates were 80.3% and 46.1% in all cohorts, respectively. The survival rates were 87.3% and 66.5% in the RP＋HT group, 94.9% and 70.0% in the EBRT＋HT group and 66.1% and 17.2% in the PHT group, respectively. A significant survival advantage was found in the EBRT＋HT group compared with that in the PHT group （P 〈 0.0001）. Also, the RP＋HT group had better survival than the PHT group （P = 0.0107）. The 5- and 10-year disease-specific survival rates for all cases were 92.5% and 80.0%, respectively. They were 93.8% and 71.4% in the RP＋HT group, 96.6% and 93.6% in the EBRT＋HT group and 88.6% and 62.3% in the PHT group, respectively. A survival advantage was found in the EBRT＋HT group compared with the PHT group （P = 0.029）. No significant difference was found in disease-specific survival between the EBRT＋HT and RP＋HT groups or between the RP＋HT and PHT groups. Condusion： Although our findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa, we recommend therapies that take into account the patients＇ social and medical conditions for Asian men with clinical stage Ⅲ PCa.
文摘BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.
文摘Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from 125 ^I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients（61.2%） in the implantation（IP） group and 87（38.9%） in the non-implantation（NIP） group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group（243±51 vs. 214±77 min）. The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively（P〈0.05）. The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from 125 I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.
