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
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 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
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(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 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 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
Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSC...Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results： After two cycles of chemotherapy, 19 （47.5%） of 40 patients had objective response （2 complete and 17 partial response）. In 40 resected tumor specimens, 2 （5%） were classified as regression grade Ⅳ, 16 （40%） as regression grade Ⅲ, 18 （45%） as regression gradeⅡ, and 4 （10%） as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ （〈10% vital tumor tissue）（P〈0.05）. The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. Conclusion： The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression （regression grade Ⅲ-Ⅳ） is predictive for superior survival time.展开更多
AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastri...AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)gastrectomy.Operative morbidity,overall mortality,and severe adverse events were compared by intention-to-treat analysis.RESULTS:From November 1999 to November 2005,70 patients were treated.After preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were R0.Pathological response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per arm.CONCLUSION:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.展开更多
AIM:To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.METHODS:All published controlled trials of NAC for advanced gastric cancer vs...AIM:To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.METHODS:All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched.Studies that included patients with metastases at enrollment were excluded.Databases included Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,and American Society of Clinical Oncology meeting abstracts from 1978 to 2010.The censor date was up to April 2010.Primary outcome was the odds ratio (OR) for improving overall survival rate of patients with advanced gastric cancer.Secondary outcome was the OR for down-staging tumor and increasing R0 resection in patients with advanced gastric cancer.Safety analyses were also performed.All calculations and statistical tests were performed using RevMan 5.0 software.tric cancer enrolled in 14 trials were divided into NAC group (n=1054) and control group (n=1217).The patients were followed up for a median time of 54 mo.NAC significantly improved the survival rate [OR=1.27,95% confidence interval (CI):1.04-1.55],tumor stage (OR=1.71,95% CI:1.26-2.33) and R0 resection rate (OR=1.51,95% CI:1.19-1.91) of patients with advanced gastric cancer.No obvious safety concerns were raised in these trials.CONCLUSION:NAC can improve tumor stage and survival rate of patients with advanced gastric cancer with a rather good safety.展开更多
Objective： The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of ra...Objective： The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of radiomicsfor pre-treatment computed tomography （CT） in the prediction of the pathological response of locally advancedgastric cancer with preoperative chemotherapy.Methods： Thirty consecutive patients with CT-staged Ⅱ/Ⅲ gastric cancer receiving neoadjuvant chemotherapywere enrolled in this study between December 2014 and March 2017. All patients underwent upper abdominal CTduring the unenhanced, late arterial phase （AP） and portal venous phase （PP） before the administration ofneoadjuvant chemotherapy. In total, 19,985 radiomics features were extracted in the AP and PP for each patient.Four methods were adopted during feature selection and eight methods were used in the process of building theclassifier model. Thirty-two combinations of feature selection and classification methods were examined. Receiveroperating characteristic （ROC） curves were used to evaluate the capability of each combination of feature selectionand classification method to predict a non-good response （non-GR） based on tumor regression grade （TRG）.Results： The mean area under the curve （AUC） ranged from 0.194 to 0.621 in the AP, and from 0.455 to 0.722in the PP, according to different combinations of feature selection and the classification methods. There was onlyone cross-combination machine-learning method indicating a relatively higher AUC （〉0.600） in the AP, while 12cross-combination machine-learning methods presented relatively higher AUCs （all 〉0.600） in the PP. The featureselection method adopted by a filter based on linear discriminant analysis ＋ classifier of random forest achieved asignificantly prognostic performance in the PP （AUC, 0.722~0.108; accuracy, 0.793; sensitivity, 0.636; specificity,0.889; Z=2.039; P=0.041）.Conclusions： It is possible to predict non-GR after neoadiuvant chemotherapy in locally advanced gastriccancers based on the radiomics of CT.展开更多
Objective： The aim of this prospective, single-arm phase II trial was to confirm the safety and efficacy of neoadjuvant chemotherapy（NAC） using oxaliplatin plus capecitabine（Cap OX） for patients with operable loc...Objective： The aim of this prospective, single-arm phase II trial was to confirm the safety and efficacy of neoadjuvant chemotherapy（NAC） using oxaliplatin plus capecitabine（Cap OX） for patients with operable locally advanced colon cancer（CC）.Methods： Patients with computed tomography-defined T4 or lymph node-positive CCs were enrolled. After radiological staging, patients were treated with at least 2 cycles of NAC consisting of 130 mg/m2 oxaliplatin on d 1,plus 1,000 mg/m2 capecitabine twice daily for 14 d every 3 weeks, followed by surgery, and then with the rest cycles of adjuvant chemotherapy. Radiological response was evaluated after 2 cycles of NAC. Tumor response, treatment toxicity, and surgical complications were recorded. The pathological response to therapy was evaluated according to the tumor regression grade（TRG） score. The primary endpoint was pathologic tumor response. This trial is registered in Clinical Trials.gov（No： NCT02415829）.Results： Forty-seven patients were enrolled in the study. Forty-two patients completed the planned treatments.The total radiological response rate was 68%（32/47）, including complete and partial response rates of 2%（1/47）and 66%（31/47）, respectively. Stable disease was observed in 32%（15/47） and progressive disease was observed in none. Complete pathologic response, major regression, and at least moderate regression were achieved in 1（2%）, 2（4%）, and 29（62%） patients, respectively. Four patients developed grade 3 treatment toxicities. One patient with wound infection occurred after operation（1/47, 2%）. There was no treatment-related death.Conclusions： Our results suggest that NAC with Cap OX is an effective and safe treatment option for patients with locally advanced CCs.展开更多
BACKGROUND Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer(LARC);however,evaluation of treatment response to neoadjuvant chemotherapy is still challenging...BACKGROUND Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer(LARC);however,evaluation of treatment response to neoadjuvant chemotherapy is still challenging.AIM To create a multi-modal radiomics model to assess therapeutic response after neoadjuvant chemotherapy for LARC.METHODS This retrospective study consecutively included 118 patients with LARC who underwent both computed tomography(CT)and magnetic resonance imaging(MRI)before neoadjuvant chemotherapy between October 2016 and June 2019.Histopathological findings were used as the reference standard for pathological response.Patients were randomly divided into a training set(n=70)and a validation set(n=48).The performance of different models based on CT and MRI,including apparent diffusion coefficient(ADC),dynamic contrast enhanced T1 images(DCE-T1),high resolution T2-weighted imaging(HR-T2WI),and imaging features,was assessed by using the receiver operating characteristic curve analysis.This was demonstrated as area under the curve(AUC)and accuracy(ACC).Calibration plots with Hosmer-Lemeshow tests were used to investigate the agreement and performance characteristics of the nomogram.RESULTS Eighty out of 118 patients(68%)achieved a pathological response.For an individual radiomics model,HR-T2WI performed better(AUC=0.859,ACC=0.896)than CT(AUC=0.766,ACC=0.792),DCE-T1(AUC=0.812,ACC=0.854),and ADC(AUC=0.828,ACC=0.833)in the validation set.The imaging performance for extramural venous invasion detection was relatively low in both the training(AUC=0.73,ACC=0.714)and validation(AUC=0.578,ACC=0.583)sets.The multi-modal radiomics model reached an AUC of 0.925 and ACC of 0.886 in the training set,and an AUC of 0.93 and ACC of 0.875 in the validation set.For the clinical radiomics nomogram,good agreement was found between the nomogram prediction and actual observation.CONCLUSION A multi-modal nomogram using traditional imaging features and radiomics of preoperative CT and MRI adds accuracy to the prediction of treatment outcome,and thus contributes to the personalized selection of neoadjuvant chemotherapy for LARC.展开更多
Objectives： To compare the survival and perioperafive morbidity between primary debulking surgery （PDS） and neoadjuvant chemotherapy followed by interval debulking surgery （NAC/IDS） in treating patients with adva...Objectives： To compare the survival and perioperafive morbidity between primary debulking surgery （PDS） and neoadjuvant chemotherapy followed by interval debulking surgery （NAC/IDS） in treating patients with advanced epithelial ovarian cancer （EOC）. Methods： We retrospectively reviewed 67 patients with stage IIIC or iV EOC treated at Peking University Cancer Hospital from January 2006 to June 2009. VVherein, 37 and 30 patients underwent PDS and NAC/ IDS, respectively. Results： No difference in overall survival （OS） or progression-free survival （PFS） was observed between NAC/IDS group and PDS group （OS： 41.2 vs. 39.1 months, P=0.23; PFS： 27.1 vs. 24.3 months, P=0.37）. The optimal debulking rate was 60% in the NAC/IDS group, which was significantly higher than that in the PDS group （32.4%） （P=0.024）. The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion, lower nasogastric intubation rate, and earlier ambulation and recovery of intestinal function than the PDS group （P〈0.05）. Conclusions： NAC/IDS is less invasive than PDS, and offers the advantages regarding optimal cytoreduction rate, intraoperative blood loss, and postoperative recovery, without significantly impairing the survival compared with PDS in treating patients with stage IIIC or IV EOC. Therefore, NAC/IDS may be a valuable treatment alternative for EOC patients.展开更多
Background:In the era of intensity?modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NACT)in treating ascending?type nasopharyngeal carcinoma(NPC)is under?evaluated.This study was to compare the effica...Background:In the era of intensity?modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NACT)in treating ascending?type nasopharyngeal carcinoma(NPC)is under?evaluated.This study was to compare the efficacy of NACT followed by IMRT(NACT+RT)with the efficacy of concurrent chemoradiotherapy(CCRT)on ascending?type NPC.Methods:Clinical data of 214 patients with ascending?type NPC treated with NACT+RT or CCRT between Decem?ber 2009 and July 2011 were analyzed.Of the 214 patients,98 were treated with NACT followed by IMRT,and 116 were treated with CCRT.The survival rates were assessed using Kaplan–Meier analysis,and the survival curves were compared using a log?rank test.Results:The 4?year overall survival,locoregional failure?free survival,distant failure?free survival,and failure?free sur?vival rates were not significantly different between the two groups(all P>0.05).However,patients in the CCRT group exhibited more severe acute adverse events than did patients in the NACT+RT group during radiotherapy,includ?ing leukopenia(30.2%vs.15.3%,P=0.016),neutropenia(25.9%vs.11.2%,P=0.011),and mucositis(57.8%vs.40.8%,P=0.028).After radiotherapy,patients in the CCRT group exhibited significantly higher rates of xerostomia(21.6%vs.Conclusions:The treatment outcomes of the NACT+RT and CCRT groups were similar;however,CCRT led to higher rates of acute and late toxicities.NACT+RT may therefore be a better treatment strategy for ascending?type NPC.展开更多
BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In ...BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In China,breast cancer is the fifth most common malignant tumor overall and the most common in women,accounting for 17%of female malignant tumors.AIM To investigate the accuracy of strain ultrasound elastography(SUE)on the evaluation of preoperative neoadjuvant chemotherapy(NAC)in breast cancer.METHODS Overall,90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study.The patients received six cycles of NAC with docetaxel,epirubicin,and cyclophosphamide.Surgical treatment was also performed,and pathological reactivity was assessed.The patients were evaluated using conventional ultrasonography and SUE before biopsy.The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test,while multivariate analysis was performed using logistic regression analysis.RESULTS Of the patients analyzed,20 had a pathological complete remission(pCR)while 70 did not achieve pCR after NAC.The ratio of the elastic strain ratio(SR)and elastic score of 4–5 in patients with pCR were 5.5±1.16 and 15.00%,respectively;these were significantly lower than those in patients without pCR(85%)and significantly higher than in patients without pCR(14%).SR and elastic score 4–5 were independent factors influencing NAC efficacy(OR=0.644,1.426 and 1.366,respectively,P<0.05).SR was positively correlated with elasticity score(rs=0.411,P<0.05).The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891,respectively(P<0.05).CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.展开更多
Neoadjuvant chemotherapy followed by surgery （NCS） has not been fully evaluated clinically. Currently, the main regimen of neoadjuvant chemotherapy （NAC） used in NCS includes cisplatin. The antitumor effects of NA...Neoadjuvant chemotherapy followed by surgery （NCS） has not been fully evaluated clinically. Currently, the main regimen of neoadjuvant chemotherapy （NAC） used in NCS includes cisplatin. The antitumor effects of NAC reduce lymph node metastasis and the tumor diameter in patients prior to surgery, and this can reduce the number of high risk patients who require postoperative radiation therapy. Many randomized controlled trials （RCTs） have examined the long-term prognosis of NCS compared to primary surgery, but the utility of NCS remains uncertain. The advent of concurrent chemoradiotherapy （CCRT） has markedly improved the outcome of radiotherapy （RT）, and CCRT is now used as a standard method in many cases of advanced bulky cervical cancer. NCS gives a better treatment outcome than radiation therapy alone, but it is important to verify that NCS gives a similar or better outcome compared to CCRT.展开更多
BACKGROUND Pancreaticoduodenectomy(PD)for advanced gastric cancer is rarely performed because of the high morbidity and mortality rates and low survival rate.However,neoadjuvant chemotherapy for advanced gastric cance...BACKGROUND Pancreaticoduodenectomy(PD)for advanced gastric cancer is rarely performed because of the high morbidity and mortality rates and low survival rate.However,neoadjuvant chemotherapy for advanced gastric cancer has improved,and chemotherapy combined with trastuzumab may have a preoperative tumorreducing effect,especially for human epidermal growth factor receptor 2(HER2)-positive cases.CASE SUMMARY We report a case of successful radical resection with PD after neoadjuvant S-1 plus oxaliplatin(SOX)and trastuzumab in a patient(66-year-old male)with advanced gastric cancer invading the pancreatic head.Initial esophagogastroduodenoscopy detected a type 3 advanced lesion located on the lower part of the stomach obstructing the pyloric ring.Computed tomography detected lymph node metastasis and tumor invasion to the pancreatic head without distant metastasis.Pathological findings revealed adenocarcinoma and HER2 positivity(immunohistochemical score of 3+).We performed staging laparoscopy and confirmed no liver metastasis,no dissemination,negative lavage cytological findings,and immobility of the distal side of the stomach due to invasion to the pancreas.Laparoscopic gastrojejunostomy was performed at that time.One course of SOX and three courses of SOX plus trastuzumab were administered.Preoperative computed tomography showed partial response;therefore,PD was performed after neoadjuvant chemotherapy,and pathological radical resection was achieved.CONCLUSION We suggest that radical resection with PD after neoadjuvant chemotherapy plus trastuzumab is an option for locally advanced HER2-positive gastric cancer invading the pancreatic head in the absence of non-curative factors.展开更多
BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemoth...BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.展开更多
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.
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.
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.
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(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.
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Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results： After two cycles of chemotherapy, 19 （47.5%） of 40 patients had objective response （2 complete and 17 partial response）. In 40 resected tumor specimens, 2 （5%） were classified as regression grade Ⅳ, 16 （40%） as regression grade Ⅲ, 18 （45%） as regression gradeⅡ, and 4 （10%） as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ （〈10% vital tumor tissue）（P〈0.05）. The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. Conclusion： The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression （regression grade Ⅲ-Ⅳ） is predictive for superior survival time.
文摘AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)gastrectomy.Operative morbidity,overall mortality,and severe adverse events were compared by intention-to-treat analysis.RESULTS:From November 1999 to November 2005,70 patients were treated.After preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were R0.Pathological response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per arm.CONCLUSION:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
文摘AIM:To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.METHODS:All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched.Studies that included patients with metastases at enrollment were excluded.Databases included Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,and American Society of Clinical Oncology meeting abstracts from 1978 to 2010.The censor date was up to April 2010.Primary outcome was the odds ratio (OR) for improving overall survival rate of patients with advanced gastric cancer.Secondary outcome was the OR for down-staging tumor and increasing R0 resection in patients with advanced gastric cancer.Safety analyses were also performed.All calculations and statistical tests were performed using RevMan 5.0 software.tric cancer enrolled in 14 trials were divided into NAC group (n=1054) and control group (n=1217).The patients were followed up for a median time of 54 mo.NAC significantly improved the survival rate [OR=1.27,95% confidence interval (CI):1.04-1.55],tumor stage (OR=1.71,95% CI:1.26-2.33) and R0 resection rate (OR=1.51,95% CI:1.19-1.91) of patients with advanced gastric cancer.No obvious safety concerns were raised in these trials.CONCLUSION:NAC can improve tumor stage and survival rate of patients with advanced gastric cancer with a rather good safety.
基金supported by the National Key Research and Development Program of China (No.2017YFC1309100)the National Natural Scientific Foundation of China (No. 81771912)the Applied Basic Research Projects of Yunnan Province, China [No. 2015FB071 and No. 2017FE467-084]
文摘Objective： The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of radiomicsfor pre-treatment computed tomography （CT） in the prediction of the pathological response of locally advancedgastric cancer with preoperative chemotherapy.Methods： Thirty consecutive patients with CT-staged Ⅱ/Ⅲ gastric cancer receiving neoadjuvant chemotherapywere enrolled in this study between December 2014 and March 2017. All patients underwent upper abdominal CTduring the unenhanced, late arterial phase （AP） and portal venous phase （PP） before the administration ofneoadjuvant chemotherapy. In total, 19,985 radiomics features were extracted in the AP and PP for each patient.Four methods were adopted during feature selection and eight methods were used in the process of building theclassifier model. Thirty-two combinations of feature selection and classification methods were examined. Receiveroperating characteristic （ROC） curves were used to evaluate the capability of each combination of feature selectionand classification method to predict a non-good response （non-GR） based on tumor regression grade （TRG）.Results： The mean area under the curve （AUC） ranged from 0.194 to 0.621 in the AP, and from 0.455 to 0.722in the PP, according to different combinations of feature selection and the classification methods. There was onlyone cross-combination machine-learning method indicating a relatively higher AUC （〉0.600） in the AP, while 12cross-combination machine-learning methods presented relatively higher AUCs （all 〉0.600） in the PP. The featureselection method adopted by a filter based on linear discriminant analysis ＋ classifier of random forest achieved asignificantly prognostic performance in the PP （AUC, 0.722~0.108; accuracy, 0.793; sensitivity, 0.636; specificity,0.889; Z=2.039; P=0.041）.Conclusions： It is possible to predict non-GR after neoadiuvant chemotherapy in locally advanced gastriccancers based on the radiomics of CT.
基金supported by grants from the National Natural Science Foundation of China (Grant No. 81472620)Shanghai Science and Technology Planning Fund (No. 13140902100)+1 种基金Shanghai Combination Study Project for Major Diseases (No. 2014ZYJB0101)Shanghai Health and Family Planning Commission (No. JGY1404)
文摘Objective： The aim of this prospective, single-arm phase II trial was to confirm the safety and efficacy of neoadjuvant chemotherapy（NAC） using oxaliplatin plus capecitabine（Cap OX） for patients with operable locally advanced colon cancer（CC）.Methods： Patients with computed tomography-defined T4 or lymph node-positive CCs were enrolled. After radiological staging, patients were treated with at least 2 cycles of NAC consisting of 130 mg/m2 oxaliplatin on d 1,plus 1,000 mg/m2 capecitabine twice daily for 14 d every 3 weeks, followed by surgery, and then with the rest cycles of adjuvant chemotherapy. Radiological response was evaluated after 2 cycles of NAC. Tumor response, treatment toxicity, and surgical complications were recorded. The pathological response to therapy was evaluated according to the tumor regression grade（TRG） score. The primary endpoint was pathologic tumor response. This trial is registered in Clinical Trials.gov（No： NCT02415829）.Results： Forty-seven patients were enrolled in the study. Forty-two patients completed the planned treatments.The total radiological response rate was 68%（32/47）, including complete and partial response rates of 2%（1/47）and 66%（31/47）, respectively. Stable disease was observed in 32%（15/47） and progressive disease was observed in none. Complete pathologic response, major regression, and at least moderate regression were achieved in 1（2%）, 2（4%）, and 29（62%） patients, respectively. Four patients developed grade 3 treatment toxicities. One patient with wound infection occurred after operation（1/47, 2%）. There was no treatment-related death.Conclusions： Our results suggest that NAC with Cap OX is an effective and safe treatment option for patients with locally advanced CCs.
基金Supported by Research Grant of National Nature Science Foundation of China,No.81971571Multimodal MR Imaging and Radiomics of Rectal Cancer,Science and Technology Department of Sichuan Province,No.2019YFS0431Sichuan University Training Program of Innovation and Entrepreneurship for Undergraduates,No.C2019104739.
文摘BACKGROUND Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer(LARC);however,evaluation of treatment response to neoadjuvant chemotherapy is still challenging.AIM To create a multi-modal radiomics model to assess therapeutic response after neoadjuvant chemotherapy for LARC.METHODS This retrospective study consecutively included 118 patients with LARC who underwent both computed tomography(CT)and magnetic resonance imaging(MRI)before neoadjuvant chemotherapy between October 2016 and June 2019.Histopathological findings were used as the reference standard for pathological response.Patients were randomly divided into a training set(n=70)and a validation set(n=48).The performance of different models based on CT and MRI,including apparent diffusion coefficient(ADC),dynamic contrast enhanced T1 images(DCE-T1),high resolution T2-weighted imaging(HR-T2WI),and imaging features,was assessed by using the receiver operating characteristic curve analysis.This was demonstrated as area under the curve(AUC)and accuracy(ACC).Calibration plots with Hosmer-Lemeshow tests were used to investigate the agreement and performance characteristics of the nomogram.RESULTS Eighty out of 118 patients(68%)achieved a pathological response.For an individual radiomics model,HR-T2WI performed better(AUC=0.859,ACC=0.896)than CT(AUC=0.766,ACC=0.792),DCE-T1(AUC=0.812,ACC=0.854),and ADC(AUC=0.828,ACC=0.833)in the validation set.The imaging performance for extramural venous invasion detection was relatively low in both the training(AUC=0.73,ACC=0.714)and validation(AUC=0.578,ACC=0.583)sets.The multi-modal radiomics model reached an AUC of 0.925 and ACC of 0.886 in the training set,and an AUC of 0.93 and ACC of 0.875 in the validation set.For the clinical radiomics nomogram,good agreement was found between the nomogram prediction and actual observation.CONCLUSION A multi-modal nomogram using traditional imaging features and radiomics of preoperative CT and MRI adds accuracy to the prediction of treatment outcome,and thus contributes to the personalized selection of neoadjuvant chemotherapy for LARC.
文摘Objectives： To compare the survival and perioperafive morbidity between primary debulking surgery （PDS） and neoadjuvant chemotherapy followed by interval debulking surgery （NAC/IDS） in treating patients with advanced epithelial ovarian cancer （EOC）. Methods： We retrospectively reviewed 67 patients with stage IIIC or iV EOC treated at Peking University Cancer Hospital from January 2006 to June 2009. VVherein, 37 and 30 patients underwent PDS and NAC/ IDS, respectively. Results： No difference in overall survival （OS） or progression-free survival （PFS） was observed between NAC/IDS group and PDS group （OS： 41.2 vs. 39.1 months, P=0.23; PFS： 27.1 vs. 24.3 months, P=0.37）. The optimal debulking rate was 60% in the NAC/IDS group, which was significantly higher than that in the PDS group （32.4%） （P=0.024）. The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion, lower nasogastric intubation rate, and earlier ambulation and recovery of intestinal function than the PDS group （P〈0.05）. Conclusions： NAC/IDS is less invasive than PDS, and offers the advantages regarding optimal cytoreduction rate, intraoperative blood loss, and postoperative recovery, without significantly impairing the survival compared with PDS in treating patients with stage IIIC or IV EOC. Therefore, NAC/IDS may be a valuable treatment alternative for EOC patients.
基金supported by grants from the Science and Technology Project of Guangzhou City,China(No.14570006)the National Natural Science Foundation of China(Nos.81372409,81402532)the Sun Yat-sen University Clinical Research 5010 Program(No.2012011)
文摘Background:In the era of intensity?modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NACT)in treating ascending?type nasopharyngeal carcinoma(NPC)is under?evaluated.This study was to compare the efficacy of NACT followed by IMRT(NACT+RT)with the efficacy of concurrent chemoradiotherapy(CCRT)on ascending?type NPC.Methods:Clinical data of 214 patients with ascending?type NPC treated with NACT+RT or CCRT between Decem?ber 2009 and July 2011 were analyzed.Of the 214 patients,98 were treated with NACT followed by IMRT,and 116 were treated with CCRT.The survival rates were assessed using Kaplan–Meier analysis,and the survival curves were compared using a log?rank test.Results:The 4?year overall survival,locoregional failure?free survival,distant failure?free survival,and failure?free sur?vival rates were not significantly different between the two groups(all P>0.05).However,patients in the CCRT group exhibited more severe acute adverse events than did patients in the NACT+RT group during radiotherapy,includ?ing leukopenia(30.2%vs.15.3%,P=0.016),neutropenia(25.9%vs.11.2%,P=0.011),and mucositis(57.8%vs.40.8%,P=0.028).After radiotherapy,patients in the CCRT group exhibited significantly higher rates of xerostomia(21.6%vs.Conclusions:The treatment outcomes of the NACT+RT and CCRT groups were similar;however,CCRT led to higher rates of acute and late toxicities.NACT+RT may therefore be a better treatment strategy for ascending?type NPC.
文摘BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In China,breast cancer is the fifth most common malignant tumor overall and the most common in women,accounting for 17%of female malignant tumors.AIM To investigate the accuracy of strain ultrasound elastography(SUE)on the evaluation of preoperative neoadjuvant chemotherapy(NAC)in breast cancer.METHODS Overall,90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study.The patients received six cycles of NAC with docetaxel,epirubicin,and cyclophosphamide.Surgical treatment was also performed,and pathological reactivity was assessed.The patients were evaluated using conventional ultrasonography and SUE before biopsy.The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test,while multivariate analysis was performed using logistic regression analysis.RESULTS Of the patients analyzed,20 had a pathological complete remission(pCR)while 70 did not achieve pCR after NAC.The ratio of the elastic strain ratio(SR)and elastic score of 4–5 in patients with pCR were 5.5±1.16 and 15.00%,respectively;these were significantly lower than those in patients without pCR(85%)and significantly higher than in patients without pCR(14%).SR and elastic score 4–5 were independent factors influencing NAC efficacy(OR=0.644,1.426 and 1.366,respectively,P<0.05).SR was positively correlated with elasticity score(rs=0.411,P<0.05).The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891,respectively(P<0.05).CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.
文摘Neoadjuvant chemotherapy followed by surgery （NCS） has not been fully evaluated clinically. Currently, the main regimen of neoadjuvant chemotherapy （NAC） used in NCS includes cisplatin. The antitumor effects of NAC reduce lymph node metastasis and the tumor diameter in patients prior to surgery, and this can reduce the number of high risk patients who require postoperative radiation therapy. Many randomized controlled trials （RCTs） have examined the long-term prognosis of NCS compared to primary surgery, but the utility of NCS remains uncertain. The advent of concurrent chemoradiotherapy （CCRT） has markedly improved the outcome of radiotherapy （RT）, and CCRT is now used as a standard method in many cases of advanced bulky cervical cancer. NCS gives a better treatment outcome than radiation therapy alone, but it is important to verify that NCS gives a similar or better outcome compared to CCRT.
文摘BACKGROUND Pancreaticoduodenectomy(PD)for advanced gastric cancer is rarely performed because of the high morbidity and mortality rates and low survival rate.However,neoadjuvant chemotherapy for advanced gastric cancer has improved,and chemotherapy combined with trastuzumab may have a preoperative tumorreducing effect,especially for human epidermal growth factor receptor 2(HER2)-positive cases.CASE SUMMARY We report a case of successful radical resection with PD after neoadjuvant S-1 plus oxaliplatin(SOX)and trastuzumab in a patient(66-year-old male)with advanced gastric cancer invading the pancreatic head.Initial esophagogastroduodenoscopy detected a type 3 advanced lesion located on the lower part of the stomach obstructing the pyloric ring.Computed tomography detected lymph node metastasis and tumor invasion to the pancreatic head without distant metastasis.Pathological findings revealed adenocarcinoma and HER2 positivity(immunohistochemical score of 3+).We performed staging laparoscopy and confirmed no liver metastasis,no dissemination,negative lavage cytological findings,and immobility of the distal side of the stomach due to invasion to the pancreas.Laparoscopic gastrojejunostomy was performed at that time.One course of SOX and three courses of SOX plus trastuzumab were administered.Preoperative computed tomography showed partial response;therefore,PD was performed after neoadjuvant chemotherapy,and pathological radical resection was achieved.CONCLUSION We suggest that radical resection with PD after neoadjuvant chemotherapy plus trastuzumab is an option for locally advanced HER2-positive gastric cancer invading the pancreatic head in the absence of non-curative factors.
基金Supported by the Guangzhou Science and Technology Project,No.201803010040Natural Science Foundation of Guangdong Province,No.2016A030310187Nation Key Clinical Discipline。
文摘BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.
