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:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditio...Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.展开更多
Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are...Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.展开更多
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
BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for ...BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.展开更多
Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designe...Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.展开更多
Objective Anthracycline-containing regimens are irreplaceable in neoadjuvant chemotherapy(NAC)for breast cancer(BC)at present.However,30% of early breast cancer(EBC)patients are resistant to anthracycline-containing c...Objective Anthracycline-containing regimens are irreplaceable in neoadjuvant chemotherapy(NAC)for breast cancer(BC)at present.However,30% of early breast cancer(EBC)patients are resistant to anthracycline-containing chemotherapy,leading to poor prognosis and higher mortality.Ki-67 is associated with the prognosis and response to therapy,and it changes after NAC.Methods A total of 105 BC patients who received anthracycline-containing NAC were enrolled.Then,the optimal model of Ki-67 was selected,and its predictive efficacy was analyzed.Immunohistochemistry(IHC)was used to determine the estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER-2)status and Ki-67 level.Fluorescent in situ hybridization(FISH)was used to verify the HER-2 when the IHC score was 2+.Results The post-NAC Ki67 level after treatment with anthracycline drugs was lower than pre-NAC Ki-67(19.6%±23.3%vs.45.6%±23.1%,P<0.001).Furthermore,patients with the Ki-67 decrease had a border line higher pathological complete response(pCR)rate(17.2%vs.0.0%,P=0.068),and a higher overall response rate(ORR)(73.6%vs.27.8%,P<0.001),when compared to patients without the Ki-67 decrease.The ΔKi-67 and ΔKi-67%were valuable markers for the prediction of both the pCR rate and ORR.The area under the curve(AUC)for ΔKi-67 on pCR and ORR was 0.809(0.698-0.921)and 0.755(0.655-0.855),respectively,while the AUC for ΔKi-67% on pCR and ORR was 0.857(0.742-0.972)and 0.720(0.618-0.822),respectively.Multivariate logistic regression model 1 revealed thatΔKi-67 was an independent predictor for both pCR[odds ratio(OR)=61.030,95% confidence interval(CI)=4.709-790.965;P=0.002]and ORR(OR=10.001,95%CI:3.044-32.858;P<0.001).Multivariate logistic regression model 2 revealed thatΔKi-67%was also an independent predictor for both pCR(OR=408.922,95%CI=8.908-18771.224;P=0.002)and ORR(OR=5.419,95%CI=1.842-15.943;P=0.002).Conclusions The present study results suggest thatΔKi67 andΔKi67%are candidate predictors for anthracycline-containing NAC response,and that they may provide various information for further systematic therapy after surgery in clinical practice.展开更多
BACKGROUND In recent studies,accumulating evidence has revealed a strong association between the inflammatory response and the prognosis of many tumors.There is a certain correlation of neutrophil-to-lymphocyte ratio(...BACKGROUND In recent studies,accumulating evidence has revealed a strong association between the inflammatory response and the prognosis of many tumors.There is a certain correlation of neutrophil-to-lymphocyte ratio(NLR)with the prognosis in gastric cancer(GC)patients undergoing neoadjuvant chemotherapy(NAC).However,the existing research results have remained controversial.AIM To explore the relationship between NLR ratio and prognosis of GC patients receiving NAC.METHODS A thorough systematic search was performed in databases such as PubMed,Embase,Web of Science,and Cochrane Library,the search is available until February 29,2024,and studies exploring the interaction of NLR with clinical outcomes were collected.Relevant studies meeting pre-defined inclusion and exclusion criteria were carefully chosen.The outcomes included progression-free survival(PFS),relapse-free survival,disease-free survival(DFS),and overall survival(OS).The hazard ratio(HR)and its corresponding 95%confidence interval(CI)were utilized for estimation.RESULTS Our analysis encompassed 852 patients and incorporated data from 12 cohort studies.The comprehensive analysis revealed a significant association of high NLR with reduced OS(HR=1.76;95%CI:1.22-2.54,P=0.003),relapsefree survival(HR=3.73;95%CI:1.74-7.96,P=0.0007),and PFS(HR=2.32;95%CI:1.42-3.81,P=0.0008)in patients.However,this correlation in disease-free survival was not significant.NLR demonstrated its crucial role in effectively predicting the OS of GC patients undergoing NAC at different detection times,ages,regions,and NLR thresholds.CONCLUSION In GC patients receiving NAC,an elevated NLR is strongly associated with reduced OS and PFS.NLR has become an effective biomarker for patient prognosis evaluation,providing valuable insights for the treatment strategies of NAC in GC patients.展开更多
BACKGROUND Stage classification for Siewert Ⅱ adenocarcinoma of the esophagogastric junction(AEG)treated with neoadjuvant chemotherapy(NAC)has not been established.AIM To investigate the optimal stage classification ...BACKGROUND Stage classification for Siewert Ⅱ adenocarcinoma of the esophagogastric junction(AEG)treated with neoadjuvant chemotherapy(NAC)has not been established.AIM To investigate the optimal stage classification for Siewert Ⅱ AEG with NAC.METHODS A nomogram was established based on Cox regression model that analyzed variables associated with overall survival(OS)and disease-specific survival(DSS).The nomogram performance in terms of discrimination and calibration ability was evaluated using the likelihood-ratio test,Akaike information criterion,Harrell concordance index,time-receiver operating characteristic curve,and decision curve analysis.RESULTS Data from 725 patients with Siewert type Ⅱ AEG who underwent neoadjuvant therapy and gastrectomy were obtained from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate analyses revealed that sex,marital status,race,ypT stage,and ypN stage were independent prognostic factors of OS,whereas sex,race,ypT stage,and ypN stage were independent prognostic factors for DSS.These factors were incorporated into the OS and DSS nomograms.Our novel nomogram model performed better in terms of OS and DSS prediction compared to the 8th American Joint Committee of Cancer pathological staging system for esophageal and gastric cancer.Finally,a user-friendly web application was developed for clinical use.CONCLUSION The nomogram established specifically for patients with Siewert type Ⅱ AEG receiving NAC demonstrated good prognostic performance.Validation using external data is warranted before its widespread clinical application.展开更多
BACKGROUND The efficacy of neoadjuvant chemotherapy(NAC)in advanced gastric cancer(GC)is still a controversial issue.AIM To find factors associated with chemosensitivity to NAC treatment and to provide the optimal the...BACKGROUND The efficacy of neoadjuvant chemotherapy(NAC)in advanced gastric cancer(GC)is still a controversial issue.AIM To find factors associated with chemosensitivity to NAC treatment and to provide the optimal therapeutic strategies for GC patients receiving NAC.METHODS The clinical information was collected from 230 GC patients who received NAC treatment at the Central South University Xiangya School of Medicine Affiliated Haikou Hospital from January 2016 to December 2020.Least absolute shrinkage and selection operator logistic regression analysis was used to find the possible predictors.A nomogram model was employed to predict the response to NAC.RESULTS In total 230 patients were finally included in this study,including 154 males(67.0%)and 76 females(33.0%).The mean age was(59.37±10.60)years,ranging from 24 years to 80 years.According to the tumor regression grade standard,there were 95 cases in the obvious response group(grade 0 or grade 1)and 135 cases in the poor response group(grade 2 or grade 3).The obvious response rate was 41.3%.Least absolute shrinkage and selection operator analysis showed that four risk factors significantly related to the efficacy of NAC were tumor location(P<0.001),histological differentiation(P=0.001),clinical T stage(P=0.008),and carbohydrate antigen 724(P=0.008).The C-index for the prediction nomogram was 0.806.The calibration curve revealed that the predicted value exhibited good agreement with the actual value.Decision curve analysis showed that the nomogram had a good value in clinical application.CONCLUSION A nomogram combining tumor location,histological differentiation,clinical T stage,and carbohydrate antigen 724 showed satisfactory predictive power to the response of NAC and can be used by gastrointestinal surgeons to determine the optimal treatment strategies for advanced GC patients.展开更多
Objective To investigate the serum lipid profiles of patients with localized osteosarcoma around the knee joint before and after neoadjuvant chemotherapy.Methods After retrospectively screening the data of 742 patient...Objective To investigate the serum lipid profiles of patients with localized osteosarcoma around the knee joint before and after neoadjuvant chemotherapy.Methods After retrospectively screening the data of 742 patients between January 2007 and July 2020,50 patients aged 13 to 39 years with Enneking stage II disease were included in the study.Serum lipid levels,including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein-α[Lp(a)],and apolipoprotein A1,B,and E(ApoA1,ApoB,and ApoE),and clinicopathological characteristics were collected before and after neoadjuvant chemotherapy.Results The mean levels of TC,TG,and ApoB were significantly increased following neoadjuvant chemotherapy(16%,38%,and 20%,respectively,vs.pretreatment values;P<0.01).The mean levels of LDL-C and ApoE were also 19%and 16%higher,respectively(P<0.05).No correlation was found between the pretreatment lipid profile and the histologic response to chemotherapy.An increase in Lp(a)was strongly correlated with the Ki-67 index(R=0.31,P=0.023).Moreover,a trend toward longer disease-free survival(DFS)was observed in patients with decreased TG and increased LDL-C following chemotherapy,although this difference was not statistically significant(P=0.23 and P=0.24,respectively).Conclusion Significant elevations in serum lipids were observed after neoadjuvant chemotherapy in patients with localized osteosarcoma.There was no prognostic significance of pretreatment serum lipid levels on histologic response to neoadjuvant chemotherapy.The scale of increase in serum Lp(a)might have a potential prognostic role in osteosarcoma.Patients with increased LDL-C or reduced TG after chemotherapy seem to exhibit a trend toward favorable DFS.展开更多
BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of debate.AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT...BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of debate.AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)for locally advanced EC(LAEC).METHODS A comprehensive search was conducted using multiple databases,including PubMed,EMBASE,MEDLINE,Science Direct,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Science and Technology Journal Database,and Chinese Biomedical Literature Database Article.Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected.RESULTS The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival.The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate(OSR)[odds ratio(OR)=0.95],complete response rate(OR=3.15),and R0 clearance rate(CR)(OR=2.25).However,nCT demonstrated a better 5-year OSR(OR=1.02)than nCRT.Moreover,when compared to nCRT,nCT showed reduced risks of cardiac complications(OR=1.15)and pulmonary complications(OR=1.30).CONCLUSION Overall,both nCRT and nCT were effective in terms of survival outcomes for LAEC.However,nCT exhibited better performance in terms of postoperative complications.展开更多
BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression...BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.展开更多
Objective:To evaluate the efficacy of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy for intermediate and advanced breast cancer using 3.0T MR and ultrasound in combination with tumour markers(CEA,...Objective:To evaluate the efficacy of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy for intermediate and advanced breast cancer using 3.0T MR and ultrasound in combination with tumour markers(CEA,CA-153,CA125),and to provide therapeutic references for the clinicians,so as to better satisfy the needs of treatment for intermediate and advanced breast cancer patients.Methods:The team collected 30 patients who were diagnosed with intermediate and advanced breast cancer by biopsy and received neoadjuvant chemotherapy,and divided them into sensitive and insensitive groups according to the MP grading of postoperative pathological results.The team retrospectively analysed the changes in the values of serum CEA,CA-153,and CA 125 before and after the neoadjuvant chemotherapy,the changes in the average ADC of the lesions before and after the observation by MRI,and the changes in the volume and size of lesions before and after the observation by ultrasonography to assess the effects of neoadjuvant chemotherapy individually,and the results of neoadjuvant chemotherapy were evaluated individually.The effect of neoadjuvant chemotherapy was assessed independently.Each of the above was evaluated independently,and the accuracy of each item was calculated by comparing the evaluation results with the pathological examination results,and the accuracy of the single item was compared with the accuracy of the three combined tests to determine whether the combined evaluation was more consistent.Results:All three examination and testing methods can achieve high accuracy,and the combined evaluation of the three is more accurate than the evaluation of the single way,and the difference is statistically significant(P<0.05).Conclusion:In neoadjuvant chemotherapy for breast cancer patients,the combined assessment of MR,CDFI and tumour markers can more comprehensively and accurately assess the effect of ADC,and more accurately guide the clinical treatment and determine the prognosis.展开更多
Breast cancer is a malignant tumor with the highest incidence in women. In recent years, the incidence of breast cancer has shown an increasing trend, especially in younger patients, which seriously threatens the life...Breast cancer is a malignant tumor with the highest incidence in women. In recent years, the incidence of breast cancer has shown an increasing trend, especially in younger patients, which seriously threatens the life and health of women. In order to improve the treatment effect of breast cancer, neoadjuvant chemotherapy has become a reliable strategy to cooperate with surgical treatment and improve the prognosis of advanced breast cancer, which is conducive to quickly and accurately curbing the growth of cancer cells, controlling the patients’ condition, reducing their pain, and improving the cure rate of breast cancer patients. This paper analyzes the development history of ultrasound radiomics, explores its application in the evaluation and prediction of neoadjuvant chemotherapy for breast cancer, and clarifies the research results of multimodal ultrasound radiomics in the analysis of high-order characteristics of breast cancer tumors and the evaluation of tumor heterogeneity, so as to provide references for the clinical treatment of breast cancer.展开更多
文摘BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a frequent complication in these patients.AIM To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer.METHODS The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College,Pidu District People’s Hospital,Chengdu,China,between January 2016 and January 2021,were retrospectively analyzed.All patients underwent a tegafur+oxaliplatin+apatinib chemotherapy regimen.According to the efficacy of chemotherapy,they were divided into an effective group(complete or partial response,n=121)and an ineffective group(stable disease or disease progression,n=64).The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses.The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared.RESULTS Univariate analysis showed that the proportion of patients with a tumor diameter>5 cm,non-tubular adenocarcinoma,lymph node metastasis,hematocrit<33%,low mean red blood cell(RBC)protein content,low RBC distribution width,hemoglobin<107 g/L,and platelets>266×109/L in the ineffective group were significantly higher than those in the effective group(P<0.05).Logistic multivariate analysis showed that a tumor diameter>5 cm,lymph node metastasis,≤3 chemotherapy cycles,hematocrit<33%,and hemoglobin<107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer(P<0.05).The 1-year,2-year,and 3-year survival rates in the effective group were 93.39%,83.47%,and 60.33%,respectively.These rates were significantly higher than those in the ineffective group(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hematocrit<33%were 74.67%,49.33%,and 29.33%,respectively,which were significantly lower than those of patients with hematocrit≥33%(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hemoglobin<107 g/L were 80.39%,58.82%,and 39.22%,respectively,which were significantly lower than those of patients with hemoglobin≥107 g/L(P<0.05).CONCLUSION Hematocrit<33%and hemoglobin<107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer.They are associated with poorer prognosis and reduced 3-year survival rates.
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.
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University)and Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
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 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BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.
基金supported by Beijing Municipal Administration of Hospitals Incubating Program (No.PZ2020027)Beijing Talent Incubating Funding (No.2019-4)+3 种基金National Natural Science Foundation of China (No.81773214)Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No.ZYLX202116)2019 Major and Difficult Diseases Chinese and Western Medicine Coordination Capacity Colorectal Cancer Project [No.(2018)275]Science Foundation of Peking University Cancer Hospital-2023 (No.JC202310)
文摘Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.
基金supported by grants from the Beijing Hospitals Authority Youth Programme,China(No.QML20231602)the Young Elite Scientist Sponsorship Program by Beijing Association for Science and Technology(BAST)(No.BYESS2023226).
文摘Objective Anthracycline-containing regimens are irreplaceable in neoadjuvant chemotherapy(NAC)for breast cancer(BC)at present.However,30% of early breast cancer(EBC)patients are resistant to anthracycline-containing chemotherapy,leading to poor prognosis and higher mortality.Ki-67 is associated with the prognosis and response to therapy,and it changes after NAC.Methods A total of 105 BC patients who received anthracycline-containing NAC were enrolled.Then,the optimal model of Ki-67 was selected,and its predictive efficacy was analyzed.Immunohistochemistry(IHC)was used to determine the estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER-2)status and Ki-67 level.Fluorescent in situ hybridization(FISH)was used to verify the HER-2 when the IHC score was 2+.Results The post-NAC Ki67 level after treatment with anthracycline drugs was lower than pre-NAC Ki-67(19.6%±23.3%vs.45.6%±23.1%,P<0.001).Furthermore,patients with the Ki-67 decrease had a border line higher pathological complete response(pCR)rate(17.2%vs.0.0%,P=0.068),and a higher overall response rate(ORR)(73.6%vs.27.8%,P<0.001),when compared to patients without the Ki-67 decrease.The ΔKi-67 and ΔKi-67%were valuable markers for the prediction of both the pCR rate and ORR.The area under the curve(AUC)for ΔKi-67 on pCR and ORR was 0.809(0.698-0.921)and 0.755(0.655-0.855),respectively,while the AUC for ΔKi-67% on pCR and ORR was 0.857(0.742-0.972)and 0.720(0.618-0.822),respectively.Multivariate logistic regression model 1 revealed thatΔKi-67 was an independent predictor for both pCR[odds ratio(OR)=61.030,95% confidence interval(CI)=4.709-790.965;P=0.002]and ORR(OR=10.001,95%CI:3.044-32.858;P<0.001).Multivariate logistic regression model 2 revealed thatΔKi-67%was also an independent predictor for both pCR(OR=408.922,95%CI=8.908-18771.224;P=0.002)and ORR(OR=5.419,95%CI=1.842-15.943;P=0.002).Conclusions The present study results suggest thatΔKi67 andΔKi67%are candidate predictors for anthracycline-containing NAC response,and that they may provide various information for further systematic therapy after surgery in clinical practice.
基金National Natural Science Foundation of China,No.82360477 and No.82060539Natural Science Foundation of Hubei Province of China,No.2022CFB344+1 种基金the Scientific and Technological Project of Enshi Tujia and Miao Autonomous Prefecture of Hubei Province,No.D20220059“Selenium Engineering”Science and Technology Project of Enshi Tujia and Miao Autonomous Prefecture of Hubei Province,No.D20230071.
文摘BACKGROUND In recent studies,accumulating evidence has revealed a strong association between the inflammatory response and the prognosis of many tumors.There is a certain correlation of neutrophil-to-lymphocyte ratio(NLR)with the prognosis in gastric cancer(GC)patients undergoing neoadjuvant chemotherapy(NAC).However,the existing research results have remained controversial.AIM To explore the relationship between NLR ratio and prognosis of GC patients receiving NAC.METHODS A thorough systematic search was performed in databases such as PubMed,Embase,Web of Science,and Cochrane Library,the search is available until February 29,2024,and studies exploring the interaction of NLR with clinical outcomes were collected.Relevant studies meeting pre-defined inclusion and exclusion criteria were carefully chosen.The outcomes included progression-free survival(PFS),relapse-free survival,disease-free survival(DFS),and overall survival(OS).The hazard ratio(HR)and its corresponding 95%confidence interval(CI)were utilized for estimation.RESULTS Our analysis encompassed 852 patients and incorporated data from 12 cohort studies.The comprehensive analysis revealed a significant association of high NLR with reduced OS(HR=1.76;95%CI:1.22-2.54,P=0.003),relapsefree survival(HR=3.73;95%CI:1.74-7.96,P=0.0007),and PFS(HR=2.32;95%CI:1.42-3.81,P=0.0008)in patients.However,this correlation in disease-free survival was not significant.NLR demonstrated its crucial role in effectively predicting the OS of GC patients undergoing NAC at different detection times,ages,regions,and NLR thresholds.CONCLUSION In GC patients receiving NAC,an elevated NLR is strongly associated with reduced OS and PFS.NLR has become an effective biomarker for patient prognosis evaluation,providing valuable insights for the treatment strategies of NAC in GC patients.
基金Supported by Key R&D Program of Zhejiang,No.2023C03172.
文摘BACKGROUND Stage classification for Siewert Ⅱ adenocarcinoma of the esophagogastric junction(AEG)treated with neoadjuvant chemotherapy(NAC)has not been established.AIM To investigate the optimal stage classification for Siewert Ⅱ AEG with NAC.METHODS A nomogram was established based on Cox regression model that analyzed variables associated with overall survival(OS)and disease-specific survival(DSS).The nomogram performance in terms of discrimination and calibration ability was evaluated using the likelihood-ratio test,Akaike information criterion,Harrell concordance index,time-receiver operating characteristic curve,and decision curve analysis.RESULTS Data from 725 patients with Siewert type Ⅱ AEG who underwent neoadjuvant therapy and gastrectomy were obtained from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate analyses revealed that sex,marital status,race,ypT stage,and ypN stage were independent prognostic factors of OS,whereas sex,race,ypT stage,and ypN stage were independent prognostic factors for DSS.These factors were incorporated into the OS and DSS nomograms.Our novel nomogram model performed better in terms of OS and DSS prediction compared to the 8th American Joint Committee of Cancer pathological staging system for esophageal and gastric cancer.Finally,a user-friendly web application was developed for clinical use.CONCLUSION The nomogram established specifically for patients with Siewert type Ⅱ AEG receiving NAC demonstrated good prognostic performance.Validation using external data is warranted before its widespread clinical application.
基金Supported by Natural Science Foundation of Hainan Province,No.823RC609.
文摘BACKGROUND The efficacy of neoadjuvant chemotherapy(NAC)in advanced gastric cancer(GC)is still a controversial issue.AIM To find factors associated with chemosensitivity to NAC treatment and to provide the optimal therapeutic strategies for GC patients receiving NAC.METHODS The clinical information was collected from 230 GC patients who received NAC treatment at the Central South University Xiangya School of Medicine Affiliated Haikou Hospital from January 2016 to December 2020.Least absolute shrinkage and selection operator logistic regression analysis was used to find the possible predictors.A nomogram model was employed to predict the response to NAC.RESULTS In total 230 patients were finally included in this study,including 154 males(67.0%)and 76 females(33.0%).The mean age was(59.37±10.60)years,ranging from 24 years to 80 years.According to the tumor regression grade standard,there were 95 cases in the obvious response group(grade 0 or grade 1)and 135 cases in the poor response group(grade 2 or grade 3).The obvious response rate was 41.3%.Least absolute shrinkage and selection operator analysis showed that four risk factors significantly related to the efficacy of NAC were tumor location(P<0.001),histological differentiation(P=0.001),clinical T stage(P=0.008),and carbohydrate antigen 724(P=0.008).The C-index for the prediction nomogram was 0.806.The calibration curve revealed that the predicted value exhibited good agreement with the actual value.Decision curve analysis showed that the nomogram had a good value in clinical application.CONCLUSION A nomogram combining tumor location,histological differentiation,clinical T stage,and carbohydrate antigen 724 showed satisfactory predictive power to the response of NAC and can be used by gastrointestinal surgeons to determine the optimal treatment strategies for advanced GC patients.
基金supported by China Medicine Education Association(CMEA)(No.2020KTS012)the National Natural Science Foundation of China(NSFC)(No.82002962 and No.81900189).
文摘Objective To investigate the serum lipid profiles of patients with localized osteosarcoma around the knee joint before and after neoadjuvant chemotherapy.Methods After retrospectively screening the data of 742 patients between January 2007 and July 2020,50 patients aged 13 to 39 years with Enneking stage II disease were included in the study.Serum lipid levels,including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein-α[Lp(a)],and apolipoprotein A1,B,and E(ApoA1,ApoB,and ApoE),and clinicopathological characteristics were collected before and after neoadjuvant chemotherapy.Results The mean levels of TC,TG,and ApoB were significantly increased following neoadjuvant chemotherapy(16%,38%,and 20%,respectively,vs.pretreatment values;P<0.01).The mean levels of LDL-C and ApoE were also 19%and 16%higher,respectively(P<0.05).No correlation was found between the pretreatment lipid profile and the histologic response to chemotherapy.An increase in Lp(a)was strongly correlated with the Ki-67 index(R=0.31,P=0.023).Moreover,a trend toward longer disease-free survival(DFS)was observed in patients with decreased TG and increased LDL-C following chemotherapy,although this difference was not statistically significant(P=0.23 and P=0.24,respectively).Conclusion Significant elevations in serum lipids were observed after neoadjuvant chemotherapy in patients with localized osteosarcoma.There was no prognostic significance of pretreatment serum lipid levels on histologic response to neoadjuvant chemotherapy.The scale of increase in serum Lp(a)might have a potential prognostic role in osteosarcoma.Patients with increased LDL-C or reduced TG after chemotherapy seem to exhibit a trend toward favorable DFS.
文摘BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of debate.AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)for locally advanced EC(LAEC).METHODS A comprehensive search was conducted using multiple databases,including PubMed,EMBASE,MEDLINE,Science Direct,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Science and Technology Journal Database,and Chinese Biomedical Literature Database Article.Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected.RESULTS The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival.The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate(OSR)[odds ratio(OR)=0.95],complete response rate(OR=3.15),and R0 clearance rate(CR)(OR=2.25).However,nCT demonstrated a better 5-year OSR(OR=1.02)than nCRT.Moreover,when compared to nCRT,nCT showed reduced risks of cardiac complications(OR=1.15)and pulmonary complications(OR=1.30).CONCLUSION Overall,both nCRT and nCT were effective in terms of survival outcomes for LAEC.However,nCT exhibited better performance in terms of postoperative complications.
文摘BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.
基金Weifang Science and Technology Development Programme Project(Medicine)(2021YX144)Weifang Municipal Health Commission Chinese Medicine Research Project(WFZYY2024-1-014).
文摘Objective:To evaluate the efficacy of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy for intermediate and advanced breast cancer using 3.0T MR and ultrasound in combination with tumour markers(CEA,CA-153,CA125),and to provide therapeutic references for the clinicians,so as to better satisfy the needs of treatment for intermediate and advanced breast cancer patients.Methods:The team collected 30 patients who were diagnosed with intermediate and advanced breast cancer by biopsy and received neoadjuvant chemotherapy,and divided them into sensitive and insensitive groups according to the MP grading of postoperative pathological results.The team retrospectively analysed the changes in the values of serum CEA,CA-153,and CA 125 before and after the neoadjuvant chemotherapy,the changes in the average ADC of the lesions before and after the observation by MRI,and the changes in the volume and size of lesions before and after the observation by ultrasonography to assess the effects of neoadjuvant chemotherapy individually,and the results of neoadjuvant chemotherapy were evaluated individually.The effect of neoadjuvant chemotherapy was assessed independently.Each of the above was evaluated independently,and the accuracy of each item was calculated by comparing the evaluation results with the pathological examination results,and the accuracy of the single item was compared with the accuracy of the three combined tests to determine whether the combined evaluation was more consistent.Results:All three examination and testing methods can achieve high accuracy,and the combined evaluation of the three is more accurate than the evaluation of the single way,and the difference is statistically significant(P<0.05).Conclusion:In neoadjuvant chemotherapy for breast cancer patients,the combined assessment of MR,CDFI and tumour markers can more comprehensively and accurately assess the effect of ADC,and more accurately guide the clinical treatment and determine the prognosis.
文摘Breast cancer is a malignant tumor with the highest incidence in women. In recent years, the incidence of breast cancer has shown an increasing trend, especially in younger patients, which seriously threatens the life and health of women. In order to improve the treatment effect of breast cancer, neoadjuvant chemotherapy has become a reliable strategy to cooperate with surgical treatment and improve the prognosis of advanced breast cancer, which is conducive to quickly and accurately curbing the growth of cancer cells, controlling the patients’ condition, reducing their pain, and improving the cure rate of breast cancer patients. This paper analyzes the development history of ultrasound radiomics, explores its application in the evaluation and prediction of neoadjuvant chemotherapy for breast cancer, and clarifies the research results of multimodal ultrasound radiomics in the analysis of high-order characteristics of breast cancer tumors and the evaluation of tumor heterogeneity, so as to provide references for the clinical treatment of breast cancer.
