Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation...Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).展开更多
Pancreatic ductal adenocarcinoma(PDAC)remains one of the most challenging malignancies,with poor survival rates due to late-stage diagnosis and limited treatment options.Neoadjuvant therapy(NAT),which involves chemoth...Pancreatic ductal adenocarcinoma(PDAC)remains one of the most challenging malignancies,with poor survival rates due to late-stage diagnosis and limited treatment options.Neoadjuvant therapy(NAT),which involves chemotherapy or chemoradiation prior to surgical resection,has emerged as a promising approach to improve resectability and overall survival(OS).The integration of advanced imaging techniques and biomarkers for evaluating the response to NAT is crucial for optimizing therapeutic strategies and surgical outcomes.However,challenges related to the heterogeneity of treatment protocols and the need for predictive biomarkers remain,highlighting the necessity for further clinical trials.The aim is to evaluate the impact of NAT on surgical outcomes and predictive markers in pancreatic cancer.A comprehensive review of the literature was conducted to evaluate the impact of NAT on surgical resectability,survival outcomes,and the role of imaging and biomarkers in assessing therapeutic response.Studies examining the efficacy of NAT in patients with PDAC,the predictive value of serum biomarkers such as carbohydrate antigen 19-9(CA 19-9),and the utility of advanced imaging modalities such as positron emission tomography/computed tomography with 18F-fluorodeoxyglucose(FDG-PET/CT)were included.NAT has demonstrated significant benefits in downstaging tumors,increasing marginnegative(R0)resection rates,and reducing micrometastatic disease.The use of serum CA 19-9 Levels as a biomarker for response evaluation and imaging modalities such as FDG-PET/CT and magnetic resonance imaging has proven valuable in predicting therapeutic efficacy and guiding surgical planning.Studies have shown that significant reductions in CA 19-9 Levels and favorable metabolic responses on imaging are associated with higher R0 resection rates and longer survival.Furthermore,the integration of multimodal imaging and biomarker assessment has enabled better stratification of patients and more personalized treatment strategies.NAT significantly improves surgical outcomes and survival in patients with resectable and borderline resectable PDAC.Advanced imaging techniques and biomarkers such as CA 19-9 play pivotal roles in evaluating the response to therapy and guiding surgical decision-making.Future research should focus on addressing variability in treatment strategies and developing more reliable predictive biomarkers.展开更多
BACKGROUND Neoadjuvant therapies induce tumor regression,resulting in improved surgical resection and pathologic complete response rates,as well as long-term diseasefree and overall survival(OS).In addition to the tum...BACKGROUND Neoadjuvant therapies induce tumor regression,resulting in improved surgical resection and pathologic complete response rates,as well as long-term diseasefree and overall survival(OS).In addition to the tumor regression score,serum inflammatory markers,including neutrophil,lymphocyte,platelet,and serum albumin levels,are used to determine prognosis.AIM To investigate the effect of histological features and serum inflammatory markers on the prognosis of gastric cancer following neoadjuvant treatment.METHODS Neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and serum albumin levels were retrospectively recorded for 177 patients receiving neoadjuvant 5-fluorouracil,leucovorin,oxaliplatin and docetaxel chemotherapy.Disease-free and OS were analyzed based on tumor histopathological features,type of surgery,regression scores,and serum inflammatory markers.RESULTS Patients over 65 years of age,those with lymphovascular or perineural invasion,hypoalbuminemia,and those who did not receive adjuvant therapy were found to be at higher risk for shorter recurrence/relapse intervals[hazard ratio(HR):1.64,P=0.04;HR:4.20,P<0.001;HR:1.87,P=0.03;HR:3.5,P<0.001;and HR:2.73,P=0.01,respectively].Lymphovascular invasion,R1 resection,lack of adjuvant treatment,and hypoalbuminemia negatively influenced OS(HR:3.68,P<0.003;HR:2.37,P=0.01;HR:3.99,P<0.001;and HR:2.50,P=0.01,respectively).No effect of NLR and PLR was observed.CONCLUSION Current neoadjuvant therapies prolong disease-free and OS.The practical application of serum inflammatory markers(NLR and PLR)is limited due to the lack of standard cut-off values.Nutritional status,hypoalbuminemia,and incomplete perioperative chemotherapy have been associated with poor prognosis.展开更多
BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple m...BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple machine learning algorithms based on magnetic resonance imaging(MRI)radiomics.METHODS This retrospective study included 132 patients with pathologically confirmed EC,were randomly divided into a training cohort(n=92)and a validation cohort(n=40)in a 7:3 ratio.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI).Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Nine classification algorithms were used to build the models,and the diagnostic performance of each model was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 1834 features were extracted.Following feature dimension reduction,ten radiomics features were selected to construct radiomics signatures.Among the nine classification algorithms,the ExtraTrees algorithm demonstrated the best diagnostic performance in both the training(AUC:0.932;SEN:0.906;SPE:0.817)and validation cohorts(AUC:0.900;SEN:0.667;SPE:0.700).The Delong test proved no significance in the diagnostic efficiency within these models(P>0.05).CONCLUSION T2WI radiomics may aid in determining the pathological response to NAT in EC patients,serving as a noninvasive and quantitative tool to assist personalized treatment planning.展开更多
BACKGROUND Neoadjuvant therapy prior to surgery plays a critical role in improving the prognosis of patients with unresectable or locally advanced gastric cancer(GC).Postoperative complications,particularly those clas...BACKGROUND Neoadjuvant therapy prior to surgery plays a critical role in improving the prognosis of patients with unresectable or locally advanced gastric cancer(GC).Postoperative complications,particularly those classified as Clavien-Dindo grade≥II,remain a major concern for surgeons.In recent years machine learning(ML)has emerged as a prominent approach for disease diagnosis and prediction.However,studies on both postoperative complications and ML in patients with GC receiving neoadjuvant therapy remain limited.AIM To develop an ML model to predict Clavien-Dindo grade≥II complications in patients with GC after neoadjuvant therapy and laparoscopic gastrectomy.METHODS Clinical data were collected from 455 patients with GC who underwent neoadjuvant therapy followed by laparoscopic gastrectomy at Peking Union Medical College Hospital(2014-2024).Potential predictors were identified through univariate analysis and least absolute shrinkage and selection operator regression.Six ML algorithms including XGBoost,random forest,neural network ensemble(NNE),logistic regression,GLMnet,and decision tree were trained and optimized using nested cross-validation.Model performance was evaluated using the area under the receiver operating characteristic curve,decision curve analysis,and calibration curves.RESULTS A total of 455 patients were included of whom 69(15.16%)developed Clavien-Dindo grade≥II complications.The predictive model was constructed using seven variables,including smoking status,Nutritional Risk Screening-2002 score,American Society of Anesthesiologists classification,neoadjuvant therapy,surgical approach,operating time,and intraoperative blood loss.Among the six models the NNE model outperformed the others,achieving the highest area under the receiver operating characteristic curve(0.789,0.739-0.840)and demonstrating superior discrimination,clinical utility,and calibration.CONCLUSION The NNE-based prediction model effectively identified patients with GC at high risk of Clavien-Dindo grade≥II complications after neoadjuvant therapy and laparoscopic gastrectomy.展开更多
Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT h...Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT has become an urgent world-wide clinical problem.Our work aims to the assessment of neoadjuvant treatment response in breast cancer patients for higher accuracy prediction using innovative artificial intelligence system.Methods:In this study,we retrospectively collected longitudinal(pre-NAT and post-NAT)multi-parametric magnetic resonance imaging(MRI)and clinicopathologic data of a total of 1,315 breast cancer patients(clinical stageⅠ-Ⅲ)who had undergone NAT followed by standard surgery and treated across 5 independent medical centers from January 2010 to January 2023.We used radiomics,3D convolutional neural network technology and clinical data statistical analysis methods to extract and screen multimodal features,and then developed and validated a Clinical-Radiomics-Deep-Learning(CRDL)model to predict patients'pCR outcomes based on multimodal fusion features.Results:We use the area under the receiver operating characteristic curve(AUC)in the primary cohort(PC)and3 external validation cohorts(VC_(1-3))to evaluate the model performance.The results showed that the AUC in the PC composed of 2 medical centers was 0.947[95%confidence interval(95%CI):0.931-0.960],and the AUC values in VC_(1-3)were 0.857(95%CI:0.810-0.901),0.883(95%CI:0.841-0.918)and 0.904(95%CI:0.860-0.941),respectively.Conclusions:The CRDL model demonstrated high accuracy and robustness in predicting pCR to NAT using multimodal fusion data.This study provides a strong foundation for non-invasive assessment of pCR status in breast cancer patients following NAT and offers critical insights to guide clinical decision-making in post-NAT treatment planning.展开更多
The high postoperative recurrence rate remains a major challenge in the treatment of hepatocellular carcinoma(HCC)following resection.Increasing research has been delved into investigating the role of neoadjuvant ther...The high postoperative recurrence rate remains a major challenge in the treatment of hepatocellular carcinoma(HCC)following resection.Increasing research has been delved into investigating the role of neoadjuvant therapy on the prognosis of resectable HCC.Recent trends in combination therapy with molecularly targeted agents and immune checkpoint inhibitors have significantly improved the efficacy of systemic antitumor treatments,yielding survival benefits exceeding 40%.Neoadjuvant therapy for HCC,whether based on systemic antitumor treatments,locoregional therapies,or their combination,has emerged as a promising research direction.However,there remains a matter of debate on neoadjuvant therapy.In this review,we summarize and discuss the research progress and challenges of neoadjuvant therapy for HCC over the past five years from the perspective of Chinese guidelines to provide new insights and future directions in this field.展开更多
BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surger...BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.展开更多
Objective:A subset of patients with human epidermal growth factor receptor 2 positive(HER2+)breast cancer shows insensitivity to neoadjuvant therapy(NAT),often evidenced by imaging results indicating stable disease(SD...Objective:A subset of patients with human epidermal growth factor receptor 2 positive(HER2+)breast cancer shows insensitivity to neoadjuvant therapy(NAT),often evidenced by imaging results indicating stable disease(SD)or progressive disease(PD),which may reflect intrinsic resistance to treatment.We aimed to investigate the factors associated with NAT insensitivity and its prognostic value in HER2+breast cancer.Methods:This study included consecutive patients with HER2+breast cancer who received NAT consisting of chemotherapy combined with anti-HER2 monoclonal antibodies.NAT insensitivity was defined as SD or PD on the basis of treatment response evaluations.Statistical analyses were conducted on the collected clinical data,and HER2 heterogeneity was subsequently assessed.Results:A total of 541 patients were included in the study,among whom 63(11.6%)were categorized as NATinsensitive group and 478(88.4%)as NAT-sensitive group.Hormone receptor(HR)status(P=0.033),HER2 status(P=0.036)and anti-HER2 therapy(P=0.007)were associated with NAT sensitivity.NAT-insensitive group had a significantly shorter event-free survival(EFS)(3-year:69.4%vs.94.3%;P<0.001)and remained an independent prognostic factor according to Cox models[hazard ratio(HR)=8.637;95%confidence interval(95%CI),3.091-24.136;P<0.001].Exploratory analysis revealed a greater proportion of HER2 heterogeneity in the NAT-insensitive group(19.4%vs.4.3%;P=0.035).Conclusions:HR positivity,HER22+/fluorescence in situ hybridization(FISH)+status,and trastuzumab monotherapy are associated with NAT insensitivity,and NAT insensitivity independently indicates poor EFS.This study also highlights the need for prospective studies to clarify the role of HER2 heterogeneity and other mechanisms involved in predicting the response to NAT.展开更多
Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)foll...Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)following NAT by evaluating the prognostic outcomes associated with various T and N stages,utilizing multicenter data from China.Methods:Patients who underwent NAT following radical gastrectomy at 10 tertiary hospitals in China between2008 and 2021 were included.The ORP was introduced to explore the disease-free survival(DFS),overall survival(OS),recurrence patterns,and influencing factors following propensity score matching(PSM).Results:A total of 1,076 patients were enrolled in this study(median follow-up period:60 months).We defined ORP as a pCR or tumor infiltration of the mucosal or submucosal layer without lymph node metastasis(pCR or yp T1N0)after NAT.The ORP group comprised 136 patients(12.6%),while the non-ORP group comprised 940patients(87.4%).After applying a 1:4 PSM,we obtained an ORP group of 136 patients and non-ORP group of 544patients.Survival analysis demonstrated that both the 3-year OS(before PSM:89.0%vs.55.0%,P<0.001;after PSM:89.0%vs.55.4%,P<0.001)and DFS(before PSM:85.8%vs.49.7%,P<0.001;after PSM:85.8%vs.50.6%,P<0.001)were significantly superior in the ORP group compared to that in the non-ORP group.Remarkably,adjuvant chemotherapy did not impact the prognosis of patients in the ORP group(3-year OS:89.0%vs.89.7%,P=0.988;3-year DFS:84.9%vs.89.7%,P=0.700).Conclusions:This study reevaluates patients with ORP following NAT,providing a more comprehensive and accurate depiction of the potential beneficiary group and survival outcomes in patients with locally advanced GC.展开更多
BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT e...BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.展开更多
Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains...Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.展开更多
Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to ...Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to the“NCCN Lung Cancer Guidelines,”stage IV NSCLC lung cancer is a contraindication for surgery.It is recommended to adopt a standard treatment plan mainly based on chemotherapy or targeted therapy with EGFR-TKIs.However,Neoadjuvant therapy with alectinib for non-small cell lung cancer with pleural metastasis is rarely reported.Case presentation:A 41-year-old Asian male patient presented with a persistent cough for one month.A chest computed tomography(CT)scan conducted two years prior revealed that a nodular radiative anomalous concentrated shadow was observed in the inferior tongue segment of the upper lobe of the left lung,approximately 2.2×1.6×1.2 cm in size,with a SUVmax of about 5.5.Two small nodular shadows were seen beside the disease in the inferior lingual segment of the upper lobe of the left lung,with the larger one having a diameter of approximately 0.6 cm.Multiple lymph node metastases in the left hilum and mediastinum;Multiple metastases of the left pleura and a small amount of pleural effusion on the left side.The patient began to receive 2 courses of chemotherapy and targeted therapy(pemetrexed+carboplatin+crizotinib)and 1 course of chemotherapy and other targeted therapy(pemetrexed+carboplatin+alectinib).The result of re-examination of CT demonstrated that peripheral lung cancer in the lower lingual segment of the left upper lung is approximately 0.8×0.9 cm in size,slightly smaller than before.A thoracoscopic lobectomy was performed,and the pulmonary bulla was removed concurrently.Pathological examination confirmed non-small cell lung carcinoma(NSCLC)in the mass.Patient discharged on the 7th day after the operation and received 2 courses of chemotherapy(pemetrexed+carboplatin)and had been receiving alectinib targeted drug treatment all along for over 5 years.However,the patient stopped taking the medicine on his own for half a year.Though in the recent CT examination,the result demonstrated no recurrence and metastasis and the patient has been clinically cured.Unfortunately,the results of brain magnetic resonance imaging suggested that multiple brain metastases of lung cancer occurred,and the patient began taking the third-generation ALK-targeted drug lorlatinib.Conclusions:The patient with stage IV non-small cell lung cancer(NSCLC)presenting with pleural metastasis received neoadjuvant alectinib therapy and underwent thoracoscopic lobectomy,which resulted in significant therapeutic effects and fulfilled the criteria for clinical cure.This case highlights the potential for improved preventative strategies and treatment approaches in similar patients.展开更多
BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for...BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.展开更多
Objective: The aim of this study was to investigate the factors influencing pathological complete response(pCR)rate in early breast cancer patients receiving neoadjuvant dual-target [trastuzumab(H) + pertuzumab(P)] th...Objective: The aim of this study was to investigate the factors influencing pathological complete response(pCR)rate in early breast cancer patients receiving neoadjuvant dual-target [trastuzumab(H) + pertuzumab(P)] therapy combined with chemotherapy. Additionally, the consistency of the Miller-Payne and residual cancer burden(RCB)systems in evaluating the efficacy of neoadjuvant therapy for early human epidermal growth factor receptor-2(HER2)+ breast cancer was analyzed.Methods: The clinicopathological data of female patients with early-stage HER2+ breast cancer who received dual-target neoadjuvant therapy at 26 hospitals of the Chinese Society of Breast Surgery(CSBrS) from March 2019 to December 2021 were collected. Patients were allocated to four groups: the HER2 immunohistochemistry(IHC)3+/hormone receptor(HR)-, IHC3+/HR+, IHC2+ in situ hybridization(ISH)+/HR-and IHC2+ ISH+/HR+groups. The overall pCR rate for patients, the pCR rate in each group and the factors affecting the pCR rate were analyzed. The consistency between the Miller-Payne and RCB systems in assessing the efficacy of neoadjuvant therapy was analyzed.Results: From March 1, 2019, to December 31, 2021, 77,376 female patients with early-stage breast cancer were treated at 26 hospitals;18,853(24.4%) of these patients were HER2+. After exclusion of unqualified patients, 2,395 patients who received neoadjuvant dual-target(H+P) therapy combined with chemotherapy were included in this study. The overall pCR rate was 53.0%, and the patients' HR statuses and different HER2+ statuses were significantly correlated with the pCR rate(P<0.05). The consistency of the pathological efficacy assessed by the Miller-Payne and RCB systems was 88.0%(κ=0.717, P<0.001).Conclusions: Different HER2 expression statuses and HR expression statuses are correlated with the pCR rate after dual-target neoadjuvant therapy in HER2+ breast cancer patients. There is a relatively good consistency between Miller-Payne and RCB systems in evaluating the pathologic efficacy of neoadjuvant therapy for HER2+breast cancer.展开更多
Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection prov...Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection provides the only chance at cure, data from trials of postoperative chemoradiation and/or chemotherapy demonstrate a modest survival advantage over those patients who undergo resection alone. As such, most practitioners believe that completion of multimodality therapy is the optimal treatment. However, the sequence of surgery, chemotherapy and radiation therapy is frequently debated, as patients may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to resection. Here we review the rationale for neoadjuvant therapy, which includes a higher rate of completion of multimodality therapy, minimizing the risk of unnecessary surgical resection for patients who develop early metastatic disease, improved surgical outcomes and the potential for longer overall survival. However, there are no prospective, randomized studies of the neoadjuvant approach compared to a surgeryfirst strategy; the established and ongoing investigations of neoadjuvant therapy for pancreatic cancer are discussed in detail. Lastly, as the future of therapeutic regimens is likely to entail patient-specific genetic and molecular analyses, and the treatment that is best applied based on those data, a review of clinically relevant biomarkers in pancreatic cancer is also presented.展开更多
Gastric cancer is one of the most common digestive system tumors in China,and locally advanced gastric cancer(LAGC)accounts for a high proportion of newly diagnosed cases.Although surgery is the main treatment for gas...Gastric cancer is one of the most common digestive system tumors in China,and locally advanced gastric cancer(LAGC)accounts for a high proportion of newly diagnosed cases.Although surgery is the main treatment for gastric cancer,surgical excision alone cannot achieve satisfactory outcomes in LAGC patients.Neoadjuvant therapy(NAT)has gradually become the standard treatment for patients with LAGC,and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate,but it also significantly improves the long-term prognosis of patients.Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies,and the regimens have also been evolved in the past decades.Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide,here,we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019,and also discuss the future of NAT.展开更多
BACKGROUND The prognosis of intrahepatic cholangiocarcinoma(ICC) with lymph node metastasis is poor.The feasibility of surgery is not certain,which is a contraindication according to the National Comprehensive Cancer ...BACKGROUND The prognosis of intrahepatic cholangiocarcinoma(ICC) with lymph node metastasis is poor.The feasibility of surgery is not certain,which is a contraindication according to the National Comprehensive Cancer Network guidelines.The role of immunotherapy as a neoadjuvant therapy for ICC is not clear.We herein describe a case of ICC with lymph node metastasis that was successfully treated with neoadjuvant therapy.CASE SUMMARY A 60-year-old man with a liver tumor was admitted to our hospital.Enhanced computed tomography and magnetic resonance imaging revealed a spaceoccupying lesion in the right lobe of the liver.Multiple subfoci were found around the tumor,and the right posterior branch of the portal vein was invaded.Liver biopsy indicated poorly differentiated cholangiocytes.According to the American Joint Committee on Cancer disease stage classification,ICC with hilar lymph node metastasis(stage ⅢB) and para-aortic lymph node metastasis was suspected.A report showed that two patients with stage ⅢB ICC achieved a complete response(CR) 13 mo and 16 mo after chemotherapy with a PD-1 monoclonal antibody.After multidisciplinary consultation,the patient was given neoadjuvant therapy,surgical resection and lymph node dissection,and postoperative adjuvant therapy.After three rounds of PD-1 immunotherapy(camrelizumab) and two rounds of gemcitabine combined with cisplatin regimen chemotherapy,the tumor size was reduced.Therefore,a partial response was achieved.Exploratory laparotomy found that the lymph nodes of Group 16 were negative,and the tumor could be surgically removed.Therefore,the patient underwent right hemihepatectomy plus lymph node dissection.The patient received six rounds of chemotherapy and five rounds of PD-1 treatment postoperatively.After 8 mo of follow-up,no recurrence was found,and a CR was achieved.CONCLUSION Neoadjuvant therapy combined with surgical resection is useful for advanced-stage ICC.This is the first report of successful treatment of stage ⅢB ICC using neoadjuvant therapy with a PD-1 inhibitor.展开更多
BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local control.Unfortunately,survival is s...BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local control.Unfortunately,survival is still poor due to distant metastases,which remains the leading cause of death among these patients.In recent years,the concept of total neoadjuvant treatment(TNT)has been developed,whereby all systemic ChT-mainly affecting micrometastases-is applied prior to surgery.AIM To compare standard therapy and total neoadjuvant therapy for LARC patients with high-risk factors for failure.METHODS In a retrospective study,we compared LARC patients with high-risk factors for failure who were treated with standard therapy or with TNT.High-risk for failure was defined according to the presence of at least one of the following factors:T4 stage;N2 stage;positive mesorectal fascia;extramural vascular invasion;positive lateral lymph node.TNT consisted of 12 wk of induction ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin,CRT with capecitabine,and 6-8 wk of consolidation ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin prior to surgery.The primary endpoint was pathological complete response(pCR).In total,72 patients treated with standard therapy and 89 patients treated with TNT were included in the analysis.RESULTS Compared to standard therapy,TNT showed a higher proportion of pCR(23%vs 7%;P=0.01),a lower neoadjuvant rectal score(median:8.43 vs 14.98;P<0.05),higher T-and N-downstaging(70%and 94%vs 51%and 86%),equivalent R0 resection(95%vs 93%),shorter time to stoma closure(mean:20 vs 33 wk;P<0.05),higher compliance during systemic ChT(completed all cycles 87%vs 76%;P<0.05),lower proportion of acute toxicity grade≥3 during ChT(3%vs 14%,P<0.05),and equivalent acute toxicity and compliance during CRT and in the postoperative period.The pCR rate in patients treated with TNT was significantly higher in patients irradiated with intensity-modulated radiotherapy/volumetricmodulated arc radiotherapy than with 3D conformal radiotherapy(32%vs 9%;P<0.05).CONCLUSION Compared to standard therapy,TNT provides better outcome for LARC patients with high-risk factors for failure,in terms of pCR and neoadjuvant rectal score.展开更多
Gastric cancer,with high morbidity and mortality rates,is one of the most heterogeneous tumors.Radical gastrectomy and postoperative chemotherapy are the standard treatments.However,the safety and efficacy of neoadjuv...Gastric cancer,with high morbidity and mortality rates,is one of the most heterogeneous tumors.Radical gastrectomy and postoperative chemotherapy are the standard treatments.However,the safety and efficacy of neoadjuvant therapy(NAT)need to be confirmed by many trials before implementation,creating a bottleneck in development.Although clinical benefits of NAT have been observed,a series of problems remain to be solved.Before therapy,more contributing factors should be offered for choice in the intended population and ideal regimens.Enhanced computed tomography(CT)scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors(RECIST),yet CT scanning results sometimes differ from pathological responses.After NAT,the appropriate time for surgery is still empirically defined.Our review aims to discuss the abovementioned issues regarding NAT for GC,including indications,selection of regimens,lesion assessment and NAT-surgery interval time.展开更多
文摘Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).
文摘Pancreatic ductal adenocarcinoma(PDAC)remains one of the most challenging malignancies,with poor survival rates due to late-stage diagnosis and limited treatment options.Neoadjuvant therapy(NAT),which involves chemotherapy or chemoradiation prior to surgical resection,has emerged as a promising approach to improve resectability and overall survival(OS).The integration of advanced imaging techniques and biomarkers for evaluating the response to NAT is crucial for optimizing therapeutic strategies and surgical outcomes.However,challenges related to the heterogeneity of treatment protocols and the need for predictive biomarkers remain,highlighting the necessity for further clinical trials.The aim is to evaluate the impact of NAT on surgical outcomes and predictive markers in pancreatic cancer.A comprehensive review of the literature was conducted to evaluate the impact of NAT on surgical resectability,survival outcomes,and the role of imaging and biomarkers in assessing therapeutic response.Studies examining the efficacy of NAT in patients with PDAC,the predictive value of serum biomarkers such as carbohydrate antigen 19-9(CA 19-9),and the utility of advanced imaging modalities such as positron emission tomography/computed tomography with 18F-fluorodeoxyglucose(FDG-PET/CT)were included.NAT has demonstrated significant benefits in downstaging tumors,increasing marginnegative(R0)resection rates,and reducing micrometastatic disease.The use of serum CA 19-9 Levels as a biomarker for response evaluation and imaging modalities such as FDG-PET/CT and magnetic resonance imaging has proven valuable in predicting therapeutic efficacy and guiding surgical planning.Studies have shown that significant reductions in CA 19-9 Levels and favorable metabolic responses on imaging are associated with higher R0 resection rates and longer survival.Furthermore,the integration of multimodal imaging and biomarker assessment has enabled better stratification of patients and more personalized treatment strategies.NAT significantly improves surgical outcomes and survival in patients with resectable and borderline resectable PDAC.Advanced imaging techniques and biomarkers such as CA 19-9 play pivotal roles in evaluating the response to therapy and guiding surgical decision-making.Future research should focus on addressing variability in treatment strategies and developing more reliable predictive biomarkers.
文摘BACKGROUND Neoadjuvant therapies induce tumor regression,resulting in improved surgical resection and pathologic complete response rates,as well as long-term diseasefree and overall survival(OS).In addition to the tumor regression score,serum inflammatory markers,including neutrophil,lymphocyte,platelet,and serum albumin levels,are used to determine prognosis.AIM To investigate the effect of histological features and serum inflammatory markers on the prognosis of gastric cancer following neoadjuvant treatment.METHODS Neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and serum albumin levels were retrospectively recorded for 177 patients receiving neoadjuvant 5-fluorouracil,leucovorin,oxaliplatin and docetaxel chemotherapy.Disease-free and OS were analyzed based on tumor histopathological features,type of surgery,regression scores,and serum inflammatory markers.RESULTS Patients over 65 years of age,those with lymphovascular or perineural invasion,hypoalbuminemia,and those who did not receive adjuvant therapy were found to be at higher risk for shorter recurrence/relapse intervals[hazard ratio(HR):1.64,P=0.04;HR:4.20,P<0.001;HR:1.87,P=0.03;HR:3.5,P<0.001;and HR:2.73,P=0.01,respectively].Lymphovascular invasion,R1 resection,lack of adjuvant treatment,and hypoalbuminemia negatively influenced OS(HR:3.68,P<0.003;HR:2.37,P=0.01;HR:3.99,P<0.001;and HR:2.50,P=0.01,respectively).No effect of NLR and PLR was observed.CONCLUSION Current neoadjuvant therapies prolong disease-free and OS.The practical application of serum inflammatory markers(NLR and PLR)is limited due to the lack of standard cut-off values.Nutritional status,hypoalbuminemia,and incomplete perioperative chemotherapy have been associated with poor prognosis.
基金Supported by Guangdong Medical Research Foundation,No.B2023272.
文摘BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple machine learning algorithms based on magnetic resonance imaging(MRI)radiomics.METHODS This retrospective study included 132 patients with pathologically confirmed EC,were randomly divided into a training cohort(n=92)and a validation cohort(n=40)in a 7:3 ratio.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI).Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Nine classification algorithms were used to build the models,and the diagnostic performance of each model was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 1834 features were extracted.Following feature dimension reduction,ten radiomics features were selected to construct radiomics signatures.Among the nine classification algorithms,the ExtraTrees algorithm demonstrated the best diagnostic performance in both the training(AUC:0.932;SEN:0.906;SPE:0.817)and validation cohorts(AUC:0.900;SEN:0.667;SPE:0.700).The Delong test proved no significance in the diagnostic efficiency within these models(P>0.05).CONCLUSION T2WI radiomics may aid in determining the pathological response to NAT in EC patients,serving as a noninvasive and quantitative tool to assist personalized treatment planning.
基金Supported by the National Key Research and Development Program of China,No.2022YFF1100404the National High Level Hospital Clinical Research Funding of China,No.2022-PUMCH-B-005.
文摘BACKGROUND Neoadjuvant therapy prior to surgery plays a critical role in improving the prognosis of patients with unresectable or locally advanced gastric cancer(GC).Postoperative complications,particularly those classified as Clavien-Dindo grade≥II,remain a major concern for surgeons.In recent years machine learning(ML)has emerged as a prominent approach for disease diagnosis and prediction.However,studies on both postoperative complications and ML in patients with GC receiving neoadjuvant therapy remain limited.AIM To develop an ML model to predict Clavien-Dindo grade≥II complications in patients with GC after neoadjuvant therapy and laparoscopic gastrectomy.METHODS Clinical data were collected from 455 patients with GC who underwent neoadjuvant therapy followed by laparoscopic gastrectomy at Peking Union Medical College Hospital(2014-2024).Potential predictors were identified through univariate analysis and least absolute shrinkage and selection operator regression.Six ML algorithms including XGBoost,random forest,neural network ensemble(NNE),logistic regression,GLMnet,and decision tree were trained and optimized using nested cross-validation.Model performance was evaluated using the area under the receiver operating characteristic curve,decision curve analysis,and calibration curves.RESULTS A total of 455 patients were included of whom 69(15.16%)developed Clavien-Dindo grade≥II complications.The predictive model was constructed using seven variables,including smoking status,Nutritional Risk Screening-2002 score,American Society of Anesthesiologists classification,neoadjuvant therapy,surgical approach,operating time,and intraoperative blood loss.Among the six models the NNE model outperformed the others,achieving the highest area under the receiver operating characteristic curve(0.789,0.739-0.840)and demonstrating superior discrimination,clinical utility,and calibration.CONCLUSION The NNE-based prediction model effectively identified patients with GC at high risk of Clavien-Dindo grade≥II complications after neoadjuvant therapy and laparoscopic gastrectomy.
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2023-JKCS-23)the Special Research Fund for Central Universities,Peking Union Medical College[No.2022-I2M-C&T-A-014,CAMS Innovation Fund for Medical Sciences(CIFMS)]。
文摘Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT has become an urgent world-wide clinical problem.Our work aims to the assessment of neoadjuvant treatment response in breast cancer patients for higher accuracy prediction using innovative artificial intelligence system.Methods:In this study,we retrospectively collected longitudinal(pre-NAT and post-NAT)multi-parametric magnetic resonance imaging(MRI)and clinicopathologic data of a total of 1,315 breast cancer patients(clinical stageⅠ-Ⅲ)who had undergone NAT followed by standard surgery and treated across 5 independent medical centers from January 2010 to January 2023.We used radiomics,3D convolutional neural network technology and clinical data statistical analysis methods to extract and screen multimodal features,and then developed and validated a Clinical-Radiomics-Deep-Learning(CRDL)model to predict patients'pCR outcomes based on multimodal fusion features.Results:We use the area under the receiver operating characteristic curve(AUC)in the primary cohort(PC)and3 external validation cohorts(VC_(1-3))to evaluate the model performance.The results showed that the AUC in the PC composed of 2 medical centers was 0.947[95%confidence interval(95%CI):0.931-0.960],and the AUC values in VC_(1-3)were 0.857(95%CI:0.810-0.901),0.883(95%CI:0.841-0.918)and 0.904(95%CI:0.860-0.941),respectively.Conclusions:The CRDL model demonstrated high accuracy and robustness in predicting pCR to NAT using multimodal fusion data.This study provides a strong foundation for non-invasive assessment of pCR status in breast cancer patients following NAT and offers critical insights to guide clinical decision-making in post-NAT treatment planning.
基金Supported by the Zhejiang Provincial Medical and Health Science and Technology Plan,No.2022ZH050the Health Science and Technology Project of Yinzhou District,No.2023Y03.
文摘The high postoperative recurrence rate remains a major challenge in the treatment of hepatocellular carcinoma(HCC)following resection.Increasing research has been delved into investigating the role of neoadjuvant therapy on the prognosis of resectable HCC.Recent trends in combination therapy with molecularly targeted agents and immune checkpoint inhibitors have significantly improved the efficacy of systemic antitumor treatments,yielding survival benefits exceeding 40%.Neoadjuvant therapy for HCC,whether based on systemic antitumor treatments,locoregional therapies,or their combination,has emerged as a promising research direction.However,there remains a matter of debate on neoadjuvant therapy.In this review,we summarize and discuss the research progress and challenges of neoadjuvant therapy for HCC over the past five years from the perspective of Chinese guidelines to provide new insights and future directions in this field.
基金Supported by the Hunan Province Clinical Medical Technology Innovation Guidance Project,No.2020SK50912Annual Scientific Research Plan Project of Hunan Provincial Health Commission,No.C2019057Hunan Provincial Natural Science Foundation of China,No.2023JJ40381.
文摘BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.
基金supported by the CAMS Innovation Fund for Medical Sciences(CIFMS,No.2021-I2M-1-014,2023-I2M-C&T-B-077 and 2023-I2M-C&T-B-081)the Beijing Natural Science Foundation(No.L258033)the National High Level Hospital Clinical Research Funding(No.2025-LYZX-D-A02)。
文摘Objective:A subset of patients with human epidermal growth factor receptor 2 positive(HER2+)breast cancer shows insensitivity to neoadjuvant therapy(NAT),often evidenced by imaging results indicating stable disease(SD)or progressive disease(PD),which may reflect intrinsic resistance to treatment.We aimed to investigate the factors associated with NAT insensitivity and its prognostic value in HER2+breast cancer.Methods:This study included consecutive patients with HER2+breast cancer who received NAT consisting of chemotherapy combined with anti-HER2 monoclonal antibodies.NAT insensitivity was defined as SD or PD on the basis of treatment response evaluations.Statistical analyses were conducted on the collected clinical data,and HER2 heterogeneity was subsequently assessed.Results:A total of 541 patients were included in the study,among whom 63(11.6%)were categorized as NATinsensitive group and 478(88.4%)as NAT-sensitive group.Hormone receptor(HR)status(P=0.033),HER2 status(P=0.036)and anti-HER2 therapy(P=0.007)were associated with NAT sensitivity.NAT-insensitive group had a significantly shorter event-free survival(EFS)(3-year:69.4%vs.94.3%;P<0.001)and remained an independent prognostic factor according to Cox models[hazard ratio(HR)=8.637;95%confidence interval(95%CI),3.091-24.136;P<0.001].Exploratory analysis revealed a greater proportion of HER2 heterogeneity in the NAT-insensitive group(19.4%vs.4.3%;P=0.035).Conclusions:HR positivity,HER22+/fluorescence in situ hybridization(FISH)+status,and trastuzumab monotherapy are associated with NAT insensitivity,and NAT insensitivity independently indicates poor EFS.This study also highlights the need for prospective studies to clarify the role of HER2 heterogeneity and other mechanisms involved in predicting the response to NAT.
基金supported by the construction funds for“high-level hospitals and clinical specialties”of Fujian Province(No.[2021]76)。
文摘Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)following NAT by evaluating the prognostic outcomes associated with various T and N stages,utilizing multicenter data from China.Methods:Patients who underwent NAT following radical gastrectomy at 10 tertiary hospitals in China between2008 and 2021 were included.The ORP was introduced to explore the disease-free survival(DFS),overall survival(OS),recurrence patterns,and influencing factors following propensity score matching(PSM).Results:A total of 1,076 patients were enrolled in this study(median follow-up period:60 months).We defined ORP as a pCR or tumor infiltration of the mucosal or submucosal layer without lymph node metastasis(pCR or yp T1N0)after NAT.The ORP group comprised 136 patients(12.6%),while the non-ORP group comprised 940patients(87.4%).After applying a 1:4 PSM,we obtained an ORP group of 136 patients and non-ORP group of 544patients.Survival analysis demonstrated that both the 3-year OS(before PSM:89.0%vs.55.0%,P<0.001;after PSM:89.0%vs.55.4%,P<0.001)and DFS(before PSM:85.8%vs.49.7%,P<0.001;after PSM:85.8%vs.50.6%,P<0.001)were significantly superior in the ORP group compared to that in the non-ORP group.Remarkably,adjuvant chemotherapy did not impact the prognosis of patients in the ORP group(3-year OS:89.0%vs.89.7%,P=0.988;3-year DFS:84.9%vs.89.7%,P=0.700).Conclusions:This study reevaluates patients with ORP following NAT,providing a more comprehensive and accurate depiction of the potential beneficiary group and survival outcomes in patients with locally advanced GC.
文摘BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.
基金supported by the National Natural Science Foundation of China(grants 82373365 and 82173317)the Tianjin Key Medical Discipline Construction Project(TJYXZDXK-009A).
文摘Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.
基金Guangzhou Municipal Health Commission Project(Project No.:2023C-TS17)。
文摘Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to the“NCCN Lung Cancer Guidelines,”stage IV NSCLC lung cancer is a contraindication for surgery.It is recommended to adopt a standard treatment plan mainly based on chemotherapy or targeted therapy with EGFR-TKIs.However,Neoadjuvant therapy with alectinib for non-small cell lung cancer with pleural metastasis is rarely reported.Case presentation:A 41-year-old Asian male patient presented with a persistent cough for one month.A chest computed tomography(CT)scan conducted two years prior revealed that a nodular radiative anomalous concentrated shadow was observed in the inferior tongue segment of the upper lobe of the left lung,approximately 2.2×1.6×1.2 cm in size,with a SUVmax of about 5.5.Two small nodular shadows were seen beside the disease in the inferior lingual segment of the upper lobe of the left lung,with the larger one having a diameter of approximately 0.6 cm.Multiple lymph node metastases in the left hilum and mediastinum;Multiple metastases of the left pleura and a small amount of pleural effusion on the left side.The patient began to receive 2 courses of chemotherapy and targeted therapy(pemetrexed+carboplatin+crizotinib)and 1 course of chemotherapy and other targeted therapy(pemetrexed+carboplatin+alectinib).The result of re-examination of CT demonstrated that peripheral lung cancer in the lower lingual segment of the left upper lung is approximately 0.8×0.9 cm in size,slightly smaller than before.A thoracoscopic lobectomy was performed,and the pulmonary bulla was removed concurrently.Pathological examination confirmed non-small cell lung carcinoma(NSCLC)in the mass.Patient discharged on the 7th day after the operation and received 2 courses of chemotherapy(pemetrexed+carboplatin)and had been receiving alectinib targeted drug treatment all along for over 5 years.However,the patient stopped taking the medicine on his own for half a year.Though in the recent CT examination,the result demonstrated no recurrence and metastasis and the patient has been clinically cured.Unfortunately,the results of brain magnetic resonance imaging suggested that multiple brain metastases of lung cancer occurred,and the patient began taking the third-generation ALK-targeted drug lorlatinib.Conclusions:The patient with stage IV non-small cell lung cancer(NSCLC)presenting with pleural metastasis received neoadjuvant alectinib therapy and underwent thoracoscopic lobectomy,which resulted in significant therapeutic effects and fulfilled the criteria for clinical cure.This case highlights the potential for improved preventative strategies and treatment approaches in similar patients.
文摘BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.
基金supported by Beijing Science and Technology Innovation Medical Development Foundation (No. KC2021-JF-0167-01 and No. KC2021-JF-0167-24)。
文摘Objective: The aim of this study was to investigate the factors influencing pathological complete response(pCR)rate in early breast cancer patients receiving neoadjuvant dual-target [trastuzumab(H) + pertuzumab(P)] therapy combined with chemotherapy. Additionally, the consistency of the Miller-Payne and residual cancer burden(RCB)systems in evaluating the efficacy of neoadjuvant therapy for early human epidermal growth factor receptor-2(HER2)+ breast cancer was analyzed.Methods: The clinicopathological data of female patients with early-stage HER2+ breast cancer who received dual-target neoadjuvant therapy at 26 hospitals of the Chinese Society of Breast Surgery(CSBrS) from March 2019 to December 2021 were collected. Patients were allocated to four groups: the HER2 immunohistochemistry(IHC)3+/hormone receptor(HR)-, IHC3+/HR+, IHC2+ in situ hybridization(ISH)+/HR-and IHC2+ ISH+/HR+groups. The overall pCR rate for patients, the pCR rate in each group and the factors affecting the pCR rate were analyzed. The consistency between the Miller-Payne and RCB systems in assessing the efficacy of neoadjuvant therapy was analyzed.Results: From March 1, 2019, to December 31, 2021, 77,376 female patients with early-stage breast cancer were treated at 26 hospitals;18,853(24.4%) of these patients were HER2+. After exclusion of unqualified patients, 2,395 patients who received neoadjuvant dual-target(H+P) therapy combined with chemotherapy were included in this study. The overall pCR rate was 53.0%, and the patients' HR statuses and different HER2+ statuses were significantly correlated with the pCR rate(P<0.05). The consistency of the pathological efficacy assessed by the Miller-Payne and RCB systems was 88.0%(κ=0.717, P<0.001).Conclusions: Different HER2 expression statuses and HR expression statuses are correlated with the pCR rate after dual-target neoadjuvant therapy in HER2+ breast cancer patients. There is a relatively good consistency between Miller-Payne and RCB systems in evaluating the pathologic efficacy of neoadjuvant therapy for HER2+breast cancer.
文摘Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection provides the only chance at cure, data from trials of postoperative chemoradiation and/or chemotherapy demonstrate a modest survival advantage over those patients who undergo resection alone. As such, most practitioners believe that completion of multimodality therapy is the optimal treatment. However, the sequence of surgery, chemotherapy and radiation therapy is frequently debated, as patients may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to resection. Here we review the rationale for neoadjuvant therapy, which includes a higher rate of completion of multimodality therapy, minimizing the risk of unnecessary surgical resection for patients who develop early metastatic disease, improved surgical outcomes and the potential for longer overall survival. However, there are no prospective, randomized studies of the neoadjuvant approach compared to a surgeryfirst strategy; the established and ongoing investigations of neoadjuvant therapy for pancreatic cancer are discussed in detail. Lastly, as the future of therapeutic regimens is likely to entail patient-specific genetic and molecular analyses, and the treatment that is best applied based on those data, a review of clinically relevant biomarkers in pancreatic cancer is also presented.
基金Supported by Beijing Municipal Science and Technology Project,No.D171100006517004CSCOROCHE Research Fund,No.Y-2019Roche-015
文摘Gastric cancer is one of the most common digestive system tumors in China,and locally advanced gastric cancer(LAGC)accounts for a high proportion of newly diagnosed cases.Although surgery is the main treatment for gastric cancer,surgical excision alone cannot achieve satisfactory outcomes in LAGC patients.Neoadjuvant therapy(NAT)has gradually become the standard treatment for patients with LAGC,and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate,but it also significantly improves the long-term prognosis of patients.Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies,and the regimens have also been evolved in the past decades.Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide,here,we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019,and also discuss the future of NAT.
基金Supported by The National 13th Five-Year Science and Technology Plan Major Projects of China,No. 2017ZX10203205-006-001 and No. 2017ZX10203205-001-003。
文摘BACKGROUND The prognosis of intrahepatic cholangiocarcinoma(ICC) with lymph node metastasis is poor.The feasibility of surgery is not certain,which is a contraindication according to the National Comprehensive Cancer Network guidelines.The role of immunotherapy as a neoadjuvant therapy for ICC is not clear.We herein describe a case of ICC with lymph node metastasis that was successfully treated with neoadjuvant therapy.CASE SUMMARY A 60-year-old man with a liver tumor was admitted to our hospital.Enhanced computed tomography and magnetic resonance imaging revealed a spaceoccupying lesion in the right lobe of the liver.Multiple subfoci were found around the tumor,and the right posterior branch of the portal vein was invaded.Liver biopsy indicated poorly differentiated cholangiocytes.According to the American Joint Committee on Cancer disease stage classification,ICC with hilar lymph node metastasis(stage ⅢB) and para-aortic lymph node metastasis was suspected.A report showed that two patients with stage ⅢB ICC achieved a complete response(CR) 13 mo and 16 mo after chemotherapy with a PD-1 monoclonal antibody.After multidisciplinary consultation,the patient was given neoadjuvant therapy,surgical resection and lymph node dissection,and postoperative adjuvant therapy.After three rounds of PD-1 immunotherapy(camrelizumab) and two rounds of gemcitabine combined with cisplatin regimen chemotherapy,the tumor size was reduced.Therefore,a partial response was achieved.Exploratory laparotomy found that the lymph nodes of Group 16 were negative,and the tumor could be surgically removed.Therefore,the patient underwent right hemihepatectomy plus lymph node dissection.The patient received six rounds of chemotherapy and five rounds of PD-1 treatment postoperatively.After 8 mo of follow-up,no recurrence was found,and a CR was achieved.CONCLUSION Neoadjuvant therapy combined with surgical resection is useful for advanced-stage ICC.This is the first report of successful treatment of stage ⅢB ICC using neoadjuvant therapy with a PD-1 inhibitor.
文摘BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local control.Unfortunately,survival is still poor due to distant metastases,which remains the leading cause of death among these patients.In recent years,the concept of total neoadjuvant treatment(TNT)has been developed,whereby all systemic ChT-mainly affecting micrometastases-is applied prior to surgery.AIM To compare standard therapy and total neoadjuvant therapy for LARC patients with high-risk factors for failure.METHODS In a retrospective study,we compared LARC patients with high-risk factors for failure who were treated with standard therapy or with TNT.High-risk for failure was defined according to the presence of at least one of the following factors:T4 stage;N2 stage;positive mesorectal fascia;extramural vascular invasion;positive lateral lymph node.TNT consisted of 12 wk of induction ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin,CRT with capecitabine,and 6-8 wk of consolidation ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin prior to surgery.The primary endpoint was pathological complete response(pCR).In total,72 patients treated with standard therapy and 89 patients treated with TNT were included in the analysis.RESULTS Compared to standard therapy,TNT showed a higher proportion of pCR(23%vs 7%;P=0.01),a lower neoadjuvant rectal score(median:8.43 vs 14.98;P<0.05),higher T-and N-downstaging(70%and 94%vs 51%and 86%),equivalent R0 resection(95%vs 93%),shorter time to stoma closure(mean:20 vs 33 wk;P<0.05),higher compliance during systemic ChT(completed all cycles 87%vs 76%;P<0.05),lower proportion of acute toxicity grade≥3 during ChT(3%vs 14%,P<0.05),and equivalent acute toxicity and compliance during CRT and in the postoperative period.The pCR rate in patients treated with TNT was significantly higher in patients irradiated with intensity-modulated radiotherapy/volumetricmodulated arc radiotherapy than with 3D conformal radiotherapy(32%vs 9%;P<0.05).CONCLUSION Compared to standard therapy,TNT provides better outcome for LARC patients with high-risk factors for failure,in terms of pCR and neoadjuvant rectal score.
基金supported by Shenzhen Sanming Project(No.SZSM201612051)。
文摘Gastric cancer,with high morbidity and mortality rates,is one of the most heterogeneous tumors.Radical gastrectomy and postoperative chemotherapy are the standard treatments.However,the safety and efficacy of neoadjuvant therapy(NAT)need to be confirmed by many trials before implementation,creating a bottleneck in development.Although clinical benefits of NAT have been observed,a series of problems remain to be solved.Before therapy,more contributing factors should be offered for choice in the intended population and ideal regimens.Enhanced computed tomography(CT)scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors(RECIST),yet CT scanning results sometimes differ from pathological responses.After NAT,the appropriate time for surgery is still empirically defined.Our review aims to discuss the abovementioned issues regarding NAT for GC,including indications,selection of regimens,lesion assessment and NAT-surgery interval time.
